Mr. Chairman, ladies and gentlemen, thank you for the honour of appearing before this committee.
My name is Alain Brunet and I am a professor at the Department of Psychiatry at McGill University. I specialize in post-traumatic stress disorder. I have submitted a document that my group wrote recently. Over the past few years, the group has analyzed the results of the Canadian Forces Mental Health Survey, which is one of the largest surveys of the Canadian armed forces, or of an active army, ever conducted. Armies are usually quite reluctant to allow researchers to conduct surveys that are as in-depth as the one conducted in 2002. Beginning in 2004, researchers had access to the results, which had been made public. My team, which works in this field, began analyzing the data.
I am going to make a brief presentation on one of the documents that I submitted. I will then answer your questions.
There is very little data on mental health problems in armed forces. Armies are typically very reluctant to allow research of this kind. Therefore, the sample we had access to, which is representative of the Canadian Forces, is truly unique. However, bear in mind that this data was collected in 2002 and that all of the conclusions drawn were based on the premise that things have not changed since, which would be a harsh judgment of the army. I do not think we can make that judgment.
The survey involved 8,441 respondents. It was a large-scale survey, comparable to the best work that is done in the world. The survey was representative of the Canadian Forces.
What are the main findings from this research and, particularly, the data that we published recently? The first finding is that many so-called peacekeeping missions are as stressful, or as traumatizing, as combat missions. The concept of a peacekeeping mission has changed considerably over the past 10 to 20 years. We talk more often about peacebuilding rather than peacekeeping.
I would also like to draw your attention to the fact that, in the general population in the United States, the rate of post-traumatic stress, for example, is approximately 6.7%. It is important to compare the rates of the various disorders found in the army to those in the general population, to determine if they are higher or lower.
The document that I submitted examines behaviours linked to the seeking of care in cases where people had a diagnosable mental disorder within the past 12 months. Of a sample of 8,441 people, we found that 1,220 of them, or 15%, had suffered a diagnosable mental disorder within the 12 months preceding the survey. Of 1,200 people, 43% had contact with a mental health professional. On the other hand, 67% never sought help.
What disorders did these 1,200 people suffer from? Major depression affected 47% of them, alcoholism, 33%, social phobia, 22%, post-traumatic stress disorder, 16%, panic disorder, 12%, and generalized anxiety disorder, 12%.
So the most prevalent disorders were major depression, alcoholism, and a little farther down the list came disorders like post-traumatic stress disorder. Bear in mind that depression, alcohol abuse, phobias and panic disorders may also be triggered by a traumatic experience. If that factor is taken into account, the prevalence of mental disorders triggered by a traumatic event is higher than what this data would suggest.
We also looked at why people with a diagnosable mental disorder were not consulting anyone, particularly Canadian Forces members who have ready access to health care. What are the main obstacles to requesting a consultation? Three main factors came to light. The first is the lack of trust in authorities. The second is not acknowledging they have a mental health problem. The third factor is that while people may acknowledge having a mental problem, they believe that they can overcome it and want to try to deal with it themselves.
We also discovered that before asking for help, 73% of soldiers may have had up to five traumatic experiences, which means more than one deployment. They had been through many traumatic experiences before asking for help.
In light of these results, what can be done when people do not realize they are suffering from a diagnosable mental disorder? One of the things we should think about is more mental health education. People must be better educated so that they have a better idea of what they are suffering from. That is even more important because for most of the mental disorders I mentioned, effective treatment exists. The treatment is not 100% effective, but it is available. We believe that is an aspect that people do not understand. Not only are they not necessarily aware that they are suffering from a mental disorder, but even when they do know, they do not know that effective treatment is available.
Another consideration that emerged from the survey is the notion of confidentiality and the stigma surrounding mental health problems. As regards confidentiality, some participants in the survey felt that the contents of their medical file might come to the attention of their superior officer. Since Canada has an army of deployable people, you can see that if your superior officer were to learn that perhaps you were not as deployable as you should be, that might jeopardize your job. A kind of shame, a macho culture, that could fall under the umbrella of stigma, is also prevalent. It is as if becoming a hardened soldier who puts aside his emotions and everything else and recognizing at the same time that that soldier might be affected psychologically and emotionally by a very traumatizing experience were contradictory. It is as if expectations for soldiers were somewhat contradictory.
I think that committee members should look into the issue of confidentiality. Should confidentiality be improved? To what extent does confidentiality need to be breached? I think that question must be asked.
A final element emerged quite clearly. As regards psychological assessments, we should not wait for people to come and see us to say they may have a problem. Soldiers returning from a mission should undergo mandatory assessments.
Some of these recommendations have already been implemented or are already being tested on a trial basis in the Canadian Forces. However, perhaps some of these initiatives should be taken a little farther.
I will stop here and answer committee members' questions, in English or French.
