Veterans Affairs Committee on May 6th, 2009

[The Chair, Conservative, David Sweet]

Good afternoon, ladies and gentlemen.

We're continuing our study of services for veterans in Commonwealth and G-8 countries. Today, we have four esteemed witnesses. Let me introduce them to you: Kathy Darte, manager, joint Department of National Defence and Veterans Affairs Canada operational stress injury social support program; Laryssa Underhill, family peer support coordinator, joint Department of National Defence and Veterans Affairs Canada operational stress injury social support program; Major Mariane Le Beau, manager, joint Department of National Defence and Veterans Affairs Canada operational stress injury social support program; Cyndi Muise, peer support coordinator, joint Department of National Defence and Veterans Affairs Canada operational stress injury social support program.

I see that some are from Mississauga, Calgary, and southern Alberta. How many people will actually be presenting opening remarks?

[Kathy Darte, Manager, Operational Stress Injury Social Support Program, Department of Veterans Affairs]

There will be two. Then we'll turn it over to the two on our left and right, so there will be four of us who will present opening remarks.

[The Chair, Conservative, David Sweet]

But you will be able to contain them to 30 minutes.

[Kathy Darte]

Yes, we will.

[The Chair, Conservative, David Sweet]

If that is fine with the committee, we will begin. Please go ahead and choose who will start. We are at your behest, and we'll ask our questions in the normal format after.

[Kathy Darte]

Good afternoon.

Thank you, Mr. Chairman and committee members, for inviting us to appear before you today. We appreciate the opportunity to talk to you about a Department of National Defence and Veterans Affairs partnership, known as the operational stress injury social support program, better known as the OSISS program.

This program focuses on CF members, veterans, and families who are suffering and struggling with operational stress injury and who know full well the impact that has on them.

How a workplace or organization responds to individuals suffering from mental health conditions and their impacts is paramount in the recovery of the individual who is struggling.

Our vision in the operational stress injury social support program is quite simple. We focus on helping to get people into treatment as early as possible and providing the support they require to continue on that road to recovery. It is a peer support program.

Before we begin the opening remarks, I am going to introduce you to the team. With me is Major Mariane Le Beau. She is the program manager for DND. I am the program manager for Veterans Affairs. Laryssa Underhill is a peer support coordinator working with families and she is a Veterans Affairs employee. Cyndi Muise is a peer support coordinator and a DND employee working with both CF members and veterans with operational stress injury.

I'll not go over our presentation outline but I will go through some slides that will give you a bit of an overview of what our program is all about. There were many drivers to this program. SCONDVA, the Standing Committee on National Defence and Veterans Affairs, was a big one, so we'll go back to the 1999-2000 area. The Croatia Board of Inquiry was another big driver, as well as the DND ombudsman's report of 2001 on operational stress injuries.

This program was the vision of Lieutenant-Colonel Stéphane Grenier, who is still serving in the Canadian Forces. He is himself a victim of post-traumatic stress disorder. He had a vision, and he is the founder of the program and has worked very hard and tirelessly to get this program up and running.

It's a partnership program. It was started at National Defence, and Veterans Affairs became a partner shortly thereafter. It was the subject of a joint ministerial announcement made by both the Minister of National Defence and the Minister of Veterans Affairs in October of 2002.

We used a phased-in approach to implementation. We started by providing peer support for CF members and veterans. We then moved on to do a needs analysis to see what the needs were of families struggling with operational stress injury and the impacts it was having on the families, and we implemented family support in 2005.

In 2006 we moved on to implement bereavement support because we were seeing a great number of families who were losing a loved one as a result of military service.

[Major Mariane Le Beau, Manager, Operational Stress Injury Social Support Program, Department of National Defence]

Our mission is to establish, develop, and improve social support programs for Canadian Forces members, veterans, and their families. As Ms. Darte has indicated, our focus and the way we do this is as a peer-based program. We define “peer” as an individual who has been through an OSI, in the case of Cyndi, for example, or an individual like Laryssa, who has lived with someone suffering from an OSI, so she can help others like her through the recovery process.

Our mandate is focusing again on developing a national peer support network. As Kathy said, we started with the members and the veterans. We moved on to families. We implemented a model in 2006 for bereavement--so families who lost a serving member, in particular, with the Afghanistan mission--and that has become quite an important aspect of our services. We're also considering developing a peer support program for military members, veterans, and their families who are dealing with a physical injury. We conducted a needs analysis in 2007, and we're starting very slowly to look at that component as well.

[Kathy Darte]

In the context of that program, we have a number of value statements, but I'm not going to go through them all. We really focus on working with others and on teamwork, working in collaboration, because we know we're only one part of that big continuum of care.

We focus on confidentiality. This program is a very grassroots program that has been built on confidentiality, and we maintain that throughout our work day to day.

[Maj Mariane Le Beau]

I would like to spend a little bit of time on the definition of an OSI--an operational stress injury--and what it means. We define it as any persistent psychological difficulty resulting from operational duties performed by a military member. It's used to describe a broad range of problems that result in impairment of functioning. We're not asking people to come to us with a diagnosis; we do not ask for a diagnosis. An OSI can be depression, an anxiety disorder, or PTSD. It is basically a psychological difficulty. We don't discriminate as to what kind of psychological diagnosis that might be. It's any of them.

The most important thing about the operational stress injury definition is that this was defined by our program, and it has been exported. It's starting to be used by other countries as well, such as the U.S., who found that the concept of the psychological injury was very important, as we did, to destigmatize the condition.

So the focus is on injury as opposed to illness.

[Kathy Darte]

Why is peer support beneficial? It helps to be able to talk to someone who understands exactly what you are dealing with, what you're struggling with, and what you are going through. They will not judge you because they've been there themselves. We certainly know that seeking treatment sometimes for individuals can be quite a lengthy process before they actually come to understand that they really need to go into treatment in order to get onto the road to recovery. As Major Le Beau has just said, a lot of that revolves around shame and stigma and so on. We also know that the consequences of stigma have major impacts on individuals.

Our program is peer-based; it's a non-clinical approach. We certainly work in collaboration and in teams with health professionals, but we are the non-clinical approach to treatment. All of our staff are all individuals who have an operational stress injury themselves. Those who are working at the field level, who are working with individuals, they themselves have an operational stress injury and have recovered to the point where they can go out and help others. The family members who are working with families know firsthand the impact of living with someone who has an operational stress injury. Everyone in our program who is working in the field has what we call that “lived experience”. They know exactly what someone else is going through.

We also include a volunteer component to our program. Again, the volunteers also have that lived experience.

[Maj Mariane Le Beau]

In terms of the current situation, we have helped over 4,000 individuals, either CF members, veterans, or families. We have provided service to 120 bereaved members in the bereavement program. These numbers are growing steadily.

I will just remind you that we started with four coordinators. We now have 28 peer support coordinators for military members and veterans and we have 20 for the families. We have 17 trained bereavement peer support volunteers, and we are about to develop full-time positions for the bereavement program as well. As we are every year, it seems, that we come here, we are also in the process of staffing new positions again.

[Kathy Darte]

Our peer support workers are what we consider to be well-trained. They come with that essential ingredient: they have worn the uniform at one point in their lives, so they are veterans of the Canadian Forces. They have lived experience. They themselves have had PTSD, depression, or other anxiety disorders—the operational stress injuries. They come to us when they are hired. They're all federal government civil servants. They work for either Defence or Veterans Affairs, and we provide formal peer support training to them. All of that training is done by mental health professionals at Ste. Anne's Hospital.

It's a fairly extensive training program, and they also receive considerable professional development and updates on training as they continue to work on a day-to-day basis.

[Maj Mariane Le Beau]

If we were to summarize the key messages and some of the strong points of our program, I think involving trained OSISS peer support workers can really help facilitate access to treatment for individuals, because peers build trust. An automatic trust relationship becomes established between someone who is suffering and someone who has been there. That really helps with accessing treatment and rehabilitation, and with the follow-up also--providing support through the rehab, the whole process.

OSISS is non-clinical, as Kathy has mentioned, and the distinction between clinical workers versus non-clinical workers is very important. One service cannot provide all services on its own. Both types of services need to be offered to the members, veterans, or their families. OSISS is basically a partner in care with the clinical side.

[Kathy Darte]

We firmly believe that we are a successful program and we continue to be very successful. Just based on what Major Le Beau has said, starting off with four field staff in 2002, working with many veterans and many CF members and many families, and in 2009 having a field staff of 48, probably says that we're very successful. It means that people are coming forward and accessing our programs. The numbers are growing daily.

We feel that the keys to our success have been working in partnership as government departments for a common cause: the health and well-being of CF members, veterans, and families with operational stress injuries.

As we've said, we are the non-clinical side within that continuum of care, but we work very closely with the clinical side because we firmly believe it's a team approach that gets people on the road to wellness. We also involve peers in our program development and policy development, and we think that too is extremely important.

Now we're going to turn it over to a couple of the field workers. I'm going to ask Cyndi Muise to speak first. Cyndi is a peer support coordinator. Then when Cyndi finishes, we'll turn it over to Laryssa Underhill.

[Cyndi Muise, Peer Support Coordinator, Operational Stress Injury Social Support Program - Calgary and Southern Alberta, Department of National Defence]

Good afternoon, Mr. Chairman and committee members. Thank you very much for having us here today. I'm Cyndi Muise and I'm a peer support coordinator in Calgary and southern Alberta.

I was born and raised in rural Labrador, in a hamlet called Pinware, with a population of 150. I joined the regular force in October 1990 as a cook, immediately following high school. After training, my first posting was at CFB Chilliwack in British Columbia with 1 Combat Engineer Regiment, or 1 CER. With 1 CER I deployed to Croatia in 1992 and 1993 on Operation Harmony. In 1994 I returned to Bosnia. In 1995 I was posted to CFB Esquimalt on the mighty warships HMCS Protector, HMCS Algonquin, and HMCS Huron, where I did many deployments with them as well. In 2002 I was diagnosed with PTSD as a result of my military service overseas. I was medically released from the CF in 2004 with PTSD, completing 14 years of service.

I started volunteering with this very rewarding, great program in Victoria in 2004. Before I started volunteering, though, I must say, I was a peer. So I started out as a peer with the OSISS program in Esquimalt; then I became a volunteer, and in 2006 I was offered the position in Calgary as a peer support coordinator, because there was only one person in the whole of the province at the time, in Edmonton.

I attend part-time university classes with a future goal of working in public relations. I am married, with one 11-year-old child, and I really love my job.

Thank you.

[Laryssa Underhill, Family Peer Support Coordinator, Operational Stress Injury Social Support Program - Mississauga, Department of Veterans Affairs]

Mr. Chair and committee, I'm very grateful to be here today and grateful to you for devoting your time to listening about the OSISS program.

I currently live in Meaford. My area of responsibility goes from Mississauga up to Borden and includes the Owen Sound-Meaford area and up the peninsula.

Today, I was asked to tell you about myself: about my education, my employment, and how I came into the job. But last night I heard Mr. Stoffer say, don't let the facts get in the way of a good story. And, Mr. Sweet, you may or may not agree, given your professional speaking background, but I don't want to start another debate here today.

[An hon. member]

That was on seals.

[Laryssa Underhill]

Yes, that's right.

I think it's imperative that this committee have some insight into the experience of those suffering with operational stress injuries and their families. I can't speak of specifics here within the committee, except for my own case, and my story is not unique.

When I was 19 years old, I married a Canadian Forces soldier, and nine days later he was deployed to Kuwait for seven months. The moment he returned from that tour, I knew he was not the same man I had put on the bus. Of the first 24 months we were married, he was deployed for 18. His symptoms manifested with nightmares, angry outbursts, and avoidance. Thankfully, he did not turn to drugs and alcohol as a means of problem-solving.

We both developed poor skills, and our life became filled with tension and anger. It came to the point where I repressed laughter, which was a real indicator for me that something was wrong. During that 10-year period, as I mentioned, neither one of us knew what the problem was, but we knew that something was significantly wrong. Finally, in the year 2001 he was diagnosed. That was 10 years later.

It seems ludicrous to me that someone would sustain a compound fracture of the femur overseas and not have it diagnosed and treated for 10 years. You can imagine the systemic issues, not just of trying to mend that broken bone, but of consequential effects. There might be blood poisoning and systemic infections. I draw that parallel to operational stress injuries and what developed over the 10 years.

During that time we were posted to Edmonton, where I completed my nursing. Two more tours had followed in the course of the marriage, for a total of four tours.

Once he was diagnosed in 2001, the cavalry came in for him. There were psychologists and psychiatrists, OSISS came on board for him, he had social networks and supports, but there was nothing for me as a family member, so I continued using all the negative skills I had adopted during that time.

We finally came to Meaford, with two boys in tow, where I augmented my nursing doing deployment support with the Military Family Resource Centre, and I began volunteering with the OSISS program. That began a huge turnaround for me. Unfortunately, my marriage ended. I was hired as a coordinator with the OSISS program in May 2008, so I've been with the program for a year. My ex-spouse still serves as a reservist, after retiring from the regular force. He's been promoted and he's deployable, and he volunteers with the OSISS program as well.

I've seen in previous meeting summaries that this committee has asked about the children of those with OSIs, so I'd like to share a story with you.

When I separated from my husband, my youngest son was three years old. At the time I thought that...you know, we hear quite regularly that children are resilient. What does he know at three years old? How much was he really aware of? But about six months ago, three years after he wasn't living in that environment anymore, he spent the weekend with his dad. They went through a Tim Hortons drive-through. Dad got him a chocolate milk, as he usually does, and because he's six, as he usually does he spilled it over the back of the seat. His immediate reaction was to freeze, and he waited for the fallout he was accustomed to. His dad turned around and said, “That's okay, buddy, don't worry about it. We'll get you another chocolate milk, and we'll clean it up when we get home.” My six-year-old's response was, “Dad, are you okay?” because that wasn't what he was accustomed to.

A message I'd like to give to you is that the greatest resource for those suffering from operational stress injuries is not Veterans Affairs. It's not DND, and--I hope I have a job tomorrow--it's not OSISS, either. It's families.

Thank you.

[Kathy Darte]

Thank you. That ends our opening remarks.

[The Chair, Conservative, David Sweet]

Thank you very much.

To Madam Muise and Madam Underhill, I'm certain that everybody greatly appreciated hearing the personal dimension. You don't have to be concerned about the fashion in which you tell your story here. So thank you for that.

Now we'll go on to questioning from the Liberal Party.

We'll have Madam Sgro, for seven minutes.

[Judy Sgro, Liberal, York West, ON]

Thank you very much to all of you, but in particular to Ms. Muise and Ms. Underhill. Thank you very much for coming and spending a few minutes with us.

Most of us on this committee are new, and we're trying to get a better understanding of military life and the challenges our men and women face, especially those who have been abroad and have faced serious military action. Our job is to make sure you're getting the services you require. I think we're all very committed to working those issues through. It's not a partisan issue. It's an issue that I believe we all care very much about. We care about all the men and women who are putting their lives on the line for us.

The family support unit started in 2005, from what I understand. I gather you have reached out and attempted to provide the services to the men and women since then. But what about going back to Ms. Underhill's comments about how long it took for her husband to finally get some help and that it's the family that needs the support, not just the individual. When you're trying to identify individuals who may be suffering from PTSD or various other operational stress injuries, are you looking at them holistically, as a family, right from the beginning, or are you just looking at an individual?

[Laryssa Underhill]

You have to look at the member holistically. There's a lot to suggest that in order to provide the best support and services for the military member, you have to incorporate the family, bring them along, educate them about signs and symptoms, and provide positive tools and skills to help the family unit recover. Veterans Affairs does have some programs in place. The area counsellors work and encourage the family members to participate in case management. I think it's imperative, and the families are being drawn in.

[Judy Sgro, Liberal, York West, ON]

How are you communicating with other families out there that are still not aware of the fact that you have these programs to help families as a whole?

[Maj Mariane Le Beau]

Obviously, the program for family services started in 2005. It's only four years old. We started with only six across the country; now we're at 20. So we're in a better position to focus more on education and not just on providing basic support services--the one on one and the group thing. I think on the DND side it has been very much on the pre-deployment and post-deployment briefings, along with the military family director services. There's been a protocol developed with the military family resource centres and OSISS, on the family side, to work together to better educate and have better outreach.

I'd like to make one comment with respect to the families and all that. You're right. In many ways, it's the families who know first that someone might be suffering from an OSI, even before the member himself may realize that he is suffering. So outreaching to the families and letting them know that the services exist is extremely important.

[Judy Sgro, Liberal, York West, ON]

How can we possibly expect any man or woman to come back from overseas, from Afghanistan or any of the services they're doing, and not be suffering from operational stress injuries? Why don't we automatically assume that everybody is going to need some degree of assistance to resettle? I think we're doing it backwards. We wait for them to be identified. Why wouldn't we assume that anybody who's gone through that experience is coming back greatly affected, to one degree or another?