Veterans Affairs Committee on March 20th, 2007

[The Chair, Conservative, Rob Anders]

It's not my time; it's the time of that member there.

[Col Donald S. Ethell]

Sorry, but just to carry on, there's a step missing here that you're not aware of.

The OSISS committee, peer support coordinators, and so forth refer people to the OSI clinic. I'm not going to read it all through, but it has: “What is an OSI clinic?”, “What services are available?”, “What can I expect when I attend the clinic?”, “How do I access the clinic?”

I'll leave this with you if you wish to make copies.

Very briefly, before you get to the aid appointment stage, an individual will go through a clinical nurse for various testings and so forth. Having personally experienced this process, I can tell you it's intensive. And there's some other testing by another staff member. Then the file is reviewed by the director, psychiatrist, and two psychologists as to who is going to see this individual on the initial assessment. A decision is made. The initial assessment is made. There is a follow-up session, another follow-up session, and then that report, whatever it may say, will go back through Veterans Affairs Canada for a decision in Charlottetown as to whether this individual is going to move forward and whether treatment—the eight sessions—is authorized.

Even though there are eight, I have enough faith in the system that if there is an ongoing problem with somebody, Veterans Affairs is not going to drop him. They will find a way.

Sorry, I didn't mean to infringe on your time.

[The Chair, Conservative, Rob Anders]

That's just fine. It's Mr. Shipley's time.

Mr. Shipley is up to five minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you very much. I appreciate all of you coming out today to be part of this process.

Can you just help me in terms of the operational stress injury, which is part of the post-traumatic stress disorder—I think one is part of the other. I am interested in who goes to you. Is there a gender difference in who will likely want to access the OSI service? Male or female, is one ahead of the other?

Second, is there a gender difference of who they would actually want to be treated by, or as a coordinator and the volunteer, who they would want to share their concerns with?

[Kathy Darte]

When we initially started the program, we thought that would be an issue, that there would be a gender difference. All of our coordinators in the beginning were of male gender. We knew there were many females out there who were also struggling with OSIs. We wondered if they would come forward.

It hasn't really been an issue in our program. We do have two female coordinators in the program and they see many males, and vice versa, the male coordinators see many females. The gender issue is really not an issue with the program, and if it is, that is discussed with the coordinator. It's made clear up front, and then the coordinator would assist that individual in getting them to speak to someone who is of the gender that they would like to speak with. So, no, it has not been an issue.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I found it interesting in the handout here that in terms of the operational stress disorder, it says, “When corrected statistically for age and sex differences, a study done through McMaster University found the lifetime prevalence of PTSD”--and this is strictly for PTSD—“in CF members matches that of the Canadian public at large”. I would suspect most of us would have said those issues around operational stress injury would be higher with our people in the Canadian Forces just because of the nature of their livelihood.

If this statement is true--and this is a study, so we take those depending on who is doing them—is it partly because of the great training and the preparation, the knowledge they have of having clinics like OSI that they can go to? Does that show the value of what you're doing here and what we're doing for our military to keep those at that rate, or am I just reading something into that?

[Col Donald S. Ethell]

I will go first.

In fact, without pre-empting what they are going to say, the OSISS program has prevented that, and I'll leave the experts here to say that, remembering that there isn't a person in this room who at one time or another hasn't suffered from a PTSD for whatever reason—a stressful traffic accident, am I going to get re-elected, that sort of thing.

[Some hon. members]

Oh, oh!

[Col. Donald S. Ethell]

I don't think I should have said that, but I'm just using that as an example.

In all seriousness, in the general public, policemen, firemen, search and rescue, RCMP, and so forth are exposed to a lot of trauma, so you want to equate all of that compared to the Canadian Forces.

At least the Canadian Forces and Veterans Affairs have a system in place now. It's called the OSISS program.

Jim.

[LCol Jim Jamieson]

We could talk about this for a long time, and I'd be happy to if you want, but I'll try to keep this very brief.

First of all, by way of direct comment, the McMaster study did not use the same criteria as the CF-Statistics Canada study of 2002, which was much more rigorous. The Statistics Canada study did not screen in what we might call pre-threshold, post-traumatic stress symptoms. I wouldn't make too much of that article.

Secondly, OSI does not just refer to post-traumatic stress disorder; it includes other major concerns, like clinical depression. Our rates of clinical depression in the Canadian Forces, according to the 2002 study, are twice as high, age corrected, as in the general population. We also have higher levels of substance abuse, which is considered to be an OSI. We have higher levels of social phobia. People often think of that as speaking in public, but what we're talking about here are soldiers who withdraw from social interactions, who withdraw from family, who start to live in their basements. This is the acronym.

So yes, I think we do screen people, we do train people, and we do help them to cope with traumatic stress, but we certainly have our share.

The other thing, sir, is that the resources required to help someone with post-traumatic stress are considerable in many cases. I think it would be false to read that we don't have a number of mental health concerns. Well, it's more than my opinion; we do.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I have some interest in having not the whole thing, but the summary of what you talked about on that study. This was handed to us, so we didn't go searching for it. I think we want the true story about actually what is affecting some of the operational stress injuries, which go beyond the post-traumatic—

[LCol Jim Jamieson]

The Statistics Canada study of 2002 is the best study we've ever had, and we can certainly make it available, sir, to you and the rest of the committee.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I guess I'm looking for the executive summary of it, if that's possible.

I have one other quick one. In terms of the peers, the coordinators, and the volunteers in the training of those, is the emphasis on some of the professional training that you would help with these peers? When you have peers talking to each other, I would think those who have come through it will obviously have that personal experience that they bring forward. Sometimes not knowing...I think it mentions every circumstance is different. Having some professional training for that volunteer likely goes beyond the important part of compassion and understanding. I may have missed it, and I apologize, but is there some professional training for the peers before they actually get involved?

[Kathy Darte]

Yes, there is. For the peers who are actually hired, paid staff, there is intensive training in the very beginning, before they even go out and start to work.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

What about the volunteers?

[Kathy Darte]

In order to be an official volunteer in the OSISS program, there are two important things that have to happen. You must be what we call medically screened. If you're in treatment, your therapist must say it's okay for you to even volunteer to do this kind of work. If we get that screening and we get all of the other checks and balances, then we bring volunteers into our program. And there have to be police checks and so on. Once we get all of that done, then we provide them with training by the mental health staff at Ste. Anne's centre. They receive three days of training, and it is official training, yes, before they start to work.

[The Chair, Conservative, Rob Anders]

Thanks, Mr. Shipley.

Now we'll go on to Mr. St. Denis, and Mr. Sweet if we have time. Just to let everybody know before this wraps up, we will want to briefly discuss who we will have on Thursday, what we would like to do for Tuesday of next week—some other witnesses.

Monsieur St-Denis.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, Mr. Chair. I'll make sure that Mr. Sweet gets on. I'll keep my remarks brief.

Thank you very much for being here. A wide territory has been covered today, and I much appreciate that. I will go to the specific point about the availability, or lack thereof, of professionals, whether they're the doctors, the nurses, and the others in the field. If you had as much money as you ever needed, are there still the people out there to hire? What is the ceiling on this? Is it the dollars or the people? Please just give a quick answer to that.

[Col Donald S. Ethell]

Other than to say I have heard the figure that the Canadian Forces medical system has only 40% of the people it needs because of a lack of resources in the area, I'll let Jim answer the question.

You can throw all sorts of money at them, but if the people aren't there—There is a great shortage of doctors at least in western Canada, and maybe across the country.

Jim.

[LCol Jim Jamieson]

It is primarily a resource especially related to the specialized area of trauma management. We have difficulty getting psychiatrists, for example. Even if we can get them, many of them do not have the background we would like them to have to best work with our clients.

It's primarily a trained resource capability, but that has many ramifications. You might have the person who is willing to work in Ottawa, but they're not willing to go to Pembroke.

I would say the other issue is availability in the sense of serving the families. As we mentioned earlier, that's a very complicated, difficult problem.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Does the military and/or Veterans Affairs have any plan that you're aware of to work with the colleges and universities or with Immigration Canada to somehow, over time, fill those gaps? Presumably the gap is not going to get smaller over time as our military engagements in the world become more complicated and less traditional, so I'm wondering if there is any plan that you're aware of to fill that gap going forward.

[LCol Jim Jamieson]

The short answer is, yes, it's difficult. We have difficulty even getting physicians to join the military, despite large incentives. There is a team of people who do nothing else but try to recruit physicians for the Canadian Forces. It's very difficult.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

In terms of career promotion, do young people think about psychiatry or psychology or psychiatric nursing in the military context while they're in high school?

[LCol Jim Jamieson]

I'm not aware of that, but I do know we will sponsor our own people to take specialties, and in only a few areas. Surgery, orthopedic surgery, and psychiatry are the only three I know of offhand. We will take our own people, and this is predictably where we have the highest success, of course. If you take military physicians and send them back to school to become psychiatrists, then if they understand the culture, they're inherently much more valuable.

Really, it's out of my area. I don't know who could answer that. Perhaps the surgeon general could answer your question better than I can, sir.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Just as a short final comment—and please give just as short an answer—when you consider the pre-trauma situation, including the training of the troops going out, the preparation for families, the selection and preparation process, and the resources required to do that, whether they're human resources, dollars, or whatever, and the cost in terms of human cost, the financial cost of dealing with trauma issues and other service issues after the fact, do we have that balance right? Are we putting enough up front in the prevention versus the cure?

I know you never get it perfect. You can't totally screen people and there are reasonable limits on that. But do we have that balance right now, given our resources?