National Defence Committee on June 12th, 2008

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

That's in an operational sense, and I appreciate what you said about the complexity of picking up these things ahead of time. People are different. How they cope is different. Their family support levels at home are all very individual, I'm sure.

We heard when we were over there--and I can see how this would happen--that soldiers often go with minimal sleep. They're young, and of course now that we're into electronic gadgets I guess sometimes they pack them along with them, and when they should be sleeping they're sometimes occupied with games, computer stuff, and so on. And we all know we need to sleep to replenish neurotransmitters. So here's an operational stress that they're under when they're over there in the sense that they're not getting sleep, first of all. Then if you combine that with any alcohol or substance issues that a subset of soldiers may be caught in, now you're really complicating the neurological components.

So my question here really is, what comes out of the molecular world? Even if you took the group here and you stuck us with too little sleep...which does happen here, by the way; you probably should do a study on members of Parliament. But regarding your soldiers who are going through too little sleep and extraordinary stresses, is anybody looking at the nutritional requirements of these guys in terms of giving them some extra nutritional support? I can hear “evidence-based” coming back at me. But you have a subset that might be worth studying in terms of giving them some additional nutritional support for their neurological system, like Phosphadityl Serine or Acetyl-L-Carnitine or neurological components that are known to support the nervous system, B vitamins and so on. Is anybody looking at that? And are we doing any primary research? And if not, why not?

[LCol H. Flaman]

That's out of my field.

[Cdr D.R. Wilcox]

I can talk to you about sleep deprivation, because DRDC Toronto has an ongoing research project to assess sleep deprivation. They used a software package called SPSS. They can model the amount of sleep deprivation and relate it to cognitive functioning.

They did a study on long-haul transport pilots, and they finished that study. Right now they're working on submariners. The submariners work six on and six off. They found that was a highly inefficient way of scheduling the submariners' work. They have huge amounts of cognitive impairment because of sleep deprivation.

That's a long explanation to say that there are research projects ongoing right now to assess the effects of sleep deprivation, but they're doing it by MOC or by occupation, and they're picking the high-risk ones, like the long-haul pilots and submariners, and then they're going to go on and delve into the other MOCs.

[The Chair, Conservative, Rick Casson]

We have Mr. Bachand, and then we go back to the official opposition and over to the government.

[Claude Bachand, Bloc, Saint-Jean, QC]

Thank you, Mr. Chair.

I read recently an American report about the rather considerable amount of antidepressants drugs being prescribed in the theatre of operations. Some Canadian newspapers also published stories saying that Canadian soldiers were overmedicated.

Could you share with me your opinion about antidepressants and the fact that it is being alleged in some media that Canadian soldiers are overmedicated? Do you share that point of view?

[Cdr D.R. Wilcox]

I'll just say two things. One, the only medication the FDA has approved for the treatment of PTSD is selective serotonin reuptake inhibitors. That's the only kind of drug that has been approved for the treatment of PTSD. Everything else is off-label. The only kind of drug that's been approved is an antidepressant.

I've just actually come from Gagetown. I spent two days there talking to their psychiatrists. There is a perception out there that benzodiazepines are abused, and there are too many people.... I looked at all the printouts from all of the psychiatrists, and there's just a very small number, like 1% to 2% who are on long-term benzodiazepines. The use of benzodiazepines—I know you didn't specifically ask that—is primarily for short-term intervention when there's an acute anxiety reaction or there's an acute bout of sleep deprivation. I can assure you that there are just a very small number that are on long-term benzodiazepines.

With respect to the antidepressants, the two modes of therapy that do have randomized control trials that support them are serotonin reuptake inhibitors and cognitive behavioural therapy.

[LCol H. Flaman]

I can just add something to that.

When I deployed, which was in 2004 for six months, I was taking blood pressure pills, which I take because I have hypertension. Some soldiers who are going over require medication for chronic conditions they have. That's presumably to make them function better when they go. There may be some who require antidepressants, but by and large, if they were on antidepressants, they would be getting those medications based on a clinical diagnosis that was already there. In the screening process, somebody would look at that very closely to see what medication they were on, for what condition, why they were taking it, and whether or not it was in their best interest to deploy. The decision as to whether or not somebody is there will have gone through about three levels of review before someone says, “You know what”--and everything is kind of risk-based--“we're going to take the risk on sending you without whatever”. And if you don't send them, the member will say, “Why can't I go? All I have is this condition. I take this medication. I function as well as any other group there.” This is the argument we have.

We're nowhere near the place where the Americans are. Again I'm not even sure of the validity of the press that was reported on that American study. Was someone trying to overstate a condition? Certainly that's not the case from my perspective with western soldiers deploying, because I see all of the screening and I get asked the questions.

Perhaps Major West can comment.

[Maj S. West]

If I were giving a quick answer to your question as to whether or not Canadian soldiers are overmedicated, I'd say no, they're undermedicated. It is extremely difficult to get patients to accept SSRIs; it doesn't matter whether they're military or civilian.

I don't know what the statistics are. My suspicion would be that if you looked at the use of psychoactive medication in military personnel versus civilians, it would be higher in military personnel, and not because military personnel need them more but because we are able to pick up on them more often and are able to offer them treatment. In the civilian world, many people just never go to a doctor, particularly now when it's so difficult to find a doctor. It's much easier to detect the need in military personnel, and even then it's difficult to get them to take it.

If they are severely disabled from their illness, whether it is a mental illness or hypertension or cardiac disease, we have systems in place to ensure that they will not be deployed until the problem is fixed.

[Claude Bachand, Bloc, Saint-Jean, QC]

My question also dealt with soldiers who are deployed on the theatre of operations. A physician would not go so far as calling in Canada to ask whether he or she can prescribe medication. It is up to him to decide.

When they are on the theatre of operations, they are submitted to a level of stress that they don't have here. The stress level is different over there. Here, you can shoot someone with blanks and you know the person will not die. Over there, it is quite another story.

I am talking about medication and antidepressant prescriptions. Are physicians more inclined to prescribe antidepressants when they are on the theatre of operations, as compared with what they prescribe when they are in Canada?

[Maj S. West]

No. We prescribe in theatre where it's medically indicated, and part of the prescription is going to be not just medication but removing the soldier from a situation where he is in undue danger or where he is placing the mission or his comrades in undue danger because of his mental illness or physical illness.

[The Chair, Conservative, Rick Casson]

Thank you. We're going to have to move on.

Mr. McGuire, then Ms. Gallant, then back to the official opposition, and then back to the government.

Mr. McGuire, for five minutes.

[Joe McGuire, Liberal, Egmont, PE]

Thank you.

Needless to say, we don't envy you your jobs. They're pretty important at any time, but particularly now.

We're looking for recommendations from you, given your experience and your positions, about how to improve things for our soldiers. For example, it's been suggested that maybe Cyprus is not the best place for decompression; maybe it should be closer to home, where they don't have to go through seven time zones after they finish the decompression before they see their families. In fact, we were told there's more PTSD inside the wire than outside, and maybe they should be given more attention and decompression than people who are outside the wire.

Do you have any comment on this, or is there anything else you might suggest that might improve the health of our people over there and the health of their families back here?

[Cdr D.R. Wilcox]

Inside the wire and outside the wire, they get the exact same decompression. There is no differentiation. They get the exact same debriefings and they're treated exactly the same.

Now, you make a good point about the time zones, and there is ongoing research to see the validity of the decompression. That is a legitimate point about the location, because they will suffer jet lag coming home.

[Joe McGuire, Liberal, Egmont, PE]

We're picking these things up from our visits to Wainwright and Valcartier and so on. These things are brought up to us.

[LCol H. Flaman]

Even though we're now two and a half or three years out from when we actually started the deployments--and, again, those first complex injuries are just coming to the point where they're being released--we don't know how to allocate whether they were predominantly inside the wire or predominantly outside the wire and what kind of conditions they were presented with. The numbers we have are so small, and we never captured them by inside the wire or outside the wire so much. We wish we had better numbers and the ability to capture all that information.

But the decompression side of things is interesting. People can actually leave theatre and go to Australia for three weeks or go to Europe for three weeks and not have any decompression requirements at all, and then after the tour is over, before they come home, they have the decompression time. Now, a lot of that decompression time, I think—and this is just me saying it—is spent blowing off a lot of steam. They go there and they are freed from the constraints that are imposed by that operational theatre. They go there, and sometimes they overdo things that we tell them they shouldn't be overdoing, like alcohol and activities that are going on. A lot of times one has to say that having them do decompression there might be better than bringing them all home to Edmonton, to Whyte Avenue, or whatever, and then allowing that sort of activity to go on in kind of a party mode.

Again, you identify people who might be at high risk for drinking, and the studies all show that they're all young. So if you take that preponderance of young individuals, they generally have a higher rate of drinking to excess. And those are certainly risk factors we have identified. They're no different from any cohort of that age group, probably, that you'd be able to measure, but that is a problem.

The biggest problem we have, really, is alcohol use, the use of normal drugs, and young guys doing that sort of stuff as part of their post-deployment.

[Cdr D.R. Wilcox]

But in the surveys on decompression, the majority of people said they felt it was of benefit.

Major West could probably comment, because she would have gone through it herself.

[Maj S. West]

Yes.

The inside-the-wire/outside-the-wire dichotomy is an artificial one. You can be outside the wire and in a fairly safe environment for your entire time, and you can be inside the wire in a position where you are seeing and doing things that human beings were never meant to see and do.

I refer to the support staff in the Role 3 Hospital. When we have casualties coming in, you may be a clerk, but you're going to be carrying stretchers. Those stretchers are pretty messy, and if you are not prepared for that, that can be quite a shock. On our rotation, we were very lucky. We had extremely good people with us, who were very quick to jump in wherever they could and who were not particularly bothered by it. But I could certainly see that being an area in which you would be particularly prone to PTSD. Medical personnel should be prepared for this. It should not be a problem for us, but our support personnel are probably exposed to more than are many people outside the wire.

Everybody does go through exactly the same decompression. To be perfectly honest, when I went through it, it wasn't listening to the lectures--because I could have taught all of that stuff, and in fact most of my corporals could have taught it--but just having a few days in a safe environment, surrounded by my army buddies, who I had just gone through a war zone with for seven months, that allowed me time to transition back to my family.

[Joe McGuire, Liberal, Egmont, PE]

[Inaudible--Editor]

[The Chair, Conservative, Rick Casson]

Yes, I realize that.

[Maj S. West]

Sorry, I missed that.

[The Chair, Conservative, Rick Casson]

Ms. Gallant, and then Mr. Rota.

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

Thank you. I'll share my time with Dr. Lunney, if there is time left over.

A number of professions in which a high level of stress is inherent have set up special hotlines for the professionals and for their family members, so that if somebody's kicking in a wall or behaving abnormally, instead of calling the police, so that there are major consequences after, they are given some direction on how to properly react.

Is there such a hotline—and not necessarily for OSI, because somebody has to make the link that this is potentially an OSI situation—that the soldiers themselves or their families can call without fear of a record being kept on the soldier or any legal action being taken? Is something like that in place?

[Cdr D.R. Wilcox]

We all have Blue Cross cards. That gives you a 1-800 number to access care after hours, and it is a nurse you talk to. That person will give you some advice on where you should go, if you describe your symptoms somewhat.

The other thing we have is CFMAP, which is the Canadian Forces member assistance program. That will allow you up to 10 sessions of psychotherapy that is at an arm's distance from us. So if you are afraid there are going to be some negative consequences to your self-declaring a mental health problem, you can go to CFMAP and be seen.

But we don't have a 1-800 number for mental health problems. We have those other two.

[LCol H. Flaman]

In Edmonton there is a program I think where they're looking at spousal abuse, violence, that sort of thing. If someone wants to call and they don't want to bring in the MPs and the police, they're looking at some sort of a process that keeps the MP side out of it, which means there's a record and then a police call and so on. By and large, if someone is living off base--this is off base sort of stuff--and feels in danger of spousal abuse or that sort of thing, then the recourse is usually to the police and it becomes a public record. The MP and the base commander then know that somebody is there.

I think people are looking at an informal network or an ability to defuse a problem in the appropriate manner, especially on the spousal side, for spousal abuse.

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

Yes. Right now, specifically, we don't have a crisis hotline, because the person involved may not be making the link that it's a mental issue and there may not be spousal abuse involved; certainly it would not fit into that category.

Is somebody looking at this right now, or what it would take to ensure such a crisis hotline that's not related or doesn't have the mental illness aspect to it or the spousal abuse aspect to it...?