Evidence of meeting #77 for National Defence in the 41st Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was care.
A recording is available from Parliament.
Head, Deployment Health Section, Department of National Defence
Regular force. Sorry.
It would be really hard for us to make much of that, and to be honest, even if we found that suicides were 27% higher in December than November, I'm not exactly sure what one would do with that, other than to try to do all the things we're already doing in suicide prevention, which are laid out in our report.
Liberal
Conservative
The Chair Conservative James Bezan
Thank you.
Time flies when you're having fun.
Mr. Strahl, you have the floor.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Mr. Chair, thank you very much.
I believe you were both here for Dr. Wiss's presentation, or part of it. Is that right?
Head, Deployment Health Section, Department of National Defence
Only the last five minutes.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
He spoke about one of the questions Mr. Opitz asked about combat stress reaction and his belief that those soldiers who are having a reaction to something that happened in combat should stay in theatre, if possible, and get back to doing the role, rather than being treated or removed from that situation, because of their desire to be there for their buddies, as he put it. Has there been a protocol developed on that? If so, has it led to improved mental health outcomes for those cases? Do you have any data that would show that as soon someone who shows signs of combat stress is removed, or for those who are rehabilitated in theatre...? Is there anything you can say on that?
Head, Deployment Health Section, Department of National Defence
This is a practice that dates back to at least the Second World War. It's not anything new. It's something that we've done, and, honestly, the philosophy hasn't changed much. But it emanated from the experience in the First World War, when they really asked much more of human beings than they ever could do, until they finally couldn't take it any more. Then they took them out of this intolerable horror, and for some reason they didn't want to go back. In response to that, what was driving this at the time was not a concern about their long-term mental health, in part because we really didn't think in those terms; what drove it was an operational necessity, which was an unsustainable practice. In World War II, first of all, they started rotating people out of the front so that they didn't have to go crazy first, before they could be excused, if you will.
That's what has been going on, and I don't know if there's any research on it, but it's generally accepted in military organizations that this is the right way to do it when the goal is operational effectiveness.
There is very little research on what the mental health effects are of that practice. There's one little study in Israel that seemed to suggest that, if anything, it was more good than bad. But that's about it. It would be a very difficult study to do.
Maj Lisa Compton
And it's very much common practice. It would really be the exception, not the rule, that somebody would leave theatre for any medical reason, and even with large groups we've set up, outside of the various Role 3's throughout theatre, you'll see what gets called a “heroes' hotel”. Basically, because people really don't need actual medical care at that time, but they need a break, they need to be checked on, they'll have kind of a cozier shack outside the hospital. Medical personnel will be assigned to look after those folks, and they get a chance to rest up and get back to duty as soon as they're medically fit to do so.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Okay. I appreciate that. Thank you.
Major, I did want to ask you about the maintenance of clinical readiness program. How often do forces' clinicians go through that program?
Maj Lisa Compton
It's an ongoing program. It's actually been revamped this September—a new manual came out—and it basically has now aligned with the strategy of operations.
There are three various levels of clinical readiness. There's a standard clinical readiness that everybody must maintain. For example, as a nurse, I'm in an administrative position right now, and basically I would go from a desk job to seeing the sickest patients that you'll ever see anywhere in the world when I deploy.
I do a minimum of 40 shifts in a civilian acute care facility a year. That's what's required for my trade. For each particular MOSID—so med tech, PA, doctor, nurse, dentist, physiotherapist—all of us, each one, have a table and we look at it. Now, if I were selected to do something on the DART, for example, if I were to be at a little more of a high-readiness level, I'd need to have more days. And some of my courses would also change a bit. We identify basically on what the demands are.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Who does the evaluating as to whether or not forces clinicians are up to par? You're doing those 40 shifts, and I'm sure you do very well. Is there a way to identify someone who's not meeting those standards? What is the success rate, I guess, is another way to put it, of the evaluation of forces clinicians' who are in those tracks?
Maj Lisa Compton
There's no formal evaluation as such, like a test. There is a tool that junior personnel would take with them when they go out. For example, if a medical technician was to go out, their supervisor would fill out a report on their progress over the year. But for the most part, when we go into practice, we've—
Conservative
Conservative
NDP
Jean-François Larose NDP Repentigny, QC
Thank you, Mr. Chair.
Dr. Zamorski, before becoming a member of Parliament, I worked as a correctional officer. I worked in prevention in a prison. In the past few years, three of my colleagues, two I was friends with, committed suicide, and those events were traumatic for all the workers.
People had to stop working because it was so devastating. The workers were seriously affected. They managed to get social workers in to speak to people. And in the course of talking to people, they realized that many people were quite depressed and that some had suicidal tendencies themselves. As a result, they called for a study, but of course the request met with resistance. Because they never got an answer, the assumption was that it had to do with cost.
I see everything you've done so far and I see how difficult it is to be a member of the military. The conditions can be absolutely appalling. You need great strength of character. The spirit and morale of these individuals can end up broken.
We see all kinds of reports. Some say things are going well and others say the opposite. You raise an important point. You say we need to delve deeper, not simplify things; we need to do more research. According to you, we need more specific data in order to do a more in-depth evaluation.
Could you comment on how it could be dangerous to claim that everything is fine and that we should stay on the same course we're on now?
Head, Deployment Health Section, Department of National Defence
Are you speaking in general, in terms of being complacent about the problem of suicide in particular?
NDP
Jean-François Larose NDP Repentigny, QC
I'm talking about any mental health problem or issue that's on the table with the CF.
Head, Deployment Health Section, Department of National Defence
In my position, I get only a superficial portrait of many people. That is the nature of what I do, and that is the nature of somebody who's trying to do research on the mental health of some 60,000 people. That kind of an in-depth understanding I think needs to be something our clinicians do, and I think they do. These people understand, above all others, exactly how complicated and difficult things are, exactly how individual and complex and connected they are with what's going on in people's lives.
I accept my own portrayal of things as always an oversimplification, but it's the best we have scientifically.
NDP
Jean-François Larose NDP Repentigny, QC
You said we needed to gather more data.
Do you feel that progress is being made and that data is being collected? We have been in Afghanistan since 2001, after all.
Head, Deployment Health Section, Department of National Defence
Certainly the more research we do, and the higher-quality research we do, the better. The upcoming mental health survey is a good example. It is basically the very best way anyone can do a mental health survey, which is to say the best possible response rate.
Statistics Canada is an amazing, capable group of people who can get great response rates. It does beautiful surveys; they are done as carefully as they can be done and they are analyzed as carefully as anyone can do it. It will provide us with a very rich picture for a mental health survey. But it always is an approximation; it's never a crystal clear picture. Whatever research we do, it always raises additional questions about things we need to do, other things to do.
