Veterans Affairs Committee on March 1st, 2007

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

These are the early days of PTSD, so you're pretty confident that as we develop more data—

[Dr. Robert Belzile]

Yes. Definitely.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

That's the one thing we're having problems with: benchmarking from other jurisdictions that are also dealing with the same—

[Dr. Robert Belzile]

That's the big problem. The military are very concerned about their data. The RCMP is very concerned about their data. That's it.

Somebody--and I don't know who, and I don't have the solution--should share. Usually occupational physicians share that information, because we don't have numbers; we're not there. This is a thing we can share, because we don't have names. We don't have to say that in Afghanistan we had more than in Kosovo--no. We just share.

[The Vice-Chair, Liberal, Brent St. Denis]

Thanks, David.

Thank you.

We're going to Ms. Hinton, and then to Gilles Perron.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

This is fascinating. I have a few concerns, and David just raised a couple of them. I would be very surprised to learn that there isn't any psychological testing done on RCMP, firemen, or military personnel before they're deployed. Surely there's some sort of testing.

You're coming from the RCMP side of it, and I would like you to reassure me now that tests are done as you enter the police academy that tell you what you can handle psychologically and what you can't handle. Canadians would be very reassured to know that there is actually some testing done.

[Dr. Robert Belzile]

I don't want to make a statement that would.... I can tell you that the only force in Canada that has compulsory periodic health assessment is the RCMP. It's every second year. That's the only force officially, the only police force.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Is that the case at the Sûreté du Québec?

[Dr. Robert Belzile]

No.

I'll tell you how we're getting that. This member from the OPP wants to go to Darfur, and he has never had a medical. He had a medical when he graduated from the Aylmer police force in Aylmer, Ontario, but nothing else. We find out he has blood pressure problems, he is diabetic, and he can't see, and then he's upset because I can't send him to Darfur. This is a hypothetical case--it's not the truth--but this is the situation.

No, the only police force that has this medical is the RCMP. I had to go to the Commission d'accès à l'information. What would be the...?

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Do you mean the Privacy Commissioner?

[Dr. Robert Belzile]

Yes, privacy. I had to document each question with the commissioner, and it was a very good thing. I substantiated each question of this three-page questionnaire with the access to information, because it was built up to assess the physical and mental capacity of the police officer to protect the public, to have a gun, and to arrest people. When you arrest people, you don't only shake their hand; sometimes you have to be a little more forceful. These questions were blessed by the commissioner.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

I have a great deal of respect for police officers. My uncle was one for many years. You just reassured me. I would like Canadians to be assured that before they give a gun and the authority of a badge to someone, they actually are testing, and I was pretty sure they were testing. If that's going on every two years, that's reassuring in itself.

Maybe you're not in a position to answer this question, but it's one of the standard ones I have. Do you think there's any difference in the needs for traditional and modern-day veterans in terms of PTSD?

[Dr. Robert Belzile]

Definitely. For the new veterans, we have to have early intervention and do it right away. We have to recognize it, etc. Unfortunately--and this is an observation, not a criticism--the old veterans suffered a lot. I had a few who suffered, and that was terrible, but I think we're doing better with that. These types of committees are recognizing that; the public communication is helping.

We still find these horror cases who have suffered alone. These people have worked for our country. The thing is, as people say, the person resists going to see a doctor. He is military. What do you want? It's the type of question. This guy probably knows more than I do. The military has training--legal training, communication training. We don't know if he is undercover or not, so is he going to tell us the truth? It's an assessment, and you need a specialized person.

Of course, dealing with Veterans Affairs as a family physician--and I'm speaking for myself--is a little difficult. It's paperwork, paperwork; sometimes it's in Gatineau, sometimes it's in Ottawa, sometimes it's in Charlottetown. The thing they say to the guy is that he's missing something. It's always us, the poor family physicians, who did not complete the right form at the right comma. With my experience as a family physician, I try to help these guys. I said I'm a specialist in forms, so I should understand that, and I'm trying to get the communication.

The process is very complicated, to say the least.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Well, I think we're on the same page on a lot of issues, Doctor.

I'm glad you recognize the difference also between traditional and modern-day veterans. So I go back to the original question that I asked you.

We talk about the traditional veteran, and there was an enormous stigma attached to any kind of admission at all that you couldn't handle what you had gone through, that you had some psychological scarring from it. I've been dealing with traditional veterans for so many years, and I've found that just in the last couple of years many of them are now opening up and talking about their experiences. They're going to talk to children in schools to relay what happened in their lives.

So that healing process is long overdue, but at least that ability to get the message out about what you've suffered, what you went through, is now happening for our 80-plus-year-old veterans.

Going back to what I asked you before, what can Veterans Affairs Canada do to change the negative stereotype for veterans who suffer from PTSD? What can we do that makes it all right for them to say, here's how I feel, here's what I went through, I need help?

[The Vice-Chair, Liberal, Brent St. Denis]

Thanks, Betty.

[Dr. Robert Belzile]

That's a good point.

Well, usually from my observations they get this message: “You have your pension for PTSD, George, and here's what you're entitled to, psychological support.” Then he goes to the psychologist, and the psychologist says, “Oh, they don't want to pay me. They say you need only two visits.”

I think there's confusion around helping the member. Once he's entitled, and he's had all this fight, the thing is that there should be a support person. I know

for veterans, there is the Royal Canadian Legion.

You could have the communication you were entitled to have. Many times as an RCMP doctor, I told them, “You're entitled to that.” But then they'll say, “No, no, if I go more than five times to the psychologist, they'll say I have a problem.”

So I think that it's not clear what they're entitled to, it's not clear who supports them. What we have is a liaison officer whom they can call. You know, it's an extension of an employee assistance program. If you call Veterans Affairs, you always have the wrong person at the wrong time. It's very complicated.

I'm a doctor and I have special privileges, even in the RCMP. I know what box to call. But if this box doesn't answer me, where do I go? For the poor little guy, you know.... I had one who called Gatineau; he was in Charlottetown, and it was for a simple thing.

So communication is poor. It needs to be improved. Usually where we have a process, we build it up: “Okay, George, your case manager is Ginette.” Well, he calls Ginette, and there's no specific.... If he wants a pair of shoes, it's x; if he wants psychological treatment, it's so complicated. So that's what is making life difficult.

They say to me, “Okay, I have post-traumatic stress disorder, I can be treated, I can talk about it, but every time I want something, boy!” These people, unfortunately, get upset with that. They get upset, and then they close the line. They say, “George is upset, don't speak to him”. You send him a registered letter; “George, don't call here anymore.” You know, that's part of the disease. They get dysfunctional and they don't understand what should be understandable.

So you have to make the process easier, and it's working with that easier process.

[The Vice-Chair, Liberal, Brent St. Denis]

Thank you, Doctor.

Gilles Perron, please.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Robert, I guess I'm going to get into some gossip here. You can either confirm or contradict what I say. I think there are some serious problems. I have been interested in post-traumatic stress disorder since 1998.

I want to say something to Ms. Hinton. Yes, there are a lot of older veterans, the ones who fought in World War II and the Korean War, who have serious problems. Since 1998, every year, on November 11, I attend the ceremony marking the end of the First World War. When you see men 85 and 90 years of age crying, it's because they have problems—mental problems. This is not the kind of event that should move people to tears. If a veteran cries, if he trembles, it's because he has problems.

The other thing that happens with our older veterans—and Pierre, who is here today, can confirm this—is that they get together at the Canadian Legion. I have nothing against that organization, but the guys deal with their post-traumatic stress by knocking back the gin. That's what they've been doing ever since they came home from the war, because before the war, they didn't have a problem with alcohol.

The wife of the President of the Canadian Legion in Deux-Montagnes, Victor Smart, told him that he was a good guy, but that his way of dealing with his mental problems was to knock back the gin. The way to treat post-traumatic stress is to change the attitude that is prevalent in both new and older veterans, which is that a soldier or a guy who has been to war and has mental problems is weak, a nobody. At Valcartier, psychologists work on the second floor: soldiers call it the “stairs of shame”. They climb the stairs to the second floor to meet with someone who is going to check to see whether they have problems—between the ears, that is. I have to apologize for using such a vulgar term, but the fact is they are considered to be fags. We must try to get rid of their fear of receiving treatment.

There's another problem I'd like to raise—I have no experience in this area—and you can tell me whether I'm right or not. Towards the mid- or late-1990s, people began to take an interest in post-traumatic stress. I'm wondering whether we currently have enough psychologists with training in that area, or in something similar, to identify people with the disorder and provide the appropriate care. Should we not be training more of them? I get the feeling that it may be a new science or a new disorder for them as well. Could we not do something to try and train more of them?

I also want to answer David. In the Canadian Armed Forces, as Ms. Brillon pointed out—and she does deal with Valcartier, Quebec—there are no psychologists.

[Dr. Robert Belzile]

Since they don't consult a psychologist voluntarily, we decided to go and visit them and to do our own assessment.

When I go to Port-au-Prince, the psychologist and myself each take half the members and arrange meetings with them. We have a short list of questions we ask them to determine whether they are experiencing stress and how they're functioning. We visit their facilities and then we do our evaluations.

We should be doing this for the solders currently in Afghanistan. The people on the ground there now who are giving them band-aids are not the ones that should be doing that. I don't like the word “audit”, but it refers to the kind of assessment we carry out. In my case, when a soldier comes back, I tell him to come and see me. That's what we do. We identify the health issues, and that's what has to be done.

There is also a second aspect to this. There are a great many psychologists in Canada, but there are not enough of them with expertise in post-traumatic stress disorder, and it's important to ensure that they know something about this. In other organizations, people wanting to treat PTSD were told they would be given training as to what to expect and what our objectives are. That is a form of agreement that we reach with these people.

Whether they are inside the Canadian Forces or not, the problem is that their salary is paid by the same organization in both cases, and there can be an appearance of conflict of interest.

Supposing Dr. Perron is the Canadian Forces psychologist and a soldier wants to come and meet with him. That person has the ability to take away his right to function, and so on. So, there has to be a Canadian Forces psychologist to set the standards to determine what he will be paid by way of compensation, how that will be done, who is to be referred to independent resources, and so on, but initially, that person has to be seen by an independent psychologist, and then by the military psychologist who can validate the decision. We cannot—and that is the problem in the Canadian Forces—ask a psychologist to diagnose PTSD, to treat that person and then decide when he can resume his duties. Unfortunately, a single person cannot wear all three hats.

From a professional standpoint, the Canadian Forces need psychologists to assess what their requirements are, keep statistics and pass them on to the committee to determine what needs to be done, but there is also a need for specialized resources. Furthermore, you can't make a soldier travel from Halifax to Montreal, or from Montreal to Vancouver, and so on.

It is possible to build such a system. I have worked for national organizations. We had our psychiatrists and our psychologists in each region, and each province, whose work was validated by an administrative psychologist who would tell us that such and such a treatment would not necessarily work. So, there are proven treatments out there. But you need to be careful, because people suffering from PTSD are manipulated by all kinds of psychologists. As far as we're concerned, the treatment has to have been proven. Sometimes someone suffering from PTSD will be told to go and consult a naturopath and eat flaxseed, and so on, but that won't help him boost his moral. And that's the reason why we need people who know something about this. The Canadian Forces needs psychologists, managers, and external specialized resources that are authorized by the Canadian Forces and can work independently to provide a diagnosis. And we need to be visiting our military personnel on the ground to see what is happening in Afghanistan and what level of stress they are exposed to.

We had a questionnaire for assessing the stress level. We want to know whether all our people in Afghanistan are sleeping properly. We can find that out by visiting them. In occupational health and safety management, it works on the basis of a pyramid model. At the base, if you have a lot of people who are not sleeping, there will be other ones at the top of the pyramid who are depressed. That is absolutely clear. That is how you manage it. So, when you go to see these people, if you see that they have huge bags under their eyes and that they haven't slept for a week, and that when you go to bed there you can't sleep because there is too much noise, that gives you an idea of the stress level. And the next day, they have to operate a tank, and so on. It's when they're exposed to stress that they are likely to go to pieces. So, that environment has to be known to you, because when people suffer from PTSD, what is important is what is going on in their head before, during and after.

[The Vice-Chair, Liberal, Brent St. Denis]

Merci.

We have Mr. Cuzner. Peter was delayed due to a flight, so we're going to put Peter in, if he'd like, after Rodger. Then we'll go from there.

Thank you.

Rodger, go ahead, please.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

I've just one question.

With your CV, it's obvious that you have international experience. I'd like your comments on how we stack up against other nations. Are there areas in which we lag behind in dealing with PTSD? Are there areas where we're really at the forefront, things that we're doing really well? Maybe we could have your comments on that.

[Dr. Robert Belzile]

I can speak only about the police force. I think there we're very proactive. We're proud of the program. In fact, we're one—

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

But you exchange with other police forces in the States?

[Dr. Robert Belzile]

Yes, because when we go to Port-au-Prince, Haiti, we visit all the police forces there and we visit the members. As you know, our members are scattered with other members from around the world, so we know.

Our pre-deployment, medical and psychological assessment is unique. Maybe France or another country like that has something, but the Americans were not there where I went. In regard to the visits, they find that excellent.

We visit all the UN and all the people. It's not a secret that Canada has an excellent reputation in regard to international peacekeeping missions most of the time. I think the chief of police officers in Abidjan, Côte d'Ivoire, was an RCMP member. The one presently in Haiti was also an RCMP member. So our reputation is good.

But this liaison that we have through the deployment of police officers with the UN creates more credibility. We improve the UN process, and it's an observation, not a criticism, that sometimes it's long and complicated, etc.

So in terms of the police officers, I would say we're proactive and we're very well respected. We're doing an excellent job. You could go and ask our members who work under our responsibility, and they would say the same thing. I hope so, anyway.

[The Vice-Chair, Liberal, Brent St. Denis]

Rodger, is that okay?