Bill C-211 (Historical)

Federal Framework on Post-Traumatic Stress Disorder Act

An Act respecting a federal framework on post-traumatic stress disorder

This enactment requires the Minister of Health to convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, the Minister of Public Safety and Emergency Preparedness, provincial and territorial government representatives responsible for health and representatives of the medical community and patients’ groups for the purpose of developing a comprehensive federal framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.

Federal Framework on Post-Traumatic Stress Disorder Act

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, it is an honour to rise and speak to Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

I would like to thank the member for Cariboo—Prince George for putting this legislation forward. His approach in getting the bill through the House is very professional. It is important to recognize that members of Parliament can work together, and this legislation is a good example of that co-operation.

There are a couple of points that I want to note with regard to the bill, but first I want to tell the House one of the reasons I have such an interest in the bill.

Some of the people in Windsor West who might be watching us today are from Branch 143 of the Royal Canadian Legion. It was during my time as a member of Parliament that I learned about the seriousness of what is taking place and the commitment that our men and women in the military make, both overseas and in Canada.

About 10 years ago, I had one of the most interesting and life-changing moments of my life. I was invited to participate in a discussion group at the Royal Canadian Legion Branch 143. Also present were a number of individuals who were suffering from post-traumatic stress disorder. That intimate exposure was certainly important. These were not just soldiers who fought in Afghanistan. They were World War II veterans, Korean veterans, peacekeepers, and others who were all still struggling with the ordinary things in daily life. That experience helped to elevate my understanding of PTSD.

I was a social worker before I came to this place. I dealt with people who came to Canada as refugees. The trauma that they experienced in their countries is quite different from what people go through here in Canada. My job was to help them integrate into Canadian society, whether it was school or work or whatever. How can we take a young man who has lost his family and his house and then integrate him into our Canadian society? He himself might have volunteered in a hospital or another traumatic place while never receiving any type of support.

This legislation is important because it would help to bridge a gap. PTSD does not just affect military personnel. It affects first responders and other citizens in all of society. We need to understand that mental health and illness issues are a life-long journey for all of us. People should not be ashamed of these issues and should not be afraid to talk about them. More importantly, work needs to be done to provide the support that people need.

Windsor West lacks many services for children who need, for example, psychologists. This is a critical problem. We do not invest in mental health in the way we should, as we do in our other health areas. Not being able to deal with these kinds of issues on a regular basis affects all of us.

If, despite the overlap of jurisdictions, we can deal with this issue as a nation from coast to coast to coast, with all of the provinces and territories and all the municipalities, it will make Canada truly special and an example for others to follow. More importantly, we can achieve effective results.

It is important to outline a few things in the legislation that people may not understand. The bill talks about bringing together the appropriate ministers in a reporting process. I will not go into all of the details, but the bill proposes putting a system in place that could deal with PTSD. The bill is not talking only about consultation. A lot of people, especially our good men and women in service, have been consulted many times, and they need action.

I will be supporting the bill in its current state because although it includes the consultation process, it also talks about expectations, measurements, and deliverables. That will put the government of the day and members of Parliament of the day on notice that this is a serious issue that affects all Canadians. At the end of the day, we expect to see results, and the results mean helping people deal with the many different personal issues related to PTSD.

Those issues affect us so profoundly. The symptoms include everything from re-experiencing traumatic events over and over or reliving them, to recurring nightmares, disturbing memories of the event, acting or feeling as if the event is happening again, avoiding friends and family, drug addiction, being unable to feel pleasure, constant anxiety, difficulty concentrating, getting angry easily, sleeping difficulties, fearing harm from others, experiencing sudden attacks of dizziness, a fast heartbeat or shortness of breath, and fear of dying. All of these things, when left in a vacuum, are not helpful, not only to the individual but to society.

I would argue, not on the principle of doing this for mere ethics or because it is the right thing to do, but I would argue that it is a bond and social contract that should be expected in return by individuals who occupy professions that put them at risk in service to their communities and society.

We have decided to provide the supports necessary to allow the people in those occupations to not only have what they have today but in the future. That is a social contract for firefighters, police officers, soldiers, nurses, and paramedics. For all of the different occupations, there is a social contract that does not end when that occupation concludes. We are asking people to perform duties that put them at risk and affect their families as part of their jobs. The social contract we have is to provide the proper supports so they can continue to be productive and, most importantly, have good mental health.

We have an opportunity in the House to make a difference with the bill. The member for Cariboo—Prince George has provided the opportunity for all of us, in a non-partisan way, to end this session on a high note. New Democrats are very proud to be part of it. There are so many people who contribute so much. We have invested in training professionals, in their occupations, in being parents, and in being community leaders. If we do not take care of them, we are not taking care of ourselves.

One reason I like community activism is the ability to act. At the end of the day, the ability to act defines us differently as Canadians. When I look at all the campaigns to stop the shame of mental illness, many of them involve the corporate sector, the non-for-profit sector, and, where I come from, the professional sector. Some of the moments for our Afghanistan veterans have put things in a different light and we now have an opportunity to go forward.

I do not want to name people, but I will name one person, because it is an important chapter that will never get told. A gentleman in the Windsor area named Wayne Hillman was among a number of Canadians who served in Vietnam. He told me that our Afghanistan veterans are coming home with some of the same issues that he and his comrades had. They had no supports when they came home, even though they served in the American military. They finally got some psychological counselling and services, which helped them in their lives. The same thing has been happening here, so we need to apply those resources.

With this bill, let us apply even more resources. Let us make sure it not just captured in one occupation or profession. Let us make sure it is part of the normal Canadian practice and culture that mental illness and wellness is part of living healthy in a healthy society.

[Sherry Romanado, Liberal, Parliamentary Secretary to the Minister of Veterans Affairs and Associate Minister of National Defence]

Mr. Speaker, I rise to speak to private member's bill, Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

Bill C-211 was introduced by the member for Cariboo—Prince George and calls on the Minister of Health to spearhead a concerted effort aimed at developing a federal framework to address a complex issue.

I would like to thank the member for Cariboo—Prince George for bringing this to the House. I would like to take a moment to talk about the important issue of post-traumatic stress disorder, otherwise known as PTSD in Canada.

As the daughter and spouse of firefighters, and the mother of two serving Canadian Armed Forces members, the issue of PTSD is a personal one for me. We have come a long way in our collective understanding of PTSD since it was first added to the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association in 1980.

This addition was a significant turning point, because it formally acknowledged PTSD as an acquired mental health condition rather than a personal shortcoming. During the last decade, neuroimaging studies have reaffirmed that PTSD is real and measurable. Researchers can now observe the brain circuits that mediate this disorder.

Unfortunately, sensational media coverage has helped perpetuate the stereotype that people with PTSD are psychotic and violent, which is an inaccurate portrayal of this mental illness.

A traumatic event involves exposure to actual or threatened death, serious injury, or sexual violence. It may be a one-time incident or involve sustained or repeated exposure.

Exposure can involve experiencing the traumatic event first-hand or witnessing or hearing about a traumatic event that happened to others.

The traumatic event or events completely wipe out the individual's capacity to deal with or process the thoughts and emotions related to the incident.

Events that may be associated with PTSD include combat exposure, childhood abuse, sexual assault, and physical violence. Many other traumatic events can be associated with PTSD, such as natural disasters, intimate partner violence, and other extreme or life-threatening events. PTSD can develop immediately after someone experiences a disturbing event, or it can develop weeks, months, or even years later.

According to a 2008 study, about 9% of people in Canada will experience PTSD at some point in their lives. This is consistent with the worldwide prevalence, which ranges between 7% and 12%. Studies show that females are twice as likely to develop PTSD compared to males, but males are less likely than females to seek help. Children and adolescents also experience this disorder, and genetics may make some people more likely to develop it than others.

We also know that certain populations are at increased risk for PTSD because their jobs expose them to extreme and traumatic events that may be recurring. While many associate PTSD with military service, it can manifest in first responders, firefighters, corrections officers, emergency room personnel, victims of crime, and members of the RCMP.

The few studies that have been conducted indicate that between 10% and 35% of first responders will develop PTSD, and the lifetime prevalence of this disorder among active members of the Canadian Armed Forces is 11%. Unfortunately, there is not enough quality data to provide a clear and complete picture of the prevalence, and social and economic impacts of PTSD in Canada.

Collecting quality data on the prevalence and impact of PTSD in Canada is only part of the solution. Another important aspect is raising public awareness about this mental illness.

Although Canadians have become much more aware of this problem in recent years, there are still gaps in their knowledge and understanding of PTSD symptoms and treatment.

As with many other mental illnesses, a big problem is that, unfortunately, the stigma associated with PTSD prevents many people from getting help and prevents others from recognizing the symptoms associated with this mental illness.

Developing PTSD is not a sign of weakness. Many factors play a part in whether a person will experience PTSD, and it will manifest itself differently for different people. Risk factors make a person more likely to develop PTSD, while protective factors can help build resilience and reduce the risk of developing this disorder.

Risk factors include having prior trauma, having been abused as a child, having pre-existing mental health issues, and having a family history of mental illness. Other socio-economic risk factors include lower levels of income and education, and being from an ethnic minority. Following a traumatic event, people who lack social supports are also at a higher risk.

Protective factors include seeking and receiving support from friends and family, finding a support group, and having positive coping strategies. Researchers study the importance and interplay of risk and protective factors. Their findings continue to inform our understanding of PTSD, including the development of effective preventive and treatment approaches.

While symptoms vary from one individual to the next, those affected by PTSD often relive a traumatic event they experienced either through flashbacks and nightmares or by being exposed to situations that trigger memories of the traumatic experience. Some symptoms include negative thoughts, feelings of isolation or distress, and lack of reaction or fear.

People with PTSD might also have sleep disorders, anxiety, and depressive behaviour, or feel paralyzed at the thought of doing the simplest task.

It is also common for individuals with PTSD to self-medicate by using drugs or alcohol.

With such a range of symptoms, it is not surprising that this disorder can also reduce a person's ability to function in relationships, at work, and in leisure activities.

Without proper treatment, the symptoms of PTSD can get worse and have lasting and devastating effects including substance abuse, chronic pain, hypertension, self-mutilation, and suicide.

Growing evidence shows that early treatment of trauma symptoms may reduce the risk of developing PTSD. This suggests that identification and early intervention using evidence-based treatments is critical to preventing this disorder. PTSD affects people differently, so a treatment that works for one person may not work for another. Some people with this disorder need to try different treatments to find what works for them. Recovery is more complicated for people who have endured repeated trauma, and for those who were traumatized early in life.

The idea is to develop more personalized, effective, and efficient treatments, and possibly even to prevent the disorder from ever manifesting.

Diverse areas of research continue to provide pieces of the puzzle bringing us closer to understanding the whole picture of PTSD. I am inspired by the work done on PTSD, not only by federal departments but also by provinces, territories, and advocacy groups across this country.

We need to come together to break the stigma and to allow those suffering, and the families who suffer along with them, to get the help they need. Today, we come together, we put partisanship aside, and we support our everyday heroes.

I very much appreciate the opportunity to speak about this important issue in the House of Commons.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

moved that the be read the third time and passed.

Mr. Speaker, I proudly rise today to speak to my private member's bill, C-211, an act respecting a federal framework on post-traumatic stress disorder.

On a personal note, I would like to express my gratitude to all those who have helped us on our journey to get to today.

From the bottom of my heart, I thank the paramedics, firefighters, military, veterans, police officers, correctional officers, dispatch, and nurses. I thank those who came forward to provide feedback about how we could go about strengthening this legislation in the future, if it is the desire and the will of the House and the Senate to enact the bill into law. I want to thank the Canadian Federation of Nurses Unions, the jurors, and Mr. Mark Farrant for the honest and heartfelt feedback.

I want to acknowledge the families of the fallen, those left behind to pick up the pieces. I want to thank them for sharing their stories of their loved ones. I want to thank them for showing incredible strength through their immeasurable and unspeakable pain they are going through. I know it has not been an easy journey for anyone, and their willingness to share their stories has been truly inspiring.

I also want to apologize to everyone that it has taken this long to get to this point. It has been 606 days since we were elected. It has been 600 days since I first landed in Ottawa with the background for Bill C-211. It has been 462 days since we tabled Bill C-211. It has been 100 days since we all stood together in the House and passed it unanimously at second reading.

Over this journey, I have tried to bring the voices of those who are suffering forward. I have tried to relay their incredible stories, with the same honest emotion they have shared with me.

I said this before and I will say again, we have received so many emails, so many calls, and so many messages, many of them full of heartbreak and tragedy. With the indulgence of members, I will take this opportunity to read a small excerpt of an email I received a little over a year ago after we first tabled Bill C-211. It is from the wife of one of our fallen, and it reads:

“Thank you.”

“As I write this, I'm trying hard to hold back the tears. The truth is I'm unsure how I even have tears left. I've cried every day since his death and it's been over a year. I can only manage a day at a time, and even that at times is too much. I don't know what tomorrow will bring. I guess no one really does. We were only married three years and he was my one true love. He would have been 30 this year. Our son will never know his father. He will never know the incredible man he was. My husband only wanted to serve and to save. Sadly, no one could save him. It's odd how everyone gathers around you at first, then life goes on. I don't get the invites anymore. It's like other wives don't want to be reminded of this, of how this could have been them.”

“Mr. Doherty, your bill is too late for my family, but I hope you will be successful. My pain endures and I'm not sure there is a fix. I will tell my son that his dad was a hero and saved lives. I believe if my husband knew of you and your efforts, it just might have given him enough hope that he would have reached out, that he would have hung on. Please keep fighting for this. For us it is too late, but you and your colleagues will save the lives of others.”

The letter ended with a big “thank you”.

This is one of hundreds, maybe even thousands of emails, messages, comments on social media and from private meetings that we have received since tabling our bill. It is truly overwhelming the stories we have heard from those who are struggling today, those who are receiving help, and those who are left behind to somehow pick up the pieces.

I challenge us all to come up with solutions so we do not lose another life to PTSD.

My team has also heard horrific stories of pain and suffering. In some cases, for those we met with along the way, today was too far away, and the pain was too great. Last week alone, we saw four responders from across Canada commit suicide. Within the last 48 hours, we have had a firefighter from Ottawa and a paramedic from Pickering commit suicide.

One of the questions I was asked when I was appearing at the health committee was whether there was one story that really stands out. The truth is that there are many. It is hard not to get emotional when talking about this, because it is an incredibly heavy burden. Collectively in this House, we have created so much hope.

I will take a moment to try to explain some of this to our hon. members who are in the House right now. From a young age, there are people we have been told to respect and to hold in the highest regard. We hear the stories of their heroics. Books are written. Movies are written and made about these larger-than-life individuals, these superheros. They truly embody all that is Canadian. They are altruistic individuals who want nothing more than to go out and go to work so they can help others, so they can save others, and so they can make their communities and our country safe.

This is something we heard very powerfully from Natalie Harris, a former advanced-care paramedic in the county of Simcoe in Ontario. When she appeared before the health committee on May 16, she told committee members that she went to school in 2001 to become a paramedic. She said, “I learned something new every day, was financially stable, and made such a difference in people's lives. I was in my glory, but no matter how much I loved it, each year became a bit tougher for me to cope with, and I didn't know why.” She would tell herself, “I've fought too hard. I've conquered so many difficult circumstances in my life.” She did not want to lose this career. She reassured herself, “I'm sure I'll be okay.”

Natalie continued by saying:

It's not normal to have a person ask you to just take their leg and arm off because they were experiencing so much pain from being trapped in a car with multiple open fractures all over their body. It's not normal to learn that the patient who hanged himself the night before had a second noose waiting for his wife, had his son not called 911 at the right time. It's not normal to witness a young woman, seven months pregnant, rub her belly with the only limb that could move as she had a stroke that would leave her disabled. It's not normal to see the cellphone on the road beside the obviously dead driver, crushed between the pavement and the car, who was texting and driving, and it's not normal to know he made the three sisters in the other car now two. It's not normal to experience and see the look of true evil when you learn how two innocent women were murdered.... It's not normal to see someone die before your eyes more times than you can actually count.

I would like to take this moment to thank Natalie once again for coming forward. Nothing prepares a person for these experiences. As politicians, we often do our best to translate our concerns and the concerns of our constituents into speeches and talking points, but I can truly say that in all my life, there are few people who have been able to make such an impactful statement. I know the members of the health committee who are here today felt the same way.

Our warriors make the ultimate sacrifice. They make the sacrifice by taking time away from their loved ones, their family, and their friends. They put their uniforms on every day knowing full well that they may never have an opportunity to say goodbye. They are those who run toward danger when we and others would run the other way. They experience human tragedy every day, yet they still, without exception, without hesitation, answer the call of duty. They face the sights, sounds, and smells that will stay with them for a lifetime.

Freedom is not free. There is a very real cost. Knowing what these individuals go through, I would like to share with members the flip side for a moment.

All of a sudden, these roles are reversed. Those people are now looking toward this House. They are looking to all of us, as members of Parliament and legislators. They are asking for help.

The hardest part in all this is having those people, who I know our hon. colleagues also look to as heroes, coming forward, through emails, calls, and messages, saying, “Thank you for bringing this legislation forward.”

It is such an honour to be a member of Parliament. It is truly a humbling experience. There are a few experiences I have had over the course of the last two years that have really hit home. I would like to tell members about a couple.

Shortly after being elected, stepping out of my car in a parking lot back home in Cariboo—Prince George, someone came up to me and asked if I was a member of Parliament. I said I was, and the person said, “We just want to let you know that our family loves you, and we pray for you every night. Thank you for your service.”

Another point was having someone come to us, with tears in his eyes, a police officer, thanking us, saying that we have saved his life because of the work we have done on this bill. It has allowed him to come forward to his family and to his friends, seeking help.

The other was at second reading, when a giant of a man, a former firefighter who himself has been fighting post-traumatic stress disorder, came to me and said, “Thank you. For the first time, I have hope.” Then he introduced me to his young son and said, “This is what a true Canadian hero looks like.” Words cannot express how humbling that was.

Is there not something to be said about that, that our heroes, our warriors, have been left to deal with the horrors of post-traumatic stress disorder alone and in silence? Even though they are hurting, they continue to remain just a call away when we need them. To me, that is simply shameful. It breaks my heart.

We have been blessed that so many people have followed us along this journey, some of whom were here March 8 when 284 members of Parliament rose together to send Bill C-211 to committee, and they have seen the good work we have done to this point. However, the work does not stop here.

Bill C-211 was developed to look at the overwhelming issue and the epidemic we have with respect to our first responders, our veterans, and our military. We are losing our warriors left and right. The challenge is this, a challenge that many groups we have met with over the last 18 months acknowledge. Today, as it stands, we do not have a piece of legislation that deals with PTSD. We have inconsistencies across our country, even in terminology, in diagnoses, and in treatment. We have some groups doing great work. We have others who hang a shingle and claim that they are experts. The reality is that they are causing more harm than good. We have inconsistencies across our nation in who or what is covered. An RCMP member serving in one part of our country may not be eligible for the same services their colleagues are in other provinces.

One academic brought forth the rule of thirds. He said 30% of those who are suffering with PTSD will recover 100%; 30% will have an okay life; and 30% we will lose altogether. That was one of my first committee meetings, and I took exception to this. Post-traumatic stress disorder is not something that can be cured 100%. It is a traumatic brain injury, and anything can trigger a setback.

I want to leave my hon. colleagues with this. If they had the power to save a live today, would they do so? If they knew their actions today could save lives, would they be brave enough to follow through? I ask because we have been given that opportunity today, as we speak. We can help ensure that another life is not lost and that the four lives last week, the two within the last 48 hours, and the hundreds lost since I first tabled Bill C-211 were not lost in vain.

As I read earlier from the wife of the fallen officer, the one line that sticks out is, “I don't know what tomorrow will bring.... I guess no one really does.”

For those who have been following our journey, those who are in the room with us today and those who are watching across our nation and internationally, tomorrow is just another excuse or delay, and sometimes tomorrow is too far away. I ask of you, let us not wait for tomorrow when we can truly make a difference today.

The House proceeded to the consideration of Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder, as reported (with amendment) from the committee.

Post-traumatic Stress Disorder

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, the average rate of suicide within the general public is 11.5 per 100,000 people. The rate of suicide within the first responder community is 56 per 100,000 people.

Today Peel Region paramedics are saying goodbye to one of their own. He was a husband, a father, a friend, and a brother. This past week families, friends, and colleagues said goodbye to first responders from North Battleford, Saskatchewan, from North Vancouver, and from northern British Columbia. Four lives were cut short because of post-traumatic stress disorder.

My bill, Bill C-211, comes too late for these families. I hope next week, when Bill C-211 enters the House for third reading, that it passes unanimously, because collectively we will send a message that these deaths were not in vain, that we stand together in the fight against PTSD, and that those who are suffering are not alone.

To my colleagues, we must be better; we must do better. To the families, friends, and colleagues of the fallen, my heart goes out to them, and I am truly sorry for their loss.

PTSD Awareness Month

[John Brassard, Conservative, Barrie—Innisfil, ON]

Mr. Speaker, June is post-traumatic stress disorder month and is dedicated to raising awareness of those it affects. This month is also meant to teach all of us how we can help those who suffer from PTSD.

As a former firefighter, I am very proud to have supported the work done by the member from Cariboo—Prince George on Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

PTSD does not discriminate. It can affect anyone at any age at any time at any stage of their lives. It affects those in combat situations, veterans, first responders, and other occupations, like doctors and nurses.

I would also like to recognize the work of Natalie Harris, a Barrie resident who, as a paramedic, suffers from PTSD, but it does not prevent her from selflessly helping others with PTSD. Natalie was in Ottawa last month testifying at the health committee. She is an inspiration to me and to so many others.

Let us all work together to raise awareness and help those suffering from PTSD.

Health

[Bill Casey, Liberal, Cumberland—Colchester, NS]

Madam Speaker, it is my pleasure and honour to present, in both official languages, the 10th report of the Standing Committee on Health in relation to Bill C-211, an act respecting a federal framework on post-traumatic stress disorder. After some incredible testimony and impressive witnesses with emotional stories to tell, the committee has studied the bill and decided to report the bill back to the House with amendment.

[The Chair, Liberal, Bill Casey]

We will call our meeting number 56 to order. Imagine: meeting number 56.

Today we are doing clause-by-clause of Bill C-211, and then we have a bit of committee business to do after that. We will go right to Bill C-211.

Is everybody ready?

Pursuant to Standing Order 75(1), consideration of clause 1, the short title, and the preamble is postponed until the end, so I am calling clause 2.

(On clause 2)

Does clause 2 carry? All in favour?

Mr. Davies.

[The Chair, Liberal, Bill Casey]

We're going to reconvene for a few minutes.

We have a few business items here to deal with.

Our next meeting is on June 6. We need witnesses for Lyme. The clerk would like to have proposed witnesses by this Friday for the Lyme disease study, the framework.

The amendments for Bill C-211 should be in immediately. We're going to do clause-by-clause on Thursday. If you have any amendments to propose, you should let us know and get them in.

We have a public health effects of pornography, M-47, bibliography of studies and sources submitted by Mr. Viersen, but it wasn't translated into French. Is it all right with the committee if we accept it only in English? Do I have consensus for that? Okay.

Mr. Kang.

[John Oliver, Liberal, Oakville, ON]

Thank you.

At the end of the day, we as a committee have to approve or amend Bill C-211. One of the clauses says that the federal framework should include “the establishment of a national medical surveillance program to use data collected by the Agency”, the Public Health Agency.

Anne-Marie, do you know whether the Public Health Agency is collecting data now that we would be able to create that from?

[John Oliver, Liberal, Oakville, ON]

Bill C-211, as a bill, basically deals with tracking of the incidence of PTSD. It ensures that there's a standard diagnosis and treatment set to manage it, and then education, and dissemination of that information across Canada. While I support that generally, I'm wondering if it really gets to the heart of the issue. I'm wondering if, at the heart of the issue, there is the reluctance of many organizations to acknowledge PTSD because of the burden it might put on them financially, and some of the issues where an employer might resist wanting to acknowledge PTSD because of it.

In Ontario, for instance, you mentioned, I think, Bill 163. The presumption is that if you have PTSD and you're a first responder, or in that category of workers, without any challenge, that is a work-related illness. Much more quickly, the treatment starts, and you're very quickly into treatment processes. WCB in Manitoba and Saskatchewan are both working on presumption clauses, that if you have PTSD, the assumption is it is work-related. There is already, I think, some pretty good case knowledge and understanding of how to identify and how to treat PTSD. Is it about better education on those things, or is it really about the receptivity of employers and other WCB agencies, potentially federal government and the military, to recognize PTSD as having a cause originating from workplace activities?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

First of all, I'd like to thank all the witnesses here. Natalie, thank you for the very moving testimony. I get emotional when I hear this kind of stuff. Definitely people are out there, and they're crying out loud for help. I think as a committee we should be doing something about it. Thanks again.

In the Bill C-211 preamble, it specifically refers to PTSD of “first responders, firefighters, military personnel, corrections officers and members of the RCMP”.

My question is to Professor Sareen or whoever feels best to answer it.

Does the process of diagnosis and treatment of PTSD among these particular groups differ from the process for other individuals? Are there any factors that make an individual either more vulnerable or more resilient to PTSD? What other groups do you think would be suffering from PTSD?

[Natalie Harris, Advanced Care Paramedic, County of Simcoe, As an Individual]

Thank you.

Good afternoon, honourable members of Parliament and your staff, members of the Standing Committee on Health, analysts, proceedings and verification officers, and honourable chairperson.

My name is Natalie Harris, and it is my pleasure to have this opportunity to share with you how important MP Todd Doherty's Bill C-211 is to myself and to so many first responders, veterans, military personnel, and corrections officers across Canada. Establishing a national framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress is essential to saving the lives of those who passionately care for and protect the citizens of this great country every day.

It has always been easy for me to share that I'm an advanced care paramedic with the County of Simcoe in Ontario and the mom of two beautiful children, Caroline and Adam, but it's only been over the last two years with the support of my family and friends that I have developed the courage to share that I also battle post-traumatic stress disorder and attempted to take my own life in 2014 when I had no hope of getting the treatment and support I needed to survive.

You may be wondering to yourselves what in the world this seemingly normal girl could possibly teach you today. I may not be representing an organization, but that's okay, because what I do represent is very important. I sit here before you representing what could be your sister, mother, daughter, wife, friend, or partner, who may be silently battling a world of darkness all on her own because she is too afraid to ask for help for fear of no longer being able to do the job she so dearly loves, for fear of being ridiculed and labelled with mental health stigma for the rest of her life, and for fear of not being heard.

In October 2014, PTSD had caused me to live in a world filled with fear and sadness that constantly undervalued my fundamental necessity to breathe. It caused me to live in a world filled with darkness, distorted thinking, and illogical reasoning. It caused me to live in a world that harboured powerful voices that told me that I should hurt myself because I was worthless, and that everyone would be better off without me. In October 2014, PTSD caused me to know for certain that I was going to take my own life. On that dreaded day, after swallowing half a bottle of muscle relaxants, I wrote a letter to whoever would find me, “I'm so sorry. You will be okay. I love you.” I then swallowed the rest of the bottle.

I started feeling tired. I knew the medicine was working. I lay in bed staring at the ceiling, more numb than I'd ever been in my life, while I was literally waiting to die. I remember feeling sick, and somehow in my haze I made it to the bathroom. That's all I remember. For all I knew, I would never wake up again. For all I knew, I was dead.

What I didn't know was that my colleagues had found me and brought me to the hospital where I remained unconscious for 12 hours. The doctors and nurses pumped litres of fluid into me with the hope of saving my liver. As the hours went by, my abdomen grew full of fluid, and I turned jaundiced as evidence that my liver couldn't keep up.

My family and friends were seriously discussing funeral plans for me, but somehow I survived. It wasn't time for me to leave this planet quite yet. I still had some pretty important work to do, which has brought me here today.

I went to school in 2001 to become a paramedic. Not long after graduating, I was hired by a service. Going to work was like a dream come true, even during SARS, which is when I was hired. Not very many people can say that about their careers. I learned something new every day, was financially stable, and made such a difference in people's lives. I was in my glory, but no matter how much I loved it, each year became a bit tougher for me to cope with, and I didn't know why.

Through difficult calls, I would silently say to myself, “I'm not going to let this amazing career slip away from me. I've fought too hard. I've conquered so many difficult circumstances in my life. I'm sure I'll be okay,” but secretly I began to develop a repertoire of illusions used to hide my true emotions even from myself. Back then, I barely knew what post-traumatic stress was, because we didn't learn about it in school.

I started to see tiny changes in myself in the early years, as days just seemed to go by and calls just happened to add up. I could let most calls move through me in a healthy way, but looking back now I can recognize the deterioration of my coping skills as life as a quiet paramedic took its toll.

Over the years, while being a full-time paramedic, I literally became very comfortable with uncomfortable. I became acclimatized to living a life that included horrific memories, relentless nightmares, and ingrained images of sadness and pain. That may sound barbaric to anyone who is not in the emergency services field, but it is literally a part of our lives almost daily.

Devil's advocates out there may be saying to themselves that we signed up for it, but we didn't. We signed up for an amazing career that allows us to help people on an extraordinary level. No one signed up for mental turmoil. We signed up for the chance to save people's lives. No one signed up for memories of patients screaming in pain. We signed up for achieving educational goals. No one signed up for drowning our sorrows in vices.

We thought we would be strong enough to avoid being uncomfortable, but no one is. Strength isn't measured by the number of deaths we pronounce. It's measured by the number of deaths we recognize we need to talk about in order to sleep at night. First responders are some amazing people, but signing up to be one didn't mean we signed our hearts away.

It's not normal to have a person ask you to just take their leg and arm off because they were experiencing so much pain from being trapped in a car with multiple open fractures all over their body. It's not normal to learn that the patient who hanged himself the night before had a second noose waiting for his wife, had his son not called 911 at the right time. It's not normal to witness a young woman, seven months pregnant, rub her belly with the only limb that could move as she had a stroke that would leave her disabled. It's not normal to see the cellphone on the road beside the obviously dead driver, crushed between the pavement and the car, who was texting and driving, and it's not normal to know he made the three sisters in the other car now two. It's not normal to experience and see the look of true evil when you learn how two innocent women were murdered. It's not normal to be handed a baby who's blue. It's not normal to watch a child have a seizure for 30 minutes because your drugs just wouldn't work. It's not normal to see someone die before your eyes more times than you can actually count.

What we do isn't normal, so why would we think it's okay to be comfortable with that? Why would it be any surprise to hear that first responders are dying every month because they can't take their often hidden memories any longer? I'm uncomfortable with how comfortable we've become.

Honourable members of the committee, we can't wait any longer to acknowledge and act upon the cries of heroes and their families that are happening right now coast to coast. They need Canada to step up to the plate and value their sacrifices in the form of education and support.

So much more needs to be done to prevent the deaths of community heroes, and MP Todd Doherty's Bill C-211 is where this can start. It's on the table, and we can't push it aside. If we do, time wasted will equal lives lost.

I would like to end my testimony by sharing a poem I wrote in memory of my friend and colleague Bob Cooke who died by suicide in September, 2014. We miss Bob, and we will never forget you.

I wish you'd see, but never feel, This illness dark, to some not real. I wish you'd know, it hurts to breathe, My lungs collapse, when comfort leaves. I wish you'd cast my scars away, Repair the marks I formed each day. I wish that answers existed near, To rid my soul of unfounded fear. I wish each tear was never there, They drown my courage left to care. I wish I'm brave enough to smile, Sustain down heartache's endless mile. I wish you'd camouflage each sting, The blackness seems to always bring. I wish I knew I'd be ok, Believe tomorrow's a brighter day. But I can wish with all my might, It won't discount this ceaseless fight. This wish will sail up to the sky, With all the rest who've said good-bye. I'll wish tomorrow, just for hope, Or conjure up some way to cope. Through darkness black, I'll make my way, Exist again another day. I wish...

I never had the opportunity to choose to hang up my uniform. Sadly, PTSD made this decision for me. I plead with you today to move forward with this bill and put Canada on the map with respect to having the best national framework for our heroes so that every uniform can be hung up when the time is right, with the hero's choice.

At this time I would like to present you, the committee, my own dress uniform. I hung that uniform up in my closet quite some time ago. I wasn't able to even look at it until yesterday. I was so sad, hurt, and heartbroken that I needed to end the job that I loved so dearly and still miss to this day. I'm asking you to please take care of my dress uniform. When this bill is moved forward, and we actually get to work on saving those lives coast to coast, would you please give it to MP Todd Doherty, so that he can keep it in his care?

Thank you for your time.

[Dr. Jitender Sareen, Professor of Psychiatry, University of Manitoba, As an Individual]

Thank you so much. It's a pleasure to be here.

For the committee to understand the context of my comments, I want to tell you a little bit about myself. I'm a psychiatrist and head of the department of psychiatry at the University of Manitoba. I have provided psychiatric consultation and treatment at the Veterans Affairs operational stress injury clinic in Winnipeg as well as at the Health Sciences Centre in Winnipeg.

Over the last 17 years, I've had the opportunity to help and learn from people who have suffered with post-traumatic stress, as well as mood and anxiety conditions. I've also held Canadian Institutes of Health Research grants on military mental health as well as first nations suicide prevention.

Currently I'm working with and leading a team of researchers and clinicians in examining the impact of trauma and post-traumatic stress among Canadians. One of the studies is a large survey with Statistics Canada that follows the Canadian military over 15 years.

I want to comment that I'm very supportive of Bill C-211 that has been brought forward. As I understand it, this bill would increase the conversation federally as well provincially in developing a federal framework for recognizing and treating post-traumatic stress disorder.

I will summarize my understanding of the current knowledge of PTSD in Canada as well as internationally. There is increasing recognition around the world about the substantial impact of traumatic stress and PTSD. We know from studies around the world that PTSD is associated with enormous cost to the individual as well as society. We know that approximately 60% to 80% of Canadians, at some point in their life, will be exposed to a severe traumatic experience. Most people exposed to that traumatic experience will be resilient and will not require treatment. Social support is the most important protective factor after exposure to trauma.

However, we do know that 20% to 30% of people exposed to a serious traumatic event will develop a trauma-related condition, for example PTSD, but also other conditions like depression, another anxiety disorder such as panic disorder, or a substance-use problem.

There is more and more knowledge that is accumulating that shows that exposure to repeated trauma over time can increase the risk of PTSD. We also know that physical injuries, assaultive trauma, motor vehicle accidents, and rapid onset of critical illness are associated with PTSD.

Our group has shown that people with PTSD have about three times the likelihood of developing suicidal behaviour compared with those who don't have PTSD.

Women, refugees, public safety officers, health care professionals, military and veterans, as well as indigenous groups, are at higher risk for PTSD. This knowledge comes from some Canadian studies, but mostly from U.S. and other populations.

Most people who have a traumatic injury at work who develop PTSD have difficulty and have complex return-to-work issues.

We also know that co-occurence of physical health problems, such as chronic pain as well as addictions, are common and are associated with morbidity and mortality.

We also know that people with PTSD can have a significant impact on their family, intimate partner, as well as their children, and we also know that relationship conflict, divorce, and separation can trigger suicidal behaviour among people with PTSD and depression.

We know most people with PTSD in the public sector have long delays in receiving evidence-based treatments.

Canadians have limited access to psychiatric and psychological treatment, as well as rehabilitation, in the public system. Many people with PTSD receive medications and treatments that are not recommended by expert consensus guidelines, such as benzodiazepines like Ativan, or medical marijuana.

Marital and family therapy can improve outcomes but is often not available. People in remote communities have limited access to psychological and psychiatric treatment.

We know that early recognition and treatment of traumatic stress symptoms in PTSD can reduce suffering and improve functioning. We also know that a combination of psychological treatments and medication treatment can help in reducing suffering for most people with PTSD.

There is more and more interest in using novel approaches to deliver psychological treatments, such as Internet-based cognitive behaviour therapy as well as large classroom-delivered cognitive behaviour therapy.

There has been a rapid expansion of mental health services in the Canadian Armed Forces and Veterans Affairs' clinics in the last 15 years. This rapid expansion has reduced waiting times and improved outcomes among Canadian military and veterans with operational stress injuries. In Manitoba, we're highlighting the need for similar interdisciplinary models for providing timely access for civilians suffering with PTSD.

Telehealth and telephone-based care have also shown efficacy in reaching those in rural populations who suffer from PTSD in the United States. These models of care have also been shown to be cost-effective.

Finally, any investment in improving recognition and treatment of PTSD requires strong evaluation.

Thank you so much. I look forward to your questions.

[Anne-Marie Ugnat, Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Mr. Chair and honourable members, thank you for the invitation to address this committee regarding its study of Bill C-211, an act respecting a federal framework on post-traumatic stress disorder.

Let me begin by reiterating a statement by the World Health Organization in 2004: that there is no health without mental health.

Mental illnesses, including post-traumatic stress disorder or PTSD, are recognized, medically diagnosable illnesses that result in the significant impairment of an individual's cognitive, affective, or relational abilities. Mental illnesses are the result of a complex interaction of biological, developmental, and psychosocial factors. Environmental factors, such as exposure to trauma, can precipitate the onset or recurrence of a mental illness.

Mental health in Canada is a complicated issue that has both direct and indirect impacts on a significant number of Canadians every year.

The federal government has a role to play in the coordination and collaboration of mental health activities. It also has a role in understanding scientific evidence related to the scope of the challenges and what works best to address them. This evidence informs the development of resources for information on best practices and innovation.

While the federal government also has responsibility for mental health services for specific federal populations, such as serving members of the Canadian Armed Forces, veterans, serving and former members of the Royal Canadian Mounted Police and the Correctional Service of Canada, indigenous populations, newcomers—including refugees—and federally incarcerated individuals, the Public Health Agency of Canada, where I work, is mandated to serve the broader Canadian population. As such, we work with other government departments, stakeholders, and partners in the promotion and monitoring of mental health for all Canadians.

Several federal and national partners play a role in mental health promotion.

Statistics Canada has a federal responsibility to collect data on the Canadian population, including through the census and population surveys. The Canadian Institute for Health Information, CIHI, holds and manages national-level health administrative data, such as hospital billing data. Health Canada manages the Canadian drug strategy, which includes the monitoring of the use of illicit substances. The Mental Health Commission of Canada coordinates a network of partners through the Mental Health and Addiction Information Collaborative, of which, we, Statistics Canada, CIHI, Health Canada, and other partners are members.

The Public Health Agency of Canada contributes an important piece to the understanding of mental health in Canada by conducting national monitoring of mental health, mental illness, self-harm and suicide, and family violence, and related risk and protective factors. These areas often have strong associations with PTSD, either as potentially precipitating factors in the case of the trauma experienced with family violence, or as outcomes with mental illness and even suicide.

Mental illness monitoring is a core public health activity relying on population surveys, such as those conducted by Statistics Canada, and on administrative data collected by the provinces and territories, which includes physician billing claims and hospital discharge records linked to health insurance registries.

Bill C-211 proposes improving the tracking of the incidence rates and the associated economic and social costs of PTSD. Currently, monitoring of PTSD in the general Canadian population relies on data from national population surveys conducted by Statistics Canada, such as the Canadian community health survey of 2012 on mental health.

In 2012, 1.7% of the population aged 15 and over reported that they had PTSD. This is an increase from 2002 when 1% reported that they had PTSD. This increase is primarily due to an increase in prevalence among women. It went from 1.2% in 2002 to 2.4% in 2012. It is important to note that estimates of self-reported diagnosed PTSD from survey data are thought to underestimate the true prevalence of the disorder.

Another consideration for the monitoring of PTSD is the use of provincial and territorial health administrative data, which has been successful for other chronic conditions, through the Canadian chronic disease surveillance system. The CCDSS is a collaborative network of provincial and territorial chronic disease monitoring systems led by the Public Health Agency of Canada and relying on linked physician billings and hospitalization data.

For PTSD specifically, physician billings are not available in all provinces and territories as not all provinces or territories go to the same level of specificity. Coding standards are jurisdictional issues in which CIHI plays a role. However, it could be possible to conduct monitoring for a few provinces and territories that can currently identify PTSD. At the national level it may be possible to establish monitoring using administrative data for broader categories, for example, adjustment disorders that include other conditions related to adjustment reactions to stress, such as but not limited to PTSD.

PTSD is often treated through therapy methods that are outside the publicly funded health care system, such as occupational therapy, psychologists' services, and social work. Therefore health care administrative data would underestimate the disease prevalence and be an indicator of health service utilization rather than disease prevalence. Currently no monitoring system captures data from community-based services outside the health care system.

It is important to note that while national population surveys have previously asked respondents to indicate whether they have PTSD, estimates based on self-reported diagnosis are thought to underestimate the true prevalence of the disorder as people may not have been diagnosed or may be unwilling to divulge their diagnosis.

Surveys that rely on the reporting of individual symptoms consistent with PTSD rather than self-reported, physician-diagnosed PTSD however, may be able to provide accurate information on the prevalence and the impacts of living with the condition for the purpose of monitoring. For example, in 2001 McMaster researchers conducted a study using symptom-based survey tools and reported a lifetime prevalence of PTSD of 9.2%, which is higher than the prevalence reported from the Canadian community health survey of 2012 on mental health. Due to the large sample of respondents that would be required as well as survey content and length, this would be costly to conduct.

Moving forward, as I've outlined, there may be opportunities to enhance the monitoring of PTSD using surveys and/or administrative data.

The Public Health Agency of Canada is committed to working with partners and stakeholders to develop ways of measuring and reporting on the burden of PTSD in Canada.

Thank you for your attention. I would be pleased to answer any questions you have.