National Defence Committee on Oct. 4th, 2012

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Mr. Chair.

Thank you very much, Dr. Aiken, for being here with us.

As you are aware, Canada has not been in a combat mission since our engagement in Korea, and now, after 10 years, our combat mission in Afghanistan, and I was proud to be there, has ended.

Could you expand on issues not previously seen or noted that returning CF members may face? I am asking this question...we had a combat situation in Croatia. I recall the Medak pocket, which was quite similar to the situation in Afghanistan; it was a highly combative situation.

What types of services do you believe would be necessary for our most seriously injured veterans coming out of Afghanistan?

[Dr. Alice Aiken]

Certainly what's come more into current awareness is the mental health research, but I think that's general in society as people are more willing to talk about mental health injuries, and I think that's a societal issue.

We did see a lot of mental health injuries coming as a result of Rwanda, Somalia, the Swiss Air disaster, and other issues like that, that weren't specifically combat but were traumatic nonetheless.

In terms of physical injuries, where you're going to see the most advances coming out of Afghanistan.... We're seeing really an unprecedented number of amputees. There are now limb transplant surgeons, so if you lose a leg, they will replace it with somebody else's, and there are bionics, particularly for upper limbs. A lot of this is being done in the States by the U.S. military researchers. The bionics are actually wired into your brain. So you don't have to use other muscles to move your artificial arm; you just think about it and the arm moves very much like a natural arm.

I think in terms of really cutting-edge research, that's going to be part of the legacy of Afghanistan. I would say that if we could pick a general term for one legacy, it's trauma medicine, and the rehab following it is going to be the big legacy in the medical world.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Are you in contact with DRDC, which has done some of the advanced research in the field of artificial blood and other things? I had the privilege of being in contact with them when I came back from Bosnia. I had a problem—not a mental problem, but it was an issue of extreme exhaustion, and I was treated very well by the DRDC specialists. That is a very good research centre, so I'm asking if you have a relationship with them, because you were talking about the universities. That is a research centre, which is also doing something in the navy and....

[Dr. Alice Aiken]

Yes, in all the fields. The government departments we work very closely with and that we're in contact with a lot are National Defence, DRDC, the Canadian Forces Health Services, and the research directorate at Veterans Affairs. So we do work very closely with DRDC as well, and they do some remarkable research, I would agree.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Of course, you cover many aspects of mental and physical health in your research, I suppose. What are the most difficult injuries or illnesses to assess and treat, except for mental illness? What kinds of injuries, because they are stress-related...?

[Dr. Alice Aiken]

Right, the mental illnesses for sure. I would say probably environmental. The military does a lot of sampling of environment and stuff, but I think we probably don't know the environmental impact Afghanistan is going to have. It's different soil and different air.

I would have to say that I think probably the thing that is the most difficult to discern, rather than diagnose, is the impact on the family. I think that's where we really need to put some resources. We are really starting down that road with our research community as well. But we know there are impacts on the spouse and the kids. There are transgenerational impacts that really need to be investigated and are difficult to diagnose, because the family is not in the same health system as the member.

[The Chair, Conservative, James Bezan]

Thank you very much.

Moving right along,

I will give the floor to Ms. Moore.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you.

I have some questions for you.

In the first aid courses given by the armed forces, I gather that people are taught a lot about treating physical wounds, but very little about how to deal with mental wounds, if I may put it that way.

In your opinion, should that be included in military training to a greater extent? Are there any studies along those lines? For example, should colleagues and other regular people be trained to be able to detect signs and symptoms of depression and to know how to get involved when a colleague is going through a stressful event?

Everyone knows that words can sometimes do real harm, even if things are not said to be hurtful. Is a lot of work being done in these areas?

[Dr. Alice Aiken]

I will answer in English, if I may.

I would have to say that the Canadian Forces are actually considered a world leader in destigmatizing mental health injuries. They actually do build in training about mental health injuries and illnesses, from the time somebody is a new recruit, to destigmatize them. They really are trying to build it into not only the medical world but the chain of command, so into the military world as well.

They do things like encourage peer support. Peer support is enormous. For example, if you are deployed with somebody and you are feeling something, your buddy says to you that he feels terrible every time he is in an elevator or something—people are able to tell you they were feeling that way and they got help, so you should. It's not perfect, but it's really helpful, and they have built it into the whole training curriculum throughout the military.

The other thing they do for people returning from deployment is they have a time for decompression. They come to a third-party location and they get to rest, relax, and have some information about reintegrating into family and civilian life. That helps. They are also given a little pocket card that looks like a business card, with the signs of mental stress, and they are told if they are feeling any of these things to go into the medical services and they will help them out.

The other militaries look to Canada for how they would destigmatize. I was at a conference with the Mental Health Commission and I was at a table with a gentleman from the RCMP and a gentleman from Corrections Canada, both of whom said they wished they could destigmatize mental health the same way the forces have.

It's a great question because they really have been working on that. It's never going to be perfect because some people don't want to go to their own...some people still have the fear they might be released. They are trying to stop that, and they are really working hard at it.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

One more thing, in terms of research. You say that it is focused on prevention, treatment and rehabilitation. What percentage goes to each of those three aspects?

[Dr. Alice Aiken]

It's difficult to tell, only because I would say, having done a review this past summer of all the literature on Canadian veterans' health, that the vast majority of it is published in mental health literature. But I think that's a trend across the country.

It doesn't mean that's the number one problem, so the research right now doesn't always reflect the greatest need. It's a bit difficult to give the percentages. I will tell you that most abstracts for our upcoming forum were submitted from the research community on mental health, then physical health and rehab, and then the third one would be occupational health.

[The Chair, Conservative, James Bezan]

Thank you very much.

Madam Gallant, you have the floor.

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

Thank you, Mr. Chairman, and through you to our witness.

Given privacy concerns, VAC and DND just can't give your organization a list of names of people who are potential subjects. How do you go about seeking out and finding willing participants for your studies?

[Dr. Alice Aiken]

It depends on the study. People are allowed to volunteer, but it's a bit more difficult for Veterans Affairs. They work more like an insurance company, so the information is really private. In the military, if you want to have access to people with a particular diagnosis, you'd typically go in through the health system.

If you want to access patients in the military, the approval has to come from the Surgeon General in every case. So the study has to have scientific rigour. It has to have merit. It has to be of interest to the military. Then they will put out a request and subjects can volunteer.

It's as you would do with any study. If I wanted to go to my local hospital and recruit patients who had knee pain, it would be on a volunteer basis.

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

Has your organization done this before, for PTSD, for example?

[Dr. Alice Aiken]

For most of the studies on PTSD right now, the researchers are either embedded in the operational stress injury clinics—they're the clinicians—or within the military clinics. They'll often partner with a research group and recruit that way.

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

Do they have any problem finding enough subjects?

[Dr. Alice Aiken]

Not yet. It's a typical scientific problem that recruitment can be an issue, but it hasn't been for any of the studies that have been done so far.

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

Does your organization also liaise with the joint personnel support units?

[Dr. Alice Aiken]

Yes.

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

Have you brought the sleep research community together with the Defence community, in the way that you mentioned the sports brain injury medical community has been combined with the Defence community?

[Dr. Alice Aiken]

That's a really great question. We've just been working on a project to bring some of the sleep researchers together with Defence researchers. The study they're proposing is under review, so I don't actually know if I'm allowed to talk about it.

It's a great question. If you think you're coping with stress, you can't fake whether you're sleeping well or not, right? I mean, you can lie about it, but you can't really fake it.

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

Could you describe any unorthodox methods of dealing with PTSD that your organization is involved with, something out of the normal, unique ways of dealing with PTSD?

[Dr. Alice Aiken]

Some of the links we've made—and this is a new study that is just starting up—is looking at fitness and yoga for treating PTSD. I wouldn't say that's particularly unorthodox—typically fitness helps a lot of problems—but fitness and yoga is one.

We've recently linked with a group in the U.K. This is very tentative right now, but we're looking at building an international study looking at meditation and mindfulness. There is a tremendous amount of support for that as well within parts of the military community.

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

How, if at all, does your organization liaise with OSISS, the operational stress injury social support group?