National Defence Committee on April 17th, 2008

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

Technically speaking, regarding communications, I know that there are certain parameters within which you have to transmit. From an operational standpoint, having that sort of data going through the air is not going to—

[MGen Tim Grant]

And that's an issue of not knowing what the scope of the problem is. I wouldn't be able to tell you whether there's enough bandwidth to pump those electrons through or not. So it really is, technically, trying to figure out what the problem is and find the technical solution. It's certainly beyond my ability as a liberal arts student.

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

Lastly, I understand that in September 2007 we had a casualty support management detachment stand up in Petawawa. From what I know about it--and I know very little--it may address some of these issues we've heard about for soldiers who have been injured in theatre, instead of having the benefit of going through the decompression stage, as well as the month-long reintegration into home life.

Can you tell us how this works, if you're familiar with it, and what it's supposed to address?

[Col Omer Lavoie]

I was particularly happy to see that progress. When we came back from our tour, we had a number of visits from the director of casualty support here, out of Ottawa. It became apparent, through lessons I learned from our tour and certainly from the PPCLI Battle Group before us, that the directorate of casualty support needed to branch out and now start putting detachments forward at the bases where the troops would be returning.

So I was particularly happy after our series of discussions here in Ottawa that the idea was approved and that a detachment is now stood up in Petawawa. Among other things, it gives soldiers direct access now, rather than having to travel to Ottawa to deal with situations that require the directorate of casualty support to assist them.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Vincent.

[Robert Vincent, Bloc, Shefford, QC]

Thank you.

Good day and welcome.

I have looked at the positions you hold.

General Grant, you are with the Canadian Expeditionary Force and you are a veteran. You have come here today to speak to us about the health services provided to Canadian Forces members, specifically services to treat post traumatic stress disorder.

You have combat experience as well as experience in a theatre of operations. However, from a medical standpoint, what can you tell us about the treatment soldiers receive when they return to Canada and the medical follow up they receive if they suffer from PTSD? I am thinking about someone who may have lost a comrade in arms. What care will that soldier receive? Who can he turn to for help?

[MGen Tim Grant]

Sir, I would start by saying that in theatre the aim is to help every soldier, whether their injury is mental or physical. There have been occasions on which Colonel Lavoie and I have actually worked closely and monitored cases and tried everything with mental health specialists to ensure that individuals who were suffering got the care they needed and were brought back on the road to recovery.

Others have not been able to be given the help they needed to get over a severe trauma in theatre, and they've had to come back home.

I will tell you from my experience that there is nothing that we will not provide to a soldier in theatre or particularly back home if it will help them get better. The CDS has made that very clear to all of us. Regardless of the nature of the injury, we will get the support that the soldiers need.

I think that goes across the board. Rank is irrelevant when it comes to either mental health or physical injuries. As I said before, the challenge is linking the injured soldier with the medical specialists who will help the most.

[Robert Vincent, Bloc, Shefford, QC]

How many mental health specialists does the Canadian Forces have and how many people avail themselves of their services? What is the ratio of mental health specialists to soldiers returning from a combat mission? Is the ratio one to ten, or one to one hundred?

[MGen Tim Grant]

Sir, I wish I could answer that question. I don't have the answer. I'm not sure if the Surgeon General had that information when she appeared before this panel, but if not, we will take that on notice and see if we can provide that.

[The Chair, Conservative, Rick Casson]

I think we already had it.

[Robert Vincent, Bloc, Shefford, QC]

It is really important to the extent that soldiers must have the sense that they are being cared for. One soldier from my region committed suicide after he returned from Afghanistan where he had lost a foot. He may not have had a spouse, but he did have family. In my opinion, providing medical follow-up services is really not sufficient when a soldier returns from Afghanistan or from another mission. Earlier, you said that you had trouble providing medical follow up services to these individuals.

What do you think you can accomplish? You also said that you lacked the necessary expertise and did not know where to go and find it. Surely soldiers from other countries are experiencing the same thing and require medical expertise and psychological counselling.

[MGen Tim Grant]

Sir, there's no doubt that my discussions with the Surgeon General lead me to believe that they are exploring all options for services and trying to find the right treatment for soldiers.

The case you mentioned is one I'm familiar with. He was a soldier who was injured under my command in Afghanistan. He came back to Canada and had been under care for almost a year. His suicide was tragic, and it affected everyone who knew him. It affected his family, it affected his peers, it affected those who had served with him in Afghanistan.

Those are tragic events that, quite frankly, some of us don't know how to deal with. But I think we need to be very careful between saying the tragic results of a person not getting care and the results of a person who ends up taking his life, in spite of the care. There are cases where that happens, and that's all the more tragic. But as I say, I'm convinced in my own mind that the Surgeon General and her specialists are working to find the best care that can be provided to soldiers.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Rota.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Thank you, Mr. Chair.

I've been listening to a lot and we've had some people on both ends. I guess when we look at it statistically and I look at the service you're giving, there's no question in my mind that the intention is very good and we want to see what's best for the individual soldier. I almost feel, though, when we ask questions, what I get is yes, this is what we mean. So the statistics are very good, and overall they seem to be in place and everything seems to be great, but I guess what we get in our office are the outliers, the data that doesn't fit in with the rest of the statistics. When a statistic is very distant, it sounds good, because you're talking 80%, 90%. But if you're part of that 10% of the population, all of a sudden it goes from being a statistic to being a personal problem, and I think that's what we see in our offices.

I have a question, and I'm not really sure how to put this. I don't want to sound insulting, but there seems to be a disconnect between some of the cases on the front line and what's going on up the ladder. Is there a review process in place to analyze just what's going on with the outliers, the people who are having troubles? Maybe you can describe to me how that would work.

Let's say somebody comes into my office and says “I've been getting terrible servic”. Now, granted, maybe some of the diseases that are existent are very hard to diagnose, they're not easy, and I'm not saying it's an easy problem to take care of, but how do you take care of that problem that is not as easy as...? Say you break a leg--you know it's there, the femur's cracked in two. You put it back together and you hope for the best, and at least you can monitor that. But when something goes on with the mind it's not exactly an easy one to take care of, and there's a lot of pain and suffering that goes with it. You're definitely not purposely leaving this person out in the cold, but they certainly feel like they are. How do you handle something like that? What would your role in something like that be?

[MGen Tim Grant]

I'll take a quick shot at it.

I would say that, even with the broken leg, the broken leg can't be repaired if the patient doesn't interface with the doctor. So if a person is coming to your office or anyone else's office, the aim is clearly to get them in connection with someone who can help them, and that someone, in my mind, would be the Canadian Forces medical health system. That is the issue. It's how you get them to the help they need.

I've been to two funerals for soldiers in my regiment in the last month. One was killed in action in Afghanistan and one took his life following a tour in Afghanistan. Both were tragic. The aim is to never let that happen. But at the same time, there will be people who...as you say, the outliers will fall through the cracks. The aim is, once they're identified, how do we get them back? I would suggest, sir, that you play a role in that, to identify that to the medical health system, so we can get them into the care they need.

[LCol Simon Hetherington]

I'd like to add, not so much from my role in Afghanistan, but as a commanding officer of a regiment in Petawawa before deploying and as a commissioned officer in the Canadian Forces, that I'd take action to look after the care of my subordinates when I hear there is an issue, and that's not just me; it's public knowledge, because it's in the newspapers, that General Hillier himself has entertained the families of those who may have fallen through the cracks. That's not meant to be taken pejoratively. He has taken it upon himself and he's led by example in that regard.

I know that within 2 Brigade I and every single one of the commanding officers I serve with, Colonel Lavoie being one of them, would take it to heart if we got a call from someone outside the military asking if we knew that soldier X had a problem. As General Grant said, we would engage the medical people to try to assist. It's the old adage of not being able to fix the problem if we don't know there is a problem.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

If we had someone like that come to see us, would it be appropriate to ask who his commanding officer was? Would that be out of line?

[MGen Tim Grant]

Sir, I would say that's very appropriate. Phone the commander of that service, the nearest base commander, whether he's army, navy, or air force. That's the approach I would take. That will ensure it gets attention.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

My concern, and the concern the individual soldiers often have, is about getting that attention and what it will mean for them. By the time they get to that point, their military career is usually pretty well over. They're not going back into theatre, and they're not getting any more work with the military. How will that affect them within the military?

The reason I ask is that I've had some come to me--and again, I'm taking individual situations and I know they're not the norm, but the outliers--who feel that if they say something, they'll be shunned, they'll be pushed aside, and maybe the attention they'll be getting won't be as positive as they might like.

[Col Omer Lavoie]

I could probably take that one on with a few examples.

The first part, sir--and I think we've gone a long way in the forces--is creating a command culture in which we don't differentiate between a physical wound and a mental wound.

It's easy to stand up in front of your troops and say that as part of your pre-deployment briefings. Certainly from what I saw.... I had soldiers in my own vehicles in a few-man crew, one of whom had to be sent back after a series of combat engagements, but I certainly never felt afterwards that the other soldiers in the crew or his fellow soldiers in that particular platoon ever cast any aspersions against him or treated him differently from any soldiers who went back with physical wounds. That's the first part.

The challenge is often that it comes to the point that you need to actually order the soldier, based on your professional determination, to get help. General Grant and I worked on a case in particular. You have to come down and sometimes order that soldier to come in and seek help, and if necessary to be repatriated back to Canada.

The segue to that was it would be the end of his career. That is not the case. In the one particular case that General Grant and I worked on for quite a bit of time after a traumatic circumstance, we sent that soldier back to Canada and after returning a few months later, followed up with him. I'm happy to say that I sat down with him and his wife back in Canada about two months after that occurred, and that soldier is now gainfully employed on our base and has received successful treatment, despite being a soldier who didn't want to come back but was ordered to come back, and in no way has his career been ended over that case. There may be limitations, perhaps, on his employment, but he'll still finish out his career and be gainfully employed within the CF.

[The Chair, Conservative, Rick Casson]

Thank you.

We'll get back. There's lots of time here.

We'll go over to Mr. Lunney.

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

Thank you, Mr. Chair.

One of the challenges we're concerned about with post-traumatic stress disorder, especially with the long deployments, is the support network at home and the connections with home. I suppose in a sense we identify with that around the House here, because our members are removed from their families to a certain extent. They're not in the same kind, although you might call this place a combat.... You'd never know that from the way it's so peaceful around the table today, but it has been described as a combat zone in another way. I can certainly say that statistics tell us that casualties in relationships for members of Parliament have been recorded; we're away from our families, and it's a concern around here.

I'm wondering what happens in the theatre for soldiers on deployment. They're away from their families a long time. We know that when they go home, the support network is going to be so important for them. How do young couples maintain a relationship? Do they get to phone home once a week? What kind of infrastructure is available for people to try to maintain relationships and talk to their support network at home?

[Col Omer Lavoie]

I can probably take that, because the bulk of my troops were deployed forward, outside of the main airfield for almost the entire duration of our time there. There is a significant amount of infrastructure in place. I think you would be pleasantly surprised. Certainly the policy was in place when my tour was out. We had satellite phones, one down per section of soldiers, which was equivalent to a ratio of about one phone for ten. The soldiers were allowed to use that phone anytime. It wasn't required for operational reasons. They could call home, I would suggest, a few times a week if they wished to.

Although initially fairly austere when we first went in and seized that ground, the forward-operating bases were developed. Certainly in my time there satellite-based Internet was brought in. Again, when soldiers weren't out on a combat patrol or otherwise, they were able to go back and use the Internet and use it as a means to send e-mails back and forth to home.

It's a pretty stark difference from what I remember in Bosnia in 1992, where you went eight weeks, if you were lucky, waiting for a five-minute phone call, with a card, to call back home. I think that's gone a long way to keeping families connected. That's on top of the other services, like the hotline numbers and the services that are available on bases now so that spouses have access to getting things forwarded to theatre as well.

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

I certainly appreciate hearing that. It wouldn't be unusual for you to actually witness your soldiers calling home somehow or logging on for some computer time. One of the advantages of computer connectivity is that you can actually pretty cheaply communicate that way.

I certainly appreciate hearing that. It has to be a tough assignment when they are having such intense experiences, and that leads me to the second question, which would come back to the decompression. I am so glad to hear it has been implemented at that time, when they come out of theatre and after that intense military family experience that they've gone through together, and then they need a bit of time coming back to civilian life. It seems to me that's a very good idea.

We saw great images with the Stanley Cup showing up and some ball hockey going on. Are recreational opportunities available as well during the decompression time?

[MGen Tim Grant]

They are indeed. The program is five days. You arrive the first day and leave on the last day. On days two and three there are formal presentations in the morning that you have to attend. In the afternoons, and on the fourth day, there are subsidized recreational activities people can participate in. You can take advantage of those or you can lie around the pool and get a suntan if you'd like. The vast majority of people do get out and do some sort of social activity, some leisure activity that they are capable of going off and doing.