Public Safety Committee on March 10th, 2016

[Dr. Jakov Shlik]

Thank you.

I appreciate very much, Mr. Chair, the fact that this question was raised. We have had some experience with people who we've worked with in the corrections system through our clinic for veterans, because some of the veterans went on to work in the corrections system. This experience is very cursory. It doesn't give us a big picture, but it does give us some reflection.

For us, it was striking how difficult this work can be, and how little support and how little ability to cope people might sometimes experience. It's not that the support systems do not exist, but perhaps they are just not accessed, not developed, or not supported.

We've heard—again, as was mentioned before, it's hard to find really reliable data—that the rate of diagnosis of post-traumatic stress disorder specifically in correction services is striking, and possibly startlingly high, and it calls for action. Some work can be done on more training, at least in practical experience with mental health nurses.

In correction services, that was provided by the Royal and it seemed to be well received. That is suggested as probably one of the stepping stones in the system. I think the workers in correction services should be empowered by the same tools and systems, including peer support and access to care, with a variety of technologies and options, as any other operational employee would be.

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

Before you answer, Mr. Sareen, I just want to elaborate on that. You've mentioned a lack of data. Is the lack of data representative of a lack of tools? Does the fact that we don't have the answers to those questions demonstrate that there is more work to be done to better understand that specific work environment and what tools we can put in place?

[Dr. Jitender Sareen]

Yes, I think it's both that and the fact that there hasn't been a survey done. Mental health surveys, if they are done well, are expensive. But we have worked with Stats Canada, and the military and Veterans Affairs have invested in getting accurate information, because you can't guide policy if you don't have an accurate number. If we have x percentage of cancer, then you know how much to spend on cancer.

We don't have information about this. What are the accurate estimates? Are we dealing with 10% PTSD, or 30%, or are we dealing with 50%, whether that's in nurses or in security officers? I completely agree with you. I've treated and seen in my practice people who have struggled with PTSD, because it is a very high-risk environment. You're holding people down and you're being assaulted, and that physical assault has been shown to be a specific risk factor for post-traumatic stress disorder.

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

I appreciate that.

The work that happens when we're talking about data, and when you look at the purview of Veterans Affairs, I don't believe it covers necessarily correctional officers. I might be wrong about that, but do we have more work to do to get data that's more in tune with their specific workplace and the issues there?

[Dr. Jitender Sareen]

Absolutely.

That is exactly what I'm recommending. We need evidence-based policy, and you can't start with programming without a good estimate of.... You know if you look at cancer registries, first you need to get accurate information about how common it is and what's happening before you can invest in it. At the same time you still have to invest in getting people treatment. I think we're about 15 years behind the military and veterans around public safety officers and what we do in Canada.

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

Okay.

Fifteen years is quite a significant gap. I appreciate your comments on this issue.

Regarding my first question, I mentioned situations that are described as workplace accidents.

For police officers and soldiers, there is a degree of physicality associated with the work they do. When we hear about accidents related to their work, we have a pretty clear idea of what that entails. I think I read in a recent report that two-thirds of those kinds of accidents involved violence.

In your opinion, should we be using more appropriate language when talking about these issues?

[Dr. Jitender Sareen]

Yes, I'm just trying to understand the question.

Is the question, should we change the terms of workplace safety?

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

When we say workplace accidents, and two-thirds of those involve violence, are we doing a disservice in making it sound like it's something that might...giving a different perception of the public that impedes our job to get the proper treatment for PTSD and such.

[Dr. Jitender Sareen]

Yes.

I agree with you. I think it is important to note though that the majority of people who are hurt are resilient. Saying that if somebody gets injured that means they have PTSD, I just don't want that to be the outcome.

You're absolutely right that the more times a person is injured there's a higher risk of getting post-traumatic stress, but I wouldn't equate it.

[The Chair, Liberal, Rob Oliphant]

Thank you.

Mr. Mendicino, go ahead.

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

I'd like to thank both of the witnesses for appearing today, and I have been listening attentively also.

I also want to thank Mr. O'Toole for his work on the file in the previous administration. I'll echo Ms. Damoff's comments. I think this is an important topic worth taking up at this committee at this time.

I have a number of questions for Dr. Shlik.

I'd like to take you to your written submission. Do you have that before, sir? If you could go to point 4, key learnings based on our clinical experience....

[Dr. Jakov Shlik]

Yes.

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

What I see in this section are what appear to be the elements of a strategy or a way forward. Some of the elements or the key ingredients of this strategy include a move toward developing policies.

The first point talks about policies to develop a positive culture and perception in the workplace. Is that a fair characterization?

[Dr. Jakov Shlik]

Yes, it's a fair characterization. It's an assortment of impressions and suggestions as you mentioned, indeed.

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

A little further down you address resources, and you talk about access to care. There is a bullet point that says, “Access to care: specialized assessments and effective evidence-based and research-informed therapies”.

We need resources to ensure those who suffer from OSI or PTSD have the requisite access. Am I right about that?

[Dr. Jakov Shlik]

That's correct.

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

Further down you have a component that deals with education and training on traumatic stress. Yes?

[Dr. Jakov Shlik]

Yes.

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

Then there's technology. This is about leveraging innovation and the developments we have in technology to ensure that those who suffer from OSI and PTSD are able to get the best treatment possible. Yes?

[Dr. Jakov Shlik]

Yes, indeed, technologies can be critical to the empowerment of individuals. They can help people become more capable of dealing with their situations and be open to seeking help when they realize that this is the time. We need to help people to make that differentiation.

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

Obviously, ideally we would be detecting these symptoms at the very earliest of stages so that we could prevent the onset and development of OSI to its latter or worst stages. Is that a fair statement as well?

[Dr. Jakov Shlik]

Yes. We as clinicians know that when an individual comes to seek help, in our minds we often think to ourselves that unfortunately it's a bit late. People do not seek help for a variety of reasons.

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

Very succinctly, could you help us stitch together these elements in a coherent strategy? How do you see these pieces fitting together?

To go back to my original analogy, I see the ingredients here. They are bullet-pointed out, and we can take them out and look at them in isolation. But do you have a vision that pulls all of these elements together for a strategy that works for your institution and that could be applied potentially as a model across the board for first responders?

[Dr. Jakov Shlik]

I really appreciate how you put this question, because it's critical to have a big picture but not to miss important components.

I might not be able to provide a very quick strategical review here at this time, but I see it as a continuum. It's a continuum that starts with the culture in the workplace: supports, openness, and the presence of certain tools and settings. Peer support, for example, is extremely helpful and in great need of empowerment. Peer support has been supportive, always useful, but sometimes it's destructing; that's maybe a separate topic.

From there it is access to care, using the opportunities provided by self-help, by self-education, by group education, and by manager education. Then there's the proximity of services in the community, a network of community providers. Not far from that is the specialized mental health services clinic.

In that continuum, specialized clinics, somewhat analogue to the OSI clinics perhaps, all—

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

Sorry, can I pause you right there?