Veterans Affairs Committee on Nov. 17th, 2016

[Dr. Jitender Sareen]

I haven't seen literature on that particular piece. That's not an area I'm familiar with.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you.

Dr. Cramm.

[Dr. Heidi Cramm]

I'm not aware of any research literature that would inform a response to that.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Okay. Thank you.

I also want to pick up on something that Mr. Bratina picked up on earlier with respect to that transition. One of the things we've been hearing consistently over the course of the last week is the loss of identity, the loss of structure. Dr. Cramm referred to that.

Are there studies to show or compare the impact that has on the mental health of our veterans and our forces personnel as they transition into civilian life compared to others who have served—more specifically, police, fire, EMS? We've heard in the past that there are similar impacts on them. What are the comparables, if there are any, to our DND personnel and those who transition from the emergency services?

[Dr. Jitender Sareen]

I'm pretty sure a study hasn't been done on that. Again, we just don't have enough funding for mental health research. I think it's really important to remember that most of the time we're not guided by evidence, and it's really important to invest in that.

I think identity, especially when you have a young veteran, is a very important issue. For someone who is struggling with PTSD and depression and is released on a medical leave, trying to figure out what they're going to do in their 20s and 30s is very challenging.

I haven't seen literature that's directly compared other police to veterans. I'm not sure if Dr. Cramm has.

[Dr. Heidi Cramm]

I haven't seen that directly. I will speak a bit on the first responder research basis, because we do have a fairly heterogeneous representation of research. There's much more research on police than there would be on fire, for example. Even within that group of first responders, it's difficult to understand their experiences.

There are some intersections between those who are releasing from the military and who then go on to do a public safety position as a second career. That's not an uncommon experience. Again, these are areas that are newer and that have not received a lot of research funding, so we have a lot of work to do there as well.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Dr. Sareen, you spoke about investing in the pursuit of this evidence. As far as the Canadian Institute for Military and Veteran Health Research is concerned, what is your funding on a yearly basis? What do you receive in grants and funding?

[Dr. Jitender Sareen]

I'm not sure what CIMVHR receives. I guess I'm talking broadly about the field of suicide. What we're trying to do is suicide prevention around the world. This is not a criticism of Canada. It's around the world. We have very limited evidence around suicide prevention. The article I'm going to submit is a two-page editorial that says we need to do these things while we look for evidence.

If we're trying to change suicide attempts and suicide deaths, you really need large, randomized trials or pretty strong investments. If you look at other health conditions like cancer and HIV, strong investments in research have turned HIV from a deadly disease into a chronic health condition, and that's through discovery.

Suicide rates have not changed in Canada and the U.S. If we want to change those rates, we really need to have good, strong evidence and investment in research.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Ms. Cramm, can you answer the question for me as well?

[The Chair, Liberal, Neil Ellis]

We're short on time, so please make it a concise answer.

[Dr. Heidi Cramm]

Certainly.

Health Canada has invested $5 million over five years in the institute to develop its capacity to harness research to inform these issues. That does not directly fund research. That is to fund the development of the research ecosystem across Canada. The contracts come through Public Works grants. Those funds vary from year to year, depending on what is released up the chain from government. We don't directly fund, as an institute, research projects. Our researchers within our network are competing for grants to do all of this work.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen.

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

Thank you, Mr. Chair.

I wonder if perhaps both of you might attempt to answer my question. Sexual assault or trauma in the military can be a significant cause of PTSD or other mental health issues. We had Brigadier-General Hugh MacKay, surgeon general of the Canadian Armed Forces, testify before this committee last Tuesday. He said that PTSD or other mental health issues resulting from sexual assault or trauma of military members are not considered operational stress injuries. Could you comment on how that perspective might well impact the mental health of a CF member who was assaulted and injured while on duty serving with the military?

[Dr. Jitender Sareen]

I wasn't aware that it was not considered an operational stress injury. Over the course of the time that I've worked at our OSI clinic, we see members, and we provide treatment. I wasn't aware of that piece.

[Dr. Heidi Cramm]

I would echo Dr. Sareen's comments. I'm not aware of that distinction.

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

Is it detrimental, or could it be detrimental, in terms of how the victim responds to being told, no, this hasn't anything to do with your service but it's something else over on the side? I'm wondering if you have any thoughts on that.

[Dr. Jitender Sareen]

I think that certainly can have an impact. For someone who has gone through a sexual assault, not having support is a really important piece. But I wasn't aware of that piece.

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

I was surprised by it myself. I thought, by virtue of the fact that young men and women are in a military situation that might make them vulnerable, it would be regarded as something connected with their service. I appreciate your response.

You did say that it is very important for family support in the case of mental health issues. I wonder how we can better support the families who are caring for CF members or veterans who have OSI, who are dealing with mental health issues.

[The Chair, Liberal, Neil Ellis]

This question is for both of you, but you'll have to give very concise answers, please.

[Dr. Heidi Cramm]

I've done a fair bit of work around the evidence for this. I think this echos back to the need to move toward a family-centred model of service delivery. As [Technical difficulty—editor] when they come in for mental health services, there is a primary referral. That's the name on the referral. That's what gets all of the remuneration going. This is how people get paid to deliver the service. But it happens...in the context that there is a secondary client, and that is whatever your social support is—typically your family, as a child. This is how it functions, because people exist in these systems.

Social support is one of the biggest predictors of people doing well in the context of living with mental health issues, so the idea that we would provide a service to someone who has something like PTSD, without supporting the family to support the person who has PTSD, is counterintuitive.

[The Chair, Liberal, Neil Ellis]

Thank you.

Go ahead, Dr. Sareen.

[Dr. Jitender Sareen]

I would completely echo that. We've developed cognitive behaviour therapy classes at our site, where we educate both clients and family members in learning the CBT skills that are important in managing depression and anxiety. The family members really appreciate being involved in learning some of the skills we're teaching. There is evidence around engaging the family members in PTSD treatment. Especially in suicide and suicide attempts, it is really important to engage family members.

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

Thank you.

[The Chair, Liberal, Neil Ellis]

That's great. Thank you.

That concludes our time for witnesses today. We'd like to give you both a couple of minutes, if you want to wrap up.

We'll start with Dr. Cramm.

[Dr. Heidi Cramm]

Thank you very much, and thanks to all the members for their interest in these areas. There is a lot happening in the field of military and veteran family health, so it is very important to have these conversations, because we're learning more all the time.

The family piece is one that can't be overemphasized, because it really is critical to everyone's success. So many people who struggle with mental health receive the service after their family disintegrates, and the family disintegration is actually the impetus for the beginning of the mental health process. I believe we can do better at supporting families to support people, so that things do not have to deteriorate to the extent they often do. It takes a lot of different stakeholders working collaboratively to really effect these changes, because no one group in this space can really make these changes happen.

Thank you.