Public Safety Committee on May 10th, 2016

[The Chair (Mr. Robert Oliphant (Don Valley West, Lib.)), Liberal, Rob Oliphant]

I'm going to call the meeting to order, with our apologies to our witnesses for our absence for voting.

I'm going to suggest to the committee, and we'll see if we have its approval, that we hear first from the Paramedic Chiefs of Canada and the Paramedic Association of Canada, as planned, and then when Mr. Head arrives, to hear from him as well. We'll have three 10-minute presentations. The RCMP has only two minutes of comments because they've spoken about these issues before, so that would be 30 minutes of presentations, and then 45 minutes of questioning. I'm only concerned that we could invite the Correctional Service of Canada folks back, because they're Ottawa-based, but I want to give full time to the paramedics to make sure. Is that a good solution for today?

We'll try to get the whole meeting done. If Mr. Head arrives, he won't have heard the first two presentations. However, he has prepared remarks, so I don't think he's going to adapt them anyway.

We're going to begin with the Paramedic Chiefs of Canada, and then we'll have the Paramedic Association of Canada with Mr. Poirier. We will begin with Mr. Mellow and Mr. Charbonneau.

[Randy Mellow, President, Paramedic Chiefs of Canada]

Good morning, Mr. Chair, and members of this committee.

We'd like to thank you for the invitation to appear before you today and for this opportunity to contribute to this crucially important focus on the effects of operational stress injuries and post-traumatic stress disorders upon public safety officers and first responders. It's my distinct pleasure to represent the Paramedic Chiefs of Canada today. It is an association that represents the paramedic chiefs in leadership across all of our provinces and territories.

We're pleased to participate in this national dialogue on this important issue that is crucial to the safety of our men and women on the frontline, regardless of the role they assume, and crucial to their families as well, who are often affected.

Our association recently participated in a round table on this important topic hosted by the Honourable Ralph Goodale, Minister of Public Safety. We prepared for that meeting by polling and interviewing a number of colleagues across Canada in trying to address three fairly simple questions. What is the problem? What are we doing about it? What do we need?

While the feedback and the answers are likely as complex as the overarching issue at hand, there certainly were themes that prevailed. I'm pleased to try to outline these to the best of my ability here today.

The message that we heard clearly though from our community is that this is a complex issue. To state that the impact is significant would definitely be an understatement. In terms of scope, we feel there is some difficulty in terms of the accepted definitions and terminology or measurements. Based solely on the limited research to date, we can easily surmise that the impact is alarming.

For perspective, Ontario has about 8,000 paramedics, and with some studies predicting that PTSD or OSI affects 22% of them, we can estimate over 1,700 of our medics are suffering from operational stress injuries.

Speaking from the paramedic community, initial steps have been and are being taken to get a better understanding of the magnitude of the problem, but that work is in isolation of a broader scope, and the research is difficult to verify. The magnitude of the problem appears to be growing in terms of its human effect, system performance, and financial burden.

The overarching message heard from our community is that there is a need to treat the problem as a whole, and not just the disorder or disease—or worse yet, an event or a symptom. With frontline work, the damage is likely to be cumulative from multiple exposures, and more research is required to determine just how the multiplicity of stressors experienced by first responders manifests into disorders or syndromes, and what we can do to intervene.

As system leaders and practitioners, we feel that it's imperative to have a coordinated and collaborative effort among and involving the first responder communities, who are here at a national level, in order to stop the hemorrhage of emotional and psychological damage that's occurring.

Peer support and critical incident stress management teams and training are needed to be supportive in the field. I think that's clear and broadly accepted, but further research is needed to employ effective methods of intervention in the field, with a greater understanding of the impacts and limitations. We feel there are gaps evident around treatment options, which are relatively new. We feel there doesn't appear to be a lot of peer reviewed literature around the efficacy of these treatment options among our paramedic community.

These identified concerns have led the paramedic community to express a need for greater understanding of the problem at hand, and for our leaders to have access immediately to tools to begin an effective and evidence-based approach to addressing the situation.

We also see the need to address gaps that have been missed, such as workplace reintegration. Presently workplace health and safety programs are challenged as to how to reintegrate some staff into the workforce safely. Small collaborative programs exist in some areas, but in many areas the only programs that exist focus on reintegrating persons with physical injuries back into the workplace, and a gap certainly exists.

Broadly, our community has concerns about the lack of coordinated research in all areas surrounding operational stress injury topics. We feel that efforts should be made to find opportunities to share research more broadly and effectively.

What is our association and our community doing to date? The Paramedic Chiefs of Canada, along with our partner here today, the Paramedic Association of Canada, have been trying to frame the discussion around mental health and wellness, both physical and mental, and not just the manifested PTSD. We believe that mental health incorporates a holistic approach that recognizes mental health promotion as part of preventing the disease's symptomatic progression to a state of disorder.

Our association has been collaborating on the following projects: the national EMS research agenda, the national research gap analysis, and the Canadian safety and security program's paramedic community of practice. Each of these has priorities that recognize that research is important for the health of the profession and, in particular, this area of focus. As an example, a current study is underway, supported by CSSP, examining mental health wellness through Queen's University, and with Frontenac as our municipal partner.

Our association has joined others to form a tri-services working group collaborating with Public Safety Canada and other key partners in an effort to continue toward meeting the federal mandate to form a national PTSD strategy.

The Paramedic Chiefs of Canada have also created an ad hoc committee and drafted a report dedicated to operational and psychological stress injuries. We've provided a copy of that today.

The scope of the report was to examine how organizations themselves can best respond to operational stress injury. As with other forms of injury, we believe that the paramedic services at the forefront of proactive action on this issue must address the following four core elements: first, comprehension and championing of the issue within the paramedic service; second, developing prevention strategies that target those who may be at risk, their environment, and the sources of injury; third, creating intervention services and strategies for those who are at risk; and fourth, ensuring that treatment and recovery programs are accessible to those affected by an operational stress injury.

Our community continues to focus on these areas, but we know that we would be much more successful with broader collaboration. We need wholesome programs that span the first responder's career and provide support at any position they may currently hold within the mental health continuum, whether they be healthy, reacting, injured, or ill.

Support needs to be holistic in its approach, spanning readiness for career, resilience training, exposure response, critical incident recovery, restoration and and return to work, and retirement/career changes or returning to the workforce as a non-first responder. These ideas and best practices need to be evidence-based, bolstered, and shared among our communities, covering pre-evaluation, prevention, resiliency, and recovery throughout the mental health continuum.

We think it's clear that broad collaboration will be the key to having a significant impact in addressing this problem and supporting the people in our communities who do great things to protect us each and every day.

A multi-pillar strategy or approach for the support of mental health for first responders is critical from the day they're hired until well after they retire. We need research, and we need the funding and support required to pool our resources.

Once again, the Paramedic Chiefs of Canada applaud the right hon. Prime Minister Justin Trudeau for calling in his mandate letter to Minister Goodale for him to work with stakeholders to develop a national action plan on post-traumatic stress disorder, which disproportionately affects public safety officers, our people.

We welcome the opportunity to work with the federal government and partners to assist in coordination, research and communications, to ensure the safety of our first responders and the citizens of Canada in providing evidence-based national standards for the assessment, treatment, and long-term care of public safety personnel.

Thank you, Mr. Chair.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

Thank you for the work you do every day, not just the work you do when you come to committee.

Mr. Poirier.

[Pierre Poirier, Executive Director, Paramedic Association of Canada]

Mr. Chair, I would like to thank the committee for giving me the opportunity to talk about the health and well-being of paramedics in Canada.

I'd like to frame our discussion in terms of what the Paramedic Association of Canada is and isn't, and to talk a little bit about mental health. Paramedics are in distress, and I have some information that highlights the severity of the issue. I'll also talk about some good initiatives that are taking place. Lastly, I'll speak about how we can work together. I think there are some great opportunities to work with the chiefs, the different levels of government and, in particular, the Canadian safety and security program.

First, the Paramedic Association of Canada is an association of paramedics. It's not the union. That's a distinction I'd like to make. We take care of the competency profile of paramedics—the things that define paramedics. We determine the skills, abilities, and knowledge of paramedics as well as the roles they undertake in providing service to the community.

It really is about the education that a paramedic needs to do the job and do it well. By the year 2025, we hope to be at a baccalaureate level in the training that's required. The job has changed that much.

There are 20,000 members of the Paramedic Association of Canada, and there are around 40,000 paramedics in the country. Often we say it's about 1,000 paramedics for every million people. That's a broad number but it's pretty accurate. This makes the paramedic community the third-largest health care provider group in the country.

In defining paramedics, the terminology is usually primary care paramedic, advanced care paramedic, and critical care paramedic. We have those three designations. The nomenclature surrounding paramedics has been consolidated in the last 15 years or so. Across the country there's a fair bit of uniformity in the terms and the titles.

Where we work is an important thing. People used to think paramedics worked strictly in ambulances. Today you see paramedics in helicopters, in clinics and hospitals, and you're starting to see them in community health centres. A great example of that is the Health Bus in Saskatoon, where paramedics form part of a team in the community paramedic program. In the spectrum of health services, the job of a paramedic has evolved from being focused on urgent care to also providing preventative care.

Mental health has become important for paramedics. There has been some fantastic research done over the last number of years. Dr. Lori Gray and the Paramedic Chiefs of Canada did a fantastic report a couple of years ago looking at occupational stress injury in paramedics. Since then we've identified that the disease process at the end of the spectrum is not the only thing that matters. We also need to focus on general wellness. We are investigating how to build up people's capacity so that they don't fall into the illness category. This is important. With PTSD, in some ways there has been a failure. We still haven't figured out how to take care of people so that they don't fall into this category.

Most distressing of all is the number of suicides that have been related to mental health and mental health issues. I think the number was 14 or 15 last year. My apologies, I don't have the exact number, but that is a wake-up call. It's a flashing red light for us that more has to be done. Recently, the Paramedic Association of Canada did an online survey of paramedics, and there were 6,000 respondents. The numbers are startling. Thirty per cent of paramedics have contemplated suicide, sixty per cent know of a colleague who has contemplated suicide, and seventy per cent are concerned that a paramedic colleague is at risk of suicide. So in spite of all the evolution in what we do and where we do it, paramedics feel that in some ways they haven't been taken care of. All of us, really, are accountable. I'm not singling out any one group. It's a societal issue that we have to address. That's why both Randy Mellow and I are so appreciative of the mandate letter that was given to Minister Goodale. This is an issue for all first responders, including paramedics.

Talking about some of the good initiatives that have taken place, there has been presumptive legislation with respect to PTSD in several provinces, including just recently in Ontario, but also Manitoba and Alberta.

There's an initiative with the University of Regina, and a round table took place at the beginning of this year, which we think is a great foundation for the first responder community to work together on this issue. That's an important piece. Recognizing that paramedics still have their own uniqueness, there's a commonality among the public safety occupation, or the first responders, that this round table is addressing quite well. We advocate that those kinds of initiatives be supported.

Recently Queen's University did a study to solicit how paramedics “feel”, but it's about understanding the scope of the issue in a research-based study. Dr. Renée MacPhee and Queen's University started this process. Other good work is going on about rooting out and defining the problem and the problem space.

The whole idea of that first responder community coming together and this committee being willing to listen to us is an important piece of starting the process of understanding what the problem is, so that we can work back. We can deal with the disease process, but we can also look back at the wellness component.

With respect to the ask—and Randy Mellow and the chiefs and the Paramedic Association are very much on the same page on this—we continue to support initiatives such as the round table at the University of Regina, and what's come out of that round table.

Recognizing that paramedics still have a unique job—we're not firefighters; we're not police officers—the understanding of how we get to the illness phase, whether it's cumulative or whether single events are triggers, we don't know. There's research to be done there.

There's an opportunity with the Canadian safety and security program, which has been very much an advocate going back the last 10 years or so in support of our community. Targeted investments could be coming from that group in support of research for paramedics, not just on PTSD but also on mental health and wellness.

Thank you very much for the opportunity to speak. I'm willing to answer any questions.

[The Chair, Liberal, Rob Oliphant]

I'm going to suggest that Mr. Head, Madame Chateauvert, Assistant Commissioner White, and Deputy Commissioner Dubeau join us at the table.

I understand that Mr. Head has a 10-minute presentation and that the RCMP has a shorter presentation. Am I correct in assuming that?

[D/Commr Daniel Dubeau, Deputy Commissioner, Chief Human Resources Officer, Royal Canadian Mounted Police]

Mr. Chair, I don't have a presentation. We'll just open it up to questions whenever Mr. Head is done.

[The Chair, Liberal, Rob Oliphant]

That's perfect.

We'll hear from Mr. Head.

Is the committee in agreement with this?

Thank you.

[Don Head, Commissioner, Correctional Service of Canada]

Mr. Chair, I think everybody has a copy of my brief in English and French. If it facilitates the question period, I could just pass on reading it out and allow more time for questions.

[The Chair, Liberal, Rob Oliphant]

Why don't you give us a few highlights, and then we will take this into evidence.

Corrections officers have become quite an important issue for us. I'd like you to have at least a few minutes to highlight your report and point us to the most important parts.

[Don Head]

Thank you, Mr. Chair, and members of the committee.

I'm pleased to be back here before you. I always enjoy appearing in front of this committee and all the honourable members to talk about this serious issue that you've taken on to study, because it does affect a number of staff in Correctional Service Canada.

Mental health in the workplace has always been a difficult topic to address, both for those who struggle with mental health issues, as well as from a management perspective. Addressing this topic in a meaningful and effective way is very important to me personally and professionally. I am very happy that we are starting to see an increase in the awareness of the importance in maintaining a healthy workplace, and that there have been a number of concrete steps taken to improve the situation across this great country of ours.

This committee's decision to study operational stress injuries and the effects of post-traumatic stress disorder, for example, has placed a spotlight on this issue, and hopefully this will continue to foster more open dialogue in society to allow those who may be struggling in silence to come forward. One of the best approaches to improving understanding of afflictions such as PTSD is awareness and prevention, and in this regard, maybe I'll just share with you some of the highlights of the work that CSC has been undertaking.

As most of you are aware, our staff members operate in a unique environment, which can often take a significant toll on the mental well-being of the staff. Given the nature of the work performed by front-line correctional staff, they are likely to witness stressful and traumatic events, including death and violence. In our 180-year history, we have had 34 members who have been killed in the workplace, 33 of those within the penitentiaries, and one in the community.

Consequently, employees are vulnerable to developing operational stress injuries. While CSC recognizes the significant challenges associated with working in a correctional environment, we are committed to providing a workplace that is conducive to the health and safety of all of its employees, including their mental health. I am proud of the work done by the Correctional Service Canada staff on a daily basis. Particularly of note is their dedication and commitment during the stressful and potentially dangerous circumstances that are common in a correctional environment.

CSC openly encourages employees to seek assistance in dealing with any personal or work-related problems that may impair their well-being. To this end, we have established an employee assistance program to encourage employees experiencing personal or work-related problems to voluntarily seek assistance, recognizing that our staff are the strength and major resource of the service, and that the well-being and productivity of employees can be affected by personal or work-related problems.

Also, CSC employees have access to the critical incident stress management program. This is a joint labour-management initiative, which was introduced to employees in the 1990s. Currently, the CISM teams, as they are referred to in short, comprise mental health professionals, chaplains, and peers from various disciplines who are trained to conform to national standards. They are used whenever there is an incident that meets policy guidelines for the provision of CISM services, such as an event that includes death, suicide, injury of any person during use of force in the conduct of duties, being the victim of physical violence, or any other incident deemed critical by management in joint consultation with our EAP coordinators.

Most recently, we have also taken steps to educate CSC employees about the potential mental health injuries that can happen as a result of their work in corrections by offering the road to mental readiness training. As you know, this was first pioneered by the Department of National Defence for its staff. This leading-edge training equips our CSC employees with the same tools and knowledge as other first responders across the country.

We formed a steering committee for workplace mental health injuries in May of last year, and we are developing an integrated mental health strategy using the new psychologically healthy workplace standard developed by the Mental Health Commission of Canada and the Canadian Standards Association as a framework. We have produced a new and comprehensive internal web page for our employees who experience a mental health injury, where they can find information about what to do and where to go if they need assistance. Just last week, we shared with all our CSC employees across Canada an internal publication about workplace mental health injuries within CSC. This publication includes CSC employees sharing their personal experiences in written format, contributions from an institutional CISM and EAP agent and a registered psychologist, a poster to help staff determine where they are on the mental health continuum, as well as a video about CSC's Steering Committee for Workplace Mental Health Injuries.

I will cut it short there, but I could talk more about the employee assistance program, our return to work program, or our duty to accommodate program. There is no question, from my perspective, and I've been in corrections now for over 38 years, that this is a very meaningful topic and one worthy of discussion.

Although I represent the federal correctional system, I'm glad to see this applies equally to provincial and territorial correctional workers. I'm glad to see that they're being recognized in these discussions going forward.

To give you a sense of some of the stress that we do deal with, last year alone, I had 27 employees or former employees either commit suicide or attempt to commit suicide. To the greatest extent possible, this is a reflection of what they've had to deal with throughout their career. Being in the service as long as I have, I know a lot of these people, and so it's a very troubling situation.

Once again, I'll cut it short there. I'm glad to see the committee doing this review, and I look forward to answering any questions that you may have.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

Thank you for being here as well, Deputy Commissioner Dubeau, from the RCMP human resources area. Do you have any opening comments?

[D/Commr Daniel Dubeau]

No, I do not not, Mr. Chair.

I thank the committee for taking an interest in this, and I will echo all of my colleague's comments.

As you know, we've been at this for several years now, and we've had our mental health strategy since 2014. I'm willing to answer any questions about some of the systems we've deployed, and comment on what you've heard here, as well as some of the research that we're considering in future to advance this in our organization.

[The Chair, Liberal, Rob Oliphant]

Perfect.

We're going to begin with Mr. Spengemann, for seven minutes.

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

Thank you, Mr. Chair, and I'd like to pass any of my remaining time to my colleague, Mr. Mendicino.

Thank you all for being here and for your incredible work and service. Through you, we'd like to thank all the people you represent who are in the field, day by day, shift by shift. We're grateful for what you're doing.

I'd like to start with the representatives from the paramedic community. I have a number of questions in the areas of definition, awareness and prevention, and then also treatment.

As the committee moves into the stage of contemplating how to frame our report, I'm wondering if you could tell us, with respect to definitions and terminology, what do we make part of this exercise. We've put the label “PTSD/OSI” on it, but there are a number of things and concepts embedded in it that we need to be very mindful of.

Monsieur Poirier, you spoke about wellness, and that takes us all the way along the spectrum into the most unfortunate outcome, namely suicide or attempted suicide. Some of the things include depression, substance use or substance abuse, panic disorder, and other diagnosable mental health injuries, if you will, that we need to be mindful of and potentially bring in.

I wonder if you have some comments on how we can not only be as precise as possible, but also as comprehensive as possible, in our terminology and definition of the problem.

[Randy Mellow]

I think that's a question we're struggling with as paramedic service leaders. Part of the ask in our presentation today was around the assistance we need to help identify those. As I said in the presentation, we are involved in a number of different areas of research, as I believe all of our colleagues are sitting around the table, but my fear is that it is being done in isolation, siloed, and not being pieced together.

While as my friend, Mr. Poirier, said, we are a unique community, we have many similarities with the others in the first responder community. Again, our ask around having that support for collaboration would help us to answer that question for you. I do believe that the work that started with a round table in Regina, particularly the work that's going on with the university and the proposed Canadian institute for public safety research and treatment, would answer those questions for us.

This is something that we're really striving to find ourselves, as we transition from our traditional role of rule-maker and enforcer into almost being some sort of a practitioner or a health care provider to our own staff. We need to answer exactly those questions that you asked in order to fulfill that role.

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

I have a quick follow-up on that first area.

Is the label “PTSD” in your profession one that evokes negative stigma?

[Randy Mellow]

Through you again, Mr. Chair, that term to me is troubling and I don't actually like to use it. I prefer to look at it as an operational stress injury. We know that we need to focus before it becomes a syndrome or a disorder, and that's what PTSD really is. As I stated earlier in my remarks, we need to look at the situation across the entire spectrum of both the career and the mental health continuum, and to focus on a disorder is too late, in my opinion.

I don't know if my colleagues would have anything else to add to that, but that's certainly our position on that.

[Pierre Poirier]

I would concur with that. That term is stigmatizing. As much as we talk about the initiatives through Bell's Let's Talk and Clara Hughes, we have to reduce the stigma. By actually attaching this label, we've actually probably done a disservice to the broader sense of mental health and wellness.

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

That's helpful.

Moving on to the second area that I've labelled, awareness and prevention, how aware do you think the Canadian public at large is of the problem that your colleagues are facing? Without being too scientific about it, just give a general sense of public awareness of this issue.

[Pierre Poirier]

I think there's an awareness through several issues and I know from Let's Talk through Bell that there is a problem out there, but I don't think it's known necessarily that well within the community. I look at the approximately 40,000 paramedics in the country. Their training really doesn't include wellness training or an understanding of mental health issues at this time, and that's something that we're moving forward on. Our community is just building that awareness. I think that's something so important—and once again coming back to the mandate letter—because I think the dialogue is so important right now to get that message out.

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

Maybe you could be a bit more specific in terms of awareness of new recruits. If a young person were contemplating joining the organization, how much knowledge would she have of the hazards of mental distress or, conversely, of the importance of wellness when she goes through the recruitment process?

[Pierre Poirier]

I can speak to that. Just in the last two years or so, we've been revising the knowledge, skills, and abilities of paramedics and paramedic education, and that's been one of the focuses of the renewal of our body of knowledge and the training programs. So yes, I would say that new recruits are given that information, but what's lacking is even our understanding of all of the component pieces in that continuum, so we're working with that.

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

Then just moving to the last area that I've called treatment, could you outline for us some of the exacerbating factors that are not necessarily evocative immediately as OSI, but some of the hazards of the work environment that may amplify somebody's propensity to suffer mental distress?

[Randy Mellow]

Again through you, Mr. Chair, I think my colleague Mr. Charbonneau may want to add to this, if that's okay. I'd like to start by saying that those exacerbating factors are exactly what I referred to earlier as the multiplicity of stressors. Each of our communities is very different. If you look at the paramedic community, we have critical incidents that we're exposed to that we have limited control over. We know that's going to occur, as do our partners in the first responder community.

We also have increasing operational stresses as we look at the aging population and the demand on our paramedics. Our paramedics are missing their lunch breaks or they're not getting done at the end of their shifts. Then we have organizational stresses when you look at us being one of the most legislated professions or regulated professions in comparison to the first responder community. So again, those exacerbating factors, as you described them, are unique to each of our individual services. That's one area where I think that the paramedic services need to have a little bit of a distinct overview or look.

If it's okay with the Chair, I'd like to just pass to my past president and see if he has anything to add to that.

[Paul J. Charbonneau, Past President, Paramedic Chiefs of Canada]

I think the stressors are becoming more and more visible to our community, which is very important. Just to add to the comments about the young paramedic recruit, 40 years ago when I became a paramedic in Toronto, we didn't talk about this in my training of four weeks. Some 15 years ago when my son became a paramedic in a one-year program, they didn't talk about it very much.

I have a grandson who I think maybe some day might want to following in his father's and grandfather's footsteps. I sure hope that there's a whole course on how to look after yourself during a career of 40 years.