Evidence of meeting #25 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 soldiers.
A recording is available from Parliament.
3:35 p.m.
Conservative
The Chair Conservative Rick Casson
I call the meeting to order.
This is our 25th meeting dealing with the study of health services provided to Canadian Forces personnel, with an emphasis on post-traumatic stress disorder.
3:35 p.m.
Some hon. members
Oh, oh!
3:35 p.m.
Conservative
The Chair Conservative Rick Casson
Mr. Bachand thinks we should have champagne to celebrate the 25th meeting. We'll leave that for other events.
Today we have a panel of witnesses. We have James Price, who is the acting chairperson for the Canadian Forces Grievance Board. With him is Caroline Maynard, director of legal services. From the Office of the National Defence and Canadian Forces Ombudsman, we have Mary McFadyen, interim ombudsman. And as an individual, we have Pat Stogran. He is a retired colonel, and I understand he works as the veterans ombudsman as well.
I understand that the three of you have presentations to make to the committee, and I will let you all do that before we go on to a round of questions. Who wants to kick it off?
Mr. Price.
3:35 p.m.
James Price Acting Chairperson, Canadian Forces Grievance Board
Mr. Chair and members, my name is Jim Price. As the chair has indicated, I am the acting chair of the Canadian Forces Grievance Board. With me is Caroline Maynard, our director of legal services.
To give my own background, I retired in 2003 from the Canadian Forces after 37 years of service, the last 23 as a legal officer and military judge. I was appointed vice-chair of the grievance board in December 2004 for a term of four years. Currently the chair's office is vacant, so I have assumed that role as well.
I think I will start off with a short background on how the Canadian Forces Grievance Board came to be. It was part of very substantial amendments made to the National Defence Act in 1998 by Bill C-25. That involved the big post-Somali amendments largely having to do with military justice.
At that time, in 1998, the grievance system was also rejigged. There had been a number of studies in the mid-nineties showing that the grievance system was slow and lacked transparency. The minister was the final authority in the process, which was not seen to be a good thing. Bill C-25 created a two-stage process, initial authority and final authority, and made the Chief of the Defence Staff the final authority rather than the minister.
With respect to the board per se, it was seen that an outside independent agency—and that's what we are, a quasi-judicial tribunal, not connected to National Defence—would add to the adjudicative fairness of the grievance process and would generally bolster confidence in the system.
It's important to understand that the grievance board is not a decision-making body; that is the chief, who is the final authority. What we do is make findings and recommendations in certain types of cases to the chief, and the chief, if he or she does not agree with our findings and recommendations, must say so in the final decision. The chief must personally adjudicate the files that come from the board, which the board has reviewed. All of the other files are done by the chief's delegate.
The subject matter jurisdiction we have is limited by regulation. Essentially it's involuntary release, harassment, pay and allowances, medical, and dental. The effect of the regulatory restriction is that we see only 40% of the grievances at the CDS level. I can tell you that we have been talking to the Canadian Forces about expanding our mandate.
We wonder, if the purpose of the existence of this board is to bolster confidence in the grievance system, why we can't see all of the grievances. I should say, too, that the Canadian Forces are not resisting this. We've been talking about it for the past year, and we have some more talking to do. We feel this is an important thing that we want to pursue.
One of the subject matter areas we have is medical care. You will see from the briefing note I have supplied to you that we have only actually seen 12 grievances on the quality of medical care--19 grievances on post-traumatic stress syndrome. I should add that these are not, of course, necessarily the only grievances in the Canadian Forces dealing with post-traumatic stress. We see them because there's a release involved or the quality of care is involved.
You may have a case, for example, of someone who has post-traumatic stress syndrome who is placed on constant probation for misbehaviour and claims that the reason for the misbehaviour is post-traumatic stress. We would not see that kind of grievance at our board, because that has to do with personnel administration; it doesn't have to do with release per se.
Out of the files that we've seen, there are two main points we would wish to make. In some of the cases there has been, we think, a requirement for financial compensation with respect to medical care. The chief has agreed with us, but unfortunately the chief has no financial authority. He has to send those kinds of cases off to a Justice lawyer who works in National Defence.
We think it would be a very good thing if the chief had the authority to give some kind of financial relief. This was recommended by Justice Lamer in 2003, when he did the five-year review of Bill C-25. Unfortunately it has still not happened.
This is something we would like to see. We think the Chief of the Defence Staff, as the final authority in the grievance process, should have the ability to bring finality to the grievance. In our view, he shouldn't have to write the griever to say, “We think you have a meritorious case, but unfortunately I don't have the authority to grant relief. I have to send it somewhere else.”
That's a point that has arisen from our review of these types of cases.
The other batch of cases that concerns us has to do with individuals who have been diagnosed with post-traumatic stress syndrome and they then misbehave in some fashion. In one of the cases I looked at the individual had assaulted his spouse, and in another case there was excessive drinking. In these cases, from what I can see at least, the military focuses on the misbehaviour. They tend to look at whether the PTSD is a defence to criminal charge or whatever, and if it isn't, then the military basically releases the individual under an item called 5(f). A 5(f) is unsuitable for further service because of factors within one's control.
Another possible release item is 3(b), which is medical, being disabled. And 3(b) carries a host of benefits that a 5(f) release does not, including full severance pay, an immediate indexed pension if you have 10 years of service, vocational training, six months' notice and so forth.
We have seen a fairly rigid attitude so far.... I caution that we have not made recommendations to the chief in some of these cases, and he may well have a different view than some of his subordinates. But it seems to us that a more generous view might be that a medical release should not be dismissed out of hand simply because the individual has misbehaved. Of course the caveat I would put on this is that every case is different and this is highly contextual. But we want to make this point to the chief in some of these cases as we go along.
I think those are the two main points out of the cases we have seen so far. And some of the cases go back to the 1990s--Croatia, Bosnia and so forth.
3:45 p.m.
Mary McFadyen Interim Ombudsman, Office of the National Defence and Canadian Forces Ombudsman, Department of National Defence
Thank you.
I would like to begin by thanking the committee for inviting me to testify this afternoon on the issue of health care services to Canadian Forces personnel, and in particular issues surrounding post-traumatic stress disorder.
It is a pleasure and an honor to be here today as the National Defence and Canadian Forces Interim Ombudsman. I have been following your work with great interest over the past few months.
Our work at the Office of the Ombudsman during the past six years has allowed us to see clearly that the post-traumatic stress syndrome affects a very high number of members of the Canadian Forces. Furthermore, it has very serious consequences for the families of those members in many cases.
Since 2002, our office has invested a great deal of time and effort in examining the problems associated with PTSD. Over the next few minutes, I will highlight some of the key findings from our original report, as well as the progress that has been made by the department and the Canadian Forces. I will also underscore some of the areas where we feel improvement is still required.
Our original investigation was conducted in 2002. It included some 200 individual interviews with CF members suffering from PTSD, their families, and members of the chain of command. The investigation produced 31 recommendations aimed at strengthening Canadian Forces leadership and improving the day-to-day lives of PTSD sufferers. The recommendations were designed to ensure proper diagnosis, improved education and training, tracking and treatment of those suffering from PTSD, as well as assistance for sufferers reintegrating into their home environments. These recommendations were the subject of a follow-up report nine months after the release of the original report. In that follow-up report, the office of the ombudsman made a commitment to continue to monitor the matter.
We are now finalizing our re-examination of the original series of recommendations. We are also looking at developing new recommendations designed to take into consideration the current operational reality of the Canadian Forces. This means that we are looking at all forms of operational stress injuries, including PTSD.
It is clear from our most recent review that the CF has made progress over the last few years in the way it approaches operational stress injuries, that is, in the way in which it attempts to prevent these injuries and to identify and treat those individuals with them. Unfortunately, it is also clear that the stigma associated with operational stress injuries is still pervasive at some individual military bases and among some units and that a real cultural problem still exists in some parts of Canada.
We have also found that what is missing is a function of general governance as well as strategic coordination relating to operational stress injuries.
Services are being delivered at a local level and on an ad hoc basis.
This has to change. No member of the Canadian Forces should be left aside because of a lack of coordination or because of ineffective management in the Forces.
Operational stress injuries also profoundly affect families. The stress of caring for and coping with a CF member suffering from PTSD can take its toll on a spouse and the family. Although we have seen progress for those in uniform suffering from operational stress injuries, the Canadian Forces have not done nearly enough to help the families of operational stress injury sufferers.
Adequate services are simply not available for the family members who may need help in dealing with their very difficult circumstances. Many sufferers of operational stress injuries, including those suffering from PTSD, are concerned about the effect their illness has on those around them and want to ensure that their families are cared for. As it stands, there is no coordinated national approach that ensures timely local access to services for family members.
Family members should be treated with compassion and understanding. They should be able to get services easily for the affected member or for themselves, wherever they live. Operational realities have changed a lot in the Canadian Forces since our initial investigation of 2002. Even though we are pleased to see that progress has been made in some areas, there is more work to do, and that work is important. The Canadian Forces should continue to move forward with the implementation of our recommendations and of those of other agencies dealing with this matter.
Thank you, Mr. Chair.
May 6th, 2008 / 3:50 p.m.
Colonel Retired) Pat Stogran (Veterans Ombudsman, As an Individual
First of all, I'd like to thank the committee for giving me the opportunity to appear before you today on something that's been very important to me, especially in the latter years of my career. I'd like to remind you that I am here as a private member. I'm not reflecting my current office as the veterans ombudsman. I may be out of the military, but the military is not out of me.
My consciousness regarding operational stress injuries--and I'd prefer to refer to them as operational stress injuries, because PTSD tends to be a particular diagnosis that doesn't really treat the entire community of personnel who have endured psychological injuries--was really heightened in 1995 in the aftermath of the Bosnian-Serb offensive on the enclave of Srebrenica. If you remember, at the time the Dutch, who were protecting the inhabitants of the enclave, had decided that they wouldn't fight. As such, the soldiers who were in the enclave had to witness the atrocities that were subsequently committed. Now, on one hand they managed to avoid the killed in action and wounded in action that they would have endured had they fought. But on the other hand, they weren't able to avoid the soldiers who had ruined lives due to alcohol misuse and drug addictions, as well as suicide. There was a huge aftermath.
I would like to think that I bring a bit of a different perspective to the table here today, because as a result of my experiences at that time, I developed the attitude that force protection is often referred to in the physical sense, but it applies just as much in the psychological domain and it remains just as much a priority for the chain of command to address. My assertion is that with all this emphasis on treating those who have been wounded or have endured psychological trauma, we have neglected to put enough emphasis on preventing or mitigating the effects of operational stress so that we have fewer casualties after a battle or an operation.
Now, many mental health experts are completely dismissive of the possibility that you can prevent operational stress injuries. However, I would submit to you that there are sporting organizations around the world that spend millions of dollars to mentally prepare their athletes for the types of competitions that they will engage in.
I will outline one of my own experiences as the commanding officer of the 3rd Battalion Patricias, which tends to validate my assumption in this respect. When I arrived at 3rd Battalion...of course, as I said, force protection is a command responsibility, and not only did I look at the physical side of it, but I also was very concerned about the psychological side. As such, I and my command team embarked on a very thorough training program that was state of the art at the time--critical incident stress debriefing. We were also a little bit avant-garde in our approach to doing business in that we developed what we called a stress inoculation training package. We drew from some of the contemporary writings in the field of killing, combat, and psychological stress. The intention was to introduce our soldiers to the types of psychological traumas that they might endure in a theatre of operations, but introduce it to them in a controlled environment with a view to controlling their responses and how they would react from it subsequently.
Now, unfortunately--or fortunately, depending on how you look at it--we were deployed to Afghanistan before we could actually get into that part of our program. But I might add that while we were in Afghanistan, with a view to protecting the mental health of the soldiers we had two padres and two military chaplains attached to us. We had a social worker, and of course, a very large number of critical incident stress debriefers in theatre.
After the operation, we embarked on a program that was established by my staff and at the time was referred to as decompression reintegration. The intention at that time was to bring soldiers out of the combat environment of Kandahar Airfield, take them to a third location, allow them to decompress somewhat, identify the soldiers that might be suffering some immediate impacts of the experience we just had, and have them learn to sleep between white sheets again and learn what had happened in the real world. In other words, we would prepare them to reintegrate into the workplace.
At the time, I encountered huge opposition to that concept. There was no scientific evidence at the time that indicated this type of activity would be advantageous. National Defence headquarters, all the medical experts, and the soldiers themselves didn't want to go to third-location decompression, because they wanted to get home to their families, and vice versa. The families and friends wanted their soldiers home.
Interestingly, we had overwhelming acknowledgement that the third-location decompression was indeed successful. In fact, I'd like to report today that they do carry out third-location decompression in Cyprus for all troops coming home from Afghanistan. There are, however, still some detractors of this concept of decompression or reintegration, and I would have to admit that I would agree with them to a point. I would say that third-location decompression is not necessarily ineffective but it's insufficient.
My recommendation would be that we should be treating the problem of operational stress injuries from recruitment through to retirement, and we should be engaging the medical community to be assisting the chain of command in preparing soldiers to endure the psychological traumas long before they might ever set foot in a field of operation.
My second recommendation is probably even more important. I submit that psychological stress injuries are the responsibility of the chain of command. I shudder when I hear senior officers say, “Yes, we've got it almost correct, but some soldiers slip through the cracks.” Personally, I consider that analogous to leaving a wounded soldier on the battlefields of Afghanistan. A casualty is a casualty, and we should endeavour to have nobody slip through the cracks.
In conclusion, I have heard forecasts, depending who you read, that there could be upwards of 20% to 25% stress casualties coming out of the field of operations in Afghanistan. I personally, as a past commander and if I were in command today, find that morally reprehensible. I find that the wrong message to be sending out to our troops, to our recruits, and most importantly, to the families and friends who have to live with the casualties when they come home.
Once again, my assertion is that we should be looking at the complete career of the soldier and that the chain of command should be held responsible for it.
I have a host of other ideas that I will defer until the question and answer session. Thank you very much, Mr. Chair.
3:55 p.m.
Conservative
The Chair Conservative Rick Casson
Thank you all for your presentations.
We'll get into the opening round of questions. It's a seven-minute round. We'll start with Mr. Wilfert.
3:55 p.m.
Liberal
Bryon Wilfert Liberal Richmond Hill, ON
Thank you, Mr. Chairman. I am splitting my time with Mr. McGuire.
Thank you all for coming.
Ms. McFadyen, I'm not going to speak directly to your report, although it's an excellent report on the reserves at the moment. I noticed a quote in there from the director general of health services, from January 2007, which says, “No one is really 100 percent sure who gets what. Nobody really knows, including me, and I run the system...”.
What I think we have found so far is that there seems to be a lack of consistency in support services, whether in the west or in the east of the country. There seems to be a lack of knowledge about the issue we're dealing with. There seems to be a lack of compassion in some cases, people telling soldiers to just suck it up. There is a lack of resources in terms of having trained psychiatrists, and so on, and a lack of consistency in terms of reintegration. And concerning the comment made by Mr. Stogran that no one should slip through the cracks, we've heard that term again and again.
First of all, are you surprised by these observations? Have you been able to look at how we can in fact respond effectively to these? When we hear from the higher ranks, they basically tell us that things are reasonably very good, except that there are cracks in the system and obviously they need to be addressed. Are there specific recommendations that you would be making?
4 p.m.
Interim Ombudsman, Office of the National Defence and Canadian Forces Ombudsman, Department of National Defence
Certainly we're in the process of re-examining our 31 original recommendations, and certainly I can make some general observations about what we've found.
What we've found is that there is inconsistency in services, as you said, throughout Canada. It depends on where you are, where you'll get services, and that allows people to slip through the cracks. As Mr. Stogran said, that's unacceptable.
We do know that the CF has made progress. They've put money towards health care. My understanding is that between 2004 and 2009, $98 million went towards mental health care. We know money has been thrown at it; is it being thrown at it properly?
We have generally observed that there's a lack of strategic coordination throughout the CF to make sure this money is being spent properly to make sure people are getting the care they need.
4 p.m.
Liberal
Bryon Wilfert Liberal Richmond Hill, ON
Through you, Mr. Chairman, in terms of the integration issue, we've heard also that for those who are reservists versus those who are in the regular forces, when they come back there's obviously a difference. Some go back to the units while others go back home, and of course family members are not able to respond as effectively. There seems to be a two-tier system here.
Again, in what you have done so far, do you see ways that this can be addressed?
4 p.m.
Interim Ombudsman, Office of the National Defence and Canadian Forces Ombudsman, Department of National Defence
Certainly with reservists and how they're treated, from what we found they appear to be treated differently in general by the length of the contract they signed as opposed to whether or not they were injured as a result of their military duty. Certainly when you quoted the Surgeon General, the policies and regulations that have been there have been there forever and they need to be updated. Nobody understands them. They're very hard to follow.
We've recommended that this be fixed so that if one is injured as a result of one's military duty or on service, CF is responsible for looking after an individual and making sure they're cared for.
4 p.m.
Liberal
Bryon Wilfert Liberal Richmond Hill, ON
My impression has been that you can't distinguish between a reservist and a regular force member. Certainly the time I visited the troops in Afghanistan, I wouldn't have known that. They were all trained the same and they all were prepared to do the same tasks. But again, the concern is that when they came home, particularly on medical issues such as this, they feel they are simply second-class.
4 p.m.
Interim Ombudsman, Office of the National Defence and Canadian Forces Ombudsman, Department of National Defence
Exactly what you have said is correct. If we are expecting them to take the same risks as regular force members, they should be treated the same way.
4 p.m.
Liberal
Joe McGuire Liberal Egmont, PE
Thank you very much.
I was wondering why you are interim and acting? How long have you been acting in the interim position?
4 p.m.
Interim Ombudsman, Office of the National Defence and Canadian Forces Ombudsman, Department of National Defence
The previous ombudsman, Yves Côté, left the position on January 7. He became associate deputy minister of justice. At that time Minister Peter MacKay appointed me as interim ombudsman, with the full powers of the office until they appoint a permanent ombudsman.
4 p.m.
Acting Chairperson, Canadian Forces Grievance Board
Ms. Diane Laurin was the chair of the Canadian Forces Grievance Board until February 25, when her term expired. The government has not appointed a new chair in the meantime, so I've been acting since that time.
4 p.m.
Liberal
Joe McGuire Liberal Egmont, PE
When do you expect to be confirmed or have somebody confirmed as permanent?
4 p.m.
Acting Chairperson, Canadian Forces Grievance Board
I don't know, sir. That's the short answer.
4 p.m.
Liberal
Joe McGuire Liberal Egmont, PE
You said that only 40% of the grievances reach the final authority. Are the other 60% that are missing simply not complaining or filing grievances, or are there a whole bunch of things that are being missed here in the legislation?
4 p.m.
Acting Chairperson, Canadian Forces Grievance Board
No. The point I was trying to make is that of the grievances that reach a final authority--and historically about 300 a year reach the final authority--the regulations that give us jurisdiction over subject matter are such that we only see 40%. We see the ones having to do with involuntary release, medical issues, and some others.
Things, for example, like personnel evaluation reports or personnel administration are done by the chief's delegate. He adjudicates these cases. So of the cases that come to the final authority level, we only see 40%. And as I was saying, we are of the view that we ought to see them all, frankly, if the whole idea is that we're adding an outside perspective.
