I want to begin by thanking you, Mr. Chair, for this opportunity to speak with you and the members of the committee.
I also want to thank you for your ongoing interest and support regarding the health of our men and women in uniform and our veterans. Your support is particularly important, as we know from history that interest in the mental health of veterans can fade soon after wars. We also know from history—our own research and that of our allies—that the full mental health impacts of difficult deployments will not be realized for years to come, if not decades.
As you are all aware, the Canadian armed forces have witnessed a decade that involved many important operations abroad, from Afghanistan to Haiti and Libya and beyond. All of these operations have placed heavy demands on the Canadian Forces and specifically on our personnel.
Now that we are coming down from this high operational tempo, we know that we will likely face challenges in providing health care services—particularly in mental health—to our returning men and women in uniform. I can assure you that the care of our ill and injured personnel is a top priority, and we recognize the unique circumstances we now find ourselves in.
I do not like to use terms like “bow wave” or “surge”, but there will likely be a steady increase in Canadian Forces members and veterans presenting symptoms of operational stress injuries in the coming years. For this reason, our clinics must remain prepared.
One of the imperatives we have is to ensure that the ill and injured have timely access to evidence-based care. I would like to expand on that last phrase, “timely access”. It's essential that when someone finds the courage to come forward and seek help, we stand ready to provide them with that support.
As I am sure members of this committee can understand, it can be difficult to come forward and seek assistance with operational stress injuries. For any number of personal reasons, the window of opportunity when someone feels comfortable to seek help can be limited. This is why we must maintain a well-resourced system that is agile and readily available, such as we currently have, with both primary care clinicians and well-trained mental health specialists. In addition, the flexibility to have clinicians in uniform, in the public service, and contractors is key to meeting the needs of our men and women.
The second imperative is evidence-based care. That is demanded of us by existing rules and regulation, but it is also a crucial element of any health system.
Simply put, our patients deserve the best that medicine has to offer: that is to say, treatment supported by sound clinical research. That is why we explicitly use treatments, whether medication or psychotherapy, that have been demonstrated to be both safe and effective in our patient population.
Evidence to support these treatments usually involves multiple large controlled studies that are published in peer-reviewed academic journals and are endorsed by international organizations such as the International Society for Traumatic Stress Studies. These studies cannot, of course, predict that 100% of people will fully respond to a treatment, but rather that for most people with a particular condition, this is the suggested approach. I can expand on this point later, if desired.
Not only is it best practice to use evidence-based treatment for everything from strep throat or lung cancer to post-traumatic stress disorder, it is also part of our governance. In his appearance before this committee, Colonel Scott McLeod described to you the function of our spectrum of care committee. Essentially, all services, treatments, or items made available to CF members must adhere to scientific principles of evidence-based medicine; be necessary for the purpose of maintaining health; be funded by at least one province or federal agency; benefit, sustain, or restore a serving member to an operationally effective or deployable status; and not be purely for experimental, research, or cosmetic purposes.
Now I will go to the topic that I believe you have asked me to discuss today: canine-assisted therapy, or, more specifically, psychiatric service dogs used by mentally ill people, including CF members and veterans suffering from a psychological injury.
As Colonel McLeod discussed, animal-assisted therapy does not currently fulfill the guidelines within our spectrum of care. Existing scientific literature on the topic, as well as information from our major allies, does not yet provide us with sufficient evidence to support the use of canine-assisted therapy in our approved treatment programs. I should also mention that our practices in this field are in line with those in the U.S. and U.K., which do not use canine-assisted therapy in their core treatments.
However, this does not mean that canine-assisted therapy has no value in support of the ill or the injured personnel. I, like many Canadians, watched the television program W5 a few weeks ago and was moved by what I saw. These men appear to have benefited quite profoundly from the empathic relationship they have developed with these dogs, but without substantive research, one can only speculate as to what role these dogs play in the treatment of the ill and the injured. I feel it is a positive social relationship that affords a level of safety and comfort in previously unsafe and anxiety-filled situations.
One thing that I want to make clear is that many things that are good for one's health are not health care per se. Among the many determinants of health, the World Health Organization lists the following elements: where we live, the state of our environment, genetics, our income and education level, and our relationship with friends and family. The World Health Organization also states that these determinants all have considerable impacts on health, whereas the more commonly considered factors, such as access and use of health care services, often have less impact.
With this in mind, we can see how important housing, income, employment, and education are. These issues were all discussed at the Tri-National Military Mental Health Symposium in Washington this past September, and the importance of relationships has already been demonstrated by our DND and Veterans Affairs operational stress injury social support program.
In this regard, canine-assisted therapy can have a positive health impact in some patients in a non-clinical social way, but at this point there is not sufficient evidence to justify the inclusion of canine therapy in our spectrum of care. Our commitment is to provide our ill and injured CF members with the best health care possible, and that means a standard of care that is supported by therapies and practice that are scientifically proven and accepted.
Of course, both General Lawson and Rear-Admiral Smith told you we are committed to continually improving how we care for our own.
Thank you again for your interest in this very important issue, the care of our ill and injured forces members. I'd be happy to answer any questions.
