National Defence Committee on March 4th, 2008

[LCol Theresa Girvin]

Well, Edmonton is not as isolated, although psychiatric services for children are pretty rare across Canada, and that's true for Edmonton as well. So if a child needs psychiatric services, they would have the same access as other non-military civilians in the area, which is not always the best.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

What have been your experiences in the 19 years you've been involved in the military? Have you seen a change in the way that PTSD is viewed? Obviously we now have this post-deployment screening that happens when soldiers come back from Afghanistan. Have you had experience with the post-deployment screening and the follow-up to that?

[LCol Theresa Girvin]

Yes.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

I wonder if you could tell us about that.

Also, are the challenges any greater for soldiers returning from Afghanistan than they were from other deployments, in your view?

[LCol Theresa Girvin]

First, on the perception of post-traumatic stress disorder, my perception of changes over about 19 years is that there's a lot more awareness, there's a lot of emphasis on it. If you look at the CF survey, there are more prevalent conditions, but the focus is on post-traumatic stress disorder, it seems, right now. I think probably that's an artifact of it being very easily linked to traumatic stress and to combat.

So there's a lot more awareness. I would say it's almost impossible for a CF member not to have some exposure to information about post-traumatic stress disorder.

Yes, I've actually participated in, I believe, three rounds, anyway, of the post-deployment screening. Most of the patients referred to me come in because the screening has identified that they're having difficulties and they need a further assessment--because it's a screening, it's not a diagnostic assessment.

I'm sorry, I don't remember what else you asked.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

I wonder if you see a difference in the soldiers who are returning from Afghanistan from the ones who return from other deployments, in terms of this post-traumatic stress disorder.

[LCol Theresa Girvin]

What I would give is just general impressions. There are lots of people going through Afghanistan, so you see more of it.

On the screening that we do post-deployment, we get more coming in, whereas before, as Dr. Brunet's study in 2002 showed, a lot of people wouldn't even recognize they had a problem, so how could they go for help? This way they're recommended for a follow-up, and it's written down. They have to see their MO, they have to go in, they have to get told. So we're seeing a lot more people.

The more we know about the mission, the more people know what to expect. For missions like Rwanda, like Somali, for different tours in the Balkans, I think maybe people weren't expecting those things, and so in some ways it was more difficult for them. The popular perception of what a deployment is like is different now here in Canada, I think, with Afghanistan from what it was on those previous deployments. So a person is probably feeling better supported here in Canada now than perhaps on one of those previous deployments.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Another question I had was on that whole issue of, as they call it, traumatic brain injury or acquired brain injury. There have been studies from the States indicating that soldiers who were experiencing explosions over and over again are coming back with various kinds of brain injuries. Someone likened it, to me, to shaken baby syndrome. I wonder if you're seeing that as well in the post-deployment treatment you're doing.

[LCol Theresa Girvin]

The study that I read from The New England Journal of Medicine actually captures a population of people who are injured, and then it separates out from those the people who had some kind of head injury with sequelae--so concussion, if you want. Then it looks at that population and says, okay, what's the incidence or prevalence of post-traumatic stress disorder in that group? And lo and behold, I think it was around 40% of the people with significant concussion had post-traumatic stress disorder.

I wondered when I was reading that study if that was a proxy to being close to combat and close to danger, which is the risk for post-traumatic stress disorder, right? So if you have an explosion significant enough to knock you out and your life is in danger, you pretty well have criteria A of post-traumatic stress disorder, a psychological trauma, down there. So I think that might be what it's predicting.

[The Chair, Conservative, Rick Casson]

Thank you very much, Ms. Black.

Over to the government and Ms. Gallant.

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

I'll be sharing my time with Dr. Lunney, if there's time left over.

Dr. Girvin, I'd like to read you a letter from a constituent, and then I'll ask my question. My riding encompasses Canadian Forces Base Petawawa.

Dear MP:

I write to you today to bring to your attention the matter of your soldiers that are returning from Afghanistan with PTSD or other mental health issues. My fiancé returned from his tour in August 2007 and has been seeking help through the military for his mental health issues. We've been attending the doctors' appointments, going to the mental health clinic, and talking to whoever will listen. All the military has done is give him time off work and grief over having to deal with this.

As of late last week, he was sent to Ottawa to see a doctor on base there, and was told he has PTSD and that there's a very good chance that he will be medically released from the army because of this mental health issue. The army is my fiancé's life, and the last thing he wants is to be released. He wants the proper care required to help overcome this issue.

It's very upsetting to me to hear that our government, that is supposed to be helping and supporting our troops, is so quick to wash their hands of the men and women that come back from their tours overseas with mental health issues. I do realize that there are hundreds of women and men that require help with their mental issues after returning to Canada and that we're not equipped to deal with all of this, since we've not seen numbers this high since World Wars I and II. I do, however, think that this issue needs to be brought to the attention of our government and that someone needs to step up and help our young men and women, because they are not disposable, and this does not only affect them, but their families, as well as our country as a whole.

Thank you very much for your time. I look forward to hearing back from you.

My question to you is this. How do I respond to this constituent?

[LCol Theresa Girvin]

If I had the letter in front of me, I could suggest an approach for you, but I don't think you really want me to respond to—

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

Not to this specific person, but as a whole, because this letter is representative of many people who have not written to me.

[LCol Theresa Girvin]

Some things stand out: that this government doesn't care, and that nobody's doing anything. I think this committee's hearing is evidence that it is.

I guess part of the next step, before sending the letter back, would be to get more facts. For example...you see, I'm coming at you from a physician's point of view. You're getting the fiancée's perspective, and I don't know if that is the perspective shared by her fiancé, the person who's affected. So I guess I would want more information before I would respond to that.

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

The heart of the matter seems to be that this person has been told by the doctor in Ottawa that he's likely to be medically released because he has PTSD. That is the challenge we have to overcome, because we're being told from the top echelons down that this is not necessarily going to mean they're to be kicked out of the military.

So what do we do to ensure that they're going to get care instead of the release?

[LCol Theresa Girvin]

The way the process works now is that the person presents, as this lady's fiancé did, for help. He is seen in the clinic and assessed and then offered treatment. I don't want to give the impression that a person is seen, assessed, and released. That isn't what happens. They're afforded a course of treatment, but because the military requires a person to be deployable, the expectation is that with treatment they're going to return to health within a period of time. In returning to health, then, they return to their full functioning and their full deployability, and then they are not released.

Not having been in the office with that patient or the doctor, I don't know what was said, but to predict from the beginning that a person is going to be released from the military seems premature.

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

Thank you.

[The Chair, Conservative, Rick Casson]

Two minutes, Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

I'd like to follow up on that, Dr. Girvin.

In your view, after 19 years and after seeing some of these so-called peacekeeping deployments in Bosnia and so on, and now in Afghanistan, what's your assessment from your professional point of view of the progress we've made within the military and government in terms of the sensitivity of the system--and I mean the whole system--in terms of treating this seriously and giving people access to the care and attention they deserve?

[LCol Theresa Girvin]

I think it's light years ahead. There's been a huge change, and not just in the last year or two either. It's been ongoing since 1997.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

And is it fair to say you're always going to find somebody who finds the system inadequate, no matter how good any system is?

[LCol Theresa Girvin]

I suppose, yes.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Is that human nature?

[LCol Theresa Girvin]

It goes with the adage that you can't please all the people all the time. I think so.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Yes, something like that. Okay.

I'd like to pass to Mr. Lunney.