National Defence Committee on Oct. 25th, 2011

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

Thank you.

I want to go back to Colonel Bernier. This is not a question of finding fault. In the best systems sometimes there are weakness or holes, and it's our responsibility to make sure we respond to those weaknesses. There are problems in my community with lack of access to mental health services. What do I do to help those people get the kinds of services they need?

[Col Jean-Robert Bernier]

We monitor. We have a performance measurement system to identify situations where there's an over-supply or under-supply of services and then redistribute accordingly.

In some places, because mental health professionals are a rare resource in Canada, we're competing with lots of other organizations. In some rural areas, it's particularly difficult to hire civilians. In those situations, we post in military mental health professionals. If we can't get enough civilians to fill some of those vacancies, we'll use other approaches, like telehealth, or we'll fly in or move in, temporarily, mental health professionals from other bases to support the gap. Sometimes, if necessary, we'll remove patients.

I could take that on notice and look up the situation in your area to find out the statistics for waiting times, specifically for the different types of services—psycho-social, mental health, psychiatric, etc.

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

I'm just asking as an MP. Say someone calls me or comes to my office and says he needs help because he's getting bounced around. He qualifies as a Canadian Forces member, but he's not getting the services he needs and he's in trouble. What do I do? Who do I call?

[Col Jean-Robert Bernier]

The individual presumably has attempted, through his medical officer or base surgeon, to have those services and they've not been made available.

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

Right. They're in a line-up.

[Col Jean-Robert Bernier]

We have to look at each case. If that case was brought to our attention, from the top down, we would look into it.

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

What can I do? I have to do something, right? These people need somebody to step up to help them and their families. So I'm asking you, what can I do?

[RAdm Andrew Smith]

I would offer you two opportunities. One is to have the individual approach his chain of command. That's what the chain of command is there for—to lobby, advocate, champion on an individual's behalf. That's the first thing. The second thing I would invite the individual to do would be to go to the joint personnel support unit. There is one in Halifax, as there is on every base. Between those two avenues, I have full confidence that the individual's problem will be addressed. That's what they're there for.

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

And if not, whom do I call? I'm telling you, these are real problems. I don't mean to find fault with the system, the chain or command, but these are people who are hurting.

Suicides too often happen because people are not being listened to. I'm trying to listen to these people, and I know you are too, but I need to find a place for them to go.

[RAdm Andrew Smith]

Mr. Chair, in the event that the chain of command and the IPSC were to be unsuccessful--which, frankly, I have a very hard time believing--you could invite any member of Parliament to call Rear-Admiral Andy Smith.

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

Thank you very much, Admiral. I appreciate that.

Let me follow it up with one question. You have given yourself up as an example, in terms of role models, or people who have experienced trauma and have changed in that continuum you talked about in terms of mental illness. But in terms of role models, do we have them? I guess you would be one--someone who has suffered trauma, gone through the system of support, and rebounded--who we could point to and say, “See? There is somebody we've recognized and we've helped, and that person is an example of somebody who raised his or her hand, who we helped, and who's back in and doing a great job.”

[RAdm Andrew Smith]

When we launched the “Be the Difference” campaign in 2009, we had five people come forward, very courageous people who had suffered depression, schizophrenia, post-traumatic stress disorder, and operational stress injuries, and stand up in a public forum to say, “I was there. I was in my basement. I couldn't get out of my basement. I didn't want to have any contact with my family. I was having dark thoughts, got into treatment, and came out the other side.” They put their hands up publicly and said, “Hey, I've been there. I've come out the other side. I'm okay. And I'm fully functioning.” By and large, with few exceptions, I would submit that the rank and file never offered any indication how badly those people were suffering. And those people came forward. Some of them were privates; some were majors who come forward. They are really poster children for the ability to put your hand up, get treated, and move on with your career.

I've also had several people, senior officers, come and express things to me. These are extremely high-performing people who opened up to me to say, “I was in a dark place. I almost wanted to jump off the bridge, the MacKay Bridge or the Macdonald Bridge, I got help, and got what I needed. What can I do now, sir, to be able to go out and help people?” They volunteer to be peer counsellors or peer support to help people get the help they need.

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

Good. Thank you.

[The Chair, Conservative, James Bezan]

Thank you, Admiral.

Mr. Dykstra, it's your turn.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you, Mr. Chair.

From my perspective, prior to becoming elected in 2006, I had not spent a whole lot of time seeing the difficulties or studying the difficulties or becoming aware of the difficulties we faced with respect to our soldiers. And in this particular area, I guess it's why I focus a little bit.... I'm much more aware of it now, but I think it has as much to do with my job as anything else.

The fifth pillar you have is about the communications, both internal and external. You talked a great deal about the internal communications, and that gives me some confidence that you've moved leaps and bounds over the last 20 years.

One of the difficulties I see is the external communications. Whether it be going through the Caring for our Own document or reading the brief on Shoulder to Shoulder and having a chance to even go through a little bit more of the material, part of the issue I see here is public awareness. I wondered if you could very briefly describe how in the past you've worked through making the public more aware of what your responsibilities are and how we serve those who are in the military.

[RAdm Andrew Smith]

Thanks for that question.

Strategic communications, specifically with respect to care and support for military members.... Success stories like these, in my estimation, frankly, don't make front pages of newspapers--regrettably. We have done so much in terms of medical care, non-clinical care, casualty support, casualty administration, and career administration.

When we had the Caring for our Own symposium nigh on about a month ago, we very purposely reached out to parliamentarians, media, advocacy groups, veteran support agencies, ombudsmen--both the veterans' ombudsman and the DND ombudsman--and selected people who were advocates in the area, specifically just to try to get that message out. Shoulder to Shoulder is all over our Canadian Forces website. All the initiatives that have been put in place are available on our website, whether it is the Be the Difference campaign, Soldier On, Shoulder to Shoulder, JPSU, or The Road to Mental Readiness. However, trying to get it out on a continual basis remains a challenge. I acknowledge that.

[Rick Dykstra, Conservative, St. Catharines, ON]

Actually, this is sort of leading into my next question, with our completion of the mission in Afghanistan and withdrawal from Libya.

One of the strengths and the characters of an organization is how it transitions from what's happened, and understanding it and describing it, and then of course transitioning as to what's next and how you are going to approach the future with respect to this issue.

I guess that's what I'm asking. How are you planning over the next two, three or four years to transition from what I understand now is a very focused and concrete program that you are trying to make people aware of, whether it's internal or external? I wonder how you plan to work through that transition over the next number of years.

[RAdm Andrew Smith]

I would offer to you that more than any institution I've ever been associated with, the Canadian Forces is a learning institution. We have a very rigorous and robust lessons learned approach where we fold tactical lessons, communications lessons, back in from a lessons learned approach in a vein of continuous improvement.

The Canadian Forces remain flexible. That's one of the things...the general purpose, combat-capable nature of our forces means that you are ready, flexible, and agile to respond, and that includes the whole area of casualty support, casualty administration, medical support. I think we've proven that over the last ten years, and I'm not worried or concerned that we are unable to face the next conflict area in that regard.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you.

[The Chair, Conservative, James Bezan]

Mr. Alexander.

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

Thank you, Chair.

I'd like to add my voice to those commending our briefers for this incredibly valuable session, and also to pay tribute to the initiatives of recent years. You've mentioned a panoply of them. I know there are others that we won't have time to get into, whether it is Be the Difference or the Soldier On fund, and then the Shoulder to Shoulder initiative, which was the proximate reason for us having this session now, because of the immediacy of that initiative, and now the broader framework of Caring for our Own.

We do see you leading and learning the lessons. In reply to your strong message on this point, Rear-Admiral Smith, I think Canadians do expect the Canadian Forces to lead on the issue of bereavement and how to deal with it, care for the ill and injured, and also mental health--in all of those areas.

We see it. Yes, there is a communications challenge. Yes, there are always going to be gaps and adjustments that have to be made, but we commend you for the leadership you've shown and we know will continue to show.

I want to address a couple of issues that may not have been covered so far. The first one is very simple. We know what the impact of the last decade has been on recruitment, particularly after the launch of the Canada First defence strategy. It's been broadly positive. But I want to ask, perhaps Colonel Bernier, about recruitment specifically to the medical field, including mental health, both for deployment and positions here. We know there are still some gaps in mental health positions despite Herculean efforts to try to access all the right people. Tell us a bit about recruitment of the medical professionals on which so much depends.

[Col Jean-Robert Bernier]

Thank you.

There are still some issues that we're addressing with respect to some of the health professions where we're still short. However, for the first time in history we're actually going to be slightly over strength for physicians, which historically has been our biggest recruiting challenge, to the point that in some years we have had less than 50% of the number of physicians we needed to have. As the quarterbacks of the medical team dealing with casualties, that's a tremendous success and a tremendous operational requirement to be able to provide that care, both in garrison and in deployed operations.

The patriotism that the conflict in Afghanistan has generated led to the recruitment of some of Canada's top clinical specialists. For example, one of the top transplant surgeons in Canada is now one of our medical officers. The director of Canada's number one trauma centre, Sunnybrook, the biggest premier trauma centre in Canada, is one of our surgeons.

So it has generated tremendous recruiting interest with very dedicated medical officers who are soldiers in mentality as well as being health care professionals, in fact to the point that with the reduction in operations in Afghanistan as the threat is reduced, it may have an adverse impact on our retention and recruiting. So we're doing very well.

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

Thank you.

Because of limited time, I'll bundle together some of these other questions. Medical records are always a difficult issue. We know the system inside the Canadian Forces is quite robust, but I'm wondering if you could comment a bit on the fidelity of transfers after members are released to the civilian system. We have all heard about challenges on this front, and it probably varies from province to province.

What is your sense of that issue, and how many ill and injured soldiers are released from the Canadian Forces every year, post-combat mission in Afghanistan? What gaps do you see between the system that you and Veterans Affairs are offering and the provincial systems? Are there still gaps, either on the federal side or the provincial side?

[RAdm Andrew Smith]

I'll jump on what I think was the second of your three questions. Historically, we have released a thousand people, give or take, medically per year. That has been consistent. It's been 950 to 1,100 per year for the last 10 years.

With respect to transfer of health records, there are always privacy issues in play there. We do have a project under way with Veterans Affairs Canada to facilitate the transfer of medical records to Veterans Affairs, and given that I often refer to Veterans Affairs as our cousins—they're inside the family—they ultimately need to have access to those medical records to help Canadian Forces members through the VAC claims process.

I'll ask Colonel Bernier to speak to the issue of fidelity of transfer to other agencies.

[Col Jean-Robert Bernier]

We can't comment on the provincial jurisdictions. However, with regard to the transfer of medical records, the records are available to the individuals themselves upon request, and they're proactively transferred any time a veteran applies to Veterans Affairs for any kind of support. We have a robust program of making sure those records are transferred well before the release period.

Ultimately, our Canadian Forces health information system—the electronic health record—will be fully up and running by early next year, and we're working on all the details required to do an electronic transfer of those medical records while being careful to protect their confidentiality.