National Defence Committee on Feb. 7th, 2008

[BGen Hilary Jaeger]

Thanks.

Rapid fire, and in English again, so I can speak more quickly, regarding 5% PTSD, about the same number have a significant depressive issue. For the largest number of people with mental health disorders coming back from a mission, it's hazardous drinking behaviour, which I think runs at about 17% in the figures we have. There's some suicidal ideation—that is, thinking about suicide, not attempting—which is running between 2.5% and 3%, if my memory serves me correctly. And the rest did not reach the level of those kinds of severity of diagnosis. That's where the figures are.

Are they always given medication? No. The thing about a multidisciplinary approach is that we employ best practice for whatever their condition might be. Very often it's a psychotherapeutic approach, frequently accompanied by medication. In the case of post-traumatic stress order and the anxiety disorders, you want to calm down the anxiety a bit so that some of the thinking can get through, calm down the noise in your brain, but it's far from 100% of the time.

Some patients just refuse anyway. There are lots of people who don't like psychoactive medications and would rather not take it. So you have to have multiple approaches.

The other thing is support for the family. We've invented a really nice term called “member-oriented family focused care”—or is it the other way around?—to describe, when the member is having difficulty, how we provide some psycho-education to the family, teach them how to live with a person who has a mental health disorder, and involve them in the family therapy that goes on.

Remember, we can't treat the family in isolation. We can't treat just the wife. If somebody has lost a leg in Afghanistan but is otherwise fine, has no mental health issues, but the wife becomes depressed as a result, we can't treat her, not through my resources. We have to leverage other resources through CFMAP and the family resource centre to get her the care she needs through the provincial system.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

What about the length of time? Can they overcome and after a while say they got over this syndrome?

[MGen Walter Semianiw]

When I was just in Afghanistan, two of my personal staff were individuals who had suffered from PTSD. So I think the short answer is yes.

[BGen Hilary Jaeger]

You can get over it. In fact, the best treatment now.... It's not the case that you're going to be on the couch for three years, telling your psychiatrist everything you know for three hours a week; the maximum is about 20 sessions if you're going to get results out of cognitive behavioural therapy. Some people do well after six or seven sessions, so it can be quite short.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Thank you.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Bachand is next, and then we'll go back to the government.

[Claude Bachand, Bloc, Saint-Jean, QC]

Thank you, Mr. Chair.

I also have three questions. I would like you to jot them down so that you do not forget.

First, you talked about your team, which involves many people. I once visited a theatre of operations and I noticed that the chaplain played a very important role. I realized that chaplains are a bit like confessors whom soldiers frequently confide in. But I do not believe that chaplains fall under health services. Perhaps we could take a closer look at the role chaplains play.

Second, the five Operational Trauma and Stress Support Centres were mentioned. I read your report and the poll, General Jaeger. The poll revealed that there is a certain stigma attached to psychological problems and that this was a reason why some soldiers did not want to come forward. I know that some of these support centres are located on military bases. The Canadian Forces ombudsman has already suggested that these centres not be located on military bases because when people go in, everyone knows. I would like to know what you think about that.

Lastly, it is important to have a social life. I know, since I visited a theatre of operations, that troops are often stressed. Everyone has their own way to deal with the stress. Some people go to a bar and have a couple of beers. However, I know that you have an anti-alcohol policy.

I went to Bosnia, and soldiers there were allowed to have two beers every night. I went to Afghanistan, but our troops are not allowed to drink. I also went to the German and Dutch theatres of operations. If German and Dutch troops had been told that they were no longer allowed to drink beer, there would have been a mutiny, probably involving some deaths.

Did you bring in this anti-alcohol policy for Afghanistan? What is it based on? Would it not be better to allow soldiers to increase their social life and get together around a couple of beers, as we sometimes do?

[BGen Hilary Jaeger]

That is a very interesting constellation of questions, and, again, I apologize for answering in English, but I'll be more efficient this way.

Chaplains, in fact, are part of our OTSSC multidisciplinary team. It's one of our leading-edge practices that we employ pastoral counsellors in our OTSSCs as full members of the team. Even without those teams, even on the ground, the chaplains are certainly a very, very important early warning system; they have a great role to play in measuring the pulse of the unit and sounding out the people who may be having difficulty, particularly those who have spiritual beliefs. If the unit member is an atheist, you're probably not going to get at them through the chaplain, but you have other ways.

Your question on stigmatization is an interesting question. It's a very difficult nut to crack. It's not unique to the military, as there all kinds of other instances of stigmas out there in the civilian world. My vision of perfection is having a single centre on base where nobody cares why you're going to the health care centre. You can be there for a sexually transmitted disease, which has a stigma all of its own; you can be there for breast cancer, and there are some women who are sensitive about that; you can be there to have a colonoscopy, and lots of people are sensitive about that; or you can be there for mental health. We're all just there to provide health care.

In the cadre of mental health, it doesn't matter if it's an operational stress injury or PTSD or if it's just that you have a mental health burden—which is in fact more of an issue in the Canadian Forces than operational stress injury, as we have more garden-variety mental health issues than the other stuff. But moving people off-base, in fact, in a certain way, perpetuates the stigma. It may work in a large city, in terms of anonymity, but perhaps it may also not encourage people to face up to some of their issues. In a small place like Petawawa, where are you going to move? Everybody knows that one PMQ is the mental health clinic, and if they see your car parked in the driveway, they know who you are.

As for the two-beers-a-day policy, our alcohol policy is the purview of the chain of command, not me. I have my own opinion about it: being dry is a very safe approach. But if you go to a two-beer-a-day policy, you have to be sure your chain of command has an absolutely iron-clad way of enforcing it or you're in dangerous territory. You have to be willing to fire every single person on that mission if they violate it, and not care if it's the task force sergeant major or the deputy commander or the commander, or your policy has no teeth and will collapse. That's not the surgeon general's opinion, but the opinion of an experienced officer in the Canadian Forces.

[The Chair, Conservative, Rick Casson]

Thank you.

Okay, back to the government, and then back to the official opposition.

Mr. Lunney.

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

Thank you.

Because we're just launching this study on PTSD, I have to pursue, in this last round, the line of questioning to do with Gulf War syndrome. There were concerns about some of the vaccines and medical interventions that were administered to soldiers before they went there, and there are soldiers who didn't even get to the battlefield who developed serious health problems.

Can I ask, what preventative health measures are the soldiers given before they go over? Is this public information? Can you advise us about these measures?

For example, even the common flu shot has thimerisol in it, a mercury derivative that is neurotoxic and a cause for concern. Many researchers are concerned about the influence it has on cognitive function, for example. So we're dealing with neurological phenomena.

Is this something you can provide us with some information on, or is it confidential?

[BGen Hilary Jaeger]

There's nothing particularly classified about the public health measures taken in preparation for Afghanistan. They're fairly routine. The risks we watch out for there are primarily arthropod-borne ones. We have the normal immunizations, but the acute risks are arthropod-borne malaria and leishmaniasis. For malaria, there's a medical approach to prevention, along with barrier approaches and vector control approaches.

I don't actually accept your premise that thimerisol is a significant risk. There are many studies that have been done on vaccine safety, and there has been absolutely no demonstrated link between the presence of thimerisol and excess side effects in the vaccine.

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

Well, there's still controversy about that. I accept your opinion on that, but of course there still is some concern out there about that.

[BGen Hilary Jaeger]

Oh, there are certainly a lot of people who have vaccine-related concerns, and we perhaps have to do a better job of explaining the science to people, because the biggest public health fear I have is that people will be too reluctant to accept vaccination when it is in fact the most prudent way to go, from both a personal health and a public health point of view.

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

Thank you. That's a common medical opinion.

Could you provide us with a list of the vaccines the soldiers are administered?

[BGen Hilary Jaeger]

I could go back to my force health protection staff and get that to you.

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

Please make it available to the committee. It would be useful in the course of our studies.

Thank you.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

General Jaeger, I think the idea of having a one-stop medical treatment centre for all the reasons you mentioned is commendable and practical, but at CFB Petawawa.... That hospital is bursting at the seams. There are wires hanging down. There are as many people as they physically can put around a desk as possible. It's been like this for over 10 years and it's getting worse. What are you going to do? Is there more infrastructure planned to better facilitate this?

[BGen Hilary Jaeger]

I've been told that Christmas is coming.

[MGen Walter Semianiw]

On the infrastructure side, if you take a look at the Rx2000 project, critical to it--and I'll be short--is this whole idea of infrastructure and actually having things in place. We need to build infrastructure in four locations, Edmonton and.... Petawawa is one of them. We need that. That is the challenge.

I've been at the warrior centre there myself. I've talked to a number of the soldiers face to face about the challenges they have. We need to find space there to be able to have them get the treatment they need, and we've put the money in place to be able to build the new site. The new location there is part of the Rx2000 infrastructure program. It needs to get done; it's going to get done.

[BGen Hilary Jaeger]

We have some money that.... It's going to look ugly. We need an interim fix, because new construction is going to take three to five years by the time you get through all the work that needs to be done to build something properly, so we are looking at a short-term infusion, whether it's trailer rentals or....

I hate providing care in trailers, but it's better than a tent in the parking lot.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

[The Chair, Conservative, Rick Casson]

Mr. Comartin, you had a question you wanted to ask. We'll let you wrap up.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

I have just a couple of things.

With reference to Mr. Blaney's question, at the public accounts committee you indicated that in the screening process at the end of the six months you had roughly 27% of all the people responding showing some difficulty. Is that still accurate?

[BGen Hilary Jaeger]

That's still accurate; it's 16% to 17% for hazardous drinking and all the other categories.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Then for major depression, if I can put it that way, it's about 5%, and about 5% for post-traumatic. Is that fair?