National Defence Committee on Dec. 4th, 2020

[The Chair, Liberal, Karen McCrimmon]

I'm calling this meeting to order.

Welcome to meeting number nine of the House of Commons Standing Committee on National Defence.

Today's meeting is taking place in a hybrid format pursuant to the House order of September 23. The proceedings will be made available via the House of Commons website. Just so that you are aware, the webcast will always show the person speaking rather than the entire committee.

Our meeting today will be twofold.

I wish to welcome our three witnesses today: Nora Spinks, president and chief executive officer of the Vanier Institute of the Family, and from the Department of National Defence, Colonel Helen L. Wright, director, mental health, health services group headquarters of the Canadian Armed Forces, and Lieutenant-Colonel Suzanne Bailey, national practice leader, social work and mental health training.

I would like to welcome Nora Spinks to the floor for her opening statement, please.

[Nora Spinks, President and Chief Executive Officer, Vanier Institute of the Family]

Good afternoon, and thank you, Karen.

Thank you for the opportunity to provide testimony today.

I would like to acknowledge that our meeting is being held on the traditional unceded territory of the Algonquin Anishinabe people and to pay my respects to indigenous elders past, present and emerging.

I would also like to acknowledge and express my gratitude and appreciation for all of you here today who have served or are serving this country. Thank you for your service. To your families, I thank them for their support and their sacrifice.

It is an honour to appear today with my fellow panellists, people I admire and people I respect, and I look forward to hearing their testimony.

I am here today as the president and CEO of the Vanier Institute of the Family. The institute is a research and education organization dedicated to understanding families, family life and family experiences. Our ultimate goal is to optimize family well-being in Canada.

Our founders, General The Right Honourable Georges Vanier, and his wife, the Honourable Pauline, understood the strength and importance of family. They understood that the military member was not apart from but rather an integral part of a family. They knew the impact that family had on operational readiness. General Vanier served in both world wars. He suffered injuries—among them, losing his leg in battle. He understood the importance of mental health. He understood the impact of military service and that impact both on the service member and on the rest of his family.

As we think about military mental health, it's important to recognize that mental health is not simply the absence of mental illness. Mental health is a state of being, not just a diagnosis. Mental health is fluid. Mental health is not about conditions, problems and crises. Mental health, like physical health, requires conscious, deliberate attention. Like physical health, managing one's mental health includes prevention, early intervention and individual calibration.

Managing one's mental health requires self-care and access to information and resources and sometimes to professional care. Managing one's mental health requires support from managers, colleagues and co-workers, and it requires a strong personal circle of support. For most people, that personal circle of support starts with family.

When we think of military mental health and supporting members to effectively manage their mental health, we need to see them as part of a family and part of a community. We need to define family broadly. Family is more than spouse and children. Family includes parents, grandparents, siblings and ex-partners. Family is connections. Family may be biological, circumstantial or consciously chosen. Family is dynamic, continuously evolving and constantly adapting. Family, in fact, is the most adaptable institution in our society, and no two families are alike.

To ensure that CAF members achieve success, to ensure that they get the help they need when they need it and not just when they have reached a point of crisis, we and DND, the country and the community need to see family as a whole. We can do that with three straightforward strategic supports.

Number one is systemic supports, which include framing and managing mental health as a key skill, recognizing and including family as key members of the wellness team and educating and training for mental health competency, both at the individual and the family level.

The second is administrative supports. We need to create a culture where help-seeking is seen as a strength and not a weakness, providing access to services within the military and in the broader community.

The third is professional supports. We need to use a family lens when developing communication strategies and treatment plans. We need to treat the whole family. We need to acknowledge that individual well-being affects and is affected by family well-being.

In conclusion, if we frame managing one's mental health as a core competency, if we focus on the whole person, including their circle of support, if we focus on the importance of social connection, and if we focus on honouring, respecting and supporting military members and their families and frame help as a tool for success, then together we will be able to optimize the mental health of military members, strengthen families and create a culture of individual and family well-being within the military, and be a model for other workplaces across Canada and around the world.

I look forward to our conversation.

Thank you, Madam Chair.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Madam Spinks.

I'd like to hand it over to Colonel Wright now, please.

[Colonel Helen Wright, Director of Mental Health, Health Services Group Headquarters of the Canadian Armed Forces, Department of National Defence]

Thank you very much, Madam Chair and members of the Standing Committee on National Defence. It is a real privilege to be here today with my colleague, Lieutenant Colonel Suzanne Bailey, and to have the opportunity to discuss mental health in the Canadian Armed Forces.

My name is Colonel Helen Wright. I'm a family medicine physician with a background in research and occupational medicine. I am currently the director of mental health within the Canadian Armed Forces health services. My team is responsible for the professional, technical and clinical lead guidance and policy for the Canadian Forces mental health services and psychosocial services.

Today I'm pleased to have at my side, at least virtually, Lieutenant Colonel Suzanne Bailey. She is the senior Canadian Forces social worker as well as the national practice leader for social work within health services. She has also, for the past decade, led the Road to Mental Readiness, known as R2MR, mental health training program, overseeing its development, delivery and evaluation of mental health training among Canadian Armed Forces personnel.

Mental illness is experienced by one in five Canadians over their lifetime and some estimates are even higher at one in three Canadians. This extraordinary impact that mental health illnesses and injuries have on Canadians is also reflected in the Canadian Armed Forces. Our studies suggest that one in six of seven regular force members experiences a new, or perhaps ongoing, mental health issue in any given year. We know that anxiety disorders are the most commonly diagnosed, followed by depressive disorders.

Accordingly, the Canadian Armed Forces encourages members to raise concerns and seek appropriate help when needed. Efforts are ongoing to engage and educate our members to reduce all types of barriers to care, as well stigma. CAF members have access to a comprehensive, evidence-based health care system. It's grounded in family medicine but augmented by mental health and psychosocial services that are delivered by teams of people consisting of psychiatrists, psychologists, social workers, mental health nurses, addiction counsellors, chaplains and many others as well as an extensive cadre of civilian mental health specialists who practise in the community who also see our Canadian Armed Forces members.

As we were just reminded, health is much more than a matter of clinical health care, particularly in a military context. Health is a very complex concept involving a broad spectrum of factors, so while excellence in health care is necessary, it is just one element in a comprehensive array of Department of National Defence efforts on wellness and health.

In the Canadian Armed Forces we're looking for a fully integrated approach for lifelong health for our members, which includes health promotion and all sorts of health care services and activities and contributions from a number of different groups in CAF, groups such as the chaplains, morale and welfare, the transition group to name just a few. It also includes engagement from the chain of command and our leaders, members' families as we were also just reminded, and of course at the centre we have the members themselves.

I've alluded to this extensive array of supports, services and health promotion. Clearly I don't have time to introduce them in these short comments, but Colonel Bailey and I look forward to being able to tell you more about some of these programs and to answer your questions on mental health in the Canadian Armed Forces.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Colonel Wright.

Lieutenant-Colonel Bailey, please.

[Lieutenant-Colonel Suzanne Bailey, National Practice Leader, Social Work and Mental Health Training, Department of National Defence]

Thank you, Madam Chair. I have no additional opening remarks to what Colonel Wright has just presented. Thank you.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Lieutenant-Colonel Bailey.

We will open the round of questions with Madam Gallant, please.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Madam Chair.

Colonel Wright, at what point are CAF members either relieved from duty or relieved from use of their weapons in training when it comes to issues related to mental for someone in the forces? They feel they have a problem. They come forth. Many members fear they will be taken off duty or won't be able to use the firearms. They don't want anyone to know that they have mental health issues because of the stigma, of course. That is what prevents some of them from coming forth. They're afraid of losing everything they know about the military and their job.

What is the trigger point at which they can no longer do their job or have their weapons taken away?

[Col Helen Wright]

Thank you very much for that question, which really speaks to some of the core important concepts. One is the privacy and confidentiality that we know is just so vital to maintain for our patients to make sure that we have reduced any kind of barrier on that front. At the same time, we owe it to the member to protect their health from further injury or illness, and to protect their colleagues if that person is not ready to perform at their best in some very demanding circumstances. We do have the system of imposing some limitations on members, but only when necessary. I can assure you that we do not take that lightly.

We do know that although we go to great efforts to make these limitations that we share with the member's chain of command...to put them in such a way that it does not reveal anything about the member's health care situation. However, a major limitation like saying a member cannot use weapons is of course something that will get noticed. As I said, we use it to protect the member, to protect their health, to protect their colleagues, and, I suppose lastly, to make sure that operations can continue in a safe way.

I can assure you that this balance is well understood. We are always trying to make sure we are using those limitations only when necessary.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

When a soldier is identified as having a mental health issue or a family situation that makes them vulnerable to or predisposed to suicide, what does the Canadian Armed Forces do in communicating that to their chain of command?

[Col Helen Wright]

That also is a great question. Because we have this extremely important responsibility to the member to keep things confidential and private, it again is that razor edge of making sure we are looking after the member—the first priority is to make sure the member is well, or is as well as can be expected, and is getting the supports they need—but in the context of operations also making sure that everyone else is safe and well supported.

It would be very unusual for us to approach a chain of command and talk about someone being suicidal. We would do that only in the most extreme circumstances, where we really felt someone's life, or a colleague of that person, was in immediate danger. Generally speaking, we would talk to them about the employment limitations and [Technical difficulty—Editor] for management of that person, but without revealing details of their illness or injury.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

The 2018 report on suicide mortality in the Canadian Armed Forces showed that post-traumatic stress disorder was a factor in the deaths of more than 33% of the cases. What additional supports and follow-ups are given to soldiers identified as suffering from PTSD while serving and also after release?

[Col Helen Wright]

Madam Chair, supports for all mental health injuries—although of course PTSD is an important one for many of our members.... I don't think there are special things that we do for PTSD specifically that we wouldn't do for every other mental health injury. I guess that's what I'm driving at—that we would do everything we can for every illness or injury, but for PTSD we have a number.... We think of our mental health care on three pillars, if you will.

One is that we understand everything that we can about that illness in our population. The second is that we educate the members, their families and the community broadly to understand illness and injury, and then the last pillar is to care for that member.

For someone suffering from PTSD, as an example, we would make sure they were, of course, getting the right care, the best clinical, evidence-based care that we could possibly give, and make sure that they're getting all the supports they can. We have peer supports through programs like OSISS, for instance, where you can get formal peer support.

I think it's definitely a multi-pronged effort to make sure that we are doing everything we can to understand the situation, support that member and their community, as well as provide that last element of clinical care.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

Go ahead, Monsieur Robillard.

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Greetings to the witnesses.

Thank you for being here today.

As you will understand, this subject is particularly important to me as I have an emotional stake in it. My nephew, a member of the Canadian Armed Forces, recently attempted suicide. That's why I'm especially interested, although all the topics we discuss here are important.

Could you tell us about the impact that mental illness has on the members of the Canadian Armed Forces and, especially, on their families?

[Col Helen Wright]

Madam Chair, I'd like to pass that question to Lieutenant Colonel Suzanne Bailey, our social work expert, to discuss some of those impacts on our members.

[LCol Suzanne Bailey]

Thank you.

From Statistics Canada epidemiological studies that were done on Canada Armed Forces members in 2002 and 2013, we know that Canadian Armed Forces members are impacted by mental illness and mental injuries at relatively the same rates as our counterparts in the Canadian general population, with a couple of exceptions.

We do know that our rates of depression within the Canadian Forces have been consistently higher than among the general population since at least 2002, and then the 2013 survey indicated that our rates of post-traumatic stress disorder—while they can't be compared with those in the Canadian general population because the same survey instruments were not used—have increased between 2002 and 2013, likely with some of that increase due to a decade of combat in Afghanistan.

We know that Canadian Armed Forces members are affected by other mental illnesses as well, such as anxiety disorder, panic disorder and alcohol abuse. Obviously, we can expect that these impact not only the members themselves but also their families. The consistent numbers indicate that in any one year about 16.5% of Canadian Armed Forces members can be expected to meet the criteria for at least one mental illness. This will affect how they perceive themselves, how they perceive others and how they interact with their families.

A large part of my role in the last several years has been, first of all, making sure that we have services and supports in place for those who do reach out for care. We have over 450 mental health clinicians in 31 different clinics. We have 37 clinics across the country, but 31 of those have specialized mental health care, so we have more than 450 mental health professionals offering multidisciplinary, evidence-based care to support those members, and we also—

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Pardon me for interrupting you, but I have several questions and very little time.

What support is currently available for Canadian Armed Forces families suffering from mental illness?

[LCol Suzanne Bailey]

For the families, the Canadian Forces health services does not have a direct mandate to deliver medical care or mental health care to families. However, we can provide care to the families in support of that member.

There are also a significant amount of services available for families through the Canadian Forces morale and welfare services. In the last decade, they have established clinical social work services that are available in over 30 military family resource centres across Canada to support those family members of the CAF members who are impacted by mental health.

There's also a 24-7 family information line, staffed by bilingual mental health clinicians, available to families. The Canadian Forces member assistance program is also a 24-7 bilingual telephone service similar to many employee assistance programs. It is available to offer crisis intervention, and also to provide referrals to both military members and their families in their local community to get the help and support they need.

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Are those treatments still available when armed forces members return to civilian life?

[LCol Suzanne Bailey]

Once military members transition out of the Canadian Forces and become veterans, their care is taken care of by their family physician, the civilian health care system as well as Veterans Affairs Canada.

We do have a memorandum of understanding between our clinics and Veterans Affairs operational stress injury clinics to provide care for each other's personnel in areas where we may not have coverage. There is a transition process that takes place through case management to ensure that there is follow-up care in place once the member leaves the Canadian Armed Forces and becomes a veteran.

[Yves Robillard, Liberal, Marc-Aurèle-Fortin, QC]

Accessibility—

[The Chair, Liberal, Karen McCrimmon]

I'm sorry, Mr. Robillard, but your time is up.

Go ahead, Mr. Brunelle-Duceppe.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Thank you, Madam Chair.

Many thanks to the witnesses for being here with us today.

Thank you, too, Colonel Wright and Lieutenant-Colonel Bailey, for your service in the forces, and thanks as well for your commitment, Ms. Spinks.

First, I have some questions for the lieutenant-colonel and colonel.

A 2020 study on armed forces veterans and active members was published in the Journal of Military, Veteran and Family Health. That study contends that women suffer from a higher rate of post-traumatic stress disorder and chronic pain than their male counterparts.

How do the armed forces respond to the gender-specific mental health needs of their members? Are there any differences, and how is that done?

[Col Helen Wright]

Indeed, we know there are differences between how women and men present with mental illness, exactly as was described in the question, but our model of treating our members is very much an individual model. We tailor the treatment to the individuals, to their illness, to their wants, and even things like their family situation and perhaps their occupation.

It's not so much that we have a difference in our approach for men, women or any of the other identity factors that we find among our population, but it's an individual approach to those individuals and tailoring the treatment to them.