Veterans Affairs Committee on March 6th, 2017

[Scott Maxwell]

It really is. One of the things in talking about this—and he also references it—is that it's not necessarily a cost change. It's more of a process change. I think that's accurate. If you're going to have the two departments—if it's not going to go the way the general just suggested, despite the fact that maybe it should go that way—we ought to ensure that when forces members are leaving, when they are releasing from one department to the next, that everything we can possibly prepare in advance is done. We ought to ensure that the transition is as smooth and soft as possible, because we know in working with this population that it doesn't take much for them to stop doing things that are going to be beneficial for their well-being, to shut down, and to isolate themselves from everything, including their own well-being.

We see it and hear it far too much. We're an organization that looks at and identifies gaps and tries to fill them. One of the biggest gaps we see continuously is the release gap, the time between departments, where they lose their identity. Their identity is in constant struggle, and they just feel that they have to retell their story too many times to too many people who simply do not care enough to give them the service support and the process support that they require to help them deal with all the questions they're receiving at home from their families, like “what's next for you and us and our life?”

It's serious, and all I can say in short is: adopt the DND ombudsman's recommendations. They do represent low-hanging fruit, but I think it's a very important basis from which to start.

[BGen Joe Sharpe]

There are a couple of points I would make very quickly. They're very similar to Scott's.

Close the gap. It's a big deal. We've got to bring these two departments closer together, and I think we've got to stop removing the membership from the individual who is leaving. In other words, once you're a member of the Canadian Armed Forces, you remain a member of the Canadian Armed Forces. What we do now is take the cards and cut them up, and you're on your own. You're a different thing.

We've got to remove that transition shock of being rejected from the family, if I can use that term.

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

Right.

[BGen Joe Sharpe]

Secondly, we have to reduce the bureaucracy, the complication of that process of transitioning. We're not going to another country; we're staying in Canada. We're simply transitioning to another government department, but the horrendous bureaucracy that surrounds that transition process is mind boggling—if you're healthy. If you're ill and injured, it's a barrier that's almost insurmountable.

Lastly, I would say remove all the barriers to that transition. Seriously study what constitutes barriers to the member and to the member's family, and target those barriers and get rid of them. We don't need the complication that we have now.

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

General, the last word is to you.

[Roméo Dallaire]

Get out of the weeds and take a strategic perspective of it, meaning that if we inculcate in these people, from the day they enter, a sense of loyalty to their service.... My Dad told me I entered a service. He said, “Don't expect anybody to say thank you. Expect an interesting career. You'll never be a millionaire.” And in those days, he said, “Change your name to Dallard, because with Dallaire, you'll go nowhere.” But anyway, that's changed.

Take the high road of remembering that loyalty does not disconnect because of the extraordinary experiences we live, and our interwoven lives; it's there forever. That's the covenant, to serve. And so if it is a covenant, then get rid of these two ways of handling the same problem. I was a veteran serving. Then I was a veteran non-serving, and I went into a whole different set of circumstances—I was not needed.

Part of the strategic perspective is looking at two departments with different regulations for helping the same individual during the same lifespan, or nearly the same.

Secondly, don't build a new charter, but as I've often said in-house, build one based on the covenant of a reformed charter. Get rid of so many of the stupid rules.

And yes, it's going to cost you more. Well, look at the billions we spend in training these people; the billions we spend in equipping them, giving them the ammunition, the food, the medical supplies; the billions we use in getting them into the theatre of operations and doing everything to reduce casualties and win the war, which we do in humongous amounts of money; and then the billions we spend in rebuilding and replacing the equipment and restocking ourselves; and then look at the amount of money we are actually spending on the human beings that have gone through it. It is the most gross disconnect that you can imagine.

Veterans Affairs at $3 billion is inappropriate. It is absolutely inappropriate compared to the scale of the commitment we're putting into every other dimension except the actual human being.

That is the strategic position that should be taken.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen, for three minutes.

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

Thank you.

I need so much more, but I'm going to—

[Roméo Dallaire]

So do we.

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

I want to go back and underscore everything you've said, because that's exactly what we heard.

This is for you, Scott, and you, General Dallaire. You said that you were in this horrific situation, and you came back to this superficial life where there was no understanding of your experience. How do we change that? How do we make sure that when that member comes back, there is recognition of that experience and what happened out there in that deployment?

[Roméo Dallaire]

The crux of that, particularly with reservists, who are all over the countryside and often abandoned.... Remember, this only gets more complicated when you're talking about reservists. It shouldn't be, but it is.

I think the crux is linking them to family. That's your anchor.

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

Okay.

[Roméo Dallaire]

For a reservist who's single, it would be his parents. They're part of the forces. And if he's married, it's his intimate family or close family and so on, his children. Bring the human side back to these individuals so they can build on that, and then work from there. We've lost a lot of people because they lost their families and there was nothing left. It was not just losing a job. They lost their families because of that, and they killed themselves because of that.

Try to keep that fundamental element of our society with them, and help them go through the years of difficulty of living with a person like that.

It's based on family, and the tool to make the family available is the family support centres. There is no better expertise than them.

[Scott Maxwell]

The one thing that General Dallaire has often talked about in relation to our work is to ensure that they never have to fight again. That is such a powerful line. If they feel as though they are fighting again when they come home in order to access everything that is available to them and their families, it's a huge problem.

When we talk about removing that feeling and how you do that, well, how about starting by making sure they don't have to fight again for everything they are entitled to upon returning from deployment in service to Canada?

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

Okay.

You said something very important, that they tried to save the cash. I have that feeling over and over again, whether it is with the new Veterans Charter, with mefloquine, with the Gulf War syndrome.

This committee some years ago did a study on Gulf War syndrome, and we had mountains of evidence that it was all in their minds, that it was not real, and yet we had veterans coming in without hair, with very clearly disoriented perspectives.

[Roméo Dallaire]

We could have given them $70,000, and add to that the fact that we recognize it's an injury. Even if we can't figure out all the legality of it, and even if some of them are going to rip us off, who gives a damn?

What it would have changed would have been the whole attitude that the troops feel regarding coming back injured. If you're undermining their getting injured, you're going to undermine their operational effectiveness and their taking the appropriate risks, and you're undermining the ability of families to handle them when they do come back.

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

It's the same feeling with mefloquine.

I asked directly if troops were advised, if they were monitored, and if anyone took care to know what the effects of these drugs were, and the answer was no. I asked if there were any repercussions for someone saying they choose not to take this drug, and it was, “Oh, no, it comes through the chain of command.”

[Roméo Dallaire]

Well, the chain of command will charge you because you're doing self-inflicted wounds because you're going against medical advice that the chain of command has accepted.

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

Even though they were guinea pigs.

[The Chair, Liberal, Neil Ellis]

That ends our time for testimony today by this panel.

We will take a short break.

On behalf of the committee, I'd like to thank all three of you for your service, for what you have done for our men and women who have served.

We'll have a two-minute break and we'll come back to the second panel.

Thank you.

[The Chair, Liberal, Neil Ellis]

I call the meeting back to order.

In the second hour we're going to have to condense a bit of time on this.

We have, from the Quebec association for suicide prevention, Kim Basque, training coordinator; and Catherine Rioux, communications coordinator.

We'll start with 10 minutes of witness testimony.

Roméo Dallaire is going to stay here, probably not to answer questions. He just wants to see how the committee works together.

We'll start with our new panel.

Thank you. The floor is yours.

[Catherine Rioux, Communications Coordinator, Association québécoise de prévention du suicide]

Mr. Chair, members of the committee and Mr. Dallaire, we want to begin by thanking you for inviting us to participate in this consultation. We know that the Canadian Armed Forces and Veterans Affairs Canada are already working on mental health and suicide prevention. We thank you for your interest in going even further.

For 30 years, our association has been advocating for suicide prevention in Quebec. It brings together researchers, responders, clinicians, survivors of suicide loss, as well as private, public and community organizations.

Our main areas of activity are education, citizen engagement, and training for responders and citizens. As you can see, our association has no military expertise. Our appearance before the committee today stems from our experience in advising various community stakeholders and developing prevention strategies for a wide range of settings. We did that recently for agricultural producers and for detention centres.

How do we reduce the number of suicides among our veterans? What we all know is that there is no simple answer and that a multi-pronged approach is required. The few approaches that we could propose during this hour and that we feel are essential have to do with education, training and the services provided.

I will begin with education, or cultural and mentality changes.

Thanks to repeated awareness-raising campaigns, mentalities have started to change on the issues of suicide and mental health. Taboos are less entrenched and are starting to fade. Unlike 10, 15 or 20 years ago, suicide is no longer seen—or is less so—as inevitable and as an individual problem. People are more aware that it is a collective problem and that prevention is possible.

People talk more about their mental health issues and asking for help is more valued. We have come a long way in this area, but there is still much work to be done. That is why we are here today.

We have a few suggestions to make with regard to education. We are convinced that it should begin with proactive education of active armed forces members, especially those who belong to units at higher risk of suicide, such as combat trades.

There are all sorts of initiatives. For instance, we may be talking about strengthening the cohesion around an individual who is experiencing difficulties or is separated from their unit for health reasons. There are messages reiterating that taking care of our mental health is just as important as taking care of our physical health. There are also campaigns promoting existing help resources.

We must also work on reducing the social acceptability of suicide. That acceptability appears to be stronger among men who conform to the traditional male role. Certain therapeutic approaches are aimed at reducing that acceptability and manage to make suicide less acceptable and to highlight the fact that, by finding other ways to put an end to their suffering, they can become models for their children and models of resiliency for their community.

We firmly believe that suicide must not be an option, on an individual or a collective level. That is why we support messages to that effect inviting people to find other ways to deal with their distress and suffering.

We also believe that, as part of education, society should avoid glorifying individuals who have died by suicide, since that involves a risk of contagion. To avoid that, the media must be educated. I know that is being done already, but the message must constantly be repeated, as newsrooms and journalists are always changing.

We must also educate people in charge of ceremonies when a death by suicide occurs, as well as grieving families. That is a very delicate thing to do, but we must pay attention to that if we want to save the lives of suffering veterans. Some practices can have consequences, such as the erection of monuments honouring military members who died by suicide. We see them as a real risk to veterans who are suffering, who are vulnerable to suicide and who have lost a tremendous amount of recognition and value. Those veterans could see suicide as a way to regain some honour and recognition. Let us be clear: appropriate funeral services must be provided for military members who have taken their lives, just like for military members who died of other causes, but attention must be paid to the potential glorification and contagion aspect.

[Kim Basque, Training Coordinator, Association québécoise de prévention du suicide]

To properly evaluate the services and training to be provided, we have to understand the suicidal individual's state of mind.

All suicidal individuals, be they military members or not, believe that they are worthless, that their situation will never change and that no one can help them. In that context, it becomes extremely difficult to seek help, to find it and to take a step toward a resource. It is even more difficult for men who conform to the traditional male role, where physical strength, autonomy, independence and solving one's own problems are valued. For someone who is going through a difficult time in their life when they think that they are worthless, that no one can help them and that the situation will never change, all those obstacles make it extremely difficult and painful to seek help.

However, in spite of their suffering, the individual will always feel ambivalent. This means that a part of them wants to stop suffering, and that is why they think about ending their life, but there is always a part of them that wants to live. That is the part that must be recognized by the individual in distress, and it is the responders' and professionals' job to help that part grow. Every time a suicidal person asks for help and shows their distress, the part that wants to live is expressing itself and continuing to hope.

As for many veterans—who are generally men—the characteristics of their way to seek help must be taken into consideration. That is true for suicide in general, and it is also true in the armed forces. A call for help will not manifest in the same way, and the way services are provided to them must also be adapted.

Research shows that, when a man conforms to the traditional male role, he is five times more likely to attempt suicide than a member of the general population. In the armed forces, a medical release is a failure of the system, but it is also a failure for the man who finds himself in a vulnerable situation. As that perception is generalized within himself and within his unit, he feels shame and has difficulty seeking help, as we were saying. Therefore, going from active military service to civilian life and becoming a veteran is a critical moment when the vulnerable soldier loses the strong and unified network with which he identified and participated in. So that will be an extremely difficult moment that must be anticipated and monitored, and that is why this consultation is important.

As you know, many services are provided by Veterans Affairs Canada. However, is sufficient training provided for the professionals who work in suicide prevention, the responders to whom our veterans can turn? Are they able to recognize signs of distress and act quickly?

A training initiative for Quebec citizens has a proven track record. “Agir en sentinelle pour la prévention du suicide”—acting as sentinels to prevent suicide—is a training initiative that is intended not for professionals but for anyone who wants to play a role in their community, in their spare time, with their work colleagues and their peers. It enables people to be proactive, identify signs of distress, refer the individual to help resources and go with them. That training works. It is effective and has already become entrenched in some military communities. It promotes timely identification and proactiveness.

In civil society as in specific communities, those sentinels must be able to rely on a designated responder. They must be supported in order to play their role and then be able to quickly help the suicidal individual connect with a responder who will provide a full intervention and decide what steps should be taken next.

Suicide prevention training is essential for responders and mental health professionals, as well as for physicians who work with military members and veterans. It should not be taken for granted that a physician, a nurse or a psychologist has received specialized training in suicide prevention. However, that type of training does exist, and it works.

The Quebec male suicide rate decreased significantly in the 2000s specifically thanks to a national strategy with training at its core. So we suggest that you make training a cornerstone of the next strategy for veterans.

Furthermore, we want to draw your attention to three major elements to consider with regard to the current services provided or with regard to what you could implement. General Dallaire referred to this earlier. I am talking about the importance of streamlining the services available to our active military members and veterans. That transition must go as smoothly as possible, so that, ultimately, the suicidal individual or military member who needs services, having successfully asked for help and found someone to help them and guide them in that endeavour, does not have to change responders or treatment teams and does not have to repeat their story, either before or after a suicide attempt.

To avoid that disconnect, we suggest that you consider a consolidation of Canadian Forces operational stress injury treatment centres and veterans centres, so that the treatment team would be the same. The therapeutic alliance is important. Veterans sometimes even go back to the same team and health professionals they dealt with when they were in active service.

We also talked about social support. General Dallaire mentioned that. We are talking about social support from families and peers, but also about support from the unit, as well as gathering around the forces and active military members. That support must be an integral part of care and of what professionals and responders propose to military members.

Men mainly turn to their spouse—sometimes exclusively—when they need emotional support. A separation occasionally occurs when they are not doing well. There may be additional problems, including mental health issues, alcoholism and substance abuse. All that puts considerable pressure on loved ones. That is why it is so important to take into account this reality in order to help military members and veterans recover.

The Canadian Armed Forces are a large and strong family. Each member can count on the others for their survival. The idea is to make sure that this strength and mutual support continue after release, whether that release has to do with medical issues or not.

In addition, we make recommendations when it comes to web-based prevention and online responses. Distress is increasingly manifesting on various platforms. People share their suicidal ideas and their distress on the web. That is especially true in the case of young people and isolated individuals, but that behaviour is becoming more prevalent among a variety of individuals. We feel that suicide prevention strategies must now take into account this reality by including a web component. That would enable people to share prevention messages, identify cases, be proactive and propose full response services online.

In closing, I want to reiterate the required elements of an effective suicide prevention strategy. First, all the stakeholders are concerned. Second, managers at various levels of the chain of command must undergo training, uphold the principle and demonstrate leadership. Third, professionals and responders must be provided with specific suicide prevention training. Fourth, the creation of sentinel networks must be supported. Fifth, strong and widespread social support must be established. Sixth, people must be provided with better education on mental health issues and be better informed on the help that may be provided. Calls for help must be encouraged to ultimately change cultures and mentalities. It is also important to pay attention to the messages and ceremonies, so that they would not increase the social acceptability of suicide. Of course, adequate funding is required to implement the proposed measures. Finally, accessible care adapted to the clientele for which it is intended is obviously required.

Thank you very much.

[The Chair, Liberal, Neil Ellis]

Thank you.

We'll start our first round, and we're going to have to shorten it to five minutes each. I'm sorry about that.

We'll start with Mr. Kitchen.

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

Thank you, Mr. Chair.

Thank you very much, Ms. Rioux and Ms. Basque.

I appreciate your coming here. That's the limit of my French.