National Defence Committee on June 12th, 2008

[LCol H. Flaman]

Do you mean some sort of official process set up by the military or the base, or whatever, in question?

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

Yes.

[LCol H. Flaman]

The problem with anything official is that it then becomes official. If you're talking about an unofficial blog that people sort of link into for their own self-help groups.... If you set it up as the base commander saying, “This will be the official line and here's how we're going to action it”, there are people talking about...we have a caring professionals kind of committee that talks about having mainly a social worker in that psychosocial setting wanting to help the commander deal with things so they don't have to elevate it to a charge and that kind of thing. They are looking at trying to do that.

How far along is it? I can't say right now.

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

Would there be records attached to that--a record of calls--or would it be completely...?

[LCol H. Flaman]

Again, it's out of my lane. I don't know.

[Maj S. West]

But the MFRCs do offer some support. I don't think it's 24 hours in most cases, but they do offer some support, and that is definitely at arm's length from the military.

[Cdr D.R. Wilcox]

And OSISS does the same thing. If you get a counsellor, often those counsellors make themselves available, but you have to have declared yourself to OSISS.

I just read a CANFORGEN from Hillier, and they were talking about having a special advisor to the CMP on OSI issues that are non-clinical and the re-establishing of the Canadian Forces OSI steering committee. They're going to create another committee, the DND-Veterans Affairs mental health services advisory committee, so they're going to revisit a lot of these things under the venues of these three different committees.

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

Thank you.

[The Chair, Conservative, Rick Casson]

Mr. Rota, and then back over to the government.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

I have a quick question on wait times. You mentioned you've just done a benchmark study, and you have your stats and what not, I would imagine.

Is there any kind of a graph showing what the wait times are and demonstrating where the outliers are? Is that available?

[Cdr D.R. Wilcox]

I can only speak of Stadacona.

Almost every base now has a quality improvement person, and one of the things they do look at is wait times. I know the Canadian Forces Health Services Centre Atlantic, or the Stadacona clinic, in Halifax, do publish a wait time, and they compare it to these benchmarks that are set by the Canadian Medical Association.

I can't speak of....

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Let me rephrase it. Could I get a copy sent to us?

I am interested. If there's any kind of a graphic representation, I'd like to see that as well. Sometimes it just makes it a little bit more understandable.

[Cdr D.R. Wilcox]

It is graphic. It's all bar graphs.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Bar graphs or dots are usually what I'm looking for, so you can see where the core is and where the outliers are, and you can see how many exceptions there actually are as opposed to the norm. What we hear in this room is often the exception. It's not the norm, I hope. I was looking for something along that line.

On that same line, as far as the feedback mechanism goes, again, we're getting the impression that at the ground level it is not the same as what you're bringing to us, and there seems to be a disparity. I'm hoping those are the outliers and not the norm; otherwise we'll be here for the next 10 years.

Regarding the feedback mechanism, to get back to how your programs are working, what do you have in place, and what is the structure that brings back the information on what's happening on the ground level with the patients or the individuals who are being treated?

[Maj S. West]

Sir, I am essentially ground level at this point. As a base surgeon, I am responsible for ensuring primary care gets delivered to members in the Ottawa area.

We are in the process of instituting throughout the system the Canadian Forces health information system, which will eventually include electronic medical records. In the early rollout periods, it allows us easier access to statistics so that we can follow things like wait times, look for problems, and try to address them before they get out of hand.

It's not completely instituted in our base yet, and I don't think it's completely instituted in any base yet, but we are working towards it.

[Cdr D.R. Wilcox]

To that end, as an interim solution, we routinely do patient surveys and clinician surveys to establish their percentage of satisfaction. We'll pick a day, and everybody that comes into the hospital or clinic on that day gets a survey. The quality improvement personnel then tabulate those and publish the results.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Very good.

[The Chair, Conservative, Rick Casson]

Thank you.

That wraps up the second round, and we'll start with the third one.

Mr. Lunney.

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

Thank you very much.

I'd like to just go back to the sleep issue for the soldiers. I'm aware of studies in which they interrupted normal subjects during the REM phase of sleep, or the rapid eye movement phase, and there was a definite decline in cognitive ability, problem solving, and the ability to learn new tasks.

It seems as though the military would be well aware of that. I suppose when you talk about something like Desert Storm, before they went into Iraq, in these pre-dawn raids, they pounded these poor guys--interrupting their sleep--before they went in on a ground assault.

Coming back to our soldiers, when we were in Valcartier we had a very interesting discussion with the base surgeon there, Chantale Descôteaux. She was remarking on some of the work they're doing there on group therapy for sleep for the soldiers. They not only identified but found resolution for some of the OSIs and PTSD and what might have been described in that realm, and they found great improvement in clinical practice just by doing group sleep therapy, which is much more palatable for the soldiers, of course.

I just wondered if you were aware of that.

[Cdr D.R. Wilcox]

There is a lot of research going on, on go/no go pills, mild amphetamines, caffeine replacement, and caffeine gum. There is a lot of research, primarily out of DRDC Toronto.

[Maj S. West]

There is also in the American system, of course.

In Ottawa, of course, with us being such a large base, we actually have our own sleep labs still in the clinic. We don't know whether we're going to be able to keep that long term. But for civilians, if there's a concern that someone has sleep apnea, at this point in Ottawa I think the wait time to get into a sleep clinic is somewhere approaching a year. For our sleep clinic it's a month or two, and we are sending an awful lot of our suspected PTSD and suspected mental health problems for sleep studies almost routinely, because obviously if there is a sleep disruption that you can address, the mental health problem tends to get better.

[Cdr D.R. Wilcox]

We participate in a lot of NATO standing committees, and there's a free exchange of research, so we freely share our research and the other NATO countries reciprocate.

[LCol H. Flaman]

My role, like Dave's, is to approve extensions of sick leave, which I say is absence from structured supervised activity. Basically, you allow people to stay home to get better. The trouble is that when people stay home to do whatever they want to do, their sleep patterns are definitely interrupted. They don't in fact have a really good structured sleep pattern.

So part of my role is to kind of diminish the amount of time you prescribe this sick leave and get people back to an activity level that imposes a better sleep, rest, and work structure. In the morning, you get up--show up at work or show up somewhere, just prove that you're up--and then you stay up. Go to sleep at the normal time and get that structure back.

With the new casualty support units that they're going to set up, I think we're going to have a better way to be able to provide a better ability to do that stuff. And some studies, of course, have shown that a 20-minute nap in the afternoon helps with cognitive functioning for everybody.

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

Yes, exactly.

I certainly support those observations. As I certainly found in my former career, when you treat people with back problems, if they're instructed to just stay home and rest and then they sit watching TV all day, that is the worst thing they can do for their backs.

[LCol H. Flaman]

Exactly.