National Defence Committee on Nov. 1st, 2012

[The Chair, Conservative, James Bezan]

Good afternoon, everyone. We are going to start our meeting.

I want to change the agenda just briefly; we have a little bit of committee business to do. We have a motion to deal with the steering committee report. I want to get it out of the way now, so that in the event some members have flights to catch, we won't be compromising them at the end of the meeting.

Leif, did we circulate that motion? I don't have a copy of it.

Do you guys have a copy of the motion in front of you...? Bear with me, colleagues.

The steering committee met on Tuesday. I want to thank Mr. Harris for filling in as chair for last Thursday's meeting and for Tuesday's meeting on my behalf while I was travelling.

While we're waiting for the circulation of the report from the subcommittee, I shall read it: your subcommittee met on Tuesday, October 30...to consider the business of the committee and agreed to make the following resolution:

That, on Thursday, November 20, 2012, the Committee resume consideration of a draft report on Maintaining the Readiness of the Canadian Forces, and that members submit further recommendations to the draft report to the clerk no later than Thursday, November 1....

That's today.

Can I have someone move that report?

Thank you, Mr. Strahl.

Is there any discussion?

Mr. McKay.

[John McKay, Liberal, Scarborough—Guildwood, ON]

I have two points. I like and admire Colonel Scott McLeod, but I see that he is also scheduled for Tuesday.

[The Chair, Conservative, James Bezan]

That could be an error in the....

[An hon. member]

I thought he was, but I didn't realize he had been scheduled for today. I thought we had—

[The Chair, Conservative, James Bezan]

This didn't make up part of the report.... There was definitely a decision to have Colonel McLeod now; we do still have Brigadier-General Jean-Robert Bernier, the Surgeon General, appearing on Tuesday. I suspect he will bring support staff with him.

Mr. McKay.

[John McKay, Liberal, Scarborough—Guildwood, ON]

My second point is on supplementary estimates (B). As I understand it, they're due on the tenth of November, and we don't see the minister until the fourth of December.

[The Chair, Conservative, James Bezan]

As long as we report back within three days of the tenth, we'll be all right.

[John McKay, Liberal, Scarborough—Guildwood, ON]

It just seems to be a bit of a rush. It seems to be a bit of a rush all the time.

[A voice]

[Inaudible—Editor]

[John McKay, Liberal, Scarborough—Guildwood, ON]

Hon. John McKay Well, my understanding is that the supplementary (B)s have to be set out on November 10. Correct me if I'm wrong—

[The Chair, Conservative, James Bezan]

They haven't been tabled as of yet, but I think the anticipation is—

[John McKay, Liberal, Scarborough—Guildwood, ON]

I think that's true. You take it from December 10, which is when they have to be reported back to the House, and you get 30 days. I think that's the way it works, yet we don't have the minister until six days before they actually have to be reported. I don't know how many sitting days that is, but it's probably not very many. If we want to do anything about the supplementary (B)s, other than see the minister, we don't actually have much of an opportunity to do so. I just make that as an observation, because I don't like to—

[The Chair, Conservative, James Bezan]

It's a fair observation, Mr. McKay. When the supplementaries are actually tabled, we'll extend the invitation. If we have to change dates, then—

[John McKay, Liberal, Scarborough—Guildwood, ON]

I may want, at that time, when they're tabled—depending on what they say—to suggest that either we move up the minister or maybe get officials in as a separate meeting.

[The Chair, Conservative, James Bezan]

Yes. We'll cross that bridge when we get to it. Is there any other discussion?

Seeing none, all in favour?

[Some hon. members]

Agreed.

[The Chair, Conservative, James Bezan]

The report is accepted.

We're going to continue with our study of the care of ill and injured Canadian Forces members. We're lucky to have with us today a few people to discuss equine therapy for mental health healing.

From the Department of National Defence, we have with us Colonel Scott McLeod, who enrolled in the Canadian Forces back in 1990. He attained his medical degree in 1993 from the University of Saskatchewan, which was followed by a certificate in family medicine in 1995. Scott holds an honours degree in biochemistry from the University of Regina and a master's degree in public health from the University of Texas. He is a member of the College of Physicians and Surgeons of Saskatchewan and the College of Family Physicians of Canada and is an associate fellow with the Aerospace Medical Association. He has completed the U.S. Air Force residency in aerospace medicine and holds a U.S. board certificate in preventive medicine in aerospace.

We also have at the table Marie Josée Hull. She's a clinical social worker and has a master's and a bachelor's in social work and is a member in good standing of the Ontario College of Social Workers and the Ontario Association of Social Workers. She has been in her career for 15 years now, working as a child and family therapist and with mental health agencies. She has a particular interest in helping people by using horses.

Joining us as well is Alison Vandergragt, the program director for Hope Reins Equine Assisted Therapy Programs, who has a great deal of experience using horses in therapy. We're also joined by her daughter, Alyssa, who is celebrating her 17th birthday today.

Happy Birthday, Alyssa. We'll save you the grief of having to listen to all of us sing to you.

With that, I'm going to open it up for opening comments. Again, I'd ask that your comments be kept to 10 minutes.

Colonel McLeod, could you kick us off, please?

[Colonel Scott McLeod, Director of Mental Health, Canadian Forces Health Services, Department of National Defence]

Good afternoon, Mr. Chair. Thank you for inviting me today.

I would also like to thank the other presenters for their interest in helping the men and women in uniform, specifically those who are suffering with mental illness.

Mr. Chair, as the members of this committee are aware, our recent operations, from Afghanistan to Haiti to Libya, have placed heavy demands on the Canadian Forces, and specifically the personnel. This intense operational tempo has brought the challenges faced by our returning military servicemen and women to the forefront of our consciousness as a country. That's why I am pleased to see that this committee has chosen to undertake a study on the care of ill and injured personnel.

In this context, mental health care is a priority for the Canadian Forces. It is critical not only to the ability of the Canadian Forces to carry out their missions, but also, and even more importantly, to the health and well-being of our men and women in uniform and their families.

I am proud to say that our clinicians are considered experts in the field of trauma-related mental illness across Canada and internationally. Today we have access to approximately 378 full-time mental health care professionals. Within NATO, this is the greatest ratio of mental health care workers to military members.

But delivering high-quality mental health care services is about more than having dedicated and well-trained professionals; it is also about having programs suited to the needs of our patients. That's why we have a comprehensive mental health care program that is founded on evidence-based best practice. Our operational trauma stress support centres are made up of multidisciplinary teams of health professionals who use the latest evidence-based treatments and techniques and who take pride in staying up to date in therapeutic techniques.

We also recognize that there are always advances in the field of treating mental illness. For that reason, we have a systematic process for reviewing any new therapies or treatments available. Our treatment standardization committee, chaired by our senior psychiatrist, Colonel Rakesh Jetly, reviews new therapies and treatments to ensure that we continue to improve our system and provide the highest quality of care to our patients.

One of the challenges we face on a daily basis is how best to deal with adjunct therapies such as equine therapy. We routinely receive requests to consider a wide variety of adjunct therapies, such as pet therapy or even creative arts therapy, that appear to have some level of benefit on an individual basis to individuals who participate; however, there is rarely sufficient evidence to prove their long-term benefit. This is not dissimilar to adjunct therapies for physical illness and injuries as well.

In order for us to have a responsible, standardized approach for all treatments and therapies, we apply the five core principles of the Spectrum of Care Committee. They are as follows:

One, the treatment, service, or item must adhere to the scientific principle of evidence-based medicine. This principle would eliminate any new medical procedure or remedy that has not been adequately investigated and scientifically found to provide a significant health benefit.

Two, the treatment, service, or item is necessary for the purpose of maintaining health and mental well-being or preventing disease; it permits the diagnosis or treatment of an injury, illness, or disability.

Three, the treatment, service, or item is not for purely experimental, research, or cosmetic purposes.

Four, the treatment, service, or item is funded by at least one province or federal agency. This principle is in keeping with the public service health care plan criteria.

Five, the benefit sustains or restores a serving member to an operationally effective and deployable status.

If we determine that a new adjunct therapy should be considered, it is presented to the Spectrum of Care Committee for consideration.

The Canadian Agency for Drugs and Technologies in Health, CADTH, recently published a rapid response report entitled “Therapy Dogs and Horses for Mental Health: A Review of the Clinical Effectiveness”. It was published on August 10, 2012, and is available on the CADTH website.

In this report, 22 potentially relevant articles were retrieved for a full text review. The conclusion of this report was as follows:

Horse-assisted therapy was found to be effective in children who have experienced family violence, patients with schizophrenia, and children with ADHD. These findings were taken mainly from a limited number of uncontrolled trials...with small sample sizes...and therefore conclusions from these studies should be taken with caution....

As no studies that compared these interventions to other standards of care such as pharmaceuticals were identified, it is unknown whether animal-assisted therapy is more or less effective than these alternative therapies. Longer-term controlled trials with larger sample sizes will be necessary to further evaluate the effectiveness of using dogs and horses to facilitate therapy session[s] for patients with mental health challenges.

At this point, there is not sufficient evidence to support the inclusion of equine therapy in the spectrum of care based on any of the five criteria. However, as with all therapies, we're open to reconsidering them as more evidence and literature become available. That being said, I want to be clear that not including equine therapy in the spectrum of care does not mean that the therapy has been shown to be of no value. It only means that there is insufficient clinical outcome data at this time to justify its funding by public health care authorities as a core medical service.

There are many things that improve our mental health, such as personal holidays, hobbies, pets, exercise programs, and many more that are not funded by health care systems. We always encourage members of the Canadian Forces to participate in activities that improve their mental health. Our duty to our patients and to responsibly manage public funds, requires, however, that we devote publicly funded health care resources to therapies that have been scientifically demonstrated and accepted by the expert health community as significantly enhancing clinical outcomes.

Our number one priority is to develop and deliver to our men and women in uniform the mental health care programs that they need and deserve.

Thank you.

[The Chair, Conservative, James Bezan]

Thank you, Colonel.

Next on our list is Ms. Hull. You have the floor.

[Marie Josée Hull, Clinical Social Worker, As an Individual]

Thank you, Mr. Chairman.

Thank you, honourable members of Parliament and distinguished guests.

I am honoured to be here to talk about equine assisted psychotherapy. I'd like to start by making a bit of a distinction between three practices in the field. You can have equine services for physical rehabilitation; you can have some for education, which is equine assisted learning; and you can have some for therapy. Today I will be talking more about the ones geared toward therapy.

In my private practice, I treat soldiers who have been diagnosed with operational stress injuries.

I'd like to explain something before I go on to speak about equine assisted psychotherapy. When members come in, their anxieties are usually very high. Soldiers usually function in more of a fight-flight mode, or survival mode, so in order for us to be able to use any cognitive-based approach to process traumatic events, we need to bring them to a baseline level of calm and stabilize them. In my practice in the office, I've found that for many of them it's very difficult to manage that. A lot of soldiers don't respond well to meditation and things like that. Soldiers are active, and they like to move. So it's been a challenge in my practice, and my colleagues agree with me on that.

When a soldier comes in and is diagnosed with such an illness, it has an impact on the soldier's entire life. It has an impact on their sense of safety; on their ability to trust themselves and to trust others; on their sense of power and control over themselves and over their environment; and on their self-esteem and their intimacy. It affects families, it affects children, and it affects them.

In terms of where equine assisted psychotherapy fits in, when we do equine assisted psychotherapy it's first of all based on nature. You're outside. Just being in nature has benefits on health, just being out, just being in tune with the natural rhythms of nature.

Then you are dealing with an animal that is quite large, that you can stand and look at eye to eye. You are asked to do certain activities with a mission in mind, so the pressure is on to perform. Some anxieties can come in. The situations you place people in are to imitate real-life situations. The material can be used as a metaphor for what is really at the surface for this particular member. However, these emotions come out in a safe environment where you are supported by your mental health professional and your equine specialist. You can really practice then and there. It's very experiential in nature. You can practice your natural coping mechanisms and see how they work or do not work. If they don't work, you can try to figure out a new one and practice it then and there. This is the richness of this therapy.

Now, it's active in nature but it's also very reflective in nature. One thing that stunned me when I began working with soldiers was that they have learned to soldier on and to not pay attention to the pain, to keep going: you're on tour, you have a job to do, you can't get into emotion. This becomes something of a habit, and it's hard for them to connect with emotion.

A horse is a very, very valuable tool, because a horse is not comfortable with a person saying something on the outside and feeling something else on the inside. Horses survive by reading the non-verbal, and also by being able to feel emotional states. There is a biological explanation for that, which I will not get into today, but they can feel emotional states. When a horse sees that the non-verbal and the emotional state do not go together, it doesn't work. A soldier has to look at what's inside to be able to have good cooperation with the horse and to have some success.

The idea behind this equine assisted psychotherapy is not to bond with an animal. The idea is to face your fears in a safe environment and to learn from little successes so that you can reintegrate into society with your family and with your children.

In the last phase of trauma treatment, after processing trauma using the cognitive, evidence-based approach, it is also nice to later reintegrate a member and help them develop skills, or get better with their skills, in practice with their family.

Equine assisted psychotherapy can be done with the family. It can be done with couples. It can be done with colleagues. It has very big value in that you wouldn't be able to get that working in an office.

That's my presentation. Hopefully, it gives you a bit of a picture. If you have any questions, feel free to ask.

[The Chair, Conservative, James Bezan]

Thank you very much.

Ms. Vandergragt, it's your turn.

[Alison Vandergragt, Program Director, Hope Reins Equine Assisted Therapy Programs, Vanderbrook Farm]

First of all, Mr. Chair, honourable members of Parliament, and distinguished guests, I am very honoured to be here and share something that is such a passion in my heart. I was a navy wife for 10 years, and horses have always been an important part of my life, so integrating them in something that has such benefit is something that's been very close to my heart.

I'm going to tell you briefly about my background, how I got to presenting these programs, and maybe about some of the things I've found.

I am the program director at Hope Reins. I've been an avid natural horsemanship student for a number of years, and I'm fascinated with the psychology of the horse. I started to realize that there was a connection between how horses thought and how they reacted to situations, and I started relating that to how we react with our own situations and relationships in our families. I found ways in which I could communicate with my horse, and I was very effective, but I wasn't so effective at home, so I started practising some of the principles there that I used with my horse. In my situation as a mother, I found that because we rely so much on verbal communication, when we start using some non-verbal communication, things go a lot more smoothly.

I've worked in community and long-term health care for 20 years. I met a lot of clients who had unresolved mental health issues. Addressing them went way beyond the scope of my practice and not being able to be part of the solution always caused me some distress. I eventually experienced my own very deep personal loss and I started to examine the connection between my own recovery and the role my horses played in my emotional healing. I began to wonder if horses could be part of the therapeutic process as well. I found from my own experience, this has been very true.

Hope Reins Equine Assisted Therapy Programs is seeking charitable status at this point. We provide equine-assisted learning and psychotherapy programs to children and adults facing issues such as cognitive deficiencies, autism, grief and loss, anxiety, addictions, PTSD, and more. I'm going to skip over the equine assisted part. It seems that everybody here has a fairly good idea of how that works. I want to touch on why we use horses.

Horses possess unique attributes beyond their traditional uses. Generally they've been used for transportation, and we've worked with them in the fields. We have quite a history of horses in our lives, but I've found that horses are very honest by nature, and they require humans to be honest in return. They are good lie detectors and offer feedback in the form of body language.

Horses rely on a precise and well-established system of communication that can be so subtle that humans may not even be aware of the conversation that's going on around them when they're in the herd. Horses have an intricate pecking order made up of leaders and followers. Each horse has its unique what I call “horsonality”, and all play an important role within the herd.

Within the horse-human interaction as presented in the therapy session, the human participant will generally use the same coping mechanisms that they use with other stressful factors in their lives. As these issues arise, the participants reveal their true selves and may break down some barriers in the communication blocks. With the use of horses, an enormous amount of metaphorical learning can be achieved.

What does an equine-assisted session look like? You might wonder what we do. Do we sit the client on one chair, the horse on another, and the therapist on their chair? Not exactly.

We take this to the arena, of course. Typically, it's carried out in an unmounted session. An equine specialist provides an activity or a series of activities to be completed by the client. Actions and reactions of both the horse and the human are closely monitored. These observations are used to relate, sometimes metaphorically, to issues the client is facing.

In our practice, when we're working with our mental health professionals, we offer each other feedback on what we're seeing. If I see something that the mental health professional doesn't see because they're not an equine specialist who may not understand the meaning behind the flick of an ear or some kind of body language, my job is to bring about some awareness and make a comment on it that the therapist in turn can use in processing with their client.

Participants will learn that the easy way is not the right way. They will learn finding success with horses requires physical and mental work—very valuable characteristics. Most importantly, horses have the ability to be a mirror of what's going on inside. What we hear all the time is “this horse is stubborn” or “this horse doesn't like me”. It might be the client's reaction, but in fact what's generally happening is that the client has to realize that change comes from within, and that the horse is offering feedback on this. It's through this honesty in that relationship, in building this relationship with the horse, that a powerful message can result.

The concept of equine-assisted therapy is recognized globally, but I'm going to focus on the U.S. for the moment. I've been watching various programs and what they're doing and who's supporting them. The information I've gathered has just been for my own personal interest, but I'll share with you what I know.

There are numerous programs across the country that are supported by Veterans Affairs. Polytrauma vets are receiving care at VA medical and rehabilitation centres and are involved in programs that take place at a base or at a locally accredited riding facility. It appears that most of the VA-supported programs are considered therapeutic riding. I didn't really touch on that, but as M.J. said, that's more focusing on the physical aspect of recovery.

Another example I have for you is the U.S. Army's Caisson Platoon's equine-assisted program. They use their own horses, which are actually part of the army's famed Old Guard. The unit is responsible for guarding the tomb of the unknown soldier and for military honours during funerals at Arlington Cemetery. Volunteers are drawn from the actual platoon itself to assist in this program. The advantages of that are peer support for the soldiers in the program.

I'm going to touch a bit on EAGALA, which, for those of you who don't know, is the Equine Assisted Growth and Learning Association. They recently announced the creation of a military service program in order to streamline hundreds of equine programs across the United States. EAGALA is strictly an unmounted program, with practitioners across the U.S. They have started to branch out and are doing certifications within a specialty of treating military personnel.

EAGALA met with key ranking officers from the behavioural division of the Surgeon General of the U.S. Army, the office of the Chairman of the Joint Chiefs of Staff, Army Medical Command, Warrior Transition Command, the Walter Reed Army Medical Center, and the Human Performance Resource Center, to demonstrate the EAGALA model of equine-assisted psychotherapy in keeping with the EAGALA model, which, again, is unmounted exercises.

According to the pilot project conducted by Refuge Services, which is one of the EAGALA military service programs in Texas, after only six sessions veterans and their spouses reported up to 60% improvement in the severity of marital problems, including physical and verbal abuse, financial disputes, parenting choices, and their ability to forgive and spend time together. Couples also reported up to 50% improvement in conflict resolution, emotional closeness, increased level of trust, respect, intimacy, and reduced anger.

We've already discussed how there's not a whole lot of research being done in treating PTSD in military personnel, but there is a little bit of good news on that horizon. In the U.K., the International Society for Equitation Science offers a grant for study of the therapeutic effects of equine-assisted activities for military veterans with PTSD and/or traumatic brain injury. In the U.S., the Horses and Humans Research Foundation recently announced the awarding of a grant to help study the serious and growing problem of untreated medical health problems in U.S. veterans. So it is possible that we will see some results in the near future, and let's hope that's soon.

I want to leave you today with maybe a better understanding of how horses are used in therapy. Whether programs are conducted in the saddle or on the ground, equine-assisted therapy is a phenomenal choice for treating PTSD. The bond between horses and humans is ancient. Using horses in this type of program is a natural extension of that long-standing relationship. I ask that you strongly consider any and all of the equine-assisted concepts for use with our military personnel.

I also wish to tell you a bit about a meeting I had earlier this week with Joanne Moss of the Canadian Foundation for Animal Assisted Support Services. I wish to inform this committee today that the foundation is well positioned to bring together related stakeholders to co-create a public policy statement. However, before they begin the first study—if funding is accessible—it's imperative that a labour market research study and an environmental scan be conducted, because of the vast scope of services, practitioners, and organizations involved. The study will likely highlight public policy as one of the priorities moving forward. The Canadian Foundation for Animal Assisted Support Services welcomes your interest and would be pleased to meet to discuss next steps with the committee.

Thank you very much. You've been great.

[The Chair, Conservative, James Bezan]

Thank you.

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

Mr. Harris, you have the first question.

[Jack Harris, NDP, St. John's East, NL]

Thank you, Chair.

Thank you to all our guests for coming.

I want to get to the actual therapies themselves. I think I'll start with Colonel McLeod to try to put them in a context.

You say that you have 376 or 378 mental health care professionals in the mental health services. Could you give us a breakdown as to what the categories are—doctors, nurses, whatever?

[Col Scott McLeod]

It includes psychiatrists, social workers, psychologists, mental health nurses....