National Defence Committee on March 20th, 2013

[The Chair, Conservative, James Bezan]

Good afternoon, everyone.

This is meeting number 72 of the Standing Committee on National Defence. We're going to continue with our study on the care of the ill and injured Canadian Forces members.

Joining us today in the first hour is Pierre Daigle, the National Defence and Canadian Forces ombudsman. He is joined by Mary Kirby, the director of strategic outreach, planning, and research.

I welcome both of you to the committee. We're looking forward to your comments.

I have Mr. McKay asking for the floor.

[John McKay, Liberal, Scarborough—Guildwood, ON]

This is just a very brief intervention, Chair.

Apparently a discussion ensued on Monday concerning a question I had raised about a coding issue when the minister was here. We have since confirmed with the PBO that it is in fact a coding issue rather than an accounting error. I just want to clarify that for the purposes of the committee and for the researchers and for any follow-up that might occur.

[The Chair, Conservative, James Bezan]

Thank you.

As you are aware, the letter that was submitted by the department to me, as chair, was circulated and given to the PBO. It is a public document. I appreciate that clarification, Mr. McKay.

Mr. Daigle, please.

[Pierre Daigle, Ombudsman, Office of the Ombudsman, National Defence and Canadian Forces Ombudsman]

Mr. Chair, thank you very much.

I would like to begin by thanking the committee for inviting me to testify this afternoon on the care of ill or injured Canadian Forces members.

The work of this committee is incredibly important for our serving members, our veterans, and their families who have given so much of themselves in service to Canada. I think it may be helpful to the committee if, in my opening remarks, I specifically address a key report my office released in September last year. It's entitled “Fortitude Under Fatigue: Assessing the Delivery of Care for Operational Stress Injuries that Canadian Forces Members Need and Deserve”.

As you mentioned, Mr. Chair, joining me today is Mrs. Mary Kirby. Mary is one of the principal authors of “Fortitude Under Fatigue”.

Operational stress injuries will remain a significant challenge for the Canadian Forces, and I would say a real hardship for Canada’s soldiers, sailors, airmen, airwomen and their families, for many years to come. And in many respects, operational stress injuries will be a generational challenge for the Department of National Defence, the Canadian Forces and the Government of Canada as a whole. I would say that it will also be a generational challenge for the families of our soldiers.

Over the next few minutes I will discuss some of the progress that has been made by National Defence and the Canadian Forces, and a number of areas that need more urgent attention.

Mr. Chair, our office has been engaged in these critical mental health issues since 2002. We have released five different reports and almost 50 recommendations meant to improve the care and treatment received by Canadian Forces members suffering from post-traumatic stress disorder or other operational stress injuries.

Our most recent report concluded that the Canadian Forces has made considerable progress in implementing our previous recommendations in addressing shortcomings in its identification, prevention, and treatment of operational mental health injuries.

We have also identified a number of broader areas where improvements have been made, particularly with respect to the Canadian Forces mental health care capability, which has evolved from an ad hoc system to one that is better structured to deliver integrated care for Canadian Forces members suffering from post-traumatic stress disorder and other operational stress injuries.

These improvements are due in no small part to the professionalism and dedication of mental health caregivers. These individuals are the most critical element in the overall functioning of the mental health care system.

While I am pleased to see that care and treatment for Canadian Forces members suffering from an operational stress injury has improved over time, there are still significant shortcomings which, in my opinion, are seriously affecting the care and support provided to those suffering an operational mental health injury.

One of our most pressing concerns is a persistent shortage of qualified mental health care professionals. The Canadian Forces is currently operating at a shortfall of between 15% to 22%, and the number of mental health personnel has not increased at all since 2010. This continues to be the largest impediment to the delivery of inclusive high-quality care and treatment to Canadian Forces members suffering from mental health injuries.

That said, we were certainly pleased to see the minister's funding announcement aimed at addressing our concerns about the shortage of caregivers. This is good news, and we will be tracking this new initiative very closely to see if it effectively addresses the concerns laid out in our report over the long term.

I'm frustrated, though, that the Department of National Defence and Canadian Forces continue to ignore the very first recommendation made by our office in 2002: the creation of a national database that would accurately reflect the number of Canadian Forces personnel who are affected by stress-related injuries. Without reliable data, it is very difficult to understand the extent and seriousness of the problem, and design and implement effective national programs to help those suffering from an operational stress injury. This data could also be used to target education and training initiatives where they are most needed.

Our office has never received an adequate explanation as to why this recommendation has not been implemented. I must say that after 11 years, I now believe there is either an unwillingness or an inability to create a database that would provide this valuable information.

Another issue that is linked to the database is the extremely limited performance measurement regime in place within the Canadian Forces to track and report on the effectiveness of the mental health system. Despite being one of the institution's top priorities, with tremendous money, time, and energy invested in the system, the mental health capability in the Canadian Forces has not undergone recurring, qualitative, system-wide performance measurements over the past 10 years.

I am troubled that the Canadian Forces still does not have an appropriate system in place to provide a current and consistent portrait of the number of members affected by post-traumatic stress disorder and other operational stress injuries.

How can the institution know if it has in place the most appropriate priorities and resource levels to manage its broader operational stress injury initiative when their data is incomplete and their research is not focused on measuring performance?

Mr. Chair, we do recognize and we welcome the progress that has been made by the Canadian Forces to prevent, identify, and treat military personnel suffering from mental health injuries. At the same time, the large number of current military sufferers, and an even larger number of anticipated sufferers, has led us to the conclusion that more needs to be done.

Mr. Chairman, as I mentioned earlier, we believe that operational stress injuries will be a generational challenge for our country. At this time we stand ready to provide any assistance that we can to the committee.

Merci.

[The Chair, Conservative, James Bezan]

Merci beaucoup.

With that, we're going to do five-minute questions all around so we can get members in with their questions during this one-hour time with these witnesses.

Mr. Harris, please.

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

Thank you, Mr. Chair.

Thank you, Mr. Daigle and Madam Kirby, for joining us today. Your work is very important, and it's very important for the committee to have your advice.

One of the things you said disturbed me quite a bit. Since you've been persistent in seeking this information, why is it that we don't know how many individuals are suffering from mental health difficulties due to their service, especially when we have clinical suggestions that 90% of individuals diagnosed with PTSD have at least one psychiatric disorder, including drug abuse, depression, or suicidal thoughts? Indications from clinicians are that you don't have adequate resources to deal with them. If we don't want to count the number of problems we have, doesn't that make it difficult to decide whether we've got enough resources to solve them?

[Pierre Daigle]

As I said, it is very disturbing. We've been asking these particular questions for the past 11 years. We figure that if you don't know exactly the scope of the problem, it's very difficult to identify the proper resources, the proper location, the proper configuration, and so on. There are 26 mental health clinics out there. The data that they're providing to the central organization back in Ottawa are most of the time outdated, and those statistics are used but do not necessarily reflect the right image or portrait of what's going on.

There was a workshop organized recently for those 26 clinics. Seventeen clinics attended the workshop, and 16 of those clinics mentioned that the top priority or concern was a manning issue, the shortage of care providers, and so on. It's very difficult when those clinics are short in resources and they're overwhelmed—ils sont débordés—by so much work. When NDHQ, the national headquarters, asked them to provide statistics, obviously, they didn't have the time, again, to go through the bureaucratic counting of numbers and so on.

There are a lot of issues at stake here. The shortage of people is definitely the more acute one.

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

On the shortage of people you're talking about, you quote a figure of 15% to 20%. Is that existing positions not filled, or is this measured against the need?

[Pierre Daigle]

In 2000 there was what they called Rx2000. It was a study that was done in order to overhaul the medical system in the Canadian Forces. This initiative in 2000 coupled with Statistics Canada's survey in 2002 pegged the ideal number of mental health care providers to be 447. That was in 2000 and 2002. When they identified that number, they did not take into account Afghanistan, as it was prior to Afghanistan.

In 2005 the department, the Canadian Forces, agreed to increase the number of people in the mental health organization from 228 to 447, and the money was set aside to do that. They never reached 447. In 2010, it flatlined at 378. This is what we're saying: 378 out of 447 represents a shortage of 22%. What's more alarming here, probably, is that this number is based on the number of 447 which was identified prior to Afghanistan. We imagine that after Afghanistan the requirement might be even greater, and therefore this 22% shortage might be greater, but obviously, we don't have the statistics now. Statistics Canada is doing this survey in collaboration with the Canadian Forces every 10 years. They did that in 2002. They started the next one in 2012, and the result of that study will be published sometime this year. We would be interested to see, at that time, if they've identified different requirements for mental health service providers.

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

We have statistics from the 2010 survey by the Canadian Forces that says only one in three veterans with major substance abuse symptoms was getting treatment. You're saying that the number of personnel available in the system to provide treatment like that hasn't changed since 2010. Is that still true today?

[Pierre Daigle]

That's still true today.

[Mary Kirby, Director, Strategic Outreach, Planning and Research, Office of the Ombudsman, National Defence and Canadian Forces Ombudsman]

As of the end of evidence collection....

[Pierre Daigle]

Yes, it's as of the end of evidence collection.

There was an effort from the leadership to increase the number from 228 to 447 between 2005 and 2009, but as I said, it flatlined at 378. It never reached 447. The money was there. Obviously, it's a question of hiring the proper resources to put them in place.

[The Chair, Conservative, James Bezan]

Thank you very much.

Mr. Norlock, you have the floor.

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

Thank you very much, Mr. Chair. Through you to the witnesses, thank you for attending today.

I have a couple of quick questions before I get to some of the meat I'd like to get into.

I think I read somewhere that Canada has the highest ratio of mental health workers to patients in the CF, as compared to the rest of our NATO allies. Are you aware of such a statistic?

[Pierre Daigle]

Not really. What I can say is that every time I see comparisons between Canada and other countries, forgive me for saying that I'm a bit skeptical. As I said before, the Canadian Forces has not yet been able to evaluate what they are doing themselves because there's no performance measurement here. We do not look at those kinds of numbers.

When people mention society at large, I would say that this is also of little value because, for people joining the Canadian Forces and the defence department, it's quite different. They join and they're expecting a moral obligation to take care of them if they're in harm's way and they're suffering following their service to the country. There again we try not to compare. It's a different thing if they get better service on the civilian street or in the military. In the military you sign up for your unlimited liability—you could give your life—so people expect to receive the proper treatment for that.

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

No one could argue with that, but someone might make the observation that other health care facilities right across Canada are experiencing a shortfall in their mental health workers because there's a huge, shall we say, demand for those services right across our society. Therefore, there's a competition for those relevant professions. The CF is just one group of people competing for that very limited resource.

I've heard in other areas where hospitals and clinics right across this country are all going to that same pool of people. I serve on the public safety committee, and there's a competition in our prisons for the very same pool of people. These professionals are cherry-picking: “where do I go for the best?”

I take it from your statement that isn't a concern of yours. The only concern of yours is whether the armed forces is providing the number of people that you think should be provided and it doesn't matter what the excuses are.

[Pierre Daigle]

Mr. Chair, when I say our concern is shortage of mental health service providers, we do realize there's competition out there. I visited 18 bases. For this particular report we had a team that went to 10 specific bases to look at all this. What we found was—and this is what we're recommending in our report—the Canadian Forces should look at internal bureaucracy processes that could be improved in order to be more competitive and attract people.

I've been on bases. I think the system should delegate down to the ground where the problems are best resolved by those dealing with the issue. I've seen places where, to hire a mental health caregiver from the civilian street, the DND, the Canadian Forces system, the staffing bureaucracy has a freeze on hiring people, and people just go away. They don't stay there. We can decentralize that, look internally to DND, make the process more agile and able to hire people, maybe pay some people a bit more because there's competition in terms of money between public servants inside the system and contractors hired from Calian by DND. I'm saying within the system there needs to be something done better to attract those people, as you said, who are in competition with any other organization.

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

I'd like to carry on in the same vein. We had witnesses who came here for a previous study, people with backgrounds from 25 universities, I think. There are some gaps. There are some inadequacies that they have observed. The consortium of these 25 universities, headed by a person from Queen's University, I believe—

[Pierre Daigle]

Yes, it was Dr. Aiken.

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

—said that in sum total, in this country we tend to have what was described as, and I hate to use the term, the Cadillac. I'm not saying that we don't need to strive for perfection. Everyone on this committee and every Canadian wants the best for our CF members. It's just sometimes reality shows its head.

When you say you need certain things, we all want them, too, but I do think, for the average person out there, the people I represent, we all use measuring sticks. We all use comparatives. When you say it really doesn't matter what the rest of NATO or the rest of the world does with their forces, with their similar army, navy, and air force, that we're just concerned with ours, I think the average person would say that they need something to compare that to.

Should we compare it to our NATO allies? Should we compare it just to Great Britain and the United States, with which we are more aligned? How do we fare as far as the number of mental health care workers per soldier, or per airman, or per sailor is concerned?

That's why I asked the question, not as a criticism of your office, because we know you're there for the good of our soldiers. What concerns me is when you say we don't need a measuring stick. I think the average person out there would want you to use a measuring stick, but then show us some of the shortfalls, if you get where I'm going.

[Pierre Daigle]

You mentioned our office, and you're right. We are looking at facts, collating facts, meeting people. It took 10 months, 500 people, and 600 documents to write the report. My role is to look at the facts, identify what could be improved, and make recommendations to the minister. They're recommendations to improve the system.

We've been saying there's a shortage of manpower, a shortage of people, but there's no performance measurement system. It has been 10 years, and the CF and DND are spending a lot of money. It's a priority to take care of people, but there's no performance measurement to see how well they're doing. People say we are better than other countries, but I'm not sure. I'm skeptical. I didn't look at that because I'm not sure we're doing that well. There are still things to be done. We want to attract others. Competition is out there, but there are barriers and impediments within DND and the CF. If you go on a more aggressive recruiting campaign, if you are more innovative in your approach, you can resolve issues. I've seen doctors on bases in this country who have initiatives that they put on the ground that help troops and their families, but as you go higher in the chain of command, there's resistance. You need to decentralize the execution sometimes. Even if you keep the policy at the higher level, decentralize the execution so people can find the solution, so they can tap into the society and hire someone.

On one base there were two ladies who were ready to come in, a social worker and a psychologist. They were ready to come in but in Ottawa there was a freeze. Every time you wanted to hire another public servant, you had to go through two committees in Ottawa. It took so long that these ladies found jobs elsewhere. I'm saying we need to address our system internally first.

[The Chair, Conservative, James Bezan]

Thank you.

Mr. McKay.

[John McKay, Liberal, Scarborough—Guildwood, ON]

It seems to me that your discussion with Mr. Norlock is founded on your key criticism, which is that you have yet to hear from the government an adequate explanation for why a national database has not been implemented. The key excuse I've heard is that it's a privacy matter. You can't collect this kind of data without breaching privacy rules.

I'd be interested in, first, the reasons you received from the government, and second, your comments on whether it is or is not a privacy issue.

[Pierre Daigle]

Maybe I'll ask Mary to expound on that. I read about the privacy issue in the minutes of the committee here. I don't think we've addressed that. To do so you need to have a system in place. You don't need to know the number, the people as such, the names, and so on.