Veterans Affairs Committee on March 6th, 2017

[The Chair, Liberal, Neil Ellis]

Good afternoon, everybody.

I'd like to call the meeting to order. Pursuant to Standing Order 108(2) and the motion adopted on December 29, the committee is resuming its study of mental health and suicide prevention among veterans.

For the first hour, we have Roméo Dallaire, retired lieutenant-general and senator; Scott Maxwell, from Wounded Warriors; and retired Brigadier-General Joe Sharpe.

We'll start with a 10-minute witness statement and then go into a round of questioning.

Good afternoon, gentlemen. Thanks for appearing today. The floor is yours.

[Roméo Dallaire, Founder, Roméo Dallaire Child Soldiers Initiative]

Thank you, Mr. Chair, and ladies and gentlemen, for receiving me in these opulent surroundings. I could barely find my way around the place. I'm very glad for you, in fact. It was high time that it was done. So well done, for bringing you the ability to work with a certain quality of life with your staff to achieve your missions.

I will read a short statement. I hope it's short, or I'll do as my Marine Corps friends have taught me: I'll power talk through it.

I have two colleagues here.

Joe Sharpe and I were intimately involved in the writing of the Liberal Party policy on veterans and have been engaged with veterans for over 10 years in specifics and policy, and also individual cases and the like, and 10 years before that, with the deputy minister at the time, Admiral Murray. He had an advisory committee, chaired by Dr. Neary, who wrote the book on the first Veterans Charter, dated 1943. We spent 10 years working together on that multidisciplinary team. We were also classmates from RMC—but he passed.

Scott Maxwell is the executive director of Wounded Warriors Canada. I am the patron of Wounded Warriors Canada, which, by far, to me, is the body of altruism and philanthropy that is putting so much of its capabilities into the field in the hands of those who are wounded—mostly psychologically. I speak of programs such as animal assistance programs, the equine program, and the veterans training program that we run out of Dalhousie University with my child soldiers initiative, where we train veterans to go back into the field and serve by training other armies on how to handle child soldiers and reduce casualties on the sides of both the child soldiers and us. They take a formal one-month program with us at Dalhousie. We can go into that as we go into the possibility of programs.

I'm going to use as a reference, if I may, my correspondence with the commander-in-chief—that being the Governor General—when I was a senator in the post-time, when I had a number of activities going on with him—his wife was also quite involved—in regard to care and concern for injured veterans, particularly with psychological injuries, as they are quite engaged in that side. I want to use it to give you a feel from there as we move forward.

I'll start by thanking you very much for permitting me and my colleagues to join you today on this matter of suicide prevention in the Canadian Armed Forces and amongst our veterans, both those who serve in the Canadian Forces still—and a large number do—and those who have been released and are in Canadian society. I commend your commitment to the welfare of these individuals and their families, and I am honoured to share my thoughts on how we can make more progress in finding solutions to this problem of people killing themselves because they're injured.

As I mentioned at other times, both publicly and in different forums, I had assembled over the years a team of advisers from diverse backgrounds and with deep knowledge of both the forces and Veterans Affairs. This group of advisers worked to develop policy recommendations and advocacy tools that have allowed us to maintain a well-researched and well-informed outlook on the issues facing our military—especially those who have, in fact, taken the uniform off—particularly related to operational stress injuries. I emphasize that I'm not necessarily always touching on all of mental health; I'm focusing on the operational stress injury part. That is the crux of those who are injured. That is the heart of the problem. That's the operational deficiency that we are seeing right now.

Some of those who are involved—just to get their names out there because they've been so committed—are Sergeant Tom Hoppe and Major Bruce Henwood, both retired; Dr. Victor Marshall; Mrs. Muriel Westmorland; Joe Sharpe, who is here with us; and Christian Barabé. Over the years, they have all been engaged with me in bringing forward the veterans scenario and have also helped me when I was chair of the veterans affairs subcommittee in the Senate.

Our research, thought, and work have led us to the conclusion that operational stress injuries, OSIs, in particular, can be and are too often fatal to those affected. Also, the consequences often last a lifetime for those who do not succeed in trying to kill themselves. From peer support organizations in the past, we've had statistics showing that peers have been able to prevent a suicide attempt a day, through the peer support program, let alone the more formal structures of the medical system.

Of course, this includes the devastating consequences for the families and those affected by OSIs. It is my belief that a comprehensive, whole-of-government approach that is engaged with society can bring significant solutions to this crucial problem of people destroying themselves, and bring them to meaningful progress instead, and, in the long run, give them a decent way of life.

The mental health of veterans and current members of the forces, and also with Veterans Affairs Canada, is a continuum that has been presented as a clinical matter with very little involvement of the overall command structure, that is to say, the essence of what people are used to living, their cultural framework, which is a chain of command and a very structured way of life. The clinical and therapeutic and medical dimensions have taken over the problem of OSI, but have also taken over the potential resolution of conflicts that would bring people to ultimately destroy themselves. The chain of command was left on the sidelines, so it was impossible for it to know what was going on. They would get troops coming back to their units with no information on their state of mind because of confidentiality or not being able to work around the access to information system or the individual's privacy rights in regards to the charter.

Using that to the extent of abuse has disconnected the chain of command from the injured, which is totally contrary to all the education we've received in command. I spent my life in command, from a platoon or a troop of 30, to the 1st Canadian Division of 12,000, in peace and in war. The command is like being pregnant. You are in command all the time, while you have a command function. It's day and night and then, when the baby's born, you're still there, just like in command. Whether you're in garrison or in operational theatres, you cannot divorce the chain of command from the ultimate responsibility of ensuring the well-being of the individuals and the command structure to ensure that the families are integrated within that support structure.

I repeat: the families must be integrated into that support structure. It's not about co-operating with the families or assisting the families, but about integrating them into the operational effectiveness of the forces. Why? It is because the families live the missions with us. In my case, I came back injured. I was thrown out of the forces injured. My family was injured. It wasn't the same family that I had left behind because the media make them live the missions with us.

Therefore, if you employ any of these policies that don't totally integrate families, including policies from DND or the Canadian Armed Forces, for veterans serving, veterans out of service, and through Veterans Affairs Canada, you're going to end up with some of the statistics I mentioned—though still anecdotal.

I was at the last military mental health research forum in Vancouver presenting a paper in which we argued that the families suffering from stresses and strains, families where individuals are suffering from mental health issues, and the individuals involved are not getting the support needed. We're now seeing teenagers who are pushed to the limit in these conditions of extreme stress and who are committing suicide. We have not only the individual members, but we're also now seeing family members who can't live with what they've seen, and in fact are committing suicide.

It is essential that we identify the early warning signs of psychological distress, and that we encourage members to seek help through support programs offered by the military, by Veterans Affairs Canada, by outside agencies like Wounded Warriors Canada and the veterans transition training programs we have. These programs give them gainful employment close to, as much as possible, their background. Why try to convert a person completely when you can build on a person? Why not find gainful employment in, around, surrounding, contractually or otherwise, what veterans have grown up with, what they have given their loyalty to, namely, the armed forces? The uniform is off, but we wear it underneath, and we wear it in our hearts. Why divorce them from that? Why not find programs that bring you much closer?

I'm going to curtail this because of time. My presentation is only to indicate that there are initiatives moving forward. Certainly, the January 2017 CDS strategic directive on suicide prevention has to be the best piece of work we've seen in a long time. He makes it clear that the chain of command is the essence of prevention. However, when you start reading the nuts and bolts, you will see that the medical people have put their finger into the pie and are, I would say, watering it down. What they're supposed to be doing is supporting the chain of chain of command, not creating the chain of command.

I will leave you with the following recommendations so that there is enough time to speak. My colleagues will amplify these and they are free to respond to your questions. I hope you will feel at ease with that.

First, the Canadian Armed Forces directive on suicide prevention strategy has to be funded, implemented, and validated. If necessary, go to what we used after Somalia. Create ministerial oversight committees that report to the minister. We did that for nearly three years. I was ADM of personnel at the time. For three years we had six oversight committees that reported every two months to the minister on how we were implementing this kind of stuff. There's nothing wrong with the political oversight getting closer to the actual implementation when you have a crisis like this.

As for the Veterans Affairs suicide prevention framework and strategy, I haven't seen it. I don't know if it's written. It had better be out there. It is critical, because they have veterans who are outside of the forces, and they have a whole whack of veterans who are inside the forces. That is critical, and it should be funded and implemented.

The third leg of that strategic focus is what is called the Canadian Forces-VAC joint suicide prevention strategy. That's where we want the two departments to come together. Certainly, in the DND one, that's what they articulate. It's what the CAF wants. I haven't seen that one either. That one is going to prevent people from falling through the cracks. That's going to permit the continuum. That's where the loyalty is not lost and where people will continue to commit.

That third strategy has to be out there—implemented, evaluated, but also validated, six months, eight months down the road. That validation has to be of such a nature to hold people accountable. That's why I come forward again with the recommendation that in these oversight committees by the minister there's nothing wrong with bringing that online and helping out.

I think the recognition of casualties caused by operational stress injuries has to be advanced at Veterans Affairs Canada to the level of the 158 who were killed overseas or any of our members who were killed in action. If we prove that an operational stress injury has caused the death an individual, that individual is part of the numbers. We didn't lose 158. We're up to 200-some-odd now. So why not use that number?

Imagine having somebody come back for four years and then losing them. After four years of striving and working hard to save them, you lose them, and you get nothing of any great significance. You don't even get recognition, apart from a medal.

Now that you've moved Veterans Affairs Canada into the military family resource centres, move the families and help the families through those centres too. Reinforce that capability. It's used to taking care of families. Let them take on that angle for both Veterans Affairs Canada and for CAF, because they're already doing it.

Finally, give them gainful employment as close as you can to their history, to their loyalty to the military or military milieu. Why try to change them at a time when they're already in crisis?

Thank you very much.

[The Chair, Liberal, Neil Ellis]

Thank you.

We'll start off the first round of questioning.

We'll start with Mr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

General, thank you very much for your service and your commitment to this very important issue.

I'd like you to expand a little bit more, if you can, on the chain of command. Can you give us some suggestions as to how we can juggle the challenge the chain of command has? Really, your conversation today is probably the first time we've had someone here at our committee speak about the conflicts between the chain of command and mental illness, the actual clinical presentation. Can you give us some ideas on how we can bring these two together?

[Roméo Dallaire]

I'll let my colleagues also intervene.

The immediate response is that the chain of command must be informed. As regards confidentiality, there's no negating that, but you can't let people be handed over to another body, even to the joint support units they were moved to, or sometimes moved back to the unit from. The unit commanding officer, who's responsible for the life of those individuals in the field, is also responsible for command back home. You can't just throw them back without giving them information. They have no idea how to handle them, because they don't know the scale of the injury the individual has.

We all have doctors in our regiments, in our units. Unless there's a means by which those doctors can provide that input, and by which that input can be moved down to the lowest level without offending, but on the contrary, reinforcing, the individual's return, you just have a bunch of walking wounded in a unit. People don't know what the hell to do with them. That isolates them more, and it pushes them more toward wanting to, maybe, end it.

[A voice]

I agree.

[Roméo Dallaire]

Joe?

[Brigadier-General, Retired) Joe Sharpe (As an Individual]

I would repeat the point that General Dallaire made earlier, that this is a leadership issue, not a medical issue. I think that is a refrain I would come back to over and over again.

Stovepipes, if I can use that term, create barriers to care. That is a major concern here. To use the 2015 numbers, 13 of the 14 suicides in 2015 were by people who had sought care within a year prior to committing suicide, 10 of them within 30 days of committing suicide.

There's a leadership message here. There was an opportunity to intervene, and I think it's an information flow that creates that barrier. Once a member transitions into Veterans Affairs, that's another stovepipe. It's another barrier. It's another obstacle to getting to the bottom of this.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

We're hearing an awful lot about barriers, and that's the biggest thing. There are a number of barriers. Here is another one that we see, or that I'm seeing at least at this point, with the chain of command. As a clinician, myself, how do I protect my Hippocratic oath in dealing with the chain of command? So I appreciate your comments.

General Dallaire, you very briefly touched on the issue of child soldiers. Obviously, that's an important issue. We were both at the CIMVHR conference together. I came away from that conference with a statement that resonates with me to this day. It's basically that what happens to soldiers oftentimes is a violent contradiction of moral expectations. As we deal with the issue of child soldiers, which potentially we could be stepping into again, we realize it's a huge conflict for a lot of our soldiers.

I'm wondering if you could comment on that. I know there's a strategy that's been presented—

[Roméo Dallaire]

Yes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You've been involved with that.

[Roméo Dallaire]

We've been working for two years with the Canadian Army, in particular, and with NATO. We've been in Africa getting research because my institute, the Roméo Dallaire Child Soldiers Initiative, based at Dalhousie University, is field focused. We train armies and police forces in countries to send them—military and police forces—into conflict zones.

We were able to influence the content of the Canadian Army by being the first army in the world to formally put into its new doctrine.... Doctrine is a reference from which you deduce tactics, organization, equipment, and the training you need to do the job, the mission. By creating that doctrine, it is now leading the world in formally recognizing it. We are going start implementing the training of trainers to then bring that forward.

This doctrine is particularly important because there isn't one conflict in the world that is not using children as the primary weapon system. The children may be nine years old, 10, 12, 13, 14, or 15. Every one of those conflicts creates not only an ethical but a moral dilemma for the members. That's what blows us further....

We always thought it was the ambush or the accident that was the hardest point. The hardest one is the moral dilemma and the moral destruction of having to face children.

A sergeant came to me in Quebec City, where I live. He looked good and spoke of five missions, and things were going well. I asked him what his job in the battalion was, and he broke down right there in the middle of the shopping centre. He couldn't talk. He stammered, and he was weak-kneed and crying. I took him aside and so on, and he said, “I was in the recce platoon, and my job was to make sure the suicide bombers didn't get to the convoys”. He said, “You know, I've been back for four years, and I still haven't hugged my children”.

We are taking significant casualties because we don't know how to handle child soldiers. This doctrine will move us a long way that way, and we'll be part of the training program.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Lockhart, go ahead.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you, gentlemen.

Thank you, General, for your service and for being here today to answer our questions.

I want to talk about a quote that I read from your book, Waiting for First Light. You said:

No one recognized what I was doing at the time. Not even me. Nobody told me I was injured. I didn't think I was injured, though I felt the weight of having had to ask to be relieved of command. Outwardly, I was still committed, determined, stable. Inwardly, the stresses I was imposing on myself were beating me down, piling up on the stresses at work.

Is there something that Veterans Affairs can do to intervene at this point in a soldier's life and a soldier's mental state that could prevent or stop the progression from this state to suicide?

[Roméo Dallaire]

With mental health—and particularly the operational stress injury side of it—you are facing an injury that gets worse with time. If you lose an arm, you know that you've lost it, so the aim is to try to build a prosthesis that will be as effective as possible. If you don't intervene with the same sense of urgency an operational stress injury by recognizing it first and then providing for it, it gets deeper and more difficult to get at and to resolve.

It took four years before I crashed. I lost one of my officers 15 years afterwards and having been treated. So there is a vacuum of how to get at them so that they don't continue to walk around as if they're not injured, without there being a stigma there.

We thought we had broken the stigma by having a veteran armed forces—and we did until not so long ago, but now have a lot more non-veterans in there. We're living what we lived in the fifties. In the fifties we had a lot of veterans, but we had a lot of non-veterans, and there was friction between the two, and they would say, “Oh, I wouldn't be injured like that”. We didn't recognize operational stress injury, so those guys simply drank themselves to death or got out. They were the rubbydubs who died on the streets because we had abandoned them. The exception was the Legion, which did help a lot, but there was also a lot of alcoholism.

We lack the ability to discern them early and to then follow it through in a progressive way.

The first time I went out for treatment, I was given eight sessions. I've been in treatment for 14 years. I still have a psychiatrist and a psychologist. I still take nine pills a day. It keeps me like this.

There are moments, though, like last week. My book was launched in French, and it was catastrophic. Writing those books is like going back to hell. There is no real value to me, but I hope it will be useful to others.

You have to find a way because you need to prevent the injury from getting worse—not just recognizing it, but preventing it from getting worse. Unless you get in there early, it's going to get worse.

[Scott Maxwell, As an Individual]

I think there are two things or two competing problems we see at Wounded Warriors Canada. On the one hand, you have the frustration when you're talking to someone who has graduated from one of our programs and you talk to them about their injury.... Here, I just want to add to the general's comments that the vast majority of injuries—when they're comfortable to tell us when they occurred in their mind—happened through an interaction with children in some way, shape, or form.

Second, it commonly took them eight to 10 years after that injury, or the action that caused the injury, before they sought or receive the help they deserved. You can imagine a life like that, the impact on the family of those eight to 10 years before they attempted to deal with their injury.

On the other side of that, a further problem we see after we write about their need to come to get help, to self-identify, to reach out peer to peer, is that because it's a much more commonly understood topic to be discussed and more people are more comfortable coming to get help to address it, we are receiving more and more people seeking help. The problem now is if they do come forward, programs like ours now have wait lists of up to two years. We have a severe access problem in Canada. That is one thing and it's very nice and all well and good if they come forward to seek help, but when they don't get it, you can imagine what that can do to their mental state and overall health care and the impact on their families.

There's a lot at play here and it's extremely serious.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you.

I think that pretty much is my time, but that was great. It was wonderful.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen.

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

Thank you, Mr. Chair.

Thank you very much for being here. We appreciate your expertise and candour, because this is very important.

We need to get to the bottom of this. We have heard so much and got so much information from veterans that is contradicted by experts or people from VAC or DND, it's frustrating and renders our ability to do the right thing questionable. I want to get down to some brass tacks.

I was with veterans on the west coast over the weekend. They told me that of course they're masking and denying their injury because to admit it means that they're out, that they will be on the outside of a brotherhood or sisterhood, a family that they need to stay connected with.

They also told me that members within the Canadian Forces are suicidal too. It's not just when they're thrown out. They're suicidal too, but all of that information is being managed and they're transitioned out so that if they are going to commit suicide, they're not in the Canadian Forces. They're on the outside and DND doesn't have to account for those deaths.

All of this is frustrating. I'm sure there are various opinions on this, but the point is that the trust has been broken. These were angry veterans and they talked about the triggers, the mountain of paperwork, the fact that they were financially insecure. They left without pensions or financial supports and they didn't know what to do and they felt that the only way out was to end it all, that they were of no use to their families, and they were either hiding in somebody's basement or they were lashing out.

What do we do? It's a catch-22. How do we re-engage those veterans? How do we re-establish that trust?

General, you talked about this study. Is that study available to us, the CDS study, the strategy you talked about? Is that available to us?

You also talked about things that should be happening with mental health and you don't know where they are. All of this combines to make us wonder what is going on, where are the support services, and when can we expect that there will be a genuine response that meets the needs of these veterans.

I know that that's a lot and there's not really a question in there, but please respond.

[Roméo Dallaire]

Brevity is not my strength either, so don't worry about it.

Let me put it this way first. We have articulated after years of working on it that unless there is an atmosphere within Canada and the Canadian people, and within government circles—and I speak of parliamentary circles too, which seems to be there, but also within the bureaucracy, which doesn't necessarily seem to be there—such that you feel a covenant, not a social contract because that means you've negotiated stuff, just like the current Veterans Charter….

I'm the one who in a day and a half pushed it through the Senate and I've regretted it ever since, because it didn't reflect the 10 years of work we had done before. It was a bureaucratic piece to try to save cash and it hamstrung the minister with all kinds of regulations. That is a new phenomenon in legislation. Before there weren't many, but now they're throwing a whole whack of them with legislation.

That new Veterans Charter doesn't need a new one. It needs a significant reform. In there you will find in the reform a lot of the answers these guys and girls need in order to get the appropriate responses and a timely response. Until you hit that target deliberately, you're going to have a problem.

The only way you can convince people to go that far is if you actually believe that there's a cradle-to-grave responsibility, not to the age of 65, not with a reduced way of life, but an actual covenant that they have committed themselves to unlimited liability, recognizing that they've come back injured, that their families are being affected, and that some of them are dead and their families are obviously affected, and then you've got them for life.

If you don't sell that, then you will not gain their trust. I'll tell you, it started right rotten with the Gulf War syndrome. We did everything to prevent them from getting anything. Every lawyer in town, every medical staffer, gave us arguments why we couldn't take care of them. That undermines the operational commitment of individuals. Do I want to get injured? It undermines also the families, and they're the ones who are creating a vacuum of experienced people because they're pulling their spouses out.

[The Chair, Liberal, Neil Ellis]

Mr. Eyolfson.

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

I'm sorry, Ms. Mathyssen.

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

No, no. Thank you. I'll come back.

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

Thank you, Mr. Chair.

Thank you so much for your service and coming here today and talking about suicide. It's an important issue. We have something in common with that. I practised medicine for 20 years and it is a problem in my profession. My medical school had three suicides in a 15-month period while I was a resident. I'm sensitive to professions where this happens.

One of the other things we have in common is that there's a stigma involved in seeking mental help. There's a place in hell for the person who said, “Physician heal thyself”. A lot of damage has been done by that attitude. Soldiers probably deal with that as well.

We do know that there's always a hesitancy to step forward, a stigma of being seen as weak, of not having what it takes. Do you think the stigma of PTSD has been reduced in the military since when you were serving?

[Roméo Dallaire]

I'm going to let Joe speak more about that, but I wish only to indicate to you that I consider myself in—because I have a psychiatrist and a psychologist. I'm getting care and I have some peer support. I don't hide it. If you were a doctor who took care of me because I had cancer, I'd talk about you, and I'd say he's a dummy, or he's a very good doctor, I like him, and so on, but we'd talk about those doctors. Why don't we talk about our psychiatrists and our psychologists? They used to in some of the films of the early seventies.

We've got to make that just as honourable as any other injury, and making it honourable will destroy that stigma. We are now seeing friction on the stigma coming back, which we thought we had pretty well with a cultural change, which Joe speaks of, by the non-veterans who feel that, with these very Darwinian, very visible type of people the military are, or any first responders, anybody in uniform—police, fireman, and so on—there's this inability to accept what you can't see. If you can't see it, you can't accept why they can't be 100%.

That, you've got to educate and train.