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.
Col Rakesh Jetly
I think there's always a potential gap in the sense that people may have health needs 24-7 and our clinics are now sort of ambulatory care. We're sort of daytime. We're not open on weekends typically, and those types of things.
So after hours, we rely on the civilian system almost exclusively across the country in terms of emergency rooms and things like that.
So there's certainly a potential need.
Conservative
Terry Dowdall Conservative Simcoe—Grey, ON
I have one last question.
Do you think it would be good to have a single, easy phone number, like 988, for people to phone when they are stressed? I know that everyone has their own little organization, but do you not think that, when people are totally stressed, that would make a lot of sense?
Col Rakesh Jetly
I'm a complete believer in leveraging technology, and I think the simpler we make things for people, the better, yes.
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
Good afternoon to the witnesses. Thank you for taking the time to come and appear before us. I have a number of questions for you. The first goes to Colonel Jetly.
Can you tell us about the Joint Suicide Prevention Strategy developed in 2017 by the Canadian Armed Forces and Veterans Affairs Canada?
Col Rakesh Jetly
In general, yes, I can speak about it.
If I can speak historically.... One of the reasons—your colleague who asked a previous question set this up nicely—why it is now a joint strategy is the absolute recognition that transition is a particularly high risk. There is a huge difference in the Canadian Armed Forces. We are in a very, very controlled, well-resourced environment. We have colleagues, a chain of command and a health system where everybody has primary care. That transition to the civilian world.... The idea is to have that seamless hand-off between the two government departments.
There are many, many items within that, and they deal with.... As I mentioned earlier, suicide is a complex factor, so it has to do with structure, vocation, health, moving and settlement, but the idea is that we recognize the fact that moving, itself, can be stressful, and stressors can increase suicidality, particularly if people are ill. A small but significant part of it is related to health services. What we have done is endeavoured to sort of improve the handover of people, particularly with identifying illnesses, to Veterans Affairs Canada, where early in my—
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
Thank you.
Colonel, how do the Canadian Armed Forces support their members who have tried to commit suicide or who have harmed themselves?
Col Rakesh Jetly
From an, I'll say, Canadian Armed Forces..., I can start with health services. Things in terms of health services—for a suicide attempt or a self-harm attempt—begin with a careful assessment to identify what illness is perhaps causing it. There are illnesses like major depressive disorder and post-traumatic stress disorder, which to lay people may be similar, but they're quite different. Then we apply the evidence-based treatment.
The entire focus there.... I think it's very interesting. In the military, we grow up with putting our our careers and the organization first. We put our families second, and we usually put ourselves third. What we demand of people at this time is to turn that completely upside down and to focus on themselves for self-care. The leadership has been, in my mind, almost always supportive. They put themselves in front, put their families second, put their careers and the missions behind, and focus on the care. We attempt to provide the evidence-based care—whether it's psychotherapy, medication, vocational rehab, retraining or whatever is needed—with the number one aim of getting people better. The number two aim is to help keep their careers and help keep them in the Canadian Armed Forces if that's what they desire. If not, we make sure that there's a smooth transition to Veterans Affairs, if they're eligible, but otherwise to the civilian system.
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
What is the current rate of posttraumatic stress syndrome among members of the Canadian Armed Forces?
Col Rakesh Jetly
It's a very tricky question because numbers are always tricky.
From the last population-based survey we did in 2013, the lifetime prevalence, I think I read, was 11.1%. That's a lifetime prevalence. It doesn't talk about cause. It doesn't say that it's because of Afghanistan. It could be from childhood, as one of our previous witnesses said. I believe—and I can be corrected later on—that the 12-month prevalence was just about 5%, which is about double what it was in the 2002 survey.
Remember that depression has been and always will be in the armed forces, even in times of war—just like in civilian society—the number one mental health condition, the most prevalent and the largest burden. PTSD varies from time to time, but trauma.... Our military members in most of our countries—Canada and the U.S.—have a higher propensity for adverse childhood events when they're growing up. It's the type of people we attract as well, so the PTSD lifetime doesn't necessarily relate to military operations, although military operations certainly are a big part of it.
Liberal
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
Thank you, Madam Chair.
Colonel Jetly, BMC Psychiatry published a study on the Road to Mental Readiness program that was prepared for Canadian Armed Forces recruits. The study showed mixed results. Actually, no positive outcomes were seen on psychological functioning, resilience and military performance. In general, the conclusions of the study did the program no great favours.
Are you in a position to comment on the results of that study?
Col Rakesh Jetly
I missed the beginning because of the translation. What paper are you referring to?
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
The study was published by BMC Psychiatry; it looked at the Road to Mental Readiness program that was prepared for Canadian Armed Forces recruits. We are told that the program did not have the desired effects—
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
I don't know the authors' names, but I can send them to you.
Col Rakesh Jetly
It's hard to comment on a specific report without knowing the authors' methodology. In general, what I can say about psychiatric care overall is that in the civilian world and military world, we have a long way to go. I think our evidence-based treatments, if we're lucky, whether it's civilian depression or PTSD, help 50% to 60% of people. A significant number of people don't benefit. I don't know if that's a specific military thing. We do have evidence that combat-related PTSD tends to respond less often, whether we're talking about Australia, Canada or the U.S., than civilian PTSD with the proper evidence-based treatment.
I absolutely 100% concede that more treatments and better treatments are needed, which is why continuing to do research and continuing to finding novel treatments is important. I just can't specifically comment on the report.
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
I completely understand. Perhaps you might have been able to comment on the Road to Mental Readiness program, but if you have not read the study, there is no point. I don't know whether another witness has read it, but if not, it makes absolutely no sense to talk about it.
Col Rakesh Jetly
The Road to Mental Readiness is a training and education program, not a treatment program. Lieutenant-Colonel Suzanne Bailey runs R2MR. Like many countries and like our allies, we have education programs to help destigmatize, to teach skills and to teach mindfulness. We start that in basic training, when people first come in, to teach them mental health literacy, to teach them the language, to understand taking a knee if they're not feeling well, and to maybe even be kinder to each other.
That's part of the training and education program. The efficacy of a training program is different from the efficacy of a treatment program.
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
I understand, but are you familiar with the program?
