Veterans Affairs Committee on April 24th, 2007

[The Chair, Conservative, Rob Anders]

Good morning, folks. We have another veterans affairs meeting.

I would like to welcome Monsieur Gaudet back. He's been away; I understand that the other committee he was with has finally put its report in to the House. We're very grateful to have his familiar and smiling face back at our committee table.

I would like to welcome our witnesses this morning from the Department of National Defence. We have Ms. Margaret Ramsay, Major Chantal Descôteaux, and Dr. Marc-André Dufour.

You can collectively have 20 minutes, or you can have snippets thereof, or you can slice it however you wish. Afterwards these folks on the standing committee get a chance to ask you questions and pick your brains. We also, at the end, have a motion from Mrs. Hinton to deal with today at our committee.

I give it over to our witnesses. Please go ahead with your presentation.

[Margaret Ramsay, Acting Senior Staff Officer, Canadian Forces Mental Health Initiative, Department of National Defence]

Good morning, all.

Mr. Chairman and members of the Standing Committee on Veterans Affairs, my name is Margaret Ramsay. I'm the acting senior staff officer for mental health services within the directorate of general health services. As such, I'm responsible for the administrative issues related to mental health services across the Canadian Forces.

With me are Major Chantal Descôteaux and Dr. Marc-André Dufour. Chantal is the base surgeon at CFB Valcartier and has the overall responsibility for all medical services at the base, including mental health services. Dr. Dufour is a clinical psychologist and is the practice leader for psychology within mental health services at Valcartier.

We're pleased to have this opportunity to meet with you today. I would like to brief you on the CF mental health services. The purpose of this briefing is to provide you with an overview of how mental health services are delivered within the Canadian Forces. As you may know, we are currently in the middle of a five-year project, called Rx2000, to markedly improve these services. Among other things, the five years will see an increase from 229 to 447 in the number of mental health providers available to our CF members.

Mental health care is provided in an interdisciplinary fashion in the Canadian Forces. Disciplines involved in this care provision include family practitioners, psychiatrists, physician assistants, nurse practitioners, social workers, mental health nurses, psychologists, pastoral counsellors, and addiction specialists.

I just want to go over a bit of background with you. In 2001 the Canadian Forces coined a new term, “operational stress injuries”, OSI, that regrouped several mental health conditions that are often the result of stress and trauma. OSI is not a medical term. “Operational stress injury” is officially defined as any persistent psychological difficulty resulting from operational duties performed by a CF member. The term OSI is used to describe a broad range of problems, including PTSD, which usually result in impairment in functioning.

In 2002 the Canadian Forces medical services contracted Statistics Canada to conduct a mental health survey of CF members to determine the prevalence of PTSD and other mental health disorders. This study found that 2.8% of the regular force and 1.2% of the reserve force reported symptoms consistent with a diagnosis of PTSD at some time during the year preceding.

Over the course of their lives, 7.2% of the regular force and 4.7% of the reserve force would have met the diagnostic criteria. The survey determined that depression and panic disorder were significantly more prevalent in the Canadian Forces than in the civilian population. The survey also revealed that regular force lifetime prevalence of PTSD, post-traumatic stress syndrome, equates to that found in the Canadian general population.

Levels of service within the CF—Mental health care is organized into two levels of service provision. This organization is differentiated by the degree of specialization of the service and is defined as either being primary care or secondary care in its delivery. Primary-level mental health care is denoted as psychosocial care. The psychosocial service is the first level of mental health clinical services and functions with the patients care unit delivery, which is called a CDU. In addition to a crisis intervention service, it provides a number of social work administrative services.

Psychosocial services are considered to be brief interventions. Higher degrees of specialization—secondary care—are called mental health services and are accessed through referral from primary clinical services. These secondary services are organized as a series of programs of various degrees of specialization.

Some of these programs consist of the operational trauma and stress support program, the general mental health program, and the addictions treatment program. These are three of our most common programs that are utilized.

Another basic principle of mental health care delivery is its use of regular interdisciplinary case intake and review. Care provided both within the Canadian Forces health care clinic and by external service providers is regularly reviewed. In this way, CF members can be assured that their care is of the highest quality, consistent with evidence-based best practices.

As to service locations, to address the medical needs of Canadian Forces members, mental health clinical services are available in all medical clinics across Canada. As well, the Canadian Forces has five large clinics that offer a full range of mental health services and include operational trauma and stress support centres. These centres are located at Halifax, Ottawa, Valcartier, Edmonton, and Esquimalt. Geographically, they're placed across the country to provide service regionally.

Canadian Forces members and families can also contact the Canadian Forces member assistance program—CFMAP—a 24-hour, seven-day-a-week confidential referral system. This is a 1-800 number. This program provides external short-term counselling for members and their families initially more comfortable in seeking assistance outside the direct military health services.

That concludes my brief for this morning.

[The Chair, Conservative, Rob Anders]

All right. Do your colleagues have things they'd like to add to that presentation? No? All right, fair enough.

For the Liberals, for the first seven minutes, we have Mr. Valley.

[Roger Valley, Liberal, Kenora, ON]

Thank you very much.

Thank you for your presentation this morning.

You mentioned a number of things. I'll go to your last comments first, if that's the way I could do it.

You talked about the service locations. Some of us here serve in northern Ontario, and we realize that there are no bases—or no base in my neck of the woods, in the Kenora riding. You talked about the clinics. You mentioned there are five across Canada. The two closest I see to us would be probably Ottawa and Edmonton.

What happens when there's a service member who needs service and he's sent back to one of the communities, like my own home community, Dryden? He's a thousand miles away from any type of help. There's not much support network in his peer group there. Because there are no great numbers of people living there, there aren't great numbers of people who serve.

So what happens? Are there services provided locally, where someone would come in? Could you run us through what happens if there's a member there who needs to be helped?

[Margaret Ramsay]

If it were an operational stress injury, first we would probably like them to come in to one of our larger centres for a good assessment, to make sure that we have the proper, thorough diagnosis and the full protocol of assessment done on them. Then we would refer them back to their local area and try to set them up with community providers. We have a number of providers in communities right across the country. There are about 500 on the list who are listed with Blue Cross. So we would have them served there by local community providers.

[Roger Valley, Liberal, Kenora, ON]

If there isn't a local community provider, which happens in many cases, I guess, they would have to stay in the larger centre?

[Margaret Ramsay]

Especially if they're that far away from a large centre, we would try to get some type of resource closer to where they live. We certainly try to do that. Petawawa is a good example, where we don't want people on the highway driving from there down to Ottawa. We try to get local resources, and we're also increasing the resources in that area at the base.

[Roger Valley, Liberal, Kenora, ON]

I'm basically talking about areas that don't have general practitioners, let alone the psychiatric type of service that you need.

[Margaret Ramsay]

I know. These would probably be reserve members who have retired.

[Roger Valley, Liberal, Kenora, ON]

No, we have people back in the community who just came from Afghanistan.

[Major Chantal Descôteaux, Base Surgeon Canadian Forces Base Valcartier, Acting Brigade Surgeon, Department of National Defence]

We provide care for the active members, not the retired ones.

[Roger Valley, Liberal, Kenora, ON]

I'm talking about people who are actually coming back to the community. They're still in the service. They're back for whatever time they get off for a leave and stuff like that.

[Margaret Ramsay]

We have resources in almost all the communities across Canada.

[Maj Chantal Descôteaux]

If he's still a serving member, he's supposed to be at his home base.

[Roger Valley, Liberal, Kenora, ON]

As I understand it, they get a certain amount of time back in their community when they come back from Afghanistan.

[Maj Chantal Descôteaux]

They have a month of leave, but their home base is where they serve, and that's where the care is.

[Roger Valley, Liberal, Kenora, ON]

Okay.

You mentioned I think it was over 7% in the regular forces who can suffer from an OSI. I might have missed it, but you mentioned that it's considerably higher than in the Canadian population. Did you have a figure for the Canadian population?

[Margaret Ramsay]

No. For PTSD, it was the same as the Canadian population. For depression and panic disorder, we were higher than the Canadian population. For depression, it is about twice as high, at about 7.2%

[Roger Valley, Liberal, Kenora, ON]

Thank you.

Lastly, one of the things we've talked about is what we can do when we identify things. It's been raised before at this committee. Is there anything we can do to identify it before they're deployed? What happens in that circumstance? Is there any kind of screening to know whether or not somebody is susceptible to this kind of issue?

[Margaret Ramsay]

Do you want to start, Major Descôteaux?

[Maj Chantal Descôteaux]

We have a process whereby each member who is deployed has to be screened by mental health professionals. They have an interview.

We also see our military members regularly for annual medicals. This is where we would address things. In the period before deployments, for a member to be tagged “green to go”, he has to go to a doctor and a social worker.

[Roger Valley, Liberal, Kenora, ON]

Has the process been redefined as we understand more and more about the issue of operational stress injuries? Is it something that becomes more complex compared to what it would have been 60 years ago to 40 years ago to 10 years ago?

[Maj Chantal Descôteaux]

Yes, they go into great detail in looking at family life, financial problems, and mental health problems. We look at all of that.

[Marc-André Dufour, Psychologist, Mental Health Services, Candian Forces Base Valcartier , Department of National Defence]

We also call the spouse in order to obtain information, verify whether she is aware of what the CF member will be doing, to see whether she is prepared for the CF member's departure. Generally, the interview lasts between 20 and 30 minutes for CF members about to deploy. In situations where further attention is warranted, interviews can systematically last up to one hour, prior to the deployment.

[Maj Chantal Descôteaux]

We don't necessarily have any studies that could indicate, at the time of enrolment, who should or should not enlist in the Canadian Forces, who is more at risk. No such studies have been done. We know that recruiting centres do not test candidates for various factors, such as drug addictions. The same is true for alcohol abuse and various personality traits. Recruiting centres admit a broad range of people; however, some screening could be done there in order to retain the ideal candidates. Currently, we would need to conduct studies in this regard, in order not to discriminate against individuals who wish to enlist in the Canadian Forces.