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.
Executive Director, Esquimalt Military Family Resource Centre
Thank you. It's nice to see you.
Liberal
The Chair Liberal Karen McCrimmon
I would actually like to reiterate our thanks, our recognition of the work that both of you do to support members of the military and their families. Your testimony here today was absolutely pivotal and crucial to this undertaking, and I want to say thank you.
With that, we will end this panel, take a one-minute break, and then start again with the second panel.
Liberal
The Chair Liberal Karen McCrimmon
All right, thank you, everyone. We are resuming our meeting, and I'd like to welcome our two witnesses for the second panel.
We have Dr. Elizabeth Rolland-Harris, senior epidemiologist and now director of force health protection at the Public Health Agency of Canada. She authored the “2019 Report on Suicide Mortality in the Canadian Armed Forces” as well as an article entitled “More than Just Counting Deaths: The Evolution of Suicide Surveillance in the Canadian Armed Forces”.
She will be followed by Dr. Jitender Sareen, head of the department of psychiatry at the University of Manitoba and chair of the 2016 suicide expert panel.
With that, I'd like to welcome Dr. Elizabeth Rolland-Harris, for her opening remarks, please.
Dr. Elizabeth Rolland-Harris Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
Thank you, Madam Chair.
My name, as you were just told, is Dr. Elizabeth Rolland-Harris. I am an epidemiologist by training. I hold a Master of Science in epidemiology from the University of Toronto as well as a Ph.D. in infectious disease epidemiology from the London School of Hygiene & Tropical Medicine in the United Kingdom.
From June 2006 to September 2019, I worked as a senior epidemiologist for the directorate of force health protection within the Department of National Defence, and during my tenure there, I was responsible for the military suicide epidemiological surveillance file as well as being the project lead and co-primary investigator for the Canadian Forces cancer mortality study II. This study was conducted in collaboration with Veterans Affairs Canada and Statistics Canada, and it endeavoured to describe the types and numbers of deaths in both still-serving and released military personnel. These deaths included suicide deaths.
In September 2019, I left the Department of National Defence and accepted a new role with the Public Health Agency of Canada. I want to make it clear that my appearance today is based solely on my duties and knowledge related to my former position with the Department of National Defence.
I am not here today as a representative or employee of the Public Health Agency of Canada, as the subject matter of this study is not related to my current position with the agency.
Thank you for your invitation to appear before the committee.
Liberal
Dr. Jitender Sareen Professor of Psychiatry, University of Manitoba, As an Individual
It's a real honour and a pleasure to be here today, and the testimonies of the previous speakers were really heartfelt. Thank you to everyone.
I'd like to also acknowledge that I'm a psychiatrist at the University of Manitoba, a department head, and I have worked at the Veterans Affairs Operational Stress Injuries Clinic in Winnipeg as a consulting psychiatrist since 2009.
The research I'm presenting today is funded by the Canadian Institutes of Health Research, as well as the Canadian Institute for Military and Veteran Health Research and the True Patriot Love organization.
The focus of the presentation will be on the 2016 report of the mental health expert panel on suicide prevention in the Canadian Armed Forces. I co-chaired this panel with Dr. Rakesh Jetly. It included a number of national or international suicide experts, DND policy-makers and VAC representatives.
The key observation of the mental health panel in 2016, which met for two and a half days, was that there are approximately 11 suicide deaths per year in the Canadian Armed Forces.
The 2013 Canadian Armed Forces survey that was conducted by Statistics Canada showed that the past-year suicidal ideation rate among active military personnel was 4.3%, and the rate of suicide attempts was 0.4%.
The panel recognized that suicide is a behaviour that is extremely difficult to predict at an individual level. Although the goal is to have no individuals die by suicide, the expert panel recognized that at times not all suicides can be prevented.
On the risk factors for suicidal behaviour among military and veterans, we looked at all of the literature internationally as well as specifically in Canada, and a number of the risk factors that are well known include being male and having relationship difficulties or being unmarried. Depression, post-traumatic stress disorder, and substance use disorders such as alcohol use can often combine to lead to an increasing risk of suicidal behaviour.
More recently there's been understanding that traumatic brain injury as well as chronic pain conditions and new onset of physical health conditions can also increase the risk of suicidal behaviour. We also know that adverse childhood experiences have been strongly linked to suicidal behaviour, not only in military personnel but also in civilian populations.
Our work and the work of others internationally has shown that exposure to traumatic events during deployments is associated with suicidal behaviour. Witnessing atrocities, combat exposure or seeing a fellow member die in combat can increase the risk, but deployment itself is not a risk factor for suicide. Incidents of self-harming behaviour as well as the transition to civilian life are seen to be very important vulnerable periods.
One of the other important areas that have been discussed by previous witnesses is that important time of crisis when people are either admitted to the hospital or in an emergency setting. The periods before and after can be times of great vulnerability.
The report that was completed and submitted had 11 specific recommendations for the Canadian Armed Forces.
The first recommendation was to have a new position called a suicide prevention quality improvement coordinator. This recommendation was based on a strong understanding that suicide prevention requires a coordinated effort between the health system and the social system, and that similar coordinators have been implemented in the U.S. Department of Veterans Affairs.
There has been an increase in awareness and improvement in access to mental health services, but as previous witnesses have said, there is still a stigma about receiving care.
The suicide prevention coordinator would develop a patient and family advisory committee, review characteristics of suicide in military members, determine the needs for education among staff for suicide-specific interventions—and I'll talk about those, as there are a number of them that have evolved more recently—and then determine the need for education in primary care and specialty services and highlight the gaps that can be improved.
Recommendation two was to make a systematic review of all CAF member suicides since 2010. The medical professional technical suicide review occurs for every individual suicide death, but it would be very, very important to look at all the deaths consecutively to address specific questions such as where the suicide occurred, what the pattern of recent work and psychosocial stressors was, what types of physical health problems were prevalent at that time, what proportion of individuals were actually getting evidence-based suicide prevention treatments and, among firearm-related suicides, what measures were taken to limit access prior to death.
This type of review could help us guide policy to target suicide prevention in an evidence-based model.
There is, as I mentioned before, this pivot in the field of suicide prevention. Previously, the idea of suicide prevention was to treat the underlying depression, alcohol and substance use problem, but now the field is really shifting to the view that we need to both treat the depression and underlying condition and also target interventions specifically for suicide.
One example is a suicide risk assessment. There is a program called the suicide assessment and follow-up engagement, so if a veteran in the U.S. has an emergency visit due to a crisis, there is brief intervention and safety planning afterwards around means restrictions, coping skills and social supports and outreach after that program.
We recommend that the Canadian Armed Forces review some of those novel programs that are being implemented in the U.S., which could be helpful.
Liberal
The Chair Liberal Karen McCrimmon
Thank you very much, Dr. Sareen. I appreciate that. I just want to make sure we have a little bit of time left for questions.
We did receive a presentation from Dr. Sareen. It is being translated and we will forward it once we have the translation.
With that, we'll hand it over to Mr. Dowdall for questions. Go ahead, please.
Conservative
Terry Dowdall Conservative Simcoe—Grey, ON
Thank you very much, Madam Chair, and I too want to thank the witnesses today for their testimony. They were compelling, for sure, and heartfelt, and I think everyone's looking for some answers as we move forward. I'm certainly proud of our Armed Forces. Whenever they've been needed, they've been there, and I think it's our time and our duty to make sure that we take care of them now as well as when they are post-military.
I was very happy to see the joint suicide prevention strategy come out in 2017. According to the Department of National Defence, there were 15 suicides among armed forces members in 2018, and this number increased to 20 in 2019. I've asked for, but do not yet have, the number for 2020.
My question is this: How effective has this strategy been and how is its effectiveness being measured?
Professor of Psychiatry, University of Manitoba, As an Individual
My role with the panel was really to chair the committee and make the recommendations, so I have not been following the specific changes that have occurred, but Dr. Harris may want to add something.
Former Senior Epidemiologist, Directorate of Force Health Protection, Canadian Forces Health Services Group, As an Individual
I have limited insight on this, not having been part of the organization in over a year, and things may have evolved.
What I can say is that while the annual suicide report from DND is very important, I think that because of the way our governance of the military and veterans is set up, we have a tendency to look at problems in silos, so we look at suicide in the military and then we look separately at suicide in the veterans population, whereas really it's a continuum. We talk about it from a life-course perspective, not as a question of whose responsibility it is. It's an individual who goes through different stages in their life.
I can't answer your specific question, but if we're looking at improving things more broadly, I think there has to be a look at changing the way things are done, and not dividing members into two discrete populations—those still serving and those who have been released. Really they are one and the same population with the same challenges and the same experiences, and they're just at different points in their life course.
Thank you.
Conservative
Terry Dowdall Conservative Simcoe—Grey, ON
I think those are great comments. I think this speaks to the earlier witnesses as well. This is a 24-7 issue that we need to address. I know that in working with the local hospitals here, they've thought of different ways that they could probably set this up and not be in a silo.
One of the things that I've been really proud of in the last little while—I don't know if you've followed it—is that my colleague, the MP from Caribou—Prince George, brought forward an idea to have a suicide prevention line number that would be simple to remember: 988. We were hoping to have this implemented before Christmas, probably, which is a tough time of year, as you know, for many individuals in the military, as well as civilians.
I'd like a quick comment from each of the witnesses on what you think of that, and if it's a good idea to really bring it all together and make sure that we're there for everyone 24-7.
Professor of Psychiatry, University of Manitoba, As an Individual
Yes, absolutely. I think that having the suicide lines is extremely important. As the previous witnesses have said, we need that availability during a 24-hour period. Crises often occur and families are often left to try to support their member. I think the important part is what happens after the crisis line. I think that's when we really want to make sure that the person gets onto the right pathway and gets the right care, and that they're not waiting on different waiting lists.
That happens not only for military members, but for many people in our system. I think the pandemic has really pivoted us into virtual care, and we can do a lot more things virtually now that reduce some of the stigma for people who would otherwise have to walk into a building for an out-patient appointment. We need to take this opportunity with the pandemic to improve access for our patients and families in getting care at the right time, because it is a 24-hour issue.
Liberal
Liberal
Yves Robillard Liberal Marc-Aurèle-Fortin, QC
My question is for Mr. Sareen.
A death by suicide in the Canadian Armed Forces is obviously one death too many.
Could you tell us about the gaps in the mental health support system currently in place in the Canadian Armed Forces?
Professor of Psychiatry, University of Manitoba, As an Individual
Could there be a translation? I don't speak French.
The Clerk
Mr. Sareen, I suspect that you are not on the right channel. If you go to the bottom of your screen, you'll see a globe with “Interpretation”. Just go there and select “English”.
Professor of Psychiatry, University of Manitoba, As an Individual
On Zoom?
The Clerk
Yes. It's on the main Zoom screen where you have the pictures of everybody. It's at the bottom, in the middle. If you move your mouse there, you will see “Participants” and, to the right of that, “Interpretation”.
Professor of Psychiatry, University of Manitoba, As an Individual
I have it on English. I didn't hear a translation.
The Clerk
Okay. We'll do a test right now.
Mr. Robillard, can you do a sound test for Mr. Sareen?
Liberal