Veterans Affairs Committee on May 6th, 2009

[Maj Mariane Le Beau]

I guess we cannot assume that for everybody. We know from the statistics that not everybody will develop operational stress injuries, even following some difficult combat situations. However, I believe there is a greater understanding in the Canadian Forces, and there are more and more steps and tools in place to prevent that.

I would like to mention the third-location decompression. When soldiers come back from Afghanistan they stop at a third location to decompress for five days. A lot of education is provided. Our peer support coordinators are there. Cyndi Muise has been there as a coordinator on the TLD, and I'll bring her in to talk about that.

The post-deployment screenings have been improved. The follow-ups have been improved. That's under the Canadian Forces Health Services and not so much about OSISS--that's not our piece of the pie. As I said, we're one piece in a big puzzle. There have been a lot of improvements in these tools and these ways of screening individuals.

If I may, I'd like to let Cyndi Muise talk about the third-location decompression and her role.

[Cyndi Muise]

Thank you, Mariane.

As Mariane said, we are part of the third-location decompression. When I was there, they would come from Afghanistan in groups of 150 at a time. When they first come they don't want to be there; they're angry and they just want to go home. But by the end they're very grateful that they've had a chance to decompress before going home.

Our role is just to be there. When we were there we made quite a few referrals to the on-site psychologist, who was able to set the soldiers up--from Cyprus--with psychological appointments in Canada for them and their families. Before they even come home they have the appointments set up. That's one preventative thing.

We do an OSISS briefing every second day while we're there. They just have fun. When they come in they're tired the first day and they're usually all in bed by seven or eight o'clock at night. The next morning they have a couple of hours of briefing, and they have the CFPSA staff there. They have all sorts of rendezvous and things for them to attend. There's some down time as well.

But they absolutely come to talk to us, and we're quite busy when we're on the third-location decompression. It's quite rewarding to be able to make referrals for them back in Canada and to follow up once we get home.

[The Chair, Conservative, David Sweet]

Thank you very much.

Thank you, Madam Sgro.

Monsieur André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Good afternoon to everyone.

Thank you for this excellent presentation of the challenges of operational stress. Thank you for the fine testimony from Ms. Muise and Ms. Underhill. Thank you also for the explanations regarding the services.

I have a few questions on the same subject that Ms. Sgro raised previously.

Ms. Underhill, in your testimony, you said that it took you 10 years to realize that your spouse was suffering from operational stress.

With this in mind, do you believe that today—we were discussing 2001, now we are in 2009—your programs have succeeded in giving more information to the families and the close associates of someone who is returning from a war or from a military conflict? Have we succeeded in informing families better so that they can identify or detect a person suffering from operational stress syndrome?

Also, I know that services are often centralized in urban centres, and this always raises a question in my mind. Let us take the case of someone living in a rural environment, for instance, in a very isolated region, someone who has had to cope with operational stress syndrome problems for several years, someone who has returned from an armed conflict. If this person is far from the large centres, for instance Sainte-Anne Hospital near Montreal, how would they go about getting services? Also, are your interventions made with a view to cooperating with existing health and social service networks? Do you train responders on the ground so that they can deliver services in the near vicinity of such persons?

I have a further question. What do you expect from the committee and the government? Are there enough resources available to persons who have to cope with operational stress, for victims of operational stress? Should we have even more resources? Do we need more research on stress prevention—on the stress prevention services offered to these people—and do we need more information for caregivers, peers, etc.?

[Kathy Darte]

On whether families are better informed today, we're hoping they are, and I think they are to some degree. When we did the needs analysis in OSISS in 2004, one of the big findings was that families really needed a lot of information. They felt they had very little information and understanding about what an operational stress injury was. They just knew that their husband or wife went off on a deployment and came back a different person. They didn't know it was an operational stress injury or what it was, but it was something that made their husband or wife different.

So they identified to us very loud and clear that they needed a better understanding and more information. We've been working on that, and implementing the family peer support coordination position has helped that considerably.

On urban areas versus rural areas, with the OSISS program the support is provided one on one, face to face, if that's doable. Often that's not doable when families or others are living in remote areas, so a lot of their work is done on the telephone. We try to reach out and use that mode. We also use Telehealth. Some of our peer support coordinators have been involved with Telehealth. Cyndi Muise is one of those.

There will soon be 10 Veterans Affairs operational stress injury clinics across the country, and they provide family services. Our peer support coordinators work with families, in collaboration with the health professionals at the clinics. It's another way of trying to work together in a team effort, because we know there are not enough resources out there to meet the demand. It's improving, but there's still a great demand for services and programs for those suffering. We use whatever manner we can with others to reach out to them.

[Maj Mariane Le Beau]

I would also like to reply in French. Thank you for your question.

With regard to education about the injuries caused by operational stress, the military is a captive audience for us. It is easy for us to require each employee to attend a presentation on the subject before being deployed. But this is not the case with families. We have to convince them to come and meet with us. Even if we could meet with them, be it in a resource centre or in the community, they still remain free to come or not to come. This makes things more complicated when we try to contact them.

In family support centres, we have developed protocols for working together so as to communicate more with them. One of the duties of our coordinators, Ms. Underhill and Ms. Muise, consists in doing a great deal of outreach and in trying to cooperate as much as possible with existing community resources. With regard to families, more specifically, our coordinators must rely on community resources in order to meet many needs. Community services are also useful for the military and for veterans. Thus, things get much more complicated.

You have read our mandates, certainly we must develop support networks, but education is also needed. About a year and a half ago, our sections were separated so that education could get the attention and the resources it needs to develop properly. The Department of National Defence then created what we call the Joint Speakers Bureau. We call it a joint bureau because the health services of the Canadian Forces, both clinical and non-clinical, are in charge of all the training regarding mental health issues. We are preparing a national campaign within the Department of National Defence to discuss mental health issues. There is also a program for families.

Are we anywhere close to saying that the information is available and easily accessible? Not yet, but as Ms. Darte said, we are improving. We have not reached perfection yet.

[The Chair, Conservative, David Sweet]

Mr. André.

Mr. Stoffer, for five minutes.

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

Thank you, Mr. Chairman.

And thanks to all of you folks for coming out today. Laryssa and Cyndi, thank you for telling us your stories.

It's funny, in all the years of hearing about the various concerns of men and women of the service and their families, every time we hear you, we always hear something a little new. I thank you both for that.

My first question is for both of you. What do the two of you do for stress relief?

I've spoken to peer coordinators in Halifax and in other areas. They listen to stories all day long. And like anyone else, you're human beings. You naturally say, “Oh, my God.” What do you do for yourselves to relieve the stress? Do you have friends or family you can go to, or do you exercise?

In the old days, an OSISS centre was called the Royal Canadian Legion. We've changed that now to something.... And it has improved. I've noticed improvements in the centre. But you're absolutely right, Madam, there could be a lot more improvements. You saw Pat Stogran's report the other day. It wasn't very pleasant in terms of DVA and other things.

But Ms. Muise and Ms. Underhill, what do you folks do to alleviate the concerns for yourselves?

[Cyndi Muise]

Thank you very much.

Part of our program, part of our employment regulation, is that we have 25% of our time as self-care. Self-care is heavily weighted into our program. If we don't take care of ourselves, we're not going to be able to help anybody else, or our families.

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

What does that mean, self-care?

[Cyndi Muise]

Taking care of ourselves.

During work, I'll go to the gym a couple of hours a day, three times a week. I go to a psychologist once every few weeks, sometimes once a month, or sometimes once a week. It depends on what's going on for me and for work.

I have a very strong family. They have educated themselves about what's going on for me. As you know, most people in the military are men, so it's unusual to have the spouse in the military...to have a female member.

And...just lots of laughing.

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

Good for you.

[Cyndi Muise]

We connect with people and our peers across the country. We connect quite a bit. We phone each other. Most of us try to make a habit of contacting each other at least once a week. We take turns phoning each other, throughout the country. We also have an MSN-AOL chat thing on our laptops and at our office, so we can always pop in and say hello to somebody, or whatever.

It's very important that we look after ourselves. And we all look out for each other. Laryssa will sometimes say to me, “Hey, take a break.” Everybody else will notice it before we do.

That's what I do.

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

Thank you.

[Laryssa Underhill]

It is quite individual, but for myself I find it very important to connect with my colleagues. Sometimes just in a very generic sense, I might bring up a difficult case. I work closely with Veterans Affairs area counsellors. They're case managers with Parkwood Operational Stress Injury Clinic. On the professional side I find that very important, because it can be very trying and stressful work. So that's a very important component.

On the personal side, yes, my kids are an important factor, and exercise is as well. We maintain overall health and relieve as much stress as we can in positive ways.

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

Thank you for that.

Kathy, I have a question for you. We did a story a while ago on Gary Zwicker that was very public in the Halifax area. One of his biggest concerns, besides the operational stress injury, were his financial concerns, which added even further stress to him and his family. It's great that the OSISS centres are going and that they're going to go from Newfoundland to Victoria and in the centre, but one of the major concerns that men and women of the service have when they get out and they're 3b-released is financial issues, which compound everything else. It puts stress on the family, the children, etc. That's one question: what is the government doing to assist them on that?

The other day I asked Darragh Mogan, I believe that's his name, a question regarding a gentleman who went through OSISS and was okay. He's now fine, but his child is still having difficulties, and DVA—and I checked again today—denied the child access to a psychologist. Mr. Mogan would like to know about that, and I have forwarded that information on to the people in Halifax. But as Laryssa said very clearly, the children and the families...because as we know, PTSD can be transferred unwittingly or whatever, and now this child is left out in the cold and the veteran doesn't know what to do.

Kathy, what should I tell him? The reality is that the DVA has told him twice now, and I plan to raise it obviously with the minister and everybody else, but I was under the assumption that these OSISS centres were there to continue the help as long as it takes. Am I wrong on that? That includes not just the veteran but the family members and especially the children. We've heard all the stories in Petawawa and we know that's improving, but there are still some serious issues out there, especially when it comes to the younger children.

Thank you.

[Kathy Darte]

I can't speak about the specific cases that you have referred to, and I don't know those cases, but I will speak generally from what I've heard you say.

Financial issues...yes, we certainly know that this is a factor—not always, mind you—and that in operational stress injuries people have financial issues. If you look back just in the situation that Laryssa has presented, when things go on for 11 years and the family is falling apart, people end up coping in very negative ways and get themselves and their families into very serious situations with serious financial impacts.

Certainly in the new Veterans Charter in Veterans Affairs there is a suite of programs helping individuals get on that road to recovery and wellness, and financial benefits are built into the suites of that program. I don't know if the individual you were referring to is part of that program, has been part of that program, or has tried to access that program, but I just wanted to point out that there are a number of financial benefits around the whole new Veterans Charter suite of programs.

In terms of children, I can't speak to that case, but I guess what I can say is that in Halifax we have two family peer support coordinators, and children are part of that family unit that they're working with. I don't know, but I would strongly encourage those two families, or however many, to access the service of the family peer support coordinator in Halifax—and maybe they already have—because they know the community. One of their goals and objectives when they start to work and continue as they work in the program is to really know the community resources. The resources may not be available within National Defence or within Veterans Affairs, but maybe there is a resource available in the community. Certainly Laryssa has seen this in her community of services that are available for children, which are outside of government departments but are community services. So I would strongly encourage you to have these families connect with OSISS. Because you're quite right, we provide peer support services until services are no longer needed in that family.

[The Chair, Conservative, David Sweet]

Thank you, Madam Darte.

Thank you, Mr. Stoffer.

Now Mr. Kerr for seven minutes.

[Greg Kerr, Conservative, West Nova, NS]

Thank you very much.

Thank you very much for being with us today. Certainly, it's compelling information, and we do learn something more every time, no question about it.

I'm going to get into the substance in a second, but I would like to know a bit more about Lieutenant-Colonel Stéphane Grenier and his vision. What was that about? What did he see and push for that made him stand out and be specifically mentioned here?

[Kathy Darte]

Certainly, I can speak to this, because I worked with Stéphane, who was a major at the time he started the program and is now a lieutenant-colonel. When the program started, he was the manager in the DND seat and I was the manager on the Veterans Affairs side, so I can speak to Stéphane's vision, because I know it and him quite well.

He is a person who has post-traumatic stress disorder, and he's made that very public. He has had many deployments, but the major one he refers to in terms of his OSI, his operational stress injury, is related to Rwanda.

Major Grenier at the time was a top-notch soldier, but when he came back he started to show signs that things weren't right. Things were happening, and he started to feel that things were not going well at work, and so on. He did seek help through the medical system, but that didn't seem to work for him.

The person who reached out to him and started him on his road to recovery was a peer, a fellow soldier in uniform, who called him aside one day and said, “Stéphane, there's something desperately wrong here; you're not the same person. You're a top-notch soldier and things are going”—as they say—“down the tubes, and you need to get help.” He said he would support him getting on the road to recovery. And that's what got Lieutenant-Colonel Grenier on that road to recovery; it was a fellow soldier, a peer, who reached out. That individual didn't wait for Stéphane to come to him, but he reached out to the major.

Major Grenier reflected on that, once he was in treatment, and he really felt it was what has been missing. He felt there had been something missing in the way the system had been set up to treat individuals with mental health conditions. He discussed his vision, his concept, with the senior leadership in his department and was asked by them to put together a proposal. When the proposal was written, it was fully accepted by the senior leadership in National Defence, and he became the program manager to get that program on the road. That was in the spring of 2001.

The vision was that of the peer, the person who reached out and pulled him aside and said, “We have to look at this and address it”, which helped him to reframe the way he was thinking at that particular time.

That's what OSISS does. That's what Cyndi does, that's what all of her colleagues do, and that's what Laryssa does.

[Greg Kerr, Conservative, West Nova, NS]

Okay. Thank you very much.

So at the beginning it started very much as peer support, and it was really non-clinical, but help, support, and contact, and I think you all said there was trust. So it started in that context in the beginning. Thank you.

I have a general question about the 10 years you referred to, Laryssa, but I don't know which one of you should answer. I know things still happen, but would that 10-year wait likely happen again, or is the intervention so different today that it couldn't be repeated?

[Maj Mariane Le Beau]

If I may, when OSISS started—and Kathy was there at the beginning—the average time for someone to ask for help, or the average delay, was seven years. That's the average time. Obviously, some of the times were longer and some shorter.

We do not have recent statistics on those delays, but we do know anecdotally that people are reaching out a lot earlier than they used to.

Would it still be possible? Yes, it probably is. It's still possible for someone to go on and continue with their career, depending on their symptoms, without being detected. It's not an impossible thing, no.

[Greg Kerr, Conservative, West Nova, NS]

But there's a greater net today than there used to be.

[Kathy Darte]

Absolutely.

[Greg Kerr, Conservative, West Nova, NS]

When we had the senior staff in here the other day, there was a comment made about post-traumatic stress versus the other psychological problems. There's still a real stigma attached to the entry or the catchment.

Has that changed at all? It's one thing to accept post-traumatic stress disorder, but to say you actually have clinical problems or are depressed or you have dependencies and so on.... Do you see any change taking place in that or ways to bridge that gap, or is the stigma still, in your minds, a very serious problem?