National Defence Committee on April 8th, 2014

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Okay, but—

[BGen Jean-Robert Bernier]

It's important to remember that mental health specialists are not the only mental health professionals we have. All of our doctors are expected to provide mental health services.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Would you agree that someone suffering from post-traumatic stress syndrome needs a specialist? The faster soldiers get help, the better their outcomes and the more likely they are to feel better.

Are the Department of National Defence and the Canadian Armed Forces planning to hire military clinical psychologists who can be deployed to address such situations? If so, Canada's military will no longer have to rely on our allies to get services in French for our soldiers.

[BGen Jean-Robert Bernier]

We are committed to hiring social workers, mental health nurses and psychiatrists to the extent possible.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

I am talking about clinical psychologists. That's where the need is.

Social workers have certain skills, and their services are very useful. We can't ignore that. However, when people have post-traumatic stress injuries, they need qualified people who have the skills to provide specific services.

[BGen Jean-Robert Bernier]

We don't currently have any psychologists in uniform. We have lots of civilian psychologists.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

I understand. That's the problem.

[BGen Jean-Robert Bernier]

We don't deploy psychologists because we haven't identified a need that can't be met by psychiatrists, mental health nurses and social workers.

We've been conducting an analysis over the past year. We'll find out the conclusions at the end of April, and that's when we'll know if we have to go ahead with hiring clinical psychologists in uniform.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

You're telling me that there aren't any right now. I don't understand why you're talking about going ahead with hiring when no psychologists have been hired.

[BGen Jean-Robert Bernier]

Because so far, we haven't identified a need. The way we deploy—

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

I think the cases that have made headlines lately indicate an obvious need. Our military personnel are in distress. Many French Canadians have been deployed. Many of them were from Valcartier, which is in my riding. These are francophones who needed those services but didn't get them. Those soldiers made it clear there was a need.

So there's a report coming in April. People have already publicly expressed a need for access to the services they didn't have access to.

[BGen Jean-Robert Bernier]

They all have access to services in French.

[The Vice-Chair, NDP, Jack Harris]

Very shortly, please.

[BGen Jean-Robert Bernier]

Usually, people who need to see a psychologist are removed from the theatre of operations. They are deployed farther away, behind the lines.

So far, care provided by psychiatrists, general practitioners, mental health nurses and social workers has met the needs of those who remain in the theatre of operations.

We are evaluating data from the Americans and other nations that have psychologists in uniform to see if it is beneficial. That study is underway.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Thank you.

[The Vice-Chair, NDP, Jack Harris]

Thank you very much.

Next, Mr. Williamson, for seven minutes.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you, Chairman.

To the witnesses, thank you so much for coming in today.

This is to follow up on Mr. Norlock's question. I want to repeat this quote again, because I'm reading it over in my mind and trying to kind of break it down. It's this quote:

Combat exposure and exposure to atrocities are risk factors for post-deployment mental illness. Deployment, however, accounts for relatively little of the overall burden of mental disorders in the CAF. Military personnel experience nearly all the non-operational risks and vulnerabilities to mental illness as their civilian counterparts.

I'm trying to get at the heart of what is being expressed in this quote from 2012. I'm not sure if it is to say that this is a constant challenge, which I agree with, but what we've seen coming out of Afghanistan is not unusual and might well be in line with what we're seeing in the population at large.

[BGen Jean-Robert Bernier]

I think the point there is that we have to have a complete mental health system that doesn't exclusively focus on operations-related mental injuries because the bulk, from a volume quantitative perspective, of our burden are the illnesses resulting from the same stresses that affect the general population. So we have a lot of PTSD, for example, from childhood trauma or car accidents or sexual abuse or sexual assault. So we have to be ready for all of that.

There are some subtle differences in the form of presentation of people who have suffered combat-related post-traumatic stress disorder, for example, or resulting from other traumatic exposures. But in general the signs and symptomatology are the same, and the same kind of diagnostic criteria apply. The treatment is generally roughly the same but tailored to the previous trauma.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you. I would agree with that. But is there any evidence or a belief that what some of our soldiers have experienced in Afghanistan puts them in a class of their own? Are there unique elements here that are outside of what the public is perhaps going to...? I don't want to say that because obviously terrible things can happen at homes as well, in some of the cases you identified.

My concern is that this risks downplaying some of the symptoms we see coming out of Afghanistan. I don't think that's your intent, but I'd like you to clarify that, please.

[BGen Jean-Robert Bernier]

Not at all. In fact that's why we award the Sacrifice Medal to people who've suffered an operational stress injury. It is treated like any other combat injury.

The name of our seven most specialized centres in mental health are called operational trauma and stress support centres to focus on the unique aspects of military operation. So mostly our 26 general mental health clinics deal with the routine, everyday stresses and illnesses arising from routine illnesses as a result of the stresses that affect all Canadians. The operational and trauma stress support centres are specialized specifically in doing a much more detailed assessment for those who have an operational stress injury. The context and the understanding of the operational context is critical to doing that, to understanding what kinds of things happen and what kinds of exposures in military operations our troops are exposed to in guiding the trauma, the exposure therapy, and other elements.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you. That is very helpful. I appreciate the clarification for my benefit.

In April a year ago the Canadian Psychiatric Association informed this committee that more research into the specific mental health needs of reservists is required. I have three questions. Do you agree with that statement? If so, or regardless, how is CAF currently evaluating the mental health care needs of reservists? And how is CAF working with the provinces to ensure that reservists are getting the mental health care they need?

[BGen Jean-Robert Bernier]

Every study we do, and we do a lot, we specifically include reservists. So far, consistently, all the research has been demonstrating that the rate of mental illness among reservists, whether related to deployed operations or not, is actually lower than it is among the regular force. Up to half in one study—half the rate of certain prevalent mental illnesses.

However, they're at greater risk because they don't have the social supports when they're demobilized, when they come back from deployed operations. Particularly those who return to units where they were the only person deployed on that operation, or a unit that's distant from a military base with a military clinic and the social setting, the social supports, that would help them either resolve their issues or encourage them to get into care.

For that reason, we have various things like the field ambulance medical link teams or the reserve field ambs whose job is to educate and to try to identify those individuals and get them into care.

There's education of all the chain of command for the same purpose. The Royal Canadian Legion has joined us as a partner because they have—I can't remember—2,400 or 1,400 centres across the country in every community. So they've agreed to set themselves up as a storefront for all of the programs available. They already do that to some extent, but they're going to expand that to all of the programs available to get people into care from within the armed forces or from Veterans Affairs, for those released from the reserve force.

We recognize that it is a special vulnerability that we have to pay particular attention to, and we have measures to try to get the word to them, identify them, and bring them into care and, if necessary, transport them. We permit them to get local care, if necessary, but the ideal is to get them to our specialized military mental health centres.

[John Williamson, Conservative, New Brunswick Southwest, NB]

When you say local care, that would be the provincial health systems?

[BGen Jean-Robert Bernier]

Right. So if they have an injury or illness, including a mental illness that occurs subsequent to their demobilization, their return to part-time service, or even after release from Veterans Affairs, they're eligible to have all their care that's not covered or not accessible by the province, covered by the armed forces.

[The Vice-Chair, NDP, Jack Harris]

Thank you, Mr. Williamson, your time's up.

And I have the next seven minutes to Ms. Murray.