Evidence of meeting #55 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was trauma.
A recording is available from Parliament.
Liberal
Sonia Sidhu Liberal Brampton South, ON
I know there is a stigma out there and there are also barriers. Can you tell us about some of the main barriers to a diagnosis of PTSD?
Professor of Psychiatry, University of Manitoba, As an Individual
One of the first and most common barriers is not understanding that the symptoms the person is dealing with are related to a mental health problem. Often the symptoms start to come up as sleep difficulties or difficulties with irritability or concentration, so the person doesn't understand what they're dealing with and often blames themself. I think it goes back to what other witnesses are saying, that helping the public understand and recognize appropriately what is or is not PTSD is very important.
The second issue is around the impact on work. If the person is diagnosed with PTSD, what happens to their career advancement at work? Are they judged by other people at work? That's a major barrier that's been shown in military personnel.
The third barrier is not necessarily a barrier; it's the attitude that they want to handle the problem on their own. That is something we're supporting by creating self-help cognitive behaviour therapy so people can access help more readily.
There are three main barriers. One is not understanding that they might be dealing with a mental health issue; the second is the impact and stigma around work; and the third is not necessarily a barrier, but a wish to try to handle the problem on their own.
Liberal
Sonia Sidhu Liberal Brampton South, ON
What is your recommendation to the committee regarding how to deal with that? I need a clear recommendation.
Professor of Psychiatry, University of Manitoba, As an Individual
I think the aim of the bill is really to increase the conversation about and awareness of PTSD in Canada. I really strongly support the bill.
I think education is really important in differentiating between what is normal and what is abnormal. One of the things I've learned is that if someone is exposed to a serious, traumatic event, such as seeing a suicide or the sudden death of a close loved one, and they're still suffering and not back to their normal self about one month after the traumatic event, that one month is an important time point. If they're still suffering, they probably need to look at getting treatment. We think it is important to really make treatment more available and user-friendly and that the treatment should come to the person rather than the person necessarily having to go to individual or group therapy.
We have developed what are called cognitive behaviour therapy classes with the idea of reducing waiting times for people waiting for CBT, because everybody has been in a class since they were four years old and people understand classes but they don't necessarily want to go into psychological treatment. That's one of the novel ways we have tried to reduce stigma and improve access.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you all, and especially you, Ms. Harris, for sharing your story and for the work you're doing now as well. You're out in the community with colleges, I understand, and you're enlightening them on what they could encounter.
I just want to ask a little bit about your training. When you were training as a paramedic, were you instructed on and prepared with respect to what you would see out there? Was there any indication that you were going to see such horrible circumstances to prepare you for the traumatic events you would see, anything at all?
Advanced Care Paramedic, County of Simcoe, As an Individual
In school we had extensive training in a scenario format. We used moulage and actors to bring, as close as possible.... We had a 400-hour mandatory ride-out program that is linked to most paramedic programs, so we would ride with an actual paramedic out on the road. But how much we would see would really depend on the call volume of that station. I know, for example, that one of my friends, as a precepting student, had a VSA—vital signs absent—the first day on the road, and also delivered a baby. Those were two pretty impactful calls that some paramedics may not have for most of their career.
We learned psychology, but anything that was addressed on post-traumatic stress was very brief and was linked to the idea that we might be treating a veteran with that, so we never discussed that it was really something we should be looking at as part of our career.
Conservative
Len Webber Conservative Calgary Confederation, AB
Absolutely, no question, it should be brought up in the training of paramedics, and our military as well. I have a son-in-law in Mosul right now, in Iraq, and I'm concerned about not only him but everyone there. They should be made aware of PTSD. It could occur with them all. I think we should be proactive rather than reactive when it comes to PTSD.
Advanced Care Paramedic, County of Simcoe, As an Individual
We've come a long way. I definitely know, especially over the last couple of years, organizations such as the Tema Conter Memorial Trust bring scholarships into the college program, which asks them to do research, and again, will raise awareness and decrease stigma. The colleges are also focusing on peer support and acknowledging that it's part of our careers. We're getting there, but we still have a long way to go.
Conservative
Len Webber Conservative Calgary Confederation, AB
Good. Thank you for pushing that, for sure.
I'm going to pass it off to Mr. Doherty now. He has some questions.
Professor of Psychiatry, University of Manitoba, As an Individual
I just want to add one comment, that it is really important to evaluate any interventions around trauma. We do know that, for example, critical incident stress debriefing, which is a group-based intervention after someone is exposed to trauma, was created to prevent PTSD, but it turned out to actually not be helpful and potentially cause harm. The key thing we've learned in the trauma and PTSD literature is that everyone recovers from trauma differently, and that if someone doesn't want to go in a group and talk about the trauma, we don't force people to do that.
Professor of Psychiatry, University of Manitoba, As an Individual
It's really important that this federal framework encourages evidence-based policy in interventions, because the challenge in trauma and PTSD is to remember that trauma is 80% of the population. So we really need to think carefully about the interventions.
However, I completely agree that training people when they're going in to work, to have skills to manage what they're going to be exposed to, is really important. I would just add the evaluation.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Dr. Sareen; thank you to our guests.
Natalie, that was incredible testimony, as always. We know that.
I want to mention two points. We talk a lot about our first responders regarding the bill. In the bill, it's not just our first responders, but it is our veterans and our military, those who put their uniforms on every day to serve our communities and our country. I just want that mentioned.
Also, Dr. Sareen, you mentioned what the military, our Canadian Forces, have been doing very well in the last six or seven years. The R2MR program, the road to mental readiness, is exactly what our colleague Mr. Webber was talking about, and the framework of the bill or the gist of the bill is to get those best practices applied right across our country.
For the information of my colleagues who are here, an RCMP who is serving in Nova Scotia and is dealing with PTSD may not be eligible for services in British Columbia. So it's to make sure that there's consistent care and diagnosis right across the country. I'm just using that as one example.
I want to direct my comments to Natalie.
Natalie, you are an accomplished author and you have shared your experience, which is really changing the views of PTSD and giving people a look inside your head, if I can put it that way, during your darkest times. You have a blog that you started writing as you were hospitalized, and out of that you wrote a book called Save-My-Life School: A first responder's mental health journey. I would like you to talk a bit about both the blog and Save-My-Life School , if that's possible.
Advanced Care Paramedic, County of Simcoe, As an Individual
Of course. Thank you.
In 2014, I started my blog when I saw Clara Hughes, one of our amazing Olympians—a six-time Olympian—on TV. She was talking on the news about Bell Let's Talk. I can tell you that I felt stigmatized to the fullest extent. I was very proud of my career. I was a teacher for Sunnybrook Base Hospital for Georgian College. I was in the first advanced-care paramedic class in the County of Simcoe.
I really didn't want anyone ever to think that there was something I was battling with that would jeopardize my career. I saw Clara Hughes talking about how she battled with this, and it gave me the strength to start a blog. That blog started, I think, on my very first day of an out-patient course, which was through the Royal Victoria Hospital in Barrie. I documented every honest day and every up and down. I carried it on when I went to Homewood in Guelph, which is a rehabilitation hospital, for my PTSD and addiction.
Afterwards, I shared about my life now and how I manage symptoms that I still experience, and how my family and kids have contributed a little bit to the book as well. I have broken down the stigma for kids their age.
The foreword was written by our Olympian Clara Hughes. Also, an acknowledgement was made by our Ottawa councillor Jody Mitic. I was very fortunate to have a lot of amazing support, including that of Todd Doherty and John Brassard, for the book. It is opening a lot of eyes for people. As Mr. Doherty said, you don't need to have a mental illness, if you read my book. What people are enjoying is that it brings you into the mind of someone who has mental illness. It's very raw; it can be very dark. It's actually quite difficult for some people to read, because it's very truthful and honest.
Thank you for letting me share that part. I appreciate it.
Advanced Care Paramedic, County of Simcoe, As an Individual
It's Save-My-Life School: A First Responder's Mental Health Journey.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
The blog is Paramedic Nat. I really urge the committee to have a look at it. It should be part of your study.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
Thank you, Mr. Chair.
I'll address this question to Dr. Sareen and Anne-Marie, or you can all answer this, please.
With Bill C-211 we are trying to address PTSD. We are a diverse country, and different communities have different approaches to address PTSD and mental health. Do you think this bill should be broadened to include different cultures and different communities? What steps can we take to ensure that the framework on PTSD respects these different cultures and communities?
Perhaps Dr. Sareen can go first.
Professor of Psychiatry, University of Manitoba, As an Individual
As Ms. Harris has pointed out, it's really important to move the conversation forward. The other issue is that it engages work-related injuries. That is a very important issue.
We know that post-traumatic stress is very important. Children, women, first nations communities, and refugees all suffer from it. This bill will raise awareness of PTSD in Canada. Because it's work-related, I think it brings up some of the complexities that one of the other committee members mentioned. It brings in the question of how much it is the responsibility of the employer and how much of the public system, and that is a complex discussion that is required.
Liberal
Executive Director, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
In terms of gathering surveillance information, it would depend on the quality of the information we could gather and on the level at which we could identify the different communities.
I would agree with my co-witnesses that the important part is to move the bar, to move forward, and then learn from the different communities that we're able to look at in enough detail to understand this, which will help us to develop a relationship with the other communities and to help them too.
