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.