National Defence Committee on Oct. 25th, 2011

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

Colonel Bernier, would you care to add to that?

[Colonel Jean-Robert Bernier, Deputy Surgeon General, Department of National Defence]

Suicide, even a single one, is a tragic event, and it affects all of us. Some of them are our own medics. We have all the mental health conditions as well. Our family is the armed forces. We're very tight. Any suicide is a great tragedy for all of us.

However, to be statistically meaningful, we have to collate them, as do all statisticians, in blocks of about five years, because the numbers of rare events need to be cumulative to have adequate power to have any kind of statistical significance and to be able to show that they're not due to chance. That gives us enough of a denominator and enough of a numerator, the number of suicides, to come up with meaningful comparisons.

Every five-year block since 1995 has shown no change in the statistical number of suicides. Our most recent one was from the 2005 to 2009 block at the height of the operations in Afghanistan. In fact, that rate per 100,000 is lower than it was in the two previous blocks—very slightly lower, not statistically significant enough. But, in essence, our suicide rate has not changed. We can't go by a single year, because in a single year there could be anomalies due to chance.

For example, looking at all the suicides from the start of operations in Afghanistan in 2002 until 2010, including all suicides we were able to capture, including females—which are extremely rare, and most years we don't have any—as well as reserves, although some reserves we may not capture because we don't have as close observation of them, there were a total of 108. Of those, 67 had never deployed anywhere. Of the 45 who had deployed, only 17 had deployed to Afghanistan. So the majority of our suicides, and the majority of our mental health burden—mental health illnesses—are caused by the same stresses that affect all Canadians.

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

The article I was reading seemed to parallel—in effect augment—your argument, and then there seemed to be this jump. Your argument, then, is that you have to look at it in a five-year block. In truth, the article doesn't look at a five-year block. The last year they looked at was 2007.

When you're tracking suicides, do you track those who have been discharged from the military? If I had been discharged two years ago, and for whatever reason I committed suicide this year, then it's an interesting argument as to whether you put that into the military suicide or you keep it out of the military suicide. How do you account for that, or not, as the case may be?

[Col Jean-Robert Bernier]

For that reason, the Canadian Forces health services led, with Veterans Affairs Canada and Statistics Canada, a study called the Canadian Forces cancer and mortality study. It looked at 188,000 serving or former armed forces members--because we don't follow them after they have been released from the armed forces.

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

You, meaning the military, or you, meaning Veterans Affairs don't follow them?

[Col Jean-Robert Bernier]

The military. The Canadian Forces only follows those currently serving in the armed forces.

Because a lot of the stresses that may lead to suicide are cumulative and can manifest in mental health conditions and subsequently suicidal behaviour years after release from the armed forces or years after the stresses have occurred, we would lose track of them. For that reason, we did this study with Veterans Affairs Canada, including, of that 188,000, 112,000 people who had released from the armed forces in the past.

It found that so far, the first part of it, looking at mortality, causes of death, for all causes of death armed forces members and veterans had a 35% lower rate of death from all causes than the general public.

However, there were two abnormalities. One was a 2.6% higher rate of death by aircraft accident, and that's accounted for probably by virtue of the fact that proportionately our population has a much higher number of aircrew, people flying. Also, suicide overall was the same as the civilian rate. But there was a 1.5 times increased rate among those who had been released who were in the 16 to 44 age group who had been released after serving less than 10 years and before 1986, so before all the mental health programs, education, screening, etc., programs that we now have in place existed.

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

These would be largely young men, I would have thought?

[Col Jean-Robert Bernier]

Mostly non-commissioned members as well, and mostly those who had been medically released or involuntarily released.

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

Thank you for that.

[The Chair, Conservative, James Bezan]

Thank you. The time has expired.

Mr. Opitz, you're going to kick us off on the five-minute round.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, Mr. Chair.

Gentlemen, first, thank you very much for being here today. We really appreciate it, and it's very informative.

As far as suicides go, I know as a former serving CF member and in the civilian world I've had colleagues, both serving and non-serving, who have committed suicide, and I know through my own experience I never saw it coming. You just never saw it coming. Sometimes statistics are very difficult to quantify that sort of thing.

Admiral, there are some tremendous programs we have now, such as Shoulder to Shoulder and the JPSU, and things like that.

You mentioned the word “marketing”. I would substitute that with the word “outreach”. Is there any kind of a road show proposed to get around to CF members and civilian stakeholders to be able to get people to understand what the consolidated view is of all of these programs?

[RAdm Andrew Smith]

Great question.

Since November of 2010 we have visited 22 bases across the country on exactly that, an outreach piece with Veterans Affairs, which I've ultimately hosted on each base with the senior personnel, my counterparts from Veterans Affairs, to do exactly that, get the word out to serving personnel, regular reserve. Veterans are invited; the Legion is invited to get it out.

My contention is that, regrettably, and maybe fortunately, when people join the Canadian Forces at the recruiting centre, they often look only at the positive side. It's a selective understanding piece. They love the training, the opportunities, the travel, the professional competencies they can get. There's a sense of adventure. But I would contend that not everybody pays close attention to what happens if, au cas où....

I have said to people as I've gone around the country, what you really need to do, ladies and gentlemen, is pay as much attention to what happens if things go bad, because we're in a dangerous game, let's admit that. You need to pay attention to how you and your family will be looked after if that happens to you, if you're one of the unfortunate ones.

After having gone to 22 bases, I can say with confidence that the word is out. And we continue an outreach program through the JPSUs, which are on each base. We continue to put out awareness material in the various publications we have. But in my view, there is no substitute for the leadership going out, giving a presentation, and then taking the questions and answers. In almost every instance--we've been across the country--there have been tough questions from people who have either been frustrated or had a bad experience, and that's what we're there for, to help them understand this.

I think we have come a long way in doing that outreach piece.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

I would agree. I think taking that contingency planning approach when somebody joins is very important, because you have to paint the whole picture of what they're headed for. I think both my friend Corneliu and I remember what joining was like.

We have a lot of public and private people, such as Canada Company. You have Care, True Patriot Love, Wounded Warriors, and so forth, also contributing to this. Canada Company, as you recall, had the scholarships for the children of fallen soldiers.

Can you comment on how these organizations integrate and complement these programs?

[RAdm Andrew Smith]

That's a great question. I'm going to ask General Bigelow to comment in a moment, but I will say that there has been an outpouring in the last 10 years. And we could have a debate about that, but it's probably been since the start of the Afghanistan mission. In my view, Canadians have discovered, or rediscovered, their Canadian Forces, their military, and have rekindled a love affair, something that is frankly unprecedented in my 32 years in uniform. We see this through corporate Canada, through charitable organizations, through John Q. Public who stops any one of us in bus stations or airports or on the street just to thank us for what we're doing. That is unprecedented in this country, and we have been particularly fortunate with True Patriot Love, Canada Company, and any number of charitable organizations. Those are only two. Many companies and organizations have come forward looking at how they can help.

So those donations flow into a non-public fund. Some of that goes to the military families fund to help people when the public cannot cover costs.

I'll ask General Bigelow. That's his specialty. All of those offers of help, casualty support, and charitable donations flow into his organization.

[Brigadier-General Fred Bigelow, Director General, Personnel and Family Support Services, Department of National Defence]

The boss touched on the military families fund. That is but one fund under the “Support Our Troops” umbrella. The hospital comforts fund relates to the discussion today to provide for some extras for folks who are hospitalized. One hugely positive aspect is the Soldier On fund, which is the non-public fund component of the Soldier On program. That is an actual regular force program we run for both current members and their families. These private agencies or fundraiser organizations or other fundraising activities we do in the military, in which our members participate, provide the funding for, in this case, Soldier On, which is, quite honestly, a fantastic program that takes injured members and gets them back into active lifestyles. That's one of the coolest things I've seen first-hand: adaptive sports organizations, family members, and injured members participating in something and just having a good time doing it. It's really heartwarming to see people in that situation have such a hugely positive thing in their lives and their families' lives.

That's a public program overseen and managed by us thanks to those donations we receive from the big fundraising organizations and from small grassroots stuff.

[The Chair, Conservative, James Bezan]

We will move on.

Mr. Chisholm, you have the floor.

[Robert Chisholm, NDP, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chairman.

Thank you, gentlemen, Rear-Admiral.

My community is metro Dartmouth—Cole Harbour, and we have a great number of military forces members and families, as well as veterans. I'm very pleased to be here to listen to what you have to say and to maybe throw a couple of questions your way.

I want to ask you two things. You indicated, in response to a question earlier, that when people come back, they don't often put their hands up and say they have a problem. My question to you is,what happens when they put their hand up six or eight months down the road and say they have a problem?

[RAdm Andrew Smith]

Obviously they may not have put their hand up previously, but now they're increasingly inclined to put their hand up. The same thing applies six, eight, or thirty months downstream if they put their hand up and say they think they have a problem. They're given the same confidential, proactive, comprehensive support that anybody else is given.

One of the things we have done involves this road to mental readiness that I spoke of. The mental health clinicians and social workers have put together a wonderful little pocket pamphlet, which I'd be happy to provide afterwards to the committee. It shows what a green state of mental health looks like and what yellow, orange, or red states look like, in deteriorating states of mental health. So people can look at it and say, “Do I have increased gambling, or do I have increased alcohol use, or am I more cynical than I used to be?” And they can see that maybe they have slid from green to yellow or to orange and put their hand up.

So they have that with them; they put it in their wallet or on their fridge. And they put their hand up.

[Robert Chisholm, NDP, Dartmouth—Cole Harbour, NS]

Thank you. What's in place to assist commanding officers and peers in helping their staff and colleagues reintegrate into active duty?

[RAdm Andrew Smith]

I would submit that the greatest thing we have done in the last three years is to stand up the joint personnel support unit. Notwithstanding that all leaders in the Canadian Forces are trained from day one to look after their troops, the reality is that the business of force generation—similar to what you may have experienced in Wainwright recently—is the day-to day-business. They still care about their troops, but it may not be their primary concern or they may not have enough time to do it.

So it's putting the joint personnel support unit in place, a comprehensive integrated suite of programs and agencies that is focused on doing just that, and getting that word out to commanding officers to say potentially the best thing you can do for Johnny or Jill is to get them to the joint personnel support unit, where we have people trained, qualified, and focused on helping those people.

[Robert Chisholm, NDP, Dartmouth—Cole Harbour, NS]

Okay. That leads me to my next question. There appears to be an attempt to integrate these services that the military provides with provincial services, both in mental health care and social services and so on.

I have to tell you it's not working particularly well in some areas. I'm hearing from a lot of people being referred to provincial services who are in line-ups, who are on huge waiting lists.

I know the military hospital of Stadacona has been ratcheted down. As the military is referring more, depending more, on the provincial system, and the system is not there to help the men and women who have come back from battle, it's creating some real problems.

I wonder if you could perhaps address that.

[RAdm Andrew Smith]

I'll ask Colonel Bernier, who is the deputy surgeon general, to address the issue specifically with respect to reliance on provincial systems.

[Col Jean-Robert Bernier]

At the end of the Cold War, we closed our military hospital system generally, not just for economies or anything like that, but primarily because seeing fit and healthy patients all the time did not clinically prepare our clinicians to be competent when operations occurred. So we integrated them into civilian hospitals, mainly university trauma centres, where they maintain their top-level skills.

At the same time, particularly for services that are difficult to access, such as mental health, where there are national shortages in Canada, we essentially doubled the Canadian Forces capacity so that most of the mental health care can be provided in-house. We went from 228 clinician positions to 447. Now we're at 380 positions that are filled.

Mental health tends to be the issue that causes us the greatest difficulty with regard to access. However, right now, compared to objective wait times that are compiled by the national Wait Time Alliance, particularly for psychosocial and psychiatric care, the wait times for Canadian Forces members are dramatically less than they are for any other Canadian.

[Robert Chisholm, NDP, Dartmouth—Cole Harbour, NS]

Let me ask you, if I can, about my community. What do I do with about those wait lists in my community?

[The Chair, Conservative, James Bezan]

I'm sorry, Mr. Chisholm, your time has expired and we have to move on.

Mr. Chisu, you have the floor.