National Defence Committee on Feb. 14th, 2008

[Col A.G. Darch]

I think often when the diagnosis is made, what happens is there is a sense of relief on the part of the patient, because now they have an explanation for what's been happening to them and now they can see that there's a treatment ahead for it.

I don't think there's so much of an issue once they have the diagnosis, sir.

[Capt(N) M.E.C. Courchesne]

The biennial periodic health examination does ask questions that will seek out symptoms of that.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

That was the impression I got.

[Capt(N) M.E.C. Courchesne]

It is not the only tool we have. I think my colleagues were very articulate in saying that we have put in many checks and balances. There's the periodic health examination every two years. There's the pre-deployment screening. There's the immediate post-deployment, if there's anything they want to report right away. And then there's the enhanced post-deployment screening that happens three to six months after they have returned, because we know that not everybody will identify immediately or manifest it immediately. But we put in another opportunity to be able to diagnose that, and the questions are geared to identify it.

[Col A.G. Darch]

In addition to that, a person can go in on sick parade to see their doctor at any point in time that they wish.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Again, I'm looking at the individual who doesn't really want to admit to it or is in denial.

Now, how do you treat someone who is in the forces and comes to see you, you've identified something, and that individual says, “No, I'm not going to....” Because there is a stigma out there, and there's no question that's something we have to get over, as a society. And it exists in the site at large in the military. Until we get over that hurdle.... We see it happen in physical illnesses as well. People don't want to admit to any kind of illness.

Does that person continue to do their job, or is there a way of removing them? Is there a way of putting them somewhere else?

[Cdr R.P. Briggs]

Certainly with the Canadian Forces health services, we are occupational doctors, so we are patient advocates, but we have to keep in mind the patient's safety to himself as well as to others and the organization.

There's a process by which we can give somebody medical employment limitations, whatever they require for their safety and for the safety of others. I guess you could always give somebody medical employment limitations prohibiting them from doing certain activities. That's not necessarily deployment. We'd couch it in employment limitations. But the medical employment limitations have to be known to the commanding officer, as well as the prognosis--not the diagnosis, but the medical employment limitations.

[The Chair, Conservative, Rick Casson]

We'll hear from Ms. Gallant for five minutes and then go back to Mr. McGuire.

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

Thank you, Mr. Chairman. I have just two brief questions.

On the occasion of a soldier being released from the military on the grounds of being disabled from an operational stress injury or perhaps for violent behaviour arising as a consequence of a psychological condition that has arisen out of service with the Canadian Forces, what measures are taken to protect civilian society from the former soldier's violent behaviour?

[Cdr R.P. Briggs]

I would say that violent behaviour has presumably been manifested in some way. Simply having a diagnosis does not mean you're not answerable to society for your actions. At that point, oftentimes, either the military or the civilian disciplinary activity occurs. At that point, the onus is on the individual to prove why, or why not, they undertook their actions.

I would say that, generally speaking, it may be out of the military's hands. If you're talking about somebody who has a medical diagnosis and who is being released from the military, really, the onus is on the military to try to gently hand over that person's care to the civilian sector, as opposed to just releasing that person and sort of washing their hands of the person.

I would certainly hope--and I'm not an expert in this area--that is generally occurring, but I can't speak to any particular cases that you may be talking about.

[Col A.G. Darch]

In addition to that, if the physician has any concerns that the patient has any specific plans or knows of any specific individuals the patient has threatened to harm or is going to harm, the physician has the duty to report that to the police.

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

There is a duty. Okay.

That leads to my next question. In recognizing that not all soldiers who suffer operational stress injuries or have psychological conditions as a consequence of their service to their country are violent--I am in no way implying that--we don't have enough doctors, let alone psychologists and psychiatrists to treat the civilian population, let alone additional cases that are coming from the military.

I am quite concerned that these people will not get the care they will need once they reach civilian society. If, as a consequence of their service, they are violent and are arrested for violent behaviour as a consequence of the illness, how are the civilian courts advised that there was a mitigating condition as a consequence of the service to the military?

[Col A.G. Darch]

That's kind of outside my lanes as well.

In general terms, what I believe would happen--but I think you'd be better to ask a lawyer that question--is that the person, even if they had PTSD, would be responsible for their actions. That would not be an excuse. So if they did something, they would be found guilty. However, the circumstances of their illness would be a mitigating influence in any sentencing that would occur.

I believe that is correct, but I would ask that you please check that with the legal authorities.

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

So the medical doctors in the military have to advise the local police that the soldier is being released--

[Col A.G. Darch]

The military police are the local police.

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

--wherever that soldier is going to live.

[Col A.G. Darch]

I believe so.

[Cdr R.P. Briggs]

That is if they have a credible reason to believe that the person is at imminent risk of harming himself or others.

[Col A.G. Darch]

Having said that, to the best of my knowledge, this is a very rare thing. Also, within the military--and our mental health people and the director of health services delivery could perhaps answer this better--if a person starts to have symptoms of PTSD, usually there is quite a protracted time before they would be released, if they are not able to return to service.

I believe in the past, that time has been anywhere from two to three years.

[The Chair, Conservative, Rick Casson]

That's it for now.

Mr. McGuire, and then back to Mr. Hawn.

[Joe McGuire, Liberal, Egmont, PE]

Thank you, Mr. Chair.

A number of months ago, on CBC television, there was a GP interviewed whose son had been to Afghanistan. This particular individual asked to go on CBC with his story. Apparently, when his son came back, he was an entirely different person, with personality changes. His father didn't know exactly what was wrong with him, but nobody would believe that there was anything wrong with him. He couldn't get anybody to respond, so he went public with it.

What happened after, I'm not sure. I'm trying to track him down to see if he was responded to.

We talk about people who refuse to admit it, but here was somebody who was crying out for help and wasn't getting it. How many others are there? Is there any documentation on how many people? To this point, 13,000 people have served in Afghanistan. How many of those really want to be treated and are not able to get it?

[Col A.G. Darch]

Sir, I would say that's a very, very rare thing.

Right now, what we aim for, when a person wants or needs mental health care, is that they get that within four weeks at a maximum. Almost invariably we are able to achieve that. We have a fairly extensive mental health care network within the military, and we will refer people to civilian resources if we need to.

In terms of the specific case that you've brought up, I'm sorry, sir, I'm not familiar with that at all, so I couldn't comment on it.

[Joe McGuire, Liberal, Egmont, PE]

Maybe I'll make you more familiar, if I can get the details of it. Hopefully what you say is true, that it's a rare thing.

I think one of you said in the presentations that in the decompression period in Cyprus, soldiers are there for three or four days. How many people are rotated out at a time there, and how much time would actually be spent with particularly those around the front? There are those who are on Kandahar airfield the whole time they're there, but there are those who are on the front and under certainly different kinds of pressures.

Are they treated any differently, and how much time would you actually be able to spend to detect if there was anything actually wrong with these people, if they're only there for such a short period of time? I imagine they have other things on their mind, too, when they go there, except to submit themselves to medical examinations.

[Col A.G. Darch]

Sir, the purpose of the third-location decompression is to bring closure to the individuals with respect to the deployment, and also to facilitate their transition back to Canada and to their home life.

We also provide, while they are there, education on operational stress injuries, and they have the opportunity to talk one on one with a mental health care professional if they wish to do that.

In terms of the third-location decompression preventing operational stress injuries, that is not the intent of it at all, but it also helps provide education to the members on operational stress injuries and it provides an opportunity for any who have any concerns at all to bring those forward.

In terms of numbers, it's based on one airplane load at a time. I'm not sure if we have the approximate number for that. Whether it would be 120 or 150 people, I'm not sure.

[Cdr R.P. Briggs]

It occurs over the process of approximately six weeks, where the actual mental health professionals are in place in Cyprus. If you could divide the 2,500 folks or so—probably less than that, minus Camp Mirage—who are rotating through, it will give you some idea as to what sort of throughput they're dealing with.

You're right, though, that it's for purposes other than just mental health identification—physical decompression, other things too—but it is made available.