Public Safety Committee on Sept. 26th, 2017

[Nicole Boisvert]

Yes, this is also just PTSD.

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

It's a subset of the mental health issues. That's why we looked at operational stress injuries, not just PTSD.

[Liane Vail]

Exactly. The way I look at PTSD—and I do have PTSD. I was diagnosed in 2012. I can honestly say that PTSD is kind of an umbrella, because my signs and symptoms were more anxiety and depression. There are prevalence rates with anxiety and depression, so if you don't look after those, the end result is PTSD.

There are also social phobia. Those are some of the more common mental illnesses that you will see in first responders.

What is the cost of doing nothing? There's absenteeism. We talked about presenteeism. There are the disability claims—that $51 billion—your injuries, the grievances, the turnover in your staff, and the legal implications based on the fact that it's no longer only physical injuries that we have to look after, but there are also the emotional injuries that can be affected within your workplace.

So what is the solution? The road to mental readiness was developed by the Department of National Defence in 2008 and 2009. Basically, this stems from Afghanistan where they noticed a higher increase in mental illness, so the chief of personnel and the surgeon general decided to pull their resources together. This was unique, because they brought in not only the specialists, the subject matter experts, but also the soldiers. The soldiers could speak to soldiers, just as police can speak to police. There's a peer piece in this program, which is vital to the presentation. A psychologist can get up and name a whole bunch of stuff on symptoms and signs, but if a peer who has lived experience and who is obviously not in crisis is able to talk about it in a way that resonates with their audience, it's much more profound and it has a huge impact on the group that they're presenting to.

What are the objectives? These are the objectives of the road to mental readiness. One of the modules looks at stigma of mental illness. What is stigma? What is prejudice? The program promotes good mental health. It will reconceptualize how participants think and talk. It helps participants identify poor mental health not only in themselves but in others, and it teaches coping skills that we'll go through later on in the presentation. It creates a more supportive environment for all.

The incident that I use is the Moncton shootings, in which we created that supportive environment for those who wanted to come. It wasn't mandatory. It wasn't necessary, but they knew it was there and that was half the battle, knowing that there was support out there for them.

In the past, we've looked at mental health and mental illness, and we've looked at them as being more black and white: either you're fit for duty or you're off sick. In this case, it's green or red. When you're healthy, you're functioning normally; you're able to bounce back and there's recovery from mental illness. You are in the green. Then the other end of the spectrum is the red, being ill, that diagnosable mental illness. The question I ask you is if you have a mental illness, can you go back to the green? Can you bounce back with a mental illness and be healthy and function well?

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

We would like the answer to always be yes, and it is probably the case, but it depends on the mental illness.

[Liane Vail]

Yes, it does.

More serious mental illnesses require more work and therapy, and perhaps more medication. In the case of anxiety, depression, social phobia and post-traumatic stress disorder, it is possible to resume work. This is not the case for all mental illnesses, but it is true for those common to police officers and first responders.

[René Arseneault, Liberal, Madawaska—Restigouche, NB]

I was referring to mental illnesses like acute schizophrenia. Some of my family who suffer from it can't work at all.

[Liane Vail]

That's right.

Here's the mental health continuum. This is really the highlight of the road to mental readiness where it's an introduction of a new continuum model that really breaks down what is healthy, what is reacting, what is injured and what is ill. The important things to look at on this slide are colours: green, you're good to go; yellow, you're reacting. The self-limiting distress; it's something you can look after yourself. Then if you move to the right of the continuum, you're looking at orange and then red. In the orange, it's more severe functional impairment and when you get to the red, it's a diagnosable illness.

That being said, I often in the presentation compare it to a physical illness, which is that light bulb moment where if one of you were to twist your ankle, is it common and self-limiting distress if you twist your ankle? Can you look after it yourself? Absolutely. Would you be reacting to something that you've done to your body? Yes. It's the same thing with mental health. You can have more stress in a week or two weeks and that could put you in the reacting stage. When you go out and you sprain your ankle, maybe it's a more severe functional impairment. Maybe you need to see your doctor, go to physio and get some treatment, see an occupational therapist to help you get back to the healthy stage. When you get to ill, that's a break. It could be a shattered leg or knee. Is that going to take more treatment and more professional help to get you back into the green? Absolutely. Can you get back to the green if you've shattered a knee cap? Yes, you can. You can also get back to being healthy after being diagnosed with a mental illness.

The important factor here is it moves from good to poor mental health along a gradient. It emphasizes the possibility to back and forth along the continuum, and eliminates the need for stigmatizing labels and non-professional diagnosis. I often call it Dr. Google, where behind the scenes we're checking out on Google that we have this and that. I laugh because as soon as I call my in-laws and say that my son has a cold, they think that he has to be hospitalized and that he has pneumonia. There is an extreme. What this continuum model does for mental illness is it takes away the stigmatizing labels. It also takes away all the Dr. Googles in the world because you can actually see for yourself where you are on that continuum.

Last, each phase outlines signs and indicators for self-assessment.

Mr. Arseneault, you asked what the warning signs or indicators were. We have divided this topic into sections.

First of all, there's the change in mood.

When we look at change of mood, you're going to see a fluctuation intensity in severity and a decrease in productivity. Essentially when you move from the right to the left of the continuum, you're in a normal mood when you're in the green. You can become irritable or impatient and that can disappear and you can go back to the green, or you're angry and anxious because of something that's more stressful and you can move back to the green. You don't necessarily go directly to the red. Some people do, and in that case you'll see them easily enraged. You'll see excessive panic. You'll see depressed mood and even a numbness where they feel nothing.

We're looking at the second piece of the signs and symptoms and that's often changes in thinking and attitudes. When we look at thinking, that's more of an internal thing. What are our thoughts? Are they positive or are they negative? What's going on in ourselves when we're looking at our partner who we're working with and we're thinking, “Oh my God, do I have to work with this guy again”, when really on other days everything is fine. Here we look at thinking as internal and attitudes as external.

Is there anybody here who's been sarcastic or is sarcastic, who uses that as a normal kind of humour? Nobody. That doesn't happen.

Then I'm going to ask you, have you ever been sarcastic with an edge and then thought that maybe you shouldn't have said what you said?

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

Every day.

[Voices]

Oh, oh!

[Liane Vail]

Every day? Okay.

I'm going to go into the reacting stage of every day and ask if it is displaced sarcasm, intrusive thoughts, or sometimes distraction or loss in focus. What we see in thinking and attitudes is that as we move to the right of that continuum, we lose our sense of humour. It perhaps becomes displaced sarcasm and can easily turn into a negative attitude, and then we have somebody who, if they're in the red, is non-compliant.

We don't want to get to the red. The whole premise of this program is to identify those signs and symptoms before we get there.

It's also important to explain some of the signs and symptoms of our thinking and attitudes when we are in the red. There are suicidal thoughts that may not lead to suicide, but then there is suicidal intent, and there are people who have taken their life by suicide.

In terms of the inability to concentrate, loss of memory, and cognitive abilities, let's say you're standing there in the kitchen and asking, “Why am I here and what was I supposed to get?” Now, if that happens on occasion, we're okay, but if that starts happening over and over, we're going to have to question where we are on that spectrum.

Then you're going to see physical changes. If you look at the screen here, you'll see that we talk about sleep patterns, appetite, energy, and weight. What do you think is the number one physical change that people will be affected by more than other signs and symptoms in our physical state? Everything else goes if we lack what?

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

Sleep.

[Liane Vail]

Yes. Sleep is very important.

When I was in charge of the return to work, people who were off duty would come into my office and talk about either a medical discharge or a plan for a return to work. Oftentimes, the first question for me to ask was, “How are you sleeping?” Sleep affects everything else.

Then we have changes in behaviour and performance. If somebody who is physically active all of a sudden is a hermit over the course of two weeks to a month, we might have some concerns. Or maybe somebody who has never missed a day of work suddenly is missing one day a week or calling in sick.

These are things that we have to identify. Then we look at patterns. Performance is one. There's procrastinating. Normally speaking, if we're procrastinating, we're reacting to something because we don't want to face it. Then, once you get into the injured, there's avoidance and there's tardiness, and obviously your performance is going to decrease.

In the red, there's the withdrawal and the absenteeism. I also talk about presenteeism, because a very good friend of mine, who for a very long time didn't realize he wasn't well, would come to work because he had to come to work. He would sit in front of his computer and he would answer those three emails and then he was done. You would see him for coffee, and he would look very happy and very content, but inside he was a mess. When he did get the help that he needed, he came back to the green. It's very important to realize that presenteeism is also a sign and an indicator.

We talk about substance use. I'm talking about the legal ones, not the illegal ones so far. Changes in substance use are something that we have to keep track of as well. These are signs and symptoms. This relates to medical prescriptions, as well as alcohol.

All of this is fine. You can look it over, but my clear point here is that what you will notice with substance use, albeit my substance use is shopping.... I love to shop, but I know something's wrong when I'm shopping too much, right? What I'm thinking is, what am I covering up?

When this starts to affect you socially, economically, legally, or financially, it becomes a problem. When there's no impact on any of those venues in your life, then it should not be a problem. Once it starts leading to some trouble, increasing trouble, or affects social, economic, legal, and financial matters, that's when you know that there is something going on and a clear sign of symptoms moving along that continuum.

I'm going to hand out these cards. We pass these out to all of those who participate in this program. There are two different programs that I'll go through. Here you are looking at the five different characteristics. This is where it's important to look at mood, your thinking and attitudes, your physical behaviour, and substance abuse. You can do a quick check in on yourself and see where you are at on that continuum. However, just because you might be in one of those categories in one of those subsections doesn't mean that you're mentally ill. It means to check in and see how you are doing and why. Does that make sense?

[Nicole Boisvert]

Apparently, the sound is going to work now.

We're going to try this again.

[Liane Vail]

Okay.

This program is education based, and there are videos throughout. We're going to show you this one.

[Video presentation]

It's very impactful. Videos like that really resonate with those sitting in the room in this workshop. The big four.... The Navy SEALs in the U.S. were struggling with the passing rates of their applicants. They introduced these, which were borrowed by the Department of National Defence, and they effectively increased the success rate of their Navy SEAL applicants' getting into the program.

With each of the four that are set out as goal setting, there is a definition. There is an activity for the group to go through. They use the SMART goals. How do you reach a SMART goal? It's very interactive. Visualization, also known as mental rehearsal, is where we do a guided visualization and we often give examples of where you could use a visualization that might help to decrease the anxiety level in a difficult situation or talking to somebody about something...dealing with a conflict.

Then there's the self-talk. There's negative self-talk, where most of the time that's what we're saying to ourselves, and then looking at the thinking traps. We're talking about thinking traps that we use as habits and trying to change them into more positive self-talk.

The fourth one we go into is what you could call tactical breathing. You can call it yoga breathing. You can call it calming or deep breathing. But in effect, you practise what I call box breathing, where you take four breaths, then hold for four, then exhale for four, and hold for four again. Again, you can go to Dr. Google and read about it. It's extremely effective in decreasing anxiety right away in a moment of anxiety or crisis.

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

That's what I do during question period.

[Liane Vail]

Do you put your arm up and breathe for four and hold for four?

[Glen Motz, Conservative, Medicine Hat—Cardston—Warner, AB]

I don't put my arms up. I just breathe.

[Liane Vail]

That's what my son says. We have two rules in the house. We take a breath before we're going to say something that we're going to regret, and if it gets really bad, we put the microwave timer on for 20 minutes and walk away until we're okay to come back and talk about it rationally.

Ad hoc incident review is another leadership tool that DND uses. It's to reduce the stress in your team. It is not to replace a debriefing. It is a very quick check in, especially with managers, if you've had a crisis or a negative situation in your workplace. You want to check in with your employees to see how they're doing. Quite simply put, it is “How are you doing”, to acknowledge that it was a tough situation or to say “I'm struggling too.” It gives them the opportunity to feel that they're in a safe environment and are able to reflect on how they're reacting, and if they are reacting over a longer period of time and they're not getting back to their normal, then obviously they can self-manage and get the help they need.

In terms of scenarios, I worked with Suzanne Bailey, who was instrumental with the Department of National Defence in this program. She by far says that in order for this to be successful you need this piece. In the leadership package, you have eight examples for leaders. The primary package...and the only difference, why there's less in one than the other is that your primary package is four hours, and your leadership package is eight.

We're going to give you a scenario, and I'd like to take a look at it. If you'd like to discuss it with the people beside you or as a group, we can certainly do this. It will give you an idea of.... When we talk about scenarios, you can say, “Oh, okay, that's what they're talking about.”

In the setting of the R2MR workshop, we divide the groups into four or five people, and they're each given a scenario. For the questions that are going to follow this, we're not looking at the team; we're looking at Elizabeth. You learn that the daughter of your subordinate Elizabeth has been diagnosed with terminal cancer. You've noticed that Elizabeth is distracted at work, and tearful at times. Her work is beginning to suffer, and you are concerned. She has been making errors, missing a lot of work, been rude to her co-workers, and refuses to take on any new work assignments.

Those who are working with her are obviously very frustrated, but they don't really know how to approach her. They're also concerned and want to help, but they don't know how.

I'm going to give you a couple of minutes to discuss it. You have your—

[The Chair, Liberal, John McKay]

Ms. Vail, let me intervene at this point.

There was some discussion about what this would be about. There was an expression of discomfort, if I may say, among colleagues with respect to actual scenarios and engaging.

[Liane Vail]

Okay. Very good.

[The Chair, Liberal, John McKay]

So I'm—

[Liane Vail]

We can certainly do this as a group, and I can guide the conversation—

[The Chair, Liberal, John McKay]

Or not do it at all.

[Liane Vail]

Okay. All right. So we—

[The Chair, Liberal, John McKay]

Excuse me for a second. I just want to engage my colleagues here, because there was a level of discomfort expressed to me, and I want to respect my colleagues.