National Defence Committee on April 3rd, 2008

[Alan Tonks, Liberal, York South—Weston, ON]

Has any statistical analysis been done on those who were diagnosed in a professional and disciplined medical regime, came home, and continued in the forces? Have any statistics been gathered as to the remediation rate of those who have overcome post-traumatic stress and are back in so-called mainstream activity to be redeployed back to active service?

[Col Jean-Robert Bernier]

I don't know what studies there have been, if any. I mentioned the directorate of medical policy, which has a deployment health section that does that kind of research. As far as I know, no....

One thing I can say is that some studies have been done on symptomatology three to six months after deployment, starting six years after the Gulf War--deployment in Kabul in the early days of the mission and most recently deployment in Afghanistan. They looked at the percentages of troops who've returned and undergone this post-deployment enhanced screening. But remember, this is just screening, not diagnosis, and so far what we're finding is not alarming. In some cases, it's reassuring, in that it suggests that people are presenting much earlier. In other words, we're starting to beat the stigma, obstacles, and various disincentives to present for care early. That's a good thing, because the earlier they present for care, the less likely they'll carry on and develop a chronic condition.

[Alan Tonks, Liberal, York South—Weston, ON]

Right. Thank you.

Thank you, Mr. Chairman.

[The Chair, Conservative, Rick Casson]

Mr. Lunney, five minutes.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

That's a good segue into where I wanted to pick up, and that's on the comments made by General Gauthier about post-deployment decompression activity as an integral part of the return process.

I'll quote from your remarks:

The purpose of this program is best thought of as an inoculation against reintegration stress by providing an interim venue between the dangerous, fast paced, rigid structure of the combat theatre, and the domestic home environment.

It's so designed, anyway.

I understand, General Gauthier, that was under your direction. I just want to say that we've heard testimony about the importance of this decompression time. I understand that's where peer counsellors are employed. I think that relates back to remarks by Colonel Bernier about the fact that people are coming forward earlier and their results are improving. So I just want to commend you for that initiative. It seems to be a very good one.

This leads into my question, though. Earlier you mentioned that about 85% come home fine. About 15% may experience some sort of operational stress injury, most of which people recover from fully, I understand. We have allies over there, some 26 nations in Afghanistan. Not all of them are tasked as our troops are, but with the U.S. and British troops you have more counter-insurgency tasking. Would the numbers we're describing here on these types of injuries be compatible with those of our colleagues from other nations?

[Col Jean-Robert Bernier]

Some of the numbers, yes, are quite compatible. Some are different because of differences in the way we deploy troops.

For example, in terms of the Americans in Iraq, recently one of their studies found that they had a significantly higher rate of symptomatology suggestive of PTSD six months after their deployment. But that was for 12-month deployments as opposed to six-month deployments.

So there are enough differences that it makes it very misleading and often invalid to compare the results.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Apples and oranges.

[Col Jean-Robert Bernier]

Yes.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I certainly respect that response.

I'd like to pick up on Mr. Tonks' earlier question about the drugs. I think what he's referring to is this international concern about not best practices related to military practice but just in treating depression in a global sense, with the failure and disappointing results worldwide in anti-depression.

But I'm pleased to say--I'll just throw this in quickly for Alan's benefit--that other options are being explored. EMDR, an eye movement desensitization and reprogramming initiative, is a natural or mechanical type of treatment that helps them revisit the trauma. They seem to be getting good results with that. I think at committee here we'll be hearing from at least some soldiers who've benefited from that.

With that comment, I'll just pass it over to my colleague,

who has been patiently waiting to ask a question.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

You are very cruel, my dear colleague.

Two minutes is my intro, actually.

Thank you, my dear colleague.

Thank you, Mr. Chair. Perhaps I will leave it to your discretion.

First of all, I would like to thank you for coming to meet us. I listed to your presentations and heard you speak about the military hospital at the base in Kandahar. Like several members of the committee, I had the opportunity to travel there, and to witness the professional standard of care that is provided. More recently, a regular Forces nursing assistant from my constituency came back from there. Of course, the things he saw disturbed him greatly.

That brings us to the subject of an illness inherent to the profession, post-traumatic stress disorder. You described it to us quite well, but naturally, we want to hear more. As we listen to you, we understand the environment in which the illness develops. We know that its effects can last for decades. Things that happen over a few months or a few years can have repercussions. You mentioned long-term effects. Mr. Lunney said that 15% of soldiers can develop psychological difficulties after events like these. If 25,000 soldiers have already served in this one mission in Afghanistan, that could be 3,000 to 4,000 people.

In the field, do soldiers diagnose each other? Do they, for example, report any of their comrades who are having problems? How do those things happen? I also want to point out that that we met the chaplain when we were in Afghanistan and he told us about the challenges.

For example, is it not time for the Canadian Forces also to think about setting up long-term care facilities, given how long the aftereffects of these disorders can last?

[The Chair, Conservative, Rick Casson]

Just before you respond, I am going to tell you how I am going to do this, because the next five minutes is for the official opposition and then we go back to the government side. So I'm going to use that five minutes to allow you to respond to his two questions.

Go ahead, you have five minutes, and you guys are next.

[LGen Michel Gauthier]

I am going to give you a quick answer to your first question and I will let my colleague answer the second.

In an infantry section, an armoured vehicle, or any vehicle for that matter, each individual sees his comrades and watches their behaviour very closely, what they say and do every day. The interaction between pairs of individuals is very personal, though it depends on the individuals. If it is more serious, someone is going to put a word in the ear of the deputy section commander and ask what he thinks. At some stage, according to how serious the situation is, either the chain of command becomes involved, or health professionals are asked to look after the situation.

You should ask General Grant, General Laroche and Colonel Hetherington that question. You are going to have them here in the next few weeks. They can give you a precise idea of how things are handled on site.

[Col Jean-Robert Bernier]

Exactly. We get wounded members referred to us by their peers, by on-site medical personnel, by chaplains, and some come to us on their own.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Can you comment on the long-term effects?

[Col Jean-Robert Bernier]

Do you mean psychological trauma?

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Yes, because there are going to be long-term effects. Canadian troops are going to have to have bases that are able to treat these conditions that develop and to stay with people outside the operational area for quite long periods.

[Col Jean-Robert Bernier]

General Semianiw has described the structures that exist to follow and support them, whether it be socially, medically, in aftercare or anything else. We even have structures to provide long-term support for families. But we do not have enough data to determine how big a problem this will be over time. As I explained a little earlier, we are encouraged by the fact that people are coming forward earlier. So there is reason to suppose, if we consider the way in which the treatment works and the natural progression of the conditions, that this will increase our chances of reducing the extent of the problem in the long term.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Very good.

[Col Jean-Robert Bernier]

Of course, as long as the mission lasts, and especially if future operations involve a lot of combat, we will continue to have casualties of this kind.

[The Chair, Conservative, Rick Casson]

Good. Thank you very much.

To finish up this second round, are there any more questions from the opposition? No.

That's probably a good spot to end then, before we deal with our report from the steering committee.

If the committee will allow me, I have a couple of questions. On the issue of lessons learned, could you quantify how long it takes to implement change in routine, change in protocol, when something like that happens, when it feeds back up the chain? Does it happen quickly? Is it a matter of days or weeks? Does it have to be studied forever or can you make a pretty quick decision?

[LGen Michel Gauthier]

I think it's anywhere from, quite honestly, minutes to years, depending on the nature of the issue. In response to IED events in-theatre, we will have someone on the scene very quickly--I'm talking minutes--and they will do an initial evaluation and a follow-on evaluation. Thanks to the information age we live in, we're able to propagate the results of that analysis very quickly--within theatre to subject matter experts in-theatre who will look at what can be done immediately, back to Canada, to the army, to ADM(Mat), to the Canadian Forces writ large. What materiel-like fixes need to be put in place? Can those be done quickly? Can they be done in-theatre? Can they be done? Will it take more time? Do we need to buy a new piece of kit that will take a little bit longer? It's the same thing with tactics, techniques, procedures, and so on.

So the system is very responsive in terms of getting the information out there. For some of it, depending on the nature of the question that's being examined, of course, the analysis will take a little bit longer in delivering, so a solution will take longer. But it can be very responsive.

[The Chair, Conservative, Rick Casson]

Very good.

I have one more. When there's a physical or a mental injury, who's responsible for making the call to say that a soldier cannot be deployed any more? Whose decision is that? Does it have to work up the chain of command that a soldier is done here and has to go home, or is that done at the platoon level?

[LGen Michel Gauthier]

I think there are two elements to that. If the medical professionals say he's not fit for duty, he's not fit for duty, and there's no further discussion, quite frankly. If, from a chain-of-command perspective, there's a view that he's not deployable, that decision can be made at any one of a number of levels.

[The Chair, Conservative, Rick Casson]

Good.

Thank you both very much. We have to do a bit more business here, but we'll let you disentangle yourselves. Keep up the good work. We appreciate everything you do. We're going to try to get to Wainwright to see some of the training given to our people before they go, to enable them to handle some of the situations you talked about. That will prove to be pretty interesting, I would think.

Thank you.

We'll just suspend for a minute.

[The Chair, Conservative, Rick Casson]

We'll come back together and deal with the report.

The subcommittee met on Tuesday and came up with a plan to go forward. The first issue we came up with is based on the witness list that was supplied by members. We've come up with a budget of $57,800 to carry on this study and have the witnesses come in.

The second issue is a visit to Wainwright. This is where the troops go through the last phase of preparing to be deployed. The best time Jim could squeeze out was May 9 to May 11. That would be a pretty active time to be there and see some good things happening.

Then there is a visit to Valcartier on June 2 to June 4.

Also, Mr. Cannis asked for a briefing on the North Atlantic Treaty Organization summit in Bucharest, and that is planned for April 15.

We have the rest of the meeting dates filled up with witnesses until the break, and if we get this passed here today, then we can move ahead. I can get the budget approved at Liaison next week, and then work on getting these travel documents put together.

Are there any comments?