Veterans Affairs Committee on Nov. 23rd, 2010

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

Okay. Later I will ask why, but I have a couple of other questions.

In terms of the families, we heard from Mr. Whelan that they're permitted two visits or something like that, according to what DVA may offer. Are any of these services allocated as well for the family members and/or their children, and are they just as extensive as for the veterans themselves?

And the last one is this. We still hear about a lot of guys who have been removed from the CF, and one of the biggest problems they have--Mr. Maguire talked about it--is the adjustment out of the military. You serve 20 or 30 years and it becomes a way of life--like that crusty petty officer you talked about. They have great difficulties in adjusting to the civilian life, and it causes a myriad of problems.

I know that transitional services are improving, but can you elaborate a touch more on what they're doing for mental health concerns, besides the pension in respect to this?

[LCol Rakesh Jetly]

Those are excellent questions. You might need to remind me of them, but I'll do the last one first.

Again, we've come way ahead. Nothing's perfect, but we have come way ahead in this area. It starts way back, but one thing we do have for members with chronic illness, physical or psychological, is the joint personnel support units that have been created on every base. So the people who need extra attention administratively, medically, and those kinds of things, belong to these units, which are on every base.

There will be a transition, so a person getting a release message will not be released from the Canadian Forces for at least six months. And “case manger” is the most badly defined term ever, because every clinic will have a different definition of case manager. But our CF case managers are all nurses, and one of their main jobs is absolutely to hook the person up with services after they leave. Again, it's a huge country and people have the right to move wherever they want. If I had my druthers, all of our members would release around large centres, for obvious reasons.

When they do know where they're to be released from the forces, we take care of details right down to telling them, “Make sure you apply for civilian health care.” We don't have OHIP cards, right? We tell them to make sure they apply for a health card. We also ask them if they have a family doctor. If not, we try to set up the person with a family doctor. If we know where they're communicating from, our mental health professionals will try to hook them up with a professional in their region. If it happens to be in a region where there is a VAC OSI—and there are a number of them now—we will make arrangements for them to transition there. They might even be seen there while they're still serving.

So we make those connections with the professionals. Maybe we'll pay by Blue Cross or something like that prior to their release.

So it's now light years ahead of where it was. We're not tossing out people and hoping that VAC.... They can apply for their pensions early. One of the first things I do when I see a patient soon after diagnosing him, even if he is nowhere close to release, is to ask, “Have you put your paperwork in to VAC?” It's much easier to go through the process while they're still with us than somebody having to find them 10 years later.

So as much as possible, we have that transition. It's not rushed, but slow. And they can start their post-secondary education or college while still serving. Within the last six months of this September, they can start in school and still come to our clinic to get care.

As for the families of the members, we are governed by the Canada Health Act. My family doesn't get care on the base either. And when we move, we had to find pediatricians and doctors for our own kids, as well.

We are allowed to provide care in support of the member. Within mental health, we stretch that as far as we can stretch it. So it doesn't mean the member has to be in the room. The member could be overseas. If the spouse walks into our psychosocial services unit and says to our social worker, “I'm having a hard time”, we will help the spouse right there.

When we're treating people and talking about PTSD, part of our standardized assessment across the country is to have the spouse come in within the first or second session. Keep in mind, it's within the member's confidentiality. He or she has to allow the spouse to come in. So very early on, we'll engage the spouse in the process and the education we provide, telling them what's going on.

We run regular educational groups for the spouses. We run couples groups for a week in Halifax. We'll fly people in, for example, to get some education about the illness, coping, anger, stress, families, raising children, and those kinds of things.

So as much as possible, we do provide help. It's not going to be a U.S. TRICARE service. For example, if a spouse suffers from depression, I can't write a prescription for an anti-depressant. We're held back in that sort of way.

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

And the screening?

[LCol Rakesh Jetly]

The screening—

[The Chair, Conservative, Gary Schellenberger]

I know that Mr. Stoffer asked quite a few questions, and we have gone overboard here. I must say that a lot of it was very good, but Mr. Mayes has a question.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you, Chair.

Thank you to the witnesses for being here today.

Gentlemen, because we're talking about the context of the Canadian Forces, there's an assumption here, I think, that the suicides on this chart are directly related to combat or the vocation of being in the Canadian Forces.

I was wondering if you had really identified whether that was the case, that every one of these recorded suicides is a direct result of combat engagement, rather than living conditions, for instance. If you live on a base, there could be a lot of people around whom you're stuck with on a base and you might not get along with, or there are family or personal problems.

Have you broken that figure down to really identify how many of those suicides are directly related to being in combat?

[LCol Rakesh Jetly]

I can start.

Statistically, we've shown that it's not. There's a very interesting thing here. Statistically, there's a thing called association. I've deployed four times. Stéphane Grenier has deployed as well. We've both been in Rwanda. We've been in Afghanistan. We've been places. There's definitely an association with these places. If seven years, ten years, from now something were to happen to me, how would you causally link that to my tour?

Having said that, we have looked at it; it's different from our allies, but all of our allies are looking at this. Deployment, per se, is not associated with it. The numbers are too small. But the majority of the suicides that have occurred this year, for example, have never deployed. Causality aside, we're not going to have the association.

Clearly, OSIs, PTSD, and depression are illnesses that increase a person's risk. I think it's a very interesting area to look at. Longitudinally, if people, after they release, have their illnesses later on and lack the containment and the care system of the CF, what happens? I think that's an interesting area, and our colleagues at VA will be looking at that.

So far, the data from Stats Canada and various sources do not bear out that theory.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

I feel that extreme stress and depression are...have some of the characteristics of an addiction, whether it be drugs or alcohol. There are some external pressures that are forcing this behaviour.

I'm not an expert here. I don't want to give you the impression that I really know a lot about this, but as a person who has had some stressful jobs, you find that the stress can become a habit.

Is part of the work to identify those external pressures, take action to get out of that cycle, and finally identify the symptoms so that you don't fall back into that same cycle?

[LCol Rakesh Jetly]

Absolutely.

That's a personal thing, but it's also a leadership thing. Sometimes you have a very keen member who keeps jumping up and keeps volunteering for tours. As a leader, sometimes you have to say, “That's enough. Take care of things at home.”

What we're trying to teach are individual coping skills, these big four. They're so basic. We should be teaching them to kids in school. Ideally, our next step is to sort of take some of this stuff and introduce it into society. These are such very basic skills. Learn how to look after yourself; then, as a leader, look after your people. I think that's the key.

As a health care professional, I have nothing to do with that. When it breaks or doesn't work, I'm happy to be there, but I think the culture needs to be such that we recognize that we can burn people out. We can use them too quickly. Sometimes they're their own worst enemies. In a competitive organization, in which results get success, every once in a while you need to sort of have that pause. When you look at a lot of the differences between our stats and U.S. stats, that's the difference: six-month tours versus 12- and 15-month tours. There's a huge discrepancy in terms of how much reserve a person has and how much energy they have.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you.

Do I still have some time?

[The Chair, Conservative, Gary Schellenberger]

No, you don't at this point. I'm sorry.

I'm going to ask for one question. We only have a few minutes. We'll have one short question, and hopefully we can get the answer.

Ms. Duncan, you can have one question.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

How often are you screening, and who's doing it?

[LCol Rakesh Jetly]

The screening is called enhanced post-deployment screening. It's done three to six months after every deployment for anybody who's had a deployment of 120 days. Because we have it canned, we will decide to use it in certain situations, even if they're not that long.

For example, in the case of the Chicoutimi sailors, I was in Scotland with them, so we decided what they had gone through warranted this, and we screened them and followed them. So it's done three to six months afterwards.

There's a lot of evidence that shows that if you ask people right when they get home, it is too soon, because everybody's fine. So just like our allies, we use a three- to six-month window. Following every deployment, you'll have it multiple times. There is a series of evidence-based questionnaires on depression, PTSD, and all that. They're scored and computerized, and then the mental health nurse, usually the mental health professional who is actually doing the face-to-face interview, has those scores in front of them and can specifically target whether you're talking about sleep, anger, or drinking, but also, if there's really not much there, can say, “How are things going?” There are semi-structured, really broad questions in terms of personal function, life function, family function, and work function. There's a very holistic approach to these things.

I've been screened a couple of times myself. Just because I'm the boss or I'm the senior person...there are no exceptions; I still get tapped. It's a chain-of-command responsibility to make sure that people get screened. It's not the responsibility of health services. The reservists are actually more compliant than are the regular force members, so the reservists are being screened as well.

[The Chair, Conservative, Gary Schellenberger]

Okay.

Mr. Kerr, and then Mr. André.

[Greg Kerr, Conservative, West Nova, NS]

Thank you, Mr. Chair.

We don't have time, I realize, but I was going to point out that with the new clinic going up at Greenwood Air Base in the valley, everybody has been talking about the fact that mental health is being brought in as part of the team package and about how important it is. I was struck by that, because they were all talking about that team work and the collaborative part.

I have a question with regard to the stigma. We were at a conference recently in Montreal, a symposium in which Veterans Affairs and civilians were involved. I realize the comment about too much media attention has been made, but at the same time, how many professionals were pointing out that the stigma is still there in many mindsets, and that the public understanding that this is as serious as any physical...? I'm just wondering how you'd address that.

[LCol Rakesh Jetly]

Just to complement what my colleague here said, we are recognized, within NATO, within the armed forces, as the “stigma busters”. I will go to a NATO meeting and people will say, “Well, in Canada, you guys have that sorted out.”

It's not as perfect as that, but it asks the exact same questions of British soldiers, U.S. soldiers, and Australians. Our stigma--the perception of people being weak, this kind of thing--is about a third of the other nations'.

So the campaigns--OSISS, “Be the Difference”, all of these things--have been working. In fact, we asked 2,500 soldiers in one block, one year, “Would you think less of somebody else who was receiving mental health care?” and only seven percent of them said yes. So we've come way ahead. In my career, there was a stigma against mental health professionals when I started, never mind patients.

It's not done. We're not done. But I think we need to look at other barriers to care as well. There are structural barriers like geography. You can take down all the stigma in the world and you're not going to make the country smaller.

So I think we'll never lose sight of that stigma and that culture, because as soon as you look away, it's going to rear its ugly head again. People like Bill Wilkerson in the economic round table point and say, “If the Canadian Forces can do this, why can't Ford, or why can't these other large companies?”

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Mr. André, you can have one short question and answer, please.

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

I have a quick question about your involvement in terms of suicide while in service. Let's take Private Couture for example. The soldiers in Afghanistan made a suicide pact. He attempted suicide while he was serving. He came back here, he was suffering from PTSD and killed himself. So I am wondering about your intervention protocol in terms of suicide while in act of service. Let's talk about health care. When professionals are trying to prevent suicide and they feel that a person is at risk, they can breach confidentiality, intervene and hospitalize that person. In the case I was talking about, the soldier was not hospitalized, at least I don't think so. There was a suicide pact and these people came back here. I only have one minute and I would like to hear what you have to say about that. I would have liked to have more time, but one minute is not that long.

[LCol Stéphane Grenier]

I have tried to kill myself three times. My wife found me during my last suicide attempt. I had a cable and I was in the middle of writing my suicide note when she found me. I am not trying to defend the armed forces, but no one saw that coming. In fact, according to Dr. Jetly, that is not even in my file.

I am not defending the system. We must still turn the corner. But the armed forces never saw that coming.

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

I am talking about a suicide pact that was on TV. That was a known fact, even on the ground.

[LCol Stéphane Grenier]

That's right, but there is a difference between the suicide pact on the ground and what happened five or six months later, while the soldier was in rehabilitation. He was being assessed by the system that was trying to find out whether he was in good condition or not.

Personally, I have been under a psychiatrist's supervision for years and my doctor let me come home, when he knew I was really not doing well. Where do you draw the line? I don't want to defend the doctors either, but where is the line that allows us to know whether to commit Stéphane Grenier or to send him home? It is not always easy.

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

I was asking the question about the professionals.

[LCol Rakesh Jetly]

I'll never speak about a specific case, and I don't know the details of the case you're speaking of, from a medical point of view.

In general, we have a robust Role 3 hospital in Kandahar. We have mental health professionals; the Americans have taken over. We absolutely train our leaders. If the leaders are concerned about members, they bring them in themselves, and that's so refreshing. It's music to the ears of a mental health professional if a sergeant or a warrant officer will say, “I'm worried about my guys, doctor. Can you see them?”

There's a suicide assessment. Nothing is perfect. You do your best training. You do your best to assess risk, to assess fatality. In a war zone, where people have weapons, the risk is higher. We will keep the person, restrain the person. We'll take his weapon away. We will put him on a C-17 and send him to Landstuhl if we have to, tied to a stretcher, medicated. Again, nothing is perfect.

I feel for every case and feel for every mother who goes to the media. We have a heightened awareness. These aren't the soldiers of the Canadian Forces; these are the people who wear the same uniforms as us. These are my comrades in arms, not my patients.

There are systems in place. If somebody is worried, we say, “Come for help.” They get briefings on mental health. The chain of command knows they can't ever stop somebody from going for care. The chain of command is told to get them to the doctor, and we have our policies and procedures in place. Despite all that, people are still going to die from their physical wounds, and there will be people who are going to have mental illness and attempt suicide.

[The Chair, Conservative, Gary Schellenberger]

Is there any pre-screening before you join the forces for mental health problems?

[LCol Rakesh Jetly]

There's a health screening. There's all kinds of legislation, human rights and all that. There's a health questionnaire, and for now it's based on the honesty of the person--i.e., “I have a peanut allergy.”

In fact, next week we are briefing all of our physicians' assistants who do the medicals across the country. They've asked me and my colleague, the addictions expert, to help them in dealing with someone who says he had a problem with alcohol a few years ago but is fine now. If you go to your civilian doctor, the civilian doctor sends a note that says he had the problem but he's fine now. So how do we help our colleagues with that?

Yes, there's a health screening. Mental health is part of health. There's no separation there. But it is difficult to predict behaviour with these screenings. There are no perfect screenings.The special forces do it; some of these organizations do it. How predictive is it? We debate. Having a personality profile to predict whether a soldier is going to do well or going to do poorly would not stand the test of human rights. A disease or a diagnosed illness is different. A personality profile or an IQ test, I don't think that would be effective. We haven't come up with any such test, and none of our allies have either.