National Defence Committee on April 8th, 2014

[BGen Jean-Robert Bernier]

That's correct.

[The Vice-Chair, NDP, Jack Harris]

Then, second, I was interested in your statement and I accept it, that individuals in the military would have mental health issues related to things other than their service and particularly other than their deployment.

But can you be more specific about what level or what percentage of the mental health issues that you're dealing with actually do relate to deployment? I'm not speaking specifically of Afghanistan. We've seen people with four or five deployments to Afghanistan who have also been to Bosnia or to other deployments, whether it be peacekeeping or peacemaking.

Do you have a statistic that would tell you what relates to actual deployment, operational? Let's call it operational factors.

[BGen Jean-Robert Bernier]

We only have specific numbers for the Afghanistan mission. The 2002 big study by Statistics Canada evaluated everybody and didn't attempt to determine whether it was related to the operations that had preceded that in Rwanda, Bosnia, etc. Statistics for mental health conditions attributable specifically to military operation, we only have for Afghanistan.

[The Vice-Chair, NDP, Jack Harris]

So you have a number for Afghanistan. What would that be? That's a number that keeps changing; I would suggest it will go up.

[BGen Jean-Robert Bernier]

For example, 13.5% of everybody deployed to Afghanistan, 40,000 troops, we anticipate based on a pretty good study to develop a mental health condition, an operational stress injury that's directly attributed to Afghanistan. That number over the course of nine years we extrapolate to increase to about 20% of everybody who deployed.

Eight percent at four and a half years for PTSD alone extrapolated to about 11.8% after about nine years post-deployment, compared to a lifetime prevalence of PTSD in the general population of anywhere from 7% to 9%. So it shows us that there's a very significant burden specifically resulting from the experience in Afghanistan.

[The Vice-Chair, NDP, Jack Harris]

Thank you. That clarifies it a bit more for me.

Ms. Rigg, perhaps you can help us on this one. I recognize that some of the issues you talked about, remoteness, etc., are factors here, but the concern I have is that the emphasis on trying to fill these positions seems to have only developed some 18 months after the funds were available to fill those positions.

It's been reported that there were internal factors that had nothing to do with the marketplace, etc., that have caused problems, such as restrictions on person-years, for example, adding person-years to DND or to the military, and specifically insisting that justification be given for particular positions.

Can you confirm that it wasn't simply the factors that you made available to us this morning?

[Jacqueline Rigg]

In terms of that, it did take a while to get the staffing up to speed, and yes, the factors I mentioned before are the primary reasons. Internally, as well, we realized that because this was such a unique workforce, we needed to stand up a tiger team, to be part of the CMP, and get this tiger team to be in more pointed actions on these hires.

Once we did that, we saw things pick up. Before that, because of the complications with the hiring of these folks, it was not going as quickly as we had wanted it to.

[The Vice-Chair, NDP, Jack Harris]

The ombudsman was complaining as late as November, for example, that almost nothing had happened at the lowest positions.

[Jacqueline Rigg]

I wouldn't say nothing had happened. It was not going to the speed we needed it to happen. Processes are run to hire folks, and they can take months. They were not expedited, but once we realized that the wait times were too long to staff these, we created a team that would make things move much quicker and take down some of the barriers.

So I wouldn't say “nothing”, but the speed was not to the speed that we'd wanted it.

[The Vice-Chair, NDP, Jack Harris]

Are you satisfied that whatever obstacles were there have been removed?

[Jacqueline Rigg]

I'm satisfied now that we have removed the main barriers and that we have given this the attention it requires to fill these positions expeditiously.

[The Vice-Chair, NDP, Jack Harris]

General Bernier, the numbers that were set in 2002 may or may not change as a result of further analysis. You referred to two reports, and you talked about the analysis of those reports. That suggests to me that there are reports in existence that are being analyzed.

Do you have any reports from either of those two studies, the lifestyle study and the Statistics Canada study that were mentioned?

[BGen Jean-Robert Bernier]

Not yet, sir. In terms of the Statistics Canada study, the analysis is being done by Statistics Canada.

[The Vice-Chair, NDP, Jack Harris]

Can I ask you specifically whether there is a report that you have access to?

[BGen Jean-Robert Bernier]

Not yet; I will, yes, but only after all the analysis is done. That one is being done independently.

The other one, the health and lifestyle information survey, is being done internally by the epidemiologists at the armed forces public health agency, the directorate of force health protection. That's ongoing now. All that data has been collected as well.

[The Vice-Chair, NDP, Jack Harris]

But neither of these studies has yet to produce a report of any kind.

[BGen Jean-Robert Bernier]

Correct.

[The Vice-Chair, NDP, Jack Harris]

So you don't have any preliminary results or anything like that.

[BGen Jean-Robert Bernier]

No, nothing like that.

[Jack Harris, NDP, St. John's East, NL]

Okay.

As well, General Bernier, obviously we're all—everywhere, both inside and outside of government—concerned about suicides. You say in your closing remarks here that “...we recognize that much can be improved to give our colleagues and our own medical personnel the best possible care”.

Could you be a bit more specific about what improvements you see that need to be made? I know that other people have suggestions, but I'd like your suggestions as to what you think must be improved.

[BGen Jean-Robert Bernier]

We have a pretty robust program based on the 2009 expert panel, which included civil and military experts from academia, allies, etc. We have actioned all of their recommendations. There have been new data, new developments, including technological and so on, since then.

You can't divorce a suicide prevention program from the broader mental health system. Good mental health is what helps prevent suicide. Pretty much everything we think we need is thematically covered by the current strategy. The biggest problem is that we've done a....

We uniquely, certainly in Canada, have a psychiatrist and a physician do a detailed assessment of every single suicide. In a review of all of those so far, since 2010, half of the people are already in care who nevertheless commit suicide, and about half are not in care. But almost all have a mental health condition either treated or not treated.

Because it's half and half, that means we have to increase getting people into care and we have to increase the quality and the effectiveness of the treatments. We need continuous research to improve the treatments, better performance management to improve the treatments in individual cases for those who are in treatment, and continuous measures for reducing stigma and removing barriers to get people into care.

[The Vice-Chair, NDP, Jack Harris]

Here's one final question. Do you feel that you have sufficient access to residential treatment facilities for individuals in the military who have psychiatric situations that require that? We had one situation where there was a clear disagreement between the family of an individual and someone in the forces as to whether or not that person needed it. I've heard of several others. Is there sufficient access to residential treatment, and are you making full advantage of what's available?

[BGen Jean-Robert Bernier]

We are making full advantage. I can't comment on individual cases. What I can say, though, is that when expert external observers evaluate our handling of individual cases and our general policy and program, their findings and their opinions are typically that it's the model. There are individual cases where we can question whether or not the right in-patient care decisions were made, but in general, access—unlike for the rest of the population—is unlimited based on what the clinical judgment requires, so we will spend any amount of money.

Even back when we had about $38.6 million a year as our mental health budget, already it was six times what any other jurisdiction spent per capita for mental health in Canada, and that was before we got the extra $11.4 million. Access and expense are not restrictions based on clinical judgment. Whatever the best clinical judgment is in an individual case, which sometimes is not an agreement between the clinicians, the family, and the individual, we will resource.

[The Vice-Chair, NDP, Jack Harris]

Thank you, General.

I want to thank you, General Bernier and Ms. Rigg, for joining us today, giving your testimony, and answering questions.

With that, I will accept the motion for adjournment.

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

I so move.