Good afternoon, and thank you for inviting me to speak with you today. I am Dr. Nicholas Carleton, a registered doctoral clinical psychologist and associate professor at the University of Regina. I have expertise in anxiety, trauma, and pain, having worked with traumatic responses for the last 15 years.
My research is supported by CIHR, and I maintain a small private practice, primarily treating RCMP officers who have PTSD. In addition, for the past few years I've been presenting to and advocating for Canadian first responder mental health.
Since World War I there have been tremendous efforts to improve our understanding of mental health, treatments for mental health disorders, and access to those treatments. We now know that mental health disorders are not the result of deficiencies in biology or character; instead, mental health is the result of a complex interplay among biological, psychological, and social elements of our reality. Our mental health influences our experiences, expectations, and behaviours. As such, it is difficult to overstate the importance of individual mental health to physical health and the health of our communities.
Despite these advances, as you've heard already, mental health disorders are pervasive and extremely costly. Fortunately, I believe we're all working toward common goals for reducing those personal, social, and economic costs by destigmatizing mental health and improving access to appropriately delivered, empirically supported treatments. For example, the MHCC strategy, action plan, opening minds initiative, and national standard. National professional and community associations have also engaged campaigns, such as Mind Your Mental Health by the Canadian Psychological Association; the Road to Mental Readiness by some military and policing organizations; Defeat Depression by the MDSC; and the Ride Don’t Hide campaign by the Canadian Mental Health Association.
We have also seen increasing corporate commitments, notably Bell Canada with their Let’s Talk media campaign, and their Canada chair in mental health and anti-stigma research at Queen’s University. Canadians have also recognized the need for ongoing dedicated efforts to support our military, veterans, first responders, and their families.
We have come a particularly long way in supporting military mental health and will continue to do better. Recently, I have also seen first-hand the exceptional leadership of our first responder communities, such as the RCMP, the Canadian Association of Chiefs of Police, paramedic chiefs, and fire chiefs, as well as the International Association of Firefighters, to name a few. Indeed, we are seeing increasing demands from all first responders to provide ready access to evidence-based solutions, interventions, and preventive strategies for improving mental health.
The rationale should be quite clear: our first responder communities are reaching a tipping point. The dramatic increase in reported operational stress injuries is starting to overwhelm the stigma that has silenced so many of these citizens for so long.
Our first responders have unique workplace environments where trauma exposure is the rule, rather than the exception. The trauma exposure that first responders face is different than the military face—not better, not worse, just different. Our first responders are deployed at home in an environment of ongoing uncertainty, often for decades. They have a complex role providing both protection and law enforcement. We are also asking them to do more, such as community development, international policing, and first aid for mental health. Accordingly, first responders require dedicated and specialized resources for their own mental health.
Canadians already have an excellent and established mechanism for supporting and communicating research evidence to improve health: the Canadian Institute for Military and Veteran Health Research, often abbreviated as CIMVHR. It represents a network of 37 Canadian universities facilitating the development of new research, research capacity, and effective knowledge translation.
I'm pleased to say that the University of Regina, a founding member of CIMVHR, is working closely with CIMVHR, and researchers from other member universities, and international leaders to develop a dedicated Canadian first responder hub to support evidence-based policies, practices, and programming for mental health.
Research evidence supporting first responder mental health can also uniquely support mental health for all Canadians. The evidence to date suggests that given the right circumstances, anyone can develop an anxiety or mood disorder. The nature of first responder careers places them at higher risk; however, the nature of their training practices and workplace processes also offers mechanisms for understanding and improving everyone’s mental health.
Solutions for first responders inform solutions for all of us. Moreover, our first responders are community leaders and role models who can facilitate transformations in attitudes and actions toward mental health at a grassroots level in every community across Canada.
Our RCMP and their Depot training facility offers an ideal opportunity for developing world-class, solution-focused, evidence-based strategies. A multi-university team of interdisciplinary researchers, supported by the new first responder hub, has conceptualized a prospective, longitudinal, comprehensive solution to do just that. The solution involves a transformative research project that builds on existing frameworks, like the Road to Mental Readiness and work by the MHCC.
The project has received ethical clearance, and the University of Regina-led team is working with the RCMP and our partner organizations to make it a reality. The highly visible project will produce research and results that can inform policies, practices, and programming, turning aspirational standards for mental health into actionable, measurable improvements for all Canadians.
The available research evidence already supports licensed and structured psychotherapy as critical for mental health care; however, we have insufficient professional capacity to offer appropriate services to all those in need. The solution requires that we do three things: first, ensure patients can and do access appropriate specialists who are correctly using evidence-based treatments; second, support the training of more specialists with appropriate credentials; and third, support research that improves evidence-based care and innovates models for care delivery.
Alternatives to these solutions risk diluting mental health care, creating false notions that all care is equal, and proliferating pseudo-scientific responses to mental health. Indeed, the ongoing proliferation of pseudo-science in mental health, as well as an overreliance on well-meaning persons with insufficient expertise, is already problematic. Many people are receiving care that is not empirically supported, and it is not good enough. Canadians deserve better, and we can do better. We have the mechanisms. We have the expertise.
Such efforts are under way. For example, the Canadian Association of Cognitive and Behavioural Therapies is working to certify practitioners and ensure access to evidence-based mental health care. Furthermore, our universities can and should be supported as foundations for collaborative research into even better evidence-based solutions to support our practitioners and therein our citizens.
That said, research should not be done to an organization or to a person. Research should be done with organizations and with people, not as an end point that produces a stand-alone report, but as an ongoing, prospective, collaborative, and, importantly, transformative solution to address a challenge.
The recent transformations to meet mental health challenges result from a convergence of factors. High-profile spokespersons, as well as leaders engaging in active organizational interventions, have helped to create a cultural shift. The research base has expanded since World War I, but we still have a long way to go to proceed as confidently as we must. There are new technologies that can improve communication, assessment, intervention, and even prevention.
We also have leaders, including all of you, who want to build on the initiatives I've highlighted today; however, a full and proper response to the calls for addressing modern mental health challenges will require increased and ongoing federal and provincial investment and involvement, as well as actions to ensure that evidence-based care is accessible.
This means investing in the new first responder hub and the research-based program for reducing PTSD and other operational stress injuries in our RCMP. This means investing in ongoing long-term research projects with interdisciplinary researchers so that we can speak with authority about variables associated with risk, resiliency, and recovery. This means investing in developing and credentialing experts to ensure the availability of evidence-based care, and also in the researchers and trainees who develop that evidence. This means investing in evidence-based prevention and early intervention.
Finally, this means investing in education to build increasingly stigma-free perceptions of mental health and knowledge about effective health care options into the mindsets of all Canadians, so that we truly change the conversation for future generations.
We can do better. We must do better. The solutions are no longer aspirational. They are achievable. Working with our first responders as role models in all of our communities, we can develop and proliferate better assessments and better interventions and engage in preventative strategies that reduce risk, increase resiliency, and improve mental health for all Canadians.
We are ready when you are.
Thank you.
