Veterans Affairs Committee on March 6th, 2017

[Some hon. members]

Oh, oh!

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

: You both said something that caught my ears, and I've got a very short period of time because I'm going to share my time with Ms. Wagantall.

Ms. Rioux, you commented on the need to avoid glorifying death by suicide. Can you expand on that? What do you mean by that?

[Catherine Rioux]

By using suicide to put an end to their suffering, a military member may receive honours, attention and recognition. That is what I call suicide glorification. We can glorify the deceased individual or pay tribute to them, but it is important to separate that from their act of suicide. A military member must not think that committing suicide will give them more honour than another soldier who died of a heart attack or another cause would get. Contagion must be avoided, and people must not end up thinking that it's a way to get recognition from the Canadian Forces and society.

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

Thank you.

There's that stigma. There's that challenge, that disconnect with the stigma for somebody who maybe has attempted to take their life because of depression, or situations, or whatever it might be, which often gets labelled. Someone says, okay, you're not worthy of anything. I'm trying to wrestle that with your comment about glorifying it and whether someone would actually look at glorifying that, but I appreciate your comments.

Mademoiselle Basque, you talked about suicide prevention training. How extensive is it in your organization?

[Kim Basque]

It is an extremely important aspect of our organization. The AQPS designs training products with major partners such as Quebec's Department of Health and Social Services, as well as with other organizations with data expertise. We have to be inspired and learn from the research to give our responders and fellow Canadians an opportunity to develop tangible skills that will enable them to play a role in suicide prevention.

The AQPS currently has about 20 different training products. We have trained more than 19,000 responders to use best practices and clinical tools that help them recognize proximal factors of suicide. There are 75 factors associated with suicide, and some carry more weight than others. Some factors are observed very closely when action is taken.

Thanks to the expertise we have acquired and the tools at our disposal, we are improving our responses to ambivalent suicidal individuals to help them reconnect with their reasons for living.

The sentinel training is developed based on a similar model, while of course respecting the role and responsibilities of volunteers in their community. That training will give those people the tools they need to determine if there is suicidal ideation, be aware of resources and guide the suicidal individual toward those resources, as that is often a difficult step for them.

Our training products are complementary and aim to strengthen the safety net around suicidal individuals.

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

Thank you very much.

I hope I've left enough time for Ms. Wagantall to ask questions.

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

As you know, we recently brought into law in Canada assisted suicide and assisted dying legislation. Since then, 800 individual Canadians have chosen that route. With its coming into play, I was very concerned about our veterans, our soldiers, who feel that life isn't worth living anymore and who might see that as an affirmation. In the work that you do, are you seeing a difference at all in response to this?

[Kim Basque]

It is too early to take stock of the situation or obtain relevant documentation on medical assistance in dying.

That said, we are extremely worried about this. When that legislation was developed, a few years ago now, we participated in the consultations of the parliamentary committee of the Quebec National Assembly to share our concerns with regard to a potential shift in the social acceptability of suicide.

A person at the end of their life feels, rightly or wrongly, that their life is no longer worth living; that is their decision. That is why they want to request medical assistance in dying, resulting in their death. Even in a medical context, we understand why people would want to use that measure.

Our concerns had to do with a way to provide a vulnerable individual who is not doing well—who feels that their suffering is intolerable, who is depressive and suicidal—the same care they should have the right to, without legitimizing a request for medical assistance in dying in a context where it would legally not apply.

We are extremely worried by that. At this time, it is too early to gauge the concrete and documented effects of medical assistance in dying.

[The Chair, Liberal, Neil Ellis]

Thank you for your answer.

Mr. Graham.

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

Thank you for your comments.

You spoke a lot about training. In the veterans context, I would like to know whom we should train.

[Kim Basque]

The health care teams should receive specialized training to be able to intervene in a complete way and properly receive the veterans, taking into account the fact that the request for help from military men does not always present in the same way. Those teams should also use precise clinical tools, as well as ensure follow-up and access to services and resources.

The networks of sentinels we referred to could also be proposed. These sentinels have to be volunteer adults who are already in a role where they have the trust of the person, who can open up and agree to talk about his troubles. The sentinels cannot be members of the health care team. They really have to be people who are involved with the veterans and can have access to them, even if they are not specialists.

If I may, I'd like to make a parallel between veterans and the agricultural milieu. We have created massive sentinel networks there, and we even set up training specifically for the agricultural environment. Agricultural producers are often isolated, and they aren't necessarily part of a network. That said, there are still people who gravitate around them and see them, because they provide services. Those are the people who are trained as sentinels to reach out to farmers.

You could think of setting up a similar system for veterans, that is to say assess where they go, who they see, who they are in contact with regularly in their daily lives. Those people can become sentinels, if they want to, of course. Indeed, that cannot be an obligation. The training of intervenors is central to all of this. The sentinel must himself have access to support and be able to direct the suicidal person to an intervenor 24/7.

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

So we could train family members and other military members.

[Kim Basque]

Yes, if the military person is not suicidal himself and if the family itself does not need care and support.

Those close to suicidal individuals have other needs and have to obtain care. They cannot act as sentinels in these extremely difficult moments in their family life. They have to take care of themselves and the other members of the family and know how to support the spouse who is not doing well. We try to avoid training loved ones, especially when they are going through difficult times. Of course at other times, that is possible.

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

You also spoke about avoiding the glorification of the death by suicide of military members.

Earlier we spoke with General Dallaire about the need to include war-related suicides in war deaths.

How can we reconcile those two approaches?

[Catherine Rioux]

Would you repeat the question? I want to make sure I understood.

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

We want to avoid glorifying suicide of course, but we also want to recognize veterans who committed suicide because of mental injuries they suffered through their participation in war. We want to acknowledge them, but not glorify suicide. How can we align that?

[Catherine Rioux]

Of course they must be recognized as victims who fought. There is indeed a certain risk involved. Certain suicide prevention workers are worried about that parallel; it is a complex question.

We recommend that you take some time and speak with experts on this issue. There are several in Quebec, such as researchers like Brian Mishara. Some intervenors who work in the army are also specialized in this.

We don't have all the answers, but we think it is important to look at this question and find good potential solutions in order to avoid glorification.

[Kim Basque]

A nuance needs to be made. Of course you have to collect useful information on the suicide of soldiers and veterans, in order to understand what could have been done to prevent them, and put in place proper services. However, in paying tribute to a person who committed suicide, we must not send the message that we are also paying tribute to the way in which he or she ended his suffering. Nor should we conceal the fact that services needed to be offered to that person, and that a security net needed to be placed around him in order to prevent his act.

That concern exists everywhere. Following a suicide, we talk about post-intervention. That consists in asking ourselves what can be done for the family members and friends, peers and environments who have experienced the loss of one of their members. We are always concerned by the way in which people who have lost a loved one wish to pay tribute to them. We don't want this to send a message of glorification, and we don't want the tribute to be disproportionate. We worry about the risks involved in emphasizing how the person died, that is to say the fact that they committed suicide.

[Roméo Dallaire]

I was just asked to reinforce that, Mr. Chair.

[The Chair, Liberal, Neil Ellis]

You'll have to make it very quick. We are running on gas here.

[Roméo Dallaire]

Before they commit suicide, the option is to have a system of recognizing them as being injured honourably. If you have a solid way of showing that they've been honourably injured, just like we take care of the guy or girl who has lost an arm or a leg, and they feel that they've been honourably recognized in that way, then you have an equilibrium with those who simply have gone the other route. If you only try to recognize them because they've committed suicide, I agree entirely with them. The onus is on the prior recognition of an honourable injury that they've received and that we've treated them honourably and that their regiments and so on have done the same. Then you have established a balance.

[The Chair, Liberal, Neil Ellis]

Thank you.

Go ahead, Ms. Mathyssen.

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

Thank you.

I'm glad that you made that point, General Dallaire, because PTSD is an injury that has debilitated a veteran in some way.

You talked about people in combat suffering this injury, but we know that PTSD can strike those who are not in a combat role. I'm thinking particularly of a statistic that we received from StatsCan's 2016 survey that found that more than a quarter of all women in the military reported sexual assault at least once during their careers.

Have you looked into military sexual assault—it's not just women, but men too—as an underlying issue with regard to PTSD during combat or non-combat situations.

[Kim Basque]

To my knowledge, the cause and effect link has not been well established, as is the case for other types of difficulties. I certainly do not want to minimize the effects of sexual assaults, that are horrific both for women and for men, but we can make someone fragile who is not, and make someone who is in distress even more fragile.

Suicide is complex. The factors that make people vulnerable to suicide are also complex. There is no single cause for suicide. I don't know if there are specific data showing a link between sexual assault and the suicide of military people.

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

Okay, thank you.

I wonder if mental health workers should play a more central role during the transition of a veteran. Would a stronger presence of mental health workers make that transition easier, underscore the value of the veteran, and provide recognition that their mental problems are understood by DND and VAC and that there is compassion?