Veterans Affairs Committee on April 5th, 2017

[Céline Paris]

Sometimes it comes with the person. In the case of Marie, she walked in having always been a very hopeful person. She had that combination of agency and pathways. Many military people have it; they just lose it along the way.

In the case of John, at the beginning he had multiple issues that I would prefer not to get into, but when I told him that I thought we could treat this, he said, “That's not what I have been hearing. Are you sure about this?” He struggled with that. I said, “Isn't it nice that you have a therapist who's hopeful? I'll carry the hope for a while.” He appreciated that. Eventually he took it on and continued.

It's interesting, though; it remained an issue throughout the whole treatment. I met them both last week, and they both said that when their SUDS were hitting peaks, they didn't believe the treatment would actually work. The only reason they continued to do it was not that I was such a wonderful therapist that I had convinced them, but that they wanted to be able to say that they had done absolutely everything. It was just real stubbornness on their part that they got through it.

That they had hope to begin with carried them. I think it's something we need to work on all the time as therapists.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I find this interesting. I can see among the witnesses we've had here who have struggled that quite often they've lost hope. They want really badly to be better, but they've lost hope.

Can you tell me a bit about exposure therapy and what you do?

[Céline Paris]

Sure. There's a whole chapter in my book that makes it pretty easy, so if you want to know more, I can lend you that later.

Essentially, you have the person do the exact opposite of what they already have been doing. It's very hard to convince them to do it. That's the hardest part. What you do is have them tell their worst trauma story in every detail, using all the senses: what they saw, what they smelled, what they felt, what they heard. It's not so much the fact but rather the impact.

Once we have a written story in great detail, they either tape it or we read it in one session of therapy, and after that they read it every day. There are rules. They have to read it for 45 minutes, and they have to read it for five days a week. If they have to read it more than once, that's okay. That's how you see that graph go down.

What I can say is that everybody who has done it has graphs just like the ones I've shown. However, the tricky thing is that there's research that has just came out that says that of Afghanistan and Iraq veterans, 70% drop out of this kind of therapy because it's so difficult. You're asking them to go back and do the opposite of what's natural: face the worst thing. You need to have a really good explanation and a good relationship with them and to really work on that hope all along, if you want them to continue to do this.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I think of General Dallaire. When he was here he talked about his struggle with two types of therapy, one to try to shut down the memories and one to bring them back. I know there are those two conflicting things. I'm sure some would argue that you probably shouldn't be doing both at the same time.

[Céline Paris]

I'd love to talk to General Dallaire about hope.

General Dallaire, if you're listening, give me a call.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

How many patients have you treated who have become...can you say they're symptom-free?

[Céline Paris]

Yes. I'm not a researcher, so I'm not the one to give you numbers. I can tell you that, as I said, everybody I've seen who does PE, prolonged exposure, has a graph just like those. They move on, and then I lose them. I don't see them anymore; they just move on.

John and Mary are too recent, but I'm sure it's going to work for them, too. In the case of the sailor in his seventies, he was reassessed a year later by an independent person and was found to be still symptom-free. It really works.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

How important is it to have the correct diagnosis of PTSD before undertaking this therapy? Is that a problem? Are people misdiagnosed?

[Céline Paris]

I think they are. That's why I was saying that I'm not keen on the term “OSI”, because I find that it's too broad an umbrella. It's too specific and too broad at the same time.

Because it's made a psychological injury a battle wound, if you have any kind of psychological symptom and you're a soldier, naturally you're going to want to fall under that umbrella because there is some honour to that. The problem with this is that the therapy has to be specific. Even within PTSD, if all you have is PTSD, which is rare and not that common, the degrees of the symptoms are going to be different and there are different strategies for each configuration of symptoms, the same as you would say about a medical condition.

Diagnosis, to me, is the first step to everything. The correct diagnosis is essential.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Benson.

[Sheri Benson, NDP, Saskatoon West, SK]

Thank you, Mr. Chair.

I'm going to start with a general comment. When we're talking about mental health and suicide prevention and we're talking about a transition for an individual from military life to non-military life, many people are going to have individualized experiences of that. Some will do it well. Some will need some support. Some will need more support. In the comments about all the different groups popping up in reaction to some of the struggles of military personnel, is the community saying that there are gaps? That's why you get all those groups coming around all over and it becomes a very complicated map because people have been trying to get help and they couldn't, so they've tried to do it on their own.

I liked your comment that now it's time to bring those pieces together.

Dr. Lee, I wonder if you could comment. I was taken by your comment. When people walk through the door they need to be treated as individuals and they need to be able to have the myriad of therapies available depending on what they need. I wonder if you might expand a bit on your comments about people getting only one kind of thing in this place and this is all that's authorized, and if they need something else, or if it's a family issue and that kind of thing, they have to go somewhere else. I would like to hear your comments on that.

[Dr. Ken Lee]

It's something I feel quite passionately about. Because of my other work in addictions and mental health, I work at the CMHA, and we see civilians with mental health issues and we treat them very differently there compared to the way the OSI clinic does.

The way we treat it is, people come into the CMHA, whether they come through addiction services, CMHA, a homeless shelter, or whatever; no door is the wrong door for someone to come in and we will provide the services. We will work out where that person gets their services, the exact funding issue, and where they go and all that. The patient doesn't need to know about that and we just direct them through and get the service.

It's different working in the OSI system. You have to qualify for an OSI-related condition to qualify for treatment at the OSI clinic. Now, honestly, we do stretch the definitions of what we're allowed to treat and we try to give as much service as we can, but in reality, the service is not as timely as people would need. From the time they are referred to the time they do an intake there is a waiting time to see a psychologist and a waiting time to see a psychiatrist. The wait times can appear deceivingly good, but in reality they may not be as good as you think they are.

If we treat them basically the same way as we treat other mental health conditions and other people, regardless of whether one has served in the military or not.... The OSI clinics really need to broaden their scope to treat whatever comes in that door, and the member should not have to worry about applying, worry about funding, and whether they qualify or not. We can work that out later among ourselves.

[Sheri Benson, NDP, Saskatoon West, SK]

Does anyone else want to comment?

I worked in community mental health and the biggest problem often is not having a wrong door. People come for help and it shouldn't matter where they walk in. If someone has asked for help, the community or the system needs to help them find a therapy that works or a service that works.

I was intrigued with your one-stop shop. I'm sorry. That might sound a little like a 7-Eleven or something, but it's shorthand for people being able to walk through one door and not 16 doors. I wonder if you might—

[François Joyet]

That's the whole basis of the project because that's what we found is the problem. I was having a discussion from a gentleman from the—

[Sheri Benson, NDP, Saskatoon West, SK]

Sometimes the system needs help, not necessarily, you know....

[François Joyet]

Yes. You have the TSO clinic in Quebec City, which is responsible for all of eastern Quebec. If someone in Rimouski has a one-hour meeting they take a four- or five-hour bus ride. They come to their one-hour meeting, and then they go back. Do we honestly believe that works? No.

That's why our project came about, saying let's try to pool everything. But if you're pooling everything, you're not just pooling psychological support and medical support. You need to get these people to become productive again. That is why we pulled together all the different elements we believe need to be pooled to be able to offer these services. The advantage is being a national organization speaking with the religious congregation. They used to manage our health care and education systems. They have these properties across the country, and they're willing to give them up for a buck. You people spend a good part of the day talking about a budget. No one ever wants to talk about money, but unfortunately, you need to talk about money. You need to create something that is going to be financially sustainable. There needs to be a beginning, an end, and a person being a productive person. That's why our project came about.

[The Chair, Liberal, Neil Ellis]

Next, we'll split Mr. Lemieux's time with Mr. Eyolfson.

Mr. Lemieux, you're up.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

I'm fortunate to be a member for the Saguenay region, where the Bagotville military base is located. I'm very concerned about prevention when it comes to the mental health of our soldiers and the well-being of our veterans.

My question is for Dr. Roberge.

Do you think veterans have trouble asking for help at first? I'm very concerned about this. Second, do you know about the new artificial intelligence systems to help veterans in a preliminary consultation, before the first contact with a therapist is established? You seem very nice, but nonetheless, the therapist may be a barrier for a soldier who has trouble asking for help.

I want you to comment on this.

[Dr. Andrée Roberge]

I must answer yes to your question.

I told you I was a scholar at the Medical Research Council of Canada. At the time, I did all my research at the Laval University faculty of medicine. I did research on stress and the hypothalamic-pituitary-adrenal axis. I thought that my colleagues and I could go to the Valcartier base to establish a partnership in this area. I was told that “No, he's in a dark place, we're not dealing with this anymore.” I retorted that we had the ability to look at what happens before, during and after.

It's now 2017. Nevertheless, it's still difficult for soldiers who aren't amputees, but who have a psycho-affective injury, to say they're suffering. It takes time. Quebec's motto is “I remember”. In that sense, soldiers will always remember what they experienced. However, it will be less painful for them when a professional family, in a place completely separate from their biological family, has helped them understand that they experienced a special situation. When they return to their family, they'll have accepted what they experienced and who they are. Their family must also understand this, which is why our project must integrate this entire approach under one roof.

Therefore, the answer to your question is yes.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

At that point, do you think an artificial intelligence tool to take the first step, which consists of asking for help, could be useful to these people?

[Dr. Andrée Roberge]

Yes. This approach is part of one of our workshops.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Is any artificial intelligence software currently being used by the armed forces?

[Dr. Andrée Roberge]

Yes. Different types of software can be used.

[Denis Lemieux, Liberal, Chicoutimi—Le Fjord, QC]

Thank you.

I'll give the rest of my speaking time to Mr. Eyolfson.