I'm Dr. Greg Passey. I served for 22 years in the Canadian Forces until September 2000, first as a general duty medical officer, then, in the last nine years, in psychiatry, with particular expertise in post-traumatic stress disorder and associated operational stress injuries.
I did the first large-scale research project in the world to investigate PTSD and major depressive disorders associated with peacekeeping deployments. This was conducted on Canadian military personnel in 1993-94 deployed for Operation Harmony and Operation Cavalier in the former Yugoslavia.
Prior to that, there was a general awareness that there were psychological injuries and costs associated with conduct in combat operations. In 1990, in their book Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939-1945, Copp and McAndrew detailed how about 25% of all Canadian military casualties during the Italian campaign in World War II were neuropsychiatric, or what we would now call operational stress injuries.
My research in 1993-94 for the Surgeon General and the Canadian Forces Medical Service revealed a depression rate of 12% and a PTSD rate of 15.5%, or an overall 20% rate of either or both of those disorders in one combat engineer regiment, the 2nd Battalion, Princess Patricia's Canadian Light Infantry, and the 2nd Battalion, Royal Canadian Regiment, upon their return home from peacekeeping duties. This established that there was a cost beyond the expenditure of money, equipment, and physical injuries when conducting peacekeeping or peacemaking military operations.
These figures shocked the military, and its upper echelon was very resistant to addressing these new findings initially. The immediate response seemed to be to try to find ways to ignore or question the validity of the numbers rather than starting to initiate a plan to acquire and reallocate medical resources to address a looming health care issue within the military.
Recommendations by me and other health specialists in regard to the acquisition and placement of multidisciplinary medical teams with the brigades and on deployments were largely ignored until the Croatia board of inquiry results were released and General Dallaire, in 1997, publicly disclosed his diagnosis of PTSD and became a strong advocate for mental health assessment and treatment within the CF. Even so, it was not until 1999 that the operational stress injury clinics were finally initiated, although CFB Petawawa did not receive one.
Recent research indicates that the PTSD rate in Canadian personnel returning from Afghanistan is about 5%. This would potentially generate 250 new PTSD cases per year. American casualty rates in Iraq indicate that their regular forces have a PTSD rate of 17%, and for the National Guard it's 25%. This duplicates my finding that reservists are more at risk of developing PTSD. In Canada we utilize a high proportion of reservists on our deployments, yet the medical system and follow-up for them is lacking compared with the regular forces.
Failure to provide access to military specialists who can diagnose and treat PTSD has significant cost to the units, individual soldiers, and their families, and potentially can result in lawsuits. In 1994 it was reported in The Medical Post that the Ministry of Defence for Britain agreed to pay 100,000 pounds to Corporal Alexander Findlay for not diagnosing and properly treating PTSD.
In 2002, in the National Post, it was reported that Sergeant Peter Duplessis launched a lawsuit against the Canadian Department of National Defence, and in particular Dr. Boddam, for failing to diagnose and treat his PTSD. This was particularly important because from 1995 until 2008, Colonel Boddam was the practice leader for psychiatry and mental health in the Canadian Forces. As such, he advised the CFMS on the size, placement, focus, and direction of mental health resources within the military.
Colonel Boddam admitted in the examination for discovery in 2003 that he did not ask questions that would enable him to diagnose PTSD. This case subsequently settled out of court for a sizeable amount, but Colonel Boddam retained his clinical and advisory positions. There were other individuals with similar circumstances who would have also launched lawsuits, but they were precluded from doing so because of the statute of limitations. At the present time, there are other lawsuits against the CF that are either proceeding through the courts or are in negotiations for settlement toward PTSD.
Competency remains an issue in the delivery of care to our injured soldiers. For example, Corporal A was recently assessed four months ago at an OSI clinic and diagnosed with PTSD. During the assessment he admitted to drinking alcohol a lot, but the specialist did not quantify how much, nor did he ask about the corporal's suicidal ideation. This is important, because excessive alcohol intake often precedes a suicide attempt.
Corporal A was quite suicidal and is fortunate to still be alive today, only because of the intervention by another experienced clinician. About 49% of individuals with PTSD have suicidal ideation, and about 19% will actually attempt suicide.
The CF has made significant progress with the establishment of the OTSSCs and the OSISS network screening procedures, and certainly General Hillier's recent CANFORGEN is spotlighting mental health before he leaves.
Nonetheless, there is evidence that the clinical resources are swamped. This was confirmed in my conversation two days ago with a doctor deploying to Afghanistan from CFB Valcartier, where there are wait lists for treatment. I educate all the medical staff who deploy to Afghanistan and who attend the Vancouver General Hospital traumatic treatment centre.
In addition, most of the assessment and treatment of OSI is now done by civilian specialists contracted to the CF or VAC. Acquisition of these resources is in direct competition with civilian health organizations, and as such many of the hired specialists do not necessarily have the clinical experience or military environment knowledge to provide optimal care.
There are a number of issues that I wanted to address. One is the stigma associated with mental health and OSI diagnosis. One recommendation is that the Canadian Forces should adopt a zero tolerance policy in regard to discrimination with OSI diagnoses in the same way they have instituted zero tolerance for either religious or gender discrimination. We need to change the terminology from “mental health”, which has a high stigma attached to it, to “neurological health”. We also need to develop a specific program to retain individuals within the CF when appropriate, such as reclassification to other military jobs.
In regard to experienced clinicians, I think it's important that the CF and VAC both sponsor a yearly national conference wherein all clinicians providing mental health care can attend and receive continuing education credits addressing assessment and treatment issues, military culture, deployment stressors, continuity of care, and transition to civilian life, with a forum for clinician feedback. There needs to be special orientation for civilians who are hired, and there needs to be ongoing recruitment of clinicians who have at least two to three years of experience. But beyond that, there needs to be a mentor program to help the less experienced clinicians.
There also needs to be the development of a quality assurance program in both the CF and VAC in regard to health care delivery that has input from the members, their families, and other clinicians.
In regard to reservist care, I would recommend that a health care specialist be appointed to specifically oversee the delivery of health care to reservists, and further, that there be the development of a tracking system and policy to ensure at least two years' follow-up, especially for those who leave the reserves.
Then there are ongoing issues in regard to continuity of care during transition, which we heard about from General Dallaire. There needs to be further development of resources for family members.
Thank you for your time.