National Defence Committee on March 4th, 2014

[The Chair, Conservative, Peter Kent]

Thank you very much, General.

Mr. Harris, your time has expired.

Ms. Gallant, please. You have seven minutes.

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

Thank you, Mr. Chairman. All my questions will be through you to General Millar.

General Millar, you mentioned that the “program has been successful at demystifying the stigma associated with getting help”. Would you please explain what is meant by that?

[MGen David Millar]

Thank you, ma'am, very much. It's good to see you again. The last time, we were in Afghanistan together.

There is a natural propensity amongst all of us as human beings to think that someone presenting with mental illness has a problem; therefore, we have a different perception of individuals. That's true across Canada, I believe, because in Canadian society we haven't demystified, de-stigmatized, mental health as being not an illness that cannot be reckoned with, but instead, as with physical health in the Canadian Forces, something that we have programs for to get us physically well and mentally well.

Therefore, when I say stigma, it's the stigma about being side by side with your battle buddy in Afghanistan and coming back, and your battle buddy is not having problems but you're having problems, and perhaps you're too proud to be able to admit it and come forward. And as I mentioned earlier, at times the preponderance of thinking is “I don't have a problem, and if I do, I can cope with it myself”. Getting people to feel comfortable that if you're not feeling well when you get up in the morning, you're feeling depressed, you should walk into the clinic, you should walk into your chain of command and say you're just not feeling well. You should call one of your peers. Getting that to be an automatic reaction, as opposed to “I'll see how I feel tomorrow” and then “I'll see how I feel the next day”, is what I mean by de-stigmatizing.

The other issue ma'am, is the career issue. There is a very strong perception, as you've been told, that if I present for mental illness, indeed if I present for a physical problem, there is a potential that I will be released from the Canadian Forces under the universality of service, which we spoke of earlier. Part of de-stigmatizing is our education and awareness about all our programs and our success rate at returning our members back to work, but also, in those cases where you breach universality of service, about the tremendous programs that we have for starting a second career, to set you off on the right foot, to provide you the education and retraining, and also provide you the benefits and support so that you can have a healthy and vibrant second career.

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

Thank you. I asked that because in the chamber, in reference to PTSD the opposition has stated that it's just a figment of the person's imagination and it's all in their head, which is totally false.

Now, you had also addressed the issue of our repeatedly hearing from the opposition that if a soldier seeks help, it's the beginning of the end of the rest of their career, yet you've talked about recovery and getting help early. But there are soldiers who are attending the clinic, and at their very first meeting with a nurse practitioner they are advised that if they seek treatment, in all likelihood they will be medically released in three years. It's not anecdotal. It's real.

Can you explain why these soldiers would be told this?

[MGen David Millar]

I will look into that case specifically, and if we can talk afterwards I'll be sure to examine it, because no, that is not the intent of our program. That is not our outlook, and that is not the way we should be treating our men and women. Indeed, as I mentioned, it's very compassionate. You cannot make that assessment when one of our soldiers presents coming through the door whatsoever. Our success rate through our return to work program is at least 23%.

When I was a young airman along with Scott, and a young soldier along with Rakesh, we did not have one-stop care and comfort. The likelihood that when I presented for a problem I would be leaving the Canadian Forces was very high. Today our sole focus is to get our men and women back on their feet, back in their jobs, staying in the Canadian Forces. Our return to work program, as I mentioned, has at least a 23% success rate, so we're very proud of that.

So I am concerned about what you've heard.

[Colonel Scott McLeod, Director of Mental Health, Canadian Forces Health Services, Department of National Defence]

Sir, I agree. That's certainly not the approach that we would have in a case like that. There is no way you can make a determination as to what somebody's prognosis is by a first meeting. As General Millar pointed out, our primary goal above all is to be able to treat the person and return them to their job. It's in everybody's best interest to do that.

I would also be very interested to know more about those cases.

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

We're trying to have the military spouses employed wherever possible. However, there are spouses or the spouses of their buddies and in some cases when they go into the medical clinic the receptionist is that spouse and that is a barrier to some of our soldiers going forward. If we could address that in the future it would be helpful.

You mentioned Master Corporal Jody Mitic and how successful the program has been for him. I want to emphasize that Master Corporal Jody Mitic is extraordinary. He is amazing. Not every soldier has that personality where they can come out and do the things and work through the program the way he has. He's probably the highest calibre. We have to think about the person who's having trouble coming forth at the very beginning.

The last question I have has to do with military personnel transitioning into civilian life, especially where people have physical illnesses. As you mentioned earlier, the provinces just aren't generating enough professionals, especially specialists, psychiatrists in particular. The soldiers are just very afraid of being medically released because once they're back to civilian life, the medical care does not exist.

[The Chair, Conservative, Peter Kent]

A very short answer, please.

[Col Rakesh Jetly]

That certainly is a challenge. Part of the cooperative work that we're doing with Veterans Affairs is to educate more and more, increase the awareness of mental health professionals in communities, because the shared care model.... While they're within the CF we can manage most things with us and through our Blue Cross providers. But when people leave, just like the reservists, they're going to communities throughout the nation and many of those areas are underserviced. Part of our thrust of education is to try to increase the awareness, the education, of professionals in the community, and in many ways to demystify the idea of working with ex-soldiers and to promote the fact that they're incredibly compliant and incredibly good patients to work with. It's a privilege to work with people like this. That's part of our thrust as we educate people in the communities.

[The Chair, Conservative, Peter Kent]

Thank you, Colonel.

Ms. Murray, seven minutes, please.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Thank you for being here to present to the committee.

I'd like to follow up on a question that was asked earlier. It has to do with screening returning service members to see whether there are any concerns with mental injuries. I understand this was something that was done on returning. Is there a structure in place for repetitive screenings so that if the person isn't caught by the first screening, the symptoms aren't presenting at that point, they will be identified in future screenings?

[MGen David Millar]

Thank you, Madam.

We've come a long way in terms of our program called road to mental readiness. We have adopted mental resilience, mental illness coping, recognition of the symptoms throughout all of our professional development in the Canadian Forces, including a real focus on pre-deployment and post-deployment follow-up.

I'll ask Scott to speak to that.

[Col Scott McLeod]

In terms of the follow-up, we have a series of follow-ups. As you pointed out, it's important that you can't only have one because you could miss people. Immediately on your return, in the third location decompression, there's an opportunity for people. They will sign a declaration and identify any high-risk involvement they've had with any other traumas, combat, and so forth that would identify them as being in the higher risk population. Then when they get home, anybody who's been identified at that point is picked up and immediately referred.

After that we do our enhanced post-deployment screening, which takes place anywhere from four to six months after their return, where they do a very in-depth questionnaire about anything related to mental health. They also have a personal interview with a mental health care provider. That's an opportunity for somebody to tease out a little bit more information. On top of that we have routine periodic health examinations that also go through and do extensive screening for any type of mental illness.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So there are ongoing health examinations with mental health professionals. I'm referring to recommendation number 14 in the standing committee's report of June 2009. This recommendation is that the Canadian Forces should monitor the mental health of its members for five years after deployment. Could I ask Colonel McLeod whether there has been a specific reference to the recommendations in the 2009 report by National Defence and if so whether this is a recommendation that's being followed by the department?

[Col Scott McLeod]

The recommendation really has been followed, because we have that screening in place. The enhanced post-deployment screening is done by a mental health care professional.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Is it for five years?

[Col Scott McLeod]

For five years the primary care team does that evaluation, and they are specialists. The family physicians are specialists who look after mental health; they are trained to be able to do that. They work closely with the mental health specialty clinic as well. They are actually tracking this, as any other family physician would be routinely tracking them.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

I want to confirm something that I thought I heard Major-General Millar say, and that is that the total number of mental health professionals identified in 2003—you named it as 452—is in your judgment enough.

Is the goal from ten years ago, from before the Kandahar deployment of the armed forces, still seen to be an adequate target to be shooting for?

[MGen David Millar]

Our current number is 452, based on the services that we provide, based on access by our military members to our health care providers and mental health care providers, yes. But as I mentioned, we can always do more, ma'am.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you for that answer.

I'm interested in whether there are surveys, or any data, or any analysis, because anecdotally we're not hearing that the number is anywhere near to being enough. I appreciate that hiring has filled a third of the gap since the recent outcry related to the institutional barriers that government has put in place with hiring freezes and budget cuts; that those barriers are being removed. But I am not clear what research or analysis is showing that 452 would be enough.

[MGen David Millar]

We, as an institution of continuous learning to understand the complexities of mental illness and suicide, are continually assessing it through our own research ability and are looking to the future of new programs and new practices supporting families and our mentally ill. So, yes.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Can I ask that any research or analysis that concludes that this is adequate be tabled with this committee?

[MGen David Millar]

Yes.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Now I'd like to talk a bit about support for families.

I met with a spouse of a serving member and a spouse of a former member, both of whose serving partners were diagnosed with PTSD. Those spouses do not support the contention that there are good services for the partners and the families. There were a number of recommendations in the 2009 report, which I go back to quite often, because it was quite a comprehensive study of these same issues.

There are recommendations such as recommendation 9, which talks about providing services to family members who are at risk of or suffering from domestic violence related to PTSD. There is number 11, which says that family members should be included in the treatment program and should be educated as to how to support their partner. There is a set of recommendations that are quite targeted at making sure that the spouses are not casualties of their partner's illness.

Can you tell me, Mr. Millar, whether there's been an analysis of the recommendations in the 2009 report and what has been done to address the specific gaps in support for families, education for families, counselling, marriage counselling, and all of the support that we're being told is not adequate to this day?

[The Chair, Conservative, Peter Kent]

Ms. Murray, I'm afraid you have talked out your seven minutes.