Evidence of meeting #31 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.
A recording is available from Parliament.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Dr. Sareen, on the question of suicide, typically does a suicide event, an attempt and so on, come after a lengthy period of some sort of continuum of behaviour, or does it often happen suddenly? Is there anything you can say about that?
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
I think there's usually a suicide attempt before, and often there's suffering for a period before someone attempts. Sometimes, if there's alcohol involved, there can be impulsive events. The strongest evidence around suicide prevention is around restricting lethal means—for example, access to firearms like hunting rifles, and access to large quantities of medications. Those are two, really, that have been shown to have quite a bit of evidence.
I think most people suffer for a long time, but if there is alcohol involved, sometimes it's quite impulsive when that event occurs.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
So it would be fair to say, just as a brief summation, that there is an opportunity for intervention, identifying an issue, if we work hard at it.
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
I completely agree with you.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Thank you very much for being here as researchers, because we've heard a lot of anecdotal information.
I actually have a couple of studies here, one from you, Dr. Sareen, “Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care”. I'm wondering if that one could be submitted to the committee as part of this report.
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
Yes. I was going to ask the question. We have some recent studies that we have done and some of the latest around suicide prevention that I would like to submit to the committee, but I just didn't have a chance to do it before the meeting.
Is it okay if I submit a couple of key papers?
Liberal
The Chair Liberal Neil Ellis
Excellent. If there are any papers or any questions you want to further elaborate on, either of you, please send them to the clerk, and the clerk will distribute them to the committee.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
I just had an opportunity to read through some of them. I think the information will be very good for our study, so thank you for that.
You mentioned in your testimony, Dr. Sareen, that military suicide rates have stabilized. Do we have any data on the rates of suicide amongst veterans?
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
Yes. I haven't reviewed the latest, but I do think there's been a small increase in both the army's suicide rates and in the veterans. I'd have to double-check that.
The important thing is that the number of suicides is quite small, so it's hard to have a significant change, but I know there has been a small increase.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Is that something that's tracked well enough that you can get the numbers?
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
I will look into it and get back to you.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Okay. Thank you very much.
You also mentioned that there are other treatment methods that should be looked at. Are they specific to PTSD or are they for all mental health? Could you expand on that a little bit for us?
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
Yes. I think the area that the operational stress injury clinics have done a really great job in is to increase the availability of PTSD-related treatments as well as other emotion-regulation skills. More recently, in the last few years, there's been an emphasis on cognitive behaviour therapy for suicide. That has been shown in American military samples to actually reduce future suicide attempts. If someone's made a suicide attempt, targeting the risk and protective factors in a psychological intervention has been shown in a randomized trial to reduce future suicide attempts. We think it's important for our military and veteran clinics to really look at those new treatments.
The second piece is safety planning. For most clinicians, and this is not just military veterans but all of us, when we see a person who's thinking about suicide, there are new ways that you can actually try to do an assessment and try to reduce the risk in that moment. Again, I can give some of that information back, but it's a suicide assessment intervention and safety planning, which includes helping the person bring out things they want to work on that would help them live, and really focusing in on, if they have access to lethal means, trying to remove those, as well as talking about social support. Those specific interventions are what they're saying we should be implementing across the system as the latest suicide prevention methods .
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Did you say those are now being used in the U.S., but they're not best practices yet here in Canada? Is that right?
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
They're not being used in the U.S. either. This is just new, new “hot off the press” kind of evidence. A new randomized trial that was done two years ago showed that this specific intervention actually had reductions. But clinical practice hasn't changed yet, and that's what I think is really important to work toward.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Okay.
Again, from the research you did, you said you studied 8,441 active military personnel. You said the conservative estimate would be that approximately 15% of the sample would be considered in need of mental health services.
Do you have a “non”-conservative estimate?
November 17th, 2016 / 4:30 p.m.
Liberal
Professor, Psychiatry, Rady Faculty of Health Sciences, University of Manitoba
In that study, and that was 2002, the liberal estimate was 31%. That included diagnoses, people who were diagnosed by a structured interview, as well as people who were receiving services, as well as people who perceived a need for care. When we looked at the whole, from a self-perceived need for care, seeking care, and meeting diagnosis, that number was 31%.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Thank you very much for being here and for the expertise you bring. I don't have a lot of background, obviously, in this whole area of research, and it's so crucial for us to understand, even as a committee, how best to make recommendations and encourage changes in our systems here.
Dr. Cramm, with your research on transition to civilian life, you mentioned government advisers. I haven't read your reports or anything. What role did those advisers come from? What were the parameters and what did they do specifically to set up these trials?