Veterans Affairs Committee on June 12th, 2012

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

What was the methodology? Was this a paper-based questionnaire to the entire cohort or...?

[Dr. David Pedlar]

There were two main pieces. It was a linkage study where we were able to identify with a list of all the released members, which was provided by the Department of National Defence/Canadian Forces. One study that focused on income over a 10-year period was linked by Statistics Canada to a Revenue Canada file, so we were able to look at 10 years of income experience, starting before transition to after transition.

We also used that list as a frame for Statistics Canada to do interviews with over 3,000 veterans who transitioned. That was a national survey. That was the basic methodology for the two primary studies.

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

I interrupted you as you were about to share the high-level findings of the study.

[Dr. David Pedlar]

Yes. The high-level findings were that there was a lot of variation in transition experience, but some people did have a difficult transition. With respect to income, veterans were less likely to experience low income than the Canadian population. They're about half as likely to fall under what is called the low-income measure, which is a StatsCan measure for low income.

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

And that makes sense intuitively. These are folks who are used to showing up to work and doing a good job and serving their country. I would imagine they would be incredible employees to have.

[Dr. David Pedlar]

Right. There was a relatively low rate of those who were using provincial social assistance programs. I think it was rarely more than 1% or 2% in any given year.

However, some veterans experienced challenges. Some of them had changes in income upon release. Those who experienced the largest changes in income after release were the medically released, women, and those who served from 10 to 20 years, so they were in mid-career. They were more likely to experience an impact on their career trajectory by leaving in mid-career.

In the area of health, there were a number of findings. One was that there were areas where veterans experienced a higher burden of health issues than other Canadians. One of those was the area of musculoskeletal conditions, such as arthritis. It was about double the rate. Back problems were about double the rate as well. Generally, they had higher levels of problems with disability—that's functioning in the community. However, a lot of this was concentrated in about 16% of that broader population. They didn't have just one condition; they tended to have multiple conditions. So it drew our attention to a population that could have high needs in terms of how they are approached through case management and other services we offer.

A final area we looked at was program reach. We learned that we do very well with some of our populations, especially those who are medically released. That's a population we've targeted since the beginning of the work on the new Veterans Charter. We have a high level of contact with that population, but there are some groups we haven't been reaching, for example, groups that have shorter periods of service, groups that had certain kinds of releases—they may have been released voluntarily—younger veterans who stayed for a shorter period of time, and other categories that concern us in terms of reach and other questions.

That's a short high-level overview.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Pedlar.

Mr. Casey, for five minutes.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chairman.

I was interested that three of the four opening presentations referenced the Canadian Institute for Military and Veteran Health Research. I'm quite happy to have all of the five minutes allocated to the Liberal Party spent discussing how the Government of Canada can do more with respect to the sustainability and the success of that body.

The Deputy Surgeon General states in here:

Because of the unique nature of military service and its operational, occupational, and environmental hazards, specialized applied research is necessary that very often is not, or cannot be, adequately addressed by civilian research.

I absolutely accept that and thereby the rationale for better support of the CIMVHR.

Mr. Pedlar, you very carefully chose your words—and I can understand why—when you said that VAC is engaged in providing “in-kind” support to the CIMVHR. You stated also that you “contribute heavily” to the annual Military and Veteran Health Research Forum. We see that kind of language coming from VAC in an awful lot of things where they partner with somebody else without putting in real dollars. Helmets to Hardhats comes to mind.

And Dr. Sareen, you indicated that CIMVHR aids your work.

Now, I'm sorry for the long introduction, but I invite comments from anyone on the panel as to....

I have one more thing before I hand it over to you. I know, and several of you know, that representatives from CIMVHR made a very compelling case to the finance committee of the House of Commons in the pre-budget submissions looking for funding—real, meaningful funding—for them to do their work. They didn't get it.

I'd like to hear from each of you on what the Government of Canada could and should be doing, and on what results we could achieve if they were to do what they should do with respect to CIMVHR.

Thank you.

[Dr. David Pedlar]

I'll start.

We've been engaged with the institute from the very beginning. We've supported it in the ways that I've mentioned.

In addition to the ways that I've mentioned, we also work with them on research applications to group organizations such as the Canadian Institutes of Health Research. We have one application that's under review right now. If that application is successful, they would administrate that research grant. There would be administrative moneys available through granting opportunities as we move forward. We're collaborating very closely with them in those granting opportunities.

So that could provide additional moneys directly to the institute.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you.

[Col Jean-Robert Bernier]

I'll talk about the origins. For many years, we had academic researchers or co-investigators from the armed forces who were quite interested in obtaining data to assist in their own or their faculties' interest in doing research on military populations or areas relevant to military health. The Canadian Forces, Defence Research and Development Canada, and I think perhaps Veterans Affairs as well, would independently fund individual academic researchers or faculties to address very specific questions.

There's a whole bureaucratic process to contracting and having bids and all that kind of thing.

The Surgeon General had the idea a few years ago of having a central clearinghouse, a central point of access, to establish a collaborative process for all of these universities. They would have one-stop shopping to find out what was relevant and of interest in addressing military and veterans' health problems.

CIMVHR does not itself have an in-house research capability. It's an administrative vehicle or institute that enhances and administers the collaborative efforts of the various elements of academia that are interested in assisting. Any moneys that would flow to them from the defence department or from Veterans Affairs would be administered by CIMVHR, which would determine the collaborative mechanism or the group of academic researchers. In most cases, our research requirements are so broad that there's no one university in Canada that can handle them all.

Often, to address these research requirements, collaborative efforts by a number of individual researchers in the same university or in multiple universities are needed. In such cases, we will often assign a military co-investigator, or a Defence Research and Development or a Veterans Affairs co-investigator, to inject the reality and the context that's so critical for making civilian health research done by civilian academic faculties specifically applicable to the armed forces.

There is some money from the defence department and Veterans Affairs, currently. We have specific research questions we want to address and have asked CIMVHR to solicit interest from the universities. We're also working on a large standing offer for research to avoid the need for a very prolonged and painstaking bureaucratic process to solicit bids for research. We hope to have a standing offer with CIMVHR that will serve as the vehicle for establishing that collaborative effort among all the best researchers across academia who have the academic and research competencies and interests.

I'll just highlight that the Australians have a military and veterans' health institute as well, but it took them 15 years to get it going. CIMVHR has only been around for two years, and we already have the first award for military health research. That has never occurred before. The Surgeon General established it with the aid of a private sponsor. Professor Sareen was the first winner for the high quality of the research he presented at the second annual Military and Veteran Health Research Forum.

Things are progressing. There is a progressively improving committee structure. It will allow us to be more efficient and to establish a fair process by which all of the research interests and competencies and capabilities of all the universities can be represented. There will be a single point of contact established for adjudication on the distribution of that money from the federal government.

It will take a while to get this fully up and running, but there has been significant progress. In the end, this will mobilize, at very little expense to the Canadian taxpayer, a much more efficient and effective and productive system for addressing military and veteran health research questions.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Colonel Bernier.

We'll now go to Mr. Chisu, for five minutes, please.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Mr. Chair. Thank you very much to the witnesses for coming to our committee.

As you know, military service is both physically and mentally demanding. Yet we often hear that there is little information available about ongoing health effects after release from the military.

Professor Sareen, in your presentation, you mentioned Shake Hands with the Devil, which was written by General Dallaire, now Senator Dallaire.

Have you ever spoken with anyone from the Medak Pocket? It was the first engagement the Canadian Forces had in Bosnia, and it was in a fighting capacity.

[Dr. Jitender Sareen]

Yes.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

That was in 1995. That is very interesting because it set the stage for Afghanistan. Now these people are veterans. Did you ever contact anybody who participated in this conflagration, or do you have any data about it? I think this was the first time that Canadian soldiers shot at, and eventually killed, somebody.

[Dr. Jitender Sareen]

Yes.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

That was the first military engagement that was completely different from the peacekeeping operations. That sets the stage, again, for the involvement in Afghanistan between 2006 and 2011.

Another issue that I would like to draw to your attention is the so-called “holding platoons”. Probably the colonel will know about that. What does it mean, “holding platoons”? It's about somebody who is joining the military, but for various reasons is not loaded in the courses, is releasing, and it is taking a long time to release from the military.

When I was a construction engineer officer in Meaford in 2006, we had a couple of accidents; one was a suicide. So I think it is worth it to be seen. I don't know if your “Life after Service” study is touching on this important element in military life.

[Dr. Jitender Sareen]

Thank you for the question.

I am treating some veterans currently who have served in the Bosnia experience. I think the previous survey that was done in 1995 looked at that issue. I agree with you that before Afghanistan and before Rwanda and before Bosnia, with most of the peacekeeping experiences, the biggest stress at times was boredom.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

I'll just take a moment to say that there was a book written about the Medak Pocket. Have you had an opportunity to see that?

[Dr. Jitender Sareen]

I have not, no.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

I really recommend that you see it, sir.

[Dr. Jitender Sareen]

On one other point, just like for who is going to develop cardiovascular disease, there's a huge range of things that happen—and we're just trying to understand even cardiovascular disease or cancer. These are complex illnesses that have genetic, environmental, family.... Thirty years ago, most of us would have been smoking cigarettes in this place, but over time, knowledge has shown that smoking is a key risk factor.

I think mental illness is like other complex illnesses, where we don't have a good understanding of why one particular person.... This is one of the important things, to go back to the forum idea, that it's a special population. If we can bring the great minds together.... I think money is important, but it's really....

We had students who I brought to the conference and they were excited to see Roméo Dallaire and listen to his speech. It's trying to get the next generation of scholars who are going to actually make the discoveries.

[Col Jean-Robert Bernier]

Specifically related to the Medak Pocket, that was the 2nd Battalion, Princess Patricia's Canadian Light Infantry battle group, and the senior medical officer for that battle group was my deputy base surgeon in Calgary. He and I established, after that operation, the first critical incident stress debriefing program for the armed forces for the western area of Canada, where the troops had come from. He had been there throughout the whole mission, including the Medak Pocket battle, and saw the development of the mental health problems that occurred, as well as the follow-on.

We had a fairly robust mental health program, or mental health clinical capability, in the armed forces at the time, but you'll recall that was right after the end of the Cold War, when we were expecting mass casualties in western Europe. We had not focused, to the extent that we have since in the last few decades, on mental health. There was the stigma that existed at the time and society declining to celebrate that particular operation. The attention and the resources available, the efforts to decrease stigma for the presentation of care, and the attitudes that existed even within the armed forces were nothing like they are today. We've gone light years beyond that now. I wouldn't say it was deplorable, but they did not have the mental health resources and the setting, ambience, and atmosphere that would have been best for the veterans of that particular battle. So some of them suffered quite intensely for a long time before getting adequate care.

Today, as I described in previous testimony, with the standard of care of screening and stigma reduction in the armed forces, and the programs that are available, even though they're not perfect, and even though occasionally there are still individuals who don't show up, or don't get the care they need.... In most cases, it's a result of self-stigma, where they simply decline to present for care.

We've come light years in the clinical mental health care, the non-clinical supports, and the atmosphere of almost the elimination of stigma. It's a countercultural change in the way mental health issues are perceived, partly because of General Dallaire's example, but also because of many other efforts to achieve where we are today.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Colonel Bernier. We're quite a bit over time.

Ms. Papillon, I would like to say welcome back. You have five minutes, please.

[Annick Papillon, NDP, Québec, QC]

Thank you very much, Mr. Chairman.

I would like to thank all our witnesses very much for being here today.

I spoke to a number of veterans over several months when I was the deputy critic for Veterans Affairs Canada, and they told me about the importance of front-line services. When we spoke about their needs, it was the importance of talking to people that came up the most. I have to say a few words about all the staff cuts, particularly in Quebec City, where I am the MP. Eleven public service positions have been eliminated in Quebec, including three in Quebec City. These are people whose main responsibility is to help veterans dealing with operational stress trauma. Of the four positions in Quebec City, only one remains. Ultimately, 75 client services positions will be eliminated. That will certainly prevent the department from responding directly to the needs of veterans. I would like to hear what you have to say about that.

This is of enormous concern to us. If we continue in this direction, there will be serious problems within five years, given our presence in Afghanistan and the fact that we will have more and more veterans. In addition, the effects of missions in Bosnia, Rwanda and Somalia are still being felt. What will the situation be in the coming years? I would like to hear what the Veterans Affairs Canada representatives have to say about that. We can talk about statistics and reports and making investments, but what about direct services for veterans and their families?