Evidence of meeting #8 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 families.
A recording is available from Parliament.
Professor of Psychiatry, University of Manitoba, As an Individual
Thank you.
I have not been keeping track of all the different recommendations, but some of them have been implemented. It would be best to ask the Canadian Armed Forces. They were accepted. The report was accepted, but as for actually getting the information on what was implemented and what was not, it would be best to ask the DND.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
Okay.
Well, actually, recommendation 9 was to “consider novel methods for delivery of psychological and pharmacological interventions”. Would you say that the care and the computer-assisted multi-model memory desensitization and reconsolidation would be that, as well as the EMDR therapy?
Professor of Psychiatry, University of Manitoba, As an Individual
Yes, I think our focus of that particular recommendation was really to ensure moving away from the one-on-one office visit to using more virtual means—telephone-based therapies, video conferencing-based therapies—because people often have difficulty accessing services. Any type of therapy can be usually done virtually, and now with the pandemic, we're seeing that. Our aim in that recommendation was to try to have more outreach and to look at novel ways of delivering care, rather than the usual one-on-one office visit.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
All right. You're talking about virtual therapy now as well, I take it, with the onset of the virus.
For Elizabeth Rolland-Harris, since what year did statistical data on CAF personnel suicides begin?
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
I don't recall off the top of my head, but I believe it is in the report. It is, I believe, sometime in the 1980s. This has been going on for a fairly.... I'm sorry. It's 1995. It's in the title of the report. It's since 1995.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
Statistics have been kept since 1995, yet over the years—at least 20 years—there has been an outright denial of statistics being kept, until very recently. Would you actually produce the documentation substantiating these statistics so that we can go back and see how we're comparing now as opposed to then?
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
I was at DND from 2006 onwards. I can't speak to prior to 2006, but I can tell you that those statistics were being tabulated, analyzed and published since 2006 at the very least. The reports were at the time being published on the National Defence website.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
What about stats on PTSD? I recall that in the early 2000s, Colonel Stéphane Grenier was the trailblazer in trying to have the public as well as the military understand that PTSD was an operational stress injury, not just an excuse to get out of doing your duties. What about the stats on PTSD?
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
That, if it was being collated—and I can't speak to it—was done by the directorate of mental health. Suicide was kept under FHP, Force Health Protection, for historical reasons, and the rest was done through the other directorate. You would have to ask someone from that directorate about that.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
Okay. PTSD would be under a different protectorate.
November 30th, 2020 / 12:55 p.m.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
It would be under the mental health directorate, yes.
Professor of Psychiatry, University of Manitoba, As an Individual
I would also like to add that I did submit a few specific articles for this committee to review that talk about the national trends in suicidal ideation and attempts from 2002 to 2013 in the Canadian Armed Forces. We have also followed a survey of Canadian Armed Forces veterans. We followed 3,000 military members over 16 years. We are starting to publish some of the key papers that will describe how common the mental health difficulties are over time, as well as some of the gaps in services.
Conservative
Liberal
Conservative
James Bezan Conservative Selkirk—Interlake—Eastman, MB
Thank you, Madam Chair.
It's indeed a pleasure to be able to, first of all, thank our witnesses.
I know that Sheila Fynes is still with us. I want to thank her for her advocacy and for telling her story, which is difficult to do.
Again, it's because of your voice that we've been able to address a lot of these issues over the years. I'm all too familiar with the loss of Stuart, as well as Shawna Rogers. I was parliamentary secretary when we dealt with those. All too often we ran into roadblocks, with provost marshals and DND blocking the timely release of information and treating families with disrespect.
I think that because of Sheila Fynes's advocacy, a lot of that now has changed. Despite the incredible agony and the tragedy of every suicide that we experience, at least there is I think a better process in place now than there was 14 years ago—in Stuart's case, 12 years ago.
I want to ask our witnesses some questions about the clinical analysis of suicide. I know that we always like to talk about PTSD. I can tell you that 10 years ago there was still a debate as to whether it even existed. Ms. Gallant was just talking about the trail-blazing work of some psychiatrists on that, but we were still trying to put everything in a box, saying it was depression or it was anxiety or there were other mental health issues.
Have we ever been able to break down which of those issues—if we don't lump them all together as PTSD—is the leading cause of suicide within the Canadian Armed Forces? I've had conversation in the past with Colonel Rakesh Jetly about how often the trigger can be attributed to service versus how many suicides are happening because of relationship breakups, financial difficulties, and so on. Are those the triggers, or is the trigger actually service-related?
Professor of Psychiatry, University of Manitoba, As an Individual
I think that is a very complex question. We know that if you look at—
Conservative
James Bezan Conservative Selkirk—Interlake—Eastman, MB
The reason I'm asking a complex question is that if we're going to be putting in place the proper mechanisms and trying to identify what the triggers are so that we can get help to those who need it the most as early as possible, we know that resources are always finite. If we do go down the path of a 988 number, you've already said quite clearly that you can have the 988 call-in number, but then are the resources there in the community, at the provincial level, and in DND to get there and help immediately? That's something we need to deal with, so how do we identify which are the high-risk factors and what the triggers are, and how do we prevent it?
Professor of Psychiatry, University of Manitoba, As an Individual
Depression and often another mental health issue like PTSD, as well as alcohol, are the most common things that trigger the increase in risk for suicide, as well as a history of having made a previous attempt. Those would be the most common and the most important risk factors.
Life stressors, whether they are work-related or home-related, and especially financial stress, have all been shown to increase the risk as well. Specifically in the military and with veterans, that transition to civilian life and that sense of identity after leaving the military—who am I, and how is that impacting my social life as well as my family?—often become very important components.
We know that specifically deployment-related experiences that are traumatic have been shown to trigger PTSD and trigger depression. Legal issues in the military, if somebody's had those, can also trigger suicidal behaviour. The important thing is that the vast majority of people do not die by suicide when they have depression or anxiety; there's usually a culmination of all of those things together.
As you mentioned, often the military member, if they require admission to a hospital, has to go into the provincial civilian hospital, and that transition out is a high-risk period for everyone who is admitted. The panel recommended looking at those key time points during crisis when things have built up and then looking at some of the means-restriction processes for which there is the strongest evidence—for example, not having access to a firearm during the crisis or not having access to a number of different medications.
Liberal
The Chair Liberal Karen McCrimmon
Thank you very much for that.
We are going a little bit over time.
Monsieur Brunelle-Duceppe and Mr. Garrison, you each have two and a half minutes left, if you wish to use them.
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
I'll try to be quick.
In the 2019 report, the army has a higher suicide mortality rate than other command categories in the Canadian Armed Forces.
What are the factors that can explain this finding?
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
Jitender, do you want to take that one?
Okay. Thanks.
Personally, I can't explain it. Given the data we have, we're not really able to answer that question.
As Dr. Sareen said, suicide is a multifactorial reality. So many factors may be involved that it is not so simple to pinpoint; it is very complex. However, while the underlying reasons cannot necessarily be explained, perhaps Dr. Sareen could say a little more about it.
Nevertheless, it's like a red light, a flag that goes up, telling us that we need to do more, for example to do what is necessary to support this particular group. Since we can't necessarily always define the underlying criteria, it tells us that this group may be more at risk. More time, effort, and resources may need to be invested to explore this issue further.
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
In short, it's not as simple as 1 + 1 = 2; the issue is more complex than that.
Do you have something to add, Dr. Sareen?
Professor of Psychiatry, University of Manitoba, As an Individual
I think Dr. Rolland-Harris has captured it.
Liberal
The Chair Liberal Karen McCrimmon
That brings us to the end of this meeting.
Thank you to our witnesses for joining us today. You have made a significant contribution to this study. Thank you for spending your valuable time with us.
To committee members, thank you for your questions. I think it was a very valuable session that will inform our work well moving forward.
With that, the meeting is adjourned.