National Defence Committee on Nov. 21st, 2013

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

I asked it on purpose because I know it is difficult. Some people think that you can do psychological hiring and hire people who are better able to cope. But as you said, it's difficult to assess trauma because you can't know how you're going to handle it until you do.

If I could turn to our occupational health therapist, one of the things that we see in our whole health care system is a great number of people who can do many good things, and they all overlap. When you overlap, there's waste. Would you see an increased reliance on or increased activity with occupational health therapists as a way to ensure that each individual receives individual care to make sure there isn't that kind of overlap? Would you see your occupation as one that could best analyze, from a personal perspective, each individual patient or client so that there isn't that overlap, there isn't that waste, there isn't that time out?

One of the things we've seen here is it takes too long sometimes for someone to be assessed, and to know who the right person to go to is, and sometimes the right persons. Do you see yourself as facilitating a more efficient and effective delivery of health care services to ill and injured soldiers?

[Elizabeth Steggles]

Certainly we do. I think there are two answers to that question.

As I mentioned before, there is a well-proven role for occupational therapists as case managers because we have that overview of the whole person. The other area that I think occupational therapists excel at is as interprofessional practitioners. We are all trained now at the Master's level and we receive training in interprofessional practice. It's a phrase that's thrown around a lot, but what it actually means is that everybody within the team is working, including the client, toward a common goal. I think if there's a common goal, the OT can certainly help facilitate reaching that common goal, which I think addresses the issue you're raising here. If one person is working on one goal and one person is working on another, what we need to do is determine with the individual what their specific goal is, so we can then all work together toward that common goal.

[The Chair, Conservative, Peter Kent]

Thank you, Ms. Steggles.

Thank you, Mr. Norlock.

Ms. Murray, please.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

And thank you for the information you've provided to our committee.

I have a quick question for Mr. Dawdy.

In Whistler, do you work with the Whistler adaptive sports program?

[Clay Dawdy]

No, but I have met the folks who do.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Yes, it's very embedded in the community, and growing. If you're looking for more connections to expand the winter sports clinic that you can offer, that's an excellent partnership potential.

[Bob Gilmour]

I'll interject here. It's Soldier On that decides. This year they decided on one clinic in Canada, and they're running it at Mount Washington, but they're doing an international event at Whistler. But they decide where they're going to have the venue, so that's basically really still controlled by Soldier On. They simply show up at Whistler and Whistler accommodates them at their adaptive ski school.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Really, I want to focus my questions on reservists, having had a meeting with one of the Legion command executives, who noted that their experience is that reservists who are injured are more likely to fall between the cracks than full-time personnel, partly because the process of tracking them after they come back from a mission doesn't really exist in a coordinated way, especially related to operational stress injury or mental injury. If they don't show up for a parade with their unit, it's not clear if there is a tracking system.

Mr. Ferdinand, you were saying there's a gap in connecting the injured with community mental health services. Have you experienced the difference between the permanent armed forces members and reservists in terms of connecting the injured with community health services, or is that something that's not really been distinguished in the analysis your organization has done?

[Mark Ferdinand]

I'd say the only thing we've recognized when speaking with Veterans Affairs Canada over time, as well as with members of the armed forces, is that we don't have data. I think that's the biggest challenge. We don't measure very well who's coming in through the door. We know what types of disorders people may have, what types of mental health issues or problems they might have, but we couldn't say that in any venue outside of the acute care health system in this country that we can actually systematically measure if the person is a reservist or a member of the armed forces. To my knowledge, that doesn't happen. And it's a gap.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So there are no specific recommendations that you might have that would address that difference between people who are full-time armed forces members who come back and have their base, their job within the National Defence family, versus those who come back and may go back into the private sector and are not as connected with the armed forces. Do you have any thoughts? Do you see any need to address the reservists with some specific processes, or just armed forces personnel as a group?

[Mark Ferdinand]

When I think about people who are working day to day in Canada or elsewhere versus people who may be deployed internationally, there may be differences, and I think the armed forces would probably be best to talk a little bit about those differences that are experienced by the different members.

We've had preliminary discussions with Veterans Affairs Canada on how we might do that at the community level—track different people—because their experiences might be different, and therefore the trauma they might experience might be different, or the types of problems they have might be different. So we've had preliminary discussions, but we still need to determine how we actually go about setting up a tracking system.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

I didn't mean so much that their experience or their injuries are different; it's more that because they are not part of the regular forces, they might fall between the cracks, and nobody knows the mental injury until it's much more serious.

I'd like to ask Ms. Steggles a similar question.

You were saying that there are 30,000 post-Afghanistan personnel, and soldiers are getting lost in the system. That's what I've heard specifically about reservists, in a different way from the comments you made. I've heard that it's the length of time to access their benefits, the complexities of the different programs, and the paperwork, especially if someone is injured, perhaps with a mental injury, and is having difficulty functioning in a normal way. Have you observed that it is different between reservists and regular armed forces members because of their different lives when they come back to Canada, as I've just explained?

[Elizabeth Steggles]

I'm not sure I can answer your specific question about reservists because I haven't particularly heard that, but since you raise it, I can quite see there might well be a difference. We certainly know there is a difference between veterans and military personnel. But I think because we have occupational therapists working in the civilian community, the reservists might head in that direction and be picked up that way by occupational therapists. And occupational therapists typically do look into all the resources that are available to a specific individual. If, for example, they would be eligible for benefits from Veterans Affairs, we would help facilitate that process.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Have you experienced that there is a benefit to early intervention or a difference in the difficulties that are being experienced if someone has been living for a number of years with the effects of operational stress injury or PTSD versus an early intervention or early reaching out for help?

[Elizabeth Steggles]

There are certainly numerous statistics that support the fact that early intervention is beneficial—return to work, for example. If somebody has been out of work for six months, then we know the chances of getting back to work after six months get pretty slim. So in that sense, yes, getting onto things as soon as possible is critical.

[The Chair, Conservative, Peter Kent]

Thank you, Ms. Murray.

We'll now begin our second round of questioning, with five minutes per questioner.

Go ahead, Mr. Opitz.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, Mr. Chair.

I'm just going to pick up on a line of questioning that Ms. Murray had, because I am a former long-term reservist. When I was commanding officer, I would instruct my returning troops, and we would monitor them very closely, as best we could, for signs and symptoms of mental trauma. Now, when they're on tour and away with the regular force—and some of these deployments are up to two years, as a soldier could go between his pre-deployment training, his deployment, and then his post-deployment—you're under close supervision with your battalion in the regular force.

The issue is when they come back. The system does work. We do try to stay on top of the soldiers; we do try to watch them. I've had many soldiers self-identify. That's part of the problem: soldiers don't want to self-identify, especially if they're combat arms. They don't want to admit any form of weakness. They don't want to admit that something is wrong with them. Getting them out or starting to address or notice symptoms—and that's where, if you're in a regular force battalion, your buddies see you all the time and they'll see if you're not the same, if you're doing something different, if all of a sudden there are signs and symptoms of trauma manifesting itself.

As you know, for some people it manifests immediately, and for some people it may take years to manifest. We're seeing that in the United States with the long deployments in Iraq and Afghanistan, and here as well now. I know we're collaborating very closely with what the U.S. does, as do our defence scientists at DRDC, who are working on this problem.

Have you worked with DRDC at all, Mr. Ferdinand?

[Mark Ferdinand]

No.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

So you haven't worked with our defence scientists? They have some programs and treatments that they're working on to address pre, during, and post mental stress. I think we'll be hearing from them down the road.

The issue with reservists, sometimes, is when they're finished their post-deployment leave and training and they're back with their home battalion, it's sometimes hard to track them. If they don't want to self-identify—no matter how many times I've asked them as a CO and how much the sergeant and the warrant officers in their chain of command monitor them, sometimes they try to conceal those symptoms. It's very hard, when you're a reservist and you also have a civilian component to your life, to be able to get them to do that.

Now, many of them may address and have addressed these issues on their own through the provincial and civilian systems. They try to keep it out of the military because they don't want their chain of command to understand that they've come back with an issue. That happens. People hide this sort of thing, and that's just a human dimension to a soldier.

Ms. Murray's point is well made. But through my experience, this is generally what happens with reservists when you're not able to monitor and supervise them 24 hours a day, as you can in a regular force battalion. Those are some of the differences.

Mr. Ferdinand, it sounds like you have a pretty decent relationship with Veterans Affairs. On a collaborative level, you have a lot of conversations and you're working very closely in being able to find solutions for our soldiers. Would that be a fair statement?

[Mark Ferdinand]

Yes.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

That's great.

Ms. Steggles, I think you said you have about 15,000 occupational therapists. You're not aware, by the way, if any of your therapists are seeing reservists at this time, or you wouldn't know if they're reservists, necessarily?

[Elizabeth Steggles]

Yes, I can't specifically answer that question.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

But you're saying that there are fewer occupational therapists on bases than you would like to see?

[Elizabeth Steggles]

Yes.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

What would your recommendation be to develop this role?