National Defence Committee on Nov. 1st, 2012

[The Chair, Conservative, James Bezan]

Thank you very much. Your time is up.

Mr. Chisu, you have the floor.

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

Thank you very much, Mr. Chair.

Thank you very much to our presenters.

I have a question for Colonel McLeod. As we are aware, some mental illnesses have delayed symptoms that do not present themselves for years. How is National Defence addressing these issues? Is the period of time that is currently given adequate for assessing the overall health of our forces members after they return from combat and a possible return to civilian life? I just mentioned that I was in Afghanistan in 2007. When I retired from the Canadian Forces in 2009 there was not quite so much in place for these things.

I have another question related to that. How many or what percentage of the mental health service professionals have had previous military experience? Because, you understand, the culture is important when you are treating military personnel.

[Col Scott McLeod]

Of your couple of questions, the last was, what percentage of our mental health care providers have military experience? I can't answer that for you, but I can try to track that down. It may be difficult to find, unless we ask every single one of them, but we do have a fairly significant number of retired health care providers who have returned as public servants. I can try to give you at least a rough estimate.

The time delay for presentation of operational stress injuries is a very good point, and I appreciate your bringing it up. We recognize that it can be 10 to 15 years after a traumatic event that somebody can present with post-traumatic stress disorder or any other operational stress injury. We're always available for people to present for an assessment. We're still having people present from Rwanda and Bosnia and operations such as those.

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

Do you have any information about people who participated in the Medak Pocket operation? It was the first combat operation in that—

[Col Scott McLeod]

Right. Do you mean the percentage of people?

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

Did you ever talk to anyone or have a patient from that....?

[Col Scott McLeod]

I know of those who participated in that event, but I don't know them as mental health care patients, no. I know people who have participated.

I've been in Afghanistan myself, sir. All of those are very challenging experiences. When you're exposed to a significantly traumatic event like that, your risk of developing an operational stress injury is obviously higher. We're available to help people get through that once they identify.

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

I was asking you about the Medak Pocket, because that was 15 years ago. As you mentioned, you don't know if there were any other cases of mental illness in that situation—

[Col Scott McLeod]

I'm sorry. I misunderstood. I don't know of any specific cases that came out of that event. We don't track specific events like that to identify percentages of people. We don't keep track of everybody who was there who may have developed that, but I suspect that there are some.

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

Thank you very much for your answers.

I would like to ask Ms. Hull and Ms. Vandergragt a question. As we are aware, some mental illnesses have very delayed symptoms. They do not present themselves for years. How does your practice, and in particular equine therapy, address and deal with this issue? I don't know if the military was saying that your service, equine therapy, is not yet recommended. The military uses HAS dogs, IED detection dogs, to detect explosives and so on, so we rely on these animals to protect us. Can you elaborate on that?

[Marie Josée Hull]

Basically, anybody who wants to get mental health services is usually already experiencing symptoms. They won't often go as a preventive measure. They will go when they experience symptoms. It doesn't matter to me as a practitioner whether the event was 15 years ago, six months ago, or one year ago. I treat the symptoms as they are. We deal with it pretty much the same way. We take the member at whatever point he is at.

[The Chair, Conservative, James Bezan]

Your time has expired.

We are going to move on.

Mr. Kellway.

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

Thank you, Mr. Chair, and through you, thank you to the witnesses for coming and speaking to us today.

This is very intriguing to me. I had never heard about equine therapy before, so I am fascinated by it.

I wanted to start with Colonel McLeod.

Your remarks conclude with the statement that, "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." It's set out that this is the number one priority.

My concern is that this notion of evidence-based therapies perhaps doesn't contradict that statement, but I don't think it's entirely consistent with that statement, because what we seem to be hearing.... Actually, you comment that this “does not mean that the therapy has been shown to be of no value”. You are identifying here that there's certainly some evidence that equine therapy is at least potentially of value to our forces. If they are our number one priority, why do we use this notion of "evidence-based" as a kind of shield to keep equine therapy out of the range of therapies that we are prepared to try for our forces?

[Col Scott McLeod]

That's a great question. The evidence base is certainly not there to exclude equine therapy. We go through a review process for all different therapies, all types of adjunct therapies that exist out there. There are many things out there that can assist all of our patients in many different ways. As was pointed out, every patient is very individual and every patient has very different needs. On at least a biweekly or weekly basis, we have people presenting different options for enhancing communication between the therapist and the patient who's suffering.

There are many different ways of approaching that. We have to have a systematic approach to determining what we're going to fund and use our public funding for. However, having said that, we're not saying these are bad things. It's just whether we can commit public funds to pay for all of the different approaches that are out there. When we decide to make it a core funded program, we have to prove that there is evidence behind it to use it. But if there were an external funding source that wanted to support that, we would certainly not say no to it. We don't necessarily use the evidence base to exclude.

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

The place we start with this is that mental health issues are an enormous issue. Our very first witness for this study talked about the level of mental health issues arising out of Afghanistan and what types of mental health issues were affecting U.S. soldiers, Canadian soldiers, and U.K. soldiers, all a bit different, interestingly.

Given that it's such a big issue and that it seems as though we haven't found the silver bullet, the right key to solve these things, shouldn't the criteria we're using and this systematic approach you're talking about incorporate some way to bring new therapies into the system that look like they're potentially helpful?

[Col Scott McLeod]

That's what our treatment standardization committee does. It reviews all of these therapies beforehand, before they even get presented to the Spectrum of Care Committee. We have specialists—and it's multidisciplinary, including psychiatrists, psychologists, and social workers—who look at these types of therapies and determine whether they are something we want to invest in.

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

To me, the five criteria listed here seem to exclude or limit the possibility of bringing in new therapies. When you look at, for example, the point that it has to be funded by somebody else first, clearly our forces can't be on the leading edge of new therapies for treating people, then, when somebody else has to go first.

[Col Scott McLeod]

Right—these are guiding principles. You don't have to meet all five criteria to be included. This committee is chaired by the assistant chief of military personnel, with representatives from the army, air force, and navy. It's an operationally led committee that can decide to include something, whether or not it meets all the criteria—if it meets two or three of the criteria—if it's the right thing to do. These criteria are to make sure that we are critically analyzing everything that's presented to us and that we have a structured process to assess them, so that we don't just take on every new therapy that shows up on a weekly basis.

Also, we want to be sure that we're not exposing our soldiers to any therapy that may be harmful. A lot of them may seem like a good idea on the surface, but in the long term, they may eventually be harmful. These are very delicate cases and very delicate folks we need to look after. Any care provider would agree that we want to be sure that what we do for these soldiers is the right thing to do. That's where we look for the evidence.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. Strahl, it's your turn.

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

Thank you very much, Mr. Chair.

My question is for Alison. What's the typical timeframe people are involved with this therapy? Is it as long as they're covered or they can afford it, or is it something you do and it sets you on your way? Or is different for every patient you see?

[Alison Vandergragt]

That's an excellent question.

Most of the programming we do is for a set period of time. It depends on the agency that we're co-facilitating with and their budget. My biggest partner would be the Phoenix Centre for Children and Families, out of Pembroke. Right now, we're looking for funding of about $130,000 for this upcoming year to provide programming. They've broken it down into a group of seven sessions because they want to see x number of clients.

In our pilot project, we did a group of five sessions. I found that five sessions were not enough to make huge progress. We did make fantastic progress, but there was so much more we could have done had we had the time.

Now, you can overkill this. I say that 12 weeks is usually the maximum, because then we would have done all the activities. We would have touched on a lot of things. After 12 weeks, our clients should have a really good foundation of some skills they can use in the family, coping and.... Again, it's based on budgets and what our supporting agencies decide as far as time goes, but definitely, five weeks is not enough. Our next pilot will be for seven weeks. I still don't feel that's enough. Ideally, it would be for 10 to 12 weeks.

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

We've heard what the CF's evaluation procedure is, and yes, that's not to say that it's not helpful.... What has the reaction been from other medical professionals to your therapy.? Are they eager to send their patients your way? What is your relationship with psychiatrists and doctors? Are they referring to you or are you in a kind of battle there to bring it into the mainstream—I won't say “legitimize it”—and to have them accept that this is something they would recommend as well?

[Alison Vandergragt]

Generally speaking, we don't have direct contact with or recommendations through physicians. Physicians will approach the agencies—Family and Children's Services, Community Living, and, again, the Phoenix Centre—and refer their clients to those centres, who in turn will come to us with the programming. Physicians aren't saying specifically that a client needs equine therapy or that they could try equine therapy; they're recommending that they go to the outside agencies, which then say, “Let's get them into the equine program because they seem like they fit the criteria for programming.”

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

Thank you.

Colonel McLeod, given the high-tempo operations that the CF is coming out of in Afghanistan, Libya, Haiti, have you seen more, less, or about what you expected in terms of numbers of individuals coming forward with mental health concerns following those deployments?

How do you set up your operation so you can handle the intake without being overstaffed? Obviously that's not a problem, but if you can get where I'm going, is it about what you thought it would be, is it more, or is it less?

[Col Scott McLeod]

That's a great question, because the first thing to also recognize is that the majority of mental health we deal with has nothing to do with operations. The majority of mental health we deal with is the same as what every other Canadian in Canada deals with, so we have a baseline of health care providers who are there to pick up the majority of that.

Once you add on, to say whether it was expected or not.... Going into this, I don't think many people knew what to expect. Canada didn't know, and the U.S., Australia, and our other NATO partners didn't know. What we're finding is that the numbers of people suffering with operational stress injuries are similar to those of other nations, such as the U.K. and Australia, that have had similar deployments and similar exposures.

We're not different in any way, but as we've studied this over the past decade—and we've done a series of studies—we've been able to redirect resources as needed to different areas that we realized would have a higher percentage of people who are suffering. That's why we opened the operational and trauma stress support centres in Gagetown and Petawawa.