Evidence of meeting #31 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.
A recording is available from Parliament.
4:05 p.m.
Liberal
4:05 p.m.
An hon. member
Did you graduate?
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Voices
Oh, oh!
4:05 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
We've talked about how VAC does have systems to identify homeless veterans and those at risk, and we know that although there's a big interplay between homelessness and mental illness, they don't always go together. Not every person with a mental illness becomes homeless, but there are ones who are particularly at risk for becoming homeless.
To any of you, could you make suggestions so that VAC could identify the veterans who are at risk of becoming homeless through either financial or mental health issues that could be dealt with before it gets to that point?
4:05 p.m.
Interim Co-Scientific Director, Canadian Institute for Military and Veteran Health Research
I think research around homelessness generally has demonstrated that there is a complexity in that prediction as well. Being able to identify who is most at risk is not a straightforward process. There may be indicators of certain things related to precarious employment and the insecurity of housing that may precipitate things, but there's also a parallel issue related to a sense of disengagement and disenfranchisement so that some people may actually elect to pursue a state of homelessness rather than fall into homelessness. It is not a homogeneous group.
4:05 p.m.
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
I would echo those comments. The transition period is really, as was said by the speakers, the important phase for the member to figure out their identity. They come from the military system, where they have access to a range of services. Trying to bridge that gap is really important around identity, financial stress, and as well relationship stress. One of the members I saw was developing suicidal ideation because he was afraid of becoming homeless due to financial losses that he was having during a divorce. We really spent a lot of time working together on trying to help him sort out his financial situation, because his concern was that he was going to become homeless. This is a member who I was seeing at an OSI clinic. We know that financial stress puts people at risk for depression as well as suicidal behaviour, and homelessness is of course a very important issue.
The other thing I'm going to remind the committee about is the “housing first” project that was led by the Mental Health Commission of Canada. In that project, people dealing with mental health problems and homelessness were randomized to get housing first and then support. That project was quite successful, and there were homeless veterans within that sample. We looked at that data; I can provide that.
There's that transition period when there are identity issues and financial issues, as well as potentially relationship issues, that can really put the person at risk. It's hard to predict who is going to be at risk, but knowing that's a vulnerable period, a public health approach might be important to look at it to ask how we can reduce the distress during that time period.
4:10 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Thank you, Mr. Chair.
Thank you to our witnesses. We truly appreciate your expertise, and are relying on the information we receive to come up with something that is important and truly works to serve our veterans and their families.
Dr. Cramm, you said you're engaged in research, and you're working with subjects who six months before they leave will be followed throughout for two and a half years past their release. What's the criteria for choosing the individuals? Is it random, or are you looking at the state of their mental health? What goes into that choice?
4:10 p.m.
Interim Co-Scientific Director, Canadian Institute for Military and Veteran Health Research
For that particular study we're trying to understand a diversity of experiences. We want to be able to have an open recruitment to see, during a period of time, who will be releasing from service. Then people can elect to join the study, recognizing it's going to be a commitment to the two and a half years with three different interview points. We will aim to have some representation across categories like the service element. Right now our plan is to be able to recruit the majority who will be coming from the army because that would represent the population. The next largest group would also be the navy and air force. We will also make sure we are capturing the experience of those who participated in the armed forces as reservists.
We want to be able to understand a variety of experiences, within the study. We'll have some categorization across things like the region of the country they are releasing from. We have to make sure that different experiences around language are represented in terms of English or French. We need to make sure that males and females are represented as well. It will depend on who is releasing within a given time frame, because if you have three-year study, you only have so many people whom you can expect to be releasing during a given time frame. We will look at about 100 of them, planning of course that we may lose some of them over the course of the study. Continued engagement in longitudinal studies is hard to maintain.
4:15 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Thank you.
Dr. Sareen, you said there's a predisposition to mental health problems in some individuals, depending on some of their experiences and stresses in their lives. One of the things we heard from General Hugh MacKay is that there is no pre-screening of new recruits regarding their mental health. I'm wondering if it's even possible. Would it be a reliable test or measure to do this pre-screening, or is it even advisable?
4:15 p.m.
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
We have discussed this quite a bit. Right now the field says there is no reliable measure or screening process. Again, it's such a common...mental health problems, if you look across 25% of the population, if you started screening people out, there wouldn't be enough people for the military.
I think this is an important area, maybe looking more deeply into that recruitment phase to really carefully understand both the vulnerabilities and the mental health training. I think the military's doing R2MR, and there's a range of different ways to build resilience, but I think it's important to have the arm's-length evaluation of that training and also to look at both time points, the recruitment phase as well as the transition out of the military phase. It would be important to review the literature in those two areas and figure out the best practices as well as look at potential interventions. I know that—
4:15 p.m.
NDP
4:15 p.m.
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
I think right now there is no screening process that is suggested around the world, that I'm aware of, to say people aren't eligible to be part of the military, unless they have a very serious psychotic illness; that's the only thing that I think would be a problem.
4:15 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Thank you.
I don't know whether you or Dr. Cramm can answer this next question. Are the services that are currently offered by DND and VAC suitable to really effectively address the mental health needs of CF members and veterans? Are the current services working? Are they adequate?
4:15 p.m.
Liberal
The Chair Liberal Neil Ellis
Dr. Cramm, you can start, but we'll have to limit it to you. We're down to the last few seconds on this question. Please make your answer concise.
4:15 p.m.
Interim Co-Scientific Director, Canadian Institute for Military and Veteran Health Research
I can tell you that last year one of the contract research studies was an environmental scan of all the programs that are available, within the CAF, within Veterans Affairs, and also within the community. There was some high-level analysis done as well across different countries to see how they might compare. The purpose of that study was not to determine the effectiveness but more to map the field and look at how those things are, how they're represented, and who they're targeted to.
4:15 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Thank you.
Dr. Cramm, it's good to see you again. We had a good conversation with the occupational therapists presentation, and I know you have done work in transition to the civilian workforce. On that one, could you describe the mental or emotional issues around someone leaving the training and the job opportunity or the service of an active military person versus the great unknown of what they're entering in post-military service?
4:15 p.m.
Interim Co-Scientific Director, Canadian Institute for Military and Veteran Health Research
Absolutely. Thank you, and certainly my training as a mental health occupational therapist really informs this perspective as well. We do know that when you have someone who's in active service, there's a great deal of structure that goes along with that particular way of life. A lot of decisions are made for you on when you wake up, where you go, what you do, where you live. If you're told that this is where you're going to be living next, you know you have three months to make that happen.
So you go from a period of time when a lot of things are externally structured for you to that great unknown, where now the time use can actually be quite a challenge to people in their mental health and well-being. You think you have all this time available to you and isn't that great, but in fact, it can be quite detrimental to positive mental health. If you have too much time on your hands, it can be very difficult to fill any of it in a meaningful way. So if you combine that, in terms of time use, with the sense of meaning and purpose....
People sign up for the military because they believe in something. They have an identity that's recognizable. People can look at you in uniform, and that means something to them about who you are and what you're bringing to bear in your day to day. But if you're just in your civilian clothes, you could be involved in any number of different kinds of jobs or contributions to society. You don't have that same kind of face value recognition around what your identity brings. You potentially have a compromised sense of your meaning, identity, and purpose. You have some difficulties potentially in how you're structuring your time, and then your sense of belonging gets quite disrupted as well. You have this very tight family of other serving members, and this is also true for military families. There's an identity of being a military service member or being a military family. We can't say the same for a veteran family or for a veteran. It's not nearly the same, and many veterans—we see this from the United Kingdom example—don't even identify themselves as veterans because they don't see themselves as veterans: they see themselves as ex-service members. Veterans to them are people who have served in combat in World War II or Korea.
So that sense of identity is quite a real issue. We know that if we can support people through the transition so that they continue to be living lives worth living, as we say in occupational therapy, then that can really support people's mental health transition and general quality of life.
4:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
On recruiting the cohort, I'm curious to know whether a veteran in Bienfait, Saskatchewan, would have similar or different issues in a large urban area like Vancouver or Montreal. Would you include that kind of diversity in your cohort?
4:20 p.m.
Interim Co-Scientific Director, Canadian Institute for Military and Veteran Health Research
This is one of the challenges to that recruitment process. When we're recruiting people, when they're still in service, we don't actually know yet where they're going to be moving to. They may be serving in Meaford but they may return to Grand Falls, Newfoundland. We don't know where people are going to end up.
Many people will attempt to get their final posting close to where they want to retire, but that's not true for everyone. So we don't have a way, necessarily, of predicting it. Sometimes people themselves don't, because they're also in the process, in that last six months before they're ending their service, of trying to map out what they're going to do next: whether they're going to have a second career, and implications like what their spouse might need to be doing for her or his career.
It's not a straightforward issue, but we do expect to be able to identify some of those patterns or trajectories across that time frame.