Veterans Affairs Committee on Feb. 13th, 2017

[Dr. Zul Merali]

Okay, that's a good question.

What you're actually seeing is a PET image—that's positron emission tomography. In that type of analysis you inject a radioactive ligand that traverses through the blood and ends up in the receptors in the brain. The receptors that you're seeing light up in that graph are what's known as the CB1 receptors. These are the cannabinoid receptors, the endocannabinoids. They are receptors in the brain that bind to marijuana-type molecules. The brain produces endocannabinoids, endogenous marijuana-type molecules that it uses in its circuits. What you are seeing there is an injection of a ligand that's binding to those receptors. You can see that those receptors are much more abundant than you would see in non-traumatic brains, which are the other two controls that you see on the right-hand side.

What's very interesting about this is that, as you know, of late there has been a lot of discussion about the use of marijuana by veterans, and a lot of anecdotal evidence indicates that they get relief from some of their symptoms by using these drugs.

What concerns me is that there is no large-scale clinical trial that actually shows the efficacy and safety of using marijuana and marijuana derivatives in the treatment of post-traumatic stress disorder. I think this really needs to happen sooner than later.

[David Graham, Liberal, Laurentides—Labelle, QC]

Speaking of large scale, how many people are you testing in your studies? Are you getting these results very consistently, or is this one person?

[Dr. Zul Merali]

No, this is a statistically significant effect, and this was the study conducted by Dr. Alex Neumeister at Yale. He's the guy whom we have recruited right now. That's not a study that was conducted on our side per se, but we plan to really expand it much further.

[David Graham, Liberal, Laurentides—Labelle, QC]

Is this consistent for all PTSDs? Does somebody who's been at war versus somebody who's working in the police get a different kind of result, or is this what it looks like?

[Dr. Zul Merali]

That's a very good question, and I'm sorry I cannot answer that because I really didn't conduct that study myself.

[David Graham, Liberal, Laurentides—Labelle, QC]

If we go further back in the process, is there any effort to do before-service brain scans? When somebody enters the military service or police service, take a brain scan so you have a baseline for when they inevitably run into trauma over the course of their careers, so that you then have that comparison. Is that kind of study happening?

[Dr. Zul Merali]

That's happening in Netherlands right now. It is starting to happen here in Canada, but we are behind in taking measures pre-deployment. There are a lot of concerns about that, because, if you see indicators of vulnerability to PTSD, does that mean that we do not deploy someone? The debate is, do you want people who are hypervigilant, ready to go, are able to grab somebody from a disastrous situation and carry them to safety, and things like that, or do we weed them out with early predictors?

It's a very interesting question of whether we can predict who's going to develop PTSD and who's not. The concern of the user community is that it will be used in a negative way, or with how it will be used. Those are the kind of debates that are ongoing right now. But I think we need to get to that point where we assess people before they go, during, and afterwards to have a much clearer idea of what is happening to the physiology and chemistry of the brain.

[David Graham, Liberal, Laurentides—Labelle, QC]

And if you identify what you are looking for, the suicidal ideation in the brain as you describe it, what can be done about it? If you say this red dot here represents a part of the brain that's affected, clearly we know that now. What can you do about it?

[Dr. Zul Merali]

Let me compare it to another condition, such as cancer. If you see a cancer and that it's responsive to a certain kinds of hormones, for example, if it's hyperactive, then what kind of treatment do we use for that particular individual? The treatment is not going to be the same, and that's exactly what we need to do for people with mental illnesses, including post-traumatic stress disorder. We need to understand the individual difference and how to treat that person rather than a category of illness. We're not there yet, but we need to get to that point of personalized intervention.

[David Graham, Liberal, Laurentides—Labelle, QC]

Thank you.

I'll go to Ms. Bradley. I have some questions for you as well.

We've heard about the whole-of-community approach. I think this is a really important step, but to tie in what I was talking about, what about a whole-of-career approach? So there's the idea of having brain scans of people in preparation before they go into battle, before they go into the service, of what they're going to be facing and how to prepare for it. In pre-treatment, are there any efforts on that side of it?

That questions open to everybody, but I'll start with Ms. Bradley.

[Louise Bradley]

The proposal that we are talking about is specific to suicide prevention. It's very specific to that, so we had not contemplated looking at.... This is something that we would like to do right across the country because, as a commission, we have to look at the suicide rates in the country as a whole. As part of the proposal that we're putting forward, we thought that we would be able to choose to include communities with a higher number of veterans in them, but this proposal is meant to be an action program at the same time as a research one, using a similar structure to one we had with homelessness, At Home/Chez Soi, in the past. It's specific to suicide reduction in specific communities.

[David Graham, Liberal, Laurentides—Labelle, QC]

Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thank you, Mr. Chair.

Thank you all very much for your presentations today. This is very helpful.

I'd like to start with you, Ms. Bradley. You talked a little bit about care for veterans. I'm wondering if you can expand on differences that you've seen between treating mental health issues within the veterans community versus the general population.

[Louise Bradley]

I'm not an expert in that area, and we haven't done specific research on that within the commission. We do know that the rates are much higher within the veterans communities, but there has been nothing specific to deal with that.

[Colin Fraser, Liberal, West Nova, NS]

I thought you made a very good point in your testimony when you said that you'd like to see more outreach to all health care service providers across Canada so that everybody is on the same page and aware of the programs that are available to reach out to veterans' communities and service personnel. How do you see that taking shape as a national outreach to these health care providers? Is it something that should be worked on with the provinces or with medical professional bodies themselves? What are your thoughts on that?

[Louise Bradley]

It's a very complex issue that you are raising. We have hopes that with the monies tied to mental health from the health accord, there would be a bringing together of some of the knowledge. What we're seeing now is that there are pockets of excellence in various provinces and territories, and yet Province A doesn't know what Province C is doing.

What we were hoping for with this funding is that there would be a small number of indicators that would be developed, so we could collect the same data in the same way in each of the provinces and territories. That is not happening right now. We would then be able to look at the issue across the country as a whole. It's very confusing when we talk to other countries. They say, “Well, this is a great program you're doing”, but it's hard to explain to them that it's really only happening in three or four different places.

It's one of the needs that we have at the commission. We have tried to close that gap with the work that's done in our knowledge exchange centre, and we've certainly made headway, but it's really only just the beginning. It's something that requires a much closer look and targeted efforts.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much.

Mr. Mantler, I believe it was you who touched on the first aid programs for veterans and their families. It seems as though we've gone through one year of 14 courses that were delivered across the country, and this year 40 are planned. It seems to be ramping up. Can you tell us preliminarily, after the first 14 courses, about some of the results and the feedback you've received? How worthwhile is this program?

[Ed Mantler]

The development phase of the mental health first aid for the veterans community and the first year of production were accompanied by an extensive evaluative research data collection component. We know early on that the user satisfaction with what they learned from those programs has been very high and very significant.

We also know that mental health first aid has many versions for various populations across the country, including seniors, youth, first nations, Inuit, etc. We know that there have now been close to 250,000 Canadians trained in mental health first aid overall. The outcomes from those many training opportunities across the country over the last six years have been consistently very good.

[Colin Fraser, Liberal, West Nova, NS]

Do you think it's important that there's outreach to all communities and there's access to this program, so it's not just in large centres, but also in more rural and remote areas? I would imagine the 14 that took place were spread across the country and now there are 40 more, so they will be going into other communities that maybe weren't selected in the first cohort.

[Ed Mantler]

The first 14 communities were ones in which there tended to be a significant veteran population, that were natural gathering communities for veterans, so many of them were tied closely to bases. Over the course of the next year, we have an opportunity to broaden the communities where the course is offered.

The vision for the future, much like all mental health first aid courses, is that be responsive to market demand. Having a network of trainers across the country gives us an opportunity to, in a flexible way, make that training available quite broadly.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much.

Do I have a little bit more time?

[The Chair, Liberal, Neil Ellis]

You have one minute.

[Colin Fraser, Liberal, West Nova, NS]

Ms. Weber, thank you very much for appearing today.

I'm wondering about standards for service dogs. My understanding is that VAC has initiated some questions about whether there should be standards for service dogs. What are your thoughts on that? How could that be developed?

[Liane Weber]

Well, service dogs are not my full zone of expertise. One of the reasons that we are focusing on therapy dogs and not service dogs is that it is a little confusing about the regulations going across....

There needs to be a standard. We are requesting on our end to have a special standard for therapy dogs. When it comes to service dogs, it's a little different because they are trained to perform tasks that are unusual dog behaviour. For example, a service dog could be trained to flick on a switch so the light turns on, or they could go into a room that is dark, check out the room, and let their new handler know that it is safe to go in.

With therapy dogs, we will not be teaching unusual dog tasks. However, each veteran who comes to us, or any individual for that matter, will be offered specific training that they will be able to perform at home if they choose to teach a specific task that otherwise would only be taught to a service dog.

It is quite confusing what is going on across Canada with regard to service dogs and the regulations. Here in British Columbia, the province has started an assessment, which I believe is absolutely fantastic, to make sure that all of these service dogs go through the right assessment and that we eliminate any fraud or any issues that can come along with not having a properly trained service dog.