National Defence Committee on Feb. 12th, 2008

[Col David Weger]

Our priority is making sure that in Kandahar and in every theatre of operations, we have all of the mental health personnel we need, regardless of their particular area of expertise. We acknowledge that we need to expand mental health services in Canada. We are developing a program to do precisely that. The Director, Health Services Delivery could give you more details about this program, including the number of service providers.

[The Chair, Conservative, Rick Casson]

Thank you, Mr. Bouchard.

Are there questions from the official opposition? No.

We'll go back to the government and Mr. Lunney.

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

Thank you, Mr. Chair.

Thank you, gentlemen. It's great to have you here with us today.

I'm interested in the discussion about the limited pool of health services and health service providers that we have in the general health care system in the country. It's a very astute observation, in response to the question from the parliamentary secretary.

With a limited pool...I want to ask about musculoskeletal injuries, for example. You mentioned that you have pharmacists, medical doctors, and nurses. If anybody wants chiropractic care they have to go off the base to get it, and I'm sure there are members who access those services where they're available.

We have a group of chiropractors on the Hill today presenting to the industry committee.

Given the shortage of resources and medical manpower to deal with some of these injuries, is there any consideration given to using other health care professionals, who may be very well qualified, to take some of the burden off those medical doctors? About 30% of the cases presenting to traditional medical offices are musculoskeletal--sprain, strain, joint-related injuries that can be managed very well by a non-medical practitioner such as a chiropractor. Has any consideration been given to expanding the range of services available on the base to help to take the pressure off those officers who are overworked?

[Col David Weger]

If you're referring specifically to having them in uniform or to being uniformed members of the Canadian Forces, our guiding principle essentially is that unless there is a direct operational employment for them, i.e., an overseas deployment, we normally will not put a profession or occupation into uniform. That, at the end of the day, is the primary purpose of having a uniformed health service. It's to provide the care where normally you cannot buy it or procure it in some other manner, either from a host nation or, potentially, allies.

Again, I am not a clinician, so I can't really speak from that perspective with respect to whether or not chiropractors can or cannot deal with more acute injuries. Our entire focus, when it comes to delivering operational health services—that is to say deployed health services—is on timelines. If an individual can be returned to full operational duty within a specific period of time, then they stay in theatre and are treated. If they cannot be, then they are evacuated out of theatre to Canada or another location where they can receive the appropriate level of care.

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

I wasn't particularly implying that to be as a first responder. When you have serious, potentially life-threatening bleeding injuries and so on, you need a different type of response. But when you're managing those injuries, if they are not managed properly, they can lead to long-term disability in many cases and shorten somebody's career.

Putting that aside and going back to our subject at hand—and forgive me for the little diversion there—as you're expanding the services for people with operational stress injuries and the mental health services, I understand there's quite a large increase in budget to attract more personnel and expand the services available and the number of personnel providing services. Is there any kind of task force or anybody looking at what other outside-the-box approaches there might be for helping people with operational stress-type injuries, or are we just looking at providing more of the same?

[Col David Weger]

All of the initiatives under Rx2000 were put together over a significant period of time. That included broad-range consultation, specifically with respect to the mental health initiative, which is where this particular one lies. I cannot really speak to how far outside the box they got. Again, Lieutenant-Colonel Richard Pucci, who is our director of health services delivery, under whom the mental health initiative falls, would be in a much better position to address that question.

[LCol Gerry Blais]

I guess I can say, though, that one thing we do provide on the social side is peer support for people with operational stress injuries. We have people who were once in uniform, who have suffered an operational stress injury themselves, who have healed to a large degree. They report to a doctor, and once he says they're good to go, they join the public service and provide peer support to injured members. We offer that service, as well, to families of those suffering from operational stress injuries.

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

We have a study going on in Alberta right now of people using vitamins and minerals for a serious form of depression, bipolar depression. Neuroscience specialists have been looking at it, and it's actually getting some surprising results with small clinical trials. But it seems to be that in Canada where we have, among our soldiers, an increased number of post-traumatic stress disorders and of course operational stress injuries, one can set the stage for another, you might say. People with operational stress injuries back in the theatre could be exposed.

Maybe it's too much to expect the military to actually lead in something avant-garde, but we have a new phenomenon with more soldiers, more of our personnel coming down with these types of injuries. There might be room to take a look at whether some of those soldiers might benefit from simply expanded nutritional support, not just more food as in more to eat, but more concentrated nutritionals that actually support the nervous system and might reduce the number of injuries.

[The Chair, Conservative, Rick Casson]

Could we have a short response to that, please? It was more of a statement than a question.

[Col David Weger]

I read the transcript from the meeting with General Jaeger. You brought forward the question at that time as well, and I do know that she has approached our director of force health protection to ask him to start looking into exactly this point.

As a guide, we focus on delivering evidence-based medicine. There is very little that would likely lie within a realm that is defensible, from that perspective, that at some point somebody might not be willing to try. It's difficult to say, but certainly General Jaeger intends to get back to the committee. I believe she made a commitment to get back to the committee with respect to that point.

[The Chair, Conservative, Rick Casson]

We're back over to the official opposition, but they're good.

It's back to the government for five minutes.

Ms. Gallant.

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

Thank you, Mr. Chairman.

When an injured soldier is well enough to return home, but not well enough to go to work and, say, he's living in a PMQ, what provisions are made to ensure that the residence is handicapped accessible? Are the families required to move off base into accommodations that are handicapped accessible?

[LCol Gerry Blais]

What we endeavour to do is provide what the soldier wants. I know of one specific case in Petawawa where the individual preferred to live on the base, then a married quarter was modernized in such a manner that it became fully accessible.

However, if a person is living off the base and would like to continue to live off the base, we have occupational therapists assess if it's possible to do that in the current residence. If it's not, benefits are in place where another residence can be purchased and the required modifications can be made there.

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

I understand that, where possible, the Canadian Forces want to retain the experience of the soldiers even though they may not be able to go to active duty; they're in teaching capacities. What improvements are being made to infrastructure or building entrances, for that matter, to accommodate these people, who may not be able to walk up stairs any ?

[LCol Gerry Blais]

I'm not an infrastructure expert, but I know for a fact that on bases they endeavour to provide handicapped-accessible entrances to all buildings. Of course, with bases being so large and some of these buildings being a little older in a lot of places, that presents different challenges, but I know the intention is definitely there to do it in any manner possible.

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

As the need arises, these changes are being made. Is there not a special program in place to make everything accessible?

[LCol Gerry Blais]

I'd defer that one to the infrastructure people.

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

Okay.

Upon receiving a diagnosis of PTSD, is a soldier automatically given a medical release?

[LCol Gerry Blais]

Anybody who suffers from basically any injury, be it mental health or physical health, is first given what is known as a temporary medical category. They are given up to three of those, during which time the doctor has a chance to say, okay, are we making progress here or are we stabilizing? If that's the case, then they continue on temporary categories as they progress through the system.

If at some point it's obvious the member is not going to get better, they're assigned permanent employment limitations. At that point, a career review is conducted and the member is told that either the limitations allow him or her to remain in the Canadian Forces or ultimately they may be released. They also have the opportunity, at that point, to provide input into the process, as to whether they agree or think that things should be looked at in a different manner.

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

There is the real fear, aside from just the embarrassment or stigma attached to a mental illness, that they will be automatically booted out of the forces if they admit to some sort of mental strain. If that is not the case, is it then in the best interest of the soldier to overcome that fear and have the injury put into the medical record so that if there's a delayed reaction, as we've heard from a previous member, at least it was on the record and they would be able to receive benefits if it's necessary at a future point in time?

[LCol Gerry Blais]

I would say it's extremely important. First of all, we want the individual to get treatment. If they don't see a doctor they're not going to be treated, and it's going to be difficult for them to get better if they're not getting the medication and the psychiatric or psychological assistance they require.

As you rightly state, if there is no documentation that the person has suffered an injury, then when they apply to Veterans Affairs for benefits, of course, it will be more difficult for them to access.

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

Are we embedding people or designating people in theatre, in a platoon, to be on a specific lookout for mental injuries while they're in the action?

[LCol Gerry Blais]

As was mentioned earlier by Colonel Weger, the only ones who can actually make a diagnosis that there has been a mental injury is a psychiatrist.

What we do, as was touched on, is provide training in all Canadian Forces leadership courses to help individuals recognize behaviours that might indicate there might be some type of mental health or other issue, and then encourage the leaders to refer these individuals in question for proper medical assessment.

Within the health services, our junior medical technicians are provided with much the same general behavioural recognition stuff. Is something going on that's out of character for an individual? At our senior paramedic level, they undertake roughly 17 hours of training specifically oriented towards the recognition of indicators of mental health problems or issues. At the physician assistant level, they undertake 33 days of training, as well as a four-week residency in a mental health facility, to provide them with the skill sets they require not only to recognize the signs and symptoms, but also to assist in actual treatment of mental health problems.

[The Chair, Conservative, Rick Casson]

That ends the second round. We're now getting into the third round.

The official opposition have indicated they're fine. Does the government side have any questions?

Go ahead, Mr. Blaney, you have five minutes.

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

My question is for the Lieutenant Colonel and touches on a subject broached by my colleague Ms. Gallant. You explained that when a solider was unable to resume his regular duties, his career was re-evaluated. Therefore, it is possible that if nothing suitable is found for him in the Canadian military, he may have no choice but to resign.

Could you elaborate further on that and also explain to us how the transition to veterans' status is made and whether disability payments are awarded?