Evidence of meeting #31 for National Defence in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was treatment.
A recording is available from Parliament.
Cdr D.R. Wilcox
If they were undergoing treatment, if they were being actively treated for an operational stress injury, we wouldn't send them, even if they volunteered.
Maj S. West
There's an extensive screening process for anyone who's about to go over. Every single soldier goes through a screening process.
If you were under any treatment, you wouldn't go. If you were not under treatment, there's a good chance the screening process would pick up the need for it.
Bloc
Claude Bachand Bloc Saint-Jean, QC
I want to welcome you and thank you for your presentation.
I will start with you, Mr. Wilcox. You talked about a standardized treatment. Would this treatment apply only to the Joint Task Force (Atlantic), or is it possible to extend it to the Canadian Forces generally? In other words, within the Canadian Forces, would a person being treated for post-traumatic stress syndrome in Vancouver receive the same treatment as another person being treated for the same problem in Halifax?
Cdr D.R. Wilcox
They certainly do. There is a lot of leeway. These are only guidelines, but most of the clinics have access to these guidelines.
I want to clarify. The committee is meeting right now to Canadianize the treatment protocols. They're using some of the American protocols or guidelines as the current guidelines, but if you read them, you see that there is a lot of leeway on when you would introduce EMDR or cognitive behaviour therapy. They give you a number of tools in your tool belt to treat post-traumatic stress disorder or operational stress injuries.
To get a more concise answer, I'd recommend that you talk to some of the psychiatrists that we have in uniform, and they can give you a detailed answer. But I do know that there is a committee that is trying to standardize the treatment as we speak.
Bloc
Claude Bachand Bloc Saint-Jean, QC
They are trying to standardize the treatments by canadianizing them, as you are saying. When I went to Halifax, I was surprised. I asked the admiral how we were canadianizing these submarines, and in answer, he told me that we had to equip them with American torpedoes. You seem to be saying the same thing about Canadian treatments. I have nothing against it, because I believe that we have a lot to learn from Americans.
You said that a committee is studying the clinical aspect. Is it possible to standardize the treatments? Are each clinician, psychologist or psychiatrist completely free to treat their patients in the way that they see fit? How can we standardize the treatments while at the same time respecting the practice of clinicians? Can it be done through an assessment grid? Will a psychoanalyst, for example, have to follow a number of steps? How does this work, generally speaking? Is it really a standardization, or are we leaving it up to each attending physician to give appropriate care to his or her patients?
Cdr D.R. Wilcox
When we say “evidence-based”, we are looking at randomized control trials that would prove one medication works better than another or one psychotherapy works better than another. Then you'd bring a working group together, and they would look at all of these randomized control trials to determine which is the best. That's what they're trying to do.
There will be one study that perhaps is performed by a pharmaceutical company and may show one result, but what we're looking for is a meta-analysis in which you take a look at all of the studies related to that one therapy and see if on balance it's effective or not. That's what these committees do. They try to look at all of the randomized control trials, and that helps.
They do work by algorithms. They give different options.
LCol H. Flaman
I'd like to add a little bit to that answer. Prior to this, everyone had post-traumatic stress disorder, and they never even made the diagnosis based on an appropriate standard diagnosis. So a lot of times there was a written diagnosis, but in fact it did not meet the criteria that were set.
So in order to add rigour to this, they basically said that first of all they wanted to standardize the criteria. When you say that someone is suffering from post-traumatic stress disorder, let's make sure they meet all the criteria of that, so if we're talking about oranges, we all understand what oranges means. Then there are other symptoms that go along with that diagnosis.
Trying to put some definition to that was the job of the mental health services, and they did an excellent job by coming together, deciding how they were going to work together, deciding what the criteria were, and trying to define those. In the past there was very little rigour applied to how diagnoses were made, etc.
Bloc
Claude Bachand Bloc Saint-Jean, QC
Mr. Flaman, you said that you were improving in this area. Are you saying that on the basis of the situation that you have described to me? You said that you are trying to offer the best treatment and to improve your approach thanks to numerous exchanges between clinicians. Is this mutual consultation the reason why you are saying that the situation is improving?
LCol H. Flaman
We're getting better in the sense that they've defined how many clinicians they need, how many psychologists in a mental health clinic they require, how many social workers they require, how many mental health people they need. That has been defined.
There has been funding available to hire those individuals, and in various OSI clinics they have put those people together, and they are now working with clear definitions of requirements and deliverables, etc., so that has been improving as we go along.
Bloc
Claude Bachand Bloc Saint-Jean, QC
Ms. West, you are the base surgeon. You said that you are monitoring all treatments, but you also stated that you have your own small clinic. I would not be very comfortable with the idea of you seeing patients and then referring them to your private clinic.
Are your colleagues or yourself able to tell me whether physicians or clinicians within the Canadian Forces are governed by a code of ethics?
Maj S. West
I'm afraid you misunderstood, sir. I have a clinical practice. I am still practising clinically. Some of the patients in our clinic are patients of mine. I do not refer out. I am busy enough on a day-to-day basis in my day job, which turns into a night job and a weekend job as well. I don't have time to practise outside.
Yes, there are ethical guidelines. There are regulations in place, both from our medical governing bodies and within the military, to govern situations such as that. We won't normally take a patient who is being seen by a clinician in our clinic and refer that patient to their private clinic downtown unless there is a legitimate reason for it. All referrals are reviewed, and anything like that would be very closely reviewed.
Bloc
Conservative
The Chair Conservative Rick Casson
Your red light is about to go off. You're out of time.
Thank you very much.
Ms. Black.
NDP
Dawn Black NDP New Westminster—Coquitlam, BC
Thank you very much, Mr. Chair.
Thanks to all three of you for coming today to appear at the committee.
I think you know our study has been going on for some time, so we've had a fair number of witnesses here giving testimony. I think it would be fair to say that some of the most compelling or dramatic testimony has come out in camera, so you wouldn't have had access to that testimony. But what we've heard over the months of these hearings has been that on a systemic basis people in the Canadian Forces are still not receiving the mental health services as quickly as perhaps they should and that the services they may need are not always available to them. We've heard that some of the health services, particularly in the mental health field, have been underfunded or understaffed, and that there are no clear guidelines for post-traumatic stress disorder, which you're saying is being rectified now, so I'm pleased to hear that. I hope you'll share that with the committee. Perhaps we could have a look at that.
Also, we've been told--again, in camera--particularly about the stigmatization of mental health or brain injury, and that the soldiers, themselves, have felt the stigmatization of that, and that it has made them perhaps less able to access treatment.
In the current situation with the war in Afghanistan, it's pretty clear I think to all of us, that a lot of the injuries that Canadian Forces members are suffering, whether they're physical or mental, are more complex perhaps than those we've dealt with over the years. We've had some information about something that in the States they're calling acquired brain injury. As a layperson, I understand that that is perhaps caused by exposure to explosions. I'm wondering whether you have been looking into that separately from post-traumatic stress disorder. I wonder if either of you could address those concerns.
Cdr D.R. Wilcox
The one thing I can address is wait times. The Canadian Medical Association, in partnership with the Canadian Psychiatric Association, established a Wait Time Alliance, and that was to benchmark what they felt were appropriate wait times. They said for urgent cases, on referral from a family physician, one to two weeks would be a reasonable wait time, and for elective or scheduled cases, the wait time would be two to four weeks. So that's the benchmark from the Canadian Medical Association.
The Fraser Institute, from January to April of 2007, looked at the wait times for psychiatric care in all the provinces, and I'll just speak of New Brunswick and Nova Scotia, of which I'm more knowledgeable. For urgent care in New Brunswick, the wait time to be seen by a psychiatrist was two weeks, and for elective cases it was eleven weeks. In Nova Scotia it was one week for urgent and eight weeks for elective. In our clinics we provide an initial intake assessment within five days, and in both Gagetown and Halifax, someone will be seen by a psychiatrist within three weeks if it's elective or non-urgent, and if it's urgent, they get the intake assessment the same day, and most times they're seen by psychiatrists the same day. So not only are we beating the present provincial wait times, but we've already met the Wait Time Alliance benchmarks. I think that speaks to the wait times.
I don't know if anyone else wanted to comment.
Maj S. West
I can say it's about the same in Ottawa for wait times. I think we've made a lot of progress, but I don't think it was ever really as bad as it was perceived to be. There are often patients who have needed help for a long time who haven't identified themselves to the medical system, and there may be a perception that that's a wait time. But from the time they are identified by our clinic, I can have someone seen within 24 hours, generally, if they need to be, and intake assessment takes place usually within about a week, I think.
