Evidence of meeting #49 for National Defence in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was researchers.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Alice Aiken  Director, Canadian Institute for Military and Veteran Health Research

3:35 p.m.

Conservative

The Chair Conservative James Bezan

Good afternoon, everyone, and welcome to our 49th meeting of the Standing Committee on National Defence. Pursuant to Standing Order 108(2), we're going to start our study of the care of ill and injured members of the Canadian Forces.

To kick us off today we're pleased to have, on very short notice, Dr. Alice Aiken, who is the director of the Canadian Institute for Military and Veteran Health Research. Dr. Aiken was co-chair of the 2011 Forum for Military and Veteran Health Research. She is an assistant professor in the physical therapy program at the School of Rehabilitation Therapy at Queen's University. She does health services and health policy research in the area of innovative models of care and disability policy and is co-editor of a collective on military and veteran health research that was just submitted to the Canadian Defence Academy Press. She lectures in clinical orthopedics. She is the current president of the board of directors of the Canadian Physical Therapy Association. Both her PhD and master's come from Queen's at Kingston and her physical therapy degree is from Dalhousie University in Halifax.

We're indeed pleased to have you. We understand you were also in Ottawa earlier this week speaking at a breakfast on this very subject. Of course, this being Mental Health Week, it is fitting that we start this study off.

Professor Aiken, we look forward to your opening comments. You have 10 minutes.

3:35 p.m.

Dr. Alice Aiken Director, Canadian Institute for Military and Veteran Health Research

Thank you.

I should say the most important part of my bio, and why I sit before you, is that I am a veteran. I did serve in the Canadian Navy for 14 years. I'm very proud of that, and it is part of the reason I'm very passionate about what we do at the Canadian Institute for Military and Veteran Health Research.

You've each been handed a folder that has our information brochure in it. It also has my business card and information about our third annual military and veteran health research forum. You all will have received invitations to our VIP event on November 26. It would be a great fact-finding mission for this committee to see all of the information that will be presented at the forum, so if any of you are interested in attending, please let me know.

Here is a little bit about the institute. Our vision is that the health and well-being of Canadian military personnel, veterans, and their families are maximized through world class research, resulting in evidence-informed practices and policies. We believe it's our mission to optimize the health and well-being of Canadian military personnel, veterans, and their families by harnessing and mobilizing the national capacity for high-impact research, knowledge creation, and knowledge exchange.

What we mean by that is we want to work at the clinical end of the research spectrum—on things that are going to affect practices and policies that will help the health of military personnel, veterans, and their families in the very short term.

Why is this necessary? Well, as I'm sure you know, there are more than 700,000 veterans in Canada, of whom only 11% are clients of Veterans Affairs. So the rest are out there in the wind and at the mercy of our provincial health care systems and not being tracked. We also have about 100,000 members of the military, which would include the reserve and the regular force.

Until the time we started the Canadian Institute for Military and Veteran Health Research, we were alone among our major military allies in not having an institute like this. Being Canadian, not only did we decide we needed to come on board, but we also decided we needed to do it in a really unique way. I'll explain a little of that to you.

We work very closely with our government partners in National Defence and Veterans Affairs, but what we're able to do is augment. By harnessing the national research capacity of researchers around Canada, we can augment the existing capacity that National Defence and Veterans Affairs have to do research. But we can also provide arm's-length...we have an arm's-length capacity for research.

I don't need to tell you that if the government does the science, regardless of the rigour, if the results are not what the public wants to hear, the government is criticized for it. Once it's in the independent academic world, that makes a difference.

I released from the military in 1998, and I don't believe this could have been started at that time, but with Afghanistan, the public interest was extraordinarily high, and I must say that the academic interest was also extraordinarily high in starting an institute like this.

What are we? If you pull out your little information sheets, you'll see that we're a network of 25 Canadian universities that are dedicated to researching the needs of Canadian military personnel, veterans, and their families. For any of you who have ever even come close to the academic world, you'll know that to get two universities to agree to something is kind of a miracle, so for 25 to come on board I think speaks to the importance and the interest in this topic.

We do serve as a conduit between the academic community, so the hub of CIMVHR is at Queen's and the Royal Military College. But where we really exist is across the country in the labs where all the research is being done and in the labs in the clinics where all the research is being done. We work most closely with National Defence, particularly the Canadian Forces Health Services group, and Veterans Affairs.

We've also been able to connect really nicely with our international organizations, the similar ones. We work very closely with King's Centre for Military Health in England, the Australian Centre for Military and Veteran Health, and many centres throughout the U.S. through the Department of Defence and VA. They don't have just one institute in the U.S.; they have many. As an institute, we believe that our outcomes are research, education, and knowledge exchange.

Education is critically important, because you can't build a research institute unless you build your next generation of researchers. We have started a graduate course, a webinar-based graduate course jointly offered by Queen's and the Royal Military College, on military and veteran health. We have 21 graduate students participating from across the country. This is our first year. We're pretty excited by that.

We also work at the knowledge exchange end of the spectrum, so we're getting the information into the hands of the clinicians who work with these people as well as the policy-makers who work with these people. What people want...everybody talks about evidence-based medicine, but we have such a captive population in Canada, especially with National Defence, and we really are able to get the best information into the hands of the clinicians who are working with soldiers, sailors, and airmen and -women.

We have been working on building partnerships and support, with meetings like this—and I'm very honoured to be here today, so I thank you for inviting me—to get to be known in the government. We have had very vocal support from the Minister of Veterans Affairs, who speaks of us often in public.

The other way that we are trying to make a difference is by linking with the national professional associations. Some of our big supporters are the Canadian Medical Association, the Canadian Physiotherapy Association, and the Canadian Association of Occupational Therapists. So we have access to the clinical community as well, which, as I told you, is important to us from our knowledge exchange perspective.

We work with a lot of university-linked research institutes, such as the Centre for Addiction and Mental Health and the Glenrose in Alberta. A lot of the clinical-based research institutes are part of us as well. Also, the Royal Canadian Legion is a big supporter. Just to show you that we take the definition of health in a very broad spectrum...the World Health Organization definition of a complete state of mental, physical, and social well-being. We were admitted to the Congress of the Social Sciences and Humanities earlier this year as well.

As for our researchers, while the majority are from the health sciences, we also have people from engineering, kinesiology, English, drama, and history, which are all different departments that are working on mental health and social health needs. In very diverse areas, people are making links that they didn't used to make.

In terms of funding and sustainability, the short answer is that we're not. We have some seed funding from Queen's for my position. I've been bought out of my teaching; I'm a professor there but have been bought out of my teaching to do this. We have been applying through the regular granting institutes, but what's happened is that a lot of researchers have come to the table with resources. They have grants for studies and what they really want is access to the populations.

For long-term sustainability, we are looking at philanthropy and industry partnerships, because the public-private partnership is the only way to go, I think, but we also have been getting universities to try to establish research chairs at their universities. Once a chair is at a university and is dedicated to military and veteran health, it stays there in perpetuity, so that ensures that this carries on. So far, there are three chairs across the country and two that are related to CIMVHR, our institute.

In terms of applicability as well, I think what is really important to notice is that while we are focused on military and veteran health, there's the applicability to other first responders such as police and firefighters—and our link through the Centre for Addiction and Mental Health, which works with people in high-stress occupations is evidence of that—but there's also applicability to the entire Canadian population. I think most of you recognize that.

Nobody likes war, but from war have come most of our medical advances. We can learn a lot in times of war. Just having come out of a period of conflict...in fact, probably the last 20 years in Canada have seen a pace of operations that is really unknown since Korea. In the medical world, we have seen that the advances coming out of peacekeeping and conflict are remarkable. Those are translating down into the civilian world.

I'll give you a tiny example of that. One of our chairs, Colonel Doctor Homer Tien, is the chief of trauma medicine at Sunnybrook. He's a military colonel embedded into the civilian health care force in order to keep him current in trauma medicine, because typically in the military you don't see it every day. At Sunnybrook Hospital, he was the one who took charge of the Scarborough shootings. He was in the papers for using the best practices that he had learned in Afghanistan in order to manage a shooting in Scarborough.

Those are just some of the things as a bit of background. I would welcome your questions.

3:45 p.m.

Conservative

The Chair Conservative James Bezan

Thank you very much, Professor Aiken. That was exactly 10 minutes. We appreciate your opening comments.

With that, we're going to do our seven-minute round.

To kick us off, Mr. Harris, you have the floor.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

Thank you.

Thank you for coming, Dr. Aiken. I was pleased to hear you the other day as well.

You are a professor, but you're not a professor of medicine. What is your discipline?

3:45 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

My research discipline is health policy and health services, but my clinical discipline is physiotherapy.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

It's physiotherapy, but you are the administrative head as well as the academic head of this institute.

3:45 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

I am the scientific director, and if we could afford an executive director, we'd have one, but barring that, I'm doing it all.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

I'm happy to call you Dr. Aiken, but we're in a different field here.

I was looking at the Department of Veterans Affairs website, for example, and they have a heading called research into trauma related to operational stress injuries. They've listed a number of research studies that are under way. I think there are three that they're funding.

They list a number of publications, but in the publications, there doesn't seem to be anything after 2006. One or two are listed as being in press, which I guess means they're current but not released. They're not published by the government; they're published by journals such as the Journal of Nervous and Mental Disease, The Canadian Journal of Psychiatry, the Journal of Traumatic Stress , etc.

These aren't what you would just call internal government studies. These would be peer-reviewed independent studies, would they not?

3:45 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

Yes, they would be, if they're published in a peer-reviewed journal.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

Can you elaborate a little bit more on what you refer to as the distinction between government studies, which result in certain decisions that people may or may not like because the studies come from the government, as opposed to independent research, just in light of that?

3:45 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

If I understand your question correctly, certainly government researchers, if the research isn't classified, are free to publish in peer-reviewed journals as well. It's not usually the science that's criticized. It tends to be stuff that's a little more controversial—not treatment-based approaches or things like that.

But I will tell you that Veterans Affairs did an enormous amount of publishing in 2010 and 2011. They just may not have updated their website.

Just this past summer, we did a scoping review of all the Canadian veterans health literature, and there's been an enormous increase. However, a lot of it has come out as government-based publications since then. Now, the government tells us they are also peer-reviewed, which is outstanding. That's always good for science. But they are still doing a lot of publishing.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

Is that accessible? I understand that your organization is relatively new, and it's great that you have the cooperation of over 20 universities across the country. I notice the university in my riding, Memorial University, is one of those, and we're happy to see that, too.

Do you have any document that you have published that would give a sort of summary of the state of play—what's there and what's not—that might be available to us as we go forward looking into this question as a committee?

3:45 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

The short answer is yes, and we have several. We published a book following our first forum. We have one coming out in November from last year's forum. All the abstracts from this year's forum will be published, so it will give a very good synopsis of the research being done.

We have several special editions of journals that are in the course of being published. The work I just spoke about—the scoping review of the veterans health work—is being amalgamated into a document right now by a graduate student of mine, and we're just trying to put live links into it so that you can go to our website, look at it, click on any link, and have the document.

3:45 p.m.

NDP

Jack Harris NDP St. John's East, NL

There may be an opportunity to update prevalent studies on operational stress injury or PTSD, for example. Our committee did a study a few years ago, and the figures were from 2008, and they are modest compared to what the predictions and projections are today. That might be a way of updating that.

3:50 p.m.

Director, Canadian Institute for Military and Veteran Health Research

3:50 p.m.

NDP

Jack Harris NDP St. John's East, NL

I think I'm done.

3:50 p.m.

Conservative

The Chair Conservative James Bezan

You have two more minutes, if you want to use them.

3:50 p.m.

NDP

Jack Harris NDP St. John's East, NL

I have two more minutes. Oh, good.

3:50 p.m.

Conservative

The Chair Conservative James Bezan

Unless you want it to be five.

3:50 p.m.

NDP

Jack Harris NDP St. John's East, NL

No, that's fine.

I said I was looking at our report there, and the indication of the studies done by the military back then when we heard the testimony was that 4% of the respondents to a survey in the military had exhibited symptoms consistent with PTSD. Another 5.8% had either PTSD or depression-related symptoms, and a total of 13% had a possible mental health diagnosis.

I suppose it's not totally necessary to be able to compare apples to oranges, but we have heard figures thrown around about prevalence rates of operational stress injuries from people who have served in combat, comparing one military to another. Would there be research of that nature included in the work that you're citing here now?

3:50 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

Yes, some of it is in that work. The centre in the U.K. has done a large tri-nation study on Canada, the U.K., and the U.S., showing the prevalence of operational stress injuries. What they've found is that the rates of PTSD are very high in the U.S., ranging somewhere between 20% and 40%. In Canada, PTSD tends to be at about 20%, but what's more prevalent in Canada seems to be depression, and in the U.K. what seems to be more prevalent as a mental health issue is binge drinking.

So there is very good evidence out there. Right now the numbers show about one in five, which is no different for the Canadian military, which is no different for the general population. The problem, as you know, with mental health injuries is that they don't often show up right away. And Veterans Affairs will tell us that they will get an influx five, ten, and fifteen years after an operation.

3:50 p.m.

NDP

Jack Harris NDP St. John's East, NL

I have another short snapper. What are the top three research issues?

3:50 p.m.

Conservative

The Chair Conservative James Bezan

Very quickly.

3:50 p.m.

NDP

Jack Harris NDP St. John's East, NL

We all need to know that, I guess.

3:50 p.m.

Conservative

The Chair Conservative James Bezan

Dr. Aiken.