Mr. Chair, I want to thank you for that eloquent introduction. I hope that I will not disappoint you.
Ladies and gentlemen, I have a prepared text and I have also distributed two charts to which I will refer later on. Certainly they're for public knowledge. They are not scientific; they are a soldier's view of a situation.
Mr. Chairman, ladies and gentlemen, thank you for the invitation to speak to you about a significant threat to the long-term well-being of the Canadian Forces, its members and veterans, as well as the operational effectiveness of the Canadian Forces. Losses of experienced serving veterans are a serious deficiency to the Canadian Forces' operational capabilities. The committee's excellent sixth report already covers much of what I wish to speak of today, and I hope to provide some updating and also some insight, as well as a few recommendations.
You have had witnesses testify to the failings of the Canadian Forces health services, and more particularly the mental health services, and you have had the commander of the Canadian Forces Health Services Group, Brigadier-General Hilary Jaeger, also testify to the tremendous hard work and the achievements of exceptional clinical results, particularly overseas. How can the same organization succeed and fail at the same time?
Let me begin with a bit of background based on my observations as the assistant deputy minister of military personnel in the late 1990s, as a soldier who was injured by operational stress and diagnosed with post-traumatic stress disorder, leading to subsequent medical release, as a veteran convalescing under continual treatment, and as a senator receiving e-mails and requests for support from Canadian Forces members, veterans, and families of both groups.
At the end of World War Two and on into the Korean War, the performance of the Royal Canadian Army Medical Corps and the Royal Canadian Dental Corps were the envy of our allies. At that time medical and dental schools were directed by former medical and dental officers and the armed forces were getting graduates who were the cream of crop. Over time, the prospect of administering a peacetime force composed of healthy young persons whose only problems were generally the odd cold or sports injury held less and less appeal to top graduates and while they still enrolled, recruitment became increasingly difficult.
With the end of the cold war and demands for a peace dividend, the structure of the medical services began to tumble with ever-increasing cutbacks. When I was the Assistant Deputy Minister of Human Resources, a band-aid solution called Operation Phoenix was applied which did nothing. We then launched RX 2000, a catchy name. Fortunately, it is still ongoing and is producing the results we find in Kandahar, in the theatre of operations.
In 1997, when I was under medical treatment, I made a painful but conscious decision to go public within the forces, and subsequently it was picked up by the general public about my injury of PTSD. Some referred to me as the poster boy of PTSD, a disparaging and hurtful appellation. However, the countless letters and e-mails I have received from families who declare that their spouses' lives and their marriages have been saved by my openness more than compensates for the lack of compassion shown by former colleagues and less than friendly editorialists.
When my book was published in the United States, the back-cover blurb indicated that I had been medically released with PTSD. When I inquired why this information had been added without my knowledge, I was told I was the only general officer to date who had acknowledged being affected by PTSD.
I bring this to your attention because one of the aspects of this injury is the compulsion to hide, to withdraw as if you have contracted some terribly devastating contagious disease such as HIV/AIDS or leprosy, and you believe you have failed and have let everyone down.
As a soldier you have recurring nightmares of placing your colleagues in situations where you actually become a burden, a hazard to their security. At first I thought I was the only one possessed with these nightmares, but others have told me they also have these terrible nights. Subsequently in my mission, I asked to be relieved because of the impact of that injury at that time.
Dr. James Obinski, who is head of Médecins sans frontières, operating out out of the King Faisal Hospital in Kigali during the height of the Rwandan genocide in 1994 describes his PTSD and the impact that it has even on an excellent and also professional medical practitioner:
I was driving along Highway 401 in Toronto as a blue Mazda Miata passed me. It was the same colour as the plastic tarp that I had been dreaming about for months without knowing why. Instantly, my car filled with the sweet semll of freshly killed flesh and blood. I saw sausages and then children's fingers in the red soil around the tarp. I veered as I tried to open the windows. The bumper scraped the guardrail as the car came to a full stop. I sat in the car, the smell and sausages gone. It was snowing outside. The wipers kept rhythm but I had fallen out of time. The worlds had not changed--I had. I sat there, counting pieces of roadside garbage and debris, and then I just drove for a while. I arrived at my parents' house three hours late.
In 1997 I was travelling with my family in Prince Edward Island. We were driving down a road where they had clearcut the sides of the road where there had been principally spruce trees. The large branches had been piled along the roads with the ends facing the road and the leaves or the quills had all rusted and turned brown.
As I drove down that I immediately fell into a trance in which it seemed to me like I was right back in Rwanda and what was piled beside the roads were the bodies of dead and decaying Rwandans. It was so overwhelming that I in fact had to stop and for a considerable amount of time took a lot of support from the family to be able to re-establish myself in my state.
PTSD is an injury. It is recurring. Whether you miss your medication or your therapy or at times even when you think you are fully taking the medication and therapy, you are continuously vulnerable to fall back into those states of shock, those states of horror, and you lose completely a sense of reality of where you are and ultimately you panic. If in a state of depression as you fall into that state, you are susceptible to suicide.
When the CF clinics were being established, two errors were committed. They insisted on calling them mental health clinics although they are now called operational trauma and stress support centres, which is a much preferred location to visit if you are a soldier with psychological problems, because of the stigma attached to mental health issues. PTSD is not an illness, it's an injury.
The second, and perhaps the most serious barrier, is the location of these clinics. The soldiers, as with anyone with a personal health issue, wish to maintain their anonymity. Being forced to report to a base location clearly identified for the treatment of psychiatric or psychological problems causes members to decline self-identification of poor psychological health or treatment. Some request release rather than undergoing the feeling of embarrassment of reporting to these locations and the perceived jeers of fellow soldiers. They are even willing to leave the Canadian Forces.
Early detection and treatment of operational stress injuries are absolutely essential to any recovery or state of “rationality”. The Canadian Forces have responded to this requirement very well and have established procedures to attempt to detect injuries. However you have read and have been told of cases falling through the cracks and this is a fact. This happens because the individual may want to fall through the cracks; some injured personnel wish to totally disappear from any sort of tracking system and contact with their former colleagues who remind them of the problems they are experiencing. This is the existing stigma of the injury taking over their thinking as they feel highly stigmatized even today.
The others are reservists who live far away from urban centres or military bases. There is no formal way to compel these individuals to continue to report or to provide funds for them to do so unless they are released and have come under the care of Veterans Affairs Canada. When it comes to care, they suffer from lethargy that could lead to serious behavioural problems and sometimes even cause them to be a danger to society.
I believe that the Canadian Forces Health Services are geared, in practice and thought, to a philosophy of repair and convalescence leading to rapid return to duty and this is how things should be to remain operational. But, operational stress injury repair is not a knee replacement followed by physiotherapy. This injury requires long-term and essential support before a reasonable amount of convalescence can be achieved, but it may also require specific assistance in order to allow individuals to survive on a daily basis without returning to a state of shock and stress.
I do not believe we have achieved the same level of excellence in this area of medical care that surgeons and dentists are demonstrating. This is a whole new dimension of military health care and something they are not, and may never be prepared to cope with, since wars continue to significantly change over time.
There are discussions about failure to attract the required specialists to the Canadian Forces because of low pay compared with their civilian counterparts. This is not entirely the case, because joining the Canadian Forces and serving Canada is a vocation, and remuneration has always been secondary for specialists, as well as for the general military population. However, responsible remuneration is required.
In any case, the large numbers of psychiatrists and psychologists required to treat the volume of soldiers returning with operational stress injury requires specialists in the civilian sector to pitch in significantly. There are civilian specialists working in some multidisciplinary Canadian Forces clinics, but I am told the turnover is high because the civilian specialists are not all geared to the Canadian Forces working environment, its rules and regulations, and a command hierarchy that from time to time overrules their expert opinion.
The matter of the various civilian pay scales has been mentioned to me. Apparently, a civilian specialist working for the Canadian Forces earns considerably less than one at a community clinic funded by provincial health plans in many parts of the country. Of interest from statistics provided, a psychiatrist in Alberta can earn as much as $195,000 a year, while the top salary in Quebec is $97,000 a year. The national average is $159,000, with Treasury Board topping out at $128,469. From this you can see that someone working full-time for the Canadian Forces will earn almost $29,000 less than the national average. Yet the Canadian Forces don't seem to have a problem in Quebec, seemingly.
Turning the problem over to external health care providers is not an ideal solution, because the Canadian Forces lose control of the service, and it is invariably more expensive than an in-house program.
I am not sure if the committee has been told of the spectrum of operational stress injuries. Not everyone has PTSD. I am told that, of the vast number of OSI cases, less than 8% are classified as PTSD.
However, I am told that a benign case of minor depression can become acute, then chronic, leading to addictions such as alcoholism, drug abuse, inappropriate compulsive behaviour and eventually PTSD, if not detected and treated as a matter or urgency. Treatments that cost a few thousands dollars in the early stages end up costing small fortunes and the individuals may well lose their family, employment and ultimately life as a result of a system's failure to act with the same urgency as for physical injuries. Regrettably, there are inherent delays in getting treatment because of scheduling delays with specialists' appointments. The multidisciplinary approach to treating stress trauma seems to be the most appropriate as it is used in the most successful clinics.
When the Canadian Forces introduced the requirement for a patient to have psychological analysis before being referred to a psychiatrist, some saw this as a method of determining if a soldier was faking the symptoms in order to claim PTSD benefits. Fortunately, specialists are very capable of determining who is genuinely ill or not; they rarely ever need a second opinion. However, the requirement to see a psychologist before a psychiatrist doubles or even triples the time required for treatment to begin because psychologists are in equally short supply, so in seeking the preferred solution we have exacerbated a serious situation by further delaying timely care to the injured.
I shall bring just a few rapid recommendations, if I may, to this committee. I take full note of the House of Commons veterans affairs committee's report and some excellent recommendations therein in regard to closer joint work between Veterans Affairs Canada and the Canadian Forces health services.
I believe it is absolutely essential that the Canadian Forces clinics be moved off the bases and that, if necessary, they even be co-located with either Veterans Affairs Canada clinics or other civilian clinics within the communities. The bottleneck of having patients only begin treatment after seeing a psychologist, to undergo a very lengthy evaluation before a psychiatrist can be seen, needs to be broken. There needs to be a more rapid way of treatment, of identifying those who need the support.
The health of reservists must be tracked for an extended period of time, even up to five years after returning from a special duty area. Of the twelve officers who joined me in Rwanda at the start of the genocide, nine of them have fallen to this injury, the last one nine years after the fact.
We should reduce the number of tours or give more time to family support.
Please look at the charts I have given you. These are not scientific; these are based on my tour when I was the assistant deputy minister of personnel and the results we were looking at then. One chart is sort of a normal chart of stress, which would be a simple curve with the families evolving over the normal period of careers. That was certainly during the Cold War, and you add a bit more stress when you have spousal employment or kids who don't want to move because they're in high school. However, in the 1990s we entered a completely different scenario that is continuing to be exacerbated today.
We are not bringing people down from the exponential curve of stress after these very complex and dangerous missions, with enough time and enough support for them to be able to evolve to the next mission, with this backdrop of saying it was tough, but we lived it, we have gained experience, and we're ready for the next one. What we are seeing, because of the rotations going so fast and the smallness of our forces and the tempo, is that one set of stresses simply leaps onto the other and ultimately it creates a scenario where families and individuals literally crash. And in fact we have even seen cases of suicide.
The Canadian Forces has instituted an excellent decompression program for groups returning from special duty areas such as Afghanistan, but it has no structured program for the large number of individual augmentees who deploy and reinforce these formed units and subsequently return. My son is due back in a couple of weeks from six months in Sierra Leone in Africa, and there is no such program established to bring them back into a level where we can assess them and also provide a level of normalcy.
It is recommended that the Canadian Forces be tasked to address this issue of the large number of individuals who are far more vulnerable than those within formed groups to actually feel the ultimate contagion of post-traumatic stress disorder. The issue is that they are not identified and subsequently not treated or treated too late, by which time they have probably self-destructed, destroyed themselves and their families.
DND and Veterans Affairs Canada should jointly build a national research training development centre in Ste. Anne. I would like to recommend that the institution at Sainte-Anne-de-Bellevue Hospital be a place that is the repository of the experience and the knowledge so that we don't fall into the same problem we did the last time, which is to take over ten years to be able to rebuild a system in order to take care of those injured by the psychological impacts of conflict. We have to maintain an expertise throughout.
My last point is there has to be a way of introducing the families in a formal way into the treatment process. Treating only the member, and not the families, is not going to achieve the operational levels we are hoping to achieve by bringing those members who have been injured to a level where we can reuse them.
I leave you with the following comment as my ending. When I came back in 1994 from Rwanda, my mother-in-law told me she would not have survived World War II if she had had to go through what my wife and children did.
In World War II my father-in-law commanded a regiment and was in the field throughout. On occasion they got a bit of information, and that little bit of information was often censored.
However, today our families live the missions with us. They are continually watching the TV, listening to the radio, and clicking to find out when it will be announced that their son, daughter, husband, or spouse has been killed, injured, abducted, or whatever. When we come back from those missions, they are not the same as they were before. Nor are we. A system that cannot absorb the responsibility of sending the individual into these mission areas, taking care of that individual when he comes back, and taking care of the family that we put through the wringer is a system that has a major deficiency.
I realize fully the problematics between federal and provincial, but that should not prevent us from maintaining operational effectiveness of our Canadian Forces by providing support not only to the members but also to their families. This makes our forces that much more effective.
Thank you.
