National Defence Committee on March 4th, 2008

Evidence of meeting #15 for National Defence in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was treatment.

A recording is available from Parliament.

On the agenda

Health services provided to Canadian Forces personnel with an emphasis on post-traumatic stress disorder

MPs speaking

Also speaking

Alain Brunet Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Theresa Girvin Psychiatrist, Mental Health Services, CFB Edmonton, Department of National Defence

4:05 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

In psychiatric terms, operational stress injury is not a diagnosis. Operational stress injury is an umbrella term that refers to a set of psychiatric conditions including depression, post-traumatic stress disorder and other disorders that can be triggered by intense or extreme stress experienced during a mission. This is what we call operational stress injury. It is a way of saying that mental health problems are another form of injury. Physical injury is recognized. It is considered to be an injury, and not an illness. Thus, we are getting away from the more pathological aspect. Between you and me, this is a euphemism.

4:05 p.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thank you.

There's been some discussion already about which ages were more vulnerable to diagnosed injuries. We have a lot of female soldiers serving over there. Was the comment related to whether there was a difference by gender between the numbers of people reporting?

4:05 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

In our study, and in the other studies that were published, we typically find that women report more mental health problems than men do.

The question then is whether women are more vulnerable or whether they are more inclined to acknowledge and discuss their mental health problems. Regarding post-traumatic stress disorder, in the civilian population, it was demonstrated that the risk... Even when taking different kinds of trauma into account, even after weighing a host of factors, it was found that women were still more likely to develop post-traumatic stress disorder.

Regarding depression, there are those who say that women get depressed and that men get drunk. This has more to do with the different ways in which men and women deal with their problems.

4:05 p.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Touché. I think most of us recognize some validity there.

Your study was back in 2002, and you'll be aware that the Canadian Forces have put a concerted effort into increasing the number of personnel available to counselling and psychological services, as well as pre- and post-counselling, and of course the decompression you mentioned, and so on.

Regarding the relevance of the incidence or severity, do you feel there has been any progress? Are you in a position to comment on that from the time you did your study?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

As far as I know, considerable progress has been made. Many initiatives have been undertaken since 2002. Thus, we may have good reason to believe that things have gotten better since then. This would be an educated guess, but it is also the impression I have when I talk to colleagues from the armed forces, other researchers, and so forth. I feel that things have improved a great deal. At the outset, the Canadian Armed Forces had a long way to go. For instance, 12 years ago, practically nothing was being done. There has been a huge investment of resources and I believe our efforts are about to pay off.

4:10 p.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

There was some indication that not only is a certain percentage reluctant to seek help, but they certainly were resistant to receiving drug help, in particular, and didn't want to go on medications.

I noticed that you have written a bit about propranolol, and I think I saw a comment go by that you were aware that the drug reduced the intensity of memories, perhaps, but didn't actually solve the problem.

I think I heard a little bit of a discussion about cognitive behavioural approach. In your own experience, do you feel it's more a behavioural approach that's superior to a medical approach, or is that something that has to be judged individually, or is a combination of therapies better?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

I think that both methods are useful and that they are a part of the package of intervention tools. Some people prefer medication, others prefer psychotherapy. In some cases, both are used together.

Regarding propranolol, this is an experimental treatment that my team is currently testing, and we are getting very interesting results. This kind of drug therapy aims at reviving the traumatic memories, and, as the brain encodes them again, at alleviating their emotional impact.

We are not trying to erase people's memories, but simply to reduce their emotional impact, because we believe that in cases of post-traumatic stress disorder, the problem is caused by the overly intense emotional impact of memories.

4:10 p.m.

Conservative

The Chair Conservative Rick Casson

I'm sorry, you're out of time.

We're going to come back to you folks right away. We have time for about three spots.

Mr. McGuire.

4:10 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

Thank you, Mr. Chair.

The 8,000 people you tested, were they all front line troops or just troops who were deployed?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

The 8,441 individuals in the sample were selected at random from the Canadian Forces. Thus, it is a representative sample.

4:10 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

So a lot of these people may not have been seeing any kind of action whatsoever?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

Most of these people had been sent into the field several times. Very few of them had never been deployed before.

March 4th, 2008 / 4:10 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

Okay. So if they were deployed, were they deployed on the front line, or as backup? In the Afghanistan case, most people who are on the base never leave the base. There are 600 to 800 actually who are out on the front line. There should be a big difference between the two groups. Do you filter out any of those differences?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

We did not have access to that information.

4:10 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

No? So regarding the concerns about confidentiality, wouldn't supervisors make it their business to find out if their troops were fit or not mentally? Wouldn't that be information they'd automatically get?

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

Some people maintain or think that officers should have access to this data, this information, because it could be important, especially during a deployment. Once the soldiers are back on the base, is this information still as relevant? I can't say.

4:10 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

If they wanted to make a career and stay in the forces and be promoted, it probably would weigh heavily on somebody's mind whether or not their supervisors felt that they were mentally healthy or not.

4:10 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

The problem is that it has a negative effect. If supervisors have access to a person's medical and psychological files, this has a negative effect to the extent that people might prefer to keep their problems to themselves, and the more they do that, the more likely it is that they eventually become ticking time bombs. On the other hand, if they consulted someone a bit earlier and if they got some help, chances are they would get the help they need to recover and get on with their career. Some soldiers are apprehensive about these things. They are faced with some rather contradictory requirements, as it were. This is not an easy problem to solve.

4:15 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

Yes, it wouldn't be very easy.

Have you compared your numbers with representative cases in the U.S. or Great Britain, as far as your findings are concerned? Did you have any kind of comparative analysis with other armies?

4:15 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

As I said previously, this study is a first and the only one, to our knowledge, that is based on a representative sampling of the Canadian Armed Forces. Perhaps the Americans and the British have not yet dared to do such a study. All we have access to are sub-samples and subsections. We never know these are representative of the whole population. Therefore, it is difficult to make comparisons.

4:15 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

Are you saying the Americans and Brits have never done something like this?

4:15 p.m.

Researcher at the Douglas Institute , Associate Professor, Department of Psychiatry, McGill University, As an Individual

Alain Brunet

The Americans and the British have not carried out any studies based on a representative sampling of their armed forces.

4:15 p.m.

Liberal

Joe McGuire Liberal Egmont, PE

I see.