National Defence committee  The suicide prevention program came out of the suicide expert panel that sat in 2009 that addressed the issue that suicide in the vast majority of cases is related to a mental illness. If you look at risk factors and try to intervene on specific risk factors, there are anywhere from 3,000 to 4,000 members of the Canadian armed forces at any one time who have the risk factor for suicide.

National Defence committee  From a health perspective, we have not changed our requirement that if somebody has an illness that is non-compliant with universality of service, they're not selected. That has not changed over the past several years. We've maintained that. From a physical fitness perspective or otherwise, I would have to defer on that, because that's not my area of responsibility.

National Defence committee  For the MELs, the time that somebody can have medical employment limitations, it can vary depending on the patient. It varies dramatically from one person to another, and there is no specific time limit that says you must be given a permanent restriction after a period of time.

National Defence committee  For five years the primary care team does that evaluation, and they are specialists. The family physicians are specialists who look after mental health; they are trained to be able to do that. They work closely with the mental health specialty clinic as well. They are actually tracking this, as any other family physician would be routinely tracking them.

National Defence committee  The recommendation really has been followed, because we have that screening in place. The enhanced post-deployment screening is done by a mental health care professional.

National Defence committee  In terms of the follow-up, we have a series of follow-ups. As you pointed out, it's important that you can't only have one because you could miss people. Immediately on your return, in the third location decompression, there's an opportunity for people. They will sign a declaration and identify any high-risk involvement they've had with any other traumas, combat, and so forth that would identify them as being in the higher risk population.

National Defence committee  Sir, I agree. That's certainly not the approach that we would have in a case like that. There is no way you can make a determination as to what somebody's prognosis is by a first meeting. As General Millar pointed out, our primary goal above all is to be able to treat the person and return them to their job.

National Defence committee  That's a great question. We have just completed the Rx 2000 rollout of what we consider to be our mental health program, and we're just initiating a validation of that model to look at a variety of different outcome measures. The other thing we're looking at doing is instituting an outcome measures tool to look at how our patients are responding to different levels of treatment.

National Defence committee  Well, it's a good question. How do you define an injury, and how do you define an illness? Post-traumatic stress disorder is an illness. It occurs as a result of a trauma that somebody has been exposed to. If you were exposed to a trauma and you broke your leg, we would call that an injury; they were exposed to a trauma and they have a mental health injury related to that as well.

National Defence committee  We have not seen any of those unique pressures in any way. We've had tremendous support in looking after anybody who is suffering with any form of injury or illness. Having the IPSCs available on the bases allows somebody to be posted to a unit while they undergo therapy. That unit can backfill with somebody else to continue doing their day-to-day job, but it allows that person the option of recovering and then returning to the unit.

National Defence committee  Yes. That's a great question. First of all, as a family physician, you do a significant amount of training in mental health. However, in this case, as the director of mental health, I'm responsible for the programs overall. The clinics that deliver the care report to the clinic managers have oversight from our clinicians on the ground.

National Defence committee  Again, I'm a family physician by training, and how I would do it as a family physician is different from what our multidisciplinary teams do in one of our operational trauma stress support centres. I think we could probably get some expert opinion from Marie Josée as well, who has worked as one of our social workers in Petawawa.

National Defence committee  I think it goes beyond what government can do. It's what all leaders in Canada can do by talking about what mental illness is, by accepting it as another injury or illness, and by recognizing the impact it has. It has a dramatic impact economically. It has a dramatic impact on people and their performance at work and within their families.

National Defence committee  We're doing far better than we ever have in the past. I have mentioned a few times this afternoon our Road to Mental Readiness training package and resiliency package. It is being instituted at all levels of professional development in the CF. We are seeing very good results from that.

National Defence committee  I think that's a better question to ask our senior psychiatrist, who is involved in the different forms of therapy. In general, we prefer to use a multidisciplinary approach to care, which involves a balance between psychotherapy and pharmacotherapy. I certainly can't speak to any individual case that you may be aware of, but we try to involve all four disciplines: the social workers, psychologists, mental health nurses, and the psychiatrists.