I will be making my presentation in French, but I am prepared to answer your questions in English.
I would first like to thank the Committee for inviting me. I am here as an occupational physician. I would like to describe what such a physician does as part of a medical surveillance program for members of the Canadian Forces.
I have 30 years experience in occupational medicine. As regards post-traumatic stress disorder, the issue being discussed today, I have five years of experience with the RCMP dealing with policy as Chief Medical Officer for the Central Region or Headquarters.
One of my responsibilities relates to international peacekeeping police deployment. Thus far, the RCMP has deployed approximately 2,000 of its members to those countries where the Canadian Forces have deployed their own members. As Regional Physician with the Outaouais Branch of the CSST, or Commission de la santé et de la sécurité du travail, I am responsible for determining the eligibility of people with psychological injuries. Two percent of all work-related injuries in Quebec involve psychological injuries, including post-traumatic stress disorder.
This morning, I would like to begin by explaining what a medical or health surveillance program is, what it means, and what it can offer in terms of managing or getting a better understanding of post-traumatic stress.
Before setting up a program, it's important to know what you're doing. What you want to do is assess risks. Is it possible to assess the risks a soldier will be exposed to, because you can never know what exactly will happen to him specifically, since he is working in an operational setting? I will come back to this point later.
Then there is the question of eligibility. How does one go about recognizing and assessing someone who is coping with psychological problems? Who does that? Is it the military physician or the civilian physician? Where does the member in distress go to have his program assessed? Once it has been determined that he has post-traumatic stress disorder, what should be done? Should he be considered a dysfunctional member and therefore eligible for a lifetime pension? Should he be rehabilitated? What can he do within society? We don't have answers to all those questions, but through a specific program, we are able to find out where we're going.
Training in occupational health provides a way of assessing the risks. With any job, risks are manageable. For example, in terms of chemical-related risks, we know that members of the Canadian Forces are exposed to lead and thus we can do a blood test to ascertain whether the lead level is high.
In terms of physical risks, because members are exposed to noise, we can also do audiograms to determine whether they have hearing loss. That allows us to manage their health problem, if they have one, and to determine whether they should be compensated or not.
There are also ergonomic-related risks. It always brings a smile to my face when I hear on television that the Forces have bought this or that piece of equipment. But, is that equipment ergonomic? Can a soldier sit comfortably for six to twelve hours? I have travelled a few times in a tank, and I can assure you that they were not the best trips I've ever had to make. So, it is important to assess the ergonomic component as well.
There are also biological risks. I am referring here to wars in which viruses, anthrax, and so on are used. There are ways of managing that.
Finally, this morning's discussion deals with psychosocial risks, the famous post-traumatic stress disorder, depression and anxiety.
How does one go about assessing the risks? Well, you need to visit the missions. You have to develop a scenario with respect to how the soldier will be deployed, whether it's to Afghanistan, Kosovo, or somewhere else.
You also have to look at the job description. A colonel who is responsible for communications does not play the same role as a major or a corporal who is in the battlefield. The risks he is exposed to are therefore different. The risk assessment depends on what the soldier is expected to do and the equipment he is given. If he is going to be given a small, uncovered jeep, is not going to be armed and will be asked to go into a troubled area, that is more stressful and unpleasant. That is what we call a risk.
In occupational medicine, there is a theory that may be idealistic, but it involves trying to reduce the risk to zero. Unfortunately, in police and military operations, it is impossible to reduce the risks to zero. There is not a zero risk when someone is on the battlefield or in the process of arresting someone.
However, there are ways of trying to bring that risk as close to zero as possible. There is the matter of the equipment that is provided. For example, for police officers, there is the bullet-proof vest or the type of gun. And the same applies to members of the military. The equipment, the vehicles, and those sorts of things are important. If I know that I am travelling in a safe vehicle, that can deflect bullets when they're fired, I will be more at ease. It will be less stressful.
Second, there needs to be appropriate training. This is often discussed. If I had never driven a tank but will have to do so in Afghanistan, it clearly is not like driving a vehicle here on Highway 148. There are differences. There are excellent training programs in place. Training is important.
Third, there is the matter of personal protection. All the types of equipment that may be provided—for example, walkie-talkies for communication purposes—become very important in this context. Finally, once you have given soldiers good equipment, have ensured they have receiving the proper training and that they have every possible type of equipment they need in terms of protection and communication, there is the medical surveillance program. Who should be entrusted with this responsibility? We all agree that in order to drive a tank, you have to have good eyesight. If you can't see anything, even though you may be a very good driver and have the best possible equipment, you won't get far. So, we agree that eyesight is something that has to be checked.
Now, in terms of psychological issues, it is not quite so clear. In other words, when you have to determine who is going to be asked to drive a tank and who is going to be sent to Afghanistan, you can determine a soldier's skill level or aptitude through physical exams. The military has quite a good program for assessing risks. Someone with high blood pressure and diabetes may become less vigilant and, if he can't eat lunch every day, his sugar level will drop and he could have serious problems. We all agree on that.
In terms of psychological assessment, personality-related tests have been validated to see how a person reacts to stress. In some organizations, that test has been used since 1998. So, we do have some experience with it. However, there is no test that provides infallible results that are accurate 100 per cent of the time. These tests were validated with a view to screening out people who can't work in a stressful environment or have a pre-existing condition that could get worse. If a person has already had psychological problems, he or she will not automatically be rejected, but it is necessary to determine how that person will react. Stress can either crush you or make you stronger. It's important to find out about someone's childhood experiences or exposure to abuse. We have to be careful here. I know my friends who work to defend human rights and I respect them. We are not trying to screen everybody out, but if there is a risk that the person's condition will deteriorate with catastrophic consequences, then I won't expose that person to that kind of outcome. Our medical knowledge in that area is increasingly extensive, and we know that if this kind of person has a problem, it won't work.
In terms of the eligibility of occupational injuries, people always thought that soldiers were guys in uniforms who carried weapons but didn't suffer from post-traumatic stress. However, scientific research increasingly shows that microtrauma, exposure to minor risks, the fear of death, catastrophic situations, a dead child, human remains, and so on can and do affect people. So, we have to deal with that. Often, where post-traumatic stress is concerned, if no screening has been done, the person will end up turning to alcohol, drugs and will ultimately have problems with the law. We try to identify that, because it is absolutely clear, as your witness told you on Tuesday, that when people become dysfunctional, they no longer know what is important and what isn't and they are completely at a loss. Often, certain signs will indicate to us that a person may be suffering from post-traumatic stress disorder. How many times in my career have I seen people being fired from their jobs who were sick. If they are sick, they need to receive medical care and afterwards, we'll see what needs to be done. That still happens quite often. We also know that soldiers, like police officers, are not in the habit of consulting a psychologist when things are not going well. The clinical signs of post-traumatic stress are not obvious.
There are experts out there who can diagnose post-traumatic stress disorder, like Ms. Brillon who was here on Tuesday, but they can't be found on every street corner. There are only a handful of them out there. And it's not easy to diagnose PTSD. Before making that diagnosis, there is a great deal of work to be done. All the different linkages have to be made. It's very difficult to do.
Furthermore, the less a person believes it the more difficult it becomes to diagnose it, and the symptoms get worse. Then they come along and ask us whether the individual is exaggerating his symptoms. When a guy goes to see a psychologist, he is starting to realize why he is dysfunctional. He is starting to understand that on a specific day, when he didn't have time to fire his gun, he was afraid to die in those five minutes, and after that he became dysfunctional. But the diagnosis is difficult to make. Yes, there are some physicians and some psychologists who can. Also, the greater the chances of confrontation, the more serious the symptoms will become, with all the complications that go along with that.
For a person to be deemed eligible, he or she must have suffered trauma. In the past, it was believed that simply seeing this kind of thing on television could cause trauma. Now it's the perception that matters. Legal changes have been made along those lines. In other words, based on medically defensible principles, the fact that someone experienced a fear of death and that there was decompensation when the event occurred could be enough. That's what counts.
In terms of soldiers seeing friends die on television, we have attempted to establish a principle. The soldiers must actually have witnessed the event. For example, it could involve someone who is part of a detachment and whose tank blew up on a mission. We have specific guidelines to follow in such cases. And the case law clearly allows us to set parameters.
It's rather strange to see what determines eligibility in cases involving post-traumatic stress disorder, for both police officers and soldiers. The rumour is that the first application is always rejected. And yet, if a soldier fractured his arm falling out of a tank, that isn't questioned. But that is not the case with post-traumatic stress, and that makes me somewhat uncomfortable. Indeed, if we determine, relying on our diagnosis, that there was trauma, it's easy enough to add it all up. But who actually does that?
The problem is that it is people internally who see the soldiers. That also applies to the RCMP. One may wonder whether their primary responsibility is to ensure that there are people to go on these missions or to ensure that dysfunctional people do not go on them. Three types of specialists are involved in the process. First, medical specialists are tasked with determining whether or not the person is eligible. Then, occupational medicine specialists develop a diagnosis. For example, we might say to an individual that his audiogram is not normal and that the results justify both his receiving a pension and a hearing aid. So, he will then be sent to see a specialist. It is our duty to do that, ethically speaking, as occupational physicians.
Once we have determined the nature of the illness and the compensation that is to be provided, that person needs to receive medical care. Civilians can be called on to provide that care. But the treatment has to be provided in an objective manner. If it's the same psychologist or psychiatrist providing the treatment, one may wonder how things will turn out. The there is the whole rehabilitation process. That means supporting not only the individual, but his family as well. In terms of disability, we don't have any direct statistics. On average, a post-traumatic stress disorder case lasts from two to seven years. In cases involving real trauma, the chances of an individual going back to work are said to be about 30 per cent. However, he can do something else. I will close on that.
Thank you.
