National Defence Committee on March 4th, 2014

[Michel D. Doiron]

Veterans Affairs Canada does not compile statistics on suicides or suicide attempts. We work with individuals.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

At National Defence, do you have that kind of information on suicide attempts?

[MGen David Millar]

Do you want to know whether we have statistics on our members?

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

I want to know whether you have statistics on suicide attempts by either members still with the forces, or recently released soldiers.

[Col Rakesh Jetly]

I think I have testified here before that the attempts are incredibly difficult to track, because we're never sure that we have a complete number.

We have a system in place with serving members. We have a policy in place under which the priority, when somebody makes an attempt, is that the chain of command and the medical people—the senior authorities on the base—are talking, communicating, and making sure that the people are in care.

That's the priority: it's not about investigating; it's not about embarrassing the members to ensure that they are in care. We have had an approach whereby the chain of command, the senior leaders and the senior doctor on the base, talk and make sure they are aware of it—if they become aware of it. If somebody attempting to take their life on a Saturday wakes up, doesn't tell anybody, or 911 is not called, we're not going to know about it.

[The Chair, Conservative, Peter Kent]

Colonel, thank you.

Ms. Michaud, your time has expired.

Mr. Bezan, please, for five minutes.

[James Bezan, Conservative, Selkirk—Interlake, MB]

Thank you, Mr. Chair.

I want to thank all the witnesses for appearing today, especially with the votes earlier. I want us to have as much time together as we want to.

I just want to touch on a couple of things.

General Millar, you talked about having success and demystifying the stigma associated with getting help. How do you measure that? What are the metrics that you're using to say that you've had success?

[MGen David Millar]

At demystifying?

[James Bezan, Conservative, Selkirk—Interlake, MB]

Yes.

[MGen David Millar]

My indicator of success is the number of people who are starting to present, the number of people who are coming forward recognizing that mental illness is not a negative problem; it's something that we can treat and help our members with. As I see more people coming out of the unit lines into my JPSUs, that's an indicator of success.

I see more conversations, more open conversations about mental illness and a greater acceptance both within Canadian society and the Canadian Forces that mental illness is not something bad. It's just something that we can all discuss and treat. As I see families coming forward to present on behalf of their members, those are all indicators to me that the stigma is starting to come down, but we have a long road to go.

[James Bezan, Conservative, Selkirk—Interlake, MB]

You're saying that 60% of the members who are currently in the JPSU have some form of mental illness. I take it that probably a lot of the people in the JPSU are on the physical side, recover from their injuries, and are of course put back in. You're saying about 23% return to work. How much of that 23% would be people who suffer from mental health problems?

[MGen David Millar]

When you have a physical illness, you can have a mental illness as well, as you can appreciate, or just a mental illness. In terms of the numbers that return, we don't track what the difference is between physical illness and mental illness. That's really on the medical side, and because of doctor/patient confidentiality, we don't distinguish that.

Rakesh, do you want to add to that?

[Col Rakesh Jetly]

I just want to talk a little bit about the stigma. We do have some data that we can forward. When we compare ourselves to our allies, we ask questions of members like a battle group returning...we ask whether they would think less of a colleague who sought mental health care, and our figure was around 6%. We've had specific questions that we've all asked. Frankly I think we're ahead of society in that area.

We also have the data that when we first set up our trauma clinics, on average people waited about seven years before they came forward for care. Now when we do enhanced post-employment screening in three to six months, over half the people who screened positive are already in care. We really have the evidence that we're moving things forward. We're never done there but we do have evidence and we do have metrics that things are heading in the right direction.

[James Bezan, Conservative, Selkirk—Interlake, MB]

I'll just follow up on that, because you're talking about screening and that they're already in care.

There are two questions here; one is on the JPSU. Of those who return back to work, how many of them are reinjured and have to come back in, especially from the mental health side?

Also, the JAMA Psychiatry Journal just released a U.S. study of soldiers down there. They found that one in ten suffered from a diagnosis of intermittent explosive disorder, which has a higher rate of suicidal tendencies. I was just wondering if you're familiar with that and whether or not that is part of some of the pre-screening that we may do at recruitment, at pre-deployment, as part of the road to mental readiness.

[Col Rakesh Jetly]

I think with the whole research, the long-standing.... One of the biggest risk factors for suicide is impulsivity, so even if somebody doesn't have a severe mental illness, you would think that severe depression is the risk, but it's the actual impulsivity of the act. We look at post-traumatic stress disorder, we look at depression, we look at these illnesses, so we are on that. Part of where we need to really get at—General Millar talked about how many people in care still commit suicide—is getting a better understanding of what happens in the care itself. That and many other studies are being done to try to understand the actual act of suicide independent of the illness, and intermittent explosive disorder and impulsivity as a trait are all part of the factors that we need to look at.

[James Bezan, Conservative, Selkirk—Interlake, MB]

Can you describe the Canadian armed forces suicide prevention program that you have in place?

[Col Scott McLeod]

The suicide prevention program came out of the suicide expert panel that sat in 2009 that addressed the issue that suicide in the vast majority of cases is related to a mental illness. If you look at risk factors and try to intervene on specific risk factors, there are anywhere from 3,000 to 4,000 members of the Canadian armed forces at any one time who have the risk factor for suicide.

Our approach has been about educating people through our road to mental readiness program, enhancing mental health literacy, decreasing stigma so people come into care, and enhancing the care that they get on a regular basis, as well as educating all levels of the chain of command on what mental illness is in the individuals, enhancing that triad of care between chain of command, the person with the illness, as well as the health care system, so it's trying to enhance education more.

[The Chair, Conservative, Peter Kent]

Thank you very much, Colonel.

Mr. Larose.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I have a point of order, Mr. Chair, that I would like to ensure that I have time for before the committee is over.

An assertion was made by a member of this committee, Ms. Gallant, who asserted that an opposition member has talked about self-stigma when we noted Ms. Gallant is on record—

[The Chair, Conservative, Peter Kent]

This is debate.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I would like Ms. Gallant to table any evidence she has that any opposition member has done exactly what she is on record as having done.

[The Chair, Conservative, Peter Kent]

Ms. Murray, your point is made.

Mr. Larose, you have until the top of the clock.

[Jean-François Larose, NDP, Repentigny, QC]

Mr. Chair, I will share my time with Mr. Harris.

I have a quick question.

You mentioned stigma.

Where is that problem situated in terms of leadership? Members of the Canadian Armed Forces influence one another once they become corporals or master corporals. That factor is an obstacle, right? I would like a very quick answer, please.

[MGen David Millar]

You are correct. As I mentioned during my presentation, I think the level of stigmatization is personal. I lose if I say the following:

“I have a mental illness.” That's the level of stigma.

[Jean-François Larose, NDP, Repentigny, QC]

Yes, but they can influence each other. They can influence their subordinates, who may develop the same concern.

Thank you.