National Defence Committee on Nov. 1st, 2012

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

Thank you.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Brahmi, you have the floor.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you, Mr. Chair.

Colonel, my first question is for you, regarding mental health workers in the Canadian Forces.

Has the proportion of civilian to military personnel working in your services, within the various mental health disciplines, changed over the past 15 to 20 years? Could you give us the percentage of military members compared to civilian members?

Obviously, you may not have these numbers. Would it be possible to get them to us?

[Col Scott McLeod]

If I understand the question correctly, it's about what percentage of our mental health care providers are civilian versus military...?

[Tarik Brahmi, NDP, Saint-Jean, QC]

Exactly.

[Col Scott McLeod]

Over the past decade, we've seen a dramatic increase in the number of civilian mental health care providers. Rx 2000 is the name of the project that we went through to rebuild our health services. In that, we hired a lot of civilian health care providers, so that number has gone up. With regard to the percentage of civilian versus military, I don't have that offhand, but I can certainly provide that to you, sir.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Absolutely. It would be a good idea to inform the committee of these figures and record them in the minutes so that they can be used in a future report.

Moreover, you said that within NATO, Canada has the greatest ratio of full-time mental health care workers to military members suffering from post-traumatic stress disorder. Is this a significant difference in ratio compared to other NATO countries? Could this be explained by the fact that Canada conducted a longer military operation than other NATO countries? Or is it due to the structure of our mental health system?

[Col Scott McLeod]

That's a good question. As for where we are in relation to other NATO nations, it all depends on the nation. Some we're actually quite close to and others.... We can provide that NATO report if you'd like to see how we compare to the other NATO nations.

Why is that? It's mainly because when we were going through the restructuring of the health services, we recognized that mental health was a significant issue in the Canadian Forces, and it was identified as something that we had to address. Also, recognizing that there was the potential for operational stress injuries going into an operation like Afghanistan, we wanted to try to ensure that we had the appropriate personnel available to look after the members.

It's difficult to say whether it's what the other nations have done—

[Tarik Brahmi, NDP, Saint-Jean, QC]

Do you think it is a direct consequence of having conducted a much longer military operation than other NATO countries?

[Col Scott McLeod]

I can't really say in comparison to other NATO nations. We just made the decisions based on what we felt our risks were going to be and what we felt we should be doing.

[Tarik Brahmi, NDP, Saint-Jean, QC]

I'd like to address my next question to Ms. Hull.

As a clinician, you see your therapy from a different perspective. The armed forces consider it a complementary therapy, from what I understood in the colonel's presentation.

Your presentation brings to mind a study done in 2010. Dr Valérie Tourjman, from the Université de Montréal, participated in that study that concluded that 70% of antidepressants were ineffective. Would you not say that that's good news for complementary therapies? In fact, perhaps it cannot be scientifically proven that complementary therapies are effective for some people.

[Marie Josée Hull]

Complementary therapies can be effective for certain people. However, in the case of horse-assisted therapy, no studies have been done to prove this.

Could you clarify the question?

[Tarik Brahmi, NDP, Saint-Jean, QC]

In general, antidepressants are considered more effective since they are a drug, as opposed to a complementary therapy. Although some studies consider that 70% of these drugs are ineffective, we use them daily and they are covered by the provincial health systems.

Doesn't that prove then that there is no way of demonstrating that complementary therapies, such as horse-assisted therapy, are useless or ineffective? This supports your argument that we cannot demonstrate that it's ineffective.

[Marie Josée Hull]

I don't think that we're trying to show that it's ineffective.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Well not you, in any case.

[Marie Josée Hull]

No, and that's not what the Department of National Defence is trying to do either.

I have a really hard time answering this question. Personally, I believe in horse-assisted therapy and its potential. Unfortunately, this therapy hasn't benefited from studies or investments that could make it an evidence-based approach.

[The Chair, Conservative, James Bezan]

Thank you very much Mr. Brahmi.

Mr. Alexander, it's your turn.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Thanks, Chair.

Colonel McLeod, we've made enormous progress under your leadership and the leadership of others in the Canadian Forces in reducing the stigma of and bringing resources to bear on these mental health issues, especially PTSD. What do you think the biggest challenge is now for Canada in meeting the challenge that so many of our returning members and legacy issues from much earlier conflicts represent?

[Col Scott McLeod]

Our biggest challenge in dealing with the mental health issues related to Afghanistan or specifically...?

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Generally, in the Canadian Forces.

[Col Scott McLeod]

I think one of our greatest issues—and we've talked about this a lot—is dealing with mental health and the stigma related to mental health in Canada in general, in trying to open up access and having people present for their mental illness earlier and get that treated. If we're talking specifically about mental health, it's about communication, education, breaking down stigma barriers, and working with other agencies to improve that awareness within Canadian society. I think that is one of our biggest challenges.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

We heard a lot about that at a Canadian-hosted seminar that you and I had the privilege of attending in Washington.

What is working best to bring members to the point where they will accept to undergo the diagnosis and then undergo the treatment? Because that does seems to be a universal weak point, not just in our system but among allies as well. Even where it's generally recognized that someone is suffering, they either feel that sense of stigma sufficiently not to have it diagnosed, or they start the treatment and don't finish. How can we make members more comfortable with this process?

[Col Scott McLeod]

One of the things that has helped a lot in the military is the fact that we've called this an injury. This is a mental health injury. Soldiers are much more likely to come forward for an injury than an illness.

The other thing we're trying to do is get people to recognize that a mental health injury or illness is the same as any other physical injury or illness we may have. Starting to accept mental illness as being like any other form of illness people suffer from is really the only way that we're going to continue to move this forward and break down those barriers.

We are seeing that. It is happening. It's not fast. Even since I started practising medicine in the nineties, there has been an enormous change in people's approach when they are suffering with mental illness. They are much more willing to come forward with these things. I have certainly seen that in the military population.

[Chris Alexander, Conservative, Ajax—Pickering, ON]

Is there a role that we in Parliament or the government can play outside of the Canadian Forces to create a public environment in which there is more pressure—benign pressure—for and acceptance of the need for members to participate in this when it has been assessed as something vital to their well-being?

[Col Scott McLeod]

I think it goes beyond what government can do. It's what all leaders in Canada can do by talking about what mental illness is, by accepting it as another injury or illness, and by recognizing the impact it has. It has a dramatic impact economically. It has a dramatic impact on people and their performance at work and within their families.

It's about all of us in society recognizing this as part of society. It's a treatable condition. We need to continue to invest in the different types of treatments and therapies we're talking about here today. We need to be open-minded as to how we can advance this study and this field.