Veterans Affairs Committee on March 20th, 2007

[Col Donald S. Ethell]

I'll let Major Le Beau answer that.

[Maj Mariane Le Beau]

I'll try to keep this short.

I don't think one is being disadvantaged over the other because of resources. There is a knowledge gap as well in terms of us knowing very little on how to predict the development of operational stress injuries. There are no foolproof tests in terms of screening, so there is a knowledge gap there as well.

Even afterwards, with some of the research that we've definitely used and based the program on, with some of the meta-analysis to look at the predictors of PTSD, some of the best predictors are not the things that occurred before but the things that occurred at trauma time and after that. The things that occur afterwards that are more predictable are peer supports and the level of stress in someone's life. Maybe these things then tell us that it's important to put the money into the events that take place afterwards, but that doesn't mean we need to totally disregard the prior events.

I hope that answers your question.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you.

Mr. Sweet, you have whatever time we have left, and then I'd like to briefly interject.

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

Thank you. I appreciate it.

Thank you very much for coming. Your contribution today has been substantial.

Lieutenant-Colonel Jamieson, in your answer to Mr. St. Denis--he went down the road I wanted to go down--you mentioned that a physician from the military who goes back and becomes a psychiatrist or psychologist knows the DNA of the force.

From your experience, would a soldier who has PTSD or any other related injury also be more apt to open up to someone who is military rather than a private contractor from a civilian background?

[LCol Jim Jamieson]

It depends on the individual. Some individuals want that familiarity. Some prefer to be treated outside. As much as possible, we give them the option.

In a city like Ottawa, that's not a problem. We have excellent trauma specialists--clinical psychologists, psychiatrists, social workers, and others--in the community, so we can make the offer. In places like Petawawa, we don't have that luxury.

Some people have become so traumatized, they can't even go on a base. They don't want anything to do with anybody in uniform, for whatever reason.

The short answer is that we try to give them the option, whatever seems to suit their case best.

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

I was encouraged, right at the beginning...because one of the big reasons soldiers won't come forward, at least for the many that I've spoken to, particularly the non-commissioned officers, is the esprit de corps, the band of brothers, the whole camaraderie aspect of the military. It's something they live and move in, and it's highly valuable. To come forward and threaten that by saying you've suffered a post-traumatic disorder experience would obviously be a big detriment.

Right at the beginning, Colonel, I think you were talking about a general who is now back in active duty even though he's a PTSD sufferer. Is that correct?

[Col Donald S. Ethell]

That's Lieutenant-Colonel Stéphane Grenier; as I say, he's back on the horse.

The CF representatives can articulate this a little better than I can, but the idea is to put people back in the field if possible, obviously under some guidelines. I don't know if you read the latest Maclean's magazine on physical injuries, but all of those lads want to go back and join their unit. They want to get back with their unit. They want to be with the unit. In fact one of them moved out of Ottawa back to Petawawa to be with his unit, just because of that comradeship, that regimental esprit de corps and so forth.

And that's where they feel they can get some peer advice, not only physical, but mental as well. If they have a problem, I'm sure they hear, just through word of mouth, why don't you go and talk to a peer support coordinator? They can provide some avenues for you to address.

It's only natural, having lived that world, that these lads would want to get back with the unit. They don't want to be thrown out of the military; they want to be made healthy.

It goes back to the statement we heard a number of times during our visits to the bases. When Veterans Affairs Canada started granting an annuity for PTSD for serving members—I don't know how many are currently receiving that, but it's in the hundreds—the word was, yes, the money is nice, but fix me. Fix me. Where can I go to be fixed? Now, that's not a nice term, but that's the term they use. They want to know, where is this peer support coordinator, and what can he tell me, where can he refer me?

Does that answer the question, sir?

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

Yes, but just specifically, if I suffer an operational stress injury, do I have good hope that if I'm capable, through the therapy, to come back 100%, I can be redeployed?

[Col Donald S. Ethell]

I'll let Major Le Beau or Colonel Jamieson take that, but in my opinion, if the circumstances are correct, and if the command's decision is made, then yes.

Jim.

[LCol Jim Jamieson]

Getting people back to work is always the number one objective.

Post-traumatic stress has a lot of focus on it, but let's start with something easier. For clinical depression, there are excellent outcomes. For post-traumatic stress, there are good outcomes over a longer period of time.

There's no written rule about this, but we tend to give people up to two years to get back or else they have to get into a different trade or perhaps leave the forces.

We've had many successes. If the right treatment and the right support are in place, the outcomes are excellent. As Mariane said a few minutes ago, what happens after the trauma is often a lot more important than what happened before. If we have all the things in place, the outcomes are excellent.

The terrible irony of this is that the longer you don't go for help, the harder it is to help you. We have a natural subculture of not being sissies and not going for help.

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

On the training the soldier gets, from everything I've heard here today, I'm under the impression that it's up to me to be alert to when I am suffering an operational stress injury so that I can come forward early.

We're now learning more and more about PTSD. Is there any training for me to be able to psychologically handle a severely traumatic situation so that I can avoid spiralling down to an emotional reaction that would cause an injury?

[Maj Mariane Le Beau]

On pre-deployment training, over the years, I would say there's again been a different “flavour of the month”.

I guess stress management training is what you would be referring to in terms of how to handle the stressors. It existed in the 1990s. There was then the critical incident stress model that the Canadian Forces used, implemented, and taught, and it also waned in terms of the approach. I guess it didn't seem to be as effective as some people had hoped.

There's battle-mind training, which is something new that the mental health people are using in third location decompression. It is stress management, helping people to switch in terms of their attitudes versus the front line and back home. But it's also an entire program of preparation for day-to-day living, and it's not only decompression focused. This might be a direction in which the CF will go.

But I again want to highlight that there's always been something. It may not be as efficient as we would look to it to be in terms of pre-deployment training, but we continue to try to find the best way of doing it.

[The Chair, Conservative, Rob Anders]

I only want to interject to say several things.

On Thursday we'll have Stéphane Guay. On Tuesday next week, I'm hoping we can bring back the bill of rights so that we can flesh it out and get it moved off the agenda. We'll then go back to the list of witnesses, and we'll have the clerk do the best he can in regard to those.

I know Colonel Ethell has some books he'd like to present.

If you could bear with me one second, sir, Monsieur Perron says he'll be 30 seconds.

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

This concerns the question that Rodger asked you earlier about the young man who accidentally killed his companion. If I correctly understood your explanation, he is still in Afghanistan, and no one is taking care of him. He was told that he could consult someone on his return to Halifax.

[LCol Jim Jamieson]

No, sir. There is a team that deals with mental health in Afghanistan: a psychiatrist, two social workers and a mental health nurse. There's a team there.

But he's going to require help later too, and that's what we need to plug him into.

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

You talked about—

[The Chair, Conservative, Rob Anders]

Colonel Ethell.

[Col Donald S. Ethell]

Mr. Chairman, thanks very much to you and your committee for having us here.

I have two copies of Combat Stress Injury: Theory, Research, and Management. It's part of a psychosocial stress series, as I mentioned, and was written by two renowned doctors, one of whom is ex-military.

In chapter 13 of this book, there's a chapter on the operational stress injury social support program, OSISS, a peer support program in collaboration between the Canadian Forces and Veterans Affairs Canada, written by Colonel Stéphane Grenier, Kathy Darte, Dr. Alexandra Heber, who is now a major and has joined the forces, and Dr. Don Richardson, who's the Veterans Affairs advisor.

I'll pass one copy to you, Mr. Chairman, for you and your committee, and one copy for your library.

Thank you very much for your time, sir.

[The Chair, Conservative, Rob Anders]

Thank you very much, Colonel Ethell. I greatly appreciate that.

I can tell by the way the committee has been participating with questions on this PTSD issue at the beginning of our study into health that there's a great deal of interest, so we appreciate your presentation. Thank you.

The meeting is adjourned.