Good afternoon, Mr. Chairman, ladies and gentlemen. Thank you for the opportunity to appear before you today with General Gauthier.
I'm the director of health services operations in the Canadian Forces health services group. In addition to providing medical advice to the strategic joint staff, my directorate works through the Canadian operational support command to support the operational commands in planning, preparing, and executing all aspects of health service support to military operations.
Among others, my key responsibilities include: assessing the health threats specific to an operation; determining and organizing the appropriate health measures and capabilities necessary for the health protection of deployed forces and for the treatment and evacuation of casualties from point of wounding all the way back to Canada; organizing the appropriate professional and technical training of deploying health services personnel and units; coordinating with the health services of host nations and allies to maximize the efficient employment of coalition resources; ensuring that deployed health services elements are provided with whatever professional support and health services resources they need during the mission, and evaluating and coordinating modifications to the training, capabilities and capacity of deployed health services according to the most current health needs of the force.
As you know, the nature of many military operations makes the development of some mental health conditions unavoidable, even with the best preventive and treatment efforts. I would, however, like to summarize the preventive and treatment efforts that are relevant to mental health in operations.
Regarding prevention and early identification, health screening occurs at enrollment, during periodic health assessments throughout a member's career, and at pre-deployment to identify those whose past or current health status might place them at increased risk of having inadequate operational capability or of suffering a serious health problem during operations.
Realistic training at enrollment with units and before deployment helps our members develop confidence in their skills, weapons, equipment, colleagues, and leaders. This is important because strong unit cohesion, social support, realistic training, and good leadership have been associated with lower rates of combat stress and are thus amongst the best preventive medicine efforts.
Stress awareness is briefed during pre-deployment training and is being integrated into officer and non-commissioned officer courses. In combination with the various chief of military personnel programs to promote good mental health, these efforts form a strong foundation for a deployable force that's as mentally fit as possible.
Determination of the mental health and other treatment capabilities to be deployed for particular missions is based on consultation between my staff, the operational commands, and senior health specialists. They take into account the threat, the nature of the mission, previous experience, medical evacuation timelines, host nation and allied health services resources, and many other factors.
Mental health staff currently in southern Afghanistan include several primary care physician assistants and physicians, two social workers, one mental health nurse and one psychiatrist. Canadian troops are also supported by a cadre of chaplains for pastoral counseling and by some US and UK mental health staff. Visits to forward operating bases by mental health specialists are conducted routinely to provide education and early intervention.
Wait times for care are negligible and emergency cases are seen immediately. Surge support in the event of mass casualties is available from other NATO health service facilities in Afghanistan, and higher level care is available at the US military's Landstuhl Regional Medical Centre in Germany.
The adequacy of the deployed Canadian capability is continually reassessed. This is based on a weekly review of patient visit statistics, regular reports and recommendations of the task force surgeon, periodic staff assistance visits from Canada, detailed biennial after-action reports, expected future operations, regular consultation with allies and many other factors.
Early identification and treatment of problems is pursued with the aim of returning members to duty, but repatriation is necessary if it's in the best interests of the member's health or if the duration and type of any employment limitations or treatment would adversely impact his or her operational capability.
As for all health conditions, these determinations are not based on blanket policies but on a professional assessment of each individual's condition and health needs. It is, for example, possible for a soldier with a well-managed condition in the maintenance phase to carry on doing all duties if doing so is in the patient's best health interests and if there are no significant risks related to the condition or prescribed medications. Among the clinical considerations is that studies have demonstrated that mental health casualties taken away from their units do not do as well and are at higher risk of developing chronic conditions such as PTSD.
As the Surgeon General previously noted, patients with acute mental health conditions would not be employed in combat duties. Normal psychiatric and occupational medical practice and Canadian Forces policy would preclude their return to such duty without a deliberate determination by competent medical staff that it was medically and operationally safe to do so.
Transient spikes in visits to medical staff may occur after high-tempo operations and traumatic incidents, but the vast majority of patients quickly recover and return to duty. The number of operational stress injuries manifesting during operations has so far not had a significant operational impact.
At the end of their deployment, members must complete a declaration of injury or illness listing potentially harmful exposures or health conditions they sustained. They undergo an initial post-deployment health screening and those with potential mental health problems are identified to their home base medical staff for follow-up. An enhanced screening is conducted three to six months later that focuses specifically on mental health concerns.
A Third Location Decompression Program also occurs over a few days in Cyprus before returning to Canada. This is an effort to ease the reintegration process by providing members an opportunity to rest and readapt to western comforts, to achieve a sense of closure by having relaxed time in a safe environment with their comrades, to provide access to mental health professionals for counseling if needed, and to provide education about operational stress injuries, common reintegration problems and how to get help.
Though not a medical intervention shown to impact the burden of operational stress injuries, there is some evidence that its educational component is contributing to the earlier presentation for care of members with mental health concerns.
Following the enhanced health screening in Canada, all members continue to have access to the pastoral, health promotion and treatment programs mentioned by previous witnesses. Individual health also continues to be monitored through periodic health assessments that include mental health screening elements.
In summary, the mission in Afghanistan may potentially have a significant long-term mental health impact, but the Canadian Forces strives to improve, and has improved, a robust program to deploy forces that are mentally ready, to support them well in-theatre with mental health resources, and to maximize the early identification and treatment of conditions that manifest after deployment.
Though not predictive of the ultimate toll on our members' mental health, the caseload in-theatre today has not been unexpected, is well within our deployed medical management capabilities, and has not had a significant operational impact.
Thank you for your patient attention. I would be pleased to answer your questions.