National Defence Committee on May 29th, 2008

[Fred Doucette]

Could I just add to that?

One of my tours was a year long. I was a military observer in Sarajevo during the war. To be honest with you, if you're on any tour of more than six months, as the doctor said, you're going to start having symptoms. I actually started having symptoms of PTSD, but I didn't realize it, nine months into my tour. So I was already ill and was still in theatre. So it just compounds the injury, I think, by lengthening the tours.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

One of the experts who testified before the committee said that each soldier returning from combat should be systematically assessed to see whether there is post-traumatic stress. The witness said this would not be very expensive.

Would you be willing to make such a recommendation?

[Dr. Greg Passey]

Well, there are two parts to this thing.

It is very difficult to screen and predict who is going to get PTSD. They attempted to do that in World War II, and basically you could flip a coin and be as effective as our screening procedures. So it's difficult to predict. Even if you say this person is vulnerable to developing PTSD, it does not mean that he or she necessarily will, and they may actually perform quite well in theatre. So the issue of screening is difficult.

The other thing is that we don't have a whole lot of stupid people in the military. They are actually very bright and well educated nowadays, and if they decide they want to go, for the most part they know how to answer the questionnaires.

The question was asked earlier, but what I found in my research is that 50% of the people I identified as having PTSD rated their emotional and psychological health as good or excellent, which tells me that they really didn't have a whole lot of insight. The problem, they said, was I'm fine, but you guys are all messed up.

So in an ideal world, it would be great if we could actually screen and pick these people out and therefore be proactive and protect them. But I'm not aware of anything that we have at our disposal at this point in time that can actually do that. If a person has severe PTSD and you're observing them, yes, you could probably pick them out. But you have 800 people in a battalion, and you just don't have the time to be doing that, so you'd be doing it by questionnaires, and questionnaires are fallible.

[The Vice-Chair, Bloc, Claude Bachand]

Thank you very much.

We will now go to the Conservative Party.

Ms. Gallant.

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

Thank you, Mr. Chairman.

Reverend Studd, in your opening presentation you observed that the Canadian military views the mental health of our soldiers through a 1950s lens. Would you please elaborate on that statement?

[Rev. Allan Studd]

My experience in trying to come back into the military as a civilian to help in the area of mental health is that I have been told outright, including by lots of people in the social work department at Base Petawawa—by the base surgeon, and by Calian, which does the contract hiring—that there are only certain professionals they recognize as being able to provide the care that is needed. Those professionals are clinical psychologists with a PhD, or a social worker. The social worker, I presume, would have to have a masters-level degree.

That's a 1950s view of who do you go to if you need help, and who do you go to if your marriage is falling apart and you want to get some marriage counselling? Well, you go to a social worker or maybe you go to a psychologist.

What I want you to understand is that there are other mental health professionals out there who are probably better trained and have the training and the depth of experience to be able to work in almost any field of mental health. So that's what I was trying to get at.

I've been very frustrated. SISIP paid for my vocational retraining, and actually paid out quite a bit of money for me to do this two-year course. I had the understanding that I would be welcome to come back into the civil service, and I haven't been able to do that. I haven't been able to make any headway anywhere.

I watch with a little bit of frustration as my colleagues in the States are recognized and are hired to do the work with OSI and PTSD that I'm very capable of doing here, and which I do in my civilian practice.

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

That's interesting. So one of the agencies of our federal government paid your tuition to take this course. Then the federal government, or a branch of it, won't recognize it.

Mr. Chairman, I'll be sharing my time with Dr. Lunney, if time permits.

One thing that jumped out at me during your opening presentation was the amount of first-hand experience you had with the military in the time you served as a Canadian Forces chaplain. Based on what you know now, how would training in marriage and family therapy have helped you cope in your previous role as a military chaplain?

[Rev. Allan Studd]

Chaplains are front-line people. We are the people who are contacted when there is a problem that has anything to do with personnel or family, so much so that when social workers in Petawawa hung up their telephones at four o'clock and went home they in fact left a message on their telephones that said to contact the duty chaplain.

What I was dealing with almost always had family relevance. If there was a problem, it involved the wife and the children, and often grandparents and parents somewhere else, because all these things happen within a relational context.

There are many skills I wish I had had in sitting and helping a couple work through their problems. Their problem might simply be that the member has been away for probably a year, because there's six months of training and then six months actually on tour. He has come back and discovered that his wife, or spouse, I should say, is suddenly taking care of the finances, taking care of the kids, and coping very well, thank you. And he or she--the member--feels left out of the family.

I didn't know how to help with that when I was a chaplain, yet I was expected to. There was a great deal of time spent sitting with couples and sitting with families and trying to help them work through their problems. But I didn't really have those kinds of skills or that kind of training at that point.

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

In speaking to this committee, Commander Dean Milner said that CFB Petawawa is severely understaffed in all categories of medical personnel. With the next rotation to Afghanistan coming from Petawawa, it's critical that we address the shortage of medical professionals now. In your mind, what would it take to get the job done?

[Rev. Allan Studd]

From what I'm hearing, because I also live in the Petawawa area, and from what I'm seeing in my own private practice, it unfortunately is going to take quite a bit. There needs to be an increase in staff in terms of what I believe is called the mental health clinic, although General Dallaire said that they're not using that name any more. A great number of people need to be hired to fill the positions so that the therapy can take place to help all the families that are hurting.

I told you about Petawawa in the 1990s. Petawawa right now is a much more tense place, because you have family members who sort of live daily with the understanding that they might get a phone call saying that their loved one who is serving in Afghanistan has died. There is a lot of stress because of that. It has increased the work for therapists in terms of families and in terms of workplace stress.

[The Vice-Chair, Bloc, Claude Bachand]

I will have to interrupt you there, Mr. Studd.

I would like to give the last two questions to the other colleagues for one or two minutes each. Then it will be over for this session.

Would you like to go, Mr. Lunney?

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

Yes. Thanks.

The time is short, so I'll rush right in here.

With respect to a comment that was made earlier about what has changed in terms of how we're approaching this, we're doubling the number of health professionals, or at least DND is trying to respond to the needs. The pre-deployment training is much better than it was. We had some discussion about that. Now we also have peer counsellors that greet and meet the soldiers on the way back. There's debriefing time and decompression time on the way back. It's a time to talk, as I think you mentioned earlier, and a time to unload, to talk to people before they're released or find themselves back here alone. I'm just wondering, first of all, if you think that's going to help.

Second, really quickly, the mission has changed since we took over, particularly if we're talking about Afghanistan. It was a very tough combat mission when we took over. Now there's less combat. There are cleanup operations and patrols. The biggest problem now, really, is IEDs.

Do you feel that now that the range or the exposure or the difficulty and the nature of the mission has changed, with less direct combat, that the high numbers are likely to drop off?

[Fred Doucette]

Just on the first one, I have two things on the fact that we can't find professionals out there. An OSI clinic opened in Fredericton two weeks ago. Psychiatrists, psychologists times three, social workers times two--found, hired, and in that clinic. VAC found them. Why can't DND find them?

As for the training, there is next to no training psychologically for the soldiers on their pre-deployment training. It's focused on the mission. They don't sit down and say “Okay guys, if we have an IED and one of us is turned into a pink mist, we're going to be able to handle it this way”. They don't do that. I was told by a commanding officer that when I want to brief them on OSIs, brief these young officers leaving the infantry school to go to units, we don't want to teach them to surrender. That was his view of what I was going to teach them.

But when I went through all my therapy as a serving soldier, I wished I had some of those skills they taught me in therapy, how to de-stress, how to focus, how to ground, how to deal with boredom, how to deal with loneliness. There's nothing voodoo about it. I'm better armed now to deal with things like that than I ever was.

So the pre-deployment training is fighting and dying stuff. That's what it is. As for the threats, be it IED, be it somebody with a rocket-propelled grenade, be it somebody with a rifle, it's the threat to life, regardless of which way it comes. It doesn't matter. That's one of the prime things of PTSD--it's the threat of losing your life. You could be sitting in a camp and hear booms miles away. That will trigger the fear that this boom may get closer some day. If you sit there for six months dwelling on that fear, guess what? It's going to manifest, and you're going to end up with a sick soldier.

That's why we have cooks with PTSD. They never leave the camp. How does a cook get PTSD? He's not outside the wire. He listens to things. He gets little snippets of conversations in the meal line, “Boy, we were lucky to get through that today”. So they're getting all these little bits. He goes back after his shift and sits in his bed space at two in the afternoon because he's got to get sleep because he's on at four in the morning and the little wheels start turning. The fear is there; it manifests. That's how a cook gets PTSD.

As the doctor said, there's no way to train a soldier on what a dead body looks like. We can't do it. It's impossible. There's no way to explain what it's like to have one of your friends killed. There's no way to train to see what it's like to come under artillery fire, to hear bullets really coming, to see those puffs of smoke beside you, because we don't want to kill our soldiers in training. Therefore, the learning curve is when they hit there.

[The Vice-Chair, Bloc, Claude Bachand]

We have some time left for a very brief question.

[Brian Jean, Conservative, Fort McMurray—Athabasca, AB]

Merci, Mr. Chair.

Congratulations to you all for your work.

I have a few questions. And if you can't answer the questions today, I'd appreciate it if you would send answers to the chair in writing.

First of all, on post-traumatic stress disorder, I've known that it leads to depression and suicide, but I'm wondering, does it lead to other diagnoses, such as chronic pain syndrome and chronic fatigue syndrome, which I dealt with as a personal injury solicitor in Alberta? It does in personal injury cases. I saw many other diagnoses come from this, and I have to say that the effects are absolutely terrible. The people who have this don't even realize it. They think they're not sane. It comes down to that in part, and I understand that it shows up two to three, even four or five years later.

Mr. Passey, I'm interested in your comments on this in particular. In 2003 you were critical of the then Liberal government in relation to their ability to deal with post-traumatic stress disorder. Are you seeing a change in government as far as a movement toward at least addressing and recognizing the disease? Of course you know the government moves slowly because it's so big, much like the military does sometimes, but are we moving in the right direction with this?

And finally, do we have the proper assessment or measurement tools in place to be able to diagnose it? Are they sufficient now?

[Dr. Greg Passey]

I don't think I actually criticized the Liberal government. I was criticizing the Canadian Forces and its inability to move in a direction I thought was necessay.

Certainly things are going in the right direction. It's much better than it was. There's still an issue around reservists and families that needs to be addressed. We could spend a whole afternoon on this, and I've sat on a VAC committee doing just those sorts of things.

To go back quickly to the comorbid diagnosis, we know that with PTSD about 50% of men will actually abuse or become dependent on alcohol. About a third will also either abuse or become dependent on other drugs. Almost 50% of men and women will also develop a major depression. We know that a person who has PTSD is 90 times more likely to develop physical symptoms than a person who does not have PTSD. We also know that for a peacekeeper with PTSD, the expense to the health services is 37 times more than for a peacekeeper without PTSD. So there is a mind-body link. There is a problem in regard to sensitivity to pain, etc. Fibromyalgia and chronic fatigue are absolutely associated. There is a much higher risk of developing those if you have post-traumatic stress disorder. The comorbid stuff is absolutely there.

You've given me an hour, but I've spent 16 years of my life on PTSD. You've asked the impossible from someone who is improbable at the best of times. PTSD, the assessment, the treatment—we're going in the right direction. Both Veterans Affairs and the Canadian Forces are going in the right direction. I still think that a lot needs to be done. There are still gaps in the number of resources, the competency of the resources, training, acquisition, etc.

We need to think outside the box in recruiting professionals. It may be something like the rural family physicians, where you go in early with training and funding while people are still students. With psychology, psychiatry, you have a real lag time of more than eight years. I think that we need to look at bringing other sorts of professionals onto the team, so that we have a surge capacity, which we don't have right now.

[The Vice-Chair, Bloc, Claude Bachand]

Thank you.

Your presentations were really interesting. There was a nice chemistry among you three, even though you were making individual presentations. We really appreciate it. It was very useful.

Be careful on your way back. Thank you.

The meeting is adjourned.