National Defence Committee on Nov. 1st, 2012

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

We're all delighted to have you here together. It illustrates the variety of therapies that are potentially available.

Are we doing enough at the other end, though? Mental health injuries have been, from time immemorial, part of combat and part of the military experience. Are we preparing our soldiers, sailors, and air crew well enough during the recruitment and training process to have the resilience to know when they need treatment and to avoid the injury if possible? Rates vary in different populations, depending on the level of preparation and the way they go into the experience.

[Col Scott McLeod]

We're doing far better than we ever have in the past. I have mentioned a few times this afternoon our Road to Mental Readiness training package and resiliency package. It is being instituted at all levels of professional development in the CF. We are seeing very good results from that. We're doing studies to see what the impact is even on training success and how people get through the daily stressors that occur in basic training and in other levels of training. We're very optimistic.

The RCMP has approached us for the same program. The Ontario Provincial Police has done that. The Mental Health Commission of Canada is speaking to us about doing this as well.

As we start utilizing this type of training in bigger populations, we will only continue to improve it. We have a robust program, but we continue to learn and to try to improve it.

[The Chair, Conservative, James Bezan]

Thank you.

For the last of the five-minute rounds, we have Mr. Norlock.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

I'll pass my time on to Ms. Gallant, please.

[The Chair, Conservative, James Bezan]

Ms. Gallant, you have the floor for five minutes.

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

Thank you, Mr. Chairman.

Ms. Hull mentioned that the first phase of treatment in dealing with PTSD—the trauma phase—is bringing the patient down, so to speak.

Colonel McLeod, I have had soldiers come into my office who were so drugged up they were incapacitated. They were just coming down from that phase. Besides prescription medicine, what other treatment is currently used to help these operationally stressed, injured soldiers come out of this first phase?

[Col Scott McLeod]

I think that's a better question to ask our senior psychiatrist, who is involved in the different forms of therapy.

In general, we prefer to use a multidisciplinary approach to care, which involves a balance between psychotherapy and pharmacotherapy. I certainly can't speak to any individual case that you may be aware of, but we try to involve all four disciplines: the social workers, psychologists, mental health nurses, and the psychiatrists. The pharmacotherapy portion of that really should play a fairly minor role. The majority of this does take place in the types of therapy that we've talked about here today.

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

Are there any other hands-on types of therapy, other than sitting in a room, talking for a while, and then having another week or a month go by before the next session? Is that generally the way it goes with the interdisciplinary group?

[Col Scott McLeod]

Again, I'm a family physician by training, and how I would do it as a family physician is different from what our multidisciplinary teams do in one of our operational trauma stress support centres. I think we could probably get some expert opinion from Marie Josée as well, who has worked as one of our social workers in Petawawa.

[Marie Josée Hull]

I worked there for a year, yes. I can only speak from what I was working on. I was on the mental health team in Petawawa. We have psychologists, psychiatrists, addictions counsellors, social workers, and mental health professionals. Generally, it's the team working together.

My role as a social worker was to go through the three phases of trauma treatment with a client, but we would elicit the help of a psychiatrist who would find a combination of medications that would fit the person well. Also, if there were any addictions issues, they get addiction services.

Sometimes a member could have two meetings a week with a person, but the therapies we use in Petawawa are office-type therapies. We're in an office. They come to the Warrior Support Centre.

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

Ms. Hull and Mrs. Vandergragt, have you approached or have organizations such as Wounded Warriors or Soldier On approached you for a different form of funding for treating PTSD in soldiers?

[Alison Vandergragt]

No, not directly. I have worked through a couple of agencies that have tried to make that connection, but I'm finding that I've been relying heavily on the actions of these agencies to make the connections. The agencies are extremely, extremely overworked at this point, and to take the time to make the connections.... So it has been part of my mandate to attempt to make some of these connections myself. That's what I'm doing currently. They have not approached us.

I think anything that we do through those agencies traditionally would have been through an agency, but right now I'm finding that the connections.... I'll have someone say to me that they're going to be in touch with Wounded Warriors or whatever and then we don't hear anything back; I go for a follow-up and they'll say they're getting to that. I think one of my goals is to get out there and make contact with these organizations myself.

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

Ms. Hull, since you have worked at Petawawa as a social worker for operational stress injuries, have you noticed a difference—and I think Mr. Chisu alluded to this—between the types of operational stress injury or how that manifests itself differently from a mission in the Medak Pocket versus Afghanistan?

[An hon. member]

[Inaudible—Editor]

[Marie Josée Hull]

Unfortunately, I wouldn't be able to answer that question, because I only had one year of experience. My caseload during that year was mainly working with people who have come out of Afghanistan.

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

Based on the experience you've had with these soldiers and the need for treatment, is there anything you can see that could be done to screen people who would be more apt to suffer an operational stress injury than people who wouldn't?

[Marie Josée Hull]

I'm only speaking from personal experience here. It's very difficult to screen somebody beforehand. I've found that sometimes you can get the best qualities in soldiers who have had previous trauma in their lives: they have been resilient and they've learned coping skills that will make them terrific soldiers. But then just a few more traumas can drive them over the edge, and their thinking is so distorted and rigid that they can't get better—but they're very good soldiers. Then again, it's also difficult because you could have somebody with a very average upbringing, and unfortunately so many things happen and they don't cope well.

It's difficult to pre-screen. I think there are some things they can look at, but it's difficult to say “yes” to one person and “no” to another. Does that answer your question?

[The Chair, Conservative, James Bezan]

The time has expired. Thank you.

We do have time for one last set of questions from each political party, so we'll have Mr. Harris from the NDP.

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

Thank you.

Thank you for your presentations today.

Colonel McLeod, I think we're going to have to have you back again, because this is a study on health services in general, but today we decided to at least look at the ideas of our other two witnesses who are here today. had.

Something did jump into my mind to ask you, based on a response to Ms. Gallant. Your training is as a family physician. I was looking at your resumé and all of that. In the structure of the CF health services, do all these other people, like the psychiatrists and the others, work for you? Do they report to you or is there some other sort of structure here?

I'm not criticizing your credentials, but I don't see anything here that has anything to do with mental health or any specialty work in that area. Can you explain to me how that structure works in terms of your role versus that of the people who are delivering the services?

[Col Scott McLeod]

Yes. That's a great question.

First of all, as a family physician, you do a significant amount of training in mental health. However, in this case, as the director of mental health, I'm responsible for the programs overall. The clinics that deliver the care report to the clinic managers have oversight from our clinicians on the ground. We have a senior psychiatrist as our adviser, Colonel Rakesh Jetly, and he's responsible for ensuring that our the treatments that we deliver are appropriate, evidence-based, and up to date.

My responsibility is more for the overall program itself, to ensure that we're delivering the care to the places that need the care. It's an overall program delivery responsibility.

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

Okay. I would like to have you back to explore some other aspects of mental health delivery, because we do have a lot of other questions to ask about that.

To our other witnesses, because I don't think we will have you back, I think you've convinced us that there's something to offer in terms of the kinds of service that's there. If Mr. McKay's suggestion is taken up in terms of a pilot project or something like that, what form might that take? If, for example, there were a request for proposals, or if there were a desire to have a pilot project, would you folks be in a position—and do you think others would be in a position—to put forth a plan for a pilot project, a definition of a project where you would say “here's what we're prepared to do to test this out”, etc.? Is that something you could do right now or is that something where you'd have to find someone else to do it?

[Marie Josée Hull]

Are you speaking of us?

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

Would you do it as individuals or in association with others or whatever...?

[Marie Josée Hull]

Definitely: it would certainly be a project that would interest me. I would think that probably Alison would be very interested as well.

When dealing with soldiers, I also like to have the collaboration of the mental health people in Petawawa, for sure, and to have them on board, because I don't think that we can work in silos when we're dealing with servicemen who have a lot of issues and maybe have multi-diagnoses. It definitely is something that I would love to look into, but I would want to have the support and the help of the mental health services on the bases.

[Alison Vandergragt]

If I could have a moment to add on to M.J.'s comments, getting back to this Canadian Foundation for Animal Assisted Support Services, they're prepared to create this umbrella over practitioners like me and the many others who are out there and who, like me, are in our own little corner of the area doing programming. If this organization can pull us together, you're going to see more consistency in the programming, and probably more effectiveness, because we're all working together using common practices and common goals. If this organization can do some of the footwork to put us under an umbrella, to give us a scope of practice, I think it's going to be grossly beneficial for a pilot project to become successful.