Veterans Affairs Committee on Nov. 18th, 2010

[Dr. Jitender Sareen]

The idea of the healthy soldier effect really is at a general level. When you're looking at a population, soldiers are generally healthier, and so you'd expect a lower rate. But in the case you're describing, the person now has to cope with the loss and the injury and can't seem to figure out how to live with that loss, and how it's going to affect their career and their family. During that time they might become depressed, and if there are any alcohol issues, they might have impulsivity.

[Lise Zarac, Liberal, LaSalle—Émard, QC]

In your assessments, have you ever heard the term “suicide pact”, about a pact that has been made in the outfit that if they don't have all of their limbs, they will kill themselves before they come back? Have you heard this?

[Shay-Lee Belik]

We've heard of suicide pacts with respect to the aboriginal communities we work with in Manitoba. A lot of youth will get together and decide that everybody will commit suicide at the same time or on a particular date because someone else they knew took their life at that time. I haven't heard about it in a military context, so that's interesting to hear.

[Dr. Jitender Sareen]

I've never seen any studies on it.

[The Chair, Conservative, Gary Schellenberger]

Okay. Thank you.

We'll move on now to the next questioner.

Mr. Carrier.

[Robert Carrier, Bloc, Alfred-Pellan, QC]

Thank you, Mr. Chairman.

Good afternoon, Ms. Belik and Mr. Sareen. You have interpretation services at your disposal, at least I hope so, because I'm going to speak in French.

You compared the studies on suicide rates. We have different sources and so it is difficult to draw conclusions. Do you think that we have access to all the necessary information?

Earlier General Dallaire was mentioning that reservists, for instance, are not tallied and they are offered virtually no follow-up when they come back from the battlefield.

Do you think that we are lacking information and statistics with regard to suicide?

[Shay-Lee Belik]

Absolutely. I was reading really carefully through the report by the Canadian Forces on rates of suicide, and I did notice in that report that they talk about how it's very difficult to track the reservist population. They do talk about a couple of different levels of reservists, and they say that they have good stats on a couple of levels, but not on all levels.

So I agree with you that there is data missing at this point. I also think that data on veterans is missing as well.

[Dr. Jitender Sareen]

The other thing I want to add is that, as Ms. Belik mentioned in her report, motor vehicle accidents are a very common cause of death, and sometimes it's not very clear to the coroner whether the accident was a suicide or an accident. It's a challenging issue. Some work from Europe has shown that the risk factors for accidents in peacekeepers were very similar to the risk factors for suicide in peacekeepers: impulsivity and alcohol abuse in young males.

But you're right that there's a challenge. A lot of what we hear is what's coming from the United States media. As Ms. Belik mentioned, we need to have more information specifically in Canada.

[Robert Carrier, Bloc, Alfred-Pellan, QC]

You talked a lot about suicide in your comments, and also about mental health, a topic that is in fact the subject of our study generally. Have you had access to data on mental health consequences, adverse consequences that do not necessarily lead to suicide?

[Dr. Jitender Sareen]

We published a paper in 2007 using the Canadian Forces data set, the same data set, basically showing what Senator Dallaire really talked about in his book, that Canadian soldiers who had been involved in combat or witnessed atrocities like human massacres were at about two to three times the risk of developing not just post-traumatic stress disorder but also major depression, alcohol problems, a self-perceived need for mental health.

Really, that's very consistent with the other studies in the U.S. and the U.K. The important message, still, is that most soldiers are resilient and do not develop any mental health problems, but a small number, probably about 20% to 30% who have been exposed to a high level of combat or a high level of witnessing atrocities like Rwanda, will develop a range of mental health problems--most commonly, depression, post-traumatic stress disorder, alcohol abuse, and panic disorder.

[Shay-Lee Belik]

I just want to mention that the study Dr. Sareen has been referring to has been sent to the committee. I think it's undergoing translation currently.

[Robert Carrier, Bloc, Alfred-Pellan, QC]

I still have time for one more short question.

General Dallaire made a comparison, and said that now families have more information on combat operations. They are given more information, daily, on what is happening in the theatre of operations.

Do you think that the fact that families can follow operations more closely now and know more about what the soldier has gone through will facilitate the soldier's return home?

[Dr. Jitender Sareen]

I think that's a very difficult question. I guess in the Korean War, the families didn't hear anything, and now it's almost become a challenge. I was at a NATO meeting a few years ago where they were talking about suicide specifically. One of the issues that came up for American soldiers is that sometimes there'd be a loss of a relationship in the family, where, say, the spouse has now left the soldier and has then sent that over by e-mail, and the soldier then becomes of course quite upset and suicidal. The people around the soldier get quite concerned. They were specifically concerned about that level of communication back and forth, for both the soldier and the family.

I think the challenge now is.... I don't know if it's better or worse. I think there's a sense of more connectiveness, that the soldier is not as “away”, with Skype and all those kinds of things. But I think there can be negative effects of that on both the soldier and the family.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Mr. Stoffer, please.

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

First, thank you very much for appearing before us today and thank you for your presentation.

One of the concerns I always have is in comparing military or veteran suicide rates with those in the general population. Years ago I used to live in the Yukon, and we had a couple of suicides in our small town of Watson Lake. At the time there was a conference in Whitehorse that I went up to. I remember talking to some first nation chiefs about the issue, and they said, “We never want to be compared with the general population. We're first nations people. We're aboriginals. Our concerns, our issues, our thoughts, our views, our beliefs are different, and we don't want to be compared with the general population.”

I notice here that you mentioned several times the comparison with the general population.

In your brief you say “yet exposure to combat and peacekeeping did not increase the risk”. Obviously I can't question your study, but I find it rather hard to believe that people who serve in a combat role or a peacekeeping role are not subjected to this risk. I remember folks who served on the Swissair disaster picking up body parts off the rocks. Some of them had to leave the service because of what they were exposed to.

Now, they may commit suicide many years down the road. As Mr. Dallaire said, one of his soldiers committed suicide 14 years later.

Second, later in your brief you say that gatekeeper training reduced suicide rates by 33%. Does that mean they reduced 33% in that year? Suicide tendencies can last for the rest of your natural life. You can commit suicide in your fifties because of something that happened in your twenties, if I'm not mistaken. So I'd like to know how you quantify these types of statistics.

I say this with great respect. You said you started this in 2004. The Afghan mission really got kicked into high gear around that time. Are you planning to do enhanced studies down the road to follow these veterans and their families, many years down the road, or is this more or less it?

Thank you.

[Shay-Lee Belik]

I should start off by saying that the data we used in our studies was collected in 2002, so it was a very different world before Afghanistan in the Canadian military.

I only wanted to clarify that point about the work we have done so far. We don't have access to follow these people. This is an anonymous database that we used, and was collected by Statistics Canada in collaboration with the Canadian Forces. It's only among active-duty soldiers, so that is another limitation to keep in mind. We're only looking at people who are in the military, serving currently, and perhaps these kinds of risk factors will change over time in their lifetime.

The study you are talking about, concerning the relationship with combat and peacekeeping and suicidal ideation and suicide attempts, says nothing about completed suicides and t says nothing about what happens when they are done with their military service.

I agree with you; of course it seems quite reasonable to expect that when people are seeing atrocities of this nature during a combat exposure it will have a possibly negative effect on their mental health afterward. It is limited by the fact that we're looking at it here and now. Anybody who had severe mental health issues at the time of the study would have not been included in that sample because they may have been released from the military. They may have committed suicide already from their experiences. This is simply a representative sample of active-duty people at the time.

Also keep in mind the fact that the combat exposure only asks “Were you in combat?” It doesn't ask specifically or address specifically the experiences they had during that combat mission, so it is possible that some of the people who had more severe experiences and the people who had less severe experiences are being put together, so that might be wiping out a little bit of the effect there. Maybe asking more specific questions around their combat experience might delineate better what kind of outcomes people have based on certain combat-related experiences, rather than only calling it combat in general.

On your second comment--

[Dr. Jitender Sareen]

Perhaps I may add to that comment.

We were surprised by that finding, as you are. We were expecting combat and peacekeeping to be associated, but as Ms. Belik mentioned, the outcomes there were suicide ideation and suicide attempts. Deaths by suicide were not assessed.

One of the important things that we didn't put in the report was that we don't have data on soldiers after the Afghanistan mission. In 2012, Statistics Canada is going to do a national Canadian mental health survey, and the hope is that they will also re-do the survey that we've been using from 2002, but I'm not sure if that will be done. I would really strongly recommend, as you are suggesting, that there is a need to understand what is happening. The combat missions that have gone on in Afghanistan are very different from those that occurred before with the soldiers that we looked at.

You have to also keep in mind that death by suicide is very different from suicide attempts. That is where some of the discrepancy can happen, too.

[Shay-Lee Belik]

Your second point was asking about gatekeeper training and the reduction in risk. Is that correct?

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

I was asking about suicide rates being reduced by 33%. Was that 33% in one year? We know that people with suicide tendencies, if they don't exercise...I hate to be simplistic on this, but if they don't exercise an option now, they may do it months or years from now.

[Shay-Lee Belik]

Yes, absolutely. That study did track active U.S. Air Force personnel. At the time, did it reduce when they did the training, and then I'm pretty sure they were followed over a five-year period to see if suicide rates went down in that time. That's as far as they went. There wasn't anything to do with after service.

[The Chair, Conservative, Gary Schellenberger]

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you, Mr. Chair.

My first question is on peer support and the operational service injury support service. Did you come across that in your research? What did you learn about that in your research?

[Dr. Jitender Sareen]

Around suicide, there isn't any literature around that; I know that's certainly a very important part of the support to the veterans. No one has ever looked at whether an intervention through gatekeeper training, where you train people to be aware of suicide risks, would have an impact on their capacity to help.

I think it makes a lot of sense. Those are the people who are in contact, and they should be aware of mental health problems and specifically suicide risk issues.

[Ben Lobb, Conservative, Huron—Bruce, ON]

In your studies, was any work done examining any of General Dallaire's comments or thoughts on prevention?

[Shay-Lee Belik]

I'm sorry, we weren't able to hear anything that General Dallaire said. Your microphone was on mute, so all we could see was the picture.