Public Safety Committee on May 5th, 2016

[Erin O'Toole, Conservative, Durham, ON]

With the overlap, as you've said, do you think the current structure could have an extra pillar or two built within it? Could CIMVHR have special chairs or something?

My concern is that when there is such overlap, although there are differences too, do you redesign something from scratch? There's a great organization doing a lot of parallel work, and maybe with some specific new expertise or an embedded joint venture or something, the trail-blazing work you have done could help with a head start.

[The Chair, Liberal, Rob Oliphant]

Very quickly. We're quite over time.

I think you have already answered that question. He gave a second answer too, but if you'd like to affirm him in his need, it's okay.

[Dr. Alice Aiken]

Certainly we're happy to help however we can.

I'm not 100% convinced it's how the public safety personnel would see it being most effective. However, if an institute were to start, we would do everything we could so they would not have to go through what I went through seven years ago and they could start where we are now. We'd do that.

[The Chair, Liberal, Rob Oliphant]

That was a noble try.

Monsieur Dubé.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

Thank you, Mr. Chair.

I would like to thank the two witnesses for being with us today.

I will continue a little along the same lines, regarding the distinction between military veterans and first responders. Obviously, our study also includes correctional officers in the first responders group.

You mentioned that they want something that would be specific to them. Based on what I've heard so far during our study, it seems that they're right because their reality is very different. I don't know what you think about it. I'll give you an example. During a previous meeting, a witness said that military personnel were in a danger zone when they went abroad, but that it was temporary because they came home afterwards. That creates very difficult challenges, of course. However, correctional officers are in a danger zone during their shift every day, and they are in their own country, their own province, their own city.

How can understanding this nuance or distinction to better respond to their needs help these people in their job?

[Dr. Alice Aiken]

You know, I don't think we....

May I answer in English?

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

Of course.

[Dr. Alice Aiken]

It's easier for me.

I don't think that the diagnostics or the understanding of disease has progressed enough in mental health to understand the subtlety of differences between deploying somewhere into danger versus potentially facing it on a daily basis. Dr. Merali might be able to speak to this a bit better.

There are reports that military-related post-traumatic stress disorder is different from that of somebody who, say, suffers an accident or something like that. If it is one instance of trauma versus repetitive trauma, I don't know if we know how big the differences are in terms of how the treatment would be affected or, for that matter, a research institute.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

It's true that we need to consider the distinction between the work done by public safety officers and the work done by military personnel.

[Dr. Alice Aiken]

Yes.

[Dr. Zul Merali]

I agree. I think you already had a presentation on a single event with two people in a car accident responding very differently to the accident and then eventually developing very different types of post-traumatic stress disorder. That talks about the individual differences.

I think the call for action is to understand that we need to be much more integrative and bring out all the evidence and information and not silo them, because we don't have enough resources to do that. I think the sooner we can come together on all different facets, with the expertise we need to solve those problems, the better it's going to be. That single exposure to the accident, with two individuals responding differently, tells you a lot about the complexity of the illness. It's not just the event; the response of the two individuals to the event was very different. Then you have to ask if this is related to the individual differences in the two people, or if it is really a gender thing? It opens up much broader questions. I think it's important to integrate.

The point you're trying to bring is that instead of addressing issues that are specific to individual groups, if we address the fundamental issue, which is individual differences, I think we'll make much more progress.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

I have another question about the existing issues.

Dr. Merali, you mentioned the physical aspect. I find that interesting. A few years ago, a representative from the Union of Canadian Correctional Officers told us that sometimes workplace accidents occur that were designated as such, but that were actually acts of violence.

What link do you make between a physical incident that happens and the post-traumatic stress disorder that may follow?

[Dr. Zul Merali]

Excuse me, but I'll answer you again in English, if you don't mind.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

That's fine.

[Dr. Zul Merali]

I think that's an interesting point you raise. I think if you look at the body's response to trauma.... Trauma does not just have to be a physical trauma or an emotional trauma. There could be traumas of many types, and often it could be a combination of the two.

The conference I said I'm going to, which is hosted by One Mind, will be addressing two of those things. It will look at physical brain injury as well as post-traumatic stress disorder. The reason they're bringing these together is that in the realm of sports, for example, there's a lot of concern about people who are exposed to physical trauma to the head that gives rise to something else.

It all boils down to how the organ of the brain responds to different kinds of trauma and what makes one person respond differently from another. The more we understand about that, the more fundamental solutions we'll be able to find.

[Matthew Dubé, NDP, Beloeil—Chambly, QC]

Thank you very much. I appreciate your answer. I also appreciate that you're willing to discuss this.

In fact, when we do a study like this, we also want recommendations to give to the government.

I have a question related to that. I know that there is still a lot of work to be done before really being able to establish treatments. At the moment, I find that the government is mainly treating the symptoms and not the causes. That's basically what you said.

With that in mind, what do you think we should recommend to the government to ensure that programs are put in place that will really deal with the problem in the long term, rather than just treating the symptoms? I would like to hear what both of you have to say about this.

[Dr. Zul Merali]

That's a very important question, and there's not an easy answer to it. I think that there are many factors that result in somebody developing mental illness. In society as a whole there are many different segments that have different kinds of stressors and different kinds of challenges.

The fundamental thing in terms of developing recommendations for the future is that there is not going to be a one-size-fits-all solution but that there will have to be different solutions tailored to the individuals; that's why I was saying in the presentation about research that my focus was to get to individualized treatments.

For example, if you have a chest pain and you are taken to a hospital, they won't give you a pill for chest pain. They'll say, “Okay, let's find out what's going on.” It may just be heartburn, or it may be a blocked artery. It may be a faulty valve. It may be an atrophied muscle. There are many different causes, and the treatment will be very specific for that cause, even though the symptom was chest pain.

This is what we're getting to. In the general domain, many people will express certain kinds of symptoms, but we need to get to the root so that we can correctly treat it.

[The Chair, Liberal, Rob Oliphant]

Thank you.

Go ahead, Mr. Mendicino.

[Marco Mendicino, Liberal, Eglinton—Lawrence, ON]

I yield my time to Mr. Spengemann.

[The Chair, Liberal, Rob Oliphant]

We'll see how it goes. We've been about a minute over for each person so far. It has been valuable, so I let it go on. We'll do the same with the next round.

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

Thank you, Mr. Chair.

Thank you both for being here and giving us your expert opinions. Thank you also for the work that you're doing.

I want to thank my colleagues on this committee for taking on this issue and giving it serious attention and public prominence as well.

For me this is all too real. I served for seven years in a war zone. During that time, over a very short horizon, I had two colleagues who committed suicide. One of them was a serving U.S. service person who went on home leave and killed himself with his service weapon. The other was a civilian PSD, personal security detail, who killed himself in theatre, again with his service weapon. Neither of the two men was directly involved in front-line combat, but neither of them, obviously, had received adequate treatment, and they had the most severe response to the condition that we know of.

I want to begin by asking a question that might be blatantly obvious, but may drill down a bit into the clinical ramifications. The fact that we're talking here, and that this is now out in the open as something to be talked about, has given us the opportunity to give it the attention, the planning, and the resources that it deserves. Again, it's stating the obvious, but is there not also a clinical component to getting past the stigma?

Dr. Merali, in your writing you compared this to the stigma that existed with respect to cancer. We're now breaking down the walls of stigma.

What can we do as parliamentarians? What can we all do as human beings to make sure that this continues to be something that is not stigmatized and is increasingly talked about? Very concretely, what might be the therapeutic benefits of bringing this phenomenon out into the open and tackling it nationally, and increasingly, internationally?

[Dr. Zul Merali]

You point to a very critical issue in the sense that at least in the military, where they keep very close tabs on the number of suicides that occur and the causes of suicide, half of the people who end up committing suicide have already been in some kind of care. The other half have not yet sought solutions.

Getting into care is not a guarantee that you've been rescued. The first step for those who have not even sought help is to get through that door, and maybe they will be helped. That's one aspect of it.

It boils down to what I was saying before: just because you alleviate stigma and get people to say that they need help, it doesn't mean that they will get the kind of help that we want, mainly because we do not always have the solutions that they're looking for. In some cases, yes, but in many cases, no. I think that's what's burdensome.

Regardless, I think it's very important from many different perspectives to remove the stigma so that it gives them the ability to at least speak about their problems and not to be hiding behind some kind of a wall.

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

I am sorry to cut you off. Would there be a prevention-level benefit as well? Let's say you have a young firefighter. She is embarking on her career and she knows that if she runs into trouble on the mental health side, there are supporting mechanisms.

Do you see potentially even just awareness and the breaking down of the stigma being helpful at the prevention level?

[Dr. Zul Merali]

Yes, I think so.

For example, I will give you a situation in Ottawa, where the Senators coach's daughter, Daron, committed suicide. When this became public—it was very good that the parents were brave enough to make it public—what happened was amazing. We were trying to figure out what to do with this problem, but the kids in the schools mobilized en masse. They were tweeting each other, having Facebook pages, doing fundraising, talking to each other, and becoming very aware and starting to discuss the issue of suicide, which had been very silent.

It raised awareness, and through that awareness I think we will save quite a few people—not everybody, but I think increasing awareness and reducing stigma have a very positive impact.

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

I have a final quick question for Dr. Aiken on the idea of repeated exposure to probably the worst stimuli that we can experience in the military field.

If someone has been treated for PTSD—again, on the far side of the spectrum—does it make any sense at all to expect that a reinsertion into a combat environment after a successful treatment is not going to result in a relapse? What is the incidence of relapse in the military?