National Defence Committee on May 1st, 2013

[LCol Alexandra Heber]

No. We often see people who have, for example, post-traumatic stress disorder and a chronic pain disorder. That's not unusual. Of course, in those cases the treatment becomes more complex and we usually have more people involved.

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

Might you see them after they have received the prescription and are taking the medication?

[LCol Alexandra Heber]

We might see them then or it may be when they come in for their assessment in the OTSSC. We also do a general physical and medical history and we may find that, in fact, here's somebody who has been having chronic pain for several years. If that is in fact the case, what we do is send them back to their medical officer to have that followed up.

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

What's the frequency of people you see that have drug or alcohol abuse problems?

[LCol Alexandra Heber]

Alcohol abuse is often seen in conjunction with post-traumatic stress disorder. Post-traumatic stress disorder, and this has been borne out in the literature, in research, is probably the most comorbid psychiatric disorder we know of, in other words, where there are other co-existing mental health conditions. One of the big ones is drug and alcohol abuse.

In my experience in the military it has been more alcohol abuse. So again what we will do in those cases is a comprehensive treatment package right at the beginning where we will also be treating them for their addiction problems.

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

Can you say in terms of comorbidity the percentage of PTSD sufferers who are codependent on drug and alcohol abuse?

[LCol Alexandra Heber]

Again, off the top of my head from my clinic, I can't.

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

It certainly would be significant.

[LCol Alexandra Heber]

Yes, it would certainly be.

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

It would be something that you would look for.

[LCol Alexandra Heber]

It's something we screen for all the time. It's very typical when we see people in OTSSC for their assessment that they have a diagnosis of PTSD, alcohol abuse or dependence, and major depression. It's a pretty common triad we see.

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

So that's that.

[The Chair, Conservative, James Bezan]

Thank you. Time has expired.

I know it goes by quickly when you get into the meat and potatoes of an issue.

Madam Gallant, you have the floor.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

Colonel Heber, first of all, I want to thank you for any role you had in ensuring that Petawawa had its own OTSSC. It has made a world of difference to the people affected there to not to have to get on the bus, spend a whole day on the bus, and have episodes on the bus, etc.

[LCol Alexandra Heber]

Thank you. Absolutely.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So it's greatly appreciated...and making sure that we got up to speed with the required number of people to help and the full complement of all the professionals there.

It was mentioned how there is a discrepancy between provincial care and the benefits that are awarded to people in the military. Given that a soldier in many circumstances is part of a family unit, and his or her behaviour affects the entire family, are there situations where the entire family or at least the spouses are receiving common care?

[LCol Alexandra Heber]

Thanks for the question.

Thank you very much. I didn't have a huge part, but because our OTSSC was providing services in Petawawa we were certainly bringing the issue forward that they needed something of their own.

In terms of spouses and families, according to the National Defence Act we only cover military members in terms of health care. However, especially in the OTSSCs, in our general mental health program we are able to push the bounds a little bit as well. But in the OTSSCs what we do is we consider helping the spouse and the family if they need help as part of helping the member. So it's as long as we can define it that way. I'll give you an example. We will see spouses for support. We will see them individually for a few sessions for support, for education. We will see them as a couple. We will see them as a family. If that spouse has his or her own depression, for example, we cannot treat their depression but what we will do, then, is help them to find a resource in the community.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Does the OTSSC see vets from Bosnia, Rwanda, Somalia, as well?

[LCol Alexandra Heber]

We see still-serving members.

Sorry, I'm not sure what you mean by veterans because there are still serving members from those peacekeeping missions, and we do see them.

In terms of people releasing or on their way to releasing, we now have wonderful resources set up by Veterans Affairs. The OSI clinic is a resource that we use. When somebody is in the process and they know they're going to be leaving, we'll set up contact for them with the OSI clinic. They can go over there to meet the staff and so on, even before they're released.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

That's good to hear because some of the people who are on their way to being medically released are terrified of being released because they're afraid they're going to lose that continuation of care and have to go through their story all over again.

Now, back in 1999-2000, OSISS was more or less the entity that interfaced with the soldiers or vets who were buried inside their basements. There seemed to be a lot of friction between the OSISS people and the professional psychiatrists. It seems that this has transitioned and evolved over time, and that all the work Colonel Grenier did—his pioneering, his bulldozing—has made some inroads.

Can you tell us what the relationship between the two entities is now?

[LCol Alexandra Heber]

Sure.

First of all, one of my priorities when I first started working in the Ottawa clinic and I met Colonel Grenier was to start forming a partnership with OSISS. I don't want to speak to what was going on before I got there because, really, I can't talk about that.

We did a lot of joint presentations on how peer support and clinical care in mental health can work together. I think out of that grew much more of a partnership. OSISS also became very involved in what's called the joint speakers bureau in our headquarters. They are members of OSISS who partner with mental health clinicians and do teaching to chain of command. They do pre-deployment teaching. They go to third-location decompression and teach there. There have been a lot of ways that we have partnered.

Quite frankly, sometimes one of the problems is just staffing. We really value our OSISS workers and for whatever reason when they get too busy and they're not available to us, we often feel that.

[The Chair, Conservative, James Bezan]

Thank you. Your time has expired.

Ms. Moore, you have five minutes.

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

Thank you.

First of all, Ms. Heber, you spoke of avoiding professional burnout among care providers. When one is a care provider, experiencing a patient's death by suicide is very difficult. I went through it as a nurse, and it was not easy. Do you have a framework with the caregiving team to intervene in the case of a patient's suicide?

Furthermore, Ms. Gélinas, let's take the example of a reservist sent for care in a regional long-term care centre, so that he or she may be closer to their family. Often, the reality is very different from that of the military. In long-term care centres, one is often surrounded by people whose average age is about 90 years old, and who have Alzheimer's disease or other pathologies. It is therefore not the same situation as our military colleagues go through.

How do you work, in the context of your civil cooperation arrangements, to offer these people a stay that will still be beneficial, one that will help them, despite the fact that the people they are dealing with on a daily basis are different from their military colleagues?

[LCol Alexandra Heber]

I'll try to be brief.

Thank you very much for that question. For the last three years we have been doing what are called medical professional technical suicide reviews. Every time there's been a suicide of a CF member, we send a team of a GDMO—general duty medical officer—and a uniformed psychiatrist from away, from another base, to do a review.

I did one most recently in Petawawa. We go there and interview all the parties, including all the clinicians involved with the person. We interview the police, if it was police who found the body. We interview the family. We try to get a full picture, then we do a report back to the surgeon general. I have to tell you, suicide is a terrible thing for everybody involved, a terrible, terrible thing. But I think one of the things I didn't realize until I started doing these was the impact it has on the health care team. You're absolutely right.

It's one of the things I've been talking to my team about. Fortunately, we have not had an event like that in the last couple of years, but it really is devastating for everyone. I think it's really important to put in a mechanism of some kind of psychological first aid, the same kind of thing we would do for any kind of critical incident, for the team that was looking after that person.

[Huguette Gélinas]

Thank you for your question.

I find it interesting to have the opportunity to speak about this. In just one situation did I take part in discussions about the fact that reservists, for example, had to go to long-term care centres and deal with a clientele that did not resemble them at all, and that was indeed in the Montérégie region. For many years, we held a great number of discussions with the recruit school, in Saint-Jean, as well as with stakeholders in the health field. These discussions were often about the fact that many anglophone soldiers or recruits, when they needed care in the area, could not receive services in English. This was especially difficult when the problems involved mental health.

Therefore, there were discussions held to implement a privileged service corridor with the Douglas Mental Health University Institute, in Montreal. We helped people from the Haut-Richelieu—Rouville Health and Social Services Centre to offer English training to their personnel. There were also discussions when we had to send, sometimes for a few days, young recruits to environments where they would be under clinical surveillance. We held these discussions mainly with the Health and Social Services Agency in Montérégie to try and find other solutions. For example, if there were several patients, we could put them together in the same section, in a residential and long-term care centre or its equivalent, or even send them to intermediate resource clinics.

And those are the experiences I had regarding the aspect that you mentioned.