Veterans Affairs Committee on March 2nd, 2011

[The Chair, Conservative, Gary Schellenberger]

Thank you very much, Mr. Westwood, for your very candid answers and great answers today to our many questions. Again, I can only say that I wish you much success in your program.

I am not a veteran, but I do belong to the Legion, so I'm glad to see that the Legion is a great sponsor of your program.

Thank you very much for attending today.

We're just going to have a short recess.

[The Chair, Conservative, Gary Schellenberger]

We'll start the second half of our meeting by welcoming our next witness, Dr. Alain Beaudet, president of the Canadian Institutes of Health Research.

Welcome, sir.

[Dr. Alain Beaudet, President, Canadian Institutes of Health Research]

Thank you, Mr. Chair.

I would first like to thank the Standing Committee on Veterans Affairs for this opportunity to discuss the issue of combat stress and its consequences on the mental health of veterans and their families.

As in all matters of health, research is critical for achieving the quality of health and health care that we wish for Canada's military veterans. In the preamble to the act that established CIHR in 2000, Parliament recognized that investment in health and the health care system is part of the Canadian vision of being a caring society.

The act went on to establish CIHR's objective: to excel according to internationally accepted standards of scientific excellence in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system.

I have believed since I became president of CIHR in 2008 that this vision means little if it does not include a responsibility for the health of those federal employees who put themselves in harm's way in defence of our country and in fulfillment of national security objectives.

Reducing the burdens of mental illness is one of the five research priorities in CIHR's latest five-year strategic plan. In order to address this priority, CIHR is relying on one of its 13 institutes, the Institute of Neurosciences, Mental Health and Addiction. The institute's mission is to promote and support research in order to improve mental health by developing new strategies for prevention, screening, diagnosis, treatment and service delivery. We often forget that Canada has excelled in this area of research. It is in fact ahead of the pack compared to the rest of OECD countries in terms of quantity, quality and the impact of its scientific publications in this field of research.

CIHR investments in mental health research have totalled more than $234.4 million since 2006—$65.2 million in 2009-10 alone. As to post-traumatic stress disorder, CIHR has invested $7.6 million in research since 2006, including $1.7 million in 2009-10. However, this figure can be deceptive, since operational stress injuries can include PTSD as well as a variety of other disorders ranging from depression to hormonal imbalance, for which CIHR is also providing research funding.

For example, new brain imaging techniques have been put to use in looking at the effects of post-traumatic stress disorder on the brain. Neuroendocrinology studies, which look at the relationships between the brain and the endocrine system, have demonstrated significantly lower levels of the stress hormone cortisol in individuals with PTSD. Finally, it is likely that genetics and epigenetics will be key in helping us better understand the factors underlying the susceptibility of certain individuals to post-traumatic stress reaction.

I would now like to turn to some of CIHR's efforts to advance research into the issues affecting military veterans and their families, as well as research in operational stress injuries. You will appreciate that while I am not a research expert on this subject matter, I am pleased to speak to CIHR's efforts to accelerate research in this area.

As the other witnesses mentioned, the mandate of a number of departments is to promote research on the health of soldiers and veterans. These departments have formed specific partnerships with CIHR in this area. The Department of Veterans Affairs and the Department of National Defence have joined us in funding various research initiatives. I think we should build on these first successes to expand and strengthen our framework for action, increase consistency and maximize impact.

To this end, CIHR has started discussions with the office of the surgeon general of the Department of National Defence in order to identify areas of possible cooperation as part of their research initiative on the health of soldiers and veterans.

More recently, I met with the associate deputy minister of Veterans Affairs Canada, and we agreed to get our staff members together as soon as possible in order to set joint research priorities on the health of soldiers and veterans, and to develop a long-term cooperation plan.

Although there is a significant body of American research on combat stress and its effects, the military culture and community in Canada are different, and so are the types of operations in which Canadian troops participate. It is therefore important that we develop a research program of our own to fit the Canadian context.

A particularly noteworthy development for Canadian research has arisen from the November 2010 Canadian military and veteran health research forum in Kingston, which is the creation of the Canadian Military and Veteran Health Research Network, a network dedicated to building a better understanding of the health and well-being of military personnel, veterans, and their families.

Together, CIHR and the network announced in the fall of 2010 a request for applications for knowledge synthesis grants to summarize existing research in this area and determine gaps within the knowledge base.

This call for applications recognizes that military personnel and veterans have unique experiences in the service of their country, which can impact their physical, mental, and social health in a manner not experienced by the rest of the population. It also recognizes the increased need for research on the health and well-being of military personnel, veterans, and their families. We anticipate announcing the results of this competition later this month and subsequently using the data to identify research priority areas.

One of Canada's leading researchers in veterans' health is Dr. Jitender Sareen. He receives funding from CIHR and he testified before you in November.

Dr. Sareen is leading a CIHR-funded team on the study of trauma and post-traumatic stress disorder among soldiers involved in peacekeeping operations. He is also examining soldiers' need to access mental health care and the obstacles they have to overcome in order to obtain care; one obstacle is the fear of stigma in the workplace. The findings of his research have helped the Canadian Forces to create programs for those who need treatment and also to develop strategies to improve the mental health of military personnel.

Also, at the University of Manitoba, Dr. Darren Campbell is using functional magnetic resonance imaging in conjunction with psychotherapy to look at the emotional responses of military personnel with post-traumatic stress syndrome.

Similarly, Dr. Alain Brunet at McGill has led a Montreal-based research team on mental health disorders, including PTSD and related problems resulting from traumatic events in high-risk workplaces, and has been funded to examine treatment available to military veterans with operational stress injuries.

Dr. Gordon Asmundson of the University of Regina led a multidisciplinary team of researchers from Regina and UBC who examined whether exposure therapy—where patients are exposed to prolonged and repeated images of trauma until the images no longer cause anxiety—may be more effective than other methods for treating the disorder. Dr. Asmundson and his team have also looked at delivery of treatment over the Internet.

In 2009-10, Dr. David Pedlar, the Director of Research at Veterans Affairs Canada and a professor at the University of Prince Edward Island, along with a team of experts, received CIHR funding to study the reintegration into the workplace of veterans with mental health conditions.

CIHR-funded researchers are also doing important neural investigation into the brain activity of individuals with post-traumatic stress disorder writ large. For example, Dr. Ruth Lanius is the director of the post-traumatic stress disorder research unit at the University of Western Ontario. Her research focus has been the neurobiology of post-traumatic stress disorder and treatment-outcome research examining various pharmacological and psychotherapeutic methods, including in patients with post-traumatic stress disorder or major depression following motor vehicle crashes.

I could cite other examples of funded research dating back to CIHR's inception to demonstrate our history of funding those with research interests in issues specific to military veterans. I would like, however, to conclude by looking forward and acknowledging that more research is needed.

Canada is approaching the completion of one of its longest and most intense military missions in recent history. The care of these young men and women who served our country in Afghanistan makes even more pressing the need to thoroughly understand the physical and mental demands of military operations. We need to better understand through research what sorts of unmet mental health needs there are for veterans so that we can meet them with outreach and treatment.

We need to recognize that Canadian health research in this area is growing but needs to move beyond its infancy. The old military saying that “no one should be left behind” should guide us in ensuring that we understand and are ready to help veterans with health issues when they have completed their service.

Your work in this study will help us to understand where the gaps are and to set directions for future health research, and I would like to thank the committee for its work. I am pleased to take your questions.

[The Chair, Conservative, Gary Schellenberger]

Thank you, sir.

We'll have the first question from Mr. Lamoureux, please.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Thank you, Mr. Chair.

I do have a couple of questions I'd like to ask the witness, and I appreciate his comments. It's encouraging when we hear about the breadth of research that seems to be in place.

Do you feel that there is a great value in terms of being able to benefit from this research so that we can develop programs such that, when a member leaves the Canadian Forces, we would have a better assessment of how serious an issue there is? Do you see any value to having assessments done when a member leaves the Forces or do you see how that could be done?

[Dr. Alain Beaudet]

That's certainly a valid area for research. I do not think there is, or at least I'm not familiar with, any research on this transition period and the difficulties linked to this transition period. But I know for a fact that we've discussed with the assistant deputy minister of Veterans Affairs Canada that this is an area in which we could collaborate on increasing support for research.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

One of the things I'm thinking of is that we have a great number of people who retire from the forces every year. The ones we hear about are the ones who come to us with issues.

Other individuals, even those from Veterans Affairs, have commented that we don't really have good tracking of information or any sense of the actual numbers. Can you comment on that, particularly with regard to the percentage that we really don't know about and any sense of what that might be?

[Dr. Alain Beaudet]

Quite frankly, I could certainly get you some information on that. I can't really comment on it because it's always difficult to get information on those who don't come to us for treatment.

What we do know, however, is that there are some areas, particularly the mental health area, in which, as you know, there are significantly higher percentages of disorders than there are in the normal population. For instance, the rate of depression for people coming out of the military is about twice that in the normal population. But again, these are indeed the people we look at.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

I guess that would be just it: how do we know which members leaving the forces are enduring some form of depression or other mental illness if we don't do some sort of an exit evaluation? Is that a fair comment?

[Dr. Alain Beaudet]

We don't. Clearly the ones we're aware of are the ones who come for help.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

When you think in terms of pre-deployment, there are all sorts of horrors in the different types of war zones and in civilian unrest. Do you feel there are things we could do to put our soldiers in a better frame of mind when going into these conflicts?

[Dr. Alain Beaudet]

Again, that's a difficult question, and it's outside my realm of expertise.

What is clear, however, is that if we look specifically at post-traumatic stress disorder, we know that certain individuals are susceptible to this disorder and others are not. That susceptibility is actually a biologically anchored event. In other words, we know that about 20% to 25% of people who will be exposed to combat stress will develop some form of post-traumatic stress disorder. As you know, for some it will be fairly short-lived and for others it will be for a very long period of time.

It is clear that certain individuals are more susceptible than others to developing this. My own belief, and it's really my own belief--again, I am not an expert on this topic--is that epigenetics and genetics studies will help us screen and identify the individuals who have an increased susceptibility to developing this type of disorder. As you know, it's a biological disorder. It's a truly anchored biological disorder. It's a link between the brain and the hormonal system and its imbalance in extinguishing the fear.

The first important thing to do is to explain to people who experience this that it is a biological phenomenon, probably a protective phenomenon, and that they don't have to be ashamed of it. You have to listen to them. You have to explain that it actually is a biological mechanism. Their hormonal system isn't balanced and their neurotransmitter system in the brain isn't balanced.

We need to better understand what type of imbalance we're facing and how it is and why it is that in certain individuals the mechanisms that normally extinguish the fear once it has appeared, which is a purely biological phenomenon, don't work. Hopefully, we'll eventually be able to screen these individuals, and either have a mechanism to protect them from that or just not send them into combat.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Finally, given what you just said, do you believe it is possible that a psychological assessment examination could be developed to give to people when they exit the forces that would give an indication of this?

[Dr. Alain Beaudet]

Frankly, I believe that eventually it's going to be more than psychological testing. I think it's going to be biological testing. I think we're going to have biomarkers that could be genetic, epigenetic or hormonal markers. I believe that we need to develop true biological markers.

I think when people see that these biological markers exist, they will lose the stigma that they're doing something wrong or that they're not up to it, which is a real issue.

[The Chair, Conservative, Gary Schellenberger]

Mr. Vincent, please.

[Robert Vincent, Bloc, Shefford, QC]

Thank you, Mr. Chair.

Good afternoon, Mr. Beaudet. How are you?

[Dr. Alain Beaudet]

Very well.

[Robert Vincent, Bloc, Shefford, QC]

At the start of your remarks, you talked about genetic evolution, and then you talked about biological evolution.

Do you think there is a difference between genetic evolution and biological evolution?

[Dr. Alain Beaudet]

There is no difference. Genetics is the basis of biology, it is most certainly rooted in it. I don't see a difference. As for this syndrome, we are really talking about an interface—which is probably genetic and epigenetic—of predispositions to an abnormal reaction to stress and, particularly—this is what I explained—to the ability to turn off the fear and stress mechanisms.

Normally, when an individual is subjected to intense stress or fear, there are biological mechanisms that engage. This fear is protective. It allows us to flee or fight, the "fight-or-flight" principle. It is entirely biological, but what is normally needed once the danger has passed is to be able to switch off this phenomenon. There are biological mechanisms that shut it down.

But, as you know, when it comes to post-traumatic stress syndrome, the fear extinguishing phenomena are dysfunctional, probably because the individuals have genetic predispositions to react to external phenomena or environments that mean that the individual is unable to extinguish this fear. So, everything replays constantly on a loop in their brain, and their stress response in their current life is totally maladjusted because a hypothalamo-hypophyseal system is functioning very poorly.

[Robert Vincent, Bloc, Shefford, QC]

In your studies…

[Dr. Alain Beaudet]

They aren't my studies. They are studies we are supporting, funding and want to provide more funding to, because this is extremely important to understand.

[Robert Vincent, Bloc, Shefford, QC]

In the context of these studies that you are funding to try to understand post-traumatic tress, genetic or biological, what link are you making between post-traumatic stress and suicide? Can a study tell us at what stage post-traumatic stress can lead to suicide?

[Dr. Alain Beaudet]

Well, with that, it becomes extremely difficult to determine. Once again, I am underscoring that I am not an expert, and I think that you have asked experts about this. So, I am speaking for myself.

It is clear that post-traumatic stress phenomena are linked to depression and, as you know, there is a relationship between suicide and depression.

That said, it is clear that the exact links between post-traumatic stress, depression and suicide are not at all clear. There are a lot of individuals who can suffer from acute post-traumatic stress syndrome and don't necessarily commit suicide.

[Robert Vincent, Bloc, Shefford, QC]

Okay. You also said that there was a difference between members of the Canadian Forces and members of the American armed forces. Can you explain this difference to me? When two soldiers, a Canadian and an American, are in the same theatre of operations, how can they be different?

[Dr. Alain Beaudet]

First, overall, the Canadian Forces are more involved in peacekeeping missions, much more than the American armed forces. That is one of the factors. Also, there is no doubt that the environment is not the same within the Canadian Forces as in the American armed forces.

To go back to what we were just talking about, I would say that we also know that the suicide rates are much higher in the American army than they are in the Canadian army.