National Defence Committee on Oct. 4th, 2012

[Dr. Alice Aiken]

Again, they fall under the umbrella of the Canadian Forces Health Services group and the director general of personnel, PFSS, Commodore Watson.

We do liaise as closely with them as we can. As I mentioned to Madame Moore, a big part of what the mental health researchers look at is peer support. It's part of the way of destigmatizing mental health issues.

We work with the OSISS clinics, the OSI clinics run by VAC, the joint personnel support units—all of those.

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

I'm also seeing applications from time to time, for example, from horse ranchers, who are helping to bring some of these people who are literally still barricaded in their basements out into daylight. They are having them interact with horses—different animals as well, but specifically horses at this time.

Are there any scientific-based studies being done on using animals to help people cope with PTSD?

[Dr. Alice Aiken]

Not in Canada currently. There is a very large-scale study being done by the United States VA on dogs helping people with mental illness. Unfortunately, the conclusion they've come to is that if they get every veteran a dog, they'd be bankrupt within five years. And they have a lot of money.

It's one of those things that is a bit difficult. I will tell you that in other literature not related to military populations, hippotherapy with horses has some very significant solid research behind it. There have been requests to do the work with military populations, but it's still very new for us.

To my knowledge, the horse therapy hasn't been done with military populations yet, and certainly not in Canada. But horse therapy itself has some very solid research behind it.

[The Chair, Conservative, James Bezan]

Thank you very much. I have horses and dogs, and I can tell you that dogs are a lot cheaper than horses.

Mr. Kellway, it's your turn.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you very much, Mr. Chair.

Alice, thank you for coming today. I'm struck, when I look at the materials, by all the logos at the bottom. I know you said 25, but the graphic here is quite something. Congratulations to you for pulling all these organizations into one institute.

I was interested in the study reference on the incidence of PTSD and how the effects of service for veterans kind of manifest themselves in the U.S., Canada, and the U.K. I have two questions about that. First, was there an explanation offered in the study for the differences? Canada, for example, has half the incidence of PTSD but so much more depression.

Second, with that in mind, I'm wondering whether this phenomenal amount of research going on in these institutes is making its way from that research field and the academics into the Canadian Forces health system. For example, when one looks at this study and sees the incidence of depression, is that research impacting on the kinds of services being offered, such as suicide prevention or something like that, in the Canadian Forces? Are we seeing that kind of translation?

[Dr. Alice Aiken]

Yes, we are.

I'll answer your first question first.

The great thing about epidemiological studies is that it's lots of people and you can really predict population trends. What you sacrifice in an epidemiological study is the why. You completely lose that. No, there's no explanation as to why. However, recognizing that there is a problem can help you in terms of treatment, because there are lots of ways to treat depression.

Yes, it has filtered its way down to the Canadian Forces, and the Canadian Forces have done a number of studies themselves. They did a study on suicide rates. They've done a study on family violence, the results of which will be released shortly. I know that they do recognize it and make a very concerted effort to implement best practices, especially with mental health research, and with all research.

[Matthew Kellway, NDP, Beaches—East York, ON]

You made an argument for such an institute being arm's length from the government departments. You also talked a bit about the clinical work and the policy work research being done. I'm wondering if you could give us, briefly, an overview of the kind of policy research being done and whether it is in fact that policy research that benefits from being arm's length from the government departments.

[Dr. Alice Aiken]

One of the examples of the policy work, which Mr. McKay brought up, was the work we did comparing the new Veterans Charter and the Pension Act. It was taken into consideration, certainly in some of the amendments made to the new Veterans Charter. That kind of policy work absolutely was done at arm's length from the government.

Some of the program and policy work is a little bit smaller scale. There are some tremendous programs out there. But if they're implemented, it's really critical to build in an evaluation piece so that you can know if the program is doing what you said it's going to do and how that translates into policy. If this is an effective program, and it's having the impacts you want it to have, then you keep it as a program and you fund it. It's not all big P policy change; it's really critical health policy change that we look at.

[Matthew Kellway, NDP, Beaches—East York, ON]

Is this research focusing on, for example, what the government departments are doing, such as Veterans Affairs and the Canadian Forces programming?

[Dr. Alice Aiken]

Absolutely, yes, because that's where a lot of the programming is coming from. For example, the operational stress injury clinics Veterans Affairs runs—I believe there are 11 across the country right now—built evaluation into all of their treatment practices from the get-go. They actually are now kind of the leading experts in treating operational stress injuries around the world. In fact, they've built workshops to train clinicians. And they have really solid evidence-based outcomes for some of the treatment programs they use. That's how it translates.

[The Chair, Conservative, James Bezan]

Thank you, Mr. Kellway. That was exactly five minutes.

Mr. Strahl, you have the last questioning in this hour.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you, Mr. Chair.

Dr. Aiken, thank you for sharing your time and expertise with us today. It was good to hear that the Canadian Forces are considered a world leader in destigmatizing mental illness. I had the opportunity to witness that firsthand when I got to welcome home some troops from Libya on the HMCS Vancouver. General Natynczyk himself, when he gathered around the sailors, talked about their needing to ask for help. It came from the very top, so it's good to see that's being noticed.

Following on that, you said that you focus on research, education, and knowledge exchange. I'm interested in that knowledge exchange part. What have we seen? It's maybe dangerous to ask a question you don't know the answer to, but compared to our near peers or some of our other NATO allies, how are we doing in the treatment of the ill and injured Canadian Forces members, from your research, compared to, say, the U.S. or Australia, which you said you had done some work with? How are the Canadian Forces doing compared to those allies?

[Dr. Alice Aiken]

In best practices, research, and treatment, the allies cooperate very well. They're on par. We're very similar to Australia and the U.K. The U.S., of course, as always, has a much larger force. You're really comparing apples and oranges then, so it's hard to say. We do know that they have a much higher suicide rate than the Canadian Forces.

Of the forces that we're comparable to, Australia and the U.K., not in terms of size but in terms of training and deployment length, I would say we’re very similar, which is well; we're doing well. The Canadian Forces Health Services system is the Cadillac of medical systems. You get everything provided—all your medications, all your therapy—and it still costs $78 less per person than any provincial health care system in Canada.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

That's interesting research right there. I'm sure we could have a large discussion about that.

I'm going to stick with the mental illness issue. It's Mental Illness Awareness Week, as the chair mentioned, so it fits in nicely. What skills are we giving to families? I know we talked about giving a soldier a card, “If you recognize this...”, but often, if not always, it's going to be the family that recognizes that there is a mental illness there or signs that it may be coming.

Are the Canadian Forces doing a good job, or is there another body of research? Are there other practices out there to equip families to (a) better diagnose this or get people into treatment, and (b) to support them when a member of the forces is diagnosed with a mental illness?

[Dr. Alice Aiken]

I would say yes. We were at a breakfast the other day and the Surgeon General was there. He said through informal work they've done, really very few people come to seek mental help because of what the medical system told them. They come because a friend, like a peer or a family member, says, “Right, you need to go seek help, something's happening”.

I think the families are well equipped for that. I think where the families are less well equipped is to deal with their own issues. So they don't have a centralized system. They live in a system that doesn't understand unique needs, and, believe me, we're working on trying to change that. I think they're probably less capable of recognizing their own needs. But in terms of the needs for the soldier, yes, I think they're doing a good job in helping families and peers to recognize when there's a mental health issue.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you, Mr. Chair.

[The Chair, Conservative, James Bezan]

Thank you.

Our time is up with Dr. Aiken. We scheduled her for one hour.

I certainly appreciate your coming on very short notice and providing your expertise and comments to help us kick off the study. Some of the other researchers you mentioned in your testimony today will be people we'll want to follow up on. As well, as a committee, we're going to take a look at the reports you talked about.

I want to thank you for your service to Canada, both as a member of the Canadian armed forces and as one of our vets, and now for the work you're doing with Canadians for military and veteran health research. You really are doing a great service for our members of the Canadian Forces and our veterans.

With that, I want to wish you a very happy Thanksgiving.

We're going to suspend. For anyone who is not tied to a member of Parliament or does not belong to a whip's office, I'm going to ask that they vacate the premises.

Thank you.

[Proceedings continue in camera]