National Defence Committee on Dec. 4th, 2020

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

Can you tell us about the treatments that are administered when a member is diagnosed with an operational stress injury, an OSI?

[Col Helen Wright]

Madam Chair, in the context of this medium and the time constraints we have, I will fall back on the reminder that our treatments are, of course, evidence-based. We try to stay right at the leading edge of guidelines on managing different mental health conditions, including operational stress-related disorders.

However, in the end, any given treatment will be customized or tailored, if you will, to that patient, to the patient's experiences and to the types of techniques that seem to work for the patient. There isn't just one given recipe that will work for everyone. That's one of our challenges in mental health especially: finding the right combination of things that work for any given individual.

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

My next question will be for Ms. Spinks.

You are the president and chief executive officer of the Vanier Institute of the Family. How do you think the pandemic has affected the lives of Canadian families, particularly those of Canadian Armed Forces personnel and those of first responders?

[Nora Spinks]

That's a very important and large question.

Madam Chair, we've been conducting polls of families week over week since March. The impacts of COVID on families and family life has been quite dramatic, but not all tragic. A lot of families are actually doing quite well.

It does lead us to a number of observations. The first is that every system in our communities and in our society—the health care system, the justice system, the child welfare system, etc., including the family system—has had its strengths magnified, amplified and intensified as a result of COVID, and equally, its weaknesses.

Families that were struggling are likely struggling harder. Those that were doing well are likely still doing well. For the ones in the middle, many are still adapting, adjusting and finding ways to support each other and work together. Workplaces all across the country—and the military is no different in this case—have had to adjust and modify how, where and when work gets done. The big issue here is the degree to which disruption has impacted a household.

The greater the disruption, the greater the likelihood is that individual family members will feel that they've lost their sense of agency, control and autonomy. When families lose that, often stress levels go up.

When we're looking at COVID, it really is everything that was pre-COVID and then some. We need to monitor and keep an eye on how families are doing, month over month and into next year and learn from every one of those experiences.

We will continue to do that with all families across Canada, including military and veteran families. We have a survey in the field looking at how veteran families are managing and adapting. We would be happy to share the results of that with this committee and the veterans committee, as well.

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

I'm going to allow the other members of the committee time to ask their questions.

[The Chair, Liberal, Karen McCrimmon]

Thank you so much.

Mr. Bezan, please.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Thank you, Madam Chair. I was expecting the NDP or the Bloc to go before me.

I do want to thank our witnesses for appearing. I believe the service you're providing to our military members, along with their families, is second to none. I know that we're always trying to do better, but with the unpredictability of suicide, it's always going to be a challenge.

Colonel Wright, my colleague, Mr. Dowdall, requested the data on the number of suicides in 2020. We are going to be publishing a report very early in the new year on suicide prevention in the Canadian Armed Forces.

Would you be able to provide us with those numbers as quickly as possibly, so that we could include them in our report when it is published in February? We'll need that data as soon as you have it, which will be, hopefully, within the first couple of days of January.

[Col Helen Wright]

Madam Chair, of course, the information will be made public. I can't tell you exactly when. There are other factors to do with public affairs and when these things are released.

I absolutely understand the interest in knowing that number, although I would take the opportunity to say again that, given that our numbers fluctuate from year to year, that is not necessarily the way we should be evaluating our system.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I appreciate that, but we do already have the data from previous years. There are a lot of people who want to look at the numbers and how they relate over time to what we're dealing with.

As we've mentioned, a number of programs have been rolled out over time. Road to Mental Readiness is one of those programs that I think has helped with self-assessment. It has helped troops assess each other and look for any indications of deterioration of mental health.

Ms. Spinks, would you be able to talk about whether military families should also be offered the road to mental readiness program to help with that self-assessment for themselves, as well as for their loved ones who are serving?

[Nora Spinks]

I think the road to mental readiness program is an excellent example of translating a very complex issue and coming up with evidence-based programs that are accessible and available—and yes, military families have had access.

Lieutenant Colonel Suzanne Bailey and I have presented the road to mental readiness program even to corporate Canada. This program has been adopted by the Canadian Mental Health Commission as well as one of their signature programs. It's a very useful program.

I also think it's really important to recognize that families, including military families, are resilient until they're not. Sometimes there's a lead up to a tipping point. We want to help people identify when they're at the suicide ideation stage—when they're thinking about it but haven't necessarily done anything about it. We want to let them know that they can seek help at that point. If they've taken it a bit further and they've developed a plan, then we need to make sure that they know they can reach out for help...and on down the steps and stages. People don't tend to go from being well one day to being suicidal the next, so we want to create as many opportunities as possible to support them and their family members along every stage.

Also, the interventions are different, depending on what stage they they're at and their families are at. I think we need to make sure that there's a broad base of support in communities, in neighbourhoods, as well as within the confines of the military family and the military operations. We want to make sure that people are aware, including those who aren't normally included, like parents, for example, who don't get access to the information, don't get included in the awareness initiatives and may or may not be aware of programs like Road to Mental Readiness.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I think the more we can do, especially when it comes to the treatment of mental health and if we can treat the entire family, we would see a lot more success in preventing suicide and reducing the number of suicides.

[Nora Spinks]

The evidence bears that out. You're absolutely right.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

One of the concerns I've always had—and this is for health services in general—is that our reservists are often located in communities where we don't have a base. We may not have an operational stress injury clinic. We may not have military psychologists, social workers and psychiatrists readily available. They may be sitting in Thunder Bay, Ontario, and the closest base is Winnipeg, an eight-hour drive away.

How do we better provide mental health services to our reservists, who may not be able to get to the Canadian Armed Forces health services group?

[Col Helen Wright]

Madam Chair, I think there are two main prongs to attack that particular problem.

The first is to remind you that we do use mental health providers extensively in the civilian community—a civilian psychiatrist who sees military patients, for instance. Although a person may find themselves a distance away from a supporting military base and one of our military clinics, that does not mean they don't necessarily get health care. For many of our reservists, depending on the type their contract or the type of work they do, their medical care is grounded in the civilian health care system anyway.

However, I am very excited about—

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Over the years, Colonel, the people whom they have access to on the civilian side often do not understand operational stress injuries in particular and how to treat them.

[Col Helen Wright]

I recognize that. You are absolutely right about that.

One of the things I, and many of us, are very excited about is this almost seismic shift in use of telehealth and virtual health that COVID-19 has helped us push forward.

I think that is going to be the way forward for some of these folks in more remote places, where we can now use other options so they can see a provider who is familiar with the military, is perhaps more familiar with operational stress injuries and speaks their official language of choice. This is another important aspect for our members, when they're distributed around the country.

As I said, I am really excited and optimistic that this is going to help us move that forward.

[The Chair, Liberal, Karen McCrimmon]

Mr. Baker, please go ahead.

[Yvan Baker, Liberal, Etobicoke Centre, ON]

Thank you very much, Madam Chair, and thank you to all of you for being here today to speak with us about this really important topic.

My first question is for Ms. Spinks. For the sake of folks who aren't as familiar with the issues we've been talking about, or for my constituents who might be watching this at home, could you share a bit about what the impact is on families when someone is struggling with mental health challenges and is also a serving member of the armed forces?

[Nora Spinks]

Families play a very important role in first identifying that there may be a problem. They play a very important role in searching through the various types of information to sort of nudge their family member to supports that might be most effective. They play a really important role as advocates if their family member is not receiving the care he or she needs. They are often a really important part of the team in-between treatments. They're the ones who are there night and day to remind patients to apply certain techniques or the therapies they have been receiving, and remind them to take their medication. Families have a very deep and important role.

When somebody is in crisis and more emergency intervention is needed, when they may have harmed themselves or put themselves at serious risk, the families then are often cut out of the circle of support, once the person is hospitalized or intensively treated. We need to make sure that families continue to be recognized as important players on the team, because when that person leaves the crisis treatment, he or she will go back to that family. Stop and start doesn't work as effectively as when the two are integrated and treated together.

The other thing that we need to recognize is that caregivers are often experiencing stress themselves and need caregiver relief and support as well. Benefits and programs directly targeting caregivers are absolutely critical in the continuum of care and the suite of programs and services we need to be considering very carefully. Without them, quite often the cascade happens very quickly into more dire situations or circumstances. It is really important to keep caregivers through the entire process, and also give them the support they need.

[Yvan Baker, Liberal, Etobicoke Centre, ON]

That's helpful. Thank you for that.

To follow-up on that, what are the things that need to be done? Given that the family plays such an important role in supporting the member of the forces through this, what needs to be done, and what more could be done, beyond what's being done today to ensure that members of CAF are being engaged appropriately to provide that support you are talking about that is so important?

[Nora Spinks]

I think the first thing is to treat the whole family unit as the core, so that it's not the military member and their family, but it's the military member's family who needs to be at the centre of any intervention and any treatment. It sounds like it's a little thing, but it's really a big thing.

I also think it's really important to recognize that family is diverse and ever-changing. It's not like you can say that once you've informed the family, check, you're done. It needs to be done on a continuing basis. Engagement of family members in the conversations and in the dialogue is critically important. The research is really clear that when there is success, it's usually because there's a strong circle of support, strong family connections and really healthy relationships. When there isn't, the same applies in the negative.

I think that, when we look at the ways in which we want to move forward and we want to plan, the family lens is critically important. Family engagement is an absolute definite. Recognizing the diversity of families is critical. When we think about the ways that we can leverage those relationships and nurture them, we can recognize them, honour them, acknowledge them and engage them early on. I know there are a number of programs in place right now that are attempting to do that. We need to celebrate the situations and circumstances that have been successful. Not only do we want to spend time studying the cases that have not ended well, but we also need to spend a lot of time researching when we get it right. How can we take those learnings and translate them across?

We do have a wonderful generational opportunity now because we're talking more about mental health. We start with children when they're toddlers: “Share your feelings, tell us how you're feeling, use your words, how can we help you, what kind of help do you need?” Kids at age two and three are now being taught how to ask for help. That's going to give us a huge opportunity going forward, because the foundation has already been laid. It's very different from previous generations that were raised with, “Suck it up, shake it off, move on, don't let it bother you and don't let them see you cry”. It's a lot harder to engage in talking about mental health in that case.

We're creating a perfect storm here with really good evidence-based programs, really good acknowledgement of what works and a commitment from people like you around this table who want to get it right. I think we're creating a perfect storm to go forward with really positive results. We can measure impact by also recognizing how people are thinking and feeling, as well as what they're doing: So thinking, feeling and doing. It's not just the end results; it's the impact of their behaviour, their thoughts and their feelings as a result of....

Even knowing that these programs are available, even if they don't need them, just knowing that they're there is sometimes program enough.

We can't underestimate the power of families and family connections in this space.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

Go ahead, Mr. Brunelle-Duceppe.

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

Thank you, Madam Chair.

What we're hearing today is really very interesting. Many thanks to our three witnesses.

This past summer, we witnessed something unique in Operation Laser. When people join the forces or the reserve, they don't expect to be involved in anything like it. We often talk about combat operations or rescue operations during natural disasters, but what we experienced this summer was something no one has gone through since the Spanish flu. It was really a unique situation.

Incidentally, I want to thank the Canadian Armed Forces for Operation Laser. All of us, regardless of political affiliation, are truly grateful for it.

It happened recently, but do you know whether any military members or reservists suffered mental injuries as a result of their involvement in Operation Laser? Are you able to answer that question?

[Col Helen Wright]

Madam Chair, that is an excellent question about how this unusual operation may have affected our people.

As it happens, Lieutenant Colonel Bailey is really the expert on how we tried to prepare folks for this different circumstance before they went in, support them while they were there, and then do post-deployment support.

I think perhaps the answer to your question is that we are doing a study of all the folks who were involved in Operation Laser, as a follow-up to try to find out exactly how it did affect them. The things we put in place to try to prepare them and support them were based on what we assumed would help, what we thought would help. We are doing a fairly extensive study with a number of different departments within DND contributing, to do something that is a little bit unprecedented, to try to find out what actually did happen. Many of our partner militaries, for instance, are following very closely to see what we learn.

I don't have results yet to announce, but it's going to be very interesting to follow what we learned and then make changes to how we prepare people for the future, even if we don't do anything exactly the same as Operation Laser, but to take those lessons into whatever the future might hold for us.

[The Chair, Liberal, Karen McCrimmon]

All right. Thank you very much.