National Defence Committee on Feb. 7th, 2008

[MGen Walter Semianiw]

It is interesting because we are very shortly going to announce a new Canadian Forces health and fitness strategy. General Jaeger's team and my team have been working on this. It's going to be announced on April 1. There are actually two parts: fitness and the issue of health and nutrition. We have had new posters made to start driving home those points and awareness.

You're right, it's something we know, but again, part of it becomes a cultural challenge.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

On the credit card issue that you raised, I thought the analogy was interesting, why you and not me.

There is certainly a body of people in the medical world—most of them in this area have worked in molecular medicine—who consider these levels of nutrition that most people take as normal, but some people are actually vitamin dependent and need more. When you're compounded with stress, and maybe not the kind of thing that would qualify for a post-traumatic stress disorder diagnosis, but the operational stuff, sleep deprivation and all the changes that happen when you're in that kind of environment, might explain why somebody suddenly has a much greater need for nutritional support than they would have in a non-combat or a non-operational theatre.

[MGen Walter Semianiw]

I think it's a fair comment.

The health and prevention piece falls under General Jaeger. She has a whole new directorate of health for self-protection.

If you look at the food we are providing—and I have been there myself—you'll see we actually provide great food in the mission. I don't know if any other members here can speak to that end for the soldiers.

I think everything you're saying in principle sounds right, and I'm in infantry, I'm not a doctor. I'm sure I'll need a better meal after this committee tonight than I normally would have, to ensure that I build up on the vitamins that I've lost. I think you're right, and what you're saying intuitively makes some sense.

[BGen Hilary Jaeger]

I'm married to evidence-based medicine, and I'll be having my staff dig through the literature and see what they can come up with.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

That's great, and I certainly have some suggestions. I would be glad to discuss that further with you, if you are open to considering it. I think it's a promising area, and perhaps it would be interesting to do a little study and find out.

I want to follow up on defining operational stress injuries and what one looks like. We sort of touched on that, but I wonder if there is room to expand on it.

[BGen Hilary Jaeger]

It's defined as any persistent psychological difficulty. Originally the context was deployment to a mission, but it has been broadened to service in the Canadian Forces. It could be related to an accident you had while training in Wainwright on your way there. That's just as much of an issue.

It can manifest itself as depression, anxiety, phobias, or post-traumatic stress disorder and—this is almost anathema to put in the room—the worsening of a personality disorder. Somebody might have had certain traits in their personality that made them a little hard to get along with, and then under stress it can push them over the threshold into a personality disorder. Substance use or any combination of all of that....

[The Chair, Conservative, Rick Casson]

Thank you.

We have Mr. Coderre for five minutes and then over to Mr. Blaney. That will end this round and we'll start the next.

[Denis Coderre, Liberal, Bourassa, QC]

I have two questions.

If you want to identify a case of post-traumatic stress syndrome, of course, I guess it would start with recruitment. You never know what can happen, and it depends on your reaction through the operation. The fact is that maybe we can change, even at recruitment, the physical test and all that. I would like you to expand on that. What's your call on post-traumatic stress syndrome versus recruitment? What tools are we working with? Prevention is better than having to cure, of course.

Second, there's a school of thought that says rehabilitation is the best way to cure that person—to bring him back as soon as possible from the battle theatre. What is your thought on that?

[BGen Hilary Jaeger]

I'll try to get through the answer clearly and reasonably quickly.

We do not do elaborate screening for psychological makeup of recruits. We do ask questions about psychiatric history. By and large, if you have a significant psychiatric history, you don't get into the Canadian Forces. But we don't apply the MMPI, or any of these standardized personality-based screenings. They tried that in the Second World War and it didn't work very well. Perhaps with more research, there is some.... But you have to hit a pretty high threshold to exclude people on that basis.

[Denis Coderre, Liberal, Bourassa, QC]

There must be a middle ground, though.

[BGen Hilary Jaeger]

Human rights tribunals are going to watch that like a hawk, and that is outside of my lane.

But prevention is better than cure. There's emerging literature on resiliency. It's not very well defined. We're watching it. Until it becomes something we can actually use.... I'd rather promote resiliency than treat people. We don't really have a good definition of the characteristics and how to promote it. It's quite nascent.

I forgot the second thread of your question.

[Denis Coderre, Liberal, Bourassa, QC]

They're saying to bring that person back right away.

[BGen Hilary Jaeger]

For acute stress reaction you treat them as soon as you identify them. But that doesn't mean moving them out of theatre. As soon as you move them out of theatre, they self-identify as patients and therefore as a failure on some level as soldiers.

[Denis Coderre, Liberal, Bourassa, QC]

What do you prefer? What's your school of thought?

[BGen Hilary Jaeger]

It's a layered approach. You approach the acute stress reaction based on simplicity. In the Second World War they called it “three hots and a cot”—you got meals and you got to sleep for a while, which maybe you hadn't done. And as your symptoms subsided over 48 or 72 hours, you went back to work with your unit. They said to keep them within the sound of the guns so they knew they were still on the mission. I'm a firm believer in that.

If that doesn't work, then you end up at Kandahar airfield chatting with the psychiatrist, who may decide it's worth a trial of medication and perhaps some modified duty to keep you in theatre. If that doesn't work, then you will be evacuated out of theatre.

The linchpin of treatment for post-traumatic stress disorder is still cognitive behavioural therapy. It's an anxiety disorder. You have to expose people, in a controlled way, to the thing that makes them anxious and teach them to reprocess it.

[Denis Coderre, Liberal, Bourassa, QC]

If I may intervene, are you suggesting that we have some soldiers who might be on medication back at the operation?

[BGen Hilary Jaeger]

This is a very interesting question.

[Denis Coderre, Liberal, Bourassa, QC]

I'm only repeating what you just said.

[BGen Hilary Jaeger]

I would not say there are infantry men at the FOBs, but I know there have been soldiers who have continued to go on things like combat logistics patrols while on psychoactive medication.

[Denis Coderre, Liberal, Bourassa, QC]

What kind of medication? It's more than Sudafed, I'm sure.

[BGen Hilary Jaeger]

It's more than Sudafed, but I would have to go to my treating psychiatrists in theatre to find out what they've been using. I know they've been intervening to keep people moving.

[Denis Coderre, Liberal, Bourassa, QC]

Okay.

I have a small question, General. When we talk about the wounded in action and IEDs, in my book it's battle, but is it a non-battle injury?

[MGen Walter Semianiw]

I have copies right here. The definition of wounded in action is injuries from IEDs, mines, rocket attacks, direct combat with an enemy force.

I have copies here.

[Denis Coderre, Liberal, Bourassa, QC]

No, that is fine, thank you.

[The Chair, Conservative, Rick Casson]

To end this round, Mr. Blaney, you have five minutes.