Veterans Affairs Committee on April 24th, 2007

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

Alcohol, drugs?

[Maj Chantal Descôteaux]

Yes.

If you suffered trauma when you were a child, you're more prone to PTSD. These are some of the major ones.

Do you want to hear more about repetitive trauma?

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

I'm just going by what I've been listening to from witnesses. I've come to the conclusion in my own mind, and you may disagree with me, that aside from those indicators, there's really nothing you can use as a measure, if you will, about how one person is going to react to these kinds of circumstances.

[Maj Chantal Descôteaux]

There is no blood test for that, but I think there could be studies done to look at that aspect.

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

Okay.

You also touched on what has always been my concern. I ask the same question of every group of witnesses: How do think Veterans Affairs Canada can contribute to changing the negative stereotype for veterans who suffer in silence from PTSD? You pretty much answered me. You told me that the dinosaurs are leaving, that this new generation of soldiers are a little bit more open to saying they have a problem and need help, rather than being stoic about it.

You're very anxious, Dr. Dufour. Go ahead.

[Marc-André Dufour]

When we talk about operational stress more than about post-traumatic stress, we are moving forward on the issue. There is no doubt post-traumatic stress exists—it is a clinical diagnosis. Operational stress is a very interesting concept. In my view, it would be difficult for any member of the force who experiences operations and situations in Afghanistan—I hear the stories they bring back—not to be traumatized. However, operational stress is normal. Stress is presented as a combat weapon. That means it's part of the game.

I have not practised with the Forces for very long, but on the basis of what I hear some long-serving members of the Forces and corporals say, they experienced extremely stressful situations but had no right to respond. They had no right to be stressed. If they exhibited stress, they were excluded and set aside. They did not even have the right to talk about it.

Now, they are told that they should not put their heads in the sand, that they will experience stress, that they will be afraid, that the enemy's goal is to make them feel afraid, and that they will experience stress. When we explain ways they can use to respond to stress, we give them the right to have a reaction to stress.

In the past, two things happened in the Canadian Forces. Members of the Forces experienced extremely stressful events, and—what I would call the second level of trauma—had no right to respond and were perceived as cowardly if they did speak out. Well, I can tell you that, with this kind of message, a soldier will not speak out and will become withdrawn. That's why today, we still see soldiers who served in the former Yugoslavia, and 10, 12 or 13 years after the facts, after losing two families, two houses and so on, come to see us for the very first time because they are completely destroyed. Those soldiers were told that if they talked about it they were weaklings. They were not supposed to talk about it. The whole thing festered inside them, became part of their personality. They became adapted to their trauma. In their heart of hearts, they end up believing that it is normal for veterans to live that way. It's dreadful.

Now, we tell them that those feelings are normal, that they are part of the mission, that they will feel stress. Even as we teach them to handle their C-7, we tell them that they also have to learn to handle and manage stress. We give them preventive tools and tell them that professional help is available if those tools don't work. That's when we move out of the pathology. We are trainers, who don't show them how to shoot—we show them how to breathe. It seems a bit strange when you first hear it, but that is what we talk about.

We say that operational stress is normal, that they will experience it, and that there are professionals there to help. As a result, military personnel come to us much more quickly, and we are seeing that. We are starting to see people who are coming back from Afghanistan. I can tell you that this is very different from what we saw with soldiers stationed in Yugoslavia. They have been living with their trauma for 10, 12 or 13 years, and it has become entrenched. Now we see much less avoidance, with anxiogenec situations well targeted. We can work much more easily with that. We can identify the trauma military personnel experienced in a certain vehicle, and establish a gradual scale of exposure—Pascale Brillon might have talked about this—so that we can gradually desensitize the member to the situation that first engendered the anxiety. With this approach, therapy takes much less time and has a much higher success rate. So we should encourage members to ask for help by normalizing stress reactions. That is the angle we need to take, and that is angle we do take.

[Maj Chantal Descôteaux]

It's a matter of education. Ms. Ramsay needs money to do this, and to have clinical personnel who focus exclusively on this. We have had to do without one of our clinical practitioners in order to establish this program. In a sense we are shooting ourselves in the foot, but we are helping ourselves for the future. We have to gear our efforts to prevention and think outside the box, think up new approaches.

At present, our resources—

[Marc-André Dufour]

In fact, we are using current resources for the prevention component. There is no particular function or position—there is no prevention officer as such. We are all clinical practitioners, and in addition to treating patients we take on the responsibility of conducting these very important prevention exercises. However, we cannot do everything, and mental health care providers are exhausted.

[Maj Chantal Descôteaux]

So are other care providers.

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

He won't interrupt your answer, but he will definitely interrupt my question. I'm going to try to jump in with another one before you answer.

[The Chair, Conservative, Rob Anders]

I'm sorry, but you're already over your time.

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

That's what I thought.

[The Chair, Conservative, Rob Anders]

We'll now go to Mr. St. Denis, for five minutes.

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

Thank you, Mr. Chair.

Thank you very much to our witnesses today.

Dr. Descôteaux, I'd like to pursue your very interesting and almost startling information about incentives.

This is no disrespect to military personnel who feel they are ill, but if our policies somewhat skew the system, we are in fact using resources that should go to those who need to pursue the benefits route, and we're using other resources for those who pursue getting better. We have to better differentiate that, because the goals are different.

If your resources and your team resources are mixed, and at the intersection of your service the two are colliding, we're not really serving either of the two streams of personnel in the best possible way. Sometimes the best-intentioned policies have an unintended consequence.

I'd like to underline for our researcher that this is an important area for our committee. Thank you for raising it.

In respect to those two streams, do you have any suggestions on how it can be better done? Is it a matter of reverting to the old way of doing it, distinguishing between those who can get better and those who say they give up getting better and want to go the benefits route? Are there some solutions you can offer?

[Maj Chantal Descôteaux]

In our military medical system, someone who comes for help and needs to be restricted in some areas gets a temporary medical category. For the first six months we will say okay, you're unfit for deployment, you have to see someone in the mental health department weekly, and are not able to lift 30 pounds, etc. We write down all the limitations. This is for the first six months. Then there is a second six months if we have not succeeded in curing him.

After a year, or a year and a half, depending on the problem, then we usually say whether the restrictions are permanent or not. If they are permanent, then the person has a permanent category, and there's a process in the medical system and the administration system by which he will know if he's going to be released or not from the CF—retained with his restrictions or released medically. When this message comes in, this is when it would be best for someone to have permission to ask for a pension, because up until that moment, efforts will be made to cure him, to help him get better.

Once it's determined the limitations are permanent, then with permanent limitations it's okay to ask for a pension. If you are allowed to ask for a pension for your knee while you're in your twelfth year of service, and yet you still serve until you reach your 25 years of service, what kind of a permanent injury is that if you're able to continue to run and do forced marches? That doesn't make sense to us. Yet we have these patients who are active duty members and who are getting their snow plowed in winter because they have a pension, which we know about, for their back, and yet they're still on fully fit duty, working as an infantry guy. This is ridiculous. We have examples of this. We're looking at that and asking, what is this? The individual is being paid for his back and we're paying to mow his lawn and whatever and he's an active duty person. It makes no sense. It should only be when we determine there are permanent limitations.

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

It's no disrespect to those who need health services to ask this question, because if we're taking resources away from those who need them because the system has become skewed, then we have a duty to look at it.

Some of us are new to veterans affairs. There obviously was a policy rationale for that. Are any of you able to say, as dispassionately as you can, what the policy rationale was to allow for an active service person to apply for pension?

[Maj Chantal Descôteaux]

I'm not sure exactly why. Honestly, I don't know why.

[Margaret Ramsay]

It's just that the pendulum has swung too far the other way now. We need to correct it.

[Maj Chantal Descôteaux]

Put it in the middle.

[Margaret Ramsay]

Put it back in the middle, yes.

I think Veterans Affairs would have to answer that question as to when their policy changed.

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

Okay, thank you, Mr. Chair.

[The Chair, Conservative, Rob Anders]

Now on to Monsieur Gaudet, for five minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chairman. I'm very happy to have the opportunity to speak here today.

You do not often mention the spouses of personnel posted on missions. I often meet those spouses, and they're extremely anxious. In your remarks this morning, you said nothing about the families. It's like the pre-pro, if I might say—before they leave. Couldn't there be some kind of—?

[Maj Chantal Descôteaux]

As Ms. Ramsay said, we're not responsible for treating families. It is important to make that point. I would like to treat families, but then I would have to treat the children, the wife, the husband, and there are already clinics to do that. Treating someone is not just a matter of treating his or her mental health. We also have to take into account the biological, psychological and social aspects involved. We are not equipped to do that at present.

Some services are provided for families, however. Each base has a family support centre. Frequently, those centres provide the services you mentioned—in Valcartier, for example—and they work very closely with us.

Here is what we can do with regard to treating the family. If a military person experiences operational stress and might benefit from our seeing his spouse or children so that they can understand what he is going through, then we will do that to the extent that we can.

But you will understand that I have to tell my staff to give priority to forces personnel coming back to Canada. I do recognize, however, that treating a member of the forces also means treating his family and those around him. If we cannot treat them ourselves on site, we make sure that we route them to appropriate resources, such as the family centre where psychologists and social workers are available, or to some centres in town.

Briefing sessions are provided for all spouses before forces members leave, in cooperation with the family centre. Unfortunately, family members are not all military personnel and we cannot force them to attend. Frequently, they don't show up to the briefing sessions.

There are Internet sites available for them as well, with Web cams and all kinds of things. Between the time I was first deployed and today, there are much greater possibilities for armed forces members to talk to their families. There are a number of services, but the members and their families do have to use them.

[Marc-André Dufour]

If we are to help the soldier's spouse or family, the soldier has to be with the Canadian Forces. We must provide services to the military. We help the soldier's family indirectly in an effort to help the soldiers themselves. That is what we are asked to do. Is it the best thing to do? Could we expand the services? We'd have to see. For the moment, however, the purpose is to help the soldier.

If the soldier is on a mission and his spouse comes to seek our services, we cannot provide help. We would have to send her to the Family Centre in Valcartier, or to provincial resources, because the soldier is not one of ours.