National Defence Committee on Oct. 25th, 2011

[The Chair, Conservative, James Bezan]

I call this meeting to order. Pursuant to Standing Order 108(2), we're going to start our study on the care of our ill and injured Canadian Forces members.

Joining us today from the Department of National Defence is Rear-Admiral Andrew Smith, who is chief of military personnel. Accompanying Admiral Smith is Brigadier-General Fred Bigelow, who's the director general of personnel and family support services; and Colonel Jean-Robert Bernier, who's the deputy surgeon general.

Welcome, gentlemen.

Admiral Smith, I'll open the floor to you for your opening comments.

[Rear-Admiral Andrew Smith, Chief Military Personnel, Department of National Defence]

Thank you, Mr. Chair.

and members of Parliament.

It is a pleasure to appear before you today to discuss how we care for the men and women of the Canadian Forces and their families if they are injured or become ill while serving. As you are aware, we've always had programs and services to address the health and well-being of Canadian Forces personnel; however, our operations over the last 10 years in Afghanistan have provided a catalyst for many changes and improvements. I will highlight some of these changes during my opening remarks. I will purposely keep these remarks brief, and will be happy to elaborate on details afterwards.

The Canadian Forces personnel function embraces dozens of lines of operation and hundreds of enabling policies, programs and activities.

As chief, military personnel, I am responsible for two strategic functions: personnel generation and personal support.

Personnel support includes providing responsive welfare, care and support programs for members, casualties, and their families. When this support is not provided properly, then personal generation and ultimately operational effectiveness are affected.

This is why mental health and the care of the fallen and injured and their families are my top priorities. When Canadian Forces members are injured or become ill, they must have confidence that they will receive the treatment and rehabilitation services necessary to restore them to health and that the needs of their families will be met. If they cannot resume military service, they must know that the Government of Canada will support them as they make new lives for themselves.

In this regard, Veterans Affairs Canada shares the Canadian Forces' commitment to provide Canadian Forces personnel and their families with comprehensive care and services. The two departments have a strong partnership and collaborate closely to integrate services and provide continuity of support. I'll be happy to expand on this collaboration during the question period, should you so desire.

We have just completed the document, placed in front of you, entitled “Caring for our Own”. It describes our comprehensive framework for the care of Canada's ill and injured men and women in uniform. This framework is based on five pillars: a whole-of-government approach to care and support, which really means the Canadian Forces and Veterans Affairs Canada working in tandem; an integrated multidisciplinary and multi-agency delivery system; access to consistent care and casualty management wherever Canadian Forces members serve; very importantly, a focus on continuous improvement to evaluate the effectiveness of policies, programs, and services in support of identified deficiencies; and communication--and that's both internal and external--regarding how we care for and support ill and injured CF members and their families.

Our concept of care envisages integrated and consistent delivery and administration of benefits and services as members navigate the three stages following injury or illness: recovery, rehabilitation, and reintegration into either military service or civilian life.

Recovery is the period of treatment and convalescence during which patients transition from the initial onset of illness or injury to the point where they are stable and ready to receive longer-term medical care and increase their ability to engage in all aspects of life including the vocational, social and physical.

Rehabilitation, which involves physical, mental, and vocational components, is the active process of regaining maximum self-sufficiency following illness or injury.

Reintegration is the transition to either returning the ill or injured CF member to a normal work schedule and workload in their regular force or the primary reserves, transition to the cadet organizations or to the rangers, or preparing for a civilian career and life after the forces.

There can be significant overlap between the three phases, as the ill or injured members move from acute recovery to long-term clinical, physical, mental, and vocational rehabilitative supports, and often simultaneously prepare to reintegrate into a work milieu.

The three Rs of recovery, rehabilitation, and reintegration are anchored in the principle of universality of service. The minimum operational standards associated with this principle include the requirements to be physically fit, employable without significant limitations, and deployable for operational duties. The universality of service is a necessary and equitable approach to preserving the Canadian Forces' trained effective strength and operational capacity.

While physical injuries and illness receive a great deal of attention, especially in light of battle casualties sustained in Afghanistan, I am equally committed to providing mental health care.

Indeed, my message is that we simply do not differentiate between the two, and commanders at all levels are acutely aware that they are expected to transmit that message to all our members, to ensure our people get the treatment they need, in part by removing the stigma associated with mental illness.

Because of the requirement to be fit for employment and deployment, we have an incredibly comprehensive and dedicated health care system. It is my firm contention that the Canadian Forces personnel have access to one of the best, if not the best, health care systems in Canada.

Above and beyond the delivery of world-class medical care, and to ensure consistent and equitable administration of military casualties, the Canadian Forces have established regional joint personnel support units with component integrated personnel support centres across the country to provide a comprehensive, decentralized, and integrated network of casualty support.

The joint personnel support unit delivers a set of core capabilities in a one-stop service approach, ensuring comprehensive and consistent support for Canadian Forces personnel and their families. Support includes return-to-work program coordination; casualty tracking; support outreach administration; and services provided by Veterans Affairs Canada, the Service Income Security Insurance Plan, Canadian Forces personnel support programs, Health Canada, and a military family liaison officer.

Public awareness is equally important in order to reassure Canadians that their sons, daughters, brothers, sisters, husbands, wives, friends and neighbours who have been entrusted to the custody and care of the Canadian Forces are being well looked after.

This trust is the basis of public support for the Canadian Forces.

The health and well-being of Canadian Forces members is a shared responsibility of leaders, health care providers, and the member. It includes a whole-of-government approach to ensure that those who serve their country and are called upon at the pointy end of the Canada First defence strategy are provided with the care and support they and their families need in the unfortunate event that they become ill or injured.

I want to thank the members of this committee for their interest in this very important matter and for their strong support for the members and families of the Canadian Forces.

I would be pleased to answer your questions.

[The Chair, Conservative, James Bezan]

Thank you.

We'll start with a question and answer period.

Mr. Kellway, you have the lead.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you very much, Mr. Chair.

And thank you, Rear-Admiral, for your opening remarks.

I was wondering if you could tell us a little more about our experience in Afghanistan and the kinds of injuries our troops have sustained that the forces have had to deal with under this program.

[RAdm Andrew Smith]

Certainly.

In our experience in Afghanistan, there have been just over 2,000 casualities in total. Six hundred and twenty of those have actually been wounded in action, and about 1,400 of those injuries are non-battle injuries. The preponderance of casualties wounded in action are associated with improvised explosive devices. There have been any number of physical and mental injuries to accompany those. Some of the biggest challenges we have had involve the rehabilitation of people following amputations. Those injuries tend to get a lot of publicity, but there have also been any number of non-battle-related physical, musculoskeletal, back, or knee injuries as well.

One thing I would point out is that, in theatre, we now have in place better personal protective equipment. I think that is responsible for a higher survival rate from blasts that previously would potentially have caused a lot more fatalities. People have lost limbs and have had terrible experiences in explosions but have ultimately survived those. I think that's a testament both to the personal protective equipment they are wearing and, unquestionably, to the trauma hospital in Kandahar. A Canadian Forces member commanded that hospital for a period of time, and now it's under the command of an American. In 97% of the cases, if an individual makes it to what we call the Role 3 trauma hospital in Kandahar airfield, the individual will survive. It's a multinational-staffed hospital. People come together and they do miracles there. I've been there on three occasions, and I've seen the miracles they produce.

So, yes, we've had lots of casualities, but I would submit there would be significantly more fatalities had we not had the personal protective equipment and the health care in place.

[Matthew Kellway, NDP, Beaches—East York, ON]

With respect to the 600 injuries, the in-action casualities, you mentioned IEDs being the main cause of those and the physical and mental outcomes of those. Do you include in the “inaction” numbers any other mental health issues, or just those that flow directly from a physical injury?

[RAdm Andrew Smith]

If a mental health condition were to be service related as a result of trauma experienced in a battlefield incident and not accompanied by a physical injury, that would certainly count in a wounded-in-action scenario.

One of the priorities I have continued to strive for is to have a mental health injury looked on in the same way as a physical injury—a bad back, a shrapnel wound, a bad knee, or a turned ankle. I think the Canadian Forces have an opportunity, in my estimation, to lead this country in reducing the stigma associated with mental health. I think we've come a long way in that regard. I freely acknowledge that there is room to improve, but I think we have seen some real progress lately in reducing the stigma associated with mental health.

When we bring soldiers out of theatre, before we bring them home we send them to a third location to decompress for a period of five days. During that five-day decompression period, they get a series of lectures and consultations on the importance of mental health and what a potential degraded state of mental health might look like. Based on that, I have seen young males, who in my estimation typically have the hardest time admitting they might have a mental health condition, put their hand up and say they'd like to see somebody. I think even as little as five years ago that type of admission, certainly in public, would have been inconceivable, and I take that as a sign of how we are moving forward in educating people that it's all right to put your hand up if you have a mental health condition.

Now, in fairness, I know your question was related to wounded in action, but the preponderance of mental health issues that we deal with in the Canadian Forces are not PTSD related. There are a lot of other mental health conditions, but your question was specifically about the....

[Matthew Kellway, NDP, Beaches—East York, ON]

Well, it's interesting. You take these troops back through this decompression stage, and I take it a lot of the mental health conditions related to their experience in Afghanistan will emerge over time. Coming back to kind of regular life is what triggers a lot of these things, or they emerge at that point in time. So for those who don't put their hands up during the decompression period, in your statistics here how do you account for those kinds of conditions that emerge when they return from their service? What are the forces doing to help folks back home?

[RAdm Andrew Smith]

We have a program we put in place in the last two and a half years. It's called “The Road to Mental Readiness”, and that includes both a pre- and a post-deployment educational awareness strategizing piece for both the members and their families. Families play a key role in this regard. So both the family and the member get an awareness session before the member deploys. On completion, the member will get the third-location decompression briefings I spoke about.

The family also will have access to an online decompression awareness piece so that when the member comes home, both the family and the member have a heightened awareness of things they might experience.

Then there is a follow-up period downstream three to six months later, when the individual will have a final post-deployment screening check-up for mental health issues.

[The Chair, Conservative, James Bezan]

Admiral, his time has expired.

We're going to move on to Madam Gallant. We have to be quite judicious with time--otherwise we won't get around--so members can ask their questions.

[RAdm Andrew Smith]

Fine.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chair.

Through you to Admiral Smith, how has the frequency of casualties been impacted since Canada received its own Chinook helicopters in theatre in Afghanistan, Kandahar?

[RAdm Andrew Smith]

I am not well positioned to speak specifically to the reduction of casualties in terms of either the Chinooks or the Griffins that were deployed in theatre. I could take the question on notice. It would really be something that the folks in CEFCOM would have tracking stats on.

I'm happy to come back to you with an answer in that regard.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

All right.

Now I'd like to move to the Shoulder to Shoulder report, and I must say that this is thoroughly impressive. It sounds like you really and truly had consultative talks with the people who were impacted in the very early years of participation in Afghanistan. A handful of widows were left to struggle for themselves, and they were the Shoulder to Shoulder people.

They almost acted as skip-tracers, trying to find the spouses of people who had fallen that they'd read about in the newspaper so they could offer their support. Through the years they developed a list of things that they thought would be helpful to have in place for other women, men, and parents who were experiencing this. One was the virtual web-based forum, and we've already implemented the visits to Afghanistan, which is something they needed for closure.

So we have this Shoulder to Shoulder program for the very first widows who have young children who may start to ask questions 10 or 12 years from now. Are you conducting outreach to them, so that when this time comes they know what is available to them?

[RAdm Andrew Smith]

Thanks for the question.

The question is very timely. Just last Friday evening, Minister MacKay formally launched a Shoulder to Shoulder bereavement support program with members of the program--widows, families, fathers, and spouses of fallen members.

One of the key attributes of the Shoulder to Shoulder program is that it is designed to be an enduring commitment, not just something that will cease when a member leaves the Canadian Forces or when a member is deceased. This is an ongoing, enduring commitment. It involves social workers and the web-based peer consultation you spoke of.

There's a network of peer counsellors that we call the HOPE program--helping our peers through empathy. It's very successful for people who have had to go through this terrible experience and come out the other side. There are seven steps to the whole grieving process. When they come out the other side, some of them put their hands up and say they'd really like to help people after what they've gone through, so there's a reach-back peer assistance piece.

For the specific case you mentioned, where a spouse and children downstream have a desire or need to have some type of bereavement support, that's totally open to them. I will just cite that this Shoulder to Shoulder program is for any death--operational or due to illness or injury. It's really for bereavement for Canadian Forces surviving entities.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Were families of the deceased in on these consultations directly?

[RAdm Andrew Smith]

Absolutely.

The Shoulder to Shoulder program is a national initiative that was born out of a wonderful initiative that started in the Edmonton area. It started out as something called the memorial cross network, when Edmonton was particularly hard hit back in 2006. Family members got together in an informal peer support, social networking piece. It was so successful that we said, “Can we not do something to take this nationally?”

We worked with chaplains and the HOPE network we had in place. We put some structure around it through the web-based consultation and the joint personnel support units, as enablers and facilitators. We pulled together some component parts, put a banner on them called Shoulder to Shoulder, and launched it. Part of it is marketing to get the word out to make sure that people know we have something in place to help people who have gone through terrible experiences.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Is there some sort of identifier or card that a widow, for example, is issued, so if she wants to go into a joint personnel support unit and access any of these services she doesn't have to tell her whole story--she can show somebody and they can take a look at the history and go from there?

[RAdm Andrew Smith]

I would say I think we'd do even better than that. Every widow or surviving spouse has an assisting officer assigned to her to help her through all the immediate after-fatality administration, but that assisting officer at some point will disengage and go back to his or her primary tasks. When this happens, and before they disengage, the surviving spouse will be introduced to people in the joint personnel support units. So there is a formal hand-off between the assisting officer and the joint personnel support unit network, who will then be up to speed on a spouse's concerns, issues, and general situation. The spouse or the surviving member has immediate access into bereavement support through the JPSU.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

That's fine if they stay in the same community for quite a length of time.

Now I'd like to switch to operational stress injuries. We've done a terrific job in the last 10 years or so, raising awareness for PTSD and other operational stress injuries and treating them and removing the stigma. We still have in our ranks a number of soldiers who have suffered injuries from previous conflicts, like Rwanda. These people have also been deployed successively to Afghanistan. All this seems to build up. Not quite done with their careers, they still want to be soldiers and be deployable, but as a consequence of not getting the treatment they needed when the injury happened, they are being released medically.

Is there anything we can do to go back and actively help our soldiers who were injured in previous conflicts, so that we can keep them on the forces as opposed to having to double our recruiting efforts and training?

[The Chair, Conservative, James Bezan]

Ms. Gallant, your time has expired.

Admiral, please give us just a brief a response.

[RAdm Andrew Smith]

I'm happy to come back to that later.

The Minister of National Defence announced in March a new, complex transition period for people. Some of those people that you identified would have traditionally been released within about six months. Now we know that some of these people have what we call a complex transition—they have physical, mental, or psychosocial needs. We now have a formal policy where we can keep them for up to three years to make sure they get all the medical support they need from our medical system, the whole family support piece. They are still, I would say in French,

entourés, encadrés

in the military system to make sure their transition is as smooth as possible and they're looked after to the extent possible.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. McKay, you have the floor.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Thank you, Chair.

I'm pleased to follow up on the suggestion that Rear-Admiral Smith come before us with his colleagues and talk about what the military is doing. I was privileged to attend the seminar you put on for the military about a month ago. I was very impressed. I was very impressed with the military, and I was very impressed with how much I believe you folks have stepped up your game over the past number of years. I was also impressed by the senior leadership that supported the initiative, including General Natynczyk.

In that context, I also wanted to ask some questions pertaining to suicide and the de-stigmatization of mental illness and things of that nature, which is problematic for our society as a whole but also for the military. I agree with your comment that the military could lead in this area. You have a discrete population that you're working with, and you have resources available to you that could be useful to the larger society. The rate of suicide in the military roughly parallelled that of the larger population up until about 2007, and then it doubled for some reason. There doesn't seem to be any concrete explanation for why the suicides would double in the military around 2007. I don't have statistics for later than that. I'd be interested in the way in which the stats are now kept. Is there something else that might be going on?

[RAdm Andrew Smith]

The question of suicide is one that we pay particular attention to. Every time there's a death in the Canadian Forces, the announcement comes across my desk, and I always pause, particularly when a suicide comes across. They tend to hit me harder than others. I often wonder how things could have gotten so bad that it was the only recourse somebody thought they had.

Traditionally—and I'll ask Colonel Bernier to follow up momentarily—the rate of suicides in the Canadian Forces has typically been well below that in the greater population in Stats Canada. I wouldn't look to debate your stats versus my stats, but we have traditionally had a lower rate of suicide than the Canadian public. For argument's sake, we have about 12 to 17 suicides per year in the Canadian Forces. Even if that number were to go up by 5, to 22, I would say it's regrettable, but it's still not indicative of a greater issue of suicide in the Canadian Forces per se. If, over time, that were to sustain itself, then I think we would have a greater issue.

But I will say the cause of suicides is a vexing issue. We look at all suicides in what we call a deep dive to see what factors could be associated with it. There is, historically, no direct link between deployments and suicides. The majority of people who die from suicide do not have a deployment history. There are other stressors in life at play, whether that be family, financial, performance, or social issues.