National Defence Committee on April 17th, 2013

[Phil Upshall]

I come from the consumer-patient-family community. I work closely with the Mental Health Commission of Canada and the institute, so it may well be better to ask them.

I can tell you that the military does not come to patient organizations that are, in our case, experts in peer support and community supports and ask us to provide them with either guidance or advice as to how to move forward. I think it's fair to say, based on our experience, that the armed forces, like a number of other paramilitary organizations and other organizations that will remain unnamed, are not open to advice from outsiders. There's a sense that their community will have the expertise within, in most instances. Obviously, calling on operational stress injuries clinics and others to provide assistance is one thing, but—

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

Do any of you work with active Canadian Forces members or are you primarily dealing with members who have been discharged as a result, perhaps, of their mental illness? Are you working with active soldiers, with CF members?

[Dr. Zul Merali]

Yes, at the University of Ottawa Institute of Mental Health Research we do have a partnership where we are exploring sleep disorders, in particular, associated with post-traumatic stress disorder.

On the silos that have existed, I see that they are starting to dissolve and there is much more resolve for coming to solutions through partnerships. I see a lot of hope in that growing even more in the next while.

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

Are there any specific recommendations or barriers that you think the Canadian Forces can address directly to better work....? Is it just, as Mr. Upshall said, that they think they have it covered in-house? Are there specific legislative or regulatory barriers that prevent them from reaching out to what, in my opinion, are excellent civilian organizations like yours that could provide some assistance?

[Louise Bradley]

I don't see there being any barriers. I do want to point out, in answer to your question and a previous one, that DND did come to the commission and say, “Look, we have something to offer and we think you can help to enhance it with the peer support project.” That is something that is widely recognized throughout Canadian Forces, and now by the commission.

It's certainly an avenue that can be built upon and that the commission is very supportive of. It's something that has proven to be effective, and I think it's something that can definitely be enhanced.

[Phil Upshall]

I was just reminded by our project manager that in fact the Mood Disorders Society of Canada and CDRIN generally are working with DND and Veterans Affairs on PTSD. DND has opened its vaults of video and information that will inform the work we are doing.

I should have referenced that earlier. I don't want you to think that they're not openly supportive.

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

Thank you.

[The Chair, Conservative, James Bezan]

The final question goes to Mr. McKay.

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

Thank you, Chair.

Thank you all for coming.

Recently we did an order paper inquiry on military suicide, and we received an answer back today. As happens around here, the press gets on it rather quickly.

I looked at the answer on the last five years of military suicides, and the pattern is that there doesn't seem to be any pattern. It seems to go through all the ranks. It seems to go through all the age groups. It seems to go in theatre and out of theatre. It averages somewhere around 15 a year.

Dr. Richardson, your comment about the more difficult response from treating soldiers piqued my interest.

Have any of you made any observations with respect to military suicides—I'll start with Dr. Richardson, but I'll ask the entire panel—and is there something the statistics are not showing?

[Dr. Don Richardson]

The research I was involved in was looking at the population within our clinic. This is an outpatient clinic that probably serves close to 20% who are still serving, but the majority are veterans, so these are release members. The best predictor of having suicidal ideation—this is not completed suicide, obviously—was depression. Although PTSD is associated with suicide and suicide attempts and suicide ideations, PTSD often occurs with depression. What we found was driving the suicidal ideation was actually the depression.

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

It was depression.

Were there any other observations?

[Dr. Zul Merali]

I think you're putting your finger on the nail. If you look at the U.S., for example, right now more returnees are dying from suicide than those in theatre. The numbers are enormous and it keeps growing, because as it says, post-traumatic stress disorder is post-trauma, and take years and years. They're back here now and experiencing trauma and having issues dealing with that.

The other point Don made was about co-morbidity. Depression and post-traumatic stress disorder go very much hand in hand. Depression is a major risk factor for suicide. I think they're all tied in. Sometimes we see them as different balloons, but they are not; they are all interlinked, and I think we need to get to the bottom of this to be able to—

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

The other thought that crossed my mind was that this was five years' worth of suicides by people in the military. It didn't track the people who have been recently discharged. It would be interesting to see what it looks like in a five-year window, post discharge.

Do any of you have any observations?

[Dr. Zul Merali]

I don't have observations in Canada, but in the States they certainly track that, and it shows that it keeps increasing with time.

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

I have one final question. The military set up the JPSU unit, which is for people who are having difficulties. On the base, I think it's frequently regarded as a dumping ground. It speaks to the issue of stigma. Once you're in that unit, you're well and truly stigmatized.

I don't impute bad motives to the military, because you have to get these guys out of handling live ammunition and things of that nature. I buy that argument. But once they're in there, their career is pretty well....

Do you have any suggestions?

[Louise Bradley]

This is something that is pervasive throughout. For anybody to acknowledge that they are having mental health problems in any workplace is akin to career suicide in many cases. So much so.... The work the commission has done with the psychological safety standard for the workplace will hold equally well anywhere, in any workplace. What we have found is that people would rather suffer than actually admit they are suffering from mental health problems. To admit is to be seen as incompetent or unstable.

The standard that the commission has developed provides a number of tools—and not rules. This isn't something for which you have to do A, B, and C.

One of the critical pieces of that work is accessing the workplace at the very beginning. This can be done on a small scale or a larger scale. Oftentimes, we simply don't know what the situation is. So the very first step in the standard is to do a thorough analysis and assessment, which is not that hard to do. Then very small things can be implemented to address them.

The workplace standard isn't designed for military settings, but I think it's something that we could well look at generalizing.

But stigma is a huge problem; there's no question about it. It keeps 40% of adults who have kids with mental health problems from going for help.

When we extrapolate it to that kind of setting, it's bound to be far worse than that.

[The Chair, Conservative, James Bezan]

I'm going to have to cut it off there. We're down to 14 minutes, and we have to get back to the House to vote.

I'd like to thank Mr. Upshall, Ms. Bradley, Dr. Merali, and Dr. Richardson for coming in. I apologize for the disruptions today with the votes.

If there's something you want to say that we didn't have time for or even if you have recollections afterwards that you want to bring to our attention, put those in writing and drop them off with the clerk and we'll make sure to review them as a committee. I appreciate that very much.

With that, do we have a motion to adjourn?

[An hon. member]

So moved.

[The Chair, Conservative, James Bezan]

We're out of here.