National Defence Committee on Dec. 4th, 2020

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

Thank you for your answer, Colonel Wright.

So there are no real gender differences in the care given for health problems. It's really provided on an individual basis. I imagine you take into account the fact you're dealing with a man or a woman. That's at least what I understand.

[Col Helen Wright]

Yes, indeed, we take into account those kinds of factors, but all of the factors, right? Individuals are much more than just their gender or sex, of course. That's what I was trying to illustrate about an individual patient approach. It's everything about those individuals, their illness, and their experience with that illness.

We know, especially in mental health, that there are many different ways to treat any given illness, and it is often a trial and error process with individuals to find what works best for them. It is the whole person, the holistic person, and the whole circumstance, that we are looking at, and treating as best we can, and, of course, that would include gender and sex.

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

Thank you very much, Colonel.

Now I have a question for Ms. Spinks.

In 2016, the Vanier Institute of the Family published "A Snapshot of Military and Veteran Families in Canada".

According to that document, 15% of the military families that continue to live on military bases in Canada have access to support at military family resource centres. Those centres offer programs and services, including mental health support.

Do the military families that don't live on those bases have access to the military family resource centres? If they don't, where can those families obtain similar services?

[Nora Spinks]

Thank you for that question.

As you mentioned, more families now are living off base than on base. This reality has taken place over the last several decades. Now the vast majority are living off base and their spouses or partners are more likely to be in the paid labour force.

We're seeing in our research that families are often seeking mental health services in their communities, such as from family physicians or community-based mental health programs. They're going to their faith leaders. They're going to the natural place to get mental health services that you and I would go to. They are able to access the services on base, but they have to get there. There are hours of operation, so if they're working in the paid labour force, it is sometimes hard to align with those services.

One of the things we've done in our military veteran health initiative is to really focus on those community members who might be the first point of contact. We've been working with our partners across the country to build military literacy, so that if a family member or a military member phones up an EAP, goes to their family physician or goes to their local mental health provider, they are aware enough of the language. They know what a posting is, what the lifestyle is and they understand what it means to be part of a military family or to be military connected.

We're trying to build the points of contact, so that when a family member is concerned about the military member needing some kind of support, if they themselves are a caregiver or a member of the circle of support needs assistance, they'll be able to access it when and where they need it.

It's not a perfect system. There's still a lot of education and awareness to be done, but we have been able to reach all family physicians across the country. We've been able to reach early childhood educators, pediatricians and a variety of professionals from whom, hopefully, if they are the first or one of the first points of contact, a family can receive the care they need and they can get the care quickly, so there's less likelihood of cascade into crisis.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

Now we'll go on to Madame Blaney, please.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you, Chair.

I would like to thank all of the witnesses here today for your important testimony. A special thank you, of course, to Colonel Wright and to Lieutenant-Colonel Bailey for your service. I really appreciate you being here with us today.

Mental health, as we all know, has a huge stigma across Canada. I do believe though, that the stigma for military and other high-stress front-line workers is even higher because everybody looks to them to be the strong ones in the middle of a crisis.

We are still losing, on average, more than one serving member per month to death by suicide. I also understand that the estimates are up to 10 times higher for the members who attempt it. I think this is such an important study because we have to make sure that in every step we take, we're supporting our military to be in the best health, mentally and physically, as we possibly can.

Again, I want to thank both of you for your service and for the work you're doing on this important file.

I'm concerned about the idea of self-harm. I know that in the National Defence Act, we have paragraph 98(c), which is really based on self-harm as a deliberate avoidance of duty. I'm very concerned that this it is not the message that we want to send out to our military folks.

I'm just wondering if you have any concerns around having this kind of language in our National Defence Act when we're looking at opening up the doors and taking away stigma for people who are considering harming themselves.

Colonel Wright, I would like to start with you.

[Col Helen Wright]

What I can tell you here is that I have never heard a patient or a health care provider in our system express concerns about paragraph 98(c) or any language like it.

My perception from my experience and the teams I work with, the patients I've worked with, is that I have not heard that message As you outlined in your question, we are working very hard, and it will be an ongoing effort to continue to reduce barriers, but this is not one that I am hearing is a barrier.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you for answering that. I still have concerns. I think language really matters and there are things that are invisible and they're right there in front of us and people see them. I know we had a mother who came forward as a witness for another study of ours and that this was her concern after losing her son. We need to make sure that language is clear.

I'm just wondering about what the current state of mental health resources are in the CAF. We've heard previously that there are reports of sometimes long waiting lists. Now with COVID we know that the demands could only be increasing. We heard testimony not too long ago from military folks who went in to help with the long-term care centres and saw the crisis, and we saw how stressful that was for them.

I'm just wondering if we could hear a little bit about the resources and whether there are any extra demands because of COVID, and if there are any recommendations we could provide.

[Col Helen Wright]

It's difficult for me to describe our supports because there really are so many that it's outside this medium to be able to explain them all. I will maybe address part of your question, at least, with respect to the concerns about COVID-19 and the potential increased demands and how we're handling that.

Initially with COVID-19, in fact, our demand went down, and we were seeing similar things. Some of our civilian colleagues were seeing the same thing. Some of our military partners were reporting the same thing. It was a little difficult to understand exactly why that was happening, but we were all, including the patients, I think, pivoting in that suddenly new circumstance.

We brought in things like virtual care. We had been working on virtual care before COVID-19, but there is no question that the circumstances and context of COVID-19 have really pushed us forward with our virtual care. That is an example where we are really trying to make sure that we are making the mental health care, as well as the psychosocial supports, as accessible as possible even in this new context. It is truly as simple as perhaps picking up the phone and having your mental health interaction with your care provider.

Interestingly, I think this does introduce different barriers depending on who you are and what your circumstances might be, because now if you're having your mental health interaction from your home, and there are perhaps other people living in your home, it may be difficult to find a truly private place to be able to have a phone or a Zoom conversation or something like that.

Interestingly, although I think on balance things like telehealth and virtual care in response to COVID-19 and making sure that we're meeting those needs are helping most of our clients, they may not actually be helping everyone. That is why we are still offering in-person support that is much more on the pre-COVID-19 model as well.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

I have only eight seconds so I will let them go.

Thank you, Chair.

[Col Helen Wright]

Sorry.

[Rachel Blaney, NDP, North Island—Powell River, BC]

No, that's okay. Thank you for your answer.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

We have Mr. Dowdall, please.

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

Thank you, Madam Chair.

Witnesses, thank you for your presentations and thank you for your service.

My first question goes to Colonel Wright, I would think.

As we know in 2017 we were extremely pleased that we had a joint suicide prevention strategy. We have numbers. In 2018 we had 15 deaths; in 2019 we had 20. In my riding I represent Base Borden. I can tell you, on a personal note, that any of those suicides certainly affect the military family here on the base, but off the base as well because they're often involved in the local hospitals as well. It's a really touching time for us.

I'm just wondering if you have some numbers—we're at December 4 now—for this year to see whether or not we are actually making some progress.

[Col Helen Wright]

Madam Chair, that is really a super question, because it allows me to talk about something that I feel is really important.

The first thing, I'm afraid, is that I am not going to share the 2020 numbers with you today. Those numbers will absolutely be made public at the end of the year.

We deliberately delay releasing some of that information because of some of the privacy concerns, which we've already alluded to in other questions. We are such a small population, and although each and every suicide obviously has a tremendous impact on family, friends and colleagues, in the end our numbers are quite small, so we would expect a variation from year to year in our small population in the numbers of suicides.

For me, it is not about the number of suicides in any given year. That is not, I don't think, how we should look at whether our suicide prevention efforts are working, because we expect that fluctuation, so it's not about chasing the number. Even if I were to tell you today that the numbers for 2020 were much better than in another year or much worse than in another year, we would still do everything we could to prevent every suicide we could, although acknowledging that we cannot prevent or predict every single one. To me, I think it's important that—

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

I agree that—

[Col Helen Wright]

Go ahead.

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

I was just going to say that I agree with your comment that every year it's going to fluctuate, but part of the reason I'm asking is that you want to, hopefully, move forward in some way, and it leads up to my next question. I've delved into this. It's a subject that's close to my heart.

Since the study came out, there were 160 new or existing actions that were supposed to take place, and I don't know how many of those 160 have been acted upon, but one of them, when you delved into it, was one that really touched me, because I think it's the most important one when people are in their darkest moments. One of the recommendations suggested having a 24-7 crisis support line, whether phone, text or chat. I was really touched when another member of Parliament, the member for Cariboo—Prince George, was bringing forward a simple number, a 988 number, so that at such a time, no matter what, a person would have someone to talk to.

I'm just wondering about it. Did we implement a 24-7 line? Or do we have anything right now presently within the military? I think that, for our government, coming up to Christmas, this is the time more than ever that we need to reach out and make sure that we have those supports. The simple question I guess would be this. Number one, have we acted on that recommendation and, if not, number two, do you believe that it's probably a good idea and that we might save a life?

[Col Helen Wright]

I think you are absolutely right about the importance of people having somewhere to turn when things are dark for them, in addition to this array of services that we have, as I keep alluding to—but of course they don't all speak to every single person.

However, with respect to your specific question on a call line, as Lieutenant-Colonel Bailey mentioned, we already have a 24-7 bilingual, completely confidential line in the CFMAP, the Canadian Forces member assistance program, and that does include a crisis line style of service. There's also the family—

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

So there's somebody on the line 24 hours a day and it's quite common that all the military would have easy access to get to that number?

[Col Helen Wright]

Yes, sir. It's 24-7, bilingual at all times, and yes, it's a number that we publicize as broadly and as widely as we possibly can. Members and their families can use it. There's also a family information line, and it too is 24-7 and bilingual, and includes a crisis line component as well as other components. They're not purely crisis lines, but that is one of the services they can offer.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

Thank you. Of the 160 recommendations—

[The Chair, Liberal, Karen McCrimmon]

I'm sorry. I'm going to have to ask for Mr. Spengemann, please.

[Sven Spengemann, Liberal, Mississauga—Lakeshore, ON]

Thank you very much.

Colonel Wright and Lieutenant-Colonel Bailey, thank you for being with us. Thank you for your service. Through you, I would also like to thank the women and men who serve under your command for their service.

It's great to have you here, Ms. Spinks, and thank you for your important work.

Madam Chair, I served in a war and conflict zone for just under seven years as a civilian UN official stationed in Baghdad. During the latter part of that time, in a fairly short window, our team lost two colleagues to suicide. One of them was a serving U.S. armed forces officer who was attached to the United Nations mission as a liaison officer to the coalition forces, and the other was a UN civilian security and protection officer who was regularly exposed to potentially hostile scenarios in greater Baghdad.

My question, I guess, is around the idea of access. We've heard a lot of testimony about the programs that are in place, the funding that backs these programs and the importance of these programs. In your assessment, are there still barriers to access that go beyond or are different from the stigma itself and are simply a function of the fact that the person in question has suffered an injury that may prevent her or him from even having the motivation to seek help?

Access, in my assessment at the moment, is still very much a demand-based option. There is very rigid mandatory screening upon entry into the Canadian Forces, including psychological screening. Are we looking at access as too much of a demand-based option? Should there be greater emphasis, in whatever rational and reasonable way, on pushing the programs more into the lap of somebody who may have an injury?