National Defence Committee on April 8th, 2014

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

My question is, if there is a re-education—and I know that you're doing programs to bring that forward, and that's my other question after, how much are you doing?—what happens if the number doubles from what was expected? How much resistance is there going to be? Because we just don't know. There's a lot of information, and you mentioned it earlier, that you're waiting on to make a reassessment. We could end up with surprises. My worry isn't how valid that information is and how much more information we need to make the correct decisions, but more, once those decisions need to be made and we realize that we have to double the amount of money to help those troops, how much resistance is there going to be? Is there an openness right now that no matter how the numbers come out, we are going to give all the services that they deserve, without any doubt?

[BGen Jean-Robert Bernier]

I and my predecessors asked for a lot of things during combat operations in Afghanistan.

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

Post-deployment, also?

[BGen Jean-Robert Bernier]

Intra-deployment and post-deployment. Everything we asked for, we received: for example, an unprecedented 4.8 psychiatrists in Petawawa for a population of 6,000. There's no other community in the world, I think, that has that level.

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

Considering the knowledge of PTSD—even in 2002, even when I was in the forces we were talking about this—why was it not in the planning to have a psychologist on field deployment? I don't understand. Because we've known this for a long time.

[BGen Jean-Robert Bernier]

The type of work that clinical psychologists do is necessary in our clinics, and that was part of the evaluation. At the time, the determination of whether or not there's a need for them in the...because in deployed operations we can't hang on to people for long times. We have a very small medical footprint, and the whole point is either they get back to duty right away or we evacuate them out of theatre.

A clinical psychologist's work tends to take longer: psychotherapy, psycho-evaluation, the bulk of the work. So the determination at the time was that, with what would be deployed among the competencies of physicians, psychiatrists, mental health nurses, and social workers, the duration of the treatment that we'd want to provide in theatre did not justify having clinical psychologists in theatre.

As a result of all our experience, seeing what the Americans and others do in Afghanistan, but primarily the Americans, and our own national experience, we're re-evaluating now whether or not we should have some or not.

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

But I'm a little confused here. In 12 years of operation, only now you're re-evaluating?

[BGen Jean-Robert Bernier]

We've continually re-evaluated it, and there was never a crisis, there was never a need that wasn't being adequately met by the existing cadre of mental health professionals deployed overseas.

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

So basically you're saying that the American services that were being used in Afghanistan were adequate? Because they were used.

[BGen Jean-Robert Bernier]

Yes. If they were available, they were used.

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

Okay. But they were not used, and I think there is a language barrier here. We have, on one side, stigma on troops who do not come forward for all kinds of reasons. Correct? We have a language barrier that's definitely there, and then there's also an evaluation done by the Canadian Armed Forces, post-deployment—correct?—on numbers that are not real, and afterwards on numbers that are still not real, because we don't know. We have an idea. And then in 12 years, not once did it come up that the language barrier shouldn't be an extra barrier to having a psychologist available on deployment, if they're using American psychologists? In 12 years...not once?

[The Vice-Chair, NDP, Jack Harris]

Very quickly, General.

[BGen Jean-Robert Bernier]

There's only one incident I know of, and it's unrelated to whether or not.... The issue of French language services is one thing, and we strive to always provide that.

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

How can they come forward if they can't even speak their own language?

[BGen Jean-Robert Bernier]

Right. So there was one incident that you've discussed, that we're aware of, and I don't know exactly what the circumstances were that led...but that's a separate issue than whether or not clinical psychologists in uniform are necessary. And we do have good data telling us what the burden is, from our operational stress injury incident study, 2009.

[The Vice-Chair, NDP, Jack Harris]

Thank you, General.

The next is Mr. Carmichael for five minutes.

[John Carmichael, Conservative, Don Valley West, ON]

Thank you, Chair.

Thank you to our witnesses.

General, I'd like to just briefly follow up. I recognize that you're going to be providing something in writing to us, based on Mr. Norlock's question earlier with regard to sleep treatment, etc., but I wonder if you could just give us a quick understanding of the difference between PTSD and depression, as it relates to causing suicide—what we know. And is there a connection between depression and a lack of sleep? Can you give us anything concrete on that at this point?

[BGen Jean-Robert Bernier]

I'm not a psychiatrist, but we know that they're both related. Depression, particularly from a volume perspective, is related more to suicide than has been post-traumatic stress disorder, in our experience. PTSD in particular is affected by lack of sleep, more so than depression. One of the symptoms of depression sometimes is excessive sleep, an inability to get up.

The burden of depression is greater in absolute numbers. Prevalent in mental health illness in the Canadian Forces is depression. As I mentioned earlier, our 2002-03 Statistics Canada mental health survey of the armed forces found that regular force males, in the armed force data, almost doubled the depression rate of the general public. It's a major concern for us.

[John Carmichael, Conservative, Don Valley West, ON]

Thank you.

In your presentation, you talked about some of the research that's being carried out right now. Some of the work is at the Hospital for Sick Children. You also have one of your colleagues working in the trauma chair at the Sunnybrook hospital.

I wonder if you could tell us, as we're learning more and more about PTSD and brain trauma, about what has been accomplished so far. Just give us an idea of what that research is generating in terms of knowledge that we can work with today. Also, what's the timing on some of the research that is currently under way? You've talked about neuroimaging and some of the different technologies that are being applied. What are we learning and how soon are we going to be able to truly apply some of this learning?

[BGen Jean-Robert Bernier]

For some of it, it's difficult to predict when it will lead to actual, practical, clinical therapeutic results. For example, for the virtual reality technologies that we have now...we're finding some greater willingness for soldiers to stay in treatment.

It's one thing to get people to start treatment. We lose a lot of folks because they withdraw from care for various reasons. Then they don't get fully cured. They don't get the best benefit from therapy.

Neuroimaging is probably the most promising element, particularly something called “magnetoencephalography”. That provides real-time imaging with no delay, whereas even a functional MRI has a certain delay that occurs in the imaging of the brain's functions. It provides both a functional...and the FMRI provides a structural demonstration of what's happening in the brain. Because the magnetoencephalography is so rapid, that is going to help us. It's already permitting us to detect patterns in the functioning of the brain that are physiologically different in depression, post-traumatic stress disorder, and mild traumatic brain injury. That's moving very quickly.

The more broadly the equipment gets disseminated across at least the academic centres for now—and ultimately the treatment centres—the more it will enhance the speed with which we can do diagnostics, the confirmation of the trajectory of care and recovery, and possibly even predict who will have greater susceptibility to post-traumatic disorder or other conditions.

[John Carmichael, Conservative, Don Valley West, ON]

In advance.

[BGen Jean-Robert Bernier]

Yes, in advance. We don't know that part yet, but that's theoretically possible, depending on how much.... It may even allow us to tailor, in combination with other technologies—genetics, particularly—specific pharmaceuticals up front, to know what will work best, and thus save many months of time in many cases in selecting the correct treatment.

[John Carmichael, Conservative, Don Valley West, ON]

Is that work being done strictly at the Hospital for Sick Children? Or are other facilities now working on that?

[BGen Jean-Robert Bernier]

We're working with several universities and the U.S. defence department, and with allies in Europe and the U.S. Department of Veterans Affairs. There are multiple research groups doing work in those areas. There are all kinds of others related to transcranial magnetic stimulation. That's showing some benefit with regard to the treatment of depression, and now we'll be applying it to PTSD as well. There are two research centres in Canada, in Toronto and Quebec City, that we're working with. There are others in the U.S. that are doing the same kinds of things.

There's quite a wide variety. We're integrated in virtually anything that can contribute to military health. We're integrated in one way or another domestically through the academic world, through the Canadian Institute for Military and Veteran Health Research, through the quintipartite technical cooperation program with the Anglo-Saxon allies, and, through NATO's science and technology organization, the world's largest research network, with the health research committee, which is chaired by my deputy.

[The Vice-Chair, NDP, Jack Harris]

Thank you, General.

Your time is up, Mr. Carmichael.

Next, for five minutes, we have Madam Michaud.