Veterans Affairs Committee on May 18th, 2023

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you very much.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Desilets.

For the next six minutes,

I'd like to invite Mr. Randall Garrison to go ahead, please.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Mr. Chair.

I'm particularly pleased to be here this evening, as I represent what's probably the second-largest military riding in the country, including CFB Esquimalt on the west coast. I have a large number of serving Canadian Forces members and a large number of veterans in my riding. We do a lot of casework with both serving members and veterans. I think the most frequently heard difficulty in my office has been the difficulty in convincing either Veterans Affairs or DND that there is a connection between mental health challenges and physical manifestations. There is a presumption that those two have nothing to do with each other, which seems to inform the programming of both organizations.

My first question is for the chronic pain centre. You've been running for about three years. Do you have the research to help support those serving members and veterans in making the case that the programming has to acknowledge that link?

[Dr. Joy MacDermid]

I think that's one of the interesting things in our study. We used a complicated statistical modelling to show what the pathways are between different things. We showed that there was a pathway from experiencing sexual discrimination or assault and distress and there was a pathway between experiencing psychological distress and having severe chronic pain. It means that for the people who had those experiences, there was a linkage. One thing led to the next thing that led to the next thing.

It really told us that there is a psychological impact in the physical impact. We can't separate that. We see this so often, especially with chronic musculoskeletal pain. Often, for people who present with chronic musculoskeletal pain, underneath that it's like an onion skin. Psychological injuries occurred that led to that. Sometimes because of the stigma around mental health, it's easier for people to present with chronic pain than to reflect on the chronic psychological distress and injuries they've had. If they don't acknowledge these problems, they manifest as chronic pain. People may talk about their physical symptoms more than they talk about their mental health symptoms because of chronic pain, but if you treat one and ignore the other, you don't get anywhere.

It's a very western philosophy to separate physical health and mental health, but we know that's not really good in any aspect of health. They really are integrated everywhere, but perhaps nowhere is this more important than with veterans.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Ms. Jaquemet or Ms. Henson, I'd like to ask you the same question. In your clinical practice, do you see this problem for people in establishing that link in order to get proper treatment?

[Alana Jaquemet]

Definitely for the veterans I treat, there's always a connection between the two. We know that PTSD lives in the body. Veterans are often seeking many different ways of managing not just the chronic pain but also other psychosocial things that are happening.

I appreciate the comment earlier about having services together in one place. That's a really valuable thing that could be improved upon, having some more of those wraparound services so that our veterans don't have to go from place to place and manage and coordinate on their own. Having a more coordinated approach would be a fantastic improvement.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

The second thing we see quite often in our office is a difficulty, particularly for veterans but also for serving members, in connecting their symptoms to their service. There's the presumption that they must have done something somewhere else, that it couldn't possibly have been their service or their status as a veteran that caused these things. There's a tendency to point people elsewhere and say “not our fault”.

I wonder if that's reflected in the experience you've had.

[Dr. Alisha Henson]

I definitely believe so. I find that it takes a long time. When veterans first present in our office, the level of stress is so high that the services we do a lot in the initial stages have to create that regulation in order to decrease some of the nervous system's response so that we can actually start putting together those pieces. We are able to borrow from a large body of literature on how trauma lives in the body, as my colleague indicated. These processes take time. We need to be very supportive in helping them build that narrative. Without it, it's like parcelling someone out into many pieces.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

With the one minute I have, I want to go back to the centre for chronic pain and ask that same kind of question. Do you have research that helps to support the linkages between the problems people face and their service?

[Dr. Ramesh Zacharias]

We do. I think probably the best data available is the data VAC produced in the Life After Service Studies in 2016 and 2019. There's a tremendous overlap between mental health and chronic pain.

The challenge often is that when veterans have an injury while they are in service, they're likely not going to report it because they're afraid it will impact their career, as Hélène has mentioned and as most veterans mention. I have assessed probably almost 600 veterans in the past five years, and, to a person, they have said they got injured in basic training but they didn't tell anybody because they did not want to get released. Part of the challenge is that the culture is “I'd better not disclose it because it could be the end of my career”, and sadly, that has happened to a number of them.

From VAC's own studies, there's clear evidence of the linkage between chronic pain and mental health, so you can't split the two and treat them separately. You have to treat them in one facility that deals with both.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Garrison.

Now let's go for the second round of questions.

I would like to invite the first vice-chair of the committee, Mr. Blake Richards, to go ahead for five minutes.

[The Vice-Chair, Conservative, Blake Richards]

Thank you, Chair.

Thank you to all of our witnesses today for their excellent contributions so far and for those still to come yet.

Madame Le Scelleur, I would like to start for sure with you.

First of all, let me say—and I know it's been said once or twice already, but it can never be said enough—thank you for your service. I am sorry, and it pained me to hear about some of the experiences that you endured during your service and during your time in the forces and since.

What I would like to focus on is your experience as a veteran. In a previous round of questions, Ms. Wagantall asked you a little bit about your transition, the day you left and in the very immediate circumstances around your release. I want to take us beyond that, if I can. I'd like to hear about your experiences in the transition into civilian life.

You mentioned in your opening remarks, although I can't remember the exact quote, something about how transition to civilian life is very particularly challenging for women veterans. I want to hear, if you're willing to share with us, a little bit of your personal story and what you experienced in that transition to civilian life. What were some of the difficulties you encountered and what would you see as some of the things that could be done to improve that experience for someone like you who would be released tomorrow, for example? How can we improve their experience in transition?

Let's start there. I have a couple of other questions for you as well.

[Hélène Le Scelleur]

Thank you for your question.

I'll answer in English and I'll try to do my best.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Feel free to answer in whichever language is most comfortable for you. That's fine.

[Hélène Le Scelleur]

I would start with the fact that it's very difficult to transition from the “we” mindset to the “I” mindset. We never learned to think about ourselves in the military, and nobody showed us how to reconnect with that.

When you're transitioning out and people are asking, even clinicians, what you want to do, what you like, it's something that you cannot answer because you never thought of anything for yourself. The “we” mindset, the culture and the military mindset, are still sticking when you're out of the military.

I told you this before. I released in 2016, and I would say that I was finally successful in my transition a year ago. I've been in different programs. I've tried many, many different things. I tried the program of Sandra Perron. I tried other organizations. Eventually the program that did stick with me and finally helped me was about trying to find who I was as a person. It's something we're not focusing on.

Even when we join the military, nobody is telling you that there's going to be an end at some point. For sure you're going to be out someday, so what's your plan B? Do you know yourself enough to transition out of the military and know where to go to do something about your life?

For me, this was one of the main things: trying to transfer from the “we” mindset to the “I” mindset.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I can only imagine it, especially for someone like yourself. You mentioned that you joined when you were 17 years old. Your entire adult life was in the military, so you would have been in that mindset and it would be very difficult to make a shift to a different one.

That actually leads really well into the next question that I want to ask.

With many veterans I talk to, I hear often that there's that sense of purpose when you're in the forces. You leave the forces and sometimes you can't find your sense of purpose in whatever it is you're doing in civilian life. Many tell me that volunteering, especially to help fellow veterans, is one of the ways they find that purpose.

I understand that you either volunteer or have volunteered with Wounded Warriors Canada. I wonder whether you could talk a little bit about the meaning and purpose you may have found in that volunteerism and what that meant in your post-service life.

[Hélène Le Scelleur]

Thank you again for the question.

You just said one word that is very important. We're “serving” in the military. We're doing things for people. This is the purpose we chose when we joined the military: It was to serve our country, our nation and our people. Doing volunteer work is exactly connecting with that.

At the same time, it's easy to lose yourself to that—to just take care of others and not take care of yourself. I was the first one saying it's easier to take care of other people because I didn't want to take care of myself.

It's a good thing for sure, because it gives you a purpose. Also, there are many organizations that you can be there for.

I would say that peer support is one thing, but you need to have someone who is successful in their transition to be able to take care of others. You have to be well established in your transition to be there and be a good guide for others.

I don't know whether it's answering your question.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I think so.

Unfortunately, I'm getting the signal that my time has expired. I really want to thank you for sharing your experiences with us.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Richards.

Now let's get to Mrs. Rechie Valdez for five minutes, please.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

Thank you, Chair.

I'd like to thank the witnesses for joining us today and to recognize those of you who have served this great country.

Through you, Mr. Chair, I'll direct my questions to Dr. Henson.

In your clinical practice, what specific mental health challenges that you haven't mentioned yet in your opening are more prevalent among women veterans compared to their male counterparts?

You listed some of them, but if there were some that you didn't mention already, could you cover that?

[Dr. Alisha Henson]

I find that a lot of the women who come to my practice have been diagnosed with comorbid disorders.

Often when men are presenting, they have PTSD as their primary concern. A lot of women I end up working with have been diagnosed with personality disorders, more serious levels of disorders. It's almost as if, when they came forward with concerns and were having difficulties, they became the issue, instead of the system. They ended up in non-culturally competent care at times, where they became the problem and needed to leave the military, instead of the military addressing the concerns to help them. That's probably the most predominant thing.

I had, I think, only one gentleman who came to me who had been diagnosed in the military, and several women.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

Thank you.

We've heard several testimonies of women veterans experiencing military sexual trauma and several other traumas. You listed those also in your opening.

With your expertise, what impact do you think that has had on their mental well-being, and on their transitions and lives?

[Dr. Alisha Henson]

One thing I find is that because of the “soldier on” mentality, when they experience systemic, micro-sexualized traumas, they stuff it down and lose their identity as to who they are as women and how they identify. In order to exist in this culture, they have to be okay with how things go.

You can only stuff for so many years. Then it manifests in, as we're hearing, a lot of chronic pain issues and family struggles, and not feeling supported on the family end as well. It becomes an explosive situation for them in all domains of their lives.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

In the recommendations you listed, you mentioned what we've heard before on this committee: the importance of having the education and experience to be able to service our veterans with the type of care they need and deserve.

Can you describe what the interactions are like with veterans at your clinic, which uses your approach?