Veterans Affairs Committee on Nov. 30th, 2010

[The Chair, Conservative, Gary Schellenberger]

I call this meeting to order.

This is the 32nd meeting of the Standing Committee on Veterans Affairs. Pursuant to Standing Order 108(2), we are studying combat stress and its consequences on the mental health of veterans and their families.

Before we start with our witnesses, I'd ask if we could get consensus because of the delay that we've had. We have a half-hour bell that will start at 5:30. Could I get consensus that we may run until 5:45? It's a shame. It's not our witnesses' fault.

Do we have consensus to do that?

[Some hon. members]

Agreed.

[The Chair, Conservative, Gary Schellenberger]

Thank you. This session will run until 4:50.

We have Pierre Daigle, ombudsman, and Mary McFadyen, general counsel, for the first hour. Welcome.

Could you please make your presentation?

[Pierre Daigle, Ombudsman, National Defence and Canadian Forces Ombudsman]

Thank you, Mr. Chair.

Ladies and gentlemen, good afternoon.

I would like to begin by thanking the committee for inviting me to testify this afternoon on the state of mental health in the Canadian Forces, particularly as it relates to operational stress injuries.

As we said in our December 2008 special report, operational stress injuries will remain a significant challenge for the Canadian Forces and a real hardship for Canada’s soldiers, sailors, airmen, airwomen, and their families for many years to come.

In June 2009, the House of Commons Standing Committee on National Defence estimated that, of the 27,000 Canadian Forces members who had served in Afghanistan between 2002 and 2008, approximately 1,120 would exhibit symptoms of post-traumatic stress disorder and 3,640 could exhibit some sort of mental health concern.

These statistics do not take into account those Canadians Forces members who have served in Afghanistan after 2008, nor do they consider they military personnel who served in dangerous and demanding military operations before the Afghanistan mission, including in the Balkans, Rwanda and elsewhere.

In many respects, operational stress injuries will be a generational challenge for the Department of National Defence and Veterans Affairs Canada, the Canadian Forces and the Government of Canada as a whole.

So I am pleased that this committee is studying these issues. Your work is incredibly important for our serving members, our veterans and their families who have given so much of themselves in service to Canada.

Mr. Chair, joining me today is Mary McFadyen, our general counsel. She has worked on these issues for many years now. Mrs. McFadyen was the interim ombudsman for 14 months before I took the position.

We have provided committee members with a brief paper meant to summarize the work undertaken by our office in the area of operational stress injuries. Over the next few minutes, I will discuss some of the progress that has been made by National Defence and the Canadian Forces and a number of areas that need more urgent attention. I will also describe our intentions vis-à-vis operational stress injuries in the months to come.

Before getting started, I would like to be clear that our evidence-based research regarding operational stress injuries is from 2008. I took my position in 2009. Our research is dated 2008. We have monitored the issue closely since then, but we have not yet undertaken a third substantive follow-up review. Still, I believe a number of the concerns raised by our office in 2008 remain relevant.

Mr. Chair, our office has been engaged in these critical mental health issues since 2002. We have released four different reports and more than 40 recommendations meant to improve the care and treatment received by Canadian Forces members suffering from post-traumatic stress disorder or other operational stress injuries.

In our December 2008 report, we found that National Defence and the Canadian Forces have made progress in identifying, preventing, and treating post-traumatic stress disorder and other operational stress injuries. However, we also found a number of cases in which military members and/or their families did not get access to the care they so desperately needed, and we have seen that the consequences for individuals who fall through the cracks are often devastating and long-lasting.

One of our most pressing concerns was the fact that the negative stigma associated with operational stress injuries remains a real problem at a number of military establishments across the country. In fact, mental health caregivers from every region in Canada raise this as one of the biggest challenges still facing the Canadian Forces.

So I was pleased to see the launch of the Mental Health Awareness Campaign in the summer of 2009 to address the stigma associated with operational stress injuries.

I was also pleased to see some of the other initiatives undertaken by Defence since we released our latest special report in 2008—including the creation of the Joint Personnel Support Unit to ensure a more coordinated and integrated approach to addressing operational stress injuries.

At the same time, we know there are areas that still need more attention. For example, the first recommendation made by our office in the 2002 special report was for the Canadian Forces to develop a database that accurately reflects the number of Canadian Forces personnel affected by stress-related injuries.

Without reliable data, it is very difficult to understand the extent and seriousness of the problem and to design and implement effective national programs to help those suffering from an operational stress injury. The data could also be used to target education and training initiatives to where they are most needed. I would say, also, that these data could help to better identify the requirements for additional caregivers and additional infrastructure. It is unfortunate that National Defence has been so slow in addressing this recommendation.

Another issue that we continue to track is the care and treatment available to the families of military members suffering from operational stress injuries. In December 2008 our office was unable to find any evidence of a coordinated national approach to ensuring timely access to care and treatment for the families of military members suffering from post-traumatic stress disorder or other operational stress injuries. The availability, quality, and timeliness of care varied greatly from military establishment to military establishment.

When a Canadian Forces member has an operational stress injury, it is a significant challenge for the whole family, not just the member.

We also remain concerned about the stress and burnout in the military caregiver community, including chaplains, social workers, physicians, psychologists, psychiatrists and mental health nurses.

Mr. Chair, these issues will be a priority for our office as we look to launch a third follow-up investigation into the issue of operational stress injuries in the Canadian Forces.

We recognize and welcome the progress that has been made by the Canadian Forces to prevent, identify and treat military personnel suffering from mental health injuries. At the same time, the large number of current military sufferers—and even larger number of anticipated sufferers—have led us to the conclusion that this issue demands additional review and evaluation by our office.

I expect to launch this follow-up investigation in the next few months.

Mr. Chair, as I mentioned earlier, we believe that operational stress injuries will be a generational challenge for our country, so I am pleased that this committee has turned its attention to addressing this challenge.

At this time, we stand ready to provide any assistance we can to the committee.

Merci. Thank you.

[The Chair, Conservative, Gary Schellenberger]

Okay.

We'll go to our first question. I'm going to hold everyone to the seven minutes or five minutes that are allotted to you, and that's for questions and answers both. If I do have to interrupt, I will. I'm going to hold tightly to the time.

Go ahead, Ms. Duncan, please.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Mr. Chair.

To the witnesses, thank you so much for coming.

I'll pick up on the database. A national database is critical in understanding the extent of the problem. It allows us to evaluate various clinical interventions and it can be used to target education and training initiatives. We now understand that this database is not going to be available until March 2012. Is there anything you can suggest in the meantime to track data?

I will also ask about a national strategy. If you could write your wish list for this committee, what is that national strategy, and what are your key recommendations for it, please?

[Pierre Daigle]

Thank you.

Mr. Chair, with reference to the database, as I said, we've done some work in this particular subject. We produced our report in 2008. For the past two years there hasn't been too much follow-up on some of those issues. I must say, though, that since I took my appointment in 2009, I've been going on outreach visits to bases and so on.

There have been some creations, such the joint personnel support units in all kinds of organizations, in order to coordinate the care and services provided to members and their families. Still, to create a database, it seems that it's easier for DND or the CF to have a database on physical injury than on mental injury. I don't have the proper means to provide some intelligent recommendations here, but to me the database of people suffering from post-traumatic stress injuries is key.

As a lot of the committee has identified, this is not going to go away in the near future. It's going to increase in the future, and people see great demands on our medical care and everything. This database will be very useful in identifying how many people are suffering, not only in order to deliver the proper care but also to dictate additional infrastructure or additional requirements for health caregivers.

So I think it is important, and we've been asking the department for the last eight years, to make sure they have this database in order to treat this psychological injury as early as possible in order to prevent, as much as possible, the result of suicide. It is not necessarily linked with it, but it is definitely better to address the issue at the origin rather than to treat it at the end.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What would you like in a national strategy to address operational stress injuries? If you could write your wish list to this committee, what would be your top five recommendations, please?

[Pierre Daigle]

Do you mean recommendations to address the issue of operational stress injury?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I mean recommendations for a national strategy to address operational stress injuries.

[Pierre Daigle]

As we recommended in our report, I would say the four key elements important to track include, first of all, the database. We need to know how many people are suffering from post-traumatic stress injury.

We need to take care of family, because family is considered to be a national entity. They're part of the operational effectiveness of the members of the Canadian Forces, so they have to be treated as a whole.

We need to take care of caregivers in terms of the number of caregivers for mental health across Canada, and also in terms of the caregivers themselves.

Obviously, as we've touched on in the past, we also need to make sure that all elements of the Canadian Forces, regular and reservist, are looked after equally, because there are still some injured reservists who are falling through the cracks.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

That brings me to the treatment side of things. We see discrepancies across the country. If you look at how quickly you can get help in Halifax, Valcartier, and Ottawa, for example, it varies significantly. As you said, early intervention matters. How can we address that?

For example, we're saying that the ratio of the clinicians to the 65,000 people is 1:186, but the reality is that we're looking at 32 psychiatrists and 61 clinical psychologists. How do we deal with the discrepancies across the country? Do we need more mental health professionals?

[Pierre Daigle]

From my visits across the bases so far--and I've touched on the three services--I think we need to see this as not being a one-size-fits-all situation. Each region, each area, is different. When there's a reduction in budget or cuts in anything, I don't think we need to apply them equally across the board.

From what I've seen so far, I would say there are main hubs where the demand on combat formation is greater. I'm thinking off the top of my head of Edmonton, Valcartier, and Petawawa. These are places with huge brigades deployed. I'm not saying that others are not paying the price, but we need to look at the needs of each of those organizations.

We also need to make sure that we support the caregiver. I've found out that a lot of caregivers are doing less and less clinical work than what they were hired for. They are doing a lot of clerical work. Doctors, physiotherapists, and X-ray employees are answering the phone and filling out forms. They do a lot of things that take them away from the front line of clinical services.

We need to make sure that when we address medical support, we give the additional number of resources at the right place, making sure that.... Everybody is saying there's going to be a great demand in the future, so obviously it doesn't make sense to cut budgets in mental or psychological health services when you expect there's going to be a growth in the demand.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thanks.

I'm going to ask one last question around stigma. In talking to--

[The Chair, Conservative, Gary Schellenberger]

Ms. Duncan, we've reached the end of our time.

Mr. André is next, please.

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

Good afternoon, Mr. Daigle. I am pleased to hear you speak both French and English. It's interesting, because this sometimes helps us understand better.

I have a few questions with regard to some of the testimony the committee has already heard.

Take the case of Frédéric Couture. This young man came back from Afghanistan, where unfortunately one of his limbs had to be amputated. He tried to commit suicide in the theatre of operations, when he was with a few of his colleagues. After that incident, he was hospitalized.

Last week, we learned that he had come back to Quebec without having received any psychological treatment in the theatre of operations. I imagine that you know the story. His mother, who is looking after him, never really found out what had happened. He ultimately took his own life.

I imagine that, in your capacity as ombudsman of the Department of National Defence and the Canadian Forces, you have heard this kind of testimony many times.

It is often the case that those who suffer from post-traumatic stress syndrome do not readily reveal their symptoms. It's not like a pimple appearing at the end of your nose overnight. The process involves therapy to screen out the condition in a person. Generally speaking, men are the ones who are afflicted with PTSD, and we know that they are less inclined to seek treatment than women are.

I would like to know what you think about this matter, even though we have heard others speak to the issue several times. When people are in the armed forces, we look after them. However when a person leaves the armed forces, it's as if they cease to exist, they do not have access to services anymore, they are ignored, as are their needs, especially the psychological ones.

Have you received many complaints about this type of thing?

[Pierre Daigle]

Mr. Chair, I will answer the more specific questions, because these are the issues that I am dealing with now, whereas the report was published in 2008.

To answer your question, I would say that our office is currently reviewing complaints. What you alluded to is something that I felt when I visited certain military bases.

First of all, although the department did launch an awareness campaign in 2009, the stigmatization still exists.

I meet young mothers who confide in me and tell me that their husband would never want them to say that they are ill, because they would never want to come out and explain the problem. When these people are sick, their first respondent, their first service provider, is the family. The wife and children look after the spouse—or the husband looks after his spouse. This is a tremendous burden for the actual families.

Right now we have families who have not yet grieved

--they have no closure yet--

for their spouse or their son. Some of them, as you mentioned, committed suicide.

We are asking people to come to our office about these things. So if you are aware of any... We are continuing to monitor some of these families closely. I am corresponding with the minister on these files.

So that is one thing that exists. Despite the stigmatization, young people, as you correctly said, are not going to confess to having any weakness, because they have the warrior spirit.

Families suffer a great deal as a result. After an operational deployment, if families need help, whether it be the closest family member, the mother, father or spouse, we bring them together for a debriefing. At that time, we tell the family what indicators to observe in their injured family member.

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

Mr. Daigle, it would appear that this work is not being done in many cases. There does not appear to be any follow-up in the theatre of operations, in the cases that I have seen. When a person attempts to commit suicide, we must first intervene and hospitalize this individual. We must provide the appropriate psychological care. Obviously, there has been a physical injury, but there is also a psychological problem, a trauma. It would appear that this problem is not dealt with.

At the same time, when a soldier comes back here after leaving the base and the army, there does not appear to be any follow-up with these individuals either. The family—I agree with you—is the first responder. However, it seems to me that National Defence should have a role to play in following up on these individuals who have experienced specific incidents while in the theatre of operations. The department should be calling these people, meeting them five or ten times.

The cases that we are talking about pertain to individuals who were never given a telephone call by National Defence although they had experienced stressful situations and significant trauma—no telephone call, no sign... It seems to me that there should be some calls, some automatic follow-up. If the person refuses, that is one thing, but at least we will force—

[Pierre Daigle]

You are quite right. That is why it is so important to try to make every possible effort to develop this database. This base would enable us to detect, as early as possible, those individuals who may have problems or who may need help and so on and so forth.

You are right, post-traumatic stress syndrome or operational stress can occur in an individual several years after he or she has come back home. Ongoing help must be available. This is not one-time help, this does not stop once the person has come back. We have to make every possible effort to determine who is likely to suffer or who is already suffering from this problem, so that we can provide assistance.

Moreover, assistance must be ongoing. Many people leave the force, become veterans and fall ill several years after that.

As for the family, of course, in my opinion, it must—

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Mr. Stoffer is next. You have five minutes, please.

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

Thank you, Mr. Chairman.

Thank you both, Pierre and Mary, for appearing today.

You quoted some numbers. You said that 1,120 could exhibit symptoms of PTSD and 3,640 could exhibit some sort of mental health concern. Where did these figures come from?

[Pierre Daigle]

Maybe Mary could expand on that, but when we did our special report in 2008, we were also testifying in front of the House of Commons committee. That committee produced a report in June 2009, and those numbers are in that report. I don't know if some of them were provided by our office, but we took the final numbers from that report. There were many people, besides those from our office, who came and testified in front of that committee.

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

Thank you.

I'm not sure if you've had a chance to see it yet, but last Sunday The Chronicle Herald, a newspaper in Nova Scotia, did a really interesting article on military personnel who had been more or less forced out of the military.

One of the biggest problems I find for service personnel is that when they're no longer deployable, it means they're no longer employable within the military. They get, in their words, “kicked out” of the military. Some veterans have even said that what DND has done is offload the problem onto VAC.

In the private sector, where I used to work, in the Canadian airlines there was a thing called “duty to accommodate”. When you became injured, there was a responsibility on the company to try, as well as it could, to accommodate you to go back to work. I don't think that applies to the military, because many service personnel who believe they can still work in DND have been asked to leave. They're being “3(b)'d”, which means medically released from the military. That adds a tremendous amount of stress to them and their families.

As you know, sir, the DND is a culture. It's a way of life. It's in their DNA. It's who they are, and all of the sudden that is gone, for whatever reason, through no fault of their own and because of an injury. Now they have to go into a completely different world that they haven't been adjusted to for quite some time.

I'd like you to expand on something for a second. If you don't have the answer for it now, could you provide it later?

First, how many DND personnel who are serving right now receive a VAC pension? Then, on the question of the duty to accommodate, is DND doing a good enough job of keeping injured soldiers within the department, or are you finding a rush out the door--once you're injured, you're no longer employable with DND?

[Pierre Daigle]

All of those questions on this issue are so important. We take good note of the concerns, because we will do, as I said, this third follow-up to our report.

I hear about duty to accommodate when I go around the country, and I will look into it more deeply. It seems to be tied to universality of service. They can accommodate, but if at some point you cannot fulfill the operational function, then you are released under those terms.

I know there was some initiative for getting onto the priority list for public service transfer and so on, but people are concerned out there about all those things. You know, even in the public service there are people who are not happy when they see all those ex-military people taking over what they say are their positions. But in the outreach discussions I have, I do tell them that the military members I have met would not ask for more than to stay in uniform. This is what they want to do. They're not the ones asking to go elsewhere.

So this is all part of the impact of those physical and psychological injuries, and that will be part of my third follow-up.

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

Merci.