Veterans Affairs Committee on Feb. 13th, 2017

[The Chair, Liberal, Neil Ellis]

I would like to call the meeting to order, pursuant to Standing Order 108(2), to resume our study of mental health and suicide prevention among veterans.

Today we have four panel groups. Each has been notified that they can start with up to 10 minutes. Then we'll move to questions.

The four groups consist of the Mental Health Commission of Canada, Mission Butterfly Inc., the Royal Ottawa Health Care Group, and The LifeLine Canada Foundation.

Via video conference, we'll start with Liane Weber of companion paws Canada, and chief executive officer of The LifeLine Canada Foundation.

We'll turn the floor over to you, Liane. Thank you.

[Liane Weber, Chief Executive Officer, Companion Paws Canada, The LifeLine Canada Foundation]

Thank you so much for inviting me to speak with all of you and for allowing me the opportunity to present to you today.

My name is Liane Weber. I am chief executive officer and founder of The LifeLine Canada Foundation, also known as TLC. TLC is a registered non-profit organization in B.C. doing work across Canada and worldwide, with its head office based in West Kelowna.

The foundation is not a crisis hotline. We work on newly developed initiatives, such as the LifeLine mobile app, the free national suicide prevention and awareness app, and companion paws Canada.

TLC was founded in 2015 as an organization committed to reducing the frequency of suicide deaths and attempts across Canada and worldwide, while developing positive mental health initiatives.

I am not a mental heath professional, nor am I a dog trainer in companion paws Canada. I was deeply affected by two suicides in 2012. After overcoming the worst part of my grief, I used my entrepreneurial mindset to create and launch the LifeLine app in 2013.

The app and website offer immediate access to guidance and support for those suffering in crisis and those who have suffered the devastating loss of a loved one from suicide, including veterans and active military personnel, and their families. They provide a wealth of information, awareness education, and prevention strategies to guide people in crisis.

TLC's newest program is called companion paws Canada, which I understand is of most interest to you. We call this CPC. The program is dedicated to supporting veterans, active military, first responders, and seniors in need, while providing a second chance for pets by rescuing, training, and pairing them with those who would benefit from a therapy-certified animal. The concept of companion pets and therapy dogs for veterans is not a new concept. There are organizations across the globe doing exactly this.

Sadly, there are alarming statistics of suicide, family abuse, and post-traumatic stress disorder facing veterans returning to civilian life after military duty. This can cause a downward spiral of apathy, unemployment, broken relationships, addiction, and depression.

It is our belief that companion animals can be the lifesaving therapy or friend that many returning servicemen and servicewomen need. Medical studies have shown that companion animals significantly improve mental and physical health, including by reducing stress, depression, and anxiety symptoms. Individuals with emotionally-based disorders in particular may find it difficult to open up and trust another human being but find this process much easier with a therapy animal.

Companion paws Canada pets are not service dogs or guide dogs. Therapy dogs are trained and tested in therapy obedience. Interaction with a therapy pet provides therapeutic, motivational, emotional, and recreational benefits to enhance quality of life, while a service dog is trained to perform specific tasks that are unusual dog behaviour.

Up until companion paws Canada's new program, a therapy dog was a dog that might only be trained to provide affection and comfort to people in hospitals, retirement homes, nursing homes, schools, hospices, and disaster areas, and to people with autism. With companion paws Canada, these types of dogs are trained and now can live permanently with a veteran in need of a therapy dog.

Through our website, individuals confidentially submit a letter from their doctor or mental heath professional, which is required, as well as a permission letter from their landlord, and proof of ability to pay for costs after placement and to take care of the animal.

The companion paws Canada team interviews each individual to ascertain what he or she is looking for in a therapy animal. We pair this with his or her personality and lifestyle to make the perfect match. We fully expect that they are already covering their bases with regard to talk therapy, medication, and reading up on their illness. By adding a very well-trained dog to their treatment plan, something profound and wonderful begins to percolate. Their ability to cope improves, because they are no longer alone on this painful journey. They have a soulmate in their dog, who is ever loyal and compassionate.

Once a suitable match is selected, the animal will spend the time required in the home of one of our trainers, who teaches the pet intensive therapy obedience and other valuable behaviours needed to live with his or her new owner. During the course of training, the new owner will be introduced to his of her new companion, which will include training sessions together.

Companion paws Canada works with physiologists, professional trainers, and behaviourists who identify the best canine candidates. All participating dogs must meet strict guidelines relating to their temperament, health, and age. Once a suitable dog is found, he or she begins a minimum 10-week training period. During that period, the dog is matched with an individual in need and paired with their “forever companion”.

The dogs will come from rescue shelters across the country. They will be between the ages of 2 and 8 years old. Companion paws Canada dogs are common domestic animals that provide therapeutic support through companionship, non-judgmental positive regard, affection, and a focus in life. We are working with rescue dogs and retired service dogs. Certifying one's own personal pet as a companion animal is not part of our program. CPC dogs will not be certified as service animals, as the dogs will be trained as therapy companion animals. However, that may be an obtainable goal with further training.

The strict level of training needed to complete the program, which includes manners, obedience, and socialization, is to the highest standards set by Therapy Dogs International, while the certification exam is performed by accredited therapy dog evaluators.

Our trained coordinator is a professional service dog trainer with decades of experience working with many kinds of service dogs on mental health illnesses such as PTSD, severe depression, anxiety, and autism.

Upon completion and passing of the exam, the new owner will receive a Companion paws Canada therapy dog vest and certificate card for the CPC dog. They will also receive a letter from The LifeLine Canada Foundation showing the authenticity of the therapy dog. The highest standards of training will be carefully monitored to ensure the standard is met across the nation.

There are no laws regulating the term “therapy dog”. The organization responsible for the CPC dog evaluation and certification was approved with permission in a joint ruling by the departments of the solicitor general's office, the Office of Consumer Affairs, Consumer Protection, and Public Safety in Victoria, with outlined expectations.

Dogs can draw out even the most isolated personality, and having to praise the animals can help traumatized veterans overcome emotional numbness. Teaching the dogs commands develops the patient's ability to communicate, and to be assertive but not aggressive, a distinction some struggle with.

Dogs can also calm the hypervigilance that is common in veterans with PTSD. Researchers are accumulating evidence that bonding with dogs has biological effects, such as elevated levels of the hormone oxytocin, the opposite of PTSD symptoms.

With the additional benefits of the companion paws training program, and given the positive effect that this sort of therapy in similar programs across the globe has been shown to deliver, we have chosen to make Companion paws Canada one of our top initiatives.

As for examples of how dogs can help veterans with PTSD, depression, and anxiety, number one is that dogs are vigilant. Anyone who has ever had a nightmare knows that a dog in the room provides information; they immediately let you know if you are really in immediate danger or if you have just had a nightmare. This extra layer of vigilance mimics the buddy system in the military; no soldier, grunt, or sailor is ever alone in the battlefield. The same is true when you have a dog by your side: you are not alone. You can use your mind in searching for data in the environment because you know the dog is doing it for you.

Number two, dogs are protective. Just like the buddy system in the military, someone is there to have your back.

Number three, dogs respond well to authoritative relationships. Many military personnel return from their deployments and have difficulty functioning in their relationships. They are used to giving and getting orders, and this usually doesn't work well in the typical home. I've talked to many servicemen and -women who have been told to knock it off once they get home. Well, dogs love it.

Dogs love unconditionally. Many military personnel return from their deployments and have difficulty adjusting to the civilian world. Sometimes they realize that the skills they've learned and used in the service aren't transferable or respected in the civilian sector. This can be devastating when they were well respected for their position in the military. Dogs don't play any of these games. They just love.

Dogs help people relearn trust. Trust is a big issue in PTSD. It can be very difficult to feel safe in the world after certain experiences, and being able to trust the immediate environment can take time. Dogs help heal by being trustworthy.

Dogs help to remember feelings of love. The world can look pretty convoluted after war. The love of a very well-trained dog is a friendship and a partnership, but also a medical therapy.

These behaviours are intended to assist veterans with PTSD because the dogs provide support and an increased means of coping with the associated symptoms, such as hypervigilance, fear, nightmares, the fight-or-flight response, and impaired memory.

The benefits of having a therapy dog can also include a reduction in required treatment and medication. Dogs can sense when their owner is not doing so well. There's no real command for it, but they respond to emotions and give a little more attention than they normally would.

When vets have a PTSD reaction, their body gets very excited. Their heart starts to race, and they begin breathing very quickly. Petting a dog is naturally relaxing. It slows their heart rate and lowers their blood pressure.

Therapy dogs serve as anchors for veterans and help keep them from having flashbacks to their time in war zones. They can be standing in the middle of a supermarket, but to them it can feel like a combat zone. A therapy dog can help ground the individual and bring them back into reality. Petting the dog and realizing the dog is there, they realize they aren't in a combat zone.

Many veterans are isolated and withdrawn when they return. A therapy dog is a way to reconnect without fear, judgment, or misunderstanding.

I hope I have been of some help to you on how The LifeLine Canada Foundation can be a service provider for veterans and how Companion paws Canada therapy dogs can be lifesavers.

This concludes my presentation. I look forward to answering any questions.

[The Chair, Liberal, Neil Ellis]

Thank you, Ms. Weber.

Next we have, from the Royal Ottawa Health Care Group, Ms. Hale, the director of the operational stress injury clinic, and Mr. Merali, the president and chief executive officer of the Royal's Institute of Mental Health Research. Welcome, and thank you for coming today.

[Shelley Hale, Director, Operational Stress Injury Clinic, Royal Ottawa Health Care Group]

Good afternoon, Mr. Chair, members of the committee, ladies and gentlemen. Thank you for the opportunity to speak with you this afternoon.

My name is Shelley Hale. I'm the director of the Royal Ottawa's operational stress injury clinic.

Our clinic has been in operation for eight years now, and we've worked with over 1,700 clients as you can see. We belong to and work within the national network of operational stress injury clinics and are fully funded by Veterans Affairs Canada. We are one of 11 clinics and the only one situated in a specialized mental health facility. Veterans Affairs, the Department of National Defence, and the Royal Canadian Mounted Police are the only agencies that can make referrals to our clinics, and we provide comprehensive assessments back to them about each referral that comes through our doors. Our clinic in Ottawa is responsible for half of the province of Ontario and western Quebec. We collaborate with seven area offices, three active bases, five integrated personnel support centres, and two RCMP divisions.

This is a snapshot of where the referrals are coming from for our catchment area. It's no surprise that Ottawa and Pembroke are our largest referral sources.

Our average client, just to paint a picture for you, is a 46-year-old male veteran who has deployed an average of two times and has served in the Canadian Armed Forces for almost 20 years. He has served on peacekeeping missions, and he has been diagnosed with both post-traumatic stress disorder and major depression. If treated at our clinic, he will stay for approximately 18 months and attend evidence-based group and individual work to process his trauma. He will leave our clinic having met his treatment goals and will feel prepared through the work he's done to carry it over into his day-to-day life. He will also recommend our clinic to his friends.

Our referrals from DND have grown at a steady pace over the last few years. What we find has been working well is a warm transfer between Veterans Affairs Canada and the Department of National Defence while the member is still serving.

We have worked with our DND colleagues in Ottawa to accept referrals for our clinic for still-serving members with up to two years left to serve so we can ensure a smooth transition of care and so no one falls into the gaps.

The feedback from clients is that this process is facilitating a smoother transition between services, and we're also beginning to see referrals from Petawawa following the same process.

In addition to services at our clinic, a few years ago we launched OSI Connect, a mobile application with self-screeners for depression, PTSD, and sleep, the three big issues for our clients, information we target to family physicians whose resources are on there for families as well. We also launched OSI Resource for Caregivers with the Department of National Defence and Veterans Affairs Canada. We filtered that with family members from across our catchment area as well, with much positive feedback from that group and our clients.

We know that not all veterans are affiliated with VAC and that the system is sometimes complicated for both veterans and service providers to navigate. What we would love to see adopted and tried is a national public awareness campaign that would cue veterans as they enter into any avenue of the health care system whether it's the emergency room, their family physician's office, or a walk-in clinic. If we could teach all health care providers to ask someone if they have served, that would open up a whole avenue for clients who aren't attached to Veterans Affairs Canada. Having all service providers educated to ask that one simple question would mean more veterans could access services that have already been established for them.

Thank you for your time.

[The Chair, Liberal, Neil Ellis]

Dr. Merali, you are going to add to this?

[Dr. Zul Merali, President and Chief Executive Officer, The Royal's Institute of Mental Health Research, Royal Ottawa Health Care Group]

Yes, I am. Let me introduce myself. I'm Zul Merali, the president and CEO of the Royal's Institute of Mental Health Research in Ottawa. I'm also the founding scientific director of the Canadian Depression Research and Intervention Network.

As you know, over 4,000 Canadians commit suicide every year. This is almost like a couple of planeloads crashing with no survivors every month of the year. You can imagine that if that were the situation for any other condition, what a public outcry there would be.

Suicide is one of the seven leading causes of death in Canada, and we have to take a public health approach. We also need to better understand the underlying causes or underpinnings of suicide or suicidal acts.

The biology of suicidal ideation and suicidal acts remains unknown, and this is particularly important because we need to understand what goes awry in the brain and why some people are susceptible while others are resilient under the same set of circumstances.

My objective here today is to call for research. We know that getting into care is not necessarily enough. About half the many people who are in care already will still go through suicidal acts and sometimes succeed in taking their own lives. The vast majority of the individuals who have experienced major trauma or are depressed do not necessarily kill themselves. We do not have a robust way of predicting who will attempt and who will complete suicide.

At the Royal, we are making a particular effort to understand suicide a lot better. I'll tell you a little about our approaches. One of them is that we have created a brain imaging centre in partnership with philanthropists, the Department of National Defence, universities, and the Legion, etc. This was a public effort to come together to bring in tools that can help us make the invisible visible. We need to look inside the brain because that's where the suicidal ideation and the will to commit suicide reside.

To make a point, this slide shows that the brains of people who have post-traumatic stress disorder look very different. They light up like a Christmas tree, as you can see here, using specific ligands in the brain as compared to the other two brains that are matched controls. Here's a demonstration not only of how imaging can be a very strong diagnostic tool, but also very powerful in understanding what some of the underpinnings of those conditions might be.

I'm happy to share with you some information that we have of late. As you know the development of anti-depressants has been rather slow, but of late we have had significant advances. I'm presenting data here that shows you that if you treat people with a certain new class of drugs—although the drug itself is not new, the use of this drug is very new, involving the use of an old anaesthetic at a very low dose, acting as a very powerful anti-depressant—it can alleviate symptoms of depression within hours or days, as compared to weeks or months with traditional anti-depressants. What's even more exciting with this line of treatment is that the suicidal ideation seems to be affected even more powerfully. It goes down much faster than the anti-depressant action, and even those individuals who do not respond with an anti-depressant action will have their suicidal ideation plummet within hours. This is really very exciting, because we can now intervene very quickly and very effectively in alleviating the suicidal ideation.

What's even more interesting are the green bars in this graph, which I would like you to focus on, showing people expressing very little suicidal ideation. The blue and the red are showing high to moderate amount of suicidal ideation. As you can see, almost 90% become free of suicidal ideation within two weeks of ketamine treatment.

This is very exciting, but what's even more exciting is the fact that it gives us an opportunity to disassociate the depressive symptoms in general, on the one hand, from suicidal ideation on the other. We want to be able to image this in the brain to see if we can identify where in the brain suicidal ideation resides. In other words, what are the brain's circuits that are responsible for suicidal ideation? If we can understand that better, I think we can then begin to target treatment much more effectively in those cases.

The action plan we have is that we want to focus on depression, because very often depression is associated with suicidal ideation. We want to also focus on post-traumatic stress disorder, which is highly correlated with suicidal acts.

We have recently created a chair in military and veterans mental health research. We have created a chair in stress and trauma research. I am very proud to say that the individual studying the use of the tool I showed you earlier, which showed you very clearly the brain of someone with PTSD, we have recruited from Yale in New York. He just started last week at our organization.

We are partnered with the National Network of Depression Centers, in the U.S., and with the European Alliance Against Depression, so that we are in tune with what's going on globally. Also, we are partnering with the Mental Health Commission of Canada to test a four-pronged approach to reducing suicidal acts in Canada.

There is a strong need to create a centre of excellence that is focused on military and non-military trauma and related outcomes, including suicidal acts.

With that, I'd say thank you for giving me this opportunity to share our excitement and our concerns. I'm happy to take any questions.

[The Chair, Liberal, Neil Ellis]

Thank you.

Next, we'll turn to the Mental Health Commission of Canada, Ms. Bradley, president and chief executive officer; and Mr. Mantler, vice president, programs and priorities.

Good afternoon.

[Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada]

Thank you very much.

The Mental Health Commission of Canada is delighted to be here today. Thank you for inviting us.

It's really encouraging to see government making veterans' mental health a key priority. As we all know, suicide is a devastating reality. This is not just the case for military and veterans' communities, as you've heard today, but is in many communities across Canada, each with its own unique challenges.

We will focus our remarks today specifically on the scope of the committee's study, which is to improve support for veterans' mental health and suicide prevention.

As committee members, you're no doubt aware that the population of Canadian veterans is estimated to be just over 700,000 people. Based on the limited data available, somewhere between one in five and one in ten diagnosed with mental health problems will experience suicidal thoughts within a year. As you've heard from Dr. Merali, there isn't a robust way of determining that.

It is also thought that the prevalence of mental illness amongst modern-day veterans is higher than amongst earlier era veterans, but again it is difficult to really determine if that is the case due to the whole issue of stigma, but it's certainly higher than amongst the general population.

The mental and emotional toll exacted on veterans isn't unexpected, given the intensity of the tasks that they are called upon to do. In Canada and worldwide, population studies paint a picture of a complex set of needs and determinants of health specific to veterans. These include everything from the predispositions of those who choose to serve, to the unique stressors of military service, and the complex transition from military to civilian life. There isn't a one-size-fits-all solution to the challenges that veterans face, but we know that a whole-of-community approach is a very good place to start.

That said, there are important government initiatives that are contributing to the well-being of our veterans. For example, Ed Mantler and I are fortunate to have been invited to sit on the minister of Veterans Affairs mental health advisory group, and, while supports offered to veterans in Canada are available, they really fall short of what is needed. We are increasingly hearing urgent calls for improvements, and we certainly hear this from the veterans themselves in the committee that we sit on.

This is particularly true in terms of providing adequate transition support. Current supports include a national network of approximately 4,000 registered mental health professionals who deliver services to veterans with operational stress injuries in the communities where they live. We highlight this initiative in particular because it's extremely important to have services close to the community that they live in.

Before I ask Ed Mantler to discuss some of the successful tools that we at the commission have developed to improve veterans' mental health, I want to highlight an ongoing study that may be of interest to the committee. The Australian government is currently carrying out a targeted review of suicide and self-harm prevention services available to its military members and veterans. Written by its National Mental Health Commission, this report is set to be released next month some time, and I think this report will certainly provide useful insights to the committee's study here.

Now in terms of partnerships that we at the commission have pursued with government, we recently launched a mental health first aid veteran community course for veterans, their families, and caregivers. I will ask Dr. Mantler to outline that for you.

[Ed Mantler, Vice-President, Programs and Priorities, Mental Health Commission of Canada]

Thank you, Louise.

The program Louise refers to, mental health first aid for the veterans community, improves knowledge about mental health and builds skills for recognizing and responding to mental health issues at the community level through the use of a tested, evidence-based plan of action. Through funding from Veterans Affairs Canada, this course is offered at no cost to participants.

The program improves the capacity of members of the veterans community and empowers them to address mental health problems and illnesses rather than simply directing them to government agencies. The veterans version of mental health first aid gives family members, community workers, and veterans themselves the tools to recognize a mental health problem and the skills to intervene until professional help can be engaged. These kinds of tangible programs put knowledge on the ground and in the community where it's closest to those who need it.

Last year alone, 14 courses were held across the country. Hundreds of members of the veterans community are now better prepared and better equipped to effectively address a mental health problem or crisis. Our goal for 2017 is to offer 40 veterans community training courses from coast to coast to coast.

Another program of potential interest to the committee is the commission's training called “The Working Mind”. It is an education-based program designed to address and promote mental health and reduce stigma related to mental illness in a workplace setting. It's based on the Department of National Defence's program as a foundation, the road to mental readiness, or as we call it, R2MR program. The training supports the mental health and well-being of employees and offers ways to talk about mental illness in a workplace context as well as means to combat stigma and encourage individuals to seek help when they need it.

The training is based on a mental health continuum model that categorizes one's mental health within a continuum. It allows individuals to identify indicators of declining or poor mental health and reinforces the reality that these indicators exist within a continuum and can move across the continuum. It contains strategies to help return to the best mental health possible. These strategies are based in cognitive behavioural theory techniques to help individuals cope with stress and improve their mental health. They're simple techniques that, once learned, any of us can do, such as purposeful diaphragmatic breathing, positive self-talk, visualization, and proper goal setting, the same kinds of techniques that Olympic athletes use to maximize their performance.

We're very excited to see that the most recent report of the Standing Committee on Public Safety and National Security included R2MR training, mentioned several times as a training tool that could help.

As important as training programs are, work needs to be done now to implement a bolder plan that will save veterans' lives. I thank Dr. Merali for introducing the issue of suicide. The risk of dying by suicide is 32% to 46% higher for veterans than for other Canadians of the same age. Veteran suicide happens within the context of their community.

Last year, in the commission's pre-budget submission, we talked to members of Parliament and Veterans Affairs about a national community development suicide prevention model. The commission would be ready to swiftly deploy a sophisticated suicide prevention strategy in 13 communities across the country, one in each province and territory, and to focus projects on military bases or areas where there is a high veteran population. The project would cost $40 million over five years, a rather modest price tag when one considers the life-saving potential of such a project. The model is based on proven programs in Quebec and internationally that significantly reduced suicide rates by more than 20% in two years.

The suicide prevention project would provide a base of evidence for a nationwide suicide prevention program. The project would focus on specialized supports, including a range of prevention, crisis, and postvention services, such as crisis lines, support groups, and coordinated planning and access. It would provide training to better equip community gatekeepers—family physicians, first responders, nurses, managers, teachers, and others—by providing access to training and ongoing learning opportunities.

The commission would be honoured if the committee would consider reviewing this proposal in full during the course of its study. I'd be pleased to provide the full pre-budget submission proposal, as well as a full briefing note to the committee.

The commission is well positioned to work with all levels of government to continue to implement programs and training for veterans.

I'd like to thank you again for providing us with this opportunity to share some of our experiences with those issues, and I welcome your questions.

[The Chair, Liberal, Neil Ellis]

Thank you.

Now, from Mission Butterfly Inc., we'll hear from Mr. Champion, vice-chair, and Dr. Thirlwell, psychiatrist, executive health team. Welcome.

You may start with your 10 minutes.

[John Champion, Vice-Chair, Mission Butterfly Inc.]

Good afternoon. It is an honour, and humbling, for me to be with you today.

My name is John Champion, and I am before you as a prior member of the Canadian Armed Forces, regular forces, a former regional police officer, a former United Nations homicide investigator, a currently serving combat engineer, a Legion branch veteran service officer and zone C-2 veteran service officer, as well as a board member of Mission Butterfly, a not-for-profit organization that provides a multimodal therapy called “healing invisible wounds”.

Throughout my work life I have witnessed the horrors that mankind can inflict, and I have seen the aftermath of destruction that political agendas can make. I have also witnessed the incredible results that Canadian peacekeepers and peacemakers have made while selflessly risking their lives for people they don't know. Unfortunately, I have also witnessed first-hand the long-lasting effects of these actions and the destruction they cause, not just to the veteran or first responder, but to their families and communities.

PTSD and suicide are running rampant within our military, veterans, and first responders. We can no longer sit on the sidelines and do little. PTSD and suicide are like a communicable disease—others around start to suffer and can be triggered.

Among the many hats I wear, the hardest is that of veteran service officer. Twenty years ago, a VSO helped vets and widows navigate the quagmire of Veterans Affairs paperwork. Now it means finding housing, employment, and treatment for vets. Having stared into the abyss myself, I can tell you that the hurdles to seeking treatment are fear of losing your job; being ostracized by your peers, family, or community; and the belief that the therapist can't relate or have knowledge of what you're feeling.

PTSD is different with each veteran. Mission Butterfly has a program with numerous models of therapy. To ensure the success of the client, we do extensive testing before the therapy begins. Veterans don't need a weekend of fly-fishing to heal. They need therapy that heals the mind, body, and soul. That means having their families involved and dealing with topics like finance and nutrition. What it doesn't require is the current medical solution of overmedication. There is a time and place for medication, make no mistake, but masking one's symptoms makes it harder to treat the real cause. Mission Butterfly offers a non-drug therapy that covers all of these.

Mission Butterfly therapists also undergo an intensive Canadian Armed Forces culture workshop so that they can bridge the barrier more quickly. Military members speak a different language. They have a different sense of ethics and respect for each other that the average civilian can't understand. Unless you know the impact of signing the oath with the string of unlimited liability attached to it, how can you relate to a veteran?

Dealing with PTSD has to be started quickly and with the individual's custom therapy in mind. Sending them to a psychiatrist for anti-depressants and time off work is not the answer. That is the current method used, and it needs to stop. Real change starts now, right here, in this room.

[Dr. Celeste Thirlwell, Psychiatrist, Executive Health Team, Mission Butterfly Inc.]

My name is Dr. Celeste Thirlwell, and I'm an executive health team member of the non-profit organization Mission Butterfly. We are a caring group of Canadians dedicated to improving the quality of life of the men and women who selflessly protect, assist, and serve the Canadian public. I'm a psychiatrist and sleep medicine specialist with a background in neurosurgery, neuroscience research, and pain management. I'm grateful for the opportunity to address the committee.

It is unjust that veterans with PTSD, their families, and their communities continue to suffer without adequate assessment, treatment, and support. The imperative for optimal and innovative treatment of veterans suffering with PTSD is an issue of social justice, military priorities, and federal leadership.

PTSD has been called shell shock in World War I, combat stress reaction in World War II, and during the Vietnam War was finally coined post-traumatic stress disorder. Now, in the DSM-5, the diagnostic manual of the American Psychiatric Association, there are four components to PTSD. The first is rear-experiencing, such as flashbacks and nightmares. The second is avoidance. The third is negative mood and cognitions, which includes hostile, aggressive, and even paranoid thinking. The fourth is behavioural arousal, such as hypervigilance, hyper-arousal, and sleep disturbances.

The issue of treating and diagnosing PTSD remains an elusive opponent, both clinically to us, and to military and other services around the world. A key component that has recently been published about is the disorder of sleep. When we train our military personnel, we set them in a combat-ready mindset, which means that their sympathetic nervous system, their fight-or-flight system, is set to overdrive. They are set to “on”. Their neuronal circuitry has been set to “on”, and has been trained to be on. When they come back from combat zones, even where there was no danger, they still perceive danger. Their “off” system, which is called the parasympathetic nervous system—it's like the brakes—is nowhere to be found. What Mission Butterfly has developed is a comprehensive, integrative system to boost that “off” system, that parasympathetic nervous system, so that we can reprogram the neuronal circuitry in these military men.

When we speak about neuronal circuitry and retraining, the shame and the guilt—many of those things that keep veterans from even coming forward for treatment—get put to the sideline. This is neuronal retraining. The good news is that we can reset the neuronal circuitry. The bad news is that it takes time and it takes an integrated approach. Pharmacology alone will not work. Behavioural management alone will not work. We need a comprehensive approach, such as that designed by Mission Butterfly.

The other thing these men need, and that I've read since I presented my literature to you, is a mission. They need a new mission. These are people who were trained to protect and serve. They come home, and there's no protection goal and no service goal. The men and women who are doing the best in the U.S. now are independent veterans who have banded together to find goodwill missions, such as helping to rebuild schools and houses. These are people who are ready and willing to serve, and who need a mission. Not only do we need to calm down their nervous systems and retrain them from the mindset of combat-ready, which is the fight-or-flight, and to boost the “off”—relax and restore, you're safe now—but we also need to heal their hearts. For their hearts to heal, they need a mission.

We all need a goal in life; we all need a mission. Without that, life is not worth living. Without that, we see the suicides.

Thank you.

[The Chair, Liberal, Neil Ellis]

We'll begin our first round of questioning.

Mr. Brassard.

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

Thank you, Mr. Chair.

I apologize to all of you at the onset, as seven minutes will not give me enough time to ask the questions that I need to ask. Hopefully, my colleagues can pick up on some of the direction I'm taking.

The first thing I want to talk about is the research that you're doing, Mr. Merali. What I found interesting from the slide that you put up was the distinction between the brain that apparently suffers from PTSD and some of the other brains that don't. I know you're in the research stage, but why are we not doing this right at the onset with those who are coming to us with PTSD? Why are we not putting them in a position where we can diagnose, similar to what we see here?

[Dr. Zul Merali]

That's a very good question, a very important question. That's exactly why I was showing you the slide. We now are developing tools that can be applied, but right now these are not standardized diagnostic tools.

For instance, when you have cancer, you can go for cancer diagnostics. It is a standardized tool. When you get your blood pressure taken, it's a standardized tool. Brain imaging is only coming into its own now. That's why I think we need to put time and effort into making these sorts of tools standardized, so they can become diagnostic tools available much more widely.

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

Are other countries doing something similar to this? Have they completed the process of this research?

[Dr. Zul Merali]

In the United States, for example, the biggest project right now, after the genome project, is something called the human connectome project, which is designed to understand the connections between different aspects of the brain circuits and how they get activated or deactivated under certain conditions. That's the major thrust right now, not just for PTSD, but in all walks of life where the brain circuits get dysfunctional and give rise to certain symptoms or certain illnesses. That is now the biggest ongoing project in the United States.

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

Interesting.

You also mentioned ketamine. I hope I pronounced that properly.

[Dr. Zul Merali]

Yes.

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

Ketamine as opposed to which other prescription drugs?

[Dr. Zul Merali]

In particular, I was talking about ketamine in the context of depression—which often coexists in individuals who attempt suicide or commit suicidal acts—as compared to other, traditional antidepressants such as serotonin reuptake inhibitors and monoamine oxidase inhibitors. Those are traditional classes of antidepressants.

Those take weeks or months to kick in, and they do not effectively treat everybody, as we just heard from the panel. It has to be individualized, and we need to figure out a way.

The main point I was trying to make with ketamine is that not only does it have a fast-acting antidepressant action but it is an even stronger anti-suicidal ideation medication.

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

Is it that much more measurable?

[Dr. Zul Merali]

It is. It is immediately measurable, within hours.

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

Okay.

I don't want to miss out on you Liane. In terms of the difference between therapy dogs and other types of dogs, one of the issues that has come up recently is tax credits.

Because of the cost associated with both therapy dogs and service dogs, not just training them but the constant, ongoing upkeep of food, veterinary care, and all that stuff, would you be looking for or want tax credits for these types of animals, for veterans specifically?

The line is frozen, I think.

[Liane Weber]

Can you hear me now?