Public Safety Committee on May 10th, 2016

[The Chair, Liberal, Rob Oliphant]

Just to let you know where we are, we have time for a second round of five minutes each, so you can prepare brilliant questions.

Mr. Miller, Mr. Di Iorio, Mr. Rayes, and Ms. Damoff, I think we'll be able to get you each in for five minutes.

Mr. Miller.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

Thank you to all of the witnesses for being here today. They were very good presentations, and good information has come out of the questions.

If a first responder has a traumatic incident, or as stated here, “a critical incident”, how does a small force of paramedics or firefighters deal with, say, two members who show up at one of these treatment bases? How are they treated—that has come up in the conversation—and to what extent, before they can actually be redeployed on the job?

This is what I'm thinking, and correct me if I'm wrong: where there are few people on the whole job, does it just happen that if you're short of people, back they go? How do you deal with that?

[Paul J. Charbonneau]

That's a very good question.

I've worked across this province all the way up to James Bay, where there were four of us looking after Moosonee. The young aboriginal paramedics who worked with me often picked up their family members, and it was very traumatic to them. We would try to support them as best we could. I often saw that with the OPP there would only be a certain number of officers there, but if something happened, as quickly as you could you would bring other officers in.

I think we're very good at supporting each other. I'm from Kingston, and if my neighbouring service, a little Napanee service in Lennox and Addington County, has an incident, I'll send paramedic officers over to offer relief and all kinds of assistance, but it certainly is a problem. It's not only a problem of getting them off and making sure that they have some down time. It's also a question of where the resources are in some of the remote areas of this country. How do you deal with an incident somewhere in Yukon? Is there a psychologist available, or do we have to parachute one in from somewhere? Those are some of the concerns that we also see. What level of treatment do we need to bring so that they can get healthy and get back to work? Each one is individual. Two partners may see the same incident and one may be off for two days and one may be gone for two months. It's a matter of how you're affected. It's a question of what that incident meant to you personally.

[Larry Miller, Conservative, Bruce—Grey—Owen Sound, ON]

To your comment about supporting each other very well, I came up through municipal politics. You have your volunteer firefighters and local paramedics. I certainly echo that because you guys do look after your own and that's good.

I would like to move to another topic that was touched on here.

Mr. Mellow, in your presentation, you talked about mental health and dealing with PTSD. While they are separate to a degree, they still become one in the same. Whether it's a physical injury, workmen's comp, or what have you, there's compensation for anybody who has a workplace injury—and, correct me if I'm wrong, but that should be the same whether it's a mental or physical injury. How do you separate, or maybe the question is, should you separate, pre-existing mental health conditions out there?

I think there is a need for that discussion. It's not one that everybody wants to talk about, but there are probably some people in jobs who had pre-existing physical injuries. I'm sure there are people who move on to jobs and who have pre-existing mental conditions.

Do you have any comments on that, and how do you go with that? It's a tough one.

[Randy Mellow]

First of all, in my opinion, the Province of Ontario has done a pretty good job of looking at that question when they introduced the bill around presumptive legislation. That legislation requires a diagnosis by a psychiatrist or psychologist using specific tools, a DSM-5 categorization. That's the way to identify it.

That's an example of a measure we would applaud, as it sets out that sort of safety net for those people, because we do have to support both the physical and mental injuries.

[The Chair, Liberal, Rob Oliphant]

Mr. Di lorio.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Thank you, Mr. Chair.

My question is also for Mr. Poirier.

Before asking my question, if I may, Mr. Head, I want to add my voice to the chorus of comments, praise, and thanks expressed to you, of course.

Mr. Poirier, I was particularly disturbed by the suicide figures. I would like to know whether your association has done any studies on the circumstances of those suicides, the situations that may have brought them about, and methods to prevent this from happening?

[Pierre Poirier]

Mr. Chair, I am sorry that I have not done any research on that subject. The Paramedic Association of Canada does not know the reasons for these suicides and does not have complete information about them. We lack data on this subject Canada-wide.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

I would like to be very clear; I am not criticizing you in any way. I would just like to know whether information on this subject exists, so we could have access to it, of course.

Mr. Head, does the Correctional Service, itself, do studies about these issues?

[Don Head]

We have not looked at it in any great detail. Part of the challenge is the fact that these situations occur off the work site, and getting access to information is challenging at times.

We have done a couple of studies over the last 20 years—nothing in great detail, but we've identified with correction officers some of the stressors or challenges around their work. We have a good sense of the kinds of things that impact people psychologically and have continued to find ways of minimizing those situations.

I'll just give you a very quick example. In the early days when we had individuals who were involved in lethal force situations, the typical response of the service 30 years ago was to take that individual out of the workplace and send him to the staff college to become a trainer with no other support.

Almost every individual I knew who was involved in one of those incidents went on to suffer significant psychological problems and mental health problems. It was only probably in the last 10-plus years that we've started to look more seriously at what is the right response. How do we put the right envelope of support and treatment around those individuals, and not force them to have to make a decision about just sucking it up and coming back to work, or going off and being forgotten?

There are some things that we know we need to work on, but in terms of in-depth research, no, we don't have the capacity to do that nor is the information readily available.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

My question is for each of you.

We will be preparing a report, with recommendations, and submitting it to Parliament. We will then ask the government to take action in response to the recommendations. I would like you to tell me any recommendation or recommendations that you would like to see included in that report.

I will start with Mr. Head.

[Don Head]

I have a series of things you may want to consider.

Part of it is looking at how we make available standardized awareness training for people to eliminate the stigma and to allow people to come forward and freely engage the supervisors. We also want to look at how we prepare managers to deal with situations of staff coming forward. These are very difficult situations for managers to deal with. How do we prepare managers to deal with those types of situations?

There is also support for family members. Through our road to mental readiness training, not only are we looking at staff and managers but we will, in our second and third phase of our initiative, also look at how we provide assistance to family members.

Regarding the issue of standardized accessible treatment, we're talking about everybody, and not just certain categories of first responders. It needs to be standard across the country. We can't differentiate between the military, the RCMP, corrections, paramedics, or whatever the case may be. There needs to be a standard approach and proper funding to support that.

We need to find a way through provincial WCB bodies to help people navigate through the system when they come forward. One of the most significant challenges we find is that people do not come forward.

We're talking a lot now about the statistics of individuals who come forward. We're not talking about the silent majority who do not forward because the system is very complicated. WCB processes are so complicated that within our own organization, we have to dedicate individuals to help people try to navigate through a system that we do not manage.

Thinking about those kinds of things will go a long way.

[The Chair, Liberal, Rob Oliphant]

Mr. Rayes.

[Alain Rayes, Conservative, Richmond—Arthabaska, QC]

Thank you, Mr. Chair.

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

Last week, one of the witnesses told us that, after people are diagnosed with a post-traumatic stress disorder and once they start treatment, a third of patients respond positively, another third have a mixed response, and another third responds completely negatively.

Awareness is an aspect that is of considerable concern to me, particularly when I see these results and I think about the time the research will take before we can progress on this. I would like all of you to tell me, not what your organization is planning to do in the next few months, days, or weeks, but what it is doing right now. What are you doing about awareness and education on this subject? Ultimately, what are you doing to raise people's awareness before they join your organization?

I would like to hear from the representative of each of the organizations.

[D/Commr Daniel Dubeau]

That is a very good question.

The Royal Canadian Mounted Police has had a complete mental health strategy for the past two years. The first year, templates were used to help managers communicate with our members. It really meant being sensitive to our members and their stories.

Constable Neily, in Cornwall, has produced some videos about this. He has done some very good work.

Constable Neily stepped up and became the face of mental health in our organization. We had members step up in the grassroots. What we noticed is that there was an appetite, and our members stepped up to talk about their experiences. That speaks more to our members than anything else, where they have a fellow member or a fellow officer saying, “Here is what's happened to me, and here is how I got that”. That was the first year it was released.

We had tool kits, and we had a lot of emphasis on destigmatization. For post-traumatic stress disorder, we do not use that terminology in our force. We avoid that terminology. We call it an “injury”. It's an operational stress injury, and we have to stop calling it a disorder. It's an injury, because otherwise it's a stigma.

The second part is training. Similar to everybody else, we are rolling out R2MR. We had tried it in New Brunswick, and we tried it before that unfortunate tragedy in Moncton happened. We had rolled out that program. We had research to show it was effective. We did roll it out, and we're rolling it out currently.

We have a peer-to-peer network that we have deployed across the country. These are members who are trained, employees who are trained, to pick up on these issues. Within the training component itself, we have it at our induction training. We start talking about this at the first stage, and then we supplement it as we go along throughout their careers.

It's still a work in progress, and that's where we are right now on that. We're doing the research project, and we're saying that we now have to go to a broader research project to find out, in our members' lifetimes—starting from training at Regina, and throughout the lifetime—what happens. What happens to an individual?

I believe a lot of people are asked, do you walk in with preconceived notions of what police work is? Yes, you do. Do you have certain conditions that may cause you to have this injury happen to you? Yes, you do. We're trying to find what those indicators are, so we're able to build resiliency or deploy better strategies to treat the members.

That's where we would be with our organization.

[Pierre Poirier]

Mr. Chair, I am going to speak in English because I will be better able to answer the question.

I'd like to address it in three phases: the education, the recruitment, and then when an event happens, because I don't think we've spoken about that piece.

On the education, I spoke earlier about the changes in the educational structure of how we teach and educate paramedics, la formation des paramedics. It's evolving right now to recognize that mental health is an integral part of that educational process. That's taking place today.

Colleges have already started to adopt it, and it's becoming a greater portion of the whole educational structure. As we recognize that and as we move toward baccalaureate education, we look at the roles paramedics take. As part of being a professional, self-reflection is part of that concept. That's an important piece to understand where you are in your context, so the education is evolving to address mental health issues.

How paramedics are recruited across the country is a mixed bag, including their initial education with respect to how they understand themselves, their mental health issues, and how they fit into the organization. I think Randy Mellow spoke earlier about all of those other impacts upon our well-being from shifts, the hours of work, the randomness of incidents, and how they affect us.

The last piece—and we've seen a fair bit of change in this area, and haven't spoken a lot about it today—is when an event happens. My apologies, because I'll use a sudden infant death event. That event may affect different people in different ways. Right now, we don't know exactly how to support our paramedics in that regard, and that's an interesting piece that's going on.

There is critical incident stress management, and there is critical incident stress debriefing. There has been a lot of research about the best way to help that individual. We don't know specifically what the answer is.

Different services across the country have chosen different methodologies. Critical incident stress management appears to be the most common, but we don't have the research to say it is the best. That's an important piece if we're looking for an understanding of what the best intervention is. We don't know. I think we all struggle with it, and I think the first responder community struggles with it because of how individualized that event is to each individual intervenant.

A paramedic, a police officer, or a firefighter who attend to that event may each have a different perception of it. That is an area where we—

[The Chair, Liberal, Rob Oliphant]

Thank you. We're well over time.

There are a few minutes left for Ms. Damoff. If we have the indulgence of the committee, we'll continue for a few more minutes.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Thanks to all of you for coming and for your work in this field.

R2MR has come up quite a bit, and I have three questions on it for each of you.

Recognizing that first responders and public safety officers are working in different conditions from veterans, which is what it was designed for originally.... Regarding veterans, I think it was CAMH that said here that they go from a safe zone to an unsafe zone and then back to a safe zone, whereas all the people you deal with are living in that unsafe zone every single day.

What modifications were made to R2MR for your various communities, how long have you been using it, and is there any research that shows it's effective for first responders and public safety officers?

Maybe we can start with the RCMP and work across, if that's okay.

[D/Commr Daniel Dubeau]

The foundation is the road to mental health readiness, and we thank the CF every day for this, as well as the Canadian Mental Health Association. We use that as a foundation. We haven't changed the core piece of it because we find that it fits very well with our organization. What we have changed, though, is where we start talking not only to our employees but also our leadership structure, where we incorporate what's unique to our organization.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Sorry to interrupt you, but isn't there a post-deployment component in R2MR? Have you changed that part of it?

[D/Commr Daniel Dubeau]

We didn't have that post-deployment part of it. Post-deployment is when they're going to deploy overseas. We don't have that. We have a post-deployment structure when we do deploy our members overseas, so we do that then, but I'm talking about a standard R2MR for all veterans.

You're right that we are constantly deployed. We are on full deployment all that time. I've lived in communities where it doesn't matter if you're in uniform or not; they're still calling you “constable”.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

So you're using it exactly as it was.

[D/Commr Daniel Dubeau]

We're using the foundational piece. What we have changed, madam, is on how the services are available in the organization, the policies we have within our organizations to deal with mental health issues and the other occupational issues, and how you will deal with the employees, as well as what and to whom the employees should be reaching out to. That's what we've changed to modify, where you go in our organization to get the help you need.

How long have we been using it? We accepted this as a standard in October of last year and made it mandatory for everybody. Prior to that we did have it in New Brunswick. Our pilot project in New Brunswick was the first time we ever used it, both in Moncton and across New Brunswick. There was a research project that followed that to see if it was effective. The subsequent report concluded that it was an effective way to build resiliency amongst our members. It allowed them to actually monitor before and after the Moncton event. Unfortunately, we had that tragedy in the middle of it, so we were able to see that, yes, the number one shock for any of us was losing a fellow officer. We saw that as the number one shock; it happened and we were able to monitor and get the people help. We do have research data that would show this. Dr. Julie Devlin and part of our team did do research that is available. If you would like to see it, we can share that with you.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Our paramedics.

[Paul J. Charbonneau]

Thank you for the question.

Through you, Chair, we'll find out tomorrow.

Ontario is going to be the lead on this. R2MR has just been “paramedicafied”, if I can call it that. As we understand it, it's about looking out for each other and knowing if you're in that stop, caution, or go zone. As the Paramedic Chiefs of Canada, we'll be watching very closely what Ontario does. We'll have some conversations at our national conference in Saskatoon in June.

From speaking to the people who are using it already, my hope is that it will really help our members to help each other.