Veterans Affairs Committee on Dec. 13th, 2016

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

Are there any impending—

[The Chair, Liberal, Neil Ellis]

I'm sorry. We'll have to get you next round.

Ms. Wagantall.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much, both of you, for being here.

Dr. Richardson, you mentioned new research. On this whole issue of individuals committing suicide, you're discovering that sleep disturbances have an impact on suicidal thought. You went on to talk about how with the treatment outcomes for the military, I believe you were saying, the talking and medication therapies for PTSD are 40% to 60% successful. Did I hear that right?

[Dr. Don Richardson]

Yes.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

If it's 40%, then 60% aren't successful. If it's 60%, then 40% aren't successful. It's in that number somewhere. I'm curious, in the diagnosing of PTSD.... You're probably also hearing right now about mefloquine toxicity and brain stem injuries. Is the diagnosis complete in that you look at the possibility of more than just PTSD? We're hearing that the two are very different. One is a physical illness and one is mental, and they're being treated without that recognition. With mefloquine right now, as you know, basically all of our allies have made it a last resort or blackboxed it. Germany has said no more, in any way, to armed forces or veterans or civilians. They all quote amnesia and suicidal behaviour. All these kinds of things can be outcomes of taking that drug.

Are we looking at this as a possibility that we need to study further, and consider that for these individuals who aren't succeeding in their treatments, it might be because we're diagnosing them incorrectly?

[Dr. Don Richardson]

I should have written those down. You asked multiple questions.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

I'm sorry. Pick one.

[Dr. Don Richardson]

I'll start with statistics. When I say 40% to 60%, it's based on different studies that have been published in terms of treatment outcomes. It's not necessarily 40% to 60% concerning those specific individuals, but multiple studies. I think one of the studies published in The American Journal of Psychiatry quoted that if individuals follow evidence-based treatment, about 50% will fully recover.

Speaking as a clinician, we tend to look at things as “thirds”. With almost all mental health conditions, one-third will fully recover, one-third will get significantly better, and one-third will have a chronic course where they're continuing to have symptoms.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

In the diagnosis of PTSD, in light of what we're learning about and hearing around the world right now, do you see that there might be a possibility, even within research, or a need for us to consider another possible diagnosis? When they're looking at PTSD, do they look at the brain stem and that type of thing? I don't know.

[Dr. Don Richardson]

As a clinician and a psychiatrist—it's also done by psychologists when we're doing a diagnosis, but probably more so as a psychiatrist—we look at the entire person and do a complete medical history. Part of it would be looking at exposures. I'm not an expert in mefloquine; however, I've read about it. Obviously some of my patients have used it, or were prescribed it during their service, I should say.

In general, however, in medicine we try to find the most probable condition the person is suffering with as opposed to trying to find multiple probabilities. For example, somebody might have taken mefloquine, but they were also deployed to an area where they were exposed to significant traumatic events, and are reliving those events. Personally, as a clinician, I would approach it by saying, “It sounds to me like the symptoms you're presenting with are probably post-traumatic stress disorder. However, there are other things that might have contributed to it. Let's try the treatments that we know work well and see how you do.” If they fully recover from the standard treatments, then most likely we have the correct diagnosis. If, however, somebody is not responding to treatment after six months, then I start getting concerned, i.e., is it the right treatment?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Do you see in the future, in light of what we're learning now, that more of a focus on this as a potential condition should be considered?

[Dr. Don Richardson]

I would try to consider all potential issues, because we haven't touched here on the whole area of mild traumatic brain injury. As a clinician, you would also do a thyroid function test to make sure that has not been affected, because it will present as depression also.

Is that helpful?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

To some degree, yes.

[Dr. Don Richardson]

Okay.

I'm sorry.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

No, that's fine. It's complicated. I appreciate how challenging this is.

Dr. Pedlar, when you do your research and come up with your responses here, I appreciate how you're saying that there are a multitude of different factors that play into the conditions that these veterans face.

When I read the list of the various issues that can be impacting them, you talk about physical health problems, difficulties in life roles, employment, all of these different things, and addictions. Do you take into consideration at all what types of medications they are on and the side effects of those, and how that might also play into their sense of well-being?

[The Chair, Liberal, Neil Ellis]

I have to apologize, Dr. Pedlar.

You'll have to get that in about a 30-second answer if you could, please.

[Dr. David Pedlar]

The answer is yes. I mean, medication can also impact well-being and can be a factor in physical and mental health. The answer would be yes.

[The Chair, Liberal, Neil Ellis]

Thank you.

We're going to split time here.

I believe Mr. Rioux is first.

[Jean Rioux, Liberal, Saint-Jean, QC]

Thank you, Mr. Chair.

I'd like to thank the witnesses for joining us today.

We've seen statistics on the transition of veterans from military service to civilian life, which, as we all know, is challenging. You told us that veterans were three times more likely to suffer from mental health issues and that the suicide rate was one and a half times higher among veterans. Do you have figures for the period when they were serving in the armed forces? Were the rates as high during those years? I'm inclined to think not. I suspect the transition to civilian life is the influencing factor. I'd also like to know whether the rates drop later on, in other words, four or five years after the return to civilian life?

[Dr. David Pedlar]

It's not exactly on that timetable, but we do find that levels of mental health problems are higher when they're veterans than when they're serving. That much we know.

We think that suicide is probably higher as well, although the Canadian Forces has noted, I think in their testimony, that there has been a trend to increasing suicide, especially among members of the army. That's a more recent trend.

[Jean Rioux, Liberal, Saint-Jean, QC]

Something you said during your presentation surprised me. You said there was a link between physical and mental health problems. I do find that somewhat surprising given that the members of our military are well-trained and supposed to be in good physical shape.

How is it that such a problem exists? They say a healthy body and a healthy mind go hand in hand. Does that mean members of the military should receive even more physical training?

[Dr. David Pedlar]

There is excellent training in the Canadian Armed Forces, and there's no question about that, but there's also no question that it's an occupation of wear and tear to a certain extent. The body isn't built to carry 125-pound packs for years on end without some kind of consequences. We see those consequences in our disability program. They are mostly musculoskeletal issues, which would be ankles, knees, backs, necks. In fact, by far the largest impacts from a pension point of view are the physical health issues.

That's why I underlined that point so much in my presentation. I see physical health and chronic pain as a very, very important pathway to mental health conditions in veterans, in addition to traumatic experiences that they might face as well. It's very important to look at physical health in veterans if we want to understand how to address mental health.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I want to ask a couple of quick questions. We heard earlier from an American witness about cognitive behaviour therapy. I'm wondering whether this is part of the therapy we're using in Canada. Has there been any research done? They said they had noted positive results from it.

[Dr. Don Richardson]

I think the simple answer would be yes. Cognitive behavioural psychotherapy is one of the treatments provided across Canada, especially within the network of clinics.