Veterans Affairs Committee on Nov. 15th, 2016

[BGen Hugh MacKay]

A decision to repatriate an individual for an acute medical condition would not usually result in an assessment of their universality of service.

It's not the medical service that looks at universality of service; it's the personnel world, but usually that occurs after we've applied permanent employment limitations. It's usually a year or more after a condition has started before we would give them permanent types of medical employment limitations based on what we can see as the prognosis for the individual. At that point in time, somebody might start to make a decision, or the file might go for consideration with respect to their universality of service.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay.

In order for them to maintain their universal status, would they at some point have to be deemed able to serve in active theatre again?

[BGen Hugh MacKay]

Yes. Typically one could continue to serve even with some minor medical employment limitations. The general result is that we're looking for people who can deploy.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right. Thank you.

In earlier sessions we had on health care delivery, we talked about possibly giving feedback data from Veterans Affairs to DND with a view to informing DND about some of the causes contributing to health.

One of the examples we brought up a few months ago came from a veteran's physician who noticed that this person, who had been a paratrooper and had done his thousand jumps, needed knee replacements five years after discharge because his knees were blown. There might be ways to inform DND that this is happening with regard to all of your personnel who perform this task. Could you review how this is done to see if you could prevent...?

Is there any sort of feedback in the direction of DND regarding mental health? Is there any mechanism whereby the physicians of veterans can inform DND of what factors are contributing to mental health issues, with a view to improving things?

[Col Andrew Downes]

There's no formal mechanism that I know about, to speak to your point, when a civilian physician notices something. There's not a 1-800 number that they could phone to provide that feedback, but we are in regular contact with Veterans Affairs physicians who work within their system, including researchers who are looking at things like the health of people after service. They've conducted a life-after-service study, for example, that includes a lot of health-related information on people who have left the forces.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Great.

This might be premature, but are there any plans to perhaps use this data as a sort of, for lack of better word, quality assurance mechanism, again to inform DND on its practices and to maybe improve the health and safety of personnel to prevent injury and illness before they happen?

[Col Andrew Downes]

I would say we're always interested in knowing about ways to prevent illness and injury. That's one of the things we pay particular attention to, because we know that preventing illness or injury in the first place favours long-term health. The challenge, though, is that some of these things are difficult to prevent. Given the nature of the work, there really are limited opportunities to modify how people do parachuting, for example, in order to protect somebody's knees.

The same thing happens with other illnesses and injuries as well, but when we find something of importance that we can intervene on, we are certainly very interested in that.

[The Chair, Liberal, Neil Ellis]

Thank you.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

How does the sentinel program work? Volunteers come forward. These are obviously professional soldiers, but not mental health professionals.

What's the recruitment? How does that work?

[Col Andrew Downes]

I can't speak to exactly how it works, but I do know that it's volunteer-based. We want people who are interested in this role; we don't want to assign this to somebody. We want them to want to do this. Then they undergo training. I think it's a day long, but I'm not 100% sure of the duration. In that training they are taught about the resources available. They're taught about how to engage people as well as what signs and symptoms to look out for in people who might be struggling.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Would it typically be peer to peer in terms of ranks?

[Col Andrew Downes]

I can't speak to how they decide this, but ideally you would want to have people at different ranks within a unit, I'd say. Rank does matter in the Canadian Forces. If somebody more junior were to approach a senior person, it might not be taken the same way as if a peer of the same rank did so.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

In that the basis of it is peer-to-peer, are you aware of a debrief or information that's drawn from the sentinels with regard to the conversations they have with their peers?

[Col Andrew Downes]

There is not, as far as I know, a formal mechanism to get feedback. These aren't designed to be clinical interventions. We don't want to encumber the process or make it such that someone would be scared to come forward to ask these people for help, knowing that the commanding officer might find out, for example. It's not done for that reason.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Probably, historically, there was often an individual in a group who you knew you could go and speak to. This is a little more formalized. They do get some training. It might be valuable to consider expanding that or, as I suggested, talking to them about what guys are talking about. Maybe that would destroy the confidential nature of a soldier talking to a soldier—“You're not going to tell anybody, are you?”—but they must have valuable insights into how someone's mental health deteriorates through a deployment or something.

[Col Andrew Downes]

I imagine they would have some insights on that. I think the role, though, is really to facilitate the access to care. As clinicians, we then have a chance to talk to those people as well and to find out what's going on. In fact, they're more likely to really open up to us about that, because they're protected by confidentiality. They know they can tell us things, and we won't....

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

The way I see it working is that I will say “Why don't you go see somebody?” if I'm the sentinel and I'm talking to my peer. Because the stigma issue is so huge, I'm not sure how you get around that, especially in terms of combat. They're all going ahead, and they're not sure they can make it, but it affects their career, so they don't say anything, etc.

[Col Andrew Downes]

Stigma is a big issue, but we really believe we've made significant headway in stigma reduction. I think people are coming forward for care. We have evidence that people are coming forward for care in numbers higher than in the civilian sector. We feel that the willingness of people to talk to peers and supervisors about their mental illness is another sign that we've cracked through a little bit. There's still work to be done, but we've made a difference in that regard.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

We know about General Dallaire. I just read that a two-star general in the United States very recently took his own life. Does the data show anything with regard to ranks?

[Col Andrew Downes]

Do you mean the suicide data?

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

I mean that or the mental health data and so on.

[Col Andrew Downes]

Generally, people of lower rank are more likely affected by mental illness.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Can you show that statistically?

[Col Andrew Downes]

Yes.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you.