Veterans Affairs Committee on Feb. 28th, 2011

[The Chair, Conservative, Gary Schellenberger]

I call the meeting to order.

Welcome, everyone, to meeting number 40 of the Standing Committee on Veterans Affairs. Pursuant to Standing Order 108(2), we are conducting a study of combat stress and its consequences on the mental health of veterans and their families.

Today from Canberra, Australia, on video conference, we have Lieutenant-Colonel Andrew Cohn, assistant director, mental health education and training. Am I correct?

Sir, I am Gary Schellenberger, and I'm the chair of the standing committee. Welcome.

If you'd like to make your presentation, we are joined with the rest of the committee. We'd like to hear your presentation, and if you can accept some questions after that, that'd be great.

[Lieutenant-Colonel Andrew Cohn, Assistant Director, Mental Health Education and Training, Mental Health, Psychology and Rehabilitation Branch, Directorate of Mental Health Clinical Programs and Standards, Department of Defence (AUS)]

Good morning, everyone.

I give apologies from our director, Colonel Hodson, who wasn't able to make it this morning. Lieutenant-Colonel Nicole Gray was going to be here this morning as well; she's become unwell, so she gives her apologies. Colonel Gray has passed on to me a few notes to pass on to you this morning.

I'll speak for a few minutes and then I'll be very happy to take any questions that you might have.

I'll start off by talking about the resilience training that we are undertaking for our ADF members--our Australian Defence Force members--and veterans. The BattleSMART program has been around for a few years now. The SMART in BattleSMART stands for “self-management and resilience training”. It's our preventive approach that we've developed for mental health problems. It's based on cognitive behavioural principles, and it aims to build individual and team psychological resilience by enhancing coping flexibility.

I'm not sure how much you know about the BattleSMART program, but I'll be very happy to take any questions that you might have. I've been involved in the development of BattleSMART since the very start, and it's evolved a long way since the very early stages. We deliver this BattleSMART program to all of our defence force recruits during their ab initio recruit training, so it's army, air force, and navy recruits who receive this psychological resilience training.

We've also developed a version for members before they deploy overseas on operations, and we're developing a version for them before they return to Australia at the end of deployment. That post-deployment version of BattleSMART is going to be integrated into a third-country decompression trial that we are going to be doing later this year. We have been asked by our government to do a trial of third-location decompression.

I'll answer questions that you might have about what we're going to be doing there. It's not in my field of expertise, but I can certainly flag any questions that you have that I don't know about and get back to you about more details on what we are doing with our third-location decompression trial.

The BattleSMART program is developing very well. As I said, we introduced it last year for the first time for members deploying to Afghanistan as part of the Mentoring Task Force 1. We're going to be delivering it to the soldiers who are deploying this year. As well, we're going to be taking over from the mentoring task force in Afghanistan.

We're also developing a version of BattleSMART for members who transition out of defence to the civilian community, and we're developing a version for family members as well. The version for those who are transitioning out of defence is called LifeSMART. It's self-management and resilience training for people leaving defence and dealing with the uniquely stressful events that they're going to have to deal with once they leave the defence force.

Does anyone have any questions about the resilience training we're doing?

[The Chair, Conservative, Gary Schellenberger]

We generally go around the table. We have a system that we follow, and we'll be following our regular system with questions.

Are you finished, or do you have more? You could finish....

[LCol Andrew Cohn]

Okay.

I've talked about resilience training. I was also asked to pass on some information about tracking veterans. I've got Colonel Gray's notes here. We acknowledge that tracking veterans is a significant problem for our defence force as well.

Just last weekend, there was an article in a few of our national newspapers about veterans returning with mental health problems. We've had a number of suicides in our defence force since the start of this year. We're up to three suicides this year; normally, our suicide rate in the ADF is around six to seven a year. This year, as I said, we're up to three, and they're all in the army, from different parts of Australia. There's no pattern of where they're from in Australia. They are geographically dispersed.

Tracking veterans is an issue for us. Our Department of Veterans' Affairs only tracks those veterans with compensation claims. Tracking those who have recognized injuries and have put in a compensation claim to veterans' affairs is the only way we can really track what's happening with our veteran community. The others are much more difficult. If they don't put in a claim for a mental health condition or a health condition, then they are much more difficult to track.

Our Department of Veterans' Affairs is currently trialing a use of social networking technology. They have a website that our veterans can log on to in order to keep track with the ADF veteran community. I'll give you the website: it's www.touchbase.gov.au. That's a social networking site for veterans to keep in touch with the ADF community. That website includes some self-care information for veterans and also has some self-screening options so that veterans can go on and do some self-screening to see how they might be tracking with their mental health.

I think that's all I really needed to talk about formally in my presentation. I'm happy to take any questions now that you might have.

[The Chair, Conservative, Gary Schellenberger]

Okay. The first question will be from Mr. Lamoureux, please.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Thank you.

Thank you very much for taking the time to make a presentation from Australia. It's the first time for me to do a video conference, as opposed to looking at the person face to face.

You've indicated there are four avenues through which someone would receive different modifications of the BattleSMART program. Every member of the Australian force, upon entry in a boot camp scenario, would receive it. Then if you have a mission, you would have both a pre-mission and post-mission BattleSMART program, and then someone getting out of the forces would receive another form of the BattleSMART program. Is that a fair assessment? Are there four?

[LCol Andrew Cohn]

Absolutely, yes. We started off with army recruits receiving the BattleSMART program back in July of 2006. Back then it wasn't actually called BattleSMART; that name was only coined in July of 2009. That was when the program became known as BattleSMART.

In July of 2006, it was introduced as a psychological resilience or coping skills program for army recruits. We kept statistics from the time it was introduced in July 2009, and in the 12 months after it was introduced we noticed a 50% reduction in the number of recruits who were referred for psychological problems and a 50% reduction in the number of recruits who were discharged for psychological problems. Also, the recruits who received the coping skills program were anecdotally much happier. They seemed, to the psychology staff and the training staff, to be a bit more savvy about psychological adjustment and coping and that sort of thing.

The program continued in the army for the army recruits, and then the air force and the navy picked up on it in about 2008, and it's been going there ever since. It has been modified as we go and as we learn things, and we have meetings with our scientific advisory committee twice a year. We have a number of Australian experts in the field of stress and coping who meet with us twice a year. We talk about modifications that we might need to make to the BattleSMART program, but as I say, it is being introduced pre-deployment and a version is being developed for post-deployment, and of course, as you say, we've got a version for those who are transitioning out of defence.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

I love what you're doing with respect to the prevention of potential symptoms by developing these programs.

In terms of the vets who are already back into civilian life, to what degree do they have access? To what degree have you developed the program to be able to assist those who have already left the forces?

[LCol Andrew Cohn]

To date, we haven't actually started making forays into the veteran community. At the moment the program is only being delivered for those members who are currently in the ADF, so the only version of the program that is given to our members who are in the process of leaving is the LifeSMART program that I told you about. So far, we haven't actually engaged with our veterans' affairs department to get a version developed for ex-serving members. That's probably our next step.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

That was going to be my next question. Do you anticipate having that put into place, and if so, do you have some timeframe for something of that nature?

[LCol Andrew Cohn]

No, there's no timeframe at this stage, because our priority has been developing the programs for our serving members. We recognize that it's something we need to do. That is the next step, because we need to be working much more closely with our veterans' affairs department, making sure that what they are delivering to veterans is consistent with what we are teaching our currently serving members. We do acknowledge that it's a priority for us.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Overall, in the training in a boot camp, you'd go for 10 weeks pre-course before deployment. You might spend a number of weeks at it. What kind of percentage of resources would go towards this sort of training? Would you say it's increasing? Obviously you have pretty positive results.

[LCol Andrew Cohn]

The training is not highly intensive. The army, for example, does a 12-week recruit training course, and the BattleSMART program is delivered to them in two modules. The first module is on the Thursday of the first week. They arrive on the Tuesday at the army recruit training centre, and then on the Thursday they receive the first module of the BattleSMART training. It's about two hours and it's cognitive behavioural training.

It's a PowerPoint presentation, but it's very interactive with the recruits. I've watched it in action a few times. They seem to engage with it very well, but it does depend a lot on the nature of the presenter. If you have someone who is quite experienced and is very confident in teaching cognitive behaviour therapy to large groups of people, then the recruits engage a lot better than with someone who is not as experienced.

That's for two hours on the Thursday. Then they get a booster session on the following Monday, once they've had the chance to experience a few things about what goes on in life in recruit training. At the booster session they get examples of things to come back and talk about in the larger group when they've actually been able to apply the principles they've been taught in BattleSMART.

[The Chair, Conservative, Gary Schellenberger]

Okay. Thank you.

We're going to move on now to Mr. André, please.

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

Good afternoon, Mr. Cohn. Welcome to the committee. You are not here with us, but I am pleased to be able to talk to you.

You have statistics on suicide rates among veterans who fought in the Vietnam War. You established a rate of 7%. We in the committee have a hard time establishing the suicide rate among veterans because it's difficult to reach those people once they leave the army and resume their civilian lives. How did you succeed in establishing statistical data on all veterans while taking into consideration the fact that those people leave the armed forces and become civilians again?

[LCol Andrew Cohn]

We have the same difficulty as you have in terms of establishing rates of suicide in our veteran community. Our Department of Veterans' Affairs cannot actually say what the rate of suicide is in the veteran community, and this is a major problem.

I mentioned that last weekend there was a newspaper article about suicide. They were trying to work out what the rate of suicide was in the veteran community, and they had to decide. The reporter said that veterans' affairs could not actually give them a figure, so that's a problem.

Every time there's a suicide in our serving defence force population, we report on it. We do a post-event review and look at the factors that might have contributed to the person's suicide. There's normally a commission of inquiry, which looks very closely at the factors that may have contributed to the person's suicide. If there are any issues that need to be explored, then the commission of inquiry looks deeply into those factors, but we can really only report on the suicides within our currently serving population.

As I mentioned, at the moment we're running at about six or seven suicides a year. Our ADF population is not large; it's about 70,000, from memory, and if you look at our rates of suicide in our defence force compared with the Australian general population, we're running at about 60% of the general population if you match them for demographics, age, and gender. If you look at the people in our defence force who have died by suicide and match them by age and gender to the Australian population, we're running at about 60% of the rate for the national population. We're not overly happy with that statistic. We would like to get it down even further.

Later this year we are going to be conducting a major evaluation of our suicide prevention program initiatives. We are going to get an external consultant to come in and conduct the evaluation of all of our suicide prevention program initiatives.

[The Chair, Conservative, Gary Schellenberger]

I'm going to move it over to Mr. Vincent, who will ask the next question.

[Robert Vincent, Bloc, Shefford, QC]

Thank you, Mr. Chair.

Colonel, I understand the statistical data you are presenting this afternoon. However, the truth is that, when a member of the Australian Armed Forces is released from the army, as you were saying earlier, they are not monitored by you unless they are taking medication. You keep track of only those who receive benefits. How can you establish a suicide rate of 7% when you are not keeping track of those who have left the armed forces? You have no information about those people, about where they live, where they currently are or about whether there have been suicides among them. So, you have a random figure of 7% that applies to those whom you are perhaps monitoring, but you have no data on those who are not in your system. In a way, the rate of 7% is skewed. It could be 7%, but it could also be 10%, 12% or 15%. Do you agree with me?

[LCol Andrew Cohn]

Yes, I totally agree with you, and I'm sure that ours is not the only country that has this problem. We need to work much more closely with our Department of Veterans' Affairs to monitor what's going on.

One of the initiatives that has started in the last couple of years is an initiative of the Australian Centre for Posttraumatic Mental Health, which is a centre of excellence in Australia. They're based down in Melbourne. They do a lot of research into post-traumatic mental health, so that's post-traumatic stress disorder and the like. They've come up with a project to look at how we can reach out and engage with ex-service members--members of our defence force who have left--and how we can help to reach out and engage with them.

That website I was telling you about is one initiative, but we are looking at the other ways there are for engaging with people who may not voluntarily come forward and seek help, so it's going to involve the community a lot as well.

These are the initiatives that we're working on. The government has given us money to advance these different projects. In 2007 I think the government committed about $1.6 million over several years to look at how we can do things better in engaging with veterans in the veteran community.

We acknowledge that this is a major problem, and at the moment there are deficiencies, but we are working on them.

[The Chair, Conservative, Gary Schellenberger]

Okay.

Now we'll move our questioning to Mr. Mayes. Mr. Vincent, we will have another opportunity in the next round.

Go ahead, Mr. Mayes, please.

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

Thank you, Mr. Chair.

Thank you for attending our committee today through video conferencing and for helping us to work through this review of operational stress and suicide. One of the issues we've heard about in some of our discussions is that there have been statements that the frequency of suicide among young people isn't any different from what it is among those in the Canadian Forces or in the general population. I'd like to know if that is the same in Australia.

Then I'd like to know a little bit about profiling those who suffer from operational stress or who commit suicide. When you look at it, is it the degree of exposure to operational combat? Is it other factors? Have you profiled those people so that you can identify where there could be some problem areas?

[LCol Andrew Cohn]

Yes, we have done some research in looking at the factors that determine whether someone suicides. One of our officers who is working in our mental health directorate, Major Damien Hadfield, did a meta-analysis in looking at the factors that were common amongst our ADF members who died by suicide. He came up with a number of things that are very common in the general society in Australia as well.

There are factors such as a significant relationship breakup or a significant change in the person's life, such as a medical downgrade, so that they aren't able to do their jobs or might be looking at being discharged from the military as a result of their medical problem. It's something significant in that person's life, something that is out of their control and leads them down the path of depression. Then, of course, you get things like alcohol abuse, especially at the point where the member suicides; alcohol is a significant factor there. There are a lot of commonalities between the factors that predispose someone in our defence force for suiciding and for the general population.

Not a lot of our members who have suicided have actually had operational service; only about a third of our members who have suicided actually were deployed on operations. I'm just thinking of two of them who deployed and who subsequently suicided. Even though they were exposed to stressful things on their deployment, it wasn't actually those things that were major factors in their suicides. A relationship breakup or a medical downgrade were actually the major factors in leading them down the path of suicide.

I hope that answers your question.

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

I'm quite interested in the BattleSMART program. It's not only the education of the recruit or the forces personnel, but also some of those indicators that come up in discussing these issues.

Are there any operational policies that your forces are implementing when, for instance, a person is maybe identified to be at a little higher risk? Would they say, “Okay, let's not put them into an operational combat situation” and help them by easing them into that more dramatic part of their job?

[LCol Andrew Cohn]

If one of our members does have a mental health condition and they are receiving help for it, and if we actually know about their mental health condition in defence, then we can alert the chain of command so that the member may not go on operational deployment. It just depends on the seriousness of their condition. If they have been treated in the past for a mental health condition and they are now better, then the doctor makes a determination as to whether they are able to be deployed.

We are very sensitive about these sorts of things. We don't want to send a member on deployment if they've only just recently recovered from a mental health condition and deployment could cause them to have a relapse of their problem. We've very careful about these sorts of things.

Normally a member who does have a mental health condition is assessed by the doctor. Everyone who goes on deployment needs to have a pre-deployment medical, so if a member has a disclosed mental health condition, that would be discussed with the doctor. Unfortunately--and I'm not sure if this is the same in your military--there are a number of our members who, if they have a mental health condition, may not come forward to ADF mental health professionals, such as psychologists or doctors. They may go outside defence and seek help for their condition outside, so we won't have any knowledge of their mental health conditions. A member like that, who is being treated by someone outside defence, could potentially go on deployment, and we would have no visibility of their problem. Their mental health issue may flare up in the operational theatre, and then we would have to bring them back home to Australia. That is an issue for us.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Now we'll move on to Ms. Sgro, please.