Veterans Affairs Committee on Dec. 13th, 2016

[Dr. David Pedlar]

I think it's what you mentioned earlier, engagement as early as possible, and also ensuring members are encouraged to develop a realistic plan before they leave. We've found veterans who have a realistic plan of release almost always do better across most of the studies. Then things like transition interviews and other mechanisms where we have an opportunity to intervene with veterans and see how they are doing on their way through is critical. Once they are out, it would be to make sure there's a contact if needed, that the transition is smooth for those who are being followed, but also to encourage people to come forward and not have feelings of stigma if they need help.

[Colin Fraser, Liberal, West Nova, NS]

Do you think proactively checking in with them on their mental health throughout this process would be valuable?

[The Chair, Liberal, Neil Ellis]

If you could make that a quick answer, please, it would be appreciated.

[Dr. David Pedlar]

I don't know the answer to that. I think some of the group processes that veterans go through as well are also helpful. When veterans can share with each other and open up about their experiences, that's also helpful, and some programs do that as well.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen, you're next.

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

Thank you to our witnesses. We truly appreciate your expertise and your taking time to be here. I'm hoping to get in lots of questions.

Dr. Pedlar, you said in your remarks that you had looked at the suicide rate among armed forces veterans, and you talked about male veterans and the fact that their suicide mortality was higher than the average population. Did you have occasion to look at suicide rates among female veterans, and if not, why not?

[Dr. David Pedlar]

We did, but the numbers were small. I think the difficulty was with the number of cases, which was small, and that made it more difficult to do analyses.

[Dr. Linda Van Til, Epidemiologist, Research Directorate, Department of Veterans Affairs]

There was an overall female rate that was similar.

[Dr. David Pedlar]

Yes, I'm sorry, there was an overall female rate that was similar to the male rate. Is that right?

[Dr. Linda Van Til]

No, it was similar to Canadians.

[Dr. David Pedlar]

Similar to Canadians, I apologize. There was an overall rate for females that was similar to Canadians. I was just corrected by my colleague.

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

Okay, thank you.

It's interesting and it makes one wonder what it is in terms of females managing their situation that is different from males, but maybe that's a different study or a question that doesn't really pertain here.

At any rate, I also want to ask about the drugs that are used in terms of treating individuals with depression, difficulties, panic disorders, or PTSD. In terms of these cocktails, I've heard there are some veterans who are taking as many as eight to 12 pills a day. Have you looked at that? By virtue of the fact that they're taking a significant number of drugs, would that not add to their inability to be socially interactive and to be more healthy in terms of their interactions with family and friends? If this has been looked at, I wonder what the cost is of all of these drugs, and how that compares to medical marijuana. Has this analysis been done?

[Dr. David Pedlar]

The answer is that, at least in my unit, we have not done large-scale studies of medication utilization, either of psychiatric medications or of medical marijuana. I don't have anything to report on that issue.

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

Would that be something that would make sense for VAC, Health Canada, or someone to entertain?

[Dr. David Pedlar]

Yes, a utilization study could be useful.

I actually did a medication utilization study on veterans many years ago now, and one of the problems we ran into is that we're not the full provider. We're often the supplementary provider, so it means that we don't have the complete medication record that would often be with health regions or provinces, so you start with a real limitation in what you can do if you're a co-payer or a second party payer of medication. That doesn't mean it can't be done, but there is that challenge that makes it more difficult to do on veterans than, for example, in a provincial environment.

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

Okay, thank you.

Thank you, Dr. Van Til, for your intervention.

Dr. Richardson, I would like to begin by saying how proud we are in London of the work at Parkwood and at Western for our veterans, so thank you for what you do.

I'm wondering about the role of mental health workers in terms of transition. Should they play a more central role? Would the stronger presence of mental health workers during the transition be of benefit?

[Dr. Don Richardson]

Just so I understand the question, are you talking about somebody transitioning out of the Canadian Forces into civilian life?

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

Yes, into civilian life, because we've heard, and it's been mentioned here today, that it's a loss of self, it's a loss of identity, and it's a loss of one's community. I wonder if mental health workers have a greater role to play in terms of making that less stressful, less painful, and less difficult.

[Dr. Don Richardson]

That's a fascinating and interesting question. First, I don't think I have the data to provide an answer to that, but I can give you what my opinion would be, just so I clarify that. Not everyone who transitions out of the Canadian Forces necessarily needs a mental health worker. If somebody has a medical condition, then it's probably that individual who is struggling more. I think if you're retiring from the military—and this is from my clinical experience—and you're retiring because you chose to retire, then I think that's a different situation from one where you are forced to retire because you have a medical condition.

In those cases, I think the biggest challenge I hear from many veterans and still-serving members is how to access and coordinate services. If you can imagine, when you're still serving, health care is provided for you and is directed to you. As civilians, because I'm not a military person, we are used to being self-directed in order to access services. For somebody in the military, that's a particular challenge. We've talked about, in other committees, the need of having a navigator, as somebody who could help them coordinate the services and learn how to access care. For a civilian, it's a challenge. If you can imagine somebody who has never done it before and who has a mental condition, it's a particular challenge.

Sorry for going over.

[The Chair, Liberal, Neil Ellis]

It's no problem.

Thank you.

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

That's fine. I go over all the time.

[The Chair, Liberal, Neil Ellis]

Mr. Eyolfson.

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

Thank you both for coming.

Dr. Pedlar, I'm familiar with some of the issues with suicide. I practised medicine for 20 years. One of the things we found.... This may be difficult to answer, because you had said in regard to Ms. Mathyssen's question about women and suicide that your numbers were much smaller and it was more difficult to analyze.

One of the things that had become apparent over the years in the suicide stats we had looked at is that, when attempted, men are more likely to be successful than women. Usually that is because men will choose more instantly lethal means and women will choose means that are less lethal and more prone to recovery.

You said that you had tracked suicides. Is there any tracking of suicide attempts, and have you noticed any difference between men and women in that?

[Dr. David Pedlar]

We did a file review in 2014 that looked at 80 cases of suicidality, and they included ideation attempts and completed over a fairly long period of time, I think from 1960-something to 2013. We do have some data on the circumstances surrounding suicide, but I don't recall that women were analyzed in detail in those findings. The findings were very helpful in understanding the specific factors associated with suicide in personal cases around veterans.