National Defence Committee on May 9th, 2023

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

What about EMDR? Is that still being utilized, rapid eye movement desensitization?

[Col (Ret'd) Richard Pucci]

Again, that's a very pointed, clinical question, and I'm here to speak about primary care functional capabilities; thus, a question about EMDR is not one I'd feel comfortable answering.

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

We have heard from ombudsmen time and time again that we need this seamless transition from the forces to medically release. Your task force sounds good, but in reality, people are spread across the country, so they don't necessarily have the same people or even a link to the people who were dealing with them during the crisis stage after they release. They have no one, as a matter of fact.

[Col (Ret'd) Richard Pucci]

Yes, that's correct. That's the whole idea of the proof-of-concept period of six months. While that period is ongoing, the task force would look at nodes across the country, say, for example, in Edmonton, Valcartier, Quebec City and Fredericton, where we would create that network, that hub of wellness for our veterans, so—

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

One of the insurers—I'm not sure if it was Veterans Affairs or a specific company—definitely dealt with all the veterans. They were receiving this EMDR from people who had qualified, but, all of a sudden, a certification was required, so these women and men lost their providers altogether, because the providers didn't have the new certification requirements. They had families; they couldn't stop working to go back to school.

Is there no way we can make the actual treatment they're getting seamless and not have to go to a layperson, because even having to explain what happened using regular military jargon.... If they have to explain their whole story over again, they become frustrated, and they find a quick and final solution to it.

[Col (Ret'd) Richard Pucci]

That's right. I've heard that story a hundred times in the last year from other veterans and their families out there. The decision to cease the modality of treatment came from Blue Cross and Veterans Affairs Canada. We need to pose those questions to them, not to people at my level who are dealing with setting up wellness hubs.

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

Could you tell us what the steps would be under the task force for how someone has to medically release? What would it look like? What would, at best, a retiring or medically released soldier go through, especially if trauma was involved?

[Col (Ret'd) Richard Pucci]

It would be a seamless transition, so as they walk out the back door of the Canadian Forces, during their SCAN seminar, which my colleague mentioned earlier, they'd be aware of accessing these hubs. The first thing the soldier would do is contact the hub to say, “I'm retiring on June 15, 2023. I'm looking for a primary care provider. I'm moving to St. Albert, in the Edmonton area. Can you help me out?”

The task force would be able to dig into its database to determine, with its network of hubs in the Edmonton area, which physicians are looking after veterans, and if we have a specific veteran clinic there with a family doc and a veteran physician assistant ready to receive that patient.

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

The Beechwood and Tay River clinics are the only ones right now. They're pretty well in the Ottawa vicinity anyhow. People from Ottawa already have access to providers.

It's the people out in Petawawa and southern Ontario—far from Toronto—who don't have access—

[Col (Ret'd) Richard Pucci]

That's right, but the people in Petawawa are quite willing to jump in their cars and drive to Tay River for treatment. We have veterans right now living in Petawawa who drive to Orleans, here in Ottawa, to see Dr. Hans Jung, who is the former surgeon general and runs a roster of 1,500 people.

[The Chair, Liberal, John McKay]

Thank you, Mrs. Gallant.

Mr. Sousa.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

Thank you, Chair.

Thank you for your presentations.

I have a question, and I'm not sure to whom it should go. Madame Lafond, maybe I will start with you on this one, and maybe Ms. Tam-Seto can respond as well.

There is an emerging conversation on PTSD versus moral injury. How are these separate but closely related impacts of trauma experienced in the course of military operations?

Can you describe how these concepts differ and how treatment needs to differ?

[Myriam Lafond]

Thank you for the question.

Our centre helps recruits who are experiencing suicidal crises, not those struggling with post-traumatic stress disorder.

So I will let a specialist answer that. Perhaps Ms. Tam-Seto can do so.

[Dr. Linna Tam-Seto]

I apologize, sir, but I don't diagnose. I could not, in my scope of practice, differentiate between PTSD and moral injury.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

Colonel.

[Col (Ret'd) Richard Pucci]

That's way outside my scope, most definitely. I'm not a clinician, sir.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

Chair, can you answer that question?

[The Chair, Liberal, John McKay]

I can answer pretty well any question. You might want some veteran information, though.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

I'll go to something else then.

I will keep it more broad, then, in terms of how work is being done to support defence research and the Canadian Forces Health Services Group.

How can this research help improve the experience of service members, veterans and their families? Can the committee hear the steps to enhance this kind of research in the lives of military members and their families? Can you answer that more broadly?

[Dr. Linna Tam-Seto]

There is research being done internally. I worked with many of the wonderful colleagues within DND and DGMPRA who are doing this amazing research. Unfortunately, they don't have the capacity to answer all the questions that we need.

A lot of great research exists out there that a lot of health associations are going to in order to try to develop military cultural competency among their members—physicians and occupational therapists. However, they tend to be grounded within international contexts, which doesn't translate well over here in Canada. Despite the efforts of internal research, there's a whole network of us through the Canadian Institute for Military and Veteran Health Research who are trying to meet the demand.

That's just a very broad statement around research.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

Colonel, if there's time, do you want to comment?

[Col (Ret'd) Richard Pucci]

No, I would just defer to my colleague here. That's more along her line of expertise and research.

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

We're talking a lot about mental health. There's this difference in trends that we see in the population of the military. Why is there a difference? Why is it more prevalent in the military?

[Dr. Linna Tam-Seto]

Why are mental health...?

[Charles Sousa, Liberal, Mississauga—Lakeshore, ON]

Why are trends in the population...? We're seeing mental health in the Canadian population as a whole. It's more evident, and it seems to be even more so with the military.