Evidence of meeting #11 for National Defence in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was illness.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Geneviève Bernatchez  Judge Advocate General, Canadian Armed Forces, Department of National Defence
Rakesh Jetly  Senior Psychiatrist, Directorate of Mental Health, Canadian Forces Health Services Group, Department of National Defence
Kyndra Rotunda  Professor, Military and International Law, Chapman University, As an Individual
Jill Wry  Deputy Judge Advocate General, Military Justice, Canadian Armed Forces, Department of National Defence

1 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Good afternoon, everyone. Welcome.

I call this meeting to order.

Welcome to meeting 11 of the House of Commons Standing Committee on National Defence.

Today's meeting is taking place in a hybrid format, pursuant to the House Order of September 23. The proceedings will be made available via the House of Commons website.

Witnesses, if you will give us a couple minutes to begin, we have a couple of small issues of committee business to deal with. Hopefully we'll keep them to a minimum. Then we will start with you, our witnesses.

On committee business, a steering committee report was circulated. We need a motion to approve that report. There were suggestions for amendments, but it became clear that there were members who were reticent to accept amendments. I don't think there are any amendments now; it's just the steering committee report as it currently stands.

1 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

I move that the report be adopted as circulated.

1 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Than you, Mr. Bezan.

It is moved.

Mr. Baker, too, thank you.

There are two movers. That's perfect.

All those in favour?

(Motion agreed to)

Thank you very much. That has been adopted.

That is the end of committee business.

Thank you, everyone. We will move on to our witnesses for today.

Our witnesses today are Rear-Admiral Geneviève Bernatchez, judge advocate general, and Colonel Jill Wry, deputy judge advocate general; followed by Colonel Rakesh Jetly, senior psychiatrist and director of mental health for the Canadian Forces Health Services Group; followed by Ms. Kyndra Rotunda, professor of military and international law at Chapman University.

I'll go to you first, Rear-Admiral Bernatchez, for your opening statement.

1 p.m.

Rear-Admiral Geneviève Bernatchez Judge Advocate General, Canadian Armed Forces, Department of National Defence

Thank you, Madam Chair. I will keep my opening remarks brief.

Please allow me to begin by introducing myself. I am Rear-Admiral Geneviève Bernatchez, the judge advocate general of the Canadian Armed Forces. I am the legal adviser to the Governor General, the Minister of National Defence, the Department of National Defence, and the Canadian Armed Forces in matters relating to military law. I am also legislatively entrusted with the superintendence of the administration of military justice in the Canadian Armed Forces.

I wish to thank the Committee for inviting my colleagues and I to appear before you today. I have the pleasure of being accompanied by Colonel Rakesh Jetly, senior psychiatrist and mental health advisor for the Canadian Armed Forces, and Colonel Jill Wry, Deputy Judge Advocate General for Military Justice.

People are at the core of everything the defence team does. The health and well-being of Canadian Armed Forces members, including their mental health, are therefore a high priority for Defence. The care and support of our members are of paramount importance to the operational success of the Canadian Armed Forces, and the military justice system's purpose is to support the operational effectiveness of the Canadian Armed Forces.

Indeed, as the Supreme Court of Canada reminded us last year in its landmark decision in R. v. Stillman, “The military justice system is...designed to meet the unique needs of the military”. It does so through its very purpose, which is to assure the maintenance of discipline, efficiency and morale of the Canadian Armed Forces.

The military justice system therefore recognizes the importance of mental health and includes necessary safeguards to help protect individuals who suffer from a mental disorder. For example, an accused person must be fit to stand trial. An accused person cannot be dealt with by way of summary trial if they were suffering from a mental disorder at the time of the alleged offence. The defence of mental disorder is available. Also, all accused members have access, free of charge, to a defence counsel, including full representation at court martial.

Last year, the Supreme Court of Canada also confirmed the constitutional legitimacy of the military justice system and affirmed that it is “a full partner in administering justice alongside the civilian justice system.” This validation of the military justice system's constitutional legitimacy comes as a result of the system's continued growth and evolution. The military justice system is enhanced through regular and periodic legislative developments; policy initiatives; external reviews; independent reviews mandated under the National Defence Act, such as the one appointed by the Minister of National Defence on November 16 of this year; judicial decisions; and, importantly, continued parliamentary interest in its development.

Together, these key processes contribute to the continued responsible evolution of Canada’s military justice system. This evolution is important, necessary, and positive.

My team and I take the evolution of the military justice system very seriously to ensure that it continues to meet Canada’s legal and societal norms and can ultimately serve its purpose of maintaining the discipline, efficiency and morale in the Canadian Armed Forces.

I understand that Colonel Jetly has some opening words for you as well. I thank the members of the committee for inviting us to appear before you today to assist in its important study.

1:05 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

We'll go to Colonel Jetly now.

1:05 p.m.

Colonel Rakesh Jetly Senior Psychiatrist, Directorate of Mental Health, Canadian Forces Health Services Group, Department of National Defence

Thank you very much.

Madam Chair and members of the Steering Committee on National Defence, I am the Chief of Psychiatry in the CAF. I have several key roles, including advising the leadership on mental health issues. I'm the senior mental health clinician of the CAF. I conduct and facilitate a great deal of mental health research related to military members, and serve as the CAF representative on international committee meetings within NATO and beyond. I thank you for your interest in the well-being of the men and women of the Canadian Armed Forces, and in particular their mental health.

As we have learned through our high-quality research efforts, mental illness is common within the Canadian Armed Forces, just as it is in civilian society. Our studies, such as the 2002 and 2013 Canadian Community Health Survey—Mental Health CF version, allowed us to understand the burden of mental illness within our organization compared with the civilian population. Our depression rates in both studies were higher than those in the civilian population, and our PTSD rates increased substantially between 2002 and 2013—not surprisingly after the conflicts in Afghanistan. For example, the 2013 survey found a 15.7% lifetime prevalence of depression in members of the CAF. Lifetime PTSD was estimated at 11.1%.

Just a significant as these crude numbers, these studies also tell us a great deal about help seeking and perceived barriers to care, and help us to understand what we call “the need-care gap”. As we continue to evolve our programs, we are guided by these studies and science with an aim of providing CAF members with timely access to evidence-based care.

The well understood barriers to care include the fact that individuals are unaware that they have a mental illness that may be amenable to care. People also often prefer to handle things themselves. They fear for their careers, and of course, there is stigma: “People may think that I am weak if I go for mental health care.”

The programs that we have developed are specifically designed as countermeasures to these barriers to care. For example, the Road to Mental Readiness aims to educate, teach coping skills, reduce stigma and increase help seeking. The term OSI concretely legitimized psychological injury alongside physical injury.

I understand that this committee is also interested in discussing suicide prevention within the CAF. Sadly, suicides occur in our society, and the Canadian Armed Forces are not an exception. Depending on the source, but conservatively using Statistics Canada numbers, 11 Canadians die by suicide each day, which is approximately 4,000 per year. Within Canada, suicide is the second leading cause of death among the young and young adults aged 15 to 34 years, and it is three times more frequent among men than women. A third of deaths by suicide occur in those aged 45 to 59 years. A quick look at these numbers shows that the men and women of the Canadian Armed Forces are within these higher risk demographics.

We have, within the Canadian Forces health services, a commitment to better understanding suicide to better manage and mitigate risk. We are in regular communication with our allies and leverage collective wisdom to implement approaches that we feel would be helpful.

It is also important to remember that suicide is not a singularly health-related issue. It is a complex, multifactorial condition that usually involves a mental health condition, diagnosed or not; a stressor, which is usually an interpersonal stressor; certain personality factors or traits, such as impulsivity; and, of course, access to lethal means.

I can expand further as desired, but the model mentioned provides many opportunities for suicide intervention. As such, within the Canadian Armed Forces, we consider suicide prevention a collective responsibility that involves leadership, colleagues, peers, health care providers and the entire community.

In 2009 and 2016, we convened expert panels on suicide prevention. We invited academic and military experts from within Canada and from our allies to help assess and guide our efforts in this important area.

We have made recent changes that include working with the Canadian Psychiatric Association to create the CAF Clinician Handbook on Suicide Prevention. It is a comprehensive document that identifies risk assessment and management of suicidality. We adopted the Columbia suicide severity rating scale to standardize our capturing of elevated risk. We also introduced CBTS through our training program across the country. This is cognitive behavioural therapy specifically aimed to address suicidal behaviour, not just the underlying mental health condition.

In March this year, we in the Canadian Armed Forces, as did all Canadians, and indeed the world, faced an unprecedented stressor, the COVID-19 pandemic, which has impacted us all and has been discussed by this committee. From a mental health care perspective, mental health services were never closed. From the outset, our leadership considered the mental health care of members of the Canadian Armed Forces a priority. We faced challenges, as all health systems did. We had to comply with local, municipal and provincial policies, and had to manage risk to our patients and staff vis-à-vis the pandemic.

Services continued and continue to be provided. Mental health care has been provided across the country in our clinics, using a variety of means, ranging from in-person assessments with both patients and clinicians appropriately wearing PPE, by telephone, and virtually, using video platforms. There have been challenges along the way in this implementation, based on technology, such as limited Wi-Fi in some of our buildings, and the compatibility of commercial platforms. This is an area we will continue to refine.

We can discuss this further, as desired, but as someone who joined the Canadian Armed Forces at the end of the Cold War, I am one who remembers that health services exist not only to provide care to the ill and injured, but also to maintain the operational readiness for times when we are expected to respond and act on behalf of the people of Canada.

During this pandemic, the CAF did respond, both domestically and internationally, when called upon, and health services supported those on operations.

I'm happy to take any questions, along with my colleagues, that the committee may have, and to let you all know that this will be the last time you will be meeting me in uniform, as I am well into my transition back to civilian society at the beginning of 2021 after 31 years of service.

Thank you.

1:10 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much, Colonel Jetly, and thank you very much for your service. You've done a lot of important work over the course of your career.

I'd now to call upon Ms. Kyndra Rotunda.

1:10 p.m.

Dr. Kyndra Rotunda Professor, Military and International Law, Chapman University, As an Individual

Good morning, and congratulations, Colonel Jetly, on you retirement. That's fantastic.

Thank you for inviting me to comment on Bill C-203, which would amend section 98 of Canada's National Defence Act by repealing the self-harm element of the malingering charge. This would preclude Canada's military from punishing service members who harm themselves to avoid military duty.

I'm a professor at Chapman University in Orange, California. I'm also a former army JAG officer. I currently direct Chapman's Military and Veterans Law Institute, where law students and recent law school graduates, working under my supervision, represent veterans and service members in all types of legal matters. I previously co-authored a short article with a colleague, Ari Freilich, entitled “Self-Inflicted Wounds: How Military Regulations Prejudice Service Members”, which is what prompted an invitation to appear at this hearing. Unfortunately, Mr. Freilich was not able to appear—he had an immovable scheduling conflict—but I have incorporated his feedback into my remarks as well.

Turning to the issue, on one hand, we can certainly understand why a nation's military would be tempted to criminalize self-harm, especially on the eve of battle. Nobody, even the most disciplined and well-trained soldiers, will calmly run toward the jaws of death. We know that it takes incredible will and incredible bravery to resist that natural flight instinct. Some may conclude, in fact, that death or injury at their own hands, on their own terms, is better than death or injury by an enemy.

On the other hand, criminalizing self-harm hurts the most vulnerable among our troops. This is especially true as our understanding of post-traumatic stress disorder evolves and our military suicide rate steeply and continuously climbs.

I've learned through my 20 years of practising military and veterans law, which entailed six years on active duty, that convictions for the crime of malingering result in immeasurable permanent harm and suffering to our troops. It shames service members; it causes them to hide their distress; and it pushes them ever deeper into depression and closer towards suicide ironically. In shame, they avoid getting the help they need. It's no wonder that the United States faces a suicide epidemic among its troops. Last month, USA Today reported that the suicide rate among our troops was at a six-year high, at 25.9 per 100,000 troops. I've read that Canada has similar statistics, with more Canadian troops dying by suicide in a 10-year period than the number of troops killed in Afghanistan over a similar 13-year period.

I wanted to turn to just a few examples. Over the life of our clinic, we've encountered several cases of service members who had been severely punished for attempting suicide. Several years ago, we encountered a case of a decorated combat veteran who was tasked with defusing IEDs over multiple war tours. He was medicated and diagnosed with PTSD. While deployed and barely holding it together, he was “stop-lossed”, which meant that he was not able to return home on schedule. In distress, he shot himself in the chest. He readily conceded under hostile questioning from his command, while he was hospitalized in the psychiatric facility, that he had “wanted to die because he could not go back to combat.” His command never disputed that the suicide attempt was genuine, but they nonetheless saw his statement about not being able to go back to combat as admission of a crime. They saw no difference between his wanting to die because of his PTSD and a malingerer's fraudulent intent to preserve their own life at military expense.

As we argued in our Law Review article, other prohibitions on fraud or duty shirking are already sufficient to deter and penalize genuine malingering. Given the still-widespread misunderstanding and stigma around mental health injury and suicide, commands too often interpret any offence whose essential element is self-injury as a licence to punish and punitively discharge suicidal troops. This deters help-seeking, especially without clear due-process protections to prevent punitive treatment of people whose conduct is at least substantially motivated by mental injury or disease, whether diagnosed or not prior to the attempt.

Another one of our clients, a decorated 21-year-old combat veteran, was heavily medicated for diagnosed mental injuries, with a gashed wrist covered in scars and held together by four staples, when his team leader appeared in his psychiatric ward hospital room to threaten him with court martial for “attempting to injure or kill himself”. He was hospitalized in an army psychiatric hospital for five weeks before he received a stigmatizing misconduct discharge for cutting his wrist with a razor. He had no disciplinary record whatsoever. He was soon diagnosed with severe PTSD, and he nearly died of a second attempt, when his brother discovered him hanging from a rope.

Criminalizing suicide in the military is at odds with jurisprudence applied in the civilian sector. Most American civilian jurisdictions decriminalized attempted suicide by the end of the horse and buggy era. Over 50 years ago, drafters of the Model Penal Code wrote, “While attempted suicide is still viewed as [criminal] in a few states, we think it clear that this is not an area in which the penal law can be effective and that its intrusion on such tragedies is an abuse.”

The drafters also rejected the criminalization of non-suicidal self-injury. No American jurisdiction has criminally punished a suicide attempt since 1961. The California Supreme Court wrote 30 years ago that “all modern research points to one conclusion about the problem of suicide—the irrelevance of the criminal law to its solution”. The Federal Ninth Circuit court has agreed, saying that there is a “modern consensus” in this area of law.

Despite being out of step with modern law, the military nonetheless still punishes suicide attempts by its troops. Not surprisingly, the U.S. military's suicide and self-harm rate only continues to increase, despite these punitive responses to self-harm.

This also causes collateral damage under our system when there's a denial of VA benefits for those who need them the most. Most of the clients we represent in our institute are seeking an upgrade to their discharge level. This is because the Veterans Administration conditions most benefits on having an honourable or general level discharge.

The VA offers all kinds of robust benefits, including an educational benefit, which funds college tuition, books, fees and even a living stipend for veterans who are going to college full-time. However, in order to receive these benefits, service members must have been separated with a higher level discharge. Even a minor infraction can result in a general level and disqualify the service member from the educational benefit that's offered in the United States.

Service members who stand to benefit the most from that benefit are those with combat-related military occupational specialties: those who manned a weapon, those who served in the special forces, were ordinance experts and the like. These dangerous soldiering jobs have no civilian equivalent, so those needing educational benefits the most are those who saw the most combat, and those who are most likely suffering with PTSD and disciplinary infractions that seem to go hand-in-hand, frankly, with a PTSD diagnosis, often, unfortunately, including malingering.

For the above-stated reasons, I support Canada's proposal to repeal the self-harm provision from the definition of malingering, and I am happy to provide any additional information, as requested, or to answer any questions.

Thank you again for the opportunity to testify on this important matter.

1:20 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much, Professor Rotunda. It is much appreciated.

We'll go to the rounds of questions now.

We'll start with Mr. Benzen, please.

1:20 p.m.

Conservative

Bob Benzen Conservative Calgary Heritage, AB

Thank you, Madam Chair, and to all of the witnesses for being here today.

Thank you to all our military personnel for your service to Canada.

Admiral Bernatchez, thinking about paragraph 98(c), it seems to me that we should maybe break it up into two parts. Part one would be pre-deployment and pre-battle, where someone who inflicts self-harm is charged with a criminal act because they're trying to avoid duty.

The second part would after deployment, after they have been in battle and seen the horror and the carnage of battle. They are now at a point where they are suffering a mental health issue. At that point, maybe they inflict self-harm. I don't think those two things are equivalent. One is trying to avoid duty and one now is a complication from being in battle.

Can you give your thoughts on how paragraph 98(c) maybe should be revised? How can we look at this differently?

1:20 p.m.

RAdm Geneviève Bernatchez

The first thing that I want to do is acknowledge the interest and the concerns that are being expressed and that the committee has heard. Certainly the information that I want to provide to the committee is truly to inform the committee's understanding of the law and to be as fair as possible.

The first thing I would like to specify here is that paragraph 98(c) of the National Defence Act addresses a situation where a member deliberately causes injury to themself with the very specific intent of avoiding service. Classic examples that we can all be familiar with would be a soldier who shoots themself in the foot or cuts a finger specifically in order not to be sent to the front. That's how the Canadian military law jurisprudence has been dealing with this section of the National Defence Act.

To my understanding, at least, and I would certainly leave it to Professor Rotunda to comment, contrary to the uniform code of military justice, which does not require proof of an intention to avoid service, our code of service discipline specifically in paragraph 98(c) requires that element.

I would also like to say that there certainly has been a recognition by different allies of the requirement to address these circumstances in order to ensure that their force will be ready and available to fight or to come to the assistance of their population in times of need. The U.S., the U.K., Australia, New Zealand, Denmark, Spain, Italy, Germany and France, to name but a few, have very comparable provisions in their own codes of service discipline.

What I think could help here is not, perhaps, to get away entirely from paragraph 98(c) and what it seeks to address, but perhaps, as is done for other offences in the code of service discipline, to insert a note in the Queen's regulations and orders that would specifically indicate the intent. I'm thinking here of something that could read like, “attempts to die by suicide or when self-harm is committed for a purpose other than avoiding service is not covered by this offence”. That would clearly indicate the intent of the legislator and what the paragraph is not meant to address, and could appease some of the concerns, I think.

1:25 p.m.

Conservative

Bob Benzen Conservative Calgary Heritage, AB

That's excellent. I think that would be very, very helpful, making it very clear so that the stigma of a suicide, especially after battle....

There's a worry that people won't come forward for mental health help, and I think that, if we remove part of that stigma, which is that they're going to be charged with a criminal offence with very high penalties, they may be more likely to come forward and do that. So thank you for that answer.

Professor Rotunda, in the States, you talk about the military's having a category of self-harm without the intent of avoiding service. Is that used a lot in the United States? Is it working, and is it allowing more people to come forward and get mental health help?

1:25 p.m.

Professor, Military and International Law, Chapman University, As an Individual

Dr. Kyndra Rotunda

First off, “malingering” is under article 83 of our UCMJ. It includes a provision that “Any person subject to this chapter who, with the intent to avoid work, duty or service—(1) feigns illness”...dismemberment, etc., or intentionally inflicts self-harm. So it does actually have intent. It's not as clearly spelled out as the Canadian law, but it does have that.

One thing that we have found is that when commanders are wanting to punish a service member, they quite easily satisfy themselves that the person was intending to avoid work. The example that we have of a service member who, through pain, after suffering a suicide attempt, admits that “I can't go back to battle”, is a very different thing from saying, “I'm afraid to go to this training”.

I do think the notion was expressed a moment ago of being able to parse out those instances where someone is healthy, able and well, but scared, like we all would be, and harms themself. It's being able to parse out those individuals who are suffering severely with mental disease. You had mentioned the notion of maybe having a pre-deployment versus post-deployment analysis. Distinguishing between someone who hurts themself pre-deployment, before they've been to war, versus someone who hurts themself post-deployment, I think is possibly a good way to get at the issue. The only thing is that you would want to be very careful about how you spell that out, because we have in our military, anyway, several people who come to military service, frankly, who have had violence in their past, who come with a lot.... They could be coming to military service with PTSD. While I think that's a step in the right direction.... I really applaud Canada, truly, for looking at this and really trying to get to how you might amend the statute in a way that could get to what we are trying to get at.

There are some instances, I think, where malingering does need to be punishable. We can't allow people to drop a brick on their foot intentionally the night before their ruck march because they don't want to go.

I don't know if I answered your question. I'm happy to go further.

1:30 p.m.

Conservative

Bob Benzen Conservative Calgary Heritage, AB

No, I think you did. I think you enlightened us a little bit more and you're moving us in the right direction. Thank you.

1:30 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

We go on to Mr. Baker, please.

1:30 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you very much, Madam Chair.

My thanks to the witnesses for joining us today.

My question goes to the Judge Advocate General. What is Canada's record in terms of charges against members of the Canadian Armed Forces under section 98(c)?

1:30 p.m.

RAdm Geneviève Bernatchez

Thank you for the question.

I will ask my colleague, Colonel Wry, to provide more information about the statistics.

From the statistics we have been able to gather in recent months, we saw that those charges were laid many times, more than 300 times, during the Second World War. So we established that the offence was a common one.

Since 2000, I believe that two charges were laid under section 98(c) specifically. In one of those cases, someone was found guilty and the other charge was withdrawn.

Perhaps my colleague, Colonel Wry, has other details for you.

1:30 p.m.

Colonel Jill Wry Deputy Judge Advocate General, Military Justice, Canadian Armed Forces, Department of National Defence

Yes, thank you, Ma'am, and to the committee for the question.

It is correct that since 2000 there have been two members who have been charged under paragraph 98(c). In the first charge, the matter was not proceeded with, and the second one proceeded to trial by summary trial and the individual was found guilty. I will say, from a bit of research into the details of that particular finding of guilty, the situation was not one where mental health was an issue. It was a situation where someone was on exercises and admitted at the time to taking particular action in order to be returned back to his home base and not to have to continue in those exercises.

That is our history since 2000, with only two members being charged under paragraph 98(c). Thank you.

1:30 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you very much.

Was the Canadian Armed Forces member who was found guilty punished? If so, how?

1:30 p.m.

RAdm Geneviève Bernatchez

Thank you for the question.

I don't think we have that information. We will send it to the committee later.

1:30 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Okay.

Do other countries, particularly those in Western Europe and the United States, have a similar provision to section 98(c)?

1:30 p.m.

RAdm Geneviève Bernatchez

As I was saying earlier, according to the research we have done up to now, the United States, Great Britain, Australia, New Zealand, Denmark, Spain, Italy, Germany and France have similar provisions, all dealing with more or less the same thing. They are designed to prevent members called to serve in defence of their country or to support the people of their country, from avoiding that service by deliberately injuring themselves.

It would be a long task to list or describe each of the provisions of the codes of military discipline of those countries. It would take a lot of the committee's time. I therefore propose to send you the document that gathers the results of our research and the provisions in the codes of military discipline of those countries.

1:35 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Okay, thank you very much.

I think I have less than two minutes left. Briefly, what effect does section 98(c) have on the motivation of Canadian Armed Forces members to seek help when they are considering suicide, for example?

1:35 p.m.

RAdm Geneviève Bernatchez

Thank you for the question.

My colleague Colonel Jitney is probably in a better position to answer it, because he is the one responsible for the services provided to those who ask for them.

1:35 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Okay.