Health Committee on May 14th, 2015

[Scott Marks, Assistant to the General President, Canadian Operations, International Association of Fire Fighters]

On behalf of our 23,000 members across Canada, I'm honoured to share our views on this very important subject with the committee.

Canada's professional firefighters are on duty 24 hours a day, seven days a week in cities large and small across this great country. We're usually the first on the scene of any emergency. Whether it's a structural fire, a highway accident, a serious medical call, a hazardous materials incident, or any other emergency, we're Canada's first line of defence.

Everyone knows that firefighting is a dangerous and physically demanding occupation, and that firefighters suffer high rates of workplace injury and illness while protecting the lives and properties of the public. For this reason, eight provincial and two territorial governments have enacted legislation since 2002 that includes hard injury and a growing list of cancers to the occupational hazards of firefighters who have a certain number of years on the job. While we welcome these advances, less known are the mental demands of being a firefighter, including the effects of being exposed on a regular basis to graphic scenes and images that anyone would find disturbing and difficult to see.

Like other first responders, firefighters are required to attend the scenes of accidents, crimes, suicides, and other incidents where people, whether adults or children, have died or been seriously injured. Only those who work as first responders know what grim sights we see in the course of our duties. We see things the general public doesn't.

Do these things take a toll on a first responder's mental health? Even for a burley firefighter, a seasoned paramedic, or police officer, of course they do. We are human after all.

For too long, post-traumatic stress disorder has been a hidden secret among firefighters and other first responders. It has existed in the shadows of our profession. Haunted by the effects of our job but feeling the stigma of appearing weak and unwell in front of our shift mates and families, in the face of society's expectations too few firefighters struggling with the mental health implications of our profession have reached out for help. Too often, firefighters have turned to alcohol or other drugs to deal with their difficulties, with marriages and other relationships crumbling under the strain. In many cases, fear of the financial implication of stepping away from a career becomes another reason to stay silent.

Tragically, PTSD has claimed the lives of numerous firefighters across Canada who succumbed to dark thoughts they could not shake and committed suicide. Our friends at Tema Conter Memorial Trust tell us that 18 first responders have died by suicide in Canada so far, in 2015. It's a sad and shocking number. Earlier this year, our affiliate in Surrey, British Columbia, IAFF Local 1271 experienced the shock and pain of two members' suicides in a seven-week period. These are difficult numbers to report, but we agree that, finally, these numbers need to be put out in the open. If we're going to address mental health and PTSD in the first responder community, we had better know the exact scope of the problem and what we're up against.

Recently, there has been a growing awareness of PTSD in firefighting, and a growing willingness among firefighters to acknowledge that they're potentially affected by PTSD and need to ask for help. At the same time, there is growing acceptance that PTSD is a direct result of certain professions, including firefighting. In 2012, British Columbia and Alberta became the first Canadian provinces to formally recognize the mental health aspects of emergency services with legislation deeming PTSD to be presumed the result of a firefighter's occupation for the purpose of workers' compensation. In November 2014, Manitoba announced it would also be adding this important protection for its first responders.

These groundbreaking legislative advances were giant strides in helping to break down barriers that have existed for too long. They assist greatly with any financial concerns firefighters or their families might have about leaving the work place to seek help and treatment for PTSD, and they help bring the disease out of the shadows even more.

The IAFF commends British Columbia, Alberta and Manitoba for leading the way provincially on this issue. We hope to see this protection spread across Canada, the same way presumptive cancer legislation did. We thank everyone who has contributed to the growing awareness about PTSD and first responders in the past year. Slowly but surely the stigma is decreasing. Any initiative that makes it easier for fire fighters to seek assistance is an initiative that will save lives.

While the issue of work place compensation is important, we believe much more needs to be done. We also believe that information and resources should be available to all of Canada's first responders, regardless of which province or city they work in. That's why we're calling on the federal government to establish a national action plan for post-traumatic stress disorder. We believe there's a role for the federal government to play, and it's an important one.

We envision a national action plan that can apply to such first responders as firefighters, police officers, and paramedics, and also to military personnel and veterans. We envision a plan that considers five elements—best practices, research, education, awareness, and treatment—and that becomes a framework for an effective and all-encompassing PTSD tool kit that can be used as a resource by any first responder agency or individual who needs it.

We encourage the committee to recommend the development of a coordinated national strategy through multi-departmental collaboration as well as input from stakeholders, including the IAFF, to assist in identifying the nuances of first responder health and ensure that best practices for mental health care and suicide prevention can be effectively addressed.

We recently lobbied the federal government on the need for a national action plan for PTSD. We were encouraged by the interest expressed by numerous MPs and senators. I hope that members of this committee will share that interest and will agree that when it comes to our first responders and what they do for us on a daily basis, we owe it to them.

In closing, I would like to say to anyone listening that if you're a leader in the fire service, please make sure you foster a culture in your department or organization in which there can be an open conversation about this particular danger; in which those who may need help know what resources are available; and in which they can access those resources promptly and confidentially. If you're a first responder or anyone else struggling with PTSD, there's no shame in reaching out and getting the help you deserve.

Thank you. I'd very happy to answer any questions from the committee.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up is the Tema Conter Memorial Trust.

Mr. Savoia, go ahead, sir.

[Vince Savoia, Executive Director, Tema Conter Memorial Trust]

Thank you, Mr. Chair.

My name is Vince Savoia. I am the founder and executive director of the Tema Conter Memorial Trust.

January 27, 1988 was a day that changed my life forever. Working as a paramedic in Toronto, I attended to the homicide of Tema Conter. What made that call so unique for me was that, as I stood over the bed and I looked at Tema, I was sure it was my fiancée who had been raped and murdered. The physical resemblance was so uncanny that my colleague, my partner, vocally asked me if this was, in fact, my fiancée.

After a couple of terrifying seconds and coming to the realization that it wasn't my fiancée, we had to make a decision, and that decision was whether or not we were going to resuscitate her. The decision we made was that we would not. That one decision of not at least attempting to resuscitate Tema caused me to go down the road of PTSD, and it took about 12 years before I even had a proper diagnosis.

Back in the late eighties PTSD wasn't even on the radar. Everybody assumed that PTSD was strictly a by-product of going to war. I don't think anyone really realized how the work of a first responder can truly affect one's psyche.

In 2001, with the blessing of the Conter family, the Tema Conter Memorial Trust was registered as a charitable organization. We originally started off with the mandate of providing a scholarship program to paramedic students at Humber College. What started off as a $1,000 scholarship is today a $30,000 per year scholarship program in which we encourage students in any public safety program, be that EMS, fire, police, correctional services, 911 communications, or even the military, to research psychological stressors of acute stress, cumulative stress, vicarious trauma, compassion fatigue, and post-traumatic stress.

We offer $2,500 per province. We offer two scholarships in Ontario, and the best paper in the country receives an additional scholarship of $2,500.

Since then we have expanded our portfolio. We have partnered with numerous hospitals and universities in the Toronto area to conduct research. We recently partnered with the University of Ottawa and Nipissing University to conduct an OSI study involving police officers across the province. As a result of that research, we now offer peer support training, and what I'm truly proud of is that we host a peer and family support assistance line for any first responder or family member to call. It's a toll-free number, and the mandate of that particular phone line is to ensure that, when they do call us, they are safe and they are not suicidal. More importantly, we act as a referral agent. We really attempt to try to get them to see a mental health professional who can truly support them.

Although peer support is gaining prominence in this country as a methodology for us to assist our colleagues—and I truly do believe in peer support—what I must say is that it is very important that we truly get our first responders, or basically any Canadian suffering from any sort of mental illness or disorder, to seek proper mental health care.

My call to action that I'd like to table here today is the inclusion of psychological care within our provincial health care plans and even the federal health care plan. You've heard from our colleagues today that we need more funding, but where is that funding going to go? I think we've done enough research. I think what we really need to do is have better access to psychologists in this country.

In addition to that I'd like to partner with my colleague, Scott Marks, in calling for a national strategy for PTSD. We really need to look at our first responder community. Our first responder community today is in crisis. Since April 29, 2014, we have sustained 45 suicides, and my suspicion is that the number is higher and that the 45 is just the number of suicides that we have been able to confirm, but anecdotally I suggest that number is higher in Canada. My concern is that there is a lack of response by both our provincial and federal governments to this crisis.

There needs to be a program in place where we really look at raising the awareness of mental health in this country, and especially within the first responder community. There is a John Wayne-ish attitude within our first responder community. Our colleagues are afraid to come forward. They are truly afraid, and they're afraid because there are organizations in this country that ridicule, ostracize, and even terminate first responders who come forward and ask for help—and that has to stop.

As you can tell, I'm very passionate about this subject matter. I consider Tema to be the true leader in the first responder community. We do not receive any provincial or federal funding. We are run strictly by donations from the general population, and we run our organization usually on a budget of about $300,000 a year. If I could ask for anything, I would ask you to please consider funding our organization. We'd really like to expand our peer and family support line, and more importantly, we would really like to get our best practices model of peer support for emergency responders out across this country.

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up is Mr. Merali. Go ahead, sir.

[Dr. Zul Merali, President and Chief Executive Officer, Royal’s Institute of Mental Health Research and The Canadian Depression Research and Intervention Network , As an Individual]

Thank you very much. I would like to thank the committee for this invitation to speak to you about the government's investment in the Canadian Depression Research and Intervention Network and about my perspectives on mental health research in Canada.

The global cost of mental illness, according to the World Health Organization, is that it is a leading cause of disability in terms of adjusted life years lost worldwide. Within the mental illness category, depression is responsible for the largest burden of illness. Indeed, 500,000 Canadians did not go to work today because of depression, and the issue is increasing in magnitude. At the recent World Economic Forum held in Switzerland, mental health was a noted concern for the first time, and mental disorders emerged as the single largest cost, with global projections increasing to $6 trillion—an unimaginable amount—annually by 2030. This is more than diabetes, cancer, and pulmonary disease combined.

Why is mental illness such an issue? It is because it usually starts early in life, and it increases the risk of other concomitant disorders in terms of non-communicable diseases associated with depression.

CDRIN, which is the Canadian Depression Research and Intervention Network, is a pan-Canadian network that is focused on depression and related conditions, including post-traumatic stress disorder and suicide. We are very grateful to the Government of Canada for its $5.2-million contribution in its federal budget to support the establishment of this network.

Through the stewardship of three founding organizations, the Royal's Institute of Mental Health Research, which is affiliated with the University of Ottawa, the Mental Health Commission of Canada, and the Mood Disorders Society of Canada, I am proud to say that the network is up and running full steam ahead.

The strength and power of this network are to promote discovery and to translate results into practice through its nationally distributed research hubs. These hubs of discovery bring together the best researchers, clinicians, people with lived experience, and young trainees. CDRIN has seven hubs spanning across Canada right now, from British Columbia to the Maritimes, including an indigenous hub in Saskatchewan, which is the newest one.

We have hosted two very successful conferences for the purpose of knowledge exchange and knowledge translation opportunities. Through the network research hubs, the best minds in research are joining forces to understand the causes of depression and to discover more effective ways to diagnose and treat depression. Each hub is akin to a large tent that brings together academic organizations, clinicians, and people with lived experience, creating a true transdisciplinary experience. The discoveries will be shared across various hubs, and the promising practice-changing approaches will be applied locally and then nationally.

Crosscutting opportunities for young researchers will ensure sustainability and progression of this effort. International links have also been forged with like-minded organizations, in particular the NNDC, which is the National Network of Depression Centers in the United States, as well as the European Alliance Against Depression.

CDRIN is taking a leadership role in partnering with people with lived experience through every phase of the research process. We are training people with lived experience how to become active members around a research table, and training researchers to embrace and incorporate the issues and ideas that emanate from people with lived experience. This partnership will ensure that the research being conducted is relevant to those suffering from mental illness, and it will help transform the mental health landscape in Canada.

In terms of military health, at the Royal we are fortunate to house an operational stress injuries clinic, and the Royal is home to NATO's first research chair in military mental health. This chair is held by Colonel Rakesh Jetly, a senior psychiatrist with the Canadian Armed Forces and a mental health adviser to the Surgeon General. It will focus on care and treatment of those suffering from post-traumatic stress disorder and other combat-related injuries. It will also focus on depression, as this illness has a prevalence rate of 8% in the armed forces, higher than PTSD, which stands at about 5.5% in the uniformed services. The work to be done on research will translate into new treatments for those with PTSD. Canada will work with NATO partners and share research and collaborate.

As for suicide, it is, as you know, a major societal concern. Youths, adults in mid-life, and indigenous communities are at particular risk. Whereas mortality due to cancer and to heart disease has plummeted over the last 10 years, if you look at the graph for suicide, it has not budged. We have not moved the needle on that at all. Suicides are, in most instances, associated with mental illness, depression in particular. It is important to always link depression with suicides.

CDRIN has a formal memorandum of understanding with the European Alliance Against Depression. Dr. Ulrich Hegerl, the head of the European Alliance Against Depression, has been a speaker at our CDRIN conferences. As well, we've hosted workshops with parties for collaboration, including the Mental Health Commission of Canada, Health Canada, and PHAC. We have had two such meetings. The European Alliance Against Depression is willing and keen to be working with us here in Canada.

We are interested in testing the Nuremberg model here in Canada as a model that has been shown repeatedly to reduce suicide by up to 20% within a year or two of its implementation in many of the European communities. We need to test this model here in the Canadian context.

I'm happy to say that we have recently created a chair in suicide prevention in partnership with the Do It For Daron foundation and Mach-Gaensslen Foundation. This person is going to be coming on board any day now.

In Canada we spend less less than 5 per cent of our research dollars to support mental health research despite the fact that mental illness is the leading burden of illness nationwide. For every hundred dollars we spend in health care, Canada has invested less than four cents towards mental health research. We spend more than ten times that amount for cancer research. We have the capacity but we do not have adequate resources to fuel these activities that need to bring us to the next realm. We need to invest more in mental health research.

With that, I'd say thank you for your attention. I'll take any questions.

[The Chair, Conservative, Ben Lobb]

Very good.

That concludes our presentations for this panel. First up for seven minutes is Ms. Leslie.

Go ahead.

[Megan Leslie, NDP, Halifax, NS]

Thanks, Mr. Chair.

Thank you all for being here.

I really want to start by commending both of your organizations for taking on the issue of PTSD, especially when you noted that there is a lot of stigma and that people are afraid to talk about it and come forward. It's really wonderful to see both of your organizations really tackle this head on.

I want to ask a few questions about PTSD because I think it's really easy to say a lot this health stuff falls under provincial jurisdiction and that there's no real role for the federal government. I disagree with that for two reasons. The first is that if you look at who first responders are, many of them do fall under federal jurisdiction; veterans and RCMP officers are examples. Also, beyond that, I think that mental health is a public health issue. This is about public health. We have the Public Health Agency of Canada. There is a role here federally.

Looking at PTSD, if the federal government were to recognize the prevalence and seriousness of PTSD, I would imagine that we would need to allocate resources towards early detection, proper awareness, proper treatment, reducing stigma. Those are some areas I think we should tackle. I would see that in something like a coordinated task force that would definitely need to have first responders involved, veterans involved, medical personnel and other relevant groups really taking from the community.

That's part of a response that I could see from the federal government.

I wonder if you have any comments on that, if you'd like to add to it, if I'm off base, if there are things you think that we should be doing.

[Scott Marks]

No, I think that's exactly it from our perspective at the International Association of Fire Fighters. There are federal firefighters as well, so certainly there's an impact from a federal basis, but I agree with you entirely.

What we've got to do is to set up a structure here so that employers, and municipalities as well, particularly smaller municipalities, have a framework to work from. Vince can probably speak more to this, but there is so much unknown about it. You know, I joined the Toronto Fire Services in 1981. At that point in time, there was little done to train firefighters even on occupational illnesses that we now know. Now, through the Workplace Safety and Insurance Board in Ontario, there's a whole program recruited firefighters go through so that they can better address their own health and safety when fighting fires to make sure that all their gear's on properly and that they're taught a lot more about the long-term impact of what they are exposed to.

There's still virtually nothing in regard to what they face from a mental health point of view. We're just behind on it, because it is a relatively new disease as far as our understanding goes. That is a role I believe the federal government can facilitate to make sure that all of these communities of interest have some information on the types of programs they should be getting involved with and setting up.

Go ahead, Vince.

[Vince Savoia]

I would agree.

One of the factors that concerns me is that when I received my paramedic training back in 1981, at no time did I receive any sort of training in suicide or crisis intervention. That is still the same today. Our first responders, even though they attend to suicide calls, are not trained in suicide intervention nor trained in crisis intervention.

What I'd like to see is a program where we really review the curriculum of our first responders and introduce this training at the college and university level. In addition to that, we really need to focus on educating them about the psychological stressors they will face—not if, but when—both on and off the job, and how to deal with them appropriately.

[Megan Leslie, NDP, Halifax, NS]

I'm going to pick up on what you both just said here because my next question is about predicting and/or preventing PTSD. I don't know enough about post-traumatic stress disorder to know if there is a way to predict or prevent it. Is it what you're talking about: at least if you know the signs, then you know when to come forward?

[Vince Savoia]

My colleague Dr. Jeff Morley, who's a psychologist, says it best, that there is no test available to predict who will be susceptible to post-traumatic stress. Unless you want to hire somebody who will be a psychopath or a sociopath, no such test exists. When we look at the causation of PTSD, it's exposure to a traumatic event or a series of traumatic events, and we really can't identify which event might be that trigger.

[Megan Leslie, NDP, Halifax, NS]

I imagine that prevention's one thing, but another is knowing in advance what the symptoms are and when to get help. I think back to this fall, when we had a shooting incident here on the Hill. Just the fact that I knew that dry mouth is one of the symptoms meant that I knew that the adrenaline was still in my body and maybe I was going to have problems afterwards. So even just something like recognizing some of those symptoms to know to get help; it's not really prevention, but it can help shorten or support you in that treatment period.

[Vince Savoia]

The Mental Health Commission of Canada has introduced its new road to mental readiness program that speaks to that exactly. It has been adopted by various police organizations across the country, and that entire program is geared to recognizing those signs and symptoms early.

[Megan Leslie, NDP, Halifax, NS]

That fits in well with my next question, because I was wondering if feedback from your members who have had experience with different programs that are out there—

[The Chair, Conservative, Ben Lobb]

Ms. Leslie—

[Megan Leslie, NDP, Halifax, NS]

Oh, that's it?

[The Chair, Conservative, Ben Lobb]

We're up to seven minutes here. I'm sorry. Maybe next round....

Mr. Lizon, go ahead, sir.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

Thank you to all the witnesses for coming here this afternoon.

Dr. Merali, you spoke a lot about mental disease and mental health. What is going on in research on the prevention side? We do focus on treatment. There are still lots of unknowns. What's happening in prevention? For every illness, we look at ways to prevent it, because if we can prevent it, we don't have to treat it.

To give you an example, if a firefighter wakes up in the morning, his pulse is 170, and his blood pressure is high, what is he going to do? He's going to call a doctor or go to the doctor. He isn't going to go to work. But there's no way to establish his or her state of mind.

Can you maybe elaborate on this a little bit? You're doing research. Where are we on research?

[Dr. Zul Merali]

You are raising a very good and very important issue right now in terms of prevention. The issue with mental illness, as you know, is that all our diagnoses to date are symptom-based. How do you feel? You express your symptoms. You may or you may not express all your symptoms to the clinician, and/or the clinician may have subjective bias in terms of interpreting the symptoms you're describing.

What we need to do is just as you explained in the case of your blood pressure and your pulse being indicators. We need to have some biomarkers that are pulsing the status of your mental health. We do not have those as yet. The reason we have those for other illnesses is that we've spent a lot of time and effort focusing on those. Once you have those, once you can measure your cholesterol level, you know what to do about it. You go into a gym, or you might try statins or whatever to reduce your cholesterol level, to take care of your health.

In mental health we don't have that. We need tools, biological tools, to be able to measure your mental status and not rely strictly on the symptoms. For example, if you look at PTSD, right now there is a lot of evidence suggesting that if you use certain markers and do brain scans, the brain actually lights up very differently, almost like a Christmas tree, in terms of certain ligands.

So we have the beginnings of understanding. Can we develop those markers as full-fledged markers that will really predict what's going on? Once you know that, you can get going to the prevention strategies much better, because you will know what you want to prevent and how you want to mitigate that risk. This is something we need to spend much more time on than we are right now.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

On that point, Doctor, what direction do you think science will take for the future? Will these markers that you mentioned be based on brain imaging, on blood tests, or on other tests? What do you think?

[Dr. Zul Merali]

We're looking at all those fronts. We're looking at EEG, just as we look at the EKG for the heart. We're looking at the electrical brain activity using relatively cheap devices to measure the electrical activity and getting signature patterns. We're looking at brain imaging. We're looking at genetics. We're looking at other biochemical changes and markers in addition to the clinical symptoms that are also being taken into account.

Where will we find the solutions? We don't know, as yet. I think we need to do it. We need to find it. It's very important that we do.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

With PTSD or any other mental condition, there is the time from when a person gets that mental condition to the time when it's diagnosed. In that time period, in most cases the person has no idea what's wrong with him or her.

How can we, or how can the medical world, help those people and identify the signs, whether they have PTSD or some other medical condition? There is a time during which people have no idea what's wrong with them. Last week we were at a breakfast with veterans. Two of them who had PTSD gave testimonies. One said very clearly that for a while he had no idea what was wrong with him. He tried to commit suicide. On the second attempt he stopped, and realized there was something wrong with him. That was when he started looking for help.

[Dr. Zul Merali]

I think that's a very good point that you raised.

One of the things that we have done in partnership with the Mood Disorder Society of Canada and CDRIN is to develop curriculum—maybe I'll have Dave talk about the specifics—that actually helps clinicians identify PTSD much more rapidly in the primary care setting. That's one way. The other way is, you're absolutely right in the sense that people need to know what those early signs and symptoms are so that they or their families can begin to identify an issue before it reaches a critical stage.

There are devices being developed right now, for example, mobile cell technology. On your cell phone you can access programs that can help you answer a few easy questions, and they will indicate to you whether you might be at risk for PTSD or not, whether you might be suffering from it or not. Then you need to go to your physician or clinician for the next steps.

But the lack of awareness and the lack of knowledge about the signs and symptoms is a critical issue for PTSD and for depression as well.

We had a recent symposium where we had brought in managers from the workplace. We asked how many of them would recognize depression if it walked into the room. Three hands went up out of a hundred. People just don't know how to recognize these things. I think that the work that's being done by the Mental Health Commission of Canada in developing some of the working tools and early intervention strategies are very important.

[The Chair, Conservative, Ben Lobb]

Okay. Perfect timing.

[Dr. Zul Merali]

Really?