National Defence Committee on Dec. 4th, 2020

[Col Helen Wright]

Madam Chair, I think a number of excellent points were made in that question. The first was your allusion to whether there are still barriers to care that are perhaps different from the one that often seems to come to the top of the list: stigma. I think unquestionably our system is not perfect. There are still barriers to care. I think you're right. A lot of it is a demand, still based on the member recognizing they need help.

However we are trying to combat that with education of our members so they can recognize when they might need help. It's extremely important.

For that I will pass the question to Lieutenant Colonel Bailey, because some of the education that she and her team do I think is really critical to that.

[LCol Suzanne Bailey]

Stigma and other barriers to care are very interesting, because we often think that stigma is the primary barrier to people seeking mental health care when in fact many studies over the past two decades, not only in the Canadian Forces but in other populations, show that the number one barrier to seeking mental health care is that the individual does not perceive they have a need for care. That was one of the reasons we developed the road to mental readiness program, which has the four-colour mental health continuum model, to increase mental health literacy and, hopefully, result in earlier recognition of distress and access to care.

We do know other barriers to care exist. Some of them are related to stigma: worrying about what others may think of me, how my leadership may perceive me and how others may treat me. For the most part, the data regarding those stigma-related barriers is fairly encouraging. The interesting part of that is we find that once people are impacted by a mental illness or a mental health injury, their perception of those barriers tends to increase significantly, and those barriers become much more important.

Some of the barriers are more structural, with people feeling they don't have time or may not know where to access help. We spend a fair amount of time in our education programs talking about how one might overcome or challenge some of those particular barriers to care.

The other aspect is negative attitudes toward care-seeking, which we also spend a fair amount of time in our education program talking about, specifically letting people know that mental health treatment is effective, that it's evidence-based and what mental health treatment might look like.

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

Lieutenant Colonel Bailey, thank you very much.

If I may in the remaining 30 seconds broach a question that perhaps there's some time to elaborate on, for those Canadian Forces members who've served in a combat setting directly or indirectly, are we moving closer to the recognition of a potential presumption of injury, or are we still quite a ways away from that?

[Col Helen Wright]

Madam Chair, we're not presuming injury, because I think there is still enough variety in the experience that this would be a step too far. To be honest, I haven't reviewed the literature on that. We screen people, and I know time is short here, but I think what is key is that when people come back from deployments or these demanding circumstances, we have a screening program to try to pick up those folks who may be suffering and do not yet realize that they are, and try to get them into service sooner.

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

Thank you very much, Madam Chair.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

We'll move on to Monsieur Brunelle-Duceppe, s'il vous plait.

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

Thank you, Madam Chair.

The Canadian Armed Forces and Veterans Affairs Canada published their joint suicide prevention strategy in 2017. According to the Department of National Defence, 15 members of the Canadian Armed Forces committed suicide in 2018, and the number increased to 20 in 2019.

How effective do you think the joint strategy is, and how can its effectiveness be measured?

[Col Helen Wright]

As I mentioned already, I think one of the ways we should not measure effectiveness is by looking at the fluctuations in our numbers from year to year. I think perhaps over many years we might be able to see trends, but certainly not year to year.

In terms of the suicide prevention strategy you mentioned for the Canadian Armed Forces, it was turned into the suicide prevention action plan. It had 95 different action items. As to your question about how we measure progress on the suicide prevention action plan, it is being tracked very carefully. We report on the different action items quarterly, for instance. As to how we measure each of those, you can imagine that in those 95 items there's a huge variety of things. Some of them, like the road to mental readiness program, might be measured on how many programs we've adapted to customize circumstances and occupations, or how many people we have trained. In another item it might be something like the clinicians handbook to prevent suicide. That one was tracked by whether we completed the task, which we did.

I think following how we're doing is dependent upon what that action might be. I would make a statement overall on how we recognize if we're doing better: It's the reports we get back from members, through surveys and things, about their ability to recognize when they might need help and recognize how they would help themselves or how they would help another person. I think it's those kinds of broad concepts. That's how we know our action plan is making a difference.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

Madam Blaney, please.

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

Thank you, Madam Chair.

Ms. Spinks, I know that when untreated, mental health issues have a huge impact on families. We've heard that some organizations who are working with our military families are really struggling to manage this. I'm also hearing stories of loved ones, family members, who notice that the person serving in their family is struggling. I think that's interesting, because as Lieutenant-Colonel Bailey said earlier, often the challenge is not knowing yourself that you need that support.

I'm wondering if you could talk about any understanding you have of the impacts on the family when somebody has a mental health issue who is not acknowledging it, and what families do to try to support that member.

[Nora Spinks]

This is a really important line of inquiry, because families are often the very first people to identify that something's off. They will see it long before the individual person, in terms of their own self-assessment or self-awareness. They'll begin to see little things that just don't seem right, and may then begin to say to their loved one, “I'm starting to see you're a little short these days,” and begin to help them self-assess. That is a skill that we can train. It's something that we can teach families to do, to observe, to interact, to intervene, and to provide some of that support that will encourage help-seeking behaviours. If not, then advocate on their behalf.

The challenge is that oftentimes without that training or that support, the tension builds within the household and the family falls apart. We need to pay attention to those caregivers and people within the circle of support. That's why I was saying earlier that we need to think about families not just as spouses, because often the spouse is the first one to notice and the first one to leave. That means that the second circle in that circle of support is the parents. Oftentimes, they'll be the ones who will be attempting to support that person with help-seeking behaviours. They may not have received the information about the 1-800 number and the help lines, so they will start Googling. They start panicking, because they're not in the loop to begin with.

When we use a family lens and we see the family as a key component of the health care team in identifying what needs to be done, identifying when things are going a little off, being there to begin that early identification and early intervention, we support that entire circle of support. That makes a difference.

The organizational culture, recognizing that families are there as a tool and not a burden or a dependant, will have a huge impact on the value and the success of the programs and services that are offered. The programs that are offered to both members and families are amazing. They're well thought out, evidence-based, and the people who deliver those services are doing so with the very best of intentions.

Families are not always aware of what's available—particularly if there is no spouse, or that spouse is no longer available—and that they are able to access or fully leverage those programs.

[The Chair, Liberal, Karen McCrimmon]

Mr. Benzen, you are next.

[Bob Benzen, Conservative, Calgary Heritage, AB]

Thank you, Madam Chair, and to all of the witnesses for appearing today and for your valuable testimony.

Colonel Wright, we've heard some testimony, and we know that in past cases when a CAF member dies by suicide, the family has great difficulty in getting information from the military. In some cases, it takes years to find out some of the details of what happened.

Can you talk a bit about what the military can do to break down some of those barriers and shorten the time frame, so that these loved ones.... In a way, they're suffering mental health issues too, because they can't get this information. We're sort of compounding the problem, and making it worse. How could we help them get more information?

[Col Helen Wright]

Madam Chair, again, there were some excellent points made there.

I think the military has come a long way in recognizing that this is an important component of what we do when we do investigations of suicide and/or when we're looking at supporting, say, the colleagues or the teams that were around the person who has died by suicide. It's important that we remember to include the family as a core group who also needs to be supported.

I do think that we've come a long way there. I know that, as part of our effort, one of the things that my group does is the medical investigation, if you will, on the deaths by suicide. That includes inviting members of the family, and not necessarily just the spouse but the parents and other family members as well, to be part of that process of the investigation to make sure they are aware of what we're aware of.

Now, of course, I'm speaking of the medical investigation, but I know that similar efforts are made for the boards of inquiry as well to make sure that, as we learn more about the event and the circumstances around it, we're feeding that information back. But I would caution that there is often also a competing interest in making sure that we are maintaining the member's confidentiality, so sometimes our hands are tied based on the member's paperwork—but that's the best way we know what the member intended. If the member has stated in paperwork that one person or so-and-so person is their next of kin, then we are obliged to work through that person, which may not always be the people who feel they should be getting information.

I know that we still have challenges there, but as you can see, it is based on the very best of intentions to make sure that we're doing what the member would have wanted based on information that we have. But I certainly recognize how challenging and painful that would be for other family members.

[Bob Benzen, Conservative, Calgary Heritage, AB]

Thank you.

The Canadian Forces ombudsman had a recommendation that the families meet with the commanding officer to discuss the events leading up to the events surrounding the suicide. Is that happening routinely now all of the time? Has that been implemented?

[Col Helen Wright]

Madam Chair, I'm afraid I don't have visibility on that, so I can't comment on that either way. I would imagine that it is happening in most cases, but I'm afraid I can't speak to it.

[Bob Benzen, Conservative, Calgary Heritage, AB]

Thank you.

In the Road to Mental Readiness there were 15 objectives, and one of them talked about suicide contagion and minimizing it, and the communication surrounding it so that it can be handled properly.

Could you talk a little bit about that concept of suicide contagion and what the leadership is doing to minimize that from happening?

[Col Helen Wright]

Madam Chair, that's a really important question.

We are torn between wanting to recognize that, in many cases, part of the picture when someone dies of suicide may be their military experiences and recognizing that person and their contributions, of course.

However, we do know—this is mostly from civilian literature, but also from some military studies in the United States—that there is this contagion and that if people read about a death by suicide that seems to glorify it or seems to make it seem as though it has additional benefits, either for them and their reputation or perhaps for their families, it can, in fact, be an additional inducement to people to choose death by suicide rather than seek supports and help for the way they're feeling and their other struggles, which, of course, is the way we would prefer people to go.

It's a difficult balance between recognizing the person, their contributions to the military and their struggles, and yet at the same time not wanting to portray suicide as an attractive option to other people because, as I said, we want them to choose different options. But it is known that it can happen, and so it's a real phenomenon that we must avoid.

[Bob Benzen, Conservative, Calgary Heritage, AB]

Excellent. Thank you.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much.

Go ahead, Mr. Robillard.

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

Colonel Wright, what are the mental health conditions that must be met for a member of the Canadian Armed Forces to be deployed to a mission?

[Col Helen Wright]

Madam Chair, that's an interesting question. I'm going to pass that to Lieutenant-Colonel Bailey with her experience in doing pre-deployment, as well as during and post-deployment mental health training.

[LCol Suzanne Bailey]

Prior to any deployment, military members will undergo a couple of types of screenings. One would be psychosocial screening. They're encouraged to include their family in that. The objective is to see if there are any personal or family factors that may interfere with their being able to complete their mission. It's a fairly standardized 30-minute screening. The intent is to make sure that we're not putting members at any additional risk by sending them on particular missions. They also go through a similar medical screening with their primary care provider to make sure that there are no underlying health conditions that may be put at risk by their going on the mission.

Prior to deployment, we also provide Road to Mental Readiness pre-deployment training, which is tailored to the mission and the environment into which they're going, to make sure that they are aware of the resources available to them and also are able to recognize early indicators of distress. We spend some time making sure that they can use some of the skills and tools within the training to manage the particular demands of the mission they're going on.

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

Are the conditions for a second deployment the same?

[LCol Suzanne Bailey]

Each deployment is evaluated before a mission is initiated, so the conditions can vary greatly depending on whether it is a combat mission, a humanitarian mission, a peacekeeping mission or even sometimes a training mission.

A number of different assessments are done to make sure that all the stakeholders involved know what the conditions of each mission are so that all the training and preparation for the members proceeding on each particular mission can be adapted to the particular environment they're going into.