Veterans Affairs committee  Thank you so much again for inviting me to speak. There are two things I want to be specific on. One is that it's really important to review suicide systematically to see what specific issues are occurring and what the intervention points are. There are general suicide intervention strategies, but during the transition period there really needs to be a systematic look taken at suicide attempts and suicide deaths over 100 or 200 consecutive cases to say, okay, how can we reduce these?

Veterans Affairs committee  I wasn't aware that it was not considered an operational stress injury. Over the course of the time that I've worked at our OSI clinic, we see members, and we provide treatment. I wasn't aware of that piece.

Veterans Affairs committee  I think that certainly can have an impact. For someone who has gone through a sexual assault, not having support is a really important piece. But I wasn't aware of that piece.

Veterans Affairs committee  I would completely echo that. We've developed cognitive behaviour therapy classes at our site, where we educate both clients and family members in learning the CBT skills that are important in managing depression and anxiety. The family members really appreciate being involved in learning some of the skills we're teaching.

Veterans Affairs committee  I'm not sure what CIMVHR receives. I guess I'm talking broadly about the field of suicide. What we're trying to do is suicide prevention around the world. This is not a criticism of Canada. It's around the world. We have very limited evidence around suicide prevention. The article I'm going to submit is a two-page editorial that says we need to do these things while we look for evidence.

Veterans Affairs committee  I haven't seen literature on that particular piece. That's not an area I'm familiar with.

Veterans Affairs committee  I'm pretty sure a study hasn't been done on that. Again, we just don't have enough funding for mental health research. I think it's really important to remember that most of the time we're not guided by evidence, and it's really important to invest in that. I think identity, especially when you have a young veteran, is a very important issue.

Veterans Affairs committee  Regarding suicidal ideation, a question that is usually asked is: “Have you thought seriously about taking your own life?” When we present these kinds of numbers, that's a question that's asked in a mental health survey. But when you're sitting with individuals clinically, it's really important to get into the details of trying to understand.

Veterans Affairs committee  I don't think there is specifically a different intervention, but as has been discussed, a transition period is so challenging around identity, financial stress, and sometimes relationship stress that it's really important to try to help, if there is a depression, to treat the depression, and if there are alcohol difficulties, to try to reduce that.

Veterans Affairs committee  I just like to shake my head.

Veterans Affairs committee  Yes. There is some literature that I didn't get into that basically describes what you're saying: caring contact. If someone has made a suicide attempt, having a letter from the institution that says, “We're thinking about you”, and there's no expectation to contact VAC, has shown in randomized trials to reduce suicide deaths.

Veterans Affairs committee  They're not being used in the U.S. either. This is just new, new “hot off the press” kind of evidence. A new randomized trial that was done two years ago showed that this specific intervention actually had reductions. But clinical practice hasn't changed yet, and that's what I think is really important to work toward.

Veterans Affairs committee  In that study, and that was 2002, the liberal estimate was 31%. That included diagnoses, people who were diagnosed by a structured interview, as well as people who were receiving services, as well as people who perceived a need for care. When we looked at the whole, from a self-perceived need for care, seeking care, and meeting diagnosis, that number was 31%.

Veterans Affairs committee  I completely agree with you.

Veterans Affairs committee  Yes. I was going to ask the question. We have some recent studies that we have done and some of the latest around suicide prevention that I would like to submit to the committee, but I just didn't have a chance to do it before the meeting. Is it okay if I submit a couple of key papers?