Veterans Affairs Committee on March 20th, 2017

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Dr. Rolland-Harris, epidemiology is a fascinating science. One of the issues is getting to ask the right questions, because it seems a lot of what you're doing is just collecting raw data, statistics on how many went in, how many came out, how many suicides there were, and that's all important data.

I don't know whether it's about exit interviews or the interrelationship with former soldiers, members of the armed forces, but in your work, do you do something beyond simply gathering data?

[Dr. Elizabeth Rolland-Harris]

I disseminate a lot of the work that we do, such as today, and at conferences, and those sorts of things but I want it to be clear that, at the end of the day, I am there to help the decision-makers, the action-takers, and so I'm behind the scenes.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Statistically, what methods are generally used by victims of suicide?

[Dr. Elizabeth Rolland-Harris]

Statistically, if you look in the annual report, the two main methods specifically for regular force males, I want to clarify, are hangings and firearms. Just so we're clear, that's consistent with what we see in the general population. The top two methods are the same both in the Canadian Armed Forces and in the general population.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

In other words, the availability of means such as firearms isn't necessarily...if someone's determined—

[Dr. Elizabeth Rolland-Harris]

No, it's very rare, if not never the case, that individuals use their military-issue firearm. They use their personal firearms. That's something that is collected very rigorously.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

You made the point, which needs to be reinforced with regard to deployment, that statistically we can't draw all the connections yet. I say so because it's common for us to think that someone who was in Afghanistan and had a bomb blow up near them is, of course, going to have...but you're saying that statistically you can't really draw all those connections yet.

[Dr. Elizabeth Rolland-Harris]

No, not at this point, and whether it's a lack of statistical power or if it's a true absence of a relationship is unclear at this point. As I said in my opening statement, you have to understand that “deployment” is a broad term.

You can have two individuals with the same military occupation code technically doing the same job in the same location on the same deployment who have entirely different experiences, or when they come back, one is scarred, and one is not. Deployment is an easy way of classifying things to look at relationships, but it's a very, very complicated concept, really, to be able to parse statistically.

[Dr. Alexandra Heber]

Do you mind if I add something?

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Please go ahead.

[Dr. Alexandra Heber]

I think one of our concerns always with the issue of deployment and that tight relationship being made between deployment and suicide is that it makes it possible. We always fear that those who commit suicide and never deployed get lost in that picture. It's an over-simplistic picture, because for sure there are the MPTSRs that Elizabeth talks about. I did MPTSRs when I was in the military, and we certainly did them for people who had never deployed but who committed suicide for a number of reasons, some of which we didn't always understand. It's important to remember that there are many factors leading that person onto that suicidal pathway. Deployment may be one of them, but not necessarily.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much, Mr. Chair.

Thank you both very much for coming and sharing this helpful information with us today.

I just want to touch on a point in response to a question by Ms. Lockhart. I believe you twice referred to the MPTSRs. Now, as I understand it, those are done in each case where there is a suicide, and that data is then collected. All of the MPTSRs are put together as findings in annual suicide report. Is that correct?

[Dr. Elizabeth Rolland-Harris]

Yes, chapter 1 of the annual suicide report.

[Colin Fraser, Liberal, West Nova, NS]

I see, okay. I don't believe we have a copy of that before our committee. I'm wondering if you can table the latest annual suicide report.

[Dr. Elizabeth Rolland-Harris]

Sure, I can give you my copy that I have here, and it's also available on the web if you just search 2016 CAF suicide report.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much. That would be helpful.

Dr. Heber, with regard to some of what we're talking about here, are you able to identify some of the factors that put a veteran, as you see it, at a higher risk of suicidal ideation? What are some of the actual factors?

I know we talked about transition to some extent, and we've heard a lot of different opinions about what these factors may be, but I'd be interested in hearing your thoughts.

[Dr. Alexandra Heber]

The first thing I'll say is that the factors that lead to what I call that “suicide pathway” are similar for veterans and for any member of the general Canadian population. The first factor is that almost all people—90% or more—likely have a mental health problem at the time they commit suicide. This finding is from international research; it's one of the most robust findings we have. It's a very important factor. It's why when we are doing work to prepare suicide prevention strategies, a lot of that work does focus on good mental health care and on getting people into care, because we know it's one of the factors that's consistently there. The other factor that is usually present right before the suicide is some stressful life event. Often it is something like a relationship breakup, or perhaps the person has run into trouble with the law or has lost their job. It's usually related: it's relational, and it's to do with a loss. This person has a mental illness—usually there's some depression in that mental health problem—and then they have this crisis, this loss, that happens. That sets them off starting to think about suicide.

There are a number of other factors that we know contribute to this. This access to lethal means is a really important factor. We know from public health research that the easier the access is.... Often people do this impulsively. Often, if people can be stopped from committing suicide today, and especially if help is provided, they will not go on to commit suicide.

[Colin Fraser, Liberal, West Nova, NS]

Identifying the underlying mental health illness is the preventative way to stop the escalation from happening?

[Dr. Alexandra Heber]

It's certainly one of the things we know contributes. Therefore, it's something on which, if we make an effort, we know that it will be helpful.

[Colin Fraser, Liberal, West Nova, NS]

What can we be doing better for our veterans to help identify it and make it easier for them to come forward to get help for their underlying mental health challenges?

[Dr. Alexandra Heber]

In the last year, Veterans Affairs Canada has been working on updating our mental health strategy. As well, we are currently developing a joint suicide prevention strategy with the Canadian Armed Forces—we're working together on this. We are doing so in part because we want to pay special attention to that transition period to make sure that we are covering people when they need the support the most, so that they don't fall through the cracks. For many years, going back to at least 2000, there have been a number of programs and initiatives in place around suicide prevention in the veteran population, but we are now updating that information and are creating a joint strategy for our two organizations.

[Colin Fraser, Liberal, West Nova, NS]

Are you seeing less stigmatization, though, of forces members coming forward with an underlying mental health illness? If we're trying to get them before these difficult life challenges happen—and the transition piece is a difficult time for any soldier exiting the forces—is there some way to break down that stigma that we haven't been using? If so, what might that be?

[Dr. Alexandra Heber]

There are a few answers to that question.

First of all, with regard to the people who we know are exiting the military with a known mental health problem for which they've been receiving treatment, we're pretty good already at making sure we do that warm handover from one organization to the other. When I was in the military, I was the head of the operational trauma and stress support centre in Ottawa. We have an OSI clinic run by Veterans Affairs Canada in Ottawa. There were a number of my patients who I handed over to the Veterans Affairs clinic before they left the military. We have a lot of that going on for people who have already been identified.

One of our concerns, of course, is people who have not been identified, people who maybe don't even realize that they have mental health issues until they leave and face extra stresses from having left the military. One of the things we have put in place is an exit interview for all members who are leaving. It is a transition interview where they meet with somebody from Veterans Affairs Canada. Even if they have never had a problem and they don't see themselves as needing our help, we've met with them face-to-face and said, “Here's who we are. Here's where we are. Here's our number; call us if you need us.”

[The Chair, Liberal, Neil Ellis]

Thank you very much.

Mr. Brassard.