Veterans Affairs Committee on April 24th, 2007

[Margaret Ramsay]

It totally varies. I was just in Esquimalt last week. We have a couple of psychiatrists who are retiring—cutting back a bit and working part-time—to very young people who are coming in.

The only thing is that we usually look at experienced personnel. We are not taking brand-new graduates out of university right now. We still do not have a mentor program in place. We are usually looking for three to five years experience for clinical psychologists, and the same thing for social workers.

The military is different. We train our own personnel through training programs at university and then do our own mentorship.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I know what most politicians do after a stressful day of talking to constituents and battling back and forth in the House of Commons, but who looks after you folks? I am sure if somebody punches a hole in your wall or threatens you or consistently harasses you, not just once, but repeatedly, that has to take a personal toll on you and your family. If it's a personal question, you don't have to answer.

Besides sports, and the camaraderie of each other in working through your concerns, when you go home at night, sometimes you're alone. You must think about your day, and it must be very stressful. Who looks after you?

[Margaret Ramsay]

Do you want to take that?

[Maj Chantal Descôteaux]

What I have realized with respect to the uniformed doctors in the military is that we tend not to go to these people, because we refer our patients to them. So if we are sick, we will not seek help from them. We found a psychologist downtown who is older and very experienced who will take over the care of the uniformed doctors. Usually the other trades, like nurses, social workers, and other medical trades, are comfortable being treated by them. This is for the uniformed people.

We have seen instances when people like me—base surgeons, military psychiatrists—were sick, and it's a challenge. It's almost impossible to treat a colleague or the person who is supposed to be your boss. So we try to be ingenious. We will see a base surgeon from another base who comes to our region. We'll set up stuff like that or have people downtown especially for us.

As for the civilians, I will let Marc-André answer that.

[Marc-André Dufour]

As public service employees, we have access to employee assistance programs which enable us to consult health professionals. With such a heavy mandate, we need teamwork in the real sense of the word. We have significant interdisciplinarity in our work. For instance, if a patient's case is particularly difficult, we can discuss it with our colleague, who is in the next office, and who is a psychiatrist and is also seeing the same patient, or we can raise the matter with the social worker who knows the family, etc. Resources in the civilian sector do not have this capacity.

The psychologist in private practice sits in his office, isolated, and also sees many other patients. He may telephone his colleagues, but we know that the physical distance creates a barrier, so that he may not dare to place the call. As a team, we have the advantage of having regular meetings where we can share our ideas about difficult cases and we also give ourselves the right to “vent”, as we say in our jargon. We have the freedom of saying that we find this hard and we may say things that we obviously would not say in front of the patient. The meetings also serve as a safety valve, which is very, very important.

With the increase in the workload, we now have the problem of no longer being able to talk to each other. At Valcartier, for instance, generally speaking anywhere from 25 to 35%, if not more, of the staff are unable to attend our meetings because they are busy training soldiers who are leaving on mission or conducting pre-deployment or post-deployment interviews. This is creating a situation where we are no longer able to catch our breath, and unfortunately, our work is now somewhat similar to that done in the civilian sector.

This situation must not occur. We must ensure that we have a working environment where we can say that people are dedicated to the clinic but that they have time to meet and that this time is sacred. We are not, however, able to do this because we are too busy.

Contrary to the situation in a hospital or in the civilian sector, as health professionals it is part of our job to meet with the soldiers and to prepare them for their mission. Prevention is very important. Part or our job is to meet with them before they leave on a mission and to talk to their spouses to make sure that everything is in order. Part of our job is also to meet with them when they get back. Right now, 2,400 soldiers are getting ready to leave, which is a great many people. If we are to do 75-minute pre-deployment interviews for 2,000 individuals, and on top of that deal with people who are undergoing therapy, it is going to get very difficult to juggle everything and we run the risk of burning out.

[Maj Chantal Descôteaux]

As regards your stakeholders

who are working with VAC, they don't get what we're trying to get. That's why we need to set up these clinics where they can talk to each other. We have to send some of our active duty members downtown, because we are not enough to care for them. But we liaise well with the psychologists, and we pay them to come to Valcartier to sit down with us when we have the interdisciplinary meetings. So they also get to vent with us.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Stoffer.

We'll go to Ms. Hinton for five minutes.

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

Thank you.

This has been very interesting today. I have never had witnesses sit in here who I haven't found interesting, but this has been very educational as well.

These are just my thoughts. Sometimes self-examination, as well, helps you realize that you have stress or that you have a problem you need help with. I'm wondering whether that's encouraged. That would be a question I'd like to ask.

This is just a comment, and it may sound silly, but when the microwave goes off at home, it makes me anxious. I couldn't understand why until I did a little self-examination one time. If you're a member of Parliament, your life is ruled by bells. They ring, and the quicker they ring, the less time you have to get there. It causes some anxiety. You don't want to be late for this, that, or the other thing. One day when this microwave went off, my husband asked me why it bothered me so much, because it's such a minor thing. And I finally realized that this was exactly what it was; it's because of the bells that happen here. You know, it's that old Pavlov's dog-training kind of thing.

There have to be a number of instances with military personnel when something that is just a normal, everyday occurrence that happens all the time triggers some sort of reaction in the individual. I would be interested in hearing what the major or Mr. Dufour—

[Marc-André Dufour]

The Resiliency Training Program that I talked about earlier also includes a peer support component. Even if military personnel are not fully aware of what they are experiencing, we try to train people within the units, ideally people of the same rank, to alert one another. We call this the buddy system. In other words, people are assigned to pay attention to another person, his or her buddy, in order to be able to tell that person when something is not right, when the person is not behaving normally, and ask whether the person is aware.

At Valcartier, we also have suicide prevention committees and committees on violence in which military personnel in the units can participate. These act a bit like eyes and ears for us on the ground, if you like. They can recognize when someone is not doing well. We even make sure that the therapists' photos are posted somewhere. That way, military personnel can identify, for example, the addictions counsellor.

During the post-deployment interview, when military personnel return to Canada, they fill out a self-evaluation questionnaire that describes various symptoms. They have to indicate for example, if they react strongly to a given situation and if their reaction corresponds to one or another of the reactions described. So this is done when they return and it is important because they do not always have the time to stop and be aware of what they are experiencing. Our presentations focus on this to some extent. The military personnel recognize themselves. Mr. Castro's Battlemind, which I mentioned earlier, is an example. I have clients who have seen that presentation and really identify with this because, for example, they see a military member speaking to his son the way he would speak to a subordinate. He uses a harsh, directive tone which would be totally appropriate in an operational theatre, but when he is talking to his five-year-old son who wants to play with him, he needs to change his tone. He needs to adapt. These are scenes from people's lives, so it is easier for members to recognize themselves in these situations. It promotes self-examination and encourages people to ask for help, obviously, because the health services are being promoted at the same time. We need to be able to fulfil our mandate.

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

You may not be in a position to answer this, and I'm not trying to put you on the spot, but 7.2% is a fairly high number, and that's for depression and panic disorder, is what I heard you saying. That's two times the normal Canadian average. I'm sure that if you were to look at firemen, for example, and that's a perfect example, they have to go into burning buildings, they know they're putting their lives on the line, oftentimes dragging out children who have succumbed to the smoke and have died, or seen people burned alive. It's got to be horrible. Do you have any comparison between firefighters and military personnel in terms of these numbers?

[Maj Chantal Descôteaux]

I think that if we look not in that book but the other book, of Pascale Brillon, she's reported a few studies. You could have percentages, but it varies in studies. After being exposed to a trauma, there is about a 15% chance of developing post-traumatic stress disorder, whether you're in the military or not. I think, if I remember correctly, she points out a few traits, so there must be something out there, but I'm not sure.

The StatsCanada study has not looked into that, but they took a very good sample, which is 5,000 people, but of the 5,000 people, how many were from the navy, the air force, and the army? This is another thing that I would just point out. If the 5,000 are from the army, maybe the numbers would be different now.

[Marc-André Dufour]

What I am going to say is not based on research, but I believe that the fact that people are far away from their usual social networks probably means that they have less protection from post-traumatic stress. It is not easy to go through difficult situations on the job, but if you can go home at night and be with your loved ones and call a friend, those things help protect you. The possibility, for example, that a firefighter might lose a colleague in a fire, another one the next day and yet another three days later is much lower than being in that kind of situation in Afghanistan, where people are killed on a regular basis. Military personnel suffer repeated traumas and are far from home. Military life requires a tremendous ability to adapt. That is the way it is; that is the way it has to be. But from a mental health perspective, it is still very difficult. That is my opinion.

[The Chair, Conservative, Rob Anders]

Monsieur Perron, for five minutes.

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

I am going to be accused of speaking too much and too quickly.

Chantal, I really appreciated your great presentation. You complained, no doubt rightly, that funding was inadequate. I would not say that I am uncomfortable, but I wonder how it is that National Defence, which is prepared to invest billions of dollars for planes, tanks, shoes, boots and uniforms, cannot set aside 0.5% or 1% of its budget for mental health.

I would like you to look into that and send me a letter or a report indicating how many thousands, tens of thousands or millions of dollars should ideally be spent for mental health. I would like to have the numbers. I know it is not easy.

[Maj Chantal Descôteaux]

In my opinion, mental health does not only involve mental health services, which Ms. Ramsay is responsible for. It involves health in general.

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

Health in general.

[Maj Chantal Descôteaux]

It involves our entire health group. It includes front line doctors, medics, nurses, infrastructure, buildings and vehicles. Our budget includes all these things and money is also spent training these people. Today, we are talking more specifically about health. I'm not the one who makes the regulations.

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

Perhaps you can give us a ballpark figure.

[Maj Chantal Descôteaux]

I have the feeling that the chief medial officer of the armed forces, Ms. Kavanagh, our big boss, could tell you what proportion of the budget is spent on health care. I don't have that information, but perhaps Ms. Ramsay could provide it.

[Margaret Ramsay]

We were given $98 million by the project management board to make the increases I gave you in the briefing notes—to add the 218 personnel and some infrastructure. We're certainly spending all that money. So compared to other parts of the health care system, we have been treated fairly well in amounts of dollars. But it's a growth industry, and we can always use more.

These clinicians are very expensive to hire. A psychiatrist's salary is $250,000 to $300,000. These are expensive resources to attain, but we have been treated fairly well by PMB, with the $98 million we were given in April 2004 to spend over five years.

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

How many soldiers are there at Valcartier? Marc-André or Chantal, how many of your colleagues are involved in health care? Is it a ratio of 1 to 10, 1 to 100, 1 to 1,000 or 1 to 10,000? If you can't answer that now, you can send it to us later.

[Maj Chantal Descôteaux]

The numbers vary depending on the season. In the summer, the cadets and reservists come to Valcartier. We treat between 7,000 and 9,000 patients, including reservists.

[Marc-André Dufour]

There are about 30 mental health workers, including all the professions.

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

For 7,000 patients?

[Marc-André Dufour]

Yes. These are not 7,000 people taken from the general population. We might have enough resources in times of peace, when things are normal. But we have to adjust our human resources because of the mission in Afghanistan. The mission in Afghanistan has changed the situation. Pre-deployment interviews are much longer and the level of danger is much higher, so our military personnel is more anxious. When they come back, chances are that more of them will ask for treatment. We therefore have to make adjustments to provide mental health services which are better adapted to the fact of the mission in Afghanistan.