Veterans Affairs Committee on March 20th, 2017

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Okay. Thanks.

Do I have a few more seconds?

[The Chair, Liberal, Neil Ellis]

There's sixty left.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Okay.

I want to go back to the statistics.

Have we done any research to see how many of those who committed suicide had received mental health care? Is this a matter of their not receiving care, or are we still struggling with how we're treating them?

I don't know who will answer.

[Dr. Elizabeth Rolland-Harris]

The MPTSR, the “Medical Professional Technical Suicide Review Report”, which is an investigation of every suicide—male, female, regular, or reserve—looks at access to care. The rates of access to care are quite high, so this opens a whole Pandora's box of the underlying mechanisms of access to care, which I think are multiple, and it could be a very long conversation.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen.

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

Thank you, Mr. Chair.

And thank you very much for this. It sounds very complex and that there are clearly multiple pieces to this puzzle, so please forgive me if I'm trying to sort this out.

Regarding the people coming into the CAF, I wonder if some pre-screening is possible with regard to their emotional health, because it seems to me that this is all tangled up together.

Dr. Rolland-Harris, you said that 70% had documented evidence of marital breakdown, distress, debt, family/friend illness, substance abuse, which it would seem to suggest a susceptibility to suicide rather than the other way around. Do you, then—if you can—say that this individual may be predisposed, may have a background such that we had better be very careful, and monitor and watch for potential suicide?

[Dr. Elizabeth Rolland-Harris]

I don't know the specifics of the recruitment process. However, I do know that the 2009 expert panel explicitly stipulated that they were not interested in looking at screening out individuals for mental health reasons.

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

Is it a matter of being fair and not prejudging an individual, or—

[Dr. Elizabeth Rolland-Harris]

Honestly, I don't know what the motivations are. You'd have to talk to the individuals who....

[Dr. Alexandra Heber]

For recruitment there is screening, as people do go through a medical examination, and part of that is a history-taking where people are asked about their previous medical history, including mental health history. Yes, that does happen.

Based on that, whether someone is screened in or out would often be on a case-by-case basis. It would depend what exactly that history was about.

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

Yes, I can understand that you wouldn't want to have a prejudice that would keep someone out, and yet if there's a vulnerability, it is a frightening thing to do to a human being to allow them to get into this quagmire that could lead to their death.

I understand the statistical reasons and the need to protect privacy with regard to the analysis of male versus female suicides, but with that in mind, could you perhaps speculate or give some idea of the trend in female suicides, whether it is or is not comparable to the trend among males?

[Dr. Elizabeth Rolland-Harris]

I can't comment on that. The numbers are statistically quite small—

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

Too small, too limited...?

[Dr. Elizabeth Rolland-Harris]

—which is a good news story, I suppose, by itself.

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

Yes, but you are possibly going to be able to identify some of the trends in future, or is that not possible?

[Dr. Elizabeth Rolland-Harris]

It's unlikely that we'll be able to do so with the annual suicide report. However, with the CF cancer and mortality study, the cohort is much larger and includes everyone who has ever worn a uniform since 1976, in essence. So the population is much larger, and we're not stopping looking at these individuals once they release; we're continuing to watch them, so the cohort is much larger. It is plausible that we will be able to have a better feel for what's happening with women's suicide as part of that larger study.

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

Okay. Thank you.

Dr. Heber, you talked about the fact that a member of the Canadian Armed Forces has wraparound health service, and it occurred to me that sometimes when people leave they may not seek medical help or may not be able to find a doctor in the public system. I wonder if there has been any finding that an inability to access health care might have been part of the reason for suicide, or do you have any thoughts on that?

[Dr. Alexandra Heber]

When we look at the veteran population, it becomes complicated, because out of the 700,000 veterans in Canada—and I'm sure you know this—120,000 are clients of Veterans Affairs Canada.

When we're talking about veterans, there are many people out there who have retired, and we know nothing about them. If they haven't come forward and asked for services, we don't know about them. That's the first issue.

Because we don't provide the health care directly, there are always a lot of problems with us gaining access to information, though if somebody leaves the forces, they have a case manager. That case manager will find out what's going on with their care, because the case manager is going to help organize further care for that veteran.

We don't have perfect information on everybody, so it's much harder for us to do that.

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

I can see there are many challenges here. This may seem simplistic, but with regard to this difference in the OSIs of army veterans as opposed to those for navy and air force veterans, might it have to do with the fact that when you're on the ground in a deployment, the realities of the violence and the impacts of that hostility are greater because you're there on the ground, as opposed to being on a ship or in the air? The others are still part of the deployment but not on the ground.

[The Chair, Liberal, Neil Ellis]

I'm sorry, but we're out of time.

We go to Mr. Bratina.

[Dr. Alexandra Heber]

Darn. We don't get to answer your question.

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

Thank you.

Dr. Heber, you have a terrific background, one that's ideal for the job you do. Could you flesh out what you do in the day? Do you ever interview patients anymore? Tell me how you actually carry out your very important role.

[Dr. Alexandra Heber]

Thank you. It's very much an advisory position. I work for the chief medical officer. She is in charge of the health professionals division within Veterans Affairs Canada. Also within that division is our directorate of mental health. Similar to the directorate of mental health in the Canadian Forces, we have set up a directorate of mental health. A lot of this is very new and has happened in the last couple of years. Some of the people who work in that directorate you will be interviewing next.

I will provide advice, guidance, and leadership in a clinical way to that directorate, to the director, to the chief medical officer, and to anybody else who needs my advice or my expertise, such as the ADM, the deputy minister, and so on. I'm kind of multi-tasking.

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

Is it a work in progress? Are we in a brave new world with regard to how we're approaching these issues that have cropped up recently?

[Dr. Alexandra Heber]

I'm sure part of it is in response to that. Several years ago, a look was taken at Veterans Affairs Canada, which had devolved from the time after the Second World War when we did have a robust health care system. Over the years, I guess, they felt there wasn't the same need. Then when medicare came in, people were taken care of by the provinces, so that sort of clinical role of Veterans Affairs decreased and decreased.

Certainly, in the last several years, especially with people coming out suffering from operational stress injuries and physical injuries because of some of the challenges during their career, I think very appropriately, it was seen that we needed to beef up the health professionals division within Veterans Affairs.