Health Committee on March 6th, 2012

[Marla Israel]

I'll start. On stigma, I think the efforts of the Mental Health Commission in their anti-stigma campaign, have gone quite a ways to highlight the issue and to not be afraid to talk about it openly. I think you can't find a better way to orchestrate those terms than the Senate report on mental health, “Out of the Shadows at Last”.

Have we come a long way in terms of recognizing, or at least being able to talk openly about challenges? I would say, yes, but I think there's still a ways to go.

[The Chair, Conservative, Joy Smith]

I'm sorry. I have to go to Dr. Fry now. We've gone over time. I know you had another comment.

Dr. Fry, with your time, do you mind if...?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Ms. Israel.

Sorry, did you want me to allow...?

[The Chair, Conservative, Joy Smith]

Colonel Jetly had another comment.

[Hedy Fry, Liberal, Vancouver Centre, BC]

All right. Please be quick.

[LCol Suzanne Bailey, National Practice Leader, Social Work and Mental Health Training, Department of National Defence]

I was just going to comment that in the Canadian Forces, we've struggled with stigma. I mean, you can imagine that in a population that's largely male and out there doing things that most of us in our society wouldn't volunteer to do, stigma has been a big issue.

We're at the point now where there's probably not an organization in Canada where it's as comfortable and routine to talk about mental health and stigma, as it is in the Canadian Forces.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

Ms. Israel asked us to comment on the issue of seniors and suicide, and I don't think we can really blame this on primary care providers. Let me finish, Ms. Israel. I think the issue of isolation among seniors is not a simple one. We need to deal with the issue of seniors without sweeping it under the carpet. You can't just wait until somebody is depressed, isolated, and despairing before you intervene. You have to look at the root causes. Why are seniors isolated and despairing? Why are seniors living in poverty? What are we doing about that?

The concept of isolated seniors.... I have so many seniors in my riding whose families don't even visit them. They live so far away. There doesn't seem to be time in our busy lives to take care of our parents and our grandparents. I think that's something we need to talk about, a societal change and how government can help to make sure seniors are not left in isolation. I think there's no one answer to this problem. There are many answers. How we pull those together is going to be an interesting issue as we talk about a strategy. A strategy is not just for Health Canada to do. It's going to have to broaden itself to all kinds of other areas—social, etc.

I wanted to go to the armed forces, because post-traumatic stress disorder is a big issue for me. I live in Vancouver, and I have so many veterans whom I meet with regularly who suffer from post-traumatic stress disorder and who have absolutely no resources. So the concept we have of a very low percentage of veterans dealing with post-traumatic stress disorder for me is not a reality. There are many of them, especially young men and women coming in from the Afghan war and from a lot of the recent wars. I think there isn't any assistance.

For instance, there is a remarkable program going on at UBC right now, which I would like to see replicated because its outcomes are excellent. It's being paid for—not by the federal government or by any government at all—by the Poppy Fund, which is the money we raise from buying poppies. We cannot afford, when we send our men and women out there to fight for us.... We cannot just allow the Poppy Fund to look after them.

When you have something that works and when it is saving lives—and this is. I have seen the work done. I have seen the videos. I have seen young men break down in tears, because they come home and they're violent and they attack their families and their family system is breaking down and they don't know what's happened, because of the trauma they experienced watching their buddy being blown up right next to them. There is nothing for them when they come back.

I really would like to know what it is that the armed forces proposes to do for what I consider to be a really urgent issue. This is not only about suicide. This is about family violence. This is about an inability to fit into your society when you come back. This is about all the things we know of current post-traumatic stress disorder. We can't let our young men and women down. What is it you propose to do?

[Col Rakesh Jetly]

Respectfully, we aren't letting our young people down. We have the highest ratio of mental health professionals to soldiers in all of NATO. We have evidence-based programs. We have education programs, transition programs, and third location decompression. We are preparing people for the transition back home, as well as preparing the families back home. We provide evidence-based treatments. Most people are responding to the treatment that we provide. It's going to detract a little bit from the purpose of this panel, but we can certainly discuss it at a future time.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Well, it's not. I know many veterans who have attempted suicide. They're not getting the help they need. This is not about trying to be in your face. This is about suggesting that there isn't enough out there, if we're talking about suicide prevention. Let's honestly look at this issue. This is not about blaming. This is about looking at the fact that there are so many people who are not getting help. If we do this, how are we going to coordinate the fact that we need to be dealing with post-traumatic stress disorder before they go out to the theatre of war, not after?

We need to talk openly and with a view to getting this thing changed for all of us. That's all I'm suggesting. It's not about bashing anybody here.

[LCol Suzanne Bailey]

Absolutely, we recognize that need to provide the education before they go. I think most of you will have seen the little booklets we've handed around as part of a six-phase pre- and post-deployment education program, where we actually spend a full day with all troops before they go overseas and we talk about mental health. We talk about what will be the behaviours that they'll see in themselves and their buddies—not the diagnostic symptoms but the actual behaviour they'll see in somebody they work with every day—and then we talk about what they can do either as a buddy or as a leader to support that person who may be struggling. Very simple early non-medical interventions can be very effective when they're out there and away from immediate medical resources.

What we're finding is that with the pre-deployment training, as well as the transition and reintegration training we provide in Cypress, soldiers are now coming into mental health services much earlier than they used to. In the early 2000s, they were waiting about five to seven years after they noticed they were struggling with an issue. Now at about the three- to six-month mark, about 50% of those who could benefit from treatment during their screening have already sought care on their own. So we're seeing a big shift towards earlier recognition and earlier acceptance that, okay, they do need to get some help and they'll go and get that. It tends to be more effective when they come and get that treatment earlier.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Do I have a minute?

[The Chair, Conservative, Joy Smith]

No, you don't. You're just about out. You have 30 seconds.

Are you finished, Dr. Fry?

[Hedy Fry, Liberal, Vancouver Centre, BC]

No, I'm not. I have one more question.

We see stigma as one of the biggest problems. People are afraid to say that they have reached the end of their tether, that they need help. There is no place that builds that culture more than the military. As I have heard from many soldiers, there is, in the military, the idea that you're macho and you're soldiering on, and you must not fall and you cannot fail. No one is blaming that culture, because everyone is supposed to be tough, strong, and face all the odds.

Are you doing anything to deal with the culture, to try to soften it just a little?

[LCol Suzanne Bailey]

Absolutely. That was the intent behind the Chief of the Defence Staff's “Be the Difference” campaign in June 2009, where he got up and did a presentation and press conferences with the theme that it was okay to suffer from a mental illness and to ask for help, and that we in the military need to get better at asking for help when we need it.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Mr. Gill. Mr. Gill, you only have time for one question. We have to suspend to pass our budget.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Madam Chair, and my thanks to the witnesses for being here with us today.

I want to acknowledge the work by our colleague, Mr. Harold Albrecht, in addressing this very troubling issue.

My question is for the Public Health Agency of Canada and the Department of Health. Many people who suffer from depression or are at the risk of suicide don't seek help for a variety of reasons. Some aren't even aware that they're depressed. What are some of the challenges and solutions for treating people in these situations?

[Marla Israel]

I think some of the answer has come out already in discussions with the Mental Health Commission of Canada. I think being able to recognize the early warning signs is important. Mental illness can sometimes be the result of a person's social situation, his family life, or his having suffered some form of abuse.

What leads individuals to commit suicide is one of the most complex problems posed—not only for researchers but also for public health practitioners. We talked about some of these things today. We need to address stigma head-on so that people who are depressed can feel comfortable enough to approach a gatekeeper or a physician. I do think physicians are part of the solution. I think that teachers are part of the solution too. Individuals who feel comfortable talking about their problems and seeking either medical treatment or other forms of treatment are important as well. As a society, creating the conditions in which people can feel comfortable talking about these issues will go a long way towards ensuring that we can move forward.

[Kathy Langlois, Director General, Community Programs Directorate, First Nations and Inuit Health Branch, Department of Health]

With regard to first nations and Inuit, the evidence has clearly shown—and this is supported in our national aboriginal youth suicide prevention strategy—that the solution lies in providing some hope for the youth in our communities. Some of this has to do with recognizing identity and having a sense of control of oneself, one's future, and one's community. Our colleagues from the Mental Health Commission of Canada referenced the notion of governance.

[The Chair, Conservative, Joy Smith]

Thank you so much. I know we could talk about this for another four hours, and I wish we had the time to do that. Unfortunately, we have to do what we need to do. I want to thank all the witnesses very much.

I'm going to suspend for one minute. We need to go into a brief budget discussion on our witnesses. I want to thank you again. You have made insightful comments on this important bill. If there are any conversations, I'd like to ask that they be done outside. We'd really appreciate that.

All of us appreciate your work so very much.

I'll suspend right now for one minute.