Evidence of meeting #29 for Veterans Affairs in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was psychological.
A recording is available from Parliament.
Conservative
Conservative
Betty Hinton Conservative Kamloops—Thompson—Cariboo, BC
—so I'm going to get this in as quickly as I can.
When a witness of your calibre comes in front of us with a four-page CV, it's staggering. I mean, you've done enormous things here, and I would not want to argue with you on any psychological points, because you're the expert. But I would want to make one point. I have met many people who had horrible childhoods, with sexual abuse and beatings, and who come from alcoholic families and all of those sorts of things. I can tell you that with many of them, if I found myself in a really bad situation, I'd want them at my back. They are probably some of the psychologically strongest people you could possibly come up with.
As an Individual
And I fully agree, because they got stronger with that stress, and we put them in front of the action. I agree with you.
Liberal
Liberal
Rodger Cuzner Liberal Cape Breton—Canso, NS
Thanks very much.
I do appreciate the points made in this last round. I understand fully the importance of trying to profile these people before we expose them to combat or to the theatre, as well as trying to harden them prior to deployment, or at least allow them to get some appreciation for what they're going to face. I think that's imperative. But sometimes the horrors are so great that there's nothing that can prepare them for those, which was certainly brought out in Tuesday's testimony as well.
I want to get a sense of what you said, that the earlier the intervention on a psychological problem.... Most often in our committee, we focus on the care of the veteran farther down the road, after he's been released and what have you, but what you're saying is that the earlier it's detected the better. So are you comfortable that our medical people on the front lines in the theatre, our senior officers or military personnel, are receiving sufficient training in identifying some of the cues and picking up on some of the triggers, so they can say, listen, we're going to have a problem with this guy and we need an intervention immediately? I would think you wouldn't have enough trained personnel, or psychologists in the field, who would be able to do that.
So just give me your sense of front-line triage on—
As an Individual
That's a good point, and it's always difficult to assess.
Each military detachment has its own medical, but how much psychological support is there? That's why we have the employee assistance program, where I see George if he's ill. So there is a way, and we enable that.
In our mission, we have a police force detachment, and we have an employee assistance program that detects the guy who thinks he's too good, etc., and like Mother Theresa, he wants to say too much and he's doing too much. So yes, we can profile that.
The thing is that I don't know how much the guy can talk in Afghanistan. Of course, I would say you can talk to George, but George is at the same level as you are, and he can help you because he has the same type of gun and the same type of uniform. But you need to talk to Sergeant Professional, because the danger is that if you give that to anybody, it's going to feed the stress instead of managing it. The objective is to manage the stress through the whole situation and not take the risk. Yes, I agree with you that you cannot predict all risks, but if you know the worst scenario, you can react to it.
So is there an employee assistance program? Is there a co-worker to detect that and then go to a psychologist to get a debriefing? I went into a detachment and I had to repatriate a certain person who was talking about being too good. I just had to ride in his car with the UN, and that was enough.
Sometimes, unfortunately--and that's where you see these horror stories on TV--the guy doesn't know he is stressed; he doesn't know he's overreacting. Of course, as a friend, sometimes you're stuck. Is this normal? Is this George today? That's why a professional needs to make an assessment. That's why we tell George he has to go to see the psychologist, who'll tell him he's done enough.
Frequently we have this problem, because we have a lot of detachments in the north where they're deployed for three years. They want to stay for six years, but we say no after three years. They don't understand that they have to come home to real life. They don't know how they're reacting. They're sleeping with their guns in their beds, etc., and that affects their morale, but they don't know. If we check them pre-deployment, and while the mission is going on we audit the mission and review how stressful the situation is—we know how many physical injuries we have and how many psychological injuries—that's where we will save a lot of members from being sick and completely off upon their return.
Liberal
Rodger Cuzner Liberal Cape Breton—Canso, NS
My own police force, the Cape Breton Regional Police Service, has been sending a lot of personnel and have been involved internationally and what have you. Do they have access to the RCMP services when they come back?
As an Individual
Until recently, all the police forces were under the responsibility of the RCMP. We still take police from all municipal police forces. This is paid for by CIDA. And yes, they have the same program. When they return, if the psychological assessment of the force is oui, we send them. We have people deployed in Halifax and everywhere in Canada.
As you know, when you're under a UN mission, if you have PTSD, you can have a pension from the UN. We even build up the file. Boy, if you think it's hard with VAC, it's a mess with the UN. We say this guy is one of our members and is obviously sick, in the rational opinion of an occupational physician. If he's sick, he's entitled to certain benefits, and we will open the door. We don't decide for them, and we don't want to decide for Veterans Affairs Canada. We want to furnish all the appropriate information so that the decision process is made early and efficiently and is good for both parties.
This is the type of case where we need to number these people. In our deployment of the military in stressful situations, I don't know how many casualties we have today that involve psychotherapy, medication, ODS, or off-duty sickness, etc.
Liberal
The Vice-Chair Liberal Brent St. Denis
Thank you, Roger.
Thank you, Dr. Belzile.
You have the floor, Mr. Roy.
After that, it will be Mr. Shipley's turn.
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
Thank you, Mr. Chairman.
Dr. Belzile, Ms. Hinton asked you a question, but I'm not sure I really understood your answer. If I heard you correctly, you said that every individual wanting to serve in the Canadian Forces should be given psychological tests so that we can assess their ability to handle the stress they will be exposed to. Furthermore, you said that the goal is not to reject people and that everyone is hired anyway. That is pretty much what I understood you to say.
I have a problem with that. I certainly wouldn't give a scalpel to someone who is afraid of blood.
As an Individual
Let me explain.
Suppose we are carrying out a mission in Jordan, where we are training police officers. The profile required for the mission in Jordan is the following: we need Canadian Forces members or police officers with extensive experience. They don't have guns and they do not interact with the people. It is possible that some men will have hearing aids and that others will be taking pills for high blood pressure or diabetes. Hospitals in Jordan are like our own. So, those men can go to the pharmacy with their prescriptions.
Others are in Darfur. They sleep in tents and their base is about 200 kilometres away from Khartoum. So, we obviously can't send someone there whose hearing aid might malfunction and break. I'm talking about physical things. If somebody's glasses break, we can't send him to get a new pair of glasses. There is no doctor. What are we going to do if he needs to have his blood pressure pills adjusted or if he runs out?
It's the same thing for a psychological profile. In Darfur, the required psychological profile is that the soldiers not have mental health issues that could require therapy, medication, and so on.
I respect what the member said. Just because someone had problems when he was a child doesn't mean he will automatically be refused, but we do want to see how he is going to react. Some people react positively and gain strength. Others are crushed and remain wounded for the rest of their lives.
Yes, we do reject some. Taking part in a mission pays off. A lot of people line up for the job and I have to reject more than I accept. I have to be certain that a police officer who is 45 years old and wants to go to Darfur for a month—in the RCMP, it's nine months—will be able to get through it. Unfortunately, I have to reject him, not because he is sick, but because he doesn't have the required medical profile and I don't have the medical means of supporting him there. The RCMP has determined that the same medical support has to be provided to members whether they are here or in other parts of the world. That is plausible. In other words, I am not going to tell them they may die of a heart attack. They will be transferred to a high-level hospital where they can receive coronary care. When I used to visit the missions, I would lay out a method of evacuation.
In terms of the Armed Forces, when it is large enough, they have their own base. They have all of that and they do it very well with Germany. Those are the standards that we set.
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
My question goes further than that. When a soldier signs a contract at the time of his enrollment in the Canadian Forces, is he subject to an initial psychological assessment?
As an Individual
Well, I looked on the National Defence website and I don't believe they do psychological assessments. They may establish a profile, but I don't know. So I can't answer that.
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
So, they do a physical exam, but they don't do a psychological assessment.
As an Individual
I really can't say. To do the training, you need discipline—the weak ones break down under the strain—but there is no psychological assessment. We recommend that both the member and his or her family be subject to psychological testing. Who is going to support the guy when he comes back? It's the family.
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
That should be done before they enroll.
As an Individual
Yes, exactly. We have had some problems because of human rights. However, most people agree voluntarily. If we're going to send someone to Africa for nine months, we want to meet the guy's wife, because she will have to help him. Most people agree to that, and we want to see how they react to stress.
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
Why do you think they don't do it? You're a doctor, you have been assessed, and you have been tested. They didn't let you in just like that. Why don't they do it?
As an Individual
The problem is that there are two schools of thought. My area of specialization is medical surveillance. When you work at the Royal Canadian Mint, you have to work with gold, arsenic, lead and mercury. When I do urine tests for screening purposes, I find traces of those metals: that's a fact.
As for psychological tests, they are somewhat more intrusive. Psychologists are a little more reserved when it comes to making a determination. It's delicate. We don't have absolute power. However, increasingly, we do have tools.
The people responsible for protecting human rights, with whom I have often worked and whom I respect, used to tell me that if I ask Mr. Roy to take a test, I will have to test everybody. In addition, they would ask me to prove to them that it would or would not make a difference. I can defend the cases I've handled in the five years I've been implementing the program inside the RCMP. However, I have to justify every single rejection, because the human rights people get on my case and I am exposing myself to a grievance. I have no problem with that, because that's part of my job, but it's not easy. You have to be vigilant: a urine test won't tell me whether the soldier I've tested is a better soldier or not, but we test everybody.
In principle, we should be looking at the quality of our intervention, because that is the basis for our decision to deploy him. That's why there needs to be good equipment. This is what they used to do in the army: they had the best guy, but in terms of equipment, they gave him the responsibility of handling it—pulling the choke to get the vehicle going.
All of that is part of training. If I am given new equipment but haven't been trained… I may have the best radio in the world, but if I don't know how to use it, it's useless. The same thing applies to personal protective gear. Those are often stresses for people.
If I have a bad tank and I don't have the right uniform, because everyone can see me three kilometres away, then I will be stressed out, and when I experience stress, I am likely to fall apart more quickly. What I'm trying to say is that we can always do psychological testing, but there are four criteria: good equipment, good training, good personal protection, and the right medical exam. They are all part of a whole. We have often focussed only on the medical aspect or the equipment aspect. But that's what a medical surveillance program is all about.
Liberal
The Vice-Chair Liberal Brent St. Denis
Merci, Jean-Yves. We can come back to you.
Bev Shipley, please.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Thank you, Mr. Chairman.
Thank you so much, Mr. Belzile, for coming out today. This has been an interesting talk, just as it was the other day.
What coordination is there with the Department of National Defence in terms of research? One issue that's coming about is that we need to spend more money on a number of areas. I'm concerned that we duplicate--I don't think that's wise--but we do need to know what the research dollars are to learn more about PTSD. With that, what progress has been made over, say, the last ten years in terms of knowledge on it?
As an Individual
That's a good question.
I can speak in regard to the RCMP. Interestingly enough, I was at the policy centre, and I tried for some liaison with the military--they opened their clinic recently--but, boy, I couldn't. I mean, the RCMP in the book says we are allowed to go there, but it was so complicated.
Unfortunately, my big brother the military could not help the RCMP in regard to liaison. We had to go à la carte.
The other thing is that of course we professional doctors do liaise one by one. I have a few military colleagues with whom I've spoken, etc., but nothing officially. And yes, I agree with you that the military spends a lot of money on that, the RCMP, and we should sit down and.... There are also a lot of universities with whom we should liaise some coordination. I know that the U.S., etc., had some committees.
So there are a lot of people. How much of this is duplication? How much of this is working on the same vision? It's difficult to know. As the occupational physician in charge of the RCMP, I had problems not with the doctors but with, “Robert, get a PO, an invoice, so I can speak to you”, and so on.