Evidence of meeting #31 for Veterans Affairs in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was event.
A recording is available from Parliament.
9:30 a.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Thank you, Mr. Chairman, and merci beaucoup, docteur Guay.
Are the studies you have done reviewed by your peers either within Canada or internationally?
9:30 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
Yes.
9:30 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
It is an extremely lengthy and comprehensive process. The studies I have referred to were all published in such journals as the Canadian Journal of Psychiatry and the Journal of Traumatic Stress. Others will be published in these journals and others as well. The material is usually reviewed by two or three peers, in addition to the editor of the journal. As a general rule, when you submit an article or a study, you receive comments from the reviewers and are asked to clarify or change certain things. It is a very lengthy process, but an extremely reliable one as well.
9:30 a.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Are the subjects you study mostly what we call modern-day veterans, or would they include, for example, World War II or Korean veterans?
9:30 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
They are modern-day veterans or soldiers who could at least become veterans, because they often have problems.
9:30 a.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Some of my colleagues have probably seen the movie Flags of our Fathers by Clint Eastwood. In the opening segment of the movie they show an elderly gentleman and his wife in bed, and he's shaking because he's remembering an event that happened in battle at Iwo Jima 60 years ago.
When I talk to some folks, they say that post-traumatic stress doesn't necessarily happen right away. It can happen many years later. An event that happens now is somehow buried, and then years later it comes out and you suffer from that. Is this a common occurrence you've seen in your studies?
9:30 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
No, it is more the exception than the rule. What is known as delayed PTSD is infrequent. In my opinion, it is more frequent to see people learn to live their lives in spite of their symptoms and in spite of their traumatic memories, in large part through avoidance. Here I'm referring not only to behavioural avoidance, but also cognitive avoidance—in other words, avoiding even thinking about the event, and so on. We also have cases such as this involving civilians. Recently, we treated a former bank director who had been through a hostage taking in 1980. He had been experiencing severe post-traumatic stress for 26 years. This was a hostage taking in which a number of people were killed and injured. He himself had confronted the robbers, and shots had been fired. It was a very serious event. And yet he had managed to live his life for 25 years, although his ability to function had been altered. But he did manage to continue living throughout that period.
9:35 a.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
We had a group here at our last session who work with the veterans. They mentioned a concern about some professionals who were exercising some caution about what they were doing—that maybe the professionals had issues or concerns about what that support group was doing.
Are you aware of that support group? Do you have any concerns about what they're trying to do to assist veterans and their families?
9:35 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
Are you referring to the OSISS?
9:35 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
I know generally about the kind of work being done by this group, which is really to provide peer support to soldiers who have been back from a mission for some time, have left the Canadian Forces, and have become veterans. The work they perform is very well regarded and seems to have positive effects. I don't have any data or studies that would attest to that, but I do know that, generally speaking, the group is well regarded and appreciated.
In terms of Veterans Affairs Canada working with families, spouses and close relatives, I can tell you that the Sainte-Anne Centre has developed intervener groups and that they are refining their interventions. I have discussions with them in order to provide any assistance I can, since I do have some expertise in developing interventions involving close relatives that can help veterans and people coping with post-traumatic stress.
So, I do know a little about it. For example, I know that they have spouses groups. They meet the spouses and get them to talk about the problems they are experiencing as a result of PTSD affecting their veteran spouse. These interventions are certainly an appropriate part of the mix. Living for seven, eight, ten or twelve years with a spouse who has PTSD, who has trouble talking about his problems and feeling positive emotions, who is more irritable, who has trouble concentrating, who doesn't sleep well, and so on, leads to lower quality of life for the entire family. Therefore, getting the family and spouses involved is a must.
9:35 a.m.
Conservative
9:35 a.m.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Thank you for coming, Dr. Guay. I appreciate your taking the time to be here this morning as part of our discussions.
I want to follow up on a question my colleague asked about OSISS. You do research, you're a psychologist, and you've talked about a number of studies. I'll come back to that.
I had a very good presentation about what they do in peer support in OSISS. Obviously they aren't all researchers, but have you worked with them? How have you engaged them in your studies about the full breadth of support for our people? It seems that they, or organizations like them, would be very important to the support of our vets or our Canadian Forces people.
I believe you said you knew a little bit about them but you had never really engaged them, and I'm wondering why—whether it's them or someone else.
9:40 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
That is correct; I have never actively collaborated with them. But there is no particular reason for that. The opportunity simply did not arise. However, I have done so indirectly. Someone conducted a qualitative study with spouses and therefore worked very closely with them. That person was a student of my colleague, Alain Brunet, whom I work with at the Sainte-Anne Centre. There is no particular reason why I haven't collaborated with them. I would obviously be very pleased to do so.
9:40 a.m.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
I want to follow up on that a little. I'm a bit surprised, and I want you to understand that we believe research is important. I have to tell you, though, that you're the only one who has come in and basically said to us that decompression before return is not effective. This is about studies.
My frustration is that it seems we get studies done by researchers who run both sides of the till a lot. I'm wondering how we are to make that decision based on different studies that are done by researchers with PhDs, and whatever. Some are saying it works and some are saying it doesn't. We actually have people on the ground who sometimes say we need to engage our peers, or we need to engage people in it.
I'd like a response on that.
9:40 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
Just to clarify, I referred to debriefing, and not to decompression. I also mentioned that there was a consensus—in other words, a significant number of researchers agree that debriefing is not effective.
The clear consensus that has emerged is that debriefing does not prevent post-traumatic stress disorder. Perhaps I could begin by explaining what is meant by debriefing, before talking about what is paradoxical about all of these studies.
Debriefing is a form of intervention that generally occurs between 24 and 48 hours after a traumatic event—for example, a bank robbery. Within 24 to 48 hours of the event occurring, a psychologist or other mental health worker comes to speak with victims and, for about an hour, he gives people an opportunity to ventilate about the event by helping them through a number of different steps. He or she begins by getting them to talk about the facts, their emotions, and so on. So, that is a debriefing, as designed and generally applied in the business setting, but also in relation to different types of victims.
That is what I was referring to when I said it is not effective. Is “decompression” a process whereby soldiers have an opportunity to decompress somewhere for a week or so before coming back to Canada?
9:45 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
I would just like to finish what I was saying. If you're talking about that type of decompression, I have absolutely no idea whether its effect is positive or negative. It is very likely something that is appreciated and beneficial, but that has yet to be confirmed.
I would just like to complete what I began to say with respect to the paradoxical nature of this. Even though a debriefing is not effective in preventing post-traumatic stress, people like it a lot. When they're asked whether they're satisfied with the intervention, whether they're happy and whether they found it helpful, their answer is yes. However, we cannot rely on that indicator alone to say that there should be debriefing. Basically, debriefing is intended mainly to prevent problems from developing. If we are no more successful at doing that by relying on debriefing, as opposed to a control group where there is no debriefing, then we know that it is a waste of time and money.
9:45 a.m.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
All right. I have just one question, and I'll have a chance a little later. On the debriefing, I guess I misinterpreted the debriefing and the decompression issue. It's interesting, and I don't think it matters whether it's with the Canadian Forces or with our emergency service people. In my former life as mayor of our municipality, I saw firefighters, for example, who would often come across fairly tragic incidents, and because we were in a community, from time to time they would know the people who had been killed or seriously injured.
We got involved by bringing people in who would be able to debrief and talk to them. They had an opportunity, not just then, within 12 hours, but maybe within two weeks. Every indication we had was that it was very positive and very worthwhile in prevention. We didn't used to have that. We saw some very serious side effects of a very tragic incident in which a neighbour hit a bridge, and one guy said it was kind of hard to scrape his friend's brains off the road. That triggered to me and others that we needed to bring in some specialists. When we had a different but similar incident involving two young kids, having those specialists, with what they were trying to do, had a very positive effect upon those emergency people.
So I have mixed feelings about the value of that. If you're saying it doesn't help, I will argue with that, because in respect of those individuals and whatever that ends up being, it may keep them from post-traumatic stress. I don't know, but if it is an opportunity in some professional way for them to get their feelings out and have someone listen to them and be able to deal with them maybe two or three weeks down the road, maybe six months down the road, I think that has a lot of value.
Those are just my comments.
9:45 a.m.
Psychologist and Director, Centre d'étude sur le trauma, As an Individual
With respect to your comments, I can tell you that, of the excellent studies conducted on debriefing, one or two also dealt with firefighters.
I am aware of the situation as regards firefighters because I have met some. In fact, I met with representatives of the Montreal Area Firefighters Association last summer. What came out of that meeting with fire chiefs was that it is generally greatly appreciated. On the other hand, the fire chiefs also told me about some of the negative aspects of debriefing, namely that when these sessions took place, there were sometimes fairly negative comments made by colleagues who blamed certain individuals for their actions. They talked about that specific problem.
Having said that, I don't want to go into too much detail about this. However, I do want to say that we have not yet properly measured all the potential effects of debriefing and that if we are able to measure such things as quality of life or happiness, for example, we may get some results. At the present time, however, we do know that it does not prevent the onset of PTSD.
At the same time, it is important not to overlook the fact that human beings have tremendous resilience. It's important to remember that even when faced with an event that evokes strong feelings of aversion and that is potentially extremely traumatic—such as seeing a colleague die—the vast majority of human beings come out of it unharmed. In fact, 90% of people come out of it without psychological or psychopathological aftereffects.
I just wanted to emphasize that human beings are extremely resilient.
9:50 a.m.
Conservative
The Chair Conservative Rob Anders
Okay, thank you very much. We will now go to round two.
Monsieur St. Denis, go ahead, please, for five minutes.
9:50 a.m.
Liberal
Brent St. Denis Liberal Algoma—Manitoulin—Kapuskasing, ON
Thank you, Mr. Chair, and thank you, Dr. Guay. That was very helpful.
I recall reading a news article a year a half ago that in the wake of September 11 in New York, if my memory serves me correctly, a swarm of helpful counsellors came in to try to help the many people who were struck by what happened—family and so on—and also in the wake of one of the school shootings; I'm not sure if it was Columbine or another one.
This report suggested very much along the lines of what you're saying. We're amateurs, at least speaking for myself in this area, and it said that sometimes that early intervention, that swarming of help, was more negative. I can't interpret the meaning of that, but you're dealing in a field that is not a cut, not a broken arm; it's a very nebulous, hard to pin down situation. It underscores the importance of our looking at this as a committee, so we appreciate what you're saying.
We had the OSISS people here. They made a good presentation, and it brings me to the question of the balance between the helpful but unprofessional peer counsellors, the families, the friends, those who have gone through a trauma before, who are recovered, versus the professional. It can be helpful or it can interfere, if you have the wrong person in the wrong place at the wrong time with somebody who's experienced something.
Are you able to speak to the balance between the peer or mentor counsellor? We want to be positive about that and use those resources, but at the same time we want to be careful. Can you speak to the balance between the professional and the non-professional?