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.