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
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Do you see that being the same issue here? Because if that's an issue, then that's the first thing that needs to be dealt with.
As an Individual
We should have regular discussions with Veterans Affairs. I don't know about the military, but unfortunately at the RCMP we had difficulty. Of course, the RCMP was a small player, at 17,000 members; the military was at 60,000.
Sometimes we'd wonder, why did they refuse that? But funnily enough, they were doctors from Veterans Affairs. I think we should have been speaking together.
Elsewhere, if I'm talking about Quebec and Ontario, we have committees of people who work at different levels--at the pension level, at the treatment level. We have committees on post-traumatic stress disorder, looking at the best treatment and how we should do this.
I did leave the force on September 1, 2006, but I must agree with you that this was very difficult.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
What sort of cooperation do you see? Maybe you can't answer this, but we are not the only country experiencing this. There is a lot of research and knowledge in other countries. The United States and some countries in Europe obviously are going through the same sort of thing. Does it make sense to you that we rely on some of their background and coordinate these?
As an Individual
Definitely. The last committee I attended was with the U.K., Australian, and U.S. military, and it was about medical issues from immunization. What we were looking at was management of the risk of a deployed member or an officer in all these countries: what kind of immunization did we offer him, what kind of medical support with regard to psychological, physical, etc.
As you know, there are all these UN clinics—it's an observation, not a criticism—and sometimes they don't have Canadian standards. For example, in Haiti, it's the Argentinian ARDA, and sometimes we have to liaison with them. There are committees to improve that, but I don't know how official that is. When you work for the UN, you take the position they give you, and you're trying to negotiate from there.
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Yes. I wouldn't want to suggest that the UN's the answer to a lot of things. But when we're talking about post-traumatic stress, do you have any idea of the percentage of actual people—and you're mainly familiar with the RCMP, maybe some with the military—who will need to be treated?
As an Individual
In the force—and I'm talking about my numbers when I left the force—it was 2%. Funnily enough, at the CSST, the Quebec compensation board, which is the only provincial compensation board that has entitlement for psychological illness, it's 2% of our workload. We have 300,000 cases a year, but 2% are psychological.
The problem with psychological impairment or entitlement of a disease is that they lose double the time. If, on average, any injury is 250 days, it's 500 days. That is the problem.
The other problem with a psychological illness is not only that it is twice as much lost time, but there's a percentage who are totally disabled. They don't have any capacity to return to work at all. That's the concern.
The numbers are not that bad. I'm talking about the RCMP and CSST; that's where I have numbers. I don't have numbers for the military. But at the end of the day, double the lost time and up to 50% are completely disabled for any return to work, etc.
Unfortunately—I'm just going to finish with that—the statistics for 2006, that was the old school. As you know, with PTSD, the new school is early intervention, early entitlement, rigorous management by competent psychologists, with EMDR, etc. If you send them to any psychologist, they'll know about all the bad things in their life from zero to 10, but it won't work positively in their return to capacity. So we feel that once we take the entitlement, we should have some control of the treatment. If you see anybody, they say go to a naturopath, etc. They might feel better, but at the end of the day, they won't get better. That's why we have to have some control of the success.
I feel that in the next five years, with this rigorous position, the numbers won't get worse.
Liberal
The Vice-Chair Liberal Brent St. Denis
Thank you, Doctor.
I'm going to take a turn for the official opposition, and then it'll be Mr. Sweet, and then possibly Betty and Gilles. Okay?
Just to pick up on something that Mrs. Hinton raised, the notion of pre-screening, if it's done right, logically, yes, you can mitigate a future problem by preparing for it ahead of time. But I can see issues of forcing people to be screened against their will, and other issues. If you have $1 to spend, hypothetically, you can spend that dollar ahead of posting--RCMP posting, military posting, what have you--or that same dollar after. If you only had that $1, would you spend it before or after?
As an Individual
Definitely before. There's all this community health. You could have advertisements on TV every night to stop smoking, but it's when I get my patient in front of me and I give him the rules. So I think individual screening....
Of course, with military and police positions, we know the risk. It's known. We've assessed the hazard for a long time. There's training. So we have a good passing grade with regard to these pre-deployment medical assessments, physical and psychological, which are working in reducing the outcome of disease. I'm talking about from a heart attack to if the guy's not physically in shape, etc. For example, if a police officer has asthma and I give him poivre de Cayenne, he has an asthma attack and he's useless. So this is a fait accompli. So these three deployment tests are good.
Psychologically, as you know, the RCMP has been doing that since 1998, so we have close to 10 years of that. We feel that it's been maintained.
Liberal
The Vice-Chair Liberal Brent St. Denis
How do you deal with the question--again, I'm sensitive to some of the points that Mrs. Hinton has raised--that somebody could be assessed as being at risk for more likelihood of having a post-traumatic stress incident, but maybe not? It's very much an ethereal or subjective thing that you're measuring, unlike a physical heart condition or asthma, etc. How do you deal with somebody who is assessed ahead of time and told, no, you shouldn't go and do that, but in their own mind they say, I can do that, and they suffer anxiety or trauma because they were refused to do something? You could create a catch-22 because of the difficult nature of what you're assessing.
As an Individual
I'm not saying we're 100%, but we do have standards that tell us the risk assessment. That's why the tests are not enough. It's an assessment by a specialized psychologist. We assess and we make a decision, and sometimes we're wrong and sometimes we're right. As you know, decisions in Canada can always be appealed. I don't mind that. There are grievance levels, human rights, and I go and fight with them and I don't have a problem with that.
But mostly my experience with that is that people understand. We explain the decision. Although we're in the military or the RCMP, we don't say, George, you're not going. No, it's George, here's the problem, here's the situation. Most of the time, 95%, I can tell you that the member agrees that yes, it's a good idea.
We're not there to have a confrontation. It doesn't help. If all my decisions go to confrontation and appeal, my boss will say, Dr. Belzile, you're very good, but you're costing the force too much, or the RCMP. So we're trying to have a solution, not a problem. At my level, it's a solution, not a problem.
Liberal
The Vice-Chair Liberal Brent St. Denis
Thank you.
I'll wait until the end for another short one.
David Sweet.
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
Thank you, Doctor. My smile is because I appreciate your level of knowledge and your frankness. It's very refreshing.
I have a couple of very specific questions. Is there no official network among Canadian health professionals for PTSD?
As an Individual
There's an association of psychologists, but if you're talking about an official association between force members, the RCMP, or the other police forces, I haven't seen any.
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
I was at a meeting a couple of weeks ago with AllerGen, which is a network of doctors across the country for allergies and diabetes. Are you familiar with that?
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
I would think that for PTSD, particularly because it's a disorder that we're still learning much about, there'd be some energy around the country to—
As an Individual
There is energy. In my job on the Quebec compensation board we do have education. I'm like a judge there and I listen to what his doctor says and the force, the Sûreté du Québec.... We have an educational training of about two years. But this is unofficial. I haven't seen any special police or military post-traumatic stress disorder education program specifically. I know there are four clinics, but how much communication of data?
As you know, the weakness is, as Dr. Brillon said...and on this I've built up my own statistics. Unfortunately, you can read all the books you want, but there are facts. We've sent 2,000 members, and we know how many have developed PTSD at the end of the day. Is it good or not? Do I have enough or not? I don't know, but that's what I can say.
At the end of the day, I compare my numbers with the normal force working in Canada. The big challenge we had...and as you know, we don't have a union with the RCMP, but a member rep said the mission is costing a fortune. We said, no, they're not sicker than you, etc. At the end of the day, that was the rationale for building up these statistics. So at the end of the day, because of rigorous screening, these members were not sicker, etc.
To answer your question, I was a member of the Quebec Association of Occupational Physicians, and we didn't have a special forum for that. It's a subject of discussion continuously. But should there be one with the force? Yes, because there are a lot of professionals--psychiatrists, psychologists, occupational physicians.
Funnily enough, we had one for pain, for all the chronic pain. We had a meeting with the judges and all the doctors, because for pain they all use narcotics. We don't like narcotics because there's a lot of dependency. I saw a forum for that, but not for PTSD specifically.
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
When I look at your resumé, I see that your experience is mostly with the RCMP. How currently did you have exposure to the military?
I'll tell you why. Mr. Stoffer asked the last witness about psychologists in the field, and we have since had a response. We have three psychiatrists at the Kandahar airfield, and Colonel Randy Boddam also leads a team of mental health nurses and medical technicians. But I thought I'd heard you felt there was no psychological profiling done on enlistees. I can understand that maybe we haven't gotten as far as family.
As an Individual
From what I saw here in the pre-deployment and our medical support to the Canadian Forces operation, I didn't see any. Now, I'm not in there working, so I can't answer more specifically. In the RCMP the health team, on a regular basis, once yearly, visited our members everywhere. We didn't see them when they came back on a stretcher; we visited positively.
I know the force has inside medical support, but this is for the broken arms, etc. How much are they doing in preventing, assessing, and auditing the risk? It has been a valued situation in regard to our UN mission to go and see the members, not when they're sick, not when they're having problems, but positively to assess the seriousness of the risk and assess the medical profile. Did we make a good decision in sending George, who had some stressful situations, and he made it or not? This could be feasible.
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
That's the other question I wanted to ask. I found your testimony fascinating around the resilient personalities who seem to develop character when they're put under stress, and others can become weakened and of course then have a disorder.
I know you have to do an interview as well, but are there any peer-reviewed instruments right now that are out there where you can establish a person's predisposition to having a post-traumatic stress disorder?
As an Individual
Yes, and as you know, the psychologist has the responsibility of testing. I have no problem working with psychologists. They're part of my life and I work with them. They're the specialists, but we doctors do the interpretation. And yes, there are tests to screen out serious illness. How precise are they? They are 80%, and that's good. If I take your blood pressure, or cholesterol, it's the same thing. If you look at all the tests we do on your body every day, you'll find they're reliable and good.
From our ten years of experience, in fact, our position will be that we'll take them and give them a chance. This is the position of Canadian human rights, and I don't have a problem with giving them a chance, because we want a solution, not confrontation. But when we're sure that we have to maintain this level of profile, and then for George we say, we cannot send you because...well, then we argue.
Conservative
David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON
Yes.
You feel the accuracy right now is about 80%.