Health Committee on May 14th, 2015

[The Chair, Conservative, Ben Lobb]

Yes, sir.

Mr. Vaughan, go ahead.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

Thank you.

You talked about the fact that anybody is susceptible to post traumatic stress disorder. I'm wondering if there are existing preconditions that make someone more susceptible. For example, I know from my time on a police service board dealing with disciplinary action that quite often the event that puts officers in a disciplinary hearing was an extreme response to a very normal situation on the job, but it was the previous stress that they had encountered away from the police force, such as a divorce or a death in the family, that made them susceptible or set a pattern that seemed to be occurring.

Has work been done to take a look at people in the first responder community who may be in a position where they would become more susceptible more quickly to post-traumatic stress disorder?

[Vince Savoia]

That is a really difficult question because I know individuals, for example, who were physically or sexually abused as children. They're working as first responders and they're coping with attending to these types of calls very, very well because they have been able to deal with those issues themselves.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

So they actually may be inoculated against it because of trauma they received in early life.

[Vince Savoia]

Exactly, they've experienced it.

Again, when it comes to trauma, in my opinion the reason that it's so difficult to understand is that one's response to trauma is a result of previous life experiences, morals, values, and the perception of the event. It's a combination of things and it's very complex. I wish there were a tool that would allow us to identify those individuals, but....

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

There are many pathways.

[Vince Savoia]

Too many.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

And similar pathways may have a completely different response to exactly the same set of experiences.

[Vince Savoia]

I look at my own Tema Conter call. I reacted one way. My partner was totally fine with the incident. We attended to the same call, but for some reason, I perceived that call completely differently.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

Looking at the issue that's starting to emerge in high-risk neighbourhoods, in areas that have experienced persistent and very violent street crime, we're now seeing young children expressing exactly the same conditions that first responders are, and it's actually amplifying some of the violence. Has there been any look at that impact, the impact of persistent or consistent exposure to high levels of violence with young people and whether that may be impeding their ability to respond in society in a way that is more positive than troublesome?

[Dr. Zul Merali]

Yes. I think that is exactly the case in the sense that early or repeated exposure to stressors predisposes you to PTSD, for sure. Then who develops PTSD and who doesn't? We still don't understand that really well, but we know some of the issues and incidents that trigger the response.

When you talk about kids being exposed to traumatic events, it is really the same across the world, whether they come from a war zone or.... There was an earlier discussion about the immigrant populations versus refugees being vulnerable to mental heath conditions, which has to do with the level of stress exposure they've had, especially in the early years of life, because it seems to be an accumulative toll at times, such that eventually a straw will break a camel's back. That's the result of an accumulation of stressful experiences.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

In acting out, it often puts them in contact with the law, which puts them in institutional care, which has its own series of stresses.

[Dr. Zul Merali]

Precisely.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

In terms of the research that has been done, peer-to-peer therapy appears to be one of the most positive forms of therapy. You need to know what it is to be able to treat it, and you will be able to talk to someone who understands what you've been through. But it's also because of the social context in which a lot of first responders work. They work in very tight groups where peer-on-peer dependency is almost trained into them. If that's the case, is there not a role, then, for first responders and youth in troubled neighbourhoods to perhaps help each other, as opposed to sometimes being seen on the opposite side of this conversation? Is there a possibility here that you could actually redeploy first responders into a social setting, both as therapy, but also as social programming?

[Vince Savoia]

I think that's an excellent idea. I'd be cautious, though, about peer supports. Historically in Canada, most peer support organizations within the first responder community have used a model called critical incident stress management, or CISM. The model works if it's utilized appropriately, but what we're finding most often is that a first responder will take three or four days of training and all of a sudden feel empowered to conduct a psychological debrief. The analogy I have for that is that if you're having a heart attack, do you want to be treated by someone with a two-day first aid certificate or a cardiologist? There is a role for peer support, but in my opinion it's more a role of a referral agent, and making sure that our peers get the appropriate care that they require.

[Adam Vaughan, Liberal, Trinity—Spadina, ON]

Finally, to Scott Marks, as we look at public service contracts, one of the areas that governments are targeting is long-term and short-term disability. It's also trying to push productivity by ramping up the penalties for taking sick days. In this context, if first responders are going to get the treatment they need, do the labour contracts have to reflect the fact that time off may be one of the ways that which you mitigate the long-term impacts of post-traumatic stress disorder?

[Scott Marks]

I think that with post-traumatic stress disorder and the increased sense of awareness of it, we've overcome some of the basic hurdles in getting it recognized through workers' compensation. In that sense, the more knowledge there is and the more it's accepted as a workplace illness, then some of the issues around contractual agreements go away.

I think the bigger issue with it, and what we've experienced in some of the provinces that have recognized it, is recurrence. It's a disease that just simply doesn't disappear. If a person's being treated for cancer and they're five years in remission and they're symptom-free, you can declare that they've beaten that cancer. I don't think the same applies here, and this is where I know that in some of the provinces that have recognized PTSD, we're having a real problem. A person enters the program and is deemed to have post-traumatic stress disorder; it's covered off under workers' compensation; they get a series of treatments; they're given a clean bill of health and they then sent back to work; but with any recurrence they have to start going through the same set of rules to determine again whether or not they have PTSD. So it just creates another stress around the person.

Contractually, I think it's like anything. As we get more knowledge of this, I think we do have to recognize it within the terms of the contract. One of the key issues, as Vince and everyone talked about is the awareness issue of it. If first responders can get some early psychological treatment covered through some enhanced health benefits, even before it's diagnosed to be directly related to PTSD, they can get some help for mental health issues. The vast majority of first responder contracts, when it comes to psychological counselling, are extremely poor. You would eat up what's in your contract with about one or two visits.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Wilks, go ahead.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thanks, Mr. Chair.

If I have time left, I'll share it with the parliamentary secretary.

This is a very interesting conversation. I'm retired from the RCMP and have seen my share of crap over the years. We all deal with it differently.

But I was very intrigued, Mr. Savoia, with what you said. I've gone through a couple of critical incidents—stress times in my life—with regard to a team coming in. The jury's out on those. It may have worked for a couple of the people who were in them. I don't know if it worked for me or not. But c'est la vie.

I do agree with you, and you mentioned it quite clearly with regard to the incident that bothered you but didn't bother your partner. Why not? I don't know.

I counted them up once, and I think I've gone to about 112 fatals, sudden deaths, in my 20 years. Why not me? I don't know. Am I one of the lucky ones? I have no clue.

But I do know there are far-reaching other problems that come with that. One of those for me, as well as for a lot of my colleagues—and I can't speak for everyone—is that we end up imbibing a little more than we should, shall we say; and it becomes a bit of a habit. For me, I ended up going to treatment for it, and fortunately I'm here today. Again, I'm one of the lucky ones.

But this is where I'd like to hear from Mr. Marks and Mr. Savoia. When it comes to those who serve, whether it's firemen, policemen, or the military—and I heard you say it earlier, and we'll agree to disagree a little bit on this—I truly believe that where we missed the mark is in dealing peer to peer; because, as you said earlier, there's this John Wayne attitude. We're afraid to come forward, because we're afraid of what the public will think of us. But that's not necessarily the case when it's peer to peer, as long as it's kept that way.

So, I'd like both of you to talk a little bit with regard to how we can move forward as a nation dealing with peer to peer consultation—if you want to call it that—or talking this thing out. That's been the best for me during my career, to talk to someone who could relate to what I had gone through; because talking to someone who can't relate to me is like talking to that wall.

Go ahead, please.

[Scott Marks]

I'll start. I think there's a role for peer to peer support. I think that's what Vince said. I think is so important to be training first responders on crisis intervention and giving them that knowledge base, not only so they can apply it when they're out in public, but also so they can start to apply it amongst themselves. I think that's the important role. He may feel differently, but I think that's the important role for peer to peer support. When you work in a fire station or a police station, as Mr. Vaughan said, you have that sense of camaraderie, you have that culture, you're relying on each other, and you're in a position to pick up on things.

I think back now on my career and the relationship I had with some of the people I worked with. I realize now the things that I saw that were signals from people who needed help and were in crisis, but at the time you're not aware of them. You're absolutely right that you see the symptoms borne out as drug and alcohol-related dependencies. I look back at how this started. I remember back in 1993 a senior member of the fire department who was going to the chief at the time and who wanted to set up an EAP. He was a person who had suffered from alcoholism. In retrospect, I think it's clear that he suffered from post-traumatic stress disorder. He was ahead of his time. EAPs now are all over the place. We are at the point now where it needs to move to the next stage. I think there's a role for peer to peer support, and that role may be to assist in the recognition of the condition, to assist the person to get further help, or at least to get the wheels turning to get that person help. I agree with what Vince says, that there comes the point where you need that professional help, and you have to turn elsewhere.

Briefly, I think the other thing that comes out is getting a network of therapists who are out there. As you say, it's hard to connect with someone. You connect better with peer to peer support. What we found as well is that there are some therapists who connect really well with people. A lot of our PTSD people may go through two or three professional therapists before they find someone they connect with.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

It's interesting two months ago when I was with the Resident Doctors of Canada who had implemented resiliency training in their curriculum. They had developed the program in partnership not only with the Mental Health Commission of Canada, but also with our military.

I was quite intrigued, Mr. Marks, by your comments. As the Mental Health Commission of Canada moves forward with its mandate, I look at what they've done for psychological health and safety in the workplace, where they've created a standard, they've created tools, and they've been all-encompassing. To me, when you talk about having some structure, the Mental Health Commission of Canada might be a good place to create that framework. Have you given that any thought?

[Scott Marks]

Two or three years ago we were approached by the Canadian Association of Fire Chiefs. A program had been set up for mental health first aid. It was a train the trainer program. We were able to put some people through it on a trial basis. They were hoping to raise funding to wheel this out amongst the first responder community so that the fire chiefs could send people there to be trained in mental health first aid and then bring that back to their departments. We were very supportive of that, but unfortunately the commission couldn't find the necessary funding to get it up and running. The program exists.

[The Chair, Conservative, Ben Lobb]

Ms. Moore, a very quick question and a very quick response.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Maybe I will ask my question of Mr. Merali because he's a researcher. Do you think there's a higher risk for first responders working in rural areas? I ask because in those regions everyone knows each other and there's the risk of being confronted with someone you know or have a relationship with. I have witnessed many times in the hospital cases where first responders have to intervene on behalf of family or friends. Do you think the risk is higher for those first responders working in rural areas?

[Dr. Zul Merali]

It's a good question. It's hard to tell if that really puts you at greater risk. What you're describing is a situation where there is repeated exposure to high trauma. That in itself is a risk factor.

But I think at the end of the day it's an interaction between your personal biology and the environment you get exposed to. As for what it is inside of you that makes you resilient or vulnerable, we still don't understand. What we do know is that repeated trauma is a factor that results in PTSD, so that's the issue.

What you're describing is true in a way because in a smaller community you are more likely to be the first there and to be responding to many more traumatic events than you would if you were in a situation where the pool might be larger, where the population might be larger and you might not have as much exposure to trauma per person.