National Defence Committee on March 25th, 2013

[The Chair, Conservative, James Bezan]

Good afternoon, everyone.

We are continuing with our study on the care of our ill and injured members of the Canadian armed forces.

Joining us today, appearing as an individual, is Lieutenant-Colonel Stéphane Grenier, who is retired. He served in the Canadian military since 1983. He has served in several missions abroad, most notably in Rwanda and Kandahar, and has also been deployed to Cambodia, Kuwait, the Arabian Gulf, Lebanon, and Haiti, just to name a few.

He was faced with his own undiagnosed PTSD and related depression upon return from Rwanda and took a personal interest in the way the Canadian armed forces was dealing with mental health issues. In 2001, Lieutenant-Colonel Grenier coined the term “operational stress injury”, and conceived, developed, implemented, and managed a government-based national peer support program for the Canadian military, namely the operational stress injury social support, OSISS, program.

In 2009 he spearheaded the development of the corporate mental health awareness campaign that was launched nationally by the Canadian Forces Chief of the Defence Staff. He had that campaign endorsed by the Mental Health Commission of Canada, with whom he works today on a volunteer basis. As well, that campaign was endorsed by the Canadian Mental Health Association and the Canadian Alliance on Mental Illness and Mental Health, using his example of corporate leadership in reducing the stigma that is often associated with mental health illnesses.

Lieutenant-Colonel Grenier was awarded the Meritorious Service Cross by the Governor General of Canada for taking the concept of peer support and driving it from the grassroots up to a formal federal government program.

He has been retired for the past year, but is still playing a leading role with the Mental Health Commission, as I mentioned earlier, on its workforce advisory committee.

Lieutenant-Colonel Grenier, welcome to committee. We look forward to your opening comments. If you could keep them to 10 minutes, that would be great.

[Stéphane Grenier, As an Individual]

Thank you very much.

Ladies and gentlemen, merci beaucoup de m'inviter ici.

As some of you may know, this is the first time I have come here as a civilian. I've been here three or four times in the past decade, always in uniform, however.

I have chosen to share with you some thoughts on the last couple of years of my military service and what I observed was happening. Of course, it's very important to me that everyone on the committee know that I am retired, and more important, that I was seconded to the Mental Health Commission of Canada for the last two years of my military career, which means that I may be outdated by a couple of years.

However, my goal today is not to get into the specifics of issues, but perhaps discuss more strategically some of the long-standing concerns that I had while I was in the military that I maintained in my role as operational stress injury special adviser for General Semianiw, in his tenure as Chief Military Personnel. To this date I still have concerns about several issues, and these issues are the ones I feel I can share with you today.

Very broadly, and I will stick to five or six minutes, I simply want to whet everyone's appetite on some issues that the committee may wish to explore further as you continue your work.

First, I would like to mention to you that one strategic concern I've always had is the care and support of military families. I start with that because I'm very passionate about making the point that, when we speak about families of military personnel and veterans suffering from stress injuries, we should stop mentioning families last because families are the pillar of our military force, to a great extent. They are the ones who literally stitch us back together when we come back from deployments and have a really hard time integrating.

While soldiers keep going back to their regiments and units and battalions, and in plain English, suck it up every day—and it is a good thing that soldiers are attempting to be resilient—it's mostly at home that things fall apart.

I wish to mention to you that many of my colleagues and I have attempted many, many times to raise the issue of the military reality with military members repeatedly moving around Canada. We know that our health care system in Canada is stretched in some provinces more than others. For a family member who is dealing with a very complex mental health condition in the family, the impact of the mental health condition on the family is very well documented. Therefore, what is the responsibility of the federal government and the Department of National Defence to take care of families in their own right?

My suggestion to the committee is perhaps that may be worthwhile looking into. Is it appropriate to simply assume that the health care system inside a new community where a family has been moved will be able to rapidly absorb and seamlessly continue the mental health care of the spouses and perhaps children? That is one point I thought I would share with you.

Switching gears now, going into some policy matters perhaps, there is a concept that I feel has not been explored sufficiently. Even in my tenure in the military, I failed to make the point in a way that would galvanize senior leadership's interest in exploring new ways of retaining military personnel with operational stress injuries.

In around 2003-04, we developed a concept of remustering, or allowing soldiers to be retained in the military through an occupational transfer but on a provisional basis. We know that in the military, after several years of career, soldiers can change classifications or change trades. There comes a point in a soldier's career, and I'm talking mainly of the combat arms, when a soldier has been on a few too many deployments, clinicians have expressed to me their concern that the soldier is no longer capable of being around cordite, explosives, and things like that, but the person would likely thrive if he or she were offered the opportunity to continue to serve in the military and carry on with his or her military career, but in another occupation.

The issue that the military confronts is that, sadly, if the soldier who wishes to transfer from one occupation to the next has a medical limitation of any kind, that makes him or her unsuitable for service in his or her current occupation. In other words, as an example, the infantry medical classification is fairly high. In order for that soldier to be able to remuster to a position that has a lesser medical category, a category that is easier to achieve, that soldier cannot remuster because the soldier must be healthy or deemed healthy in his current trade.

It's a weird logic that the system has been built that way. Nevertheless, it is built that way, and what I saw during my tenure were dozens, if not hundreds, of soldiers who were literally medically released who might have been able to continue in the military, which would essentially allow the military to maintain that corporate expertise or experience that had been garnered and gathered over the first part of that soldier's career.

I worked on that provisional occupational transfer policy for years and never got that off the ground, really. I failed at it myself, and I wish that soldiers in the future would or could benefit from that.

Clinicians have shared with me that being medically released sometimes is a good thing. Of course, not everyone would fit in that category. For many, facing a medical release is not always happy times, of course, and having that opportunity to serve in another capacity is something we should seriously consider.

Let me speak a bit about physical injuries and operational stress injuries. As the opening remarks indicated, I did coin the term “stress injury” years ago.

When the heavy fighting started in Afghanistan in the mid-2000s, as you're aware, we started repatriating a lot of physical casualties. From that moment on, there was a school of thought that we needed to create support programs for these physically injured soldiers. I attempted to ensure that we would not create two streams. An injured soldier is an injured soldier. It doesn't matter if it's an injury of the brain or an injury of the leg or the foot. If you lose a foot, you lose a foot; if you lose your marbles, you lose your marbles.

Unfortunately, what I've noticed since I've been retired is that there are two streams. While the military continues to attempt to combat the stigma around stress injuries and mental health and post-traumatic stress disorder, I believe it is a strategic mistake to create two separate programs. As long as we continue to separate the injured, we are continuing to emphasize or indirectly support and really endorse the fact that there are legitimate injuries and there are injuries of the mind that could be imagined, and so on and so forth.

I'm not suggesting that somebody who has post-traumatic stress disorder could support an amputee. However, from a structural perspective, I believe it's a strategic mistake to have separated these programs as opposed to integrating them into one. It's one thing to say that an injured soldier is an injured soldier, but the military needs to behave like they truly believe that.

Moving on, I am simply making the point that when I started the peer support program 12 or 13 years ago, I was a major back then. I remember a full colonel telling me here in Ottawa, “Stéphane, you're too late. We don't need this any more because the tough Bosnia days are over.” I looked at the colonel and said, “I'm not a historian, but history has demonstrated that after periods of reconstitution and strategic pauses, the military is re-engaged in yet another conflict. So now that we are in strategic pause, it is time to build these programs.” Despite his opinion, the leadership made a decision. We launched these non-clinical programs, which are still alive today. I am just hoping that through all these cuts we're not going to make that mistake and start shaving the ice cube and end up as we were after Rwanda, when I came back, where we had literally nothing to support the soldiers.

Despite the cuts, and I can understand the austerity measures in the government and at National Defence, I'm hoping that some of these programs will be protected.

I have a few thoughts on my own transition out of the military. I was not pleasantly surprised to go through the military release process. I must say that I wish I were here today to tell you that we have come a long way because my military release was a very seamless, smooth process. I share this with you not to complain, making the point that if it happened to a colonel, who was the OSI special adviser, who the surgeon general knew and who Veterans Affairs Canada knew, imagine the corporal from Valcartier or Petawawa who is being medically released today, who doesn't know anybody. If these things happened to me, such as medication coverage stopped, my doctors' bills, which I receive at home and I'm sorting those out now.... This is not a complaint. I'm making the point. There are nice people at DND and Veterans Affairs who are fixing the matter. However, I was very surprised to see that because I've been in so many meetings and boardrooms where, you know, people would look at each other and say, “We've come such a long way.”

Well, I remember supporting soldiers who were literally going postal who were very angry at the system in 2001-02, thinking, “What am I going to do to afford these medications; my psychiatrist is too expensive, I can't pay him and I'm getting the bills ” Well, in 2013 I have my own medication bill and my own doctors' bills. It will get sorted out; however, it's very disappointing for me to see that we have not come a long way.

I have a couple of last, quick remarks. I encourage this committee to find the clinicians who have left medical practice at National Defence. I, out of respect, will not share the names of those clinicians, but I encourage you to do so, and invite them here so that you may ask them why they left the medical practice for the military. They will probably tell you stories of inefficiencies in the medical system in the military and the fact that they cannot live with themselves making more money, seeing fewer patients every day. I, out of integrity, am here to encourage you to have a look at that issue and potentially find clinicians who have left the practice.

I also encourage you to look at the in-patient treatment issues. Despite clinicians and treatment facilities that will tell you that everything is fine, you will rapidly notice, if you delve into the issue, that the criteria are so strict and stringent, that you're either too sick or too healthy to be in those programs.

I will stop here and am open for questions.

[The Chair, Conservative, James Bezan]

Thank you very much for your opening comments.

Ms. Moore, you have seven minutes.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you very much, Mr. Chair.

I would like to talk about the Operational Stress Injury Social Support Program, which is provided by peers. Could you give me an overview of how that program works?

Considering that this is a peer support group, is any supervision provided by professionals?

[Stéphane Grenier]

The program has been in place for 13 years. It used to be supervised by professionals more than it is today. In the program's first six years, we had a multidisciplinary team—made up of mental health nurses, social workers, psychologists and even a psychiatrist—on my advisory committee.

Unfortunately, over the past few years, there has been an erosion in that multidisciplinary approach, and I now see a tendency to bureaucratize that program. I'll give you an example.

This peer support program is basically provided by people who have suffered from mental health issues themselves. By the way, as a civilian, I now institute that approach in large companies to help employees with mental health issues. That's seen as a service that will contribute to companies' ability to deal with their employees' mental health problems.

Naturally, employees really need to be taken care of in a peer support program. That applies to any company. However, when you manage a peer support program, you certainly have to monitor the situation and really take care of your employees.

Over the past two years, I have noticed a bureaucratization of this approach and a laissez-faire attitude toward a few of the self care policies that were important to me. Those policies ensured that people would have quick access to a psychologist when they are going through the wringer because their case is very difficult to handle. So that monitoring has declined over the years. I am always worried when I hear that a program refers peer support volunteers to traditional programs for assisting federal government employees.

I think the program should do more.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

How is the family involved in this program? Is that a separate program? For instance, do spouses provide peer support to other military spouses?

[Stéphane Grenier]

Yes.

I don't know what the numbers are today, but when I left the Department of National Defence, there were about 20 coordinators in charge of family support, and most of them were wives. There was no segregation—in other words, they were not all women—but unfortunately, or fortunately, I think most of them were. There were 23 veterans.

So there is one program for veterans and military members, and another program for families. Families that provide support to other families have a lot of relevant experience.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Are any services provided to children—perhaps not to three- of four-year-olds, but maybe to teenagers—to help them deal with injured parents? Is there a component dedicated to teenagers or children who are able to grasp that dynamic?

[Stéphane Grenier]

To my knowledge, there is no such program. I was unable to develop something like that, and I don't think my successors have done it either. That's very complex. There have been some small initiatives where peers, on a family level, established connections with social workers and psychologists locally. Those were small local initiatives. However, nothing has ever been established in terms of strategy.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Okay.

How do you deal with people who come to seek peer support, but who have never consulted a health care professional and have consequently not received a diagnosis out of concern that it would appear in their medical records and cause problems, especially in terms of their career or insurance coverage? The seriousness of their injury is not really known.

[Stéphane Grenier]

You just described about 70% to 75% of the cases involving individuals who use the peer support program. That's sort of a typical case. It's exactly as you described it.

I have been working with the commission as a civilian for three years. It's really important to understand that a peer support program does not replace clinical care—as you probably implied with your question. It complements it. There is a complementarity between the two systems when things are going well.

Thirteen years ago, when I established this organization, many doctors were convinced that it wouldn't work, that these people were sick, that they would exceed their limitations, and so on. Fortunately, no such problems have arisen. Peer helpers generally work closely together. The situation in some parts of Canada may be worse than in others, but I think that, generally speaking, peer helpers are the light at the end of the tunnel that gives people hope. Peers give them enough confidence to seek help. Their situation will certainly get worse if they do not seek help. We cannot guarantee that their doctor will help them recover fully. However, it's certain that, if they continue to experience symptoms of that nature, they will slip up and get fired.

Basically, peer helpers encourage people to seek help, but without making any promises.

We don't know what the outcome is going to be.

In any case, that's what I saw when I was part of the program and what I still see when I work with them as a civilian.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Do the peer helpers who participate in the program undergo a psychological assessment—either on an annual basis, or more or less frequently—to ensure that the task entrusted to them does not become too difficult to handle? Is an assessment carried out to ensure that peer helpers' mental health does not deteriorate because they help others and have to deal with their suffering?

[Stéphane Grenier]

I would like to provide a bit of background.

Over the program's first three years, we assessed the mental health of our employees on a voluntary basis to determine whether it was deteriorating, improving or remaining stable. We noted no deterioration, despite some minor snags here and there. However, we really emphasized self care.

That self care comprised seven levels when it came to program policies. One of those key levels was regular access to a psychologist. A sort of update was done three times a year, when people could really talk to a psychologist. That was not clinical care, but it was related to what they were doing to protect their mental health. There is a whole theory about that. That's what I was saying earlier. That aspect has been abandoned, and that worries me because it was one of the program's strategic pillars.

To answer your question, I am not sure whether this is still the case, but we used to do medical screening. However, that was not a psychological assessment. It was essentially normal screening similar to what's done when someone with a health problem is hired. That employee is asked to consult their doctor and show them their job description. The doctor can look at the job description, understand their patient, make connections, say whether it's appropriate and whether they think problems may arise. It's somewhat similar to any other medical condition where an employee could be at risk in a different work environment.

[The Chair, Conservative, James Bezan]

Thank you very much.

Mr. Alexander, it's your turn.

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

Thank you, Mr. Chair.

I want to thank Mr. Grenier for joining us today. Your testimony is very important to us because, given your very diverse professional experience, your thoughts on this issue will carry a lot of weight with us.

I congratulate you on the role you are playing in helping us gain a more accurate understanding of post-traumatic stress disorder injuries. I also want to congratulate you on your tour of duty in Afghanistan—where we ran into each other—and on having the courage to talk about Rwanda and the harrowing experience involved in that operation. That's now a bit further behind us, but it's still very relevant when we think about Africa and the international situation. That was a nightmare we do not want to recur.

I would like to move on to a few very direct questions. They are also related to our conversations with other witnesses. Your expertise could be very useful to us.

A great deal has been said about tenacity, resistance and the prevention of mental health issues. Experts and doctors sometimes debate over that. In your experience, how much of a role did that play for people who were being prepared for deployment to Afghanistan or Rwanda? Is it really possible to toughen our soldiers and make them more resistant to sometimes traumatizing experiences they will go through, and to prevent mental health issues through sound training?

[Stéphane Grenier]

The question is very complex. I am not a scientist or an epidemiologist. So I am speaking from experience, but there is also some supporting evidence out there. Today, neuroscience is starting to provide fairly rigorous evidence that change is possible.

It has been known for some time that there is some plasticity to the brain. I think the true meaning of your question is the following: What can be done to change things? Exposing a whole battalion or unit to unimaginable situations will certainly have a major impact. What can be done to prepare people better?

About seven or eight years ago, I created another program, which is now called the Joint Speakers Bureau. That is a program for educating military members that has taken on a very positive role over the past few years. The program's name is Road to Mental Readiness—that was the “pre-deployment” version of the Joint Speakers Bureau. For the committee, the beauty of this program lies in the fact that the instruction is not provided by doctors. It's given by soldiers, by veterans who have credibility with their audience. That's a first step in the right direction.

To achieve total prevention, we would have to move forward and completely change the military culture. According to doctors like Matthieu Ricard—who is doing studies with Tibet Buddhists—many philosophical changes need to be made in order to exercise the brain. In light of all my current knowledge, I unfortunately don't think a 19-year-old man is either ready or mature enough to accept that philosophical shift. Making a young 20-year-old man who wants to serve his country think differently is a monumental task. However, we know that it's possible.

What kind of contributions will research in neuroplasticity make over the coming decades? That remains to be seen. However, the answer to your question is yes. Figuring out how to achieve that goal is a separate issue.

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

However, I don't think everyone will volunteer to become a Buddhist monk—

[Stéphane Grenier]

That's certainly true.

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

—or would be willing to go through that preparation, but some of them will do that or something similar.

I will ask two questions at the same time.

You have noted some shortcomings in our system. We have already talked about the issue of leadership. Nothing can work in this area without leadership.

Have you had an opportunity to compare Canada with its allies when it comes to mental health and the quality of our programs? We are trying to make that comparison in our study, but your comments on the issue would be very useful.

You also talked about two types of injuries—the so-called normal injuries and mental injuries—and the need to treat them equally. We agree with you. However, our mental health system is still much bigger than the military system when it comes to hospitals that are dedicated to those types of illnesses.

Have you seen any noteworthy precedents in the civil system or in other military systems where the two kinds of injuries are treated equally? Are there any we may want to try to imitate?

[Stéphane Grenier]

Regarding your first question, I think that, if you have not yet invited Dr. Marc Zamorski, you should ask him to appear before your committee. He could provide you with a very comprehensive answer to the question of how Canada stacks up against its allies. I want to point out very candidly that he shared with me in 2009 certain studies indicating that, compared with the United States, England, New Zealand and Australia, Canada was a leader in “destigmatization”.

Dr. Zamorski congratulated me and pointed out that we have invested a great deal of effort in the peer support program. He did not give the program I launched all the credit for Canada's position among other countries, but he said that it has certainly had an impact. He also mentioned the fact that the Canadian culture was not comparable to the culture of other countries. So this is a complex issue, but I suggest that you invite him because, as an epidemiologist, he is very open. He could provide you with much more information on this topic.

Based on my experience and on what I have noticed by working primarily with Americans, I think that we are indeed ahead of the pack. As for the term “operational stress injury”, I developed it somewhat strategically by moving away from the notion of combat. When the United States began to use that term—which was first adopted by the U.S. Marine Corps—they reverted to the use of the word “combat”. They talk about “combat stress injury”.

I think that is a tactical error because it gives the impression that people need to participate in combat to experience the consequences of an overseas deployment. In short, I think this is both a step forward and a step backward.

To answer your second question regarding the two types of injuries, my answer would be no. Unfortunately, I have not seen any programs that are as rigorous as the Canadian one in terms of non-clinical care. Some countries have made a lot of progress on a clinical level. The idea, especially in the United States, is to deal with physical injuries through a psychological approach from the outset. Here, in Canada, I think we are a little bit behind in terms of that. Unfortunately, other countries don't have any significant non-clinical programs. So I have not seen any examples we could follow.

[The Chair, Conservative, James Bezan]

Merci.

Just for everyone's information, Dr. Mark Zamorski is on our potential witness list, so hopefully we will invite him.

Mr. McKay, you have the last one, for seven minutes.

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

Thank you, Chair.

Thank you, Colonel Grenier.

You came out of Rwanda with undiagnosed PTSD. How did that affect your career?

[Stéphane Grenier]

I would say that in the end, it affected my career trajectory, but I can honestly say that for me, but I am an exception, it did not negatively impact my career in the sense that I was not promoted or I didn't get the good posting. I did not notice any of that.

What happened, however, is all the unwritten stuff. When people become aware that you have a mental problem, there is a very silent movement of the culture. Different associate deputy ministers would react to me very differently. I was actually, for all intents and purposes, relieved of my duties in 2006 because I was probably seen as somebody with bad judgment and things like that, and the fact that the person who relieved me knew that I had an operational stress injury probably compounded that. We'll never know.

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

That was 10 years after the fact.

[Stéphane Grenier]

Yes.

I was in a role where I was managing the operational stress injury social support program. I was an internal advocate for policy change. As I said earlier, this occupational transfer policy was very important to retain our people in the company. Of course, depending on who is the ADM, some will be happy with this kind of thinking and some won't, and those who aren't will probably, unbeknownst to themselves, be impacted by the notion that “Well, no wonder Grenier is such an avid advocate, he's half crazy.” Essentially the stigma works in very interesting and—