National Defence Committee on March 25th, 2013

[Stéphane Grenier]

As you have surely noticed, I don't mince words. When I am not happy, I say so. However, the Canadian Forces have made some improvements in this area. Once again, Dr. Zamorski could show you how much things have changed over the past few years.

When I left to join the Mental Health Commission of Canada, most military members—if not 80% of them—who were showing early signs of mental health issues six months after returning from Kandahar were already receiving clinical care. That was not the case during the Bosnian conflict. Generally, people would wait between seven and eight years to seek help.

In the 1990s, people would wait seven or eight years. They were hurt, things were not going well in their lives, and they were falling apart. That waiting period has been reduced to less than six months today. That is a pretty significant difference, but it does not mean that there are no problems. A lot has been done in this area, and that is a good thing. You seem to be a bit surprised.

[Jean-François Larose, NDP, Repentigny, QC]

No, but I am glad to hear it.

[Stéphane Grenier]

However, this is not for everyone.

[Jean-François Larose, NDP, Repentigny, QC]

As you said, there is a problem when it comes to incentives.

[Stéphane Grenier]

Yes, but the culture has changed considerably.

If we had more time, I could tell you some stories. I encourage the committee to watch a video. I can give you its title later. A 30-minute video was made about the military culture and operational stress injuries. The video shows uniformed soldiers talking a lot. I think the video depicts an everyday reality. Military members are hiding that reality much less than they used to.

The video also shows an infantry sergeant in Afghanistan, and his story is amazing. He was not given a script to read. He simply talked about what happened in Afghanistan. He talked about the experience very openly. Soldiers had told him they were becoming worried because he was starting to make bad decisions. That was after a fight with the Taliban. The culture has to have changed for soldiers and corporals to say to a commanding section sergeant that they were worried because he was starting to make some strange decisions. That would not have happened when I was younger.

[Jean-François Larose, NDP, Repentigny, QC]

Exactly.

You talked about how important families are. That is a very important element. Where do family needs fit in in this sponsorship program? What kind of an experience do families go through? Have you noted any changes?

[Stéphane Grenier]

I can't really comment on the improvement. Once again, I do not have a family perspective. However, through my work, I realized at some point that there was so much isolation and guilt involved. Families don't know what is going on or what is happening to the family unit. Many wives feel guilty. They wonder whether they are to blame for the problem and feel that their husband no longer loves them. Since all those dynamics do not stem from a specific incident on a given date that resulted in an obvious physical injury—such as the loss of a leg—they erode the family unit.

Military wives are very often isolated; they feel guilty and ashamed. Once they acknowledge the problem, they need to be given support. That's why I am wondering if anything could be done to improve services for families. Currently, spouses cannot seek help from on-base clinics. They have to wait in the mental health system's queue. The government needs to determine whether those families have deserved to be given priority. That's the first question.

The second question is knowing what kind of mental health care families receive on the civilian side. I don't think that the civilian health care system was designed to deal with those kinds of dynamics or that it's strong enough for that task.

In a perfect world, those families would be provided with services on base and not in the civilian world.

[Jean-François Larose, NDP, Repentigny, QC]

Thank you.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Norlock, it's your turn.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much, Mr. Chair.

Through you to the witness, thank you for attending today.

I have a whole whack of questions I'd like to ask, but I have only five minutes.

I'm very interested in something. When a member is injured, physically or mentally—I'll say injured and let's forget about what kind of injury, because it's all the same—are you telling me there is no unit in the Canadian armed forces that says that officer Joe Blow has received this kind of injury, so what job is he qualified for—forget about what he is not qualified for—if he can no longer serve in that particular unit. Is there no unit that makes that kind of determination? Is it left up to the commanding officer or someone in the unit?

[Stéphane Grenier]

No, sir. There is a unit here in Ottawa in the headquarters that will slice, essentially. It will look at somebody's file. It will determine yes or no, the person can remuster or the person cannot. There is an office. However, the process to allow injured members to be retained in the military after an injury occurs, in my estimation, is wrongly calibrated. It is calibrated for an antiquated peacetime vision of occupational transfer. I won't apologize for saying what I'm about to say, but I'm very sorry to have the opinion that when a soldier has given 17 years of loyal service and has been on seven deployments, we should give that person another chance if they feel as though they want to serve and their employment limitations say that they still could deploy and that their limitations are that limited that they would allow the soldier to transition to a softer trade.

I'm not saying, sir, that every military person who is injured should be retained. The military exists to fight wars, but there is room for change.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

I'm interested in the processes. Would the people who work with this person day in and day out—his commanding officer, the guy next to him.... I come from a paramilitary background. Is there not some kind of chain of command that says, “This is my guy. Here's what is wrong. I know him and have worked with him for x number of years. This is his record previous to coming under my command. He is no longer able to work in my unit; however, I think he is capable of doing this, that or the other thing”?

The commander knows what other parts of the military apparatus could handle that. Are you saying that doesn't exist, or that insufficient attention is paid to this at a higher level?

[Stéphane Grenier]

The unit that makes the decision here in Ottawa does so based on a bunch of reports. The commanding officer normally has his or her piece to say, and that will be factored in. I think the processes are there. The system has enough wrenches and screwdrivers to make this work. There is, however, a bit of an antiquated paradigm driving the decision-making process. I've seen the decision-making process occur, and I would not change the process. I would change the filters through which people read the files. As I said earlier, when you read a file that says the person can no longer serve in the armoured corps, it's very clear to me, and I interpret this as, what else can this military person do? However, for some reason, the people in those spots interpret the file in a very different way.

The system exists. The commanding officer has his or her say, “yes” or “yes to all”, but unfortunately there's a piece of culture missing.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Is the filter the person?

[Stéphane Grenier]

In most cases it is.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Or is the filter the system, or an attitude? People are promoted because they fit the profile that management wants. The senior military is management. It's like any company. They promote the people they think have the attitude that best meets their needs, so what you want to change is people's attitudes.

In the report we're going to write, what kind of recommendation could we make to solve that? As a member of Parliament whose riding has a very large military base, Trenton, members come to see me when they run into problems, and I'm surprised that we have as much success as we do in the system.

What specific recommendation could we make that would help change the filter?

[Stéphane Grenier]

I think the million-dollar question is, who audits that process? Nobody audits that process. I'm sorry, but if you are a psychologically injured soldier and you're asked to put a redress of grievances or to go to court, you will not have the energy or the wherewithal to do that. Because there is no audit process, I think the time will come, perhaps through your efforts, when National Defence is asked to demonstrate that every single injured soldier who was released could not be employed elsewhere in the military without affecting the operational effectiveness. That's the catch-all.

If you're pushing paper at the base orderly room in Trenton, how operational do you need to be? I understand universality of service, but if you dig into that principle, you will find that the navy, the air force, and the army don't test universality of service the same. If I am an infantry soldier, to demonstrate my universality of service, I go through a lot more physical exertion than if I'm in Trenton.

All that said—

[The Chair, Conservative, James Bezan]

Time has expired.

Mr. Brahmi, go ahead.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Mr. Grenier, thank you for agreeing to appear before us today.

I would like to have a quick look at the history of the peer support program you created and at what prompted you to create the program.

I understand that this program has more in common with a psychotherapeutic approach than with a medicated one. Was that one of the factors that prompted you to create the program? We know that some people do not respond to pharmacological approaches in the treatment of mental health injuries.

[Stéphane Grenier]

I would say no. Just to correct the record, I would clarify that the peer-support program is not an approach based on psychotherapy or one that conflicts with a drug-based approach.

Last week, I was speaking with people who were looking to launch a peer support program for doctors in a particular province. They already have a similar program but not for mental health specifically. It's a peer support program because it's doctors helping other doctors. And they want to take that program further by adding a mental health component, given that many doctors suffer from those issues.

I think doctors understand the difference. If a doctor in a province has a mental health issue and turns to the physician's assistance program, when that person asks the doctor who is supposed to be helping them how he or she overcame the problem, the helper cannot answer the question. The doctor acting as the peer helper has never been in that situation. At the end of the day, peer support answers that question and gives the individual hope for a way forward, be it with the help of psychotherapy, drugs or other means.

That lack of hope is often the reason someone suffering from a mental health illness in our society today doesn't seek out help. They think those who provide assistance are just quacks and that the treatment doesn't work. But there's nothing like asking the question and hearing an honest and genuine answer that comes from the heart. There's nothing like hearing someone explain how they overcame their problem, knowing they will be there for you and realizing you'll get through it together.

So peer support is that ongoing assistance.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Very well.

You mentioned a problem that could arise. There can be different perceptions of what constitutes an operational stress injury versus what constitutes more of a combat stress injury.

That brings to mind a constituent of mine who suffers from such an illness. Since she was on a ship, she was not exposed to combat directly. Her injury stems more from operational stress than the stress of being deployed. She did not have first-hand experience with an explosive device exploding, for example.

What more could peers bring to the table, through your program, in those two different cases?

[Stéphane Grenier]

I would start by saying that, under the peer support paradigm, no diagnosis is required. The traditional medical model requires a diagnosis and a list of symptoms. Each specific intervention addresses a specific symptom. Conversely, peer support looks at the human being with the initial understanding that a specific incident need not have occurred, a bomb need not have gone off, for example, to recognize that the person has a problem. From the outset, it is understood that the person's problem can be the result of trauma, wear and tear or operational fatigue. It can be related to grief or the moral conflicts that arise when serving the institution.

By broadening our understanding of what contributes to an individual's collapse and psychological illness, we remove judgment. We look at the individual's circumstances with a broader understanding, instead of simply noting traumas. There is a sort of generalized acceptance. In short, our peer helpers are chosen because they understand those dynamics. They don't pass judgment. We look for open-mindedness. There is no doubt that if we were to limit our peer helpers to those who had been in combat, who had a very narrow view of things and who were inclined to pass judgment, the program would not be the same. At least, I would not be choosing those people. Regardless, there are selection criteria. An effort is made to choose someone who is truly open-minded and who understands that whole spectrum of causes.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you.

[The Chair, Conservative, James Bezan]

Mr. Chisu.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Colonel, for appearing in front of our committee.

You mentioned that your PTSD and depression, after returning from your deployment in Rwanda, went undiagnosed.

I know for sure, and I went through these things, that there are pre-deployment checkups and post-deployment checkups for Canadian armed forces members to try to curtail the development of combat-sustained injuries, including mental injuries. On top of this, when you are promoted from one rank to another, at least in the regular force, you need to go through a medical checkup, at least at the officer level, and when you leave, you have another medical checkup.

How are these different? I understand, and I personally experienced it, that when you are deployed, the pre-deployment checkup is very thorough and very well done. Post-deployment is less so. When it comes to a release from deployment checkup there is none or it's quite non-existent.

I just retired in 2009. Is there any difference in this one, or do you observe the same things I observed?