Evidence of meeting #7 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 ptsd.
A recording is available from Parliament.
Clinical Director, Operational Stress Injury Clinic, Royal Ottawa Health Care Group
Yes, of course.
Liberal
Marco Mendicino Liberal Eglinton—Lawrence, ON
I'll tell you the reason I asked the question. For those of us who are learning about this subject for the first time in a serious way, I think you can imagine that it can be a rather overwhelming subject to tackle. Just by sheer volume, and disparate views on how to address this important health issue, I have found in the early stages that is there not a lot of uniformity. What I am going to try to extrapolate, as we move our way through this study and through our witnesses, are some of the common themes, which I hope we'll weave into a committee report.
Perhaps not today—it doesn't seem we'll have the time, given what's left—but if both of you could turn your minds to this question when you leave here, I think we'll be able to build on it as we make our way through the course of this study.
Professor of Psychiatry, University of Manitoba, As an Individual
I think that's a great idea.
One thing I want the committee to be aware of is the model of stepped care that's talked about.
If somebody is struggling with emotional difficulties, they get their care and support in the primary care clinic. If they're still struggling, they move to specialized care.
I really want to underscore what you were describing. That early intervention in the first year of the onset of these conditions is really an important timely piece. We have shown in Manitoba that, with people who have their first diagnosis of a mental health problem, the first year is the time of highest risk for suicide. So I really support what you're saying, that we really need a systematic approach and screening and development of services. I think the challenge is that you have provincial, national, and workplace issues. It's really important to try to interact with those three.
Liberal
The Chair Liberal Rob Oliphant
Thank you very much.
We have time for one more questioner.
Mr. Doherty, you have five minutes.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Mr. Chair.
I want to thank our guests, as well as my colleagues across the floor.
As my colleague Mr. O'Toole has mentioned, I'm deeply passionate about this. This is something I'm very familiar with and I have spent a long time working with those who have been inflicted with PTSD. I have had a lot of colleagues, over the years, who have been dealing with this.
I'm going to direct a few questions, but I'm going to do a shameless self-promotion, if I can, because my passion and my belief in this area and why it's so critical—and I applaud this government for taking this on—is that this discussion is long overdue. That is why I tabled Bill C-211 calling for a national strategy and the development of a national framework dealing with PTSD in first responders and veterans.
Specifically for the areas of concern that we've been talking about here and some of the intricacies in dealing with what our guests are talking about, there has to be a national strategy that deals with and then can build on the standards and consistencies among all of the levels of first responders or the classification. This means the terminology, the best practices, ultimately the care and education, looking at pre- and post-vulnerability, dealing with the very real stigma attached to PTSD, so that our first responders or veterans have the ability to come forward and have a voice, and that we've armed their colleagues and families with the tools to be able to deal with and recognize the concerns and the challenges as we move forward, and the warning signs, so that we don't lose another person.
I do have a question for Dr. Sareen.
In your testimony before the Senate Subcommittee on Veterans Affairs, you referred to a concept called “the rule of thirds” and you indicated that a third of OSI patients can be expected to have a full recovery, a third will have a moderate recovery that leaves some remaining symptoms but it enables a patient to function well, and another third will continue to struggle over a long period of time
I have to challenge you on this. I'm not quite sure we can erase the traumatic incident from people, which they've experienced. I agree on recovery. I think we can provide resources and the ability to cope and to lead a productive life, but I'm not quite sure that we can fully recover, as with any other mental health issue.
Dr. Sareen, can you provide a little bit more insight as to how you came to that recommendation that there can be full recovery on that? I'm interested in your comments.
Professor of Psychiatry, University of Manitoba, As an Individual
It's a very good point.
I'll tell you where I learned that first. I learned from my first supervisor when I was a resident about the prognosis of emotional difficulties. In the DSM, the Canadian Psychiatric Association and the American Psychiatric Association, the idea that someone who.... I agree with you that you never erase the traumatic event, but people can recover and have amelioration of their symptoms and get back to the highest level of functioning. They still have a—
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Let me interject for one second.
In my opinion, it is comments like those, unfortunately, from academics and our medical profession— again, we are all learning as we move forward with this to fully understand the scope of it—that then lead to those who are suffering.... They may go back to work, because as somebody has said there is a full expectation that they can recover, but then another traumatic event comes up, or a flash, and they are again having to go off.... It puts the burden of proof back onto the person who is suffering to demonstrate that he or she is not fully recovered.
Would you agree with that?
Professor of Psychiatry, University of Manitoba, As an Individual
It's a controversial issue. On the one side, you could say that a person who's ever had some PTSD will never be able to go back to work, and that's also a challenge.
I completely agree with you that we don't want to put people at risk of trying to show that they are ill or anything like that, but I guess it is a challenging issue. I can understand your perspective.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
I have just one final comment. This is to Dr....
Do I have time?
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
The comment is about not having a national resilience program or a program that is national. I think we have a great tool at our hands, the road to mental readiness program that the military and the Royal have been implementing. I think it deals at the earliest point of induction into either the military or RCMP or first responders. I think it is a great model that we can move forward with.
The one other thing I would probably recommend is that we also include 911 or emergency call dispatchers in this area.
Liberal
Liberal
The Chair Liberal Rob Oliphant
I want to thank our witnesses for your truly expert testimony today.
We're just going to take a few minutes as we change the regime and get our next panel ready. Thank you very much.
Liberal
The Chair Liberal Rob Oliphant
Let's reconvene.
I want to thank our witnesses. We have, via video conference, Tom Stamatakis, the president of the Canadian Police Association.
It's nice to see you again—twice in one week.
From the Mental Health Commission of Canada we have Louise Bradley and from Mood Disorders Society, Phil Upshall.
I'm going to suggest that we begin with the Canadian Police Association for a 10-minute presentation and then go to our guests here, only because it always gives us a chance, if the video conference somehow fails us, to get you back in if we need you. If we begin with you, it gives us a little extra chance.
Thank you for your attendance today.
Tom Stamatakis President, Canadian Police Association
Good morning, Mr. Chair and members of the committee. Thank you for the kind invitation to appear before you today as you begin a very important study into the effects of operational stress injuries and post-traumatic stress disorder upon public safety officers and first responders.
With so many new faces around the committee table, I want to begin my remarks today with a brief introduction of the Canadian Police Association, though I am very happy to say that I had the opportunity to meet with many of you during our annual legislative conference in Ottawa. I'd like to thank you for taking the time to meet with our delegates last week.
The CPA represents more than 60,000 civilian and sworn front-line police personnel across Canada. Membership includes police personnel serving in 160 police services across Canada, from those in Canada's smallest towns and villages to those working in our largest municipal and provincial police services and members of the RCMP, railway police, and first nations police personnel.
I should also note that I'm a police officer in the city of Vancouver. I'm seconded from the Vancouver Police Department to the Vancouver Police Union as its president. I'm also the president of the British Columbia Police Association, which is an association of all the municipal police unions in the province of British Columbia, and I am the president of the Canadian Police Association.
I am seconded to these positions while I'm elected in the capacity as president. If I were no longer in that capacity, I would return to my policing career in Vancouver.
Introductions aside, though, the CPA is quite encouraged that your committee has made this important issue one of the first topics you have chosen to study in this new Parliament. As I mentioned, our organization recently concluded our annual legislative conference, at which almost 200 delegates from policing agencies across Canada came to Ottawa to meet with members of Parliament on the need to push the new government to fulfill its platform commitment to establish a national strategy with respect to first responders who are suffering from post-traumatic stress disorder. We're very encouraged by the responses we received from MPs representing all political parties. It can sometimes be an overused cliché, but in this case, protecting those who protect others is truly a non-partisan issue.
Part of the difficulty in this discussion, though, is that there is no single cause for operational stress injuries or PTSD in the first responder community. For some it's a question of a single traumatic event, which is often followed by intense analysis by supervisors, media, and the general public, all with the benefit of hindsight and time, while for others it is built up over years of exposure to some of the worst circumstances. It's almost impossible to predict and extremely difficult to prevent. We also must not forget the role that organizational policy and practices play in this issue.
There's absolutely no question about the urgent need for action. Since April 2014, 77 first responders have taken their own lives. Obviously, not all of these suicides are a direct result of PTSD, but apart from the elevated risk of suicide, almost every officer I know has direct experience and knows a friend, a colleague, a partner who has suffered from what we now recognize as PTSD or operational stress injury.
To illustrate, the Vancouver Police Union recently completed a survey of my own home service in which we reached out to members through their private email addresses to get a better idea of how widespread PTSD might be. In tallying the responses, it became evident that more than 30% of our members meet the criteria to be clinically diagnosed with PTSD.
Surveys conducted in other major police services across Canada by the Canadian Police Association have shown similar results. These results offer a glimpse into the scope of how serious this problem is.
While suicide is obviously the most severe of the consequences that can be suffered, it's far from the only one. Our recent conference heard testimonials from service police personnel regarding their own personal experiences dealing with provincial workplace insurance boards when filing claims for benefits for those suffering from a disease whose symptoms aren't always easily visible. This is why our members have been actively advocating for presumptive legislation to reverse the burden of proof for those who have been diagnosed.
I am pleased to say that a number of provinces have already taken very positive steps in this regard, including Ontario, which is the latest to move in this direction.
Of course, not all the solutions come directly from government, and I will certainly acknowledge that we have work to do ourselves as police leaders, both on the front lines and particularly at the executive level. “End the stigma” is a familiar refrain that recognizes that we all need to work harder to understand the difficulties faced by those who are suffering. It will come as no surprise that in a world like policing, there has been for a long time a culture that encourages our members to tough it out and work through problems while still pulling your weight as part of your policing team, whether on patrol or as part of a specialized unit within the service.
Everyone from partners to supervisors must work harder within the policing structure to understand the signs and to reach out with a helping hand and the necessary assistance when one of our colleagues needs it the most.
I should also note that police associations across Canada have made tremendous progress in recent years in addressing the issue. Employee assistance programs, peer counselling, and psychological health and safety standards are all innovations that have been pushed by front-line representatives.
Despite all of that, there is still a tremendous lack of research into the issue itself, particularly with respect to first responders, and I believe that is one major area where the federal government can play a significant role. While a number of organizations have taken steps to begin to better understand PTSD, there is a lack of focus in this area that could be addressed with federal leadership. As president of the CPA, I'm approached regularly by researchers and groups that want to be more involved. However, without proper coordination, there is a serious concern that any new resources might not be used in the most effective or efficient way possible.
Underlying all of this is one very important point. While any action plan needs to engage professionals across a number of disciplines, from academic researchers to psychiatrists, this must be a process for and by first responders. I firmly believe that for any new project to have the necessary credibility among those who need it the most, it must be driven by those with a serious understanding of the particular culture and environment that is unique to the first responder community, and I hope the committee can help us reinforce this important point. I know the time here today is limited, so while I could continue for some time, I've always found the greatest benefit in appearing before a committee is the opportunity to answer your questions.
I'll conclude here and I'll reiterate my thanks for the invitation here today and for the work you're all doing taking on this study. I know I speak on behalf of my front-line colleagues when I say that we appreciate your efforts and I look forward to seeing some action on this front.
Thank you.
Liberal
The Chair Liberal Rob Oliphant
Thank you very much.
Now we're going to turn to our other witnesses. You have 10 minutes together. I don't know how you're going to split that time.
Thank you.
Louise Bradley President and Chief Executive Officer, Mental Health Commission of Canada
Thank you very much. I'm absolutely delighted to be here today to talk about operational stress injury and post-traumatic stress disorder.
I'm Louise Bradley of the Mental Health Commission of Canada, and I'm joined by Phil Upshall from the Mood Disorders Society of Canada. Together, our organizations are poised to act quickly in a critical area, thanks to internal knowledge, and strong and existing stakeholder partnerships in Canada and worldwide.
Canadian first responders and public safety officers bear the weight of tremendously responsible jobs. These unsung heroes are quick to act in times of crisis, courageously putting their personal safety at risk in an effort to help others. In a relatively short time, the true toll exacted by this work has become the focus of an impassioned national dialogue. The safety risk faced by first responders goes well beyond their physical well-being. That's why it's heartening to see the federal government showing leadership and taking an active role in confronting the reality of occupational stress injuries like post-traumatic stress disorder.
It's important to note that the mental health concerns of public safety officers are not limited to PTSD. They include a range of problems, from depression and somatic and psychosomatic complaints to chronic fatigue and difficulties with alcohol and other substances. We know the suicide rate is approximately 30% higher than comparison groups, while marital problems are twice as prevalent.
Thankfully, the collaborative work spearheaded by organizations like the commission is lending a voice to this quiet crisis. Our efforts are centred on empowering first responders by exchanging knowledge, sharing best practices, and leading cutting-edge research.
Among our seminal work is the adaption of the road to mental readiness program, referred to as R2MR, which is a program that was originally developed by the Department of National Defence and designed to foster stigma reduction and mental health promotion in the Canadian Forces. The Mental Health Commission has taken this excellent blueprint and modified it to reflect the needs of police officers, firefighters, paramedics, and other first responders. Participants are familiarized with a mental health continuum model and provided with a simple, colour-coded self-assessment tool with clear indicators of good, declining, and poor mental health. R2MR also focuses on teaching a set of cognitive behavioural techniques that help manage stress and build resiliency.
Currently, more than 500 police, firefighter, and paramedic organizations across the country are partnering with the Mental Health Commission to deliver this training. Within the federal government, our partners include the RCMP, which has agreed to deliver training to its 30,000 employees. The recognized need for R2MR is overwhelming. Meeting the demand is among our significant challenges.
It's certainly an area where the allocation of more resources would have a significant impact. To date, the Mental Health Commission has also conducted two train-the-trainer courses with Correctional Services Canada—one in English, one in French. They are rolling out R2MR to corrections personnel as we speak. We're also doing work at the provincial level, both in corrections and with other first responder groups.
I'd like to touch just briefly on our efforts to support the training of Ontario's 30,000 regular and volunteer firefighters, which began in February of this year. We are particularly honoured that the R2MR has received the endorsement of the Canadian Association of Fire Chiefs.
Our work with first responders also extends to the provision of mental health first aid. Offered in over 20 countries around the world, mental health first aid consistently offers key results for those who participate in the course, namely an increased awareness of the science and symptoms of mental health problems and decreasing stigmatizing attitudes. The importance of this training also extends to the promotion of good mental health and prevention of mental illness among first responders themselves. In 2013, more than 40 fire departments, 30 paramedic organizations, and 80 police organizations, as well as the Department of National Defence, delivered mental health first aid training.
We're also working to adapt mental health first aid for use by veterans and their families.
As president and CEO of the Mental Health Commission of Canada, I feel very fortunate to be at the helm of this organization at a time when so many positive initiatives are being undertaken. However, I'm even more hopeful about the positive outcomes that may result as mental health becomes an integral part of workplace safety training, for which the commission has given a great deal of time, effort, and research.
Now, more than ever, we're in a position to equip our first responders with life-saving tools and training. As far as I can see, it is a societal obligation. Ultimately, to neglect the mental health of our first responders is to put the welfare of our communities at risk, and that's a risk we cannot take.
I'd now like to turn the rest of the remarks over to Phil Upshall, who's going to tell you about a proposal that will help ensure first responders seek help, and that it's met with informed and supported care.
Thank you.
Phil Upshall National Executive Director, Mood Disorders Society of Canada
Thank you, Louise.
Thank you for the opportunity, Mr. Chair and members, to be with you today.
My name is Phil Upshall. I'm the national executive director of the Mood Disorders Society of Canada.
Before I start into my quick remarks, I'd like to point out the fact that Syd Gravel is sitting here with us today. Syd is the co-chair of the Mood Disorders Society of Canada's peer and trauma support team. Syd has lived and continues to live with PTSD and its impact, as a former police officer in Ottawa. He's well informed on both the national stage and the provincial stage, particularly in Ontario as it looks at it's WSIB issues. Syd and his co-chair lead our peer support and trauma team, which is the largest peer support team in Canada, and probably in North America, directed specifically at first responders and people who have significant issues with PTSD. If you want to talk to him later on, you're more than welcome to. He's really a great guy.
The Mood Disorders Society of Canada is a national consumer-led, patient-led, and caregiver-led organization. All of our team, including me, have lived with mental illness, at one stage or another. My associate national executive director, Dave Gallson, lives with PTSD, having lost his legs in a terrible accident. It took him a year to recover physically from losing his legs, and it's taken him many years to recover from the PTSD associated with it.
My senior research person and project manager, a fellow by the name of Richard Chenier, is a former RCMP officer whose colleague was shot to death while he was writing up a report. He lived with that trauma for 29 years before he got the proper help.
Now I'm going to have to really go quickly.
As we outlined to the finance committee a few weeks ago, 85% of first responders and veterans dealing with mental illnesses, including PTSD, go to their primary health care provider. Regardless of all the other opportunities out there for help, if someone is going to go for help with PTSD, most go to their family physicians. Sadly, many of them, over half in many instances, leave without adequate care.
I'm not going to remind you of PTSD's significance today. Because of the expert advice you've been given, I won't get into what PTSD is. But from our perspective, PTSD is an issue that does not need to come to fruition, if you like, if early diagnosis is available and if help in the community in which that person lives is available.
Mood Disorders Canada learned about this problem when people phoned us and asked, “Where can we get help? There's no help for us.” We would refer them to the armed forces, Veterans Affairs, or their own police department, and they would always come back saying there was no help.
The first thing we did was ask, “How come?” We held a meeting. It was called Out of Sight, Not Out of Mind. At that meeting, it became very clear that we needed to attack the problem in a very significant way. As an organization with limited financial resources, we chose to focus on one thing, and that was family physicians and health care providers. They are the door. They're the gatekeepers. They're the first ones who see people living with mental illnesses. They are not taught appropriately in their medical training with regard to mental illnesses generally, and certainly not with regard to PTSD.
We have a very good working relationship with the College of Family Physicians of Canada and the shared care community, including all primary care providers. We've talked to them about working to engage them in the business of learning about PTSD, and they're all on board.
Liberal
National Executive Director, Mood Disorders Society of Canada
Thanks very much for the opportunity. I'm happy to respond to any questions.
Liberal
Liberal
Sven Spengemann Liberal Mississauga—Lakeshore, ON
Thank you, Mr. Chairman.
Ms. Bradley, Mr. Stamatakis, Mr. Upshall, thank you so much for joining us today. I think I speak for all members of the committee when I say we're extremely grateful to have this opportunity to conduct this study, and we are grateful for the opportunity to hear your insights this afternoon.
For the benefit of Canadians who may be listening or reading the transcript later, and for the benefit of the committee, I wonder if we could start by taking a closer look at the human costs of what we call OSI, PTSD, the mental stressors we're talking about. What exactly is it? How do the individuals react who are exposed to these circumstances? How do their families react? How destructive a force is it? With examples, if you can, could you illuminate this issue for us and paint a picture of what we're talking about?
National Executive Director, Mood Disorders Society of Canada
How about the fact I got a call yesterday that a first responder had killed himself? That's a pretty big impact.
How about a family that's broken apart with six kids? The person involved with PTSD is totally unable to cope with life, after asking for three or four years for help. The family breaks apart. There's no income, no disability payments. Those are just two of hundreds of thousands of issues in terms of the cost. I leave it to the others to comment as well, but it's very significant and it's a totally avoidable cost.
President and Chief Executive Officer, Mental Health Commission of Canada
I can provide a personal example as well.
My niece is a police officer, 24 years of age. She called me after her first call-out in the middle of the night to an abandoned car and she said to me that the woman had died by suicide. She told me the woman's face looked like a Halloween mask and she had to stay with that person for about an hour before help arrived. She went on a few weeks later to have other similar situations. She's 24 years old and I think it's safe to say that's pretty traumatic. The expectation was that she go back to work the next day. Had she broken her leg in the line of duty, it would have been different.
Fortunately, I am head of the Mental Health Commission. Not everybody has such an aunt. I pushed her to get help and she's doing well, but it's an ongoing process because these situations are very real on a daily basis, and I'm sure our police officers have many examples.