Evidence of meeting #14 for Public Safety and National Security in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was treatment.
A recording is available from Parliament.
12:35 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
Dr. Aiken, I'd like to come back to the issue of data that was raised at the end of the first hour. It was said that, compared with the existing data for veterans, we are missing data for first responders, which includes public safety officers and correctional officers.
Is that really the case? If it is, how can we rectify the problem?
12:35 p.m.
Director, Canadian Institute for Military and Veteran Health Research
It's interesting, because there have been treatment centres with a research arm focused on first responders for longer than there have been those specifically for the military or, outside of the military, for veterans in particular.
There is research out there on first responders, a lot of it being done through CAMH, the Centre for Addiction and Mental Health in Toronto, and organizations like that. I don't have a good appreciation of how much research there is on first responders and whether there is more or less.
I can tell you, though, that once we had a concentrated effort on military veterans and families, we really saw the amount of research being done increase tremendously. Where we work is really at the clinical end of the spectrum, so it's research that can be translated into practices, policies, and programs fairly rapidly. To have a focus on the research actually really impacts the treatment and the lives of the people.
12:35 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
We had a witness, a psychiatrist, who mentioned—I forget the exact number of years, and it was perhaps a number just to give us an idea—that for public safety officers, we were something like 15 years behind in terms of data compared to what was available for veterans and RCMP officers because we've been focused on military service more than on other first responders.
Is that something you would consider accurate?
12:35 p.m.
Director, Canadian Institute for Military and Veteran Health Research
No. We know a lot about people who serve in the military. In Canada we know almost nothing about our veterans, because when you're released from the military, unless you were injured in service, you're not tracked by anybody. We have socialized medicine, which is great, and none of us wants to give that up, but if you go out into a provincial system that knows nothing about you....
I was released when I was 32. I went to a family doctor and nobody asked me if I was a veteran. We don't know about our veterans—we really don't—and I don't know enough to tell you if we're tracking public safety officers any better, but we've only just started tracking veterans.
12:40 p.m.
President and Chief Executive Officer, The Royal’s Institute of Mental Health Research and the Canadian Depression Research and Intervention Network, As an Individual
I would like to respond to that in the sense that I think it is an important issue that needs to be addressed, because there is not enough being done. I would like to suggest that there be one or many centres of excellence that focus on all kinds of responders—first responders and military veterans. Let's just take away those barriers and have groups that come from very different walks of life who are going to be exposed to trauma as first responders.
12:40 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
In other words, you mean sort of looking at everyone together, as opposed to
12:40 p.m.
President and Chief Executive Officer, The Royal’s Institute of Mental Health Research and the Canadian Depression Research and Intervention Network, As an Individual
No, but we should be able to slice and dice in order to address these issues. Otherwise we always end up addressing where we flow the money to. We always chase the money, so if the money is there, people do the work. I think instead that if there were resources to study this phenomenon, then we could specifically look at different groups to see what the commonalities are and what the differences are. If we don't do that, then we are working based on information that comes from select groups.
12:40 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
Dr. Aiken, your point about tracking folks in the military but then not afterward, when they become veterans, is interesting. I think it's been touched upon a little bit, but what's the difference? Even with first responders, what kind of recommendations would there be with regard to how we have to look at what's happening during their work as opposed to after it, for lack of a better way of putting it?
12:40 p.m.
Director, Canadian Institute for Military and Veteran Health Research
Every province keeps health utilization data. At the research team I lead, we just found the veterans' identifier in the Ontario health utilization data. That's part of a big data set that Stats Canada links with a bunch of different sources. We were able to show that veterans in their first five years post-release are higher users of the health system for all reasons, and separately for mental health reasons, than the general population.
We were also able to show that young male veterans—we have 26-year-old veterans—are more likely to use an emergency department for a mental health crisis than age-matched controls. We are just starting to learn about some of the data, so we don't know why. Epidemiology tells you what, not why, but it's important to know that. We've never known that in Canada before, but they have different needs. We know that veterans who are released when they're older tend to have higher rates of diabetes over time, and we don't know why.
All those things are important to track. They've had different lives, different exposures, and when we say veterans, the veterans' identifier also included RCMP veterans until they went under the provincial system a few years ago, because when you release, you don't have the three-month interprovincial wait to get a health card.
12:40 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
For first responders and correctional officers and so on, would it be the same thing?
12:40 p.m.
Director, Canadian Institute for Military and Veteran Health Research
We don't know.
12:40 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
You don't know, so is it safe to say that one of the recommendations we should probably make is to have more data on the specific groups we are looking at here?
12:40 p.m.
Director, Canadian Institute for Military and Veteran Health Research
Absolutely, yes.
12:40 p.m.
NDP
Matthew Dubé NDP Beloeil—Chambly, QC
Okay, thank you.
Dr. Frewen, could you tell us a little more about the issue of the vocabulary used and the existing culture? Ms. Damoff spoke about it, but could you expand on it? Is taking the steps to get treatment sometimes a challenge for people because of this culture?
12:40 p.m.
Professor, Psychologist, Department of Psychiatry, University of Western Ontario, As an Individual
I think it was touched on earlier that part of the job is to present it in a way that is palatable for the particular target group. Much of that can be rectified through, for example, conductive focus groups with the target population. It may have much to do with how it's packaged and what it is in the end. These practices with respect to meditation are millennia old, and we're also now building in the technological approach to augment these practices.
I'm also seeing—
12:45 p.m.
Liberal
The Chair Liberal Rob Oliphant
I'm afraid I need to cut you off there. We're at eight minutes, so thank you very much.
Mr. Di Iorio.
12:45 p.m.
Liberal
Nicola Di Iorio Liberal Saint-Léonard—Saint-Michel, QC
Dr. Merali and Dr. Aiken, thank you very much. I very much appreciate your presentation.
With very little time allowed to me, I will address my questions to Dr. Frewen.
Dr. Frewen, I very much appreciated your presentation. You gave us an innovative perspective on solutions. I learned that methods exist to provide support, help and assistance to individuals affected and afflicted by this terrible disorder.
I would like to give you the opportunity to explain how you came to develop these methods, these tools, this infrastructure. It would help us see how we can learn from your approach and apply it in other areas or fields where people suffer from similar conditions, while adapting it to the circumstances of their workplace.
12:45 p.m.
Professor, Psychologist, Department of Psychiatry, University of Western Ontario, As an Individual
Thanks very much.
In this particular Internet-based intervention—MMTT, I'll call it for short—all of them are inspired and validated interventions. The journaling activity is part of a cognitive behaviour therapy standard approach, the automatic thought record. It is to take those six principles that I described and apply them to everyday stressors that the individual is experiencing, using those concepts and applying them to regulate themselves to be able to manage their distress, reflect, and respond in a more adaptive way. That is part of typical approaches, but we're using the mindfulness language and specifically making use of it and applying it to that journaling activity. However, the journaling activity, broadly speaking, is a well-validated and researched intervention.
We also include a specific practice that we developed here at Western whereby we can determine the level of concentration experienced during the meditation. It's a self-report methodology, but we're validating it against various experimental methodologies, including collecting EEG, and we're able to predict, for example, the brain state from the self-report, and whether the person was concentrating or distracted during the meditation. As they sit quietly and attend, for example, to their breath, their mind will wander, and it may wander towards the trauma and intrusive memory, but in terms of the degree to which it does so, we can provide some prompts, some cues, to bring them back to the breath, back to the target of their attention.
Finally, the different guided meditations that we include have all been used in various formats, most especially the well-researched mindfulness-based stress reduction and mindfulness-based cognitive therapy. Each of the interventions available through the website has been well researched in different domains with various populations, including PTSD, but also, as you say, various anxiety disorders, depressive disorders, dissociative disorders, substance abuse disorders, which PTSD is typically comorbid with.
12:45 p.m.
Liberal
Nicola Di Iorio Liberal Saint-Léonard—Saint-Michel, QC
Could you give us an overview of the resources that were needed to develop the methods, the tools and the intervention systems you have and that you make available? By resources, I would like to know how much time you needed to get there and how many people worked on it. I'd also like to know the related costs.
12:45 p.m.
Professor, Psychologist, Department of Psychiatry, University of Western Ontario, As an Individual
Thank you.
These practices are self-directed. They could be part of an additional therapy, and that's ideally how I would recommend them. I would recommend that they augment additional approaches, such as the face-to-face psychotherapy that a person might have, but as we know, they may not have access to the other evidence-based psychotherapies, so doing this on one's own—
12:50 p.m.
Liberal
Nicola Di Iorio Liberal Saint-Léonard—Saint-Michel, QC
Dr. Frewen, no, that wasn't my question.
My question is how much did it cost to develop these tools that you developed, and what kind of resources are required to develop these tools? I don't mean from a user's point of view, but from the developer, meaning you and your team.
12:50 p.m.
Professor, Psychologist, Department of Psychiatry, University of Western Ontario, As an Individual
Thank you.
Actually, we developed these tools on a very low budget. It was very much, in fact, my time. I've done a lot of the programming myself. Some of it I've outsourced, but at quite a low budget. The software is relatively simple to acquire. It's really more the creativity that goes into developing the stimuli, for example. The current website exists. Essentially, it could be available at very little cost. I would be very interested to continue to research outcomes at this particular website, but as for the resources, really, I put a lot of my own energy into this. There are a lot of hours that went into it in that respect, but the technology is now available in the form of a website that can be used on any device. It's not an app that's specific to a particular platform or operating language. It's a website, it will play, and it's fully available.