Evidence of meeting #49 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was hope.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

François Joyet  President, Canada Company, Quebec Chapter, Project For Life
Andrée Roberge  President, The Neuro Group Inc., Project For Life
Ken Lee  Medical Consultant, Parkwood Institute's Operational Stress Injury Clinic, Canadian Mental Health Association, Middlesex-London Branch, As an Individual
Céline Paris  Psychologist, As an Individual

4:35 p.m.

Liberal

The Chair Liberal Neil Ellis

I call the meeting to order. Pursuant to Standing Order 108(2) and the motion adopted on September 29, the committee resumes its study of mental health and suicide prevention among veterans.

I apologize on behalf of the committee. We had a vote and we are a little late, but thank you for sticking in with us. We're going to start with the panel with 10-minute statements, followed by some Qs and As.

We'll start with the presentation “A Project for Life”, with François Joyet and Andrée Roberge.

The floor is yours.

April 5th, 2017 / 4:35 p.m.

François Joyet President, Canada Company, Quebec Chapter, Project For Life

Good afternoon, ladies and gentlemen. I am François Joyet, president of the Quebec chapter for Canada Company, and a board member.

As fast as I can I'll say that over the last two years our organization has been sponsoring a respect campaign spearheaded by Steve Gregory and Doug Bellevue, which has brought us to meeting a lot of different people, different organizations, throughout Quebec, Ontario, and the west, to come to a very basic conclusion.

Being from a business mindset and not a medical mindset, in business, we often say that we are as strong as the weakest link of our chain. We've noticed that there are many people doing many different things and millions of dollars being invested to help our veterans find solutions to what I think is generally agreed, that PTSD is a mental illness, and homelessness comes from it, as does suicide.

We started wondering how we could find a way to fix this. We had the pleasure of meeting people from the Saguenay region who were in contact with les Frères Maristes, which has an old school congregation site. We started asking questions of how we as a group could put everyone together and offer one complete service, with the end result being the reinsertion into Canadian society of our veterans becoming productive Canadian citizens again.

I don't think I can go over everything here with you today, but one of our asks was how we can get formal approval to putting these various organizations around the table to come to a complete and formal proposal. We've met the people from l'Hôpital Sainte-Anne. We've met people from the Old Brewery Mission in Montreal. We haven't met with the people from OSI yet, but we have identified them as people we need to be sitting down and talking with.

We do not have an interest in reinventing anything. Everything is out there. You have people doing zootherapy with dogs. You have Wounded Warriors financing programs with equestrian centres in the west. You have True Patriot Love, which is even financing a program at the University of Southern California—I'm searching for my words because I got off my text; I was told to be very short and sweet and to the point—which brings the person into a simulator where they're revisiting what caused the PTSD.

When you go across Canada and you start meeting all these different people, everyone is doing something, but no one is doing it together. No one is doing it under one roof, offering a complete service. How do we bring the person to an end result, which is back into society as a productive citizen? This is something we'd like.

I sent my text, so I think you will have it. There's a lot of work to be done. I do not have a formal proposal to give to you, but I think if we, as an independent voice, business leaders, were able to put all these people around the table to come up with a formal project, we could do something like that.

Rapidly, that's it.

4:40 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

Madame Roberge.

4:40 p.m.

Dr. Andrée Roberge President, The Neuro Group Inc., Project For Life

Hello. Thank you for meeting with us today.

As a scholar at the Medical Research Council of Canada, I had the opportunity to work in the neuroscience field and to study various structures of the nervous system. I did research on neurodegenerative disorders and stress, in particular post-traumatic stress, but also other types of stress. I also did research on depression, schizophrenia and psychiatric disorders.

Through the Project for Life, we offer individuals suffering from post-traumatic stress and their families access to all the resources under one roof. This starts with the medical file, which contains the information about the diagnosis and explains the different therapeutic approaches used. We include blood tests that quantitatively measure the entry and exit of information in the brain and that help distinguish between all conditions, including diagnoses related to anxiety or depression, cognitive disorders or psychiatric disorders. Based on the result, we can look at the situation with the doctor and the individual, and start providing care.

To follow our program, individuals must understand that they've experienced a difficult situation, in this case post-traumatic stress. They must accept this fact in order to receive care, find a way to reintegrate into society and get back the quality of life they had before and they had chosen. We're talking about an integrated approach that groups together everything under one roof and that's based on the medical file and the family, meaning the spouse and children.

Thank you.

4:40 p.m.

Liberal

The Chair Liberal Neil Ellis

Next we have Dr. Ken Lee, medical consultant at Parkwood Institute's Operational Stress Injury Clinic.

Welcome.

4:40 p.m.

Dr. Ken Lee Medical Consultant, Parkwood Institute's Operational Stress Injury Clinic, Canadian Mental Health Association, Middlesex-London Branch, As an Individual

Thank you very much.

Just by way of background to let you know what I do in my practice, I've been working at the Parkwood OSI Clinic for about 10 years, since 2006, as a part-time medical consultant, but my main area of practice in London is in addictions and mental health with the CMHA London and Addiction Services. I've been a member of the Ontario Minister of Health's advisory committee on addressing the opiate crisis in Ontario. That's some of the background I want to give you so that you know where I'm coming from.

The mental health care provided in OSI clinics has always been focused on PTSD. Significant time and resources are spent in those clinics to filter out the diagnosis of PTSD as distinct from other mental health conditions that are not necessarily treated in OSI clinics.

If we're going to make an impact on reducing veterans' suicide and improving their mental health, I think it's important that these OSI clinics broaden their scope and treat other mental health conditions. Depression is a large component of what we see, but the veterans do not necessarily qualify for treatment within these clinics unless there's an identified service-related PTSD condition. We make the diagnosis of sub-threshold PTSD to allow people to be qualified for treatment.

The other big impediment that I see in my experience in these clinics is that there's a significant problem with alcohol and substance abuse in the population of patients we see in the OSI clinics. Alcohol use disorder is tracked, but other substances are not necessarily tracked that closely.

We don't have the capacity in the OSI clinics to address these problems. We refer people to treatment programs and residential rehab programs, such as Homewood, Bellwood, and other programs in the province, but we do not actually have the capacity to address these problems in the clinic. We do not have an addiction counsellor in our clinics. The main treatment in PTSD is not pharmacotherapy; it is mainly psychotherapy by psychology. Psychotherapy and trauma exposure therapy do not work that well, if at all, in the background of alcohol abuse and substance abuse.

It would be nice to broaden the scope of the OSI clinics to address whatever mental health concern the member presents with. These are people who need care otherwise anyway, whether related to their service or related to transitioning to civilian life. Whether they get the care through the federal OSI clinic system or through the provincial health care system, I think it's important that the care be delivered in a timely fashion. My philosophy is that we deliver the care that's needed and worry about the funding later, whether it's provincial or federal. That could be worked out later, at a committee elsewhere.

That's the gist of what I want to say. I think we owe a duty of care to veterans who have willingly risked their lives, life and limb, to serve and protect our country. The least we can do is give back and provide the service they need after their service to our country.

Thank you.

4:45 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

Now we will have Ms. Paris, psychologist.

Thank you for coming today.

4:45 p.m.

Céline Paris Psychologist, As an Individual

Thank you very much for the invitation. I'm honoured to be here. I'm very aware that I have only 10 minutes, so I will fly through my text. My apologies to the interpreters.

My name is Céline Paris. I'm a psychologist. I've been working with soldiers and veterans since 1990. I started within the CF system. Since 2005 I have been in private practice. At first I did mainly diagnostics, and now I do mainly treatment.

I want you to know at the start that I was drafted to speak with you today. I was drafted by a brilliant young veteran. He said, “Céline, you have to tell them about hope.” I take hope very seriously, so here I am.

I like positive psychologist Rick Snyder's definition of hope. It's more than optimism or a general positive outlook on life. For Snyder, hope is made up of agency and pathways. You have hope when you believe you can achieve your goals through your own efforts, “agency”, and when you have a plan to achieve them, “pathways”. Hope is about being goal-oriented and staying that way through the highs and lows of life. I think hope has left the hearts of too many veterans, and as a society we're not doing all we can to stop the bleeding.

My message of hope will be in two parts. The first is fact and the second is opinion.

The fact is that therapy works. There is scientific research that shows objectively, repeatedly, that psychological treatments for PTSD work. Science is the solid foundation that every other strategy builds on. I hope you will listen to Dr. Hector Garcia's TED talk or read the transcript I've provided to you. The title of his talk says it all: “We train soldiers for war. Let's train them to come home, too.” His message is that today we know how to eliminate PTSD.

Yes, he uses the word “eliminate”. This is a very strong claim, so I came with proof. These are not scholarly articles, although I have some here, if you like. These are three graphs. I hope you have the graphs. I'm going with moins mais mieux.

SUDS, subjective units of distress, is a scale used to measure progress in therapy. A score of 10 means extremely distressed and a score of one means perfectly comfortable. When a person with PTSD is going through this active part of therapy, which means reliving their trauma story every day to finish processing it, their psychologist asks them to track their SUDS each day.

I'll turn now to my three graphs. Page 1 shows the progress over two weeks of a soldier still on active duty. I'll call her Marie. She was brutally assaulted by her partner and left for dead. Pages 2 and 3 show the progress of a young Afghanistan veteran who faced grave dangers and horrors. He lost friends to the Taliban and later to suicide. He stayed fully engaged in love and work, but, boy, was he suffering. Let's call him John. As it happens, both Marie and John completed their trauma therapy for their worst event just this month.

The third case, on page 4, is from 2013. He is a sailor in his seventies who was almost killed in a fire at sea in 1969. He left the navy as soon as he got off the ship. By the time he heard there was such a thing as PTSD, more than 40 years had passed. He came to therapy because his wife wanted to go on a cruise, and setting foot on a boat was unthinkable.

As you can see, their SUDS ratings start high and go down from day to day and week to week. Like Carlos, Dr. Garcia's Vietnam vet, after a few weeks of hard work their trauma was truly in the past. The whole idea behind prolonged exposure is that it will stay there.

Are these three individuals different from most? Maybe. You might guess that they had more courage, but I don't think that's it. Soldiers are brave. What they did have was hope. They refused to let a diagnosis determine how they were going to live their lives. Without hope, they would not have been willing to summon and confront their worst memories, any more than a cancer patient would sign up for the cruelties and indignities of chemo.

To explain to our patients why they need to face their traumas, we tell them that all emotions have a function. They are a signal, like hunger, pain, or cold, that something needs attention. Ignore them and they get worse. If we haven't eaten, it doesn't occur to us to label our hunger as the problem, because if we did, we could just take an appetite suppressant rather than eat.

With anxiety it is trickier. Unlike hunger, our first instinct is the wrong one. The first thing we all try is to push the bad memories out of our minds. Avoidance is addictive, because it works wonderfully in the short term. In the long term it makes the problem worse. The alternative is exposure.

What I flee follows me, and what I face is erased.

So, therapy works, and now for the opinion.

Hope is in crisis, and we have to do something soon. Why is PTSD portrayed as a chronic condition, necessarily, by default? Why are newly diagnosed soldiers like Marie, who is just starting out in life, being told by clinicians and peers that managing their symptoms is all that they can hope for? It looks to me like hope needs a lobby group.

For every new effort of support, I ask that we remind ourselves that a safety net can catch, but it can also entangle. The short answer to why soldiers and veterans choose suicide is not PTSD, it's not depression, and it's not lack of support. It's hopelessness. Support without hope creates victims, not survivors, and soldiers don't make good victims. They don't need their struggles to be glorified. The antidote to shame is not honour, anyway; it's self-compassion, remembering our common humanity, the idea that there but for the grace of God go I. When they understand what they need to do to get past PTSD, they just get on with it, but first they need to grasp that they do have agency, and there are pathways, well-worn pathways, in fact.

No societal change is all positive. PTSD has become a household word, but awareness has come at a price. A treatable psychological condition has somehow become equated with a chronic disability, a life sentence, and an identity. Yet, a diagnosis is something you have, not something you are.

I don't love the term “OSI”, operational stress injury, mainly because I haven't found the analogy of injury terribly useful. I know the idea is to combat stigma, but I'm just not convinced it's lived up to its promise. I like analogies that hint at agency—what you can do yourself to recover—analogies that contain the seeds of hope. My favourite for anxiety is a wave that you can't control, that could very well engulf you, but that you can learn to surf or ride. That's why I chose it for the cover of my book.

Besides, a diagnostic label is a useful thing. I was so excited to read that our government is opening new centres of excellence and using the term “PTSD” in their name. A precise diagnosis is crucial, like you were saying, because it dictates the treatment. Just as in medicine, everything starts with the right diagnosis and stalls with the wrong one. Sticking with medical analogies, we know that cancer is not one illness. Choosing the best treatment protocol depends on an exact diagnosis.

I do know the word “eliminate” is scary. We certainly don't want to give false hope or, heaven forbid, leave those who didn't respond to therapy feeling like they didn't try hard enough. Believe me, I share those fears. Then I wonder, if we were talking about cancer, wouldn't I be grateful for any hope I was given? In medicine, it's natural to treat hope as the precious gift that it is. Sure, the risk of relapse does exist, especially if there are more traumas in my future, but then I can be PTSD-free, like we say cancer-free.

Of course, the cancer metaphor is not perfect either. You don't need hope to recover from cancer. A great surgeon could be enough. With anxiety, passive won't work. Someone like me has to convince you to take the scalpel bravely in hand and show you how to use it.

To sum up, support has a crucial, vital role to play before, during, and after treatment. It's protective and it's healing, but it's not treatment any more than support is a treatment for leukemia, diabetes, or a broken leg. When it's coupled with the message that this is all you can hope for, a beautiful safety net becomes a trap.

There is a controversial book that has come out this year called Against Empathy. In it author Paul Bloom argues that empathy can be a bad strategy for caregivers because it can lead to burnout and neglect of evidence-based solutions to people's problems. This stance has been criticized as being too extreme, and I tend to agree. Empathy without reason is blind, but reason without empathy is empty.

Good therapy is based on reason, and support is based on empathy. Our soldiers and veterans need and deserve both—oh, and also, hope.

Thank you.

4:55 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

We've saved some time, so I think we'll be able to do the first round and extend them to six minutes now.

We'll start with Mr. Kitchen.

4:55 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you, Mr. Chair.

Thank you, all of you, for coming.

I apologize for the tardiness on our part. Hopefully we'll get through, and we can all get a good response to some of our questions. This has been something we've been following quite extensively, and we've learned a lot about it. This committee is working very well together and we look forward to hearing what you have to say.

A lot of the things that we've heard about on the issue of mental health and suicide are around that transition from being a solider to becoming a veteran. In our previous study, we looked at some of those aspects, and we hope to have some answers. We've come up with some recommendations. Likewise, we will come up with some good recommendations through this study.

One of the things we've heard about is that we train our soldiers to fight. We indoctrinate them from day one, the moment they join the forces, and we keep them that way, and they learn to march based on the order of the hierarchy of the system. When they're finished, we don't decommission them. We don't train them to be civilians. Would you agree with that? This question is for anybody who'd like to respond.

4:55 p.m.

President, Canada Company, Quebec Chapter, Project For Life

François Joyet

We run a program at Canada Company called the military employment transition program, which deals with a big piece that I think relates to what you're talking about, which is called education.

One of the issues they have during their military career is that they're basically living in a society within a society. They have their own language. They walk out of there and they basically talk a language that is completely different from what they find in the civilian community, so they need to learn how to express everything they've learned.

We also work with the business community to try to get them to understand the reality of what they went through and what they were, because they have a whole set of skills that are comparable to those in our civilian communities, but it's just a matter of how they communicate. One of the attributes of that program is helping them with that, so I would agree with what you're saying. It's a big piece of education.

4:55 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Dr. Roberge.

4:55 p.m.

President, The Neuro Group Inc., Project For Life

Dr. Andrée Roberge

I agree with what you said.

We're offering an integrated project. This means that we take into account what the soldiers were and what they should keep being. We know that they went through a dramatic situation, in this case post-traumatic stress, the key word for everybody. Post-traumatic stress can manifest itself on a neuropsychological level through anxiety issues and depression, which can lead to suicide.

We're proposing an integrated program where we provide care for individuals by taking into account their medical file, diagnosis and all the therapeutic approaches prescribed to them. We then conduct blood tests that measure the entry and exit of information in the brain. These tests help the clinicians and the employer, the Canadian Forces, confirm that the individuals can be rehabilitated and reintegrated into society.

5 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Dr. Lee.

5 p.m.

Medical Consultant, Parkwood Institute's Operational Stress Injury Clinic, Canadian Mental Health Association, Middlesex-London Branch, As an Individual

Dr. Ken Lee

I absolutely agree that reintegrating into society is a big issue. What they've learned is that their behaviours in the military do not work well in civilian life. They don't know quite how to fit in, and they lose that sense of belonging in normal civilian life.

For example, if you're working in a job in civilian life, you can't be giving orders the same way you give orders in the military. People get angry and you get charged with harassment, and you end up losing your job, etc., and it goes down the line. I think it's quite important to teach people how to cope with that, absolutely.

5 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Ms. Paris.

5 p.m.

Psychologist, As an Individual

Céline Paris

I'll focus mainly on helping people reintegrate when they have PTSD. That's exactly what the TED talk from Hector Garcia is about. He says that we train soldiers for war, so let's train them to come home, too. The psychological therapies that help with PTSD have a lot in common with training. They involve repetition, as does the training. He says that if you put a gun in somebody's hands, you train them how to use it. In the same way, when you reintegrate someone coming home, you need to do some things. If some of your experiences are now associated with PTSD, it's about the stress response becoming stuck, and you need help to become unstuck, and you need training in order to do that.

5 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you.

Dr. Roberge, I have your presentation and it intrigues me. I'm a very black-and-white person. I'm a scientist. I believe that I need facts, and when you talk about blood tests, that's a factual thing that people can grasp.

You talk about the HPAS axis. We've heard in committee how proper training may be helpful in terms of the exposure they get. Where do you see that fitting in, from a scientific point of view, when we're dealing with somebody? We train them to do this, basically on the responses that you have when we detrain them. Can you comment on that and on how you see that fitting into your presentation?

5 p.m.

Liberal

The Chair Liberal Neil Ellis

I apologize, but you'll have to provide your answer in about 30 seconds, if you could, please. Thanks.

5 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Sorry, I've asked you a technical question. Answer as quickly as you can.

5 p.m.

President, The Neuro Group Inc., Project For Life

Dr. Andrée Roberge

Just in a few words, according to the results that we have from the first test, we could go to the axis, the relationship between the brain and the adrenal and the hypothalamus glands. We know exactly which situation the person is in from a neurophysiological point of view. We could through our way of taking care of the person—because he or she has to understand and accept that according to the result we have on the axis, the test, we know there is a profound type of psycho-effective type of situation, which they have to live with first. They have to deal with the family. They have to live with the socio-environmental situation. That's why we have this three-way kind of thinking

to reintegrate individuals into society.

It takes about six to nine months to be sure the person is able to go back to work—

5 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

5 p.m.

President, The Neuro Group Inc., Project For Life

Dr. Andrée Roberge

—and be able to make a choice to be in the army or outside of the army. We have some workshops that give the opportunity for the person to make a choice.

5 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

Ms. Lockhart.

5 p.m.

Liberal

Alaina Lockhart Liberal Fundy Royal, NB

Thank you, Mr. Chair, and thank you to all of you for your insights today.

Céline, you talk about support and hope. Where does hope come from?