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.