National Defence Committee on May 29th, 2008

[Bonnie Brown, Liberal, Oakville, ON]

Thank you, Mr. Chair.

Thank you, General Dallaire.

I want to pick up on this professional help, because obviously this is the answer to getting people back on their feet and functioning well. You say that it's not the remuneration that is the problem with getting psychologists and psychiatrists. It seemed to me that in your list of things, the one that struck me was this business that the diagnosis or the treatment plan of such a professional might be overruled by the command structure, and you referred to that again in your most recent comments.

It would seem to me that if we could get rid of that, I think we'd get a lot more psychiatrists from the general community as well as within the armed forces, because these professionals don't necessarily have this vocation to serve in the Canadian Forces. They have a vocation that is elsewhere. It is to heal the mind and spirit of the patients who come to them, and to restore them to a state of responsible self-determination and health and ability to move forward.

So what we have here is a conflict between the vocation of a mental health professional and the culture of the armed forces, which tends towards conformity, obedience, brotherhood, and honour defined in a certain way. My guess is that a mental health professional might define “honour” quite differently from a military professional.

So how you bridge that gap, to me, would only be if we could get these external people to have freedom of treatment, not interfered with by the command structure. What do you think of that?

[Senator Roméo Dallaire]

In fact there has been CANFORGENs—I suppose you're familiar with the term—that have been issued by the Chief of the Defence Staff over the years, where the chain of command has no authority at all into the medical support that an individual gets. However, when we use chain of command, it's often used in the informal way; that is to say, it's not necessarily by order and directive, but it's by the boss: he's a warrant officer and I'm a corporal, and the warrant officer doesn't like anybody talking about PTSD or anything problematic of that nature. So the chain of command is not something that turns on and off, but a lot of the informal authority that still remains is a significant influence.

That's why I argued that there has to be a deliberate culture exercise, an attitudinal exercise change within the forces in order to ensure that both veterans and non-veterans are on line in regard to that injury and its honour as an injury, just like a physical one. That's on the in-house side. So there's a continuum of culture shift that absolutely has to be implemented and responded to, and not be ad hoc, which too often happens, and the supervision thereof.

In regard to the therapist, when I was working with the VAC side of the house, one of the first things we realized was that some of the therapists had enormous problems with the patients they were seeing because they didn't know how to talk to them. So there is an apprentissage that the therapist has to go through in learning the jargon. One of the things we insisted on is that in every one of the clinics they have a retired warrant officer or sergeant to explain the culture of the military, what its background is, the ranks, the acronyms, and so on, so that the therapist is able to move into that milieu with more comfort and not look foolish.

One of the first things we realized was we needed to sell the forces patient, this unusual patient, to therapists who are used to civilians. One of the answers we did look at was looking at those therapists who work with police, firemen, paramedics, people like that, and trying to bridge the gap on how they work with those specialists and how they could work with the forces. But the overriding factor is some of them just don't want to find themselves in a complexity that is not within the norm of patients. And that then falls on us to sell the product much more effectively.

[The Vice-Chair, Bloc, Claude Bachand]

Thank you, General for your critical testimony. The committee encourages you to continue your excellent work. You have an exceptional presence, and you use it to help those the most in need. Thank you for appearing before our committee today. We want to say good luck, and until the next time.

[Senator Roméo Dallaire]

Mr. Chairman, thank you. I simply want to remind you of one thing, namely that families are absolutely crucial. My family had to receive care. We are still experiencing this situation today. So please, don't forget how important the family is.

[The Vice-Chair, Bloc, Claude Bachand]

We will take that into consideration.

We will now suspend our proceedings for a few minutes.

[The Vice-Chair, Bloc, Claude Bachand]

We will now continue our deliberations.

Welcome to the Standing Committee on National Defence. As you know, we have an hour together. I don't know how much time you need for your presentation, but the shorter it is, the more time you will have to answer members' questions.

[Fred Doucette, As an Individual]

I don't think we're actually here as a group.

[The Vice-Chair, Bloc, Claude Bachand]

Will each one of you make a presentation? If so, can you please limit yourselves to five minutes each?

Go ahead, Mr. Doucette.

[Fred Doucette]

My name is Fred Doucette. To start with, I'm here as Fred Doucette, former soldier, not as a DND employee. As the questions go along, I guess we can segue into the work that I do.

I joined the army in 1968 and served until medically released in 2002 with PTSD. I did not meet the universality of service, in that I could no longer deploy outside Canada. By 1999 I had served on six overseas missions: Cypress in 1973, 1974, and again in 1986; 1995 with UNPROFOR; 1996 with IFOR; 1999 with SFOR; and a year as a military observer in Sarajevo, where I was wounded in July 1995.

I served on domestic operations such as the federal prison strikes in the 1970s, the 1976 Olympics, Oka, the Swissair Flight 111 recovery, and the ice storm, to mention a few.

I began my recovery when I was diagnosed with severe chronic PTSD in 2000. At that time, I requested that I not receive any therapy from a military practitioner. My reason was based on my visit with the base social worker to sign my referral to the OTSSC in Halifax.

I was a proud, well-trained infantry officer who had made a very difficult decision to admit to a mental illness. The base social worker began by asking me my symptoms. When I got down to the one that was concerned with my emotions, I said that they were all over the place. And his response as a trained professional was that I was just getting old.

If it weren't for the coffee table between me and him, I would have probably hit him. I told him to sign the--expletive--paper and left. And I never went back inside the base social work office again.

My therapy began in July 2000 with a civilian practitioner in Fredericton. By the time of my release in October of 2002, I was 100% healthier, and I've never looked back.

Since 2002 I've been employed as the operational stress injury social support coordinator for New Brunswick and P.E.I. I've dealt with approximately 500 soldiers and veterans and currently have about 120 active peers on my phone list.

[The Vice-Chair, Bloc, Claude Bachand]

Mr. Passey.

[Dr. Greg Passey, As an Individual]

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.

[The Vice-Chair, Bloc, Claude Bachand]

Reverend Studd.

[Rev. Allan Studd, As an Individual]

Mr. Chair, I am the Reverend Captain (Retired) Allan Studd. I'm an Anglican priest and a retired Canadian Forces chaplain and a marriage and family therapist.

I am the son and grandson of career members of the Canadian Forces. I grew up on base at Wainwright, Borden, and Oakville.

I was ordained to the ministry in 1979. There were attempts at that point to get me into the military chaplaincy, but it was not until 1994 that I began to work as a chaplain at CFB Petawawa. I was commissioned as an officer and a chaplain on August 4, 1995, with the 1st Air Defence Regiment, which was a reserve unit in Pembroke, Ontario, and an asset of 2 Combat Mechanized Brigade Group at Petawawa at that time.

I served on continuous class B contracts as garrison chaplain and then chaplain to 2nd Combat Engineer Regiment and 1st Air Defence Regiment. Later I was posted to base chaplain and chapel life coordinator. I was medically released on October 30, 2002. I have PTSD comorbid with major depression and migraine headaches.

I concur with everything that General Delaire told us in his presentation. Very quickly, remember that between the years1994 and 2000, CFB Petawawa was returning from Somalia and saw the shutdown of the Airborne Regiment. They were just returning from mop-up operations in Rwanda. We were deployed in Croatia. Later on we deployed to Bosnia and did that twice. We deployed as well as aid to civil power, to Winnipeg during the Red River flood, and the ice storm in eastern Canada. We took the DART team to an earthquake in Turkey and Hurricane Mitch in Honduras. Finally, we deployed to Kosovo and managed another refugee crisis there. Somewhere in there, I was seconded as well to the American forces and I served as chaplain to Fort Sherman, the Panama Canal Zone, for a jungle operations training course.

I go through this because this is only a list of the extraordinary deployments. It says nothing of the regular training cycle of the Canadian Forces that takes soldiers away for extended periods of time. And through all of this, the military families suffered, and as chaplain I daily dealt with, counselled, and provided therapy to members, their spouses, and their families, as those families splintered under the strain.

Alcoholism, Internet chat rooms, infidelity, domestic violence, financial difficulties, brushes with the law, injuries as a result of automobile accidents, depression, mental illness, eating disorders, home sickness, illness of immediate family members, death of immediate family members, Gulf War syndrome, PTSD, suicide and the death of my own engineers while serving in Bosnia, all of these I dealt with daily, any time of the day or night.

In March 2000 I left the base exhausted, an exhaustion that after eight years I still have not fully recovered from, and I returned to a family that no longer knew me. The frenetic pace of operations, the breakdown of the day-to-day operation of the chaplain team in Petawawa, the constant stress of trying to be a caregiver, a 24/7 on-call work style, and a well-documented case of harassment left me a mere shell of who I had been in 1994.

This is a snapshot of the military family and what General Delaire was trying to impress upon us. When asked by SISIP what I would like to participate in for vocational retraining, I elected to attend a 24-month post-masters clinical training program in marriage and family therapy. I understood that I hadn't had the skills and training needed for the task of providing counselling therapy to the military families of CFB Petawawa.

I also knew from personal experience of the toll taken on the military family by members returning with post-traumatic stress disorder. So at my own expense I participated in a clinical week at the Veterans Administration National Center for PTSD in Palo Alto, California. Both my military and civilian training to this point had led me to become deeply concerned about this particular disorder. I was not yet ready, however, to admit that I was affected myself. That came later.

Today I sit before you as a marriage and family therapist. Family therapists are core mental health clinicians trained to treat disorders commonly faced by returning service members and veterans.

In my training I received 500 hours of supervised training in a clinical setting. In fact, as a discipline we received more supervision of our clinical work than any other discipline, including psychologists, psychiatrists, and social workers. Our supervision ratio is one hour for every five completed and it is not matched in any other profession. I have the professional equivalent of a PhD. I have completed almost another 500 hours of supervised counselling therapy since leaving there.

I had hoped I would be doing this so that I could get back to the military family. The Canadian military, however, views mental health care for our soldiers through a 1950s lens. It's a lens that says the only professional able to provide mental health care is a social worker, a clinical psychologist, or of course a psychiatrist, and there is a disturbing vacancy rate.

I want you to know that my colleagues are ready to offer professional mental health care to our CF members and their families. Marriage and family therapy has been recognized as a discipline since 1942. We have the only training where the focus is relational. It recognizes that all mental health problems exist within a system of relationships and what affects the individual affects the whole.

Marriage and family therapists are highly trained mental health professionals. We use evidence-based methods of therapy. That means that a method has been thoroughly studied and peer-reviewed before it goes into practice. We are able to work with a whole range of mental health problems, from depression, PTSD, and occupational stress injuries to relationship breakdown and mental illnesses such as schizophrenia. All of us have a master's degree and many of us have much more than that. We are collaborative as well, meaning that we work closely with all other health professionals. MFTs can be found in private practice, hospital settings, family health teams, and community based agencies. You name it, we're there. We're also inter-professional. Our initial training and experience can come from any of the helping professions. Mine came from the ministry. We are closely regulated through the American Association for Marriage and Family Therapy and we are required to have exhaustive core competencies.

It's deeply frustrating for me that after another five years of post-graduate training I have not been recognized as properly trained to do all the things I was expected to do as a chaplin. I have found it impossible to get myself hired to help in the mental health clinics for our soldiers.

The Americans have recognized us. We are recognized by both the Department of Defense and the Veterans Administration. The DOD has just recently opened 44 MFT positions across that country to work with its members. In fact, I myself have been asked during the past week to consider joining the mental health clinic at Fort Drum, New York, just a few hours south of this city, in order to fill one of those positions. I can tell you, I would much rather travel the 45 minutes to CFB Petawawa than the four hours to Fort Drum to do the same job.

I am here today as a person who grew up in PMQs. I'm here as an army brat and I'm also here as a chaplin who has agonized over how best to help our military members, veterans, and their families, and I am here as a person who himself is affected by post-traumatic stress.

The way I chose and the way I think would help solve a lot of the things we've heard spoken about today was the way of marriage and family therapists. We are extensively trained professionals who are the best of what the mental health profession has to offer.

My presence here today is endorsed by the Registry of Marriage and Family Therapists in Canada. I want you to know that there are 1,000 registered members in Canada. I know that many of them would want to work with the Canadian military.

I would like to recommend that the Department of National Defence institute as a policy the hiring of registered marriage and family therapists to work as psychotherapists in the mental health, PTSD, and occupational stress injury clinics. I would recommend as well that DND develop a relationship with the Canadian registry of MFTs and its training centres, so that military health providers can receive training in marriage and family therapy to better help the military members and families. As well, mental health positions could be filled with graduates from those centres.

l want only the best treatment for our soldiers who suffer from PTSD and OSI. This was my motivation in seeking out what l knew to be the best training. I want to assist our soldiers, veterans, and their families. l am so convinced of this that l would be happy to make some introductions between the National Defence staff, Veteran Affairs, and key voices in my profession.

Ultimately, I would like to pursue the goal of ensuring that there are registered marriage and family therapists on staff at every base and every regional veterans centre to fill the void that exists in most places today.

Thank you for your attention, and thank you for inviting me to be here today.

[The Vice-Chair, Bloc, Claude Bachand]

Thank you.

Mr. Regan.

[Geoff Regan, Liberal, Halifax West, NS]

Thank you.

Thank you for having given the witnesses the opportunity to make their statements. It was very beneficial for everyone.

I would like to thank all three witnesses for excellent presentations and for coming today. Along with General Dallaire, all of you have given us much food for thought. I hope that this will have a positive impact on the future.

I want to start with Dr. Passey. First of all, what do you think is the answer is to the situation you described where the upper echelons were very resistant to the findings you had? This could be asked about perhaps any department when it is resistant to change. We see this often in government. Do you have a prescription for ensuring that departments examine things that may cause them to realize it's time to change something?

Second, I don't know if you talked at all about marriage and family therapists in your comments, but would you agree with what we heard from Reverend Studd? I thought that was excellent.

[Dr. Greg Passey]

In response to your first question, you need to realize that all people resist change. Organizations such as the Canadian Forces and the RCMP are steeped in tradition. It's very difficult to implement new types of programs, particularly if it goes against a belief system. The belief used to be that only weak people would develop PTSD. I deal with torture victims, immigrants, etc., and I can say that there's no person on earth for whom we cannot devise a situation that will cause him to develop PTSD.

The issue of change is difficult in the military. One of the things that's necessary—and I have to congratulate the military on the job they're doing here—is education. Education is occurring at the basic training level, at leadership levels, and at the higher levels. At this point, I believe they're embracing it. Certainly General Hillier's recent CANFORGEN would support this. He's actually pushing it.

When I came out with my study, there was huge denial going on, and it was very difficult to present the findings, let alone change anyone's mind. So I think the military has come a long way, but anytime you attempt to change a belief system and an organization steeped in tradition, it becomes very difficult. It's all about education. People are quick to judge. It takes a lot of energy to understand and become educated about something.

In regard to Reverend Studd's comments, I agree with him. In regard to a PTSD, like alcohol, it does not just affect the individual, it affects the supervisors, the co-workers, and the family members. We're talking about relationship issues. There are just not enough psychiatrists and psychologists around. I would certainly embrace any other profession with credible credentials that can do this type of work. Way back in 1993 I recommended that we have multidisciplinary teams approach this disorder and the evolution of it.

I would certainly agree with what he had to say. On the civilian side, we typically work with multidisciplinary teams. That is the best way to address this problem, which is affecting both the professional and personal sides of the individual.

[Geoff Regan, Liberal, Halifax West, NS]

It's good to hear that obviously your research, while it took a long time, led to these kinds of changes in attitude, and undoubtedly there's still change to be had. I think you've all referred to that, but thank you for your work in that regard.

Mr. Doucette, you talked about this, and maybe this falls within that question. You talked about the fact that when you talked to your base social worker, you mentioned that there were emotional issues and he said you were just getting old. Is it your sense now that if a soldier, sailor, or airman went to the base social officer or social worker today, they'd get a different kind of reaction? Are you satisfied that this is the case?

[Fred Doucette]

Yes. Things have changed radically. One of the biggest changes is that the people who are in those desks now have served in those places. The fellow I saw was a sailor, a navy guy, and he had done all those clinical things, so he had no idea what I was talking about as far as I was concerned. But you see it all through the chain of command. The people who are in the positions now have served in the Bosnias, the Rwandas, the Somalias, the Haitis, and the Afghanistans. So you have that knowledge, and they've been exposed to what the soldiers are exposed to.

It was a learning curve, but it's nice to see that General Hillier.... He and I were in IFOR together. He saw what I saw. So guess what? He appreciates it. So that's where a lot of the learning has come from. I think the fact is that they're coming to realize now that it's the cost of doing business. If a paramedic or a fireman walked up to you and said “Yes, I'm trashed, I have post-traumatic stress disorder”, you could understand that. Well, why not a soldier?

It has changed. In the six years that I have been involved with the OSIs program, I've seen amazing things happen.

[Geoff Regan, Liberal, Halifax West, NS]

So for the foreseeable future, you're satisfied that those kinds of positions will very often be filled by people who understand because they've been there. The question that occurred to my mind was that we've had all this experience in the last decade or so, and if there were a period when we didn't have that experience, then you would not have people like that. But I guess that's not today's problem, in a sense. I think it's important to be sensitized to this, but you and I can't ensure that the people running the military in twenty or thirty years are sensitized. I don't know how you do that exactly.

[Fred Doucette]

The thing is, one of the key things about this injury is the first word in it, “post-”. The numbers probably ramped up radically after Dr. Passey put his study out. It would be great if it were “pre-”, because then we could screen them so they wouldn't get this illness, but it's “post-”, and the post can come six months, four months, ten months, four years, five years after. I spoke to a veteran who was 82 years old, who was having the symptoms of PTSD because he was now retired, sitting on his front porch, and his memories were coming back. He told me, “Fred, the shadows are starting to have faces”. That's 65 years after the war. So this is the gift that keeps on giving.

So however we maintain that knowledge, hopefully as the operational trend may die down that expertise doesn't drift off or we start saying let's not pay attention to it because it's not the flavour of the day. That's what we've always been afraid of: once we get out of an operational tempo that's not as heavy as it is now, the concern and the focus over mental health within the military will drift off. So it has to be maintained, I would say.

[The Vice-Chair, Bloc, Claude Bachand]

Thank you, Mr. Regan.

Mr. Bouchard, you have eight minutes.

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

Thank you, Mr. Chairman.

I would also like to thank our witnesses for being here today.

Dr Passey, I have an article here written by Mr. Stéphane Guay and which was published on February 18, 2008. It is entitled “Les militaires consultent peu les ressources en santé mentale” [military personnel rarely turn to mental health experts]. The article states, among other things, that the suicide rate within the military is double that of the general population.

Should we be concerned about this statement? In your opinion, do military authorities care? Based on what you have observed within your practice, if the suicide rate is not twice as high, is it nevertheless higher than in the general population?

[Dr. Greg Passey]

It's a very good question, and it's something I've revisited on a number of occasions with the military.

First off, should we be concerned? Absolutely. A suicide death is a preventable death. If there are adequate resources available and they're accessible without stigma, and they're also experienced and competent, then a lot of these suicides could be prevented.

The military should have a much lower rate of suicide than the normal population. We don't have the very elderly. We don't have the people with cancers, the very ill, the alcoholics, the drug addicts. There's a whole host of people who typically have high suicide rates, and in the military we don't have that. We've done screening out, we've been looking for people who can handle stress. For the most part I feel that our troops are well trained.

We have to have a look at what is actually causing these things. Is it the deployments? Is it the tempo? Sometimes the stressor is not necessarily the deployment. It may be the stress that is affecting the family and is then transferred back to the individual. Again, we need to be looking at more than just the individual. We need to be looking at the family as a whole and the support system in that regard.

I think, compared to where we were.... I keep saying “we”. I'm out of the military, but you can't get the military out of me. I think we've come a long way in regard to mental health. I think we can go further.

Again, I think the regular force members have much better support than they used to, but my big concern right now is with the reservists. These people come back and they may leave their unit. They become civilians, and then they're lost for follow-up and they're lost in the statistics.

How many times have you read about a young individual who crashes their vehicle or motorcycle at high speed? That's never classified as a suicide, yet I can tell you right now, a significant number of the individuals I see, military and ex-military, engage in very high-risk behaviour, and they do not care if they die or not.

So the reservist issue is a huge one that I think we need to address much more than we have to date.

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

Dr Passey, some time ago, during the mission in Afghanistan, soldiers were sent into combat for a six-month rotation, and then they came home. However, I have heard that the rotation period is longer today. It is nine months or even longer. So there are two approaches. I think this is because it is difficult to recruit new military personnel and because the mission has been extended until 2011.

In your opinion, is it better to have six-month rotations, and to repeat them more often, rather than having nine-month rotations? What do you think would be the better approach to reduce cases of post-traumatic stress disorder?

[Dr. Greg Passey]

It's difficult. On the one hand, if you have shorter tours of duty, given the small size of our army it means that people are going to have to rotate back into theatre much sooner. The advantage of a longer tour of duty, nine months or a year, is it allows other people back here in Canada a little bit of extended time before they have to start gearing up for training, so they have perhaps a little more time with their families and stuff.

The flip side of that, though, is that the longer you're in theatre, the more you're exposed to traumatic events. And we know that it doesn't have to be just one traumatic event. We know that the cumulative effect of stress can actually cause PTSD or other sorts of OSI.

The ideal--and it's what I had recommended way back in the nineties--is that the individuals have a minimum of two years, but preferably three years, in between the tours. The problem is that often there are certain MOCs or occupations for which there are just not a lot of trained people. When I was still in the military in Edmonton, I heard of people getting off the airplane and being approached to actually go back on the next tour.

So I agree with General Dallaire on recruitment. The military needs more numbers in order to better space out and spread out the stress exposures for its troops.