Yes. I can hear it.
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.
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.
12:40 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
Yes. I can hear it.
12:40 p.m.
The Clerk
We can continue.
12:40 p.m.
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
A death by suicide in the Canadian Armed Forces is obviously one too many.
Could you tell us about the gaps in the mental health support system currently in place in the Canadian Armed Forces?
12:40 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
The recommendations we made in 2017 I think really encouraged trying to be very specific around suicide-specific interventions. There has been a lot of effort on improving access to treatment for depression and post-traumatic stress disorders, but there are specific suicide prevention strategies and psychological therapies. As well, in the moment of crisis, there are specific things that could be done.
Our recommendation was to review and look at what the needs are and to see if we can have more training in those suicide-specific strategies, in collaboration with other medications, supports and family supports, to ensure that our members who have made a suicide attempt or who have had thoughts about suicide are really getting that suicide-specific therapy and medications.
That's a report that we made in 2017. I'm not clear on what level of change has occurred in the military.
12:45 p.m.
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
What support is provided to the families of Canadian Forces members who die by suicide and to those who have attempted suicide?
12:45 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
I think that was also another recommendation. It was that we should look at those specific processes and policies, but I'm not sure exactly what specifically is being done in the military today when somebody has lost a family member to suicide. That's a very important question.
12:45 p.m.
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
Based on your personal experience, what measures now in place could have prevented a suicide death in the Canadian Armed Forces?
12:45 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
The most common things that have been shown to be helpful in reducing suicides include restriction of access to means—which include firearms or large quantities of medications—making sure we're recognizing depression and post-traumatic stress disorder and treating them with appropriate treatments, and engaging family members and supports in any sort of crisis planning that occurs when somebody is suicidal.
12:45 p.m.
Liberal
12:45 p.m.
Bloc
Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC
Thank you, Madam Chair.
I thank the witnesses for being with us today to discuss this issue that is so important to us.
I would also like to take this opportunity to thank the House employees who are doing their utmost under the current conditions. Frankly, I take my hat off to them.
This is not mentioned very often, but the 2019 Report on Suicide Mortality in the Canadian Armed Forces does not include the percentage of suicides among women because suicide among women is uncommon. In 2017-18, I don't think there were any suicides among women.
Would you be able to explain to me how the mental health problems experienced by women in the Canadian Armed Forces differ from those experienced by men in the Canadian Armed Forces?
My question is for either of the witnesses.
12:45 p.m.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
This question is of a more clinical nature. So I think my colleague should answer it first.
12:45 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
In the general population, men are much more likely to die by suicide than are women. We know that men experience more alcohol use as well as depression. Women in the military have a higher likelihood of having post-traumatic stress disorder and anxiety disorders, but a lower likelihood of having alcohol and drug use. That's some of the work we have done.
I'm sorry. I don't have a good answer as to why we have such low rates of suicide in active military. However, when we look at veterans, there is an increase in suicides among women veterans at that period of transition. As Dr. Roland-Harris is saying, that transition from military life to a veteran's life is an extremely important time.
12:50 p.m.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
Indeed, as my colleague was saying, especially on the issue of women, it's really very important to have a more comprehensive picture. According to the data for veterans, the percentage of suicides is increasing shockingly among women, especially in the 40 to 50 age group, if I remember correctly. Again, I haven't looked at this file in a little while, and I may be wrong in terms of the age range. However, it more or less corresponded to when people make the transition from the military system to the civilian system.
In terms of family life, this is also the time when we see an increase in the end of marriages or relationships. In addition, it is often when children move into their teens that family problems develop. The role of the woman in the family, the family nucleus, therefore changes and this creates stress. I think it's very important to look at the situation of women not only during their years in the military system, but also after they've come out of it.
12:50 p.m.
NDP
Randall Garrison NDP Esquimalt—Saanich—Sooke, BC
Thank you very much, Madam Chair.
We do, of course, focus on those who successfully die by suicide, as we should, as it's a big loss to the Canadian Forces and to their families.
I wonder if either of the witnesses would like to comment on the fact that perhaps this is an undercount of the problem, since the problem is the attempt to die by suicide. We know that some 20% to 25% of medical releases from the military are for mental health reasons, and we know from U.S. estimates that as many as ten times more attempt to die by suicide than actually succeed. By focusing on that number alone, are we undercounting the problem?
12:50 p.m.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
It's a numbers one. Is it okay if I take it, Jitender?
12:50 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
Yes.
12:50 p.m.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
Okay.
In a nutshell, yes. Obviously, it is just a.... We call it the iceberg. It's the tip of the iceberg. There's obviously a lot of stuff that's happening underneath the water.
Just from an accounting perspective and taking away the emotional or the humanistic side of things, the reality of it is that it's very hard to count attempts. We only ever see the most severe ones on our radar, because those are the ones that seek medical care because they require it to survive, in essence.
Even best efforts to try to capture that sort of underlying reality are very difficult by virtue of the breadth of severity with respect to attempts.
12:50 p.m.
NDP
Randall Garrison NDP Esquimalt—Saanich—Sooke, BC
I would agree with your comments that the suicide rates are likely underestimates. With regard to accidental deaths, some of them could also be suicides, so that's also important. Suicide attempts are also, as Dr. Rolland-Harris has said, difficult to capture, so you're absolutely correct.
Dr. Sareen, did the expert panel look at the interface between stigma and military discipline and the attempts to prevent suicide? We heard very powerful testimony from previous witnesses that it's the stigma and the discipline that's often applied to those suffering from mental illness that contribute to the difficulties in getting help.
12:50 p.m.
Professor of Psychiatry, University of Manitoba, As an Individual
That was not a topic specifically discussed at the two-and-a-half-day panel. Clearly, barriers to care and fear of the impact that getting care will have on the person's career were absolutely seen to be important factors in why people may not come forward for care.
12:50 p.m.
Liberal
12:50 p.m.
Conservative
Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON
Thank you, Madam Chair.
I will go to Dr. Sareen first.
You chaired the 2016 expert panel report and made a number of recommendations. Which of the 11, if any, are outstanding—that is, have not been acted upon?
