Evidence of meeting #31 for Veterans Affairs in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was soldiers.
A recording is available from Parliament.
3:30 p.m.
Conservative
The Chair Conservative Gary Schellenberger
I call the meeting to order.
I'd like to welcome everyone this afternoon to meeting number 31 of the Standing Committee on Veterans Affairs. Pursuant to Standing Order 108(2), we are continuing our study of combat stress and its consequences for the mental health of veterans and their families.
For the first hour our witness is Don Richardson, consultant psychiatrist with the Parkwood Operational Stress Injury Clinic.
Welcome, Mr. Richardson. You're on, sir.
3:30 p.m.
Dr. Don Richardson Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
Thank you for inviting me.
Usually when I'm asked to present, I'm asked to do a PowerPoint presentation, so I'm assuming that you don't want me to do a long presentation. I'll keep it relatively short, and maybe there will be more time for questions and discussions.
3:30 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
I did send in advance a couple of published articles that focus on Canadian veterans and military members. I think some of them are being translated. I'll just review some of their highlights and then open it up for questions.
As you're probably aware, Statistics Canada did a survey in 2002, the Canadian community health survey, that had a supplement focusing on currently serving members of the military. Probably the most comprehensive published research on that survey was done by Jitender Sareen in the Archives of General Psychiatry in 2007. The prevalence in any past year of a medical mental disorder—this is for any psychiatric condition—was about 15%. For major depression, it was 6.9%; for PTSD, or post-traumatic stress disorder, it was about 2.3%; for alcohol dependence, it was 4.8%.
The other thing that came out of the analysis was that most individuals who met a criterion for a mental disorder diagnosis were not using mental health services. Furthermore, deployment to combat operations and witnessing atrocities were associated with increased prevalence of mental disorders.
Other published studies that have looked specifically at PTSD include one with a sample of Canadian veterans with medical conditions. In that study, the one-month prevalence rate for PTSD was about 10%. In a sample of American military members deployed to Iraq and Afghanistan, the prevalence of PTSD was estimated to be between 11% and 17%. In U.K. members, the rate was 4.8%. As you can see, there's quite a variation.
The other thing for combat-related PTSD specifically and other psychiatric illnesses is that there are high levels of comorbidity. When we ask about comorbidity, it means that if you have one thing, such as PTSD, there are chances of having something else. The most common comorbidities are going to be major depression, and then addictions and chronic pain, and then other physical conditions.
The many studies that were done, though, indicate that even though PTSD often presents with significant impairment, if you are using established guidelines or evidence-based practice, remission rates of anywhere from 30% to 50% can be achieved.
I think I will end there, if that's okay.
3:35 p.m.
Conservative
3:35 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you, Mr. Chair, and thank you for coming, Dr. Richardson.
What I'm trying to get from you today are really your recommendations. We've heard that in the military, people will be screened for mental health challenges about six months after deployment. I'm wondering if you think that's enough. I'm also wondering if you think there are different ways to screen. For example, in the U.S. they have self-screening, but you can't offer that alone. It has to be with treatment.
My first question is this: how can we better help our forces members to get mental health treatment while they're serving?
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
I think it's been demonstrated that regular periodic screening tends to work better, because in this way, if you're going in for your regular medical checkup and you get screened at that time, and it's not necessarily deployment-specific.... Somebody coming back from deployment, for example, may minimize their symptoms or may not have acknowledged their symptoms at that time, but maybe if the screenings are repeated regularly as part of their general health assessment, then....
3:35 p.m.
Liberal
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
I'm not sure how often they would normally be screened. I wouldn't want somebody to be going in too regularly, but I would imagine that they usually go for periodic screening at least once a year.
3:35 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Do you think having self-screening available is a useful tool, as in the United States?
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
If we look at the concept of “no doors are closed”, meaning that if you have the opportunity to do self-screening, which is available online for Canadians as well--you can go online and complete all kinds of self-screening instruments—it generally will provide you with information at the end saying that if you scored at a certain level, you should see your primary health care provider.
3:35 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
You mentioned there is variation in the statistics. Who has the lowest statistics, and what are they doing?
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
Do you mean the lowest rate of...?
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
If we look at what has been presented, it really depends on how the survey was done—
3:35 p.m.
Liberal
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
—and on how the data were collected, so it would be very difficult to come to a conclusion. If one population has a lower rate, it would be very difficult to have a basis for the conclusion that they are doing something different without knowing exactly how the data were collected.
As well, deployments differ in length in each country. For example, U.S. deployments tend to be longer than Canadian ones, so other aspects are also involved there.
3:35 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Can you talk about transitional services? When people come out, how can we make sure they are followed up and have access to suitable screening? How can we make sure they are hooked up and are followed by a case manager?
What would your recommendation be to ensure that people are getting the necessary treatment and follow-up they need? Perhaps you can add some comments on addictions when talking about this aspect.
3:35 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
Just so I understand, are you talking about the transition out of the military—
3:40 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
—or transition coming back from deployment?
3:40 p.m.
Liberal
3:40 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
I think it's a matter of the continuity of care when somebody who is in service leaves and becomes a civilian. For that, there are transitional services available if somebody has already identified themselves as having a problem. Then it's easy for Veterans Affairs, I would assume, to take on that patient client, because the person has already been identified.
Those who release and have not yet acknowledged, or have not yet been identified as having, a psychiatric condition, fall off into primary care by family physicians in Canada, so part of—
3:40 p.m.
Consultant Psychiatrist, Parkwood Operational Stress Injury Clinic
One issue with larger organizations such as the Canadian Psychiatric Association and the Canadian Mental Health Association is having them inform primary caregivers, whether physicians and nurses or emergency departments, to actively screen for trauma-related illnesses, including depression, and asking the simple question, “Have you ever served in the military?”. That may open the door for an ex-service member to talk about having experienced something that was difficult for them.