National Defence Committee on June 12th, 2008

[Cdr D.R. Wilcox]

There will always be a requirement to have civilian health care providers. The theory is that we want to have enough civilians in the clinics so that we can extract all of the uniformed doctors but the clinics can still run. That's why we're so useful during domestic operations. We can pull out those clinicians and nurses and support a domestic operation, whereas in Ontario, with its HERT system, they have to take them from emergency departments.

So there will always be a need for civilian health care providers even if we attract enough uniformed physicians.

[The Chair, Conservative, Rick Casson]

Thank you.

That ends the opening round. We'll now move to five minutes each.

Mr. Rota, and then Mr. Lunney, for five minutes.

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

Thank you for coming today.

I wasn't going to go on this track, but I find it interesting that there's screening in the U.S. and self-selection here in Canada. When I think of that, I think of young people trying to fit in and saying, “I think this is where I'd like to be.” But it's kind of hard to say, “Yes, this is where I am going to fit.”

I'll ask you a couple of questions on that, and then I'll let you answer them.

First, do they have a choice of being screened or being given an aptitude test on where they would fit in based on their mental aptitude? If you want to go into, say, artillery, or into flying a plane, those are two completely different fields. I would imagine there's a certain amount of skill and aptitude required, for one, and a tolerance for the type of stress you'll be under. Is that something that is considered or that is available to the individuals?

Many of the people we've seen to date have said they didn't realize they were sick until later. People would ask them what was wrong: “Nothing. Nothing is wrong.” They went for a year or two until suddenly it hit them that this was not the way they were supposed to be, this was not the way they were supposed to feel. Then they realized they had post-traumatic stress disorder.

So does any kind of screening take place on a regular basis? I hear, yes, there are programs in there for them to identify each other or to see what's going on, and the commanding officer is supposed to check it out, but it's very difficult. Is there any one-on-one program where they go in once every six months, say, and go through things? I'm not talking about when you get out of theatre and you go for post-deployment debriefing or cooling down. Is there anything on-site that can be done to screen people as they're going through? I know they're saying the commanding officer might notice something a little bit different, but is there any kind of test or any screening done to detect that?

[Cdr D.R. Wilcox]

I can speak to the first part.

They do have aptitude testing for certain military occupations. Pilots in particular have to show manual dexterity, and they do go through a number of aptitude tests. For the majority, though, it's self-selection. We have an obligation to try to explain what an occupation would entail. However, if they don't like it after they've been involved in that trade, they can ask for an occupational transfer. In that sense they're self-selecting to something else.

We see that a lot in our medical profession. A lot of our health care administrators have transferred from the artillery. So we do allow that.

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

I know one of the biggest things is someone thinking that they don't want to show weakness. It's a mentality that's existed probably since Roman times, or even before that, in military psyches. I'm just wondering, if there is some kind of a—

[A witness]

A particular transfer usually is not a problem.

[A witness]

There's no stigma there.

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

There is no stigma with a transfer to another area.

[Cdr D.R. Wilcox]

It happens all the time.

[LCol H. Flaman]

But in the army, as soon as somebody says, “I don't want to stay with this group here, I'd like to just transfer into another one”--because they have to do it officially through the chain, sometimes they'll be told, “Then I'm not giving you a course now. If you're not going to be with us, I'm going to give the course to the next guy, because you've already told me you don't want to be with this group.” You're sort of saying that you want to move on, and you're not part of the group. So a little bit of that goes on.

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

Would screening enable the person to get around that?

[LCol H. Flaman]

Well, there is screening. You have to go to a PSO in order to get a vocational transfer into another occupation. That PSO will in fact have all the psychometric kinds of testing things they do to see what your aptitude is and whether in fact you should go into that trade. They do that.

In the recruiting centres, when you go, you actually do aptitude tests. But a lot of times in the recruiting centres they need so many infanteers, so you may say, “I'd like to go here”, and they'll sort of push you in one direction or another. As with any system, you really have to be willing to fight the bureaucracy a little bit, because that's the way it works.

[Cdr D.R. Wilcox]

Just on the screening, every two years there's a periodic health exam. It's carried out by a family physician. We're taught to screen within that for mental health, alcohol-related problems, or mental health-related problems. They get that every two years.

[LCol H. Flaman]

But the member himself has to check the box that says “I drink more than I should” or “I have problems”. They ask the questions. How the members answer those questions determines how this information is going to be used.

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

I would think that denial is probably one of the biggest problems.

[A witness]

It's a coping mechanism.

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

We can call it whatever we want. We can call it one of the greatest coping mechanisms with post-traumatic disorder. I was wondering if there's any way of getting around that.

[LCol H. Flaman]

Here's the thing, and I'm sorry if I sound kind of preachy. I always say everybody is coping. We are all coping with kids, interpersonal relationships, financial stuff, career stuff, everything. We're going along and we're coping. Some are coping better; some are not coping so well.

How do you know if a person is coping well or not? They either have to declare that they're not coping well or they get into trouble--driving while impaired, spousal violence, or legal stuff that occurs, and then the chain of command becomes aware that somebody is there. Or a member says, “Gee, I went home last night and yelled at my kids, and my wife pointed it out to me. Can I get some help here?” So he shows up at the medical side. Now if he shows up on the medical side, we don't tell the commanding officers and everybody else that this guy is here for help, because we see that as a positive. We then apply the appropriate diagnostic sort of criteria, tests, to see what the problem is, and then we determine if it's an addiction or whatever.

That's how things happen. That's why I said it's the individual who determines when they need some sort of support. We don't go around and try to find people. We have general screening processes. The pilots always had pilot sort of stuff because the Aeronautics Act says we're supposed to check a pilot on a regular basis. That was never applied to the army guys.

Now we are applying a two-year periodic health evaluation that is tied and focused on whatever stage in life you happen to be at. So if you're a young guy, we focus on those things that young people do. If you're a 40-year-old, we're going into cholesterol and your cardiac risk factors and stuff. The periodic health evaluation is sort of focused now on that—

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

The post-traumatic stress disorder is not part of that?

[LCol H. Flaman]

There's a mental health aspect in all of those. We focus on post-traumatic stress disorder, but that's a small portion of total mental health. We sort of single it out as being the targeted thing. It is one component of depression, anxiety disorders, all those other things.

[The Chair, Conservative, Rick Casson]

Thank you. At some point we'll want you to give us a very detailed example of how you examine pilots, just for Mr. Hawn's benefit.

Mr. Lunney.

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

Thank you very much, Mr. Chair.

We know that the pilots are used to having their fluid levels checked regularly. It's certainly a culture of safety when we're dealing with aeronautics.

I'll ask my question; I'm getting some encouragement here.

When you're talking about self-reporting abnormalities, this is the challenge with any form of mental illness, that the person who's not thinking straight is the last one to recognize it, or the last one to report on it, usually. Post-deployment, family members will notice changes, but is there any screening? Do we ask family members to participate in the screening process to pick up on some of those clues, such as not sleeping or substance issues?

[LCol H. Flaman]

I can tell you this. The MFRCs, the military family resource centres, are in fact holding educational sessions to talk about the battle mind, and I know it's been mentioned in some other groups. This is the program that was developed by the Americans to say that you have a battle mind that you need when you're hypervigilant and all that sort of stuff and then the ability, when you come back, to apply a different mindset. I pushed that educational program down to the MFRCs in western Canada when the redeployment was going on, to educate the spouses and the next of kin on what things to look out for.

Let's face it, the member may not self-declare, and the unit may not even see it, because they have a culture that says your business is your business as long as it doesn't affect me. But the spouses definitely see it. So we're trying to encourage people to talk to their spouses, and if their spouse or the kids see it, guess what, you should come in. This is part of the education.

So the one thing that should be done is an educational program about what to see, what to look for.

[Cdr D.R. Wilcox]

I'll just follow up on that. The combat-related first aid course that every soldier needs to take describes how to recognize operational stress injuries. In the tactical combat care course, a course that two members per section get, they're taught how to recognize OSI in their fellow soldiers. Then on the bases you have PSP courses, and they have anger management, suicide prevention, relationship enhancement, and so on.

So there are all kinds of courses all over the place provided by different agencies, and they may not specifically be mentioning OSI, but it's always in the mix.

[Maj S. West]

I could add something from the clinical perspective, as someone who has worked in the civilian system as well.

It's commonly quoted that approximately 40% of family practice visits are for overt mental health problems. Mental health problems are the bread and butter of what family practitioners do. It is the family practitioner, the general duty medical officer, who does the periodic health assessment every two years. We are very sensitive to it. We both actively and passively will pick up on most mental health problems in that situation.