Veterans Affairs Committee on June 12th, 2012

[The Chair, Conservative, Greg Kerr]

Good afternoon, everybody.

Welcome this afternoon as we continue our study on transformation initiatives at Veterans Affairs Canada.

I want to welcome our witnesses today. The order has been changed slightly. It looks as though we may not be interrupted by votes, which would be a nice change.

Just to briefly tell anybody who is brand new, the routine is that we have the opening statements, and then we have rounds of questions by the members. We try to get everything in that we possibly can before the time wraps up.

Having said that, I will go through the names. From the University of Manitoba, we have Professor Sareen, professor of psychiatry.

From Veterans Affairs, we have David Pedlar, director, policy and research, and Carlos Lourenso, director of treatment benefits and veterans independence programs.

From the Department of National Defence, we have Colonel Gerry Blais, director of casualty support management; Colonel Bernier, deputy surgeon general; and Susan Truscott, director general, military personnel and research analysis. If there is anybody else you want to introduce as we go through, please feel free to do that.

If we are ready to go, we will start. Each one has 10 minutes for opening comments.

Professor Sareen, please go ahead.

[Dr. Jitender Sareen, Professor of Psychiatry, University of Manitoba]

Thank you.

I'd like to thank the committee for inviting me to speak today. I look forward to initiating a dialogue with you about the optimum methods of improving the health of our Canadian Forces and veterans.

Canada should be proud of the efforts that have been made over the last ten years in improving the mental health care system for our service members and our veterans. However, Canadian policy-makers will need to foster strong partnerships across academic and government sectors to face the challenges of providing care for veterans who have had combat experiences in Afghanistan in the context of limited resources.

During this presentation, I'll present my background and experience to help you understand the context of my comments. I'll also provide a story that highlights some of the key issues that our system needs to consider. Then I'll describe some of the important work that our group has done, and end with future directions.

I'm an adult psychiatrist working in the Veterans Affairs operational stress injury clinic in Winnipeg, Manitoba. I'm also professor of psychiatry and director of research at the University of Manitoba, and chair of the science committee at the Canadian Psychiatric Association.

My research work has been supported by the Canadian Institutes of Health Research, the Manitoba Health Research Council, and the Canadian Institute for Military and Veteran Health Research.

To illustrate the important issues we're facing, I'll describe a case. This case is a composite of several people who I've treated so as not to breach confidentiality and potentially identify any single individual.

A 25-year-old service member is referred to our OSI clinic for assessment and treatment. The member presents with nightmares, sleep problems, irritability, and thoughts about suicide. He remembers being thrown from his vehicle, during his tour in Afghanistan, because of an explosion. His fellow soldier was killed instantly during the explosion. He lost consciousness and broke his leg. He spent many weeks recovering from the physical injury.

Since returning home nine months ago, he has been avoiding activities with his wife and children due to depression. He feels enormous amounts of guilt, and wonders whether he could have done something to help save his fellow soldier.

He's been binge-drinking alcohol on weekends to numb the memories and control the physical pain he is having and to try to improve his sleep. His marriage is falling apart.

The story that you've just heard is a common one that many of us working in the operational stress injury clinics across Canada hear on a daily basis. As you can imagine, the emotional costs of deployment to Afghanistan have been substantial for Canada. Not only do problems like post-traumatic stress disorder, depression, and alcohol abuse impact on the individual and their families, these issues have a strong impact on the military, veterans, and our society.

There are some important questions raised by these stories. How many Canadian service members have developed mental health problems related to their deployment? Why does one person who faces combat develop mental health problems while another does not? Who among service members is at risk for developing mental health problems? What can be done to reduce mental illness in our service members and veterans? Most importantly, how can we prevent suicide?

Steven Fletcher, Minister of State for Transport and member of Parliament for Charleswood, visited our clinic last year and asked the following question that I didn't have the answer to: are civilians in Canada more or less likely to get appropriate treatment for depression than our veterans? It's an important question, because the military has been previously criticized for not taking care of the emotional needs of our veterans.

To date, we don't have scientific data to answer many of the questions that I've posed to you. Through important partnerships, through researchers, Canadian Forces, and veterans, we have aimed to try to address some of these important issues.

Our research group began approximately ten years ago. In 2002 Canadian Forces and Statistics Canada conducted a landmark mental health survey to understand the mental health needs of our active military. Stats Canada conducted in-person interviews with over 8,000 active military personnel and tried to understand the mental health needs. We have been supported by the CIHR, the Canadian Institutes of Health Research, over the last ten years to analyze this rich database that's unique in the world.

Here are three key findings from our work.

First, we were inspired by Senator Roméo Dallaire's book, Shake Hands with the Devil. He describes his horrifying experiences as a peacekeeper in Rwanda. He really raised important awareness of post-traumatic stress in Canada.

Second, our research findings demonstrated for the first time that Canadian military personnel acting in peacekeeping roles who experienced combat and witnessed atrocities, such as human massacres, had an increased risk of a range of mental health problems, not just PTSD. However, it's important to note that the majority of mental illness in the military was not related to combat or deployments. Less than 10% of mental illness, if there was a causal link, was related to deployment experiences.

The third main finding from our major study showed that in 2002, untreated mental illness in the military was a common problem. Approximately 50% of people with a diagnosed mental illness, such as depression and anxiety, did not receive care.

The research findings from our work have had substantial scientific and policy impacts. We've published papers from this work in international journals and have presented our findings at national and international conferences, including workshops at NATO on suicide prevention and post-traumatic stress disorder. Two years ago, I was invited to present on suicide risk at the Senate Committee on Veterans Affairs.

Over the last 10 years, the government has taken strong action to improve access and quality of care for our members. They have expanded the Veterans Affairs operational stress injury clinics across Canada. The deployment health section has developed a post-deployment mental health screening survey to provide early and timely access to care for our returning soldiers.

It's important to note that the findings of our work were based on a 2002 mental health survey, which occurred prior to the deployment of ground troops in 2004. Thus, more recent information about the needs of our service members is required, because our recent service members have faced much more combat than ever in history.

I'd like to move towards the partnerships we're working on.

At Queen's University, Dr. Alice Aiken has been leading a Canadian military and veterans health research forum. This brings together universities across Canada and key stakeholders to advance knowledge in the area of military mental health.

I attended the conference last year and have initiated two important partnerships.

First, at this conference, I became aware of the recently collected survey by Stats Canada and Veterans Affairs called “Life after Service”. Our University of Manitoba research group was invited to partner with Dr. Pedlar and his group at Veterans Affairs to address important questions related to mental health. These include household income changes and financial stress in relation to mental illness, and physical health problems and chronic pain in relation to suicidal behaviour.

Second, one of the programs I'm leading is to design a follow-up of the original 2002 Canadian service members survey. I am working on developing partnerships, through funding from Defence Research and Development Canada, the Canadian Forces, and the Mental Health Commission. The original participants will either have become veterans over the last 10 years or will have been sent over to deployment. This would be a unique study in the world. It will address very important questions about pre-deployment, deployment, and post-deployment risk and protective factors for mental illness.

During this presentation, I've tried to give an overview of the important mental health issues faced by our service members. Clearly, there are many more details on each of these issues, which I would be happy to address in the question period.

I would like to end by reminding the committee that the investment in research and other health care areas, such as cardiovascular disease, HIV, and cancer have led to a rapid advancement in knowledge and a reduction in morbidity and mortality in Canada and around the world. I strongly advocate that the need for investment in military mental health research and partnerships can lead to a rapid increase in knowledge and can actually reduce suffering and save lives.

Thank you for listening.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Professor Sareen.

I'm sure there will be lots of questions when we get around to it.

Now I believe David Pedlar is going to take the next round, for 10 minutes.

[Dr. David Pedlar, Director, Policy and Research, Department of Veterans Affairs]

Thank you very much.

It's a pleasure to be back before committee, this time to talk to you about how research work at Veterans Affairs is primarily conducted in partnership with various departments and organizations to strengthen our collective understanding of the health and well-being of veterans.

I would like to acknowledge my research colleagues who represent some of our partners, who are here with us today to join in this discussion.

I lead the VAC research section. Our work is applied, meaning that it directly supports and advances Veterans Affairs Canada's priorities. Although our capacity is modest in size, we have a strong track record of conducting and analyzing military and veteran health research and have produced many studies, reviews, and publications. We also provide technical and administrative support to the Veterans Affairs Canada Scientific Advisory Committee on Veterans' Health.

Our research team includes a gerontologist, an epidemiologist, a health economist, a medical adviser, and statistical experts. Our work supports the advancement of effective policies, programs, and services that respond to the needs of veterans and their families. It also helps play an important role in clarifying and understanding emerging mental and physical health issues that can impact veterans across the life course.

The work we do has two key functions. We produce new knowledge through research studies linked to our priorities. In recent years, a key research priority has been understanding transition from military service to civilian life. For example, the “Life after Service” studies that I spoke to you about in February helped address this priority. This work is essential to understand the health, well-being, and disability of a new generation of today's veterans so we can move forward on a foundation of solid evidence.

We also synthesize existing knowledge, meaning that we interpret and monitor military and veteran scientific evidence and expert opinion. This work informs best practices in disability compensation and care of veterans and their families.

Let me underline that this is a specialized area. Many health problems encountered by military personnel, veterans, and their families are common to civilians, but there are differences owing to the unique aspects or context of military service. For example, the military nature of service-related physical and psychological trauma is rarely encountered by civilians. Consider the extreme mental stress of combat or consider a blast injury. These are relatively rare in a civilian context but are more common in battlefield or military operations. The transition from military service to civilian life is also unique.

Partnerships are absolutely essential, so we can conduct this work more effectively, much more so than doing it alone. Through partnerships, we coordinate our research priorities so that we're working toward complementary goals and avoiding duplication. They also bring some of Canada's best minds to the table to help us work on these problems, minds like Dr. Sareen's. Working as a team also allows us to learn together, leverage resources, and maximize efficiency and outcomes. Some of our research partners are the Department of National Defence, the Canadian Forces, and the Canadian Institutes of Health Research. Other key partners are Statistics Canada and the Canadian Institute for Military and Veteran Health Research.

We have a very close working relationship with the Department of National Defence and the Canadian Forces in the area of research. This connection is natural because a veteran's health today is determined by their experiences earlier in life, and of course these experiences include service. Consequently, our research is integrated into a close working relationship on a wide range of issues. Over the past several years a key area of mutual interest and collaboration has been on understanding transition from military service to civilian life, and generally how well released personnel do in life after military service.

Working closely with Susan Truscott's group and Statistics Canada, we completed two studies to inform VAC's work in support of military to civilian transition. One was on income and one was on health and well-being. These studies looked at all former regular force full-time personnel who released over a recent 10-year period.

We also collaborated with the Canadian Forces Health Services Group, Colonel Bernier's group, on a third study, the Canadian Forces cancer and mortality study, for which they are the lead. The mortality study, which compared rates of death in serving and released personnel to the general Canadian population, was released in 2011, and the cancer study is under way. A wide range of analyses are under way from this information that we've collected on topics like mental health, income, suicide, and whether VAC programs are reaching the people they were intended to reach.

Statistics Canada is also a big player. They bring technical expertise and hold secure national registries of information on things like cancer, causes of death, and income. They're essential to do this work.

Regarding the Canadian Institutes of Health Research, VAC researchers have a track record of involvement in a number of projects, including one we led on the challenges of workplace reintegration of veterans with mental health conditions.

Last October, Veterans Affairs, the Canadian Forces, DND, and the Canadian Institute for Military and Veteran Health Research met with the president of the CIHR and their scientific council to explore opportunities to strengthen collaboration through CIHR research programs. Since that time, VAC researchers have participated in an invitational workshop on traumatic brain injury that will lead to a national network on traumatic brain injury, which we'll be part of. We're also in discussions about participation in a number of other opportunities, including one that can lead to best practices in mental health.

This work is international in scope. A great deal of veteran health research is conducted by our allies in other countries, especially the United States, but also Australia and the U.K. Therefore, we're actively involved in research information exchange. For example, I chair an international research subcommittee of a group called the Senior International Forum. This forum involves senior officials from the United States, the United Kingdom, Australia, New Zealand, and Canada. We meet annually to discuss issues and initiatives, and in fact research was the theme of the 2011 forum that was hosted in Ottawa. The discussions at the forum and the preceding ministerial summit focused on this question of transition from military service to civilian life.

As I move towards closing, another key partnership is with the Canadian Institute for Military and Veteran Health Research. This organization represents a network of about 21 universities across Canada, and it is successfully increasing the engagement of Canada's university community in the area of veteran health and veteran health research. We're very active, providing in-kind support to this organization and participating in its governance structure, on its advisory council, on its scientific direction committee, as well as on other committees. We also contribute heavily and we're very involved in the annual forum that Dr. Sareen talked to you about, through planning, sponsorship, and participation. In fact, our minister, the Honourable Steven Blaney, gave the opening remarks at the forum last year.

We have worked extensively with university-based researchers across the country for many years, but recently the Canadian Institute for Military and Veteran Health Research has helped us facilitate these relationships even more. As Dr. Sareen mentioned, we are working with his group on three studies, including one on suicide ideation and another on the impact of income on mental health. This work will further inform our work in a number of areas, including suicide prevention.

We're also working with Queen's University on two studies related to chronic pain and well-being, because chronic pain is another problem that's common among veterans.

We're also working with the Université de Sherbrooke on a tool to help in assessment of barriers to workplace reintegration for veterans in our rehabilitation program.

The energy and interest generated among Canadian research continues to strengthen. We look forward to the third Military and Veteran Health Research Forum hosted by the institute this fall. The forum showcases the increasing scope of current Canadian research, which is supporting the needs of veterans and their families.

In closing, despite or perhaps because of the modest size of our research section, VAC has leveraged partnerships to be a national leader in veteran health research, and we're proud to have played a role in the growth of key research partnerships in this area over the past decade. The collaboration in this research area ensures strong evidence to inform VAC programs, policies, and services, with the goal of benefiting Canada's veterans.

Thank you.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Pedlar.

Now we move to our last 10 minutes.

Ms. Truscott is going first? Okay. Thank you very much.

[Susan Truscott, Director General, Military Personnel and Research Analysis, Department of National Defence]

Good afternoon, Mr. Chair and members of the Standing Committee on Veterans Affairs. Thank you for the opportunity to speak to you today about the research we do and our partnership with Veterans Affairs.

My name is Susan Truscott. I am the director general of military personnel research and analysis. I am a defence scientist with 30 years of experience conducting and managing research related to military personnel in the Department of National Defence and the Canadian Forces. With me today are Colonel Jean-Robert Bernier, Deputy Surgeon General, and Colonel Gerry Blais, director of casualty support management.

I'd like to tell you a little bit about my organization, the type of research we do, why we do it, and why our collaboration with Veterans Affairs Canada is beneficial both to the Department of National Defence and to Veterans Affairs, and, importantly, to service members, veterans, and their families.

DGMPRA is both a division of the Military Personnel Command under the Chief of Military Personnel and a research centre within Defence Research and Development Canada, DRDC, under the assistant deputy minister, science and technology. It is comprised of both civilian and military researchers who hold PhDs or master's degrees in a variety of disciplines but predominantly in the social sciences.

Our mission is to inform personnel policy and decision-making in the Canadian Forces and the Department of National Defence by conducting relevant and responsive strategic and operational personnel research and analysis; by developing and employing innovative methodologies and measures such as selection tests, survey instruments, and workforce models; by exploiting cutting-edge technologies to enhance research effectiveness; by providing expert, objective, evidence-based advice to leadership; by prioritizing and coordinating research to achieve the Canadian Forces mission; and by engaging academic, industrial, government, and allied partners in the development and application of personnel research and analysis.

The Canadian Forces military personnel management system is a complex system of interrelated and interdependent subsystems that require constant monitoring, prioritization, and transformation. Because of these interdependencies, policy decisions made in one area need to be taken with the full knowledge of the impacts, both short and long term, that may occur in a number of other areas across the system.

As a consequence, personnel research is a core military personnel management capability and is essential to the development of informed, evidence-based policy and strategic planning in support of personnel management. This is the function that DGMPRA fulfills for the Chief of Military Personnel in his role as the Canadian Forces functional authority for military personnel policy.

We conduct much of this research with our own in-house resources, but, where possible and appropriate, we employ contracts and collaborate with other organizations within and external to government in order to maximize our research capability. One of those organizations we collaborate with is Veterans Affairs. This makes perfect sense, not just in the area of research related to the transition from Canadian Forces to civilian life, but also from the perspective of the life course of veterans.

As you are already aware, DGMPRA and Veterans Affairs have collaborated on the “Life after Service” studies, which produced three reports discussing the methodology, the results of the income study, and the results of the survey on transition to civilian life. In addition, the medical researchers in Colonel Bernier's organization, the director general of health services, led the Canadian Forces cancer and mortality study in collaboration with Veterans Affairs.

DND has also conducted its own research on transition. A recent literature review on transition to civilian life focused on mental health and career challenges of individuals who have transitioned out of the military. As a result of this research, a number of important areas for further collaborative research with Veterans Affairs have been identified, and initial work involving secondary analysis of the data collected in the “Life after Service” studies has already been initiated.

The Department of National Defence is also involved in projects led by university researchers that are exploring the “Life after Service” data, examining the relationship between chronic pain and reduced well-being, and the effect of all co-existing physical and mental health conditions on individual veterans.

Finally, planning is under way to conduct a study of reservists, which will employ the same methodology as the survey on transition to civilian life of former regular force members. As was the case in the former survey, our department is participating in discussions related to research methodology, providing administrative data, and providing guidance on policies related to reservists, and we will participate in the writing and the review of the reports. It is anticipated there will be issues unique to reservists, and conducting the study separately has the benefit of enabling us to identify these issues and focus on them in the survey and analysis.

I fully expect the research collaboration between the Department of National Defence and Veterans Affairs Canada will continue and we will derive benefits from this collaboration in terms of a coordinated approach to evidence-based policies and programs for Canadian Forces members, veterans, and their families across the life course.

Thank you, Mr. Chair.

[The Chair, Conservative, Greg Kerr]

Thank you, Ms. Truscott.

Colonel.

[Colonel Jean-Robert Bernier, Deputy Surgeon General, Department of National Defence]

Mr. Chair, committee members, thank you for this opportunity to speak about Canadian Forces health research partnerships.

As the senior defence department advisor on all matters related to health and the provider of health services to the Canadian Forces, the Surgeon General requires a robust health surveillance, analysis, and research capability to identify concerns and improve related policies, programs, and clinical capabilities. Because of the unique nature of military service and its operational, occupational, and environmental hazards, specialized applied research is necessary that's very often not, or cannot be, adequately addressed by civilian research.

The Surgeon General's health research strategy and its program, therefore, focus on military needs and pursue maximum efficiency and productivity through collaboration with other organizations.

We have significant internal research capacity through our clinician-scientists in Canadian Forces clinics and university medical centres and through scientific staff at our national headquarters and at the Canadian Forces Environmental Medicine Establishment. They annually publish dozens of peer-reviewed studies, academic theses, and technical reports, and they have a worldwide reputation as leaders in key areas of military health research, such as trauma management, critical care, and mental health.

Defence Research and Development Canada is one of our most important partners and we currently have over 40 joint projects together. It provides some nationally-unique and critical research capabilities in such areas as medical defence against chemical-biological agents, blast injury, elements of mental health, and other militarily-significant areas. We also collaborate with other DND elements, several other government departments and agencies, industry and academia.

Collaboration with academia in particular is increasing since the Canadian Institute for Military and Veteran Health Research was established in response to a proposal by the Surgeon General. This network of 22 universities aims to supplement our research through coordination of relevant academic work, and it has already organized two research forums to maximize the transfer of relevant findings nationally.

We also collaborate bilaterally and multilaterally with allied military health research authorities, including several NATO health research organizations. By pooling resources to research common interests, we often achieve results at relatively little cost or with a disproportionately high return on investment.

By increasing research efficiency and collaboration with our partners, we strive to continue maximizing health research output that makes a difference in protecting the lives and the health of Canadian Forces members.

Thank you for your attention.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Colonel.

Ms. Truscott, I want to ask you this just before we do the tour—you would probably be asked anyway. You're going to collaborate on the study for reservists. Is that something that will be undertaken fairly soon, do you know?

[Susan Truscott]

It's already under way to some degree.

[The Chair, Conservative, Greg Kerr]

Thank you.

As I say, I don't want to take questions away, but that's been a question that has come up quite often, so thank you.

We'll go to Ms. Mathyssen, for five minutes, please.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much, Mr. Chair

And thank you to all of you for being here and providing us with this other aspect of the research we would like to do in connection with transformation.

I have a couple of questions. Anyone can answer, but I thought I'd start with Dr. Sareen.

You talked about the research and the concerns in regard to veterans adjusting. One of the things I've been particularly concerned about is homelessness among veterans. Those men and women have served in peacekeeping missions and have done remarkable service for their country, yet we're hearing tragic stories of these folks ending up in the most desperate of circumstances.

You talked about mental health and the research you've done around that. Have you connected or thought or done work in terms of homelessness and mental health and how those two things seem to go together?

[Dr. Jitender Sareen]

That's an excellent question. I'm one of the co-leaders of the Winnipeg site for the Mental Health Commission's homelessness project. As you're aware, the Housing First initiative of the Mental Health Commission of Canada has five cities, and part of that is a small but significant proportion who are veterans.

I do think that mental illness can impact on personal income and household income and lead to what's been called “social drift”. Also, if you have financial strain and you're in the United States, you have financial strain all the time right now. There have been household income and financial stressors around the world. We've done studies on this showing it has an independent risk for mental health problems, as well as suicide.

As you're saying, there's a strong link between homelessness and financial stress and mental health, and it's a bi-directional relationship. If you're depressed and you can't work, then you're on disability, which can then lead to financial problems. On the other side as well, if you had financial changes or a job loss, whether you're in the military or moving from the military into life after service, it's a very important issue.

I don't want to get into the homelessness study, but I think one of the key questions the homelessness study is trying to address is the idea of housing first. Rather than treating the mental illness and then the person gets into housing, it's trying to go after it from a housing first approach. I think that is the right way.

We were invited from Winnipeg because of our work in aboriginal and mental health. I think you'll hear positive stories from that study.

[Dr. David Pedlar]

If I could address that as well, I want to build on Dr. Sareen's remarks. He mentioned the Chez Soi project. It's a large-scale demonstration pilot around an intervention for homelessness at four or five sites across the country. We've been engaged in that since the very beginning.

It's a demonstration project, but it's also a research project, to find out what works and what doesn't work and more about that population. During the beginnings of that project we worked with a scientific team to ensure veteran identifier questions were part of the protocol for every participant in that program across the country, which could be as many as 2,200. We will be in a position to work with the Mental Health Commission to look at the veteran dimension of that moving forward.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you.

[The Chair, Conservative, Greg Kerr]

A very brief question.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Okay.

Dr. Sareen, you were also involved in work with regard to suicide and the impact of low income on mental health. You've perhaps answered that to a degree. In terms of your preliminary findings, is the impact of low income different for veterans than the general population?

[Dr. Jitender Sareen]

There is no study that's been done. We have a doctoral student who's doing a PhD on this issue because we couldn't find any literature. There's a lot of literature on two issues. There's literature on whether money buys happiness: if you win the lottery, does it buy happiness in the general population, and does it buy happiness if you have mental illness and poverty?

There's very little to no information in military samples. As you're aware, disability and benefits and those kinds of issues have a big impact.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Professor.

Now we go to Ms. Adams, for five minutes, please.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thank you all very much for coming today.

Dr. Sareen, we heard earlier that Veterans Affairs conducts research focusing on two key functions. The first is synthesizing existing knowledge, interpreting and monitoring military and veteran scientific evidence and existing expert opinion. The second is undertaking primary research, which produces new knowledge through studies such as the one that was discussed, the “Life after Service” studies.

Could you give me a high-level overview of the study's findings and whether or not that study is completed at this point?

[Dr. Jitender Sareen]

On the “Life after Service” study, it's probably better if Dr. Pedlar addresses that specific question. We're addressing specific issues around that, but I think it might be better....

[Dr. David Pedlar]

Is it okay if I take this?

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Of course.

[Dr. David Pedlar]

The study was undertaken to get an understanding of the transition experience from military service to civilian life, as well as to understand the health and well-being of veterans after they're released from service. One of the limitations of work we've done in the past is that we've only looked at our clients, who tend to be about 10% or 15% of this broader veteran population. One of the strengths of this study is that we were able to look at the entire 37,000 full-time force—not reserves—that released over a 10-year period, from 1997 to 2007. It was our first broad look at this new population.

There were a number of important findings. This population is very heterogeneous. In other words, one can follow a lot of different trajectories in the process of transition, and many of them are positive trajectories. Most veterans said they did well in transition and that their transition was relatively easy. However, an important minority, around 25%, found transition to be difficult or very difficult. So it allowed us to identify a subpopulation who experienced more problems.