Veterans Affairs Committee on April 10th, 2017

[Col Rakesh Jetly]

Yes, absolutely.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

How do you plan to reduce the time required to transfer their records and to improve wait times for assessments?

[Col Rakesh Jetly]

Those are challenging, and it's case by case. There are several groups. Ideally, somebody is already on the books of Veterans Affairs long before they release, so the determination of eligibility and things have occurred. In that case, it's simply a matter of ensuring there's care available where they're going. That can start once the person decides their intended place of release. It's easy if they're releasing in a place where there's a Veterans Affairs OSI clinic. It's much more challenging if somebody goes to a more isolated location. That's the one group.

The second group are the people who are in the process of applying at release time. There is more and more being done to expedite the records and those kinds of things.

The third group, of course, are the people who leave and six years after leaving feel they're unwell and need to go in. You need to have solutions for all of them.

From a health services perspective, there are Veterans Affairs people who are working. It has become much easier with electronic health records and not paper records. There still needs to be some severing for privacy reasons and things. It's being worked on.

[The Chair, Liberal, Neil Ellis]

For the last three minutes, we have Ms. Sansoucy.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

You spoke of your collaboration with the Bell Let's Talk program. In addition to your participation in the program, how do your actions help reduce the stigma surrounding suicide? You touched on the matter in your presentation, but I want to hear more about the link between your work and the reduction in stigma surrounding suicide.

[Col Rakesh Jetly]

Stigma is a complicated thing, in the sense that there's social stigma, individual stigma, self-stigma, institutional stigma. It has to be addressed at all the different levels. I think there's an institutional stigma in provinces that don't cover psychotherapy. It's the most evidence-based treatment for mental illness, but they don't cover it.

In terms of how we are addressing stigma, there are many, many different ways. One of the interesting ways that we started teaching road to mental readiness was that we had a mental health professional, side by side with the soldier, teaching about mental health and mental health awareness. Soldiers respect the instructor. This is the boss, the person who is the expert. Then, somewhere along the way, they would maybe disclose that they've had a mental health condition themselves. They have PTSD.

The biggest thing for stigma reduction—evidence based—is to actually meet somebody with a mental illness and realize they are okay. They're competent. They're able to do things. It needs to challenge your image of what it is, as much as possible. That's a big part of it.

A few years ago, we put out a call—just a quick email—for people who were interested in talking about their experiences with mental illness. There were hundreds of people who responded. We had everyone, from privates up to admirals, saying that they got ill and the best thing they did was to talk to their boss. My boss got me into care, or my friend, my family—this kind of idea.

It's right down to that personal level kind of idea. It's not always about campaigns. It's not always about hearing the psychiatrist, a certain general, the CDS saying that we need to do this. Sometimes it's all of the different ways, from the personal....

You want to challenge people's beliefs, and then show them evidence that people who have mental illness stay in the forces. People who have mental illness can get promoted—all of these kinds of things.

It's many, many different levels. Bell Let's Talk, is just an example of us joining...but every opportunity we can get is—

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Have you formalized this approach? In other words, among the people you've already helped, have you identified those who can speak and therefore help reduce stigma in this area?

[Col Rakesh Jetly]

Yes, it's—

[The Chair, Liberal, Neil Ellis]

I'm sorry, the time is up. I'm going to have to ask for a short answer on that, please.

[Col Rakesh Jetly]

Okay.

Yes.

[The Chair, Liberal, Neil Ellis]

Great, that's short. Thank you.

We'll have to suspend for a couple of minutes.

I'd like to thank Colonel Jetly for coming again in front of the committee, and for the work that you've done for the veterans and the men and women who have served.

We'll suspend for about three minutes and come back to our second panel.

Thank you.

[Col Rakesh Jetly]

Thanks very much.

[The Chair, Liberal, Neil Ellis]

We'll call the meeting back to order.

We now have Marvin Westwood, counselling psychology, University of British Columbia, on video conference. Thank you for joining us today

Doctor, we will start with up to ten minutes of testimony, and then questions and answers.

[Dr. Marvin Westwood, Professor Emeritus, Counselling Psychology, University of British Columbia, As an Individual]

Good afternoon. It's good to be with you. Even though I'm 4,500 kilometres away from you, it feels as though I'm in the same room. It's a testament to the technology.

Also, I want to acknowledge first that I'm speaking to publicly elected officials, who are also in service for us. We often thank veterans for their service. To all the people there on the committee, who stood for election and are taking that role on, thank you for your service. We have multiple kinds of groups doing service in our country.

I am going to talk today, following Dr. Jetly's presentation, a little more upstream, for the treatment and not prevention of suicide. I don't talk a lot about prevention of suicide because I don't believe suicide can be prevented. It's ubiquitous, it's around, it's everywhere. It has always been and probably will be, but in general, what we can do, in my opinion, and with my colleagues out here, is reduce the risk of suicide. That's as far as I think we might be able to get, but that's a long way in saving lives of people. For me, then, the focus is on risk, rather than prevention.

When I think about the people I've worked with over the last 20 years in the Canadian military who are being released, both a usual release at end of tour of duty or medical release, I'm aware that, for veterans, we in the helping professions have to understand, first and foremost, that we're dealing with a unique population. I'm not the first witness to say this, but let's just remind ourselves about the military cultural socialization that takes place. The men, and also the women, who work in this particular career adopt this cultural socialization that demands of them to be high functioning and places a high value on competency, maintaining fitness for battle, frustration of weakness, self-sufficiency, and the universality of service.

Why is it important to recognize the social-cultural mapping here? It's because these very values that served them so well in their work and in doing their work for us make it almost difficult, or impossible for some of them, to seek or ask for help. We all know that an increased risk of suicide ideation is not necessarily mental illness. I prefer to use the term, and they use it in the military, of course, “operational stress injury”, because many people have operational stress injuries that do not progress to disorders. They do, however, handicap or prevent them from achieving their life goals.

The notion of a mental illness in this culture is stigmatized. We must remember that a post-traumatic stress experience, or even disorder, is a “normal experience to an abnormal event”. We do remind our veterans when we're working with them that what has happened to them is a normal experience in the face of an abnormal event.

What does that do if they use language such as, “I have an operational stress injury”? I'm less shamed, I'm less stigmatized, and I'm less likely to avoid going to a health professional to get help because that's a sign of failure. We learn from them very early on to change the language. To represent skills and help with injuries is more effective for them in making contact with services, whether it's in our clinics or in VAC, or wherever.

Dr. Jetly has referred to the medical interventions for those who have indeed full-blown mental health injuries, if they are untreated, and they do certainly exist. I'm talking about the majority of people leaving our service, who are leaving a culture that is really a very challenging one and having to let that go to adopt a new culture in the civilian world.

I think our focus should be primarily on the management of risk factors rather than prevention of suicide. I've said that. The goal in the management of risk factors related to suicide would be early detection, an intervention working from an upstream, rather than a downstream approach, long before they slide into isolation, depression, suicide ideations, and then, for a small percentage of them, acting on their desire to end their life.

The theoretical lens that I would like to refer to today, which Dr. Jetly referred to also, is the interpersonal theory of suicide. I think that is very helpful for us in working with our veteran group. Now, over 700 have gone through the program and have returned.

We endorse and work with the interpersonal theory by Joiner. The main constructs of this theory are really important for us to remember. The first thing to remember is that when someone leaves the service, they lose the primary group to which they belong. It's called thwarted belongingness.

In terms of attachments in the service, they have their other mates there who they work with, live with, connect with, and identify with. All of a sudden, one day you no longer belong because you're back in Canada, and you don't have the key group that you were with originally.

Another characteristic for many of the veterans after they return is that, because of what has happened to them, they can't function as well. There are limits in adjusting to the culture and dealing with the stress. They have a perceived sense of burdensomeness. As many of the veterans say to us, “That burdensomeness means I have to go quiet. I can't talk about what happened to me because, should I do that, it would distress, upset, and hurt members of my family and friends.”

The other thing that I think is important to remember is the acquired capacity for suicide, the capacity to actually take one's life. What I talk about there is that, for many of them, the injury could have been what I call a moral injury. They actually move to a place of feeling that they've failed the troops, that they've failed in a number of ways. They do know how to end their life and believe it may be the right thing to do. That's coming from a different place than most people in the civilian population. Those are the four points.

With a medical release versus a general release, everyone on this committee would know that it can trigger a downward spiral because of “loss of ability to serve due to injury, physical or psychological, stigmatization and feelings of incompetence, and a fragmented identity.” To prevent this chain reaction, special attention should be given to the following constructs, which I've referred to:

Again, “I've lost my primary group of attachment. I don't belong.”

They would say things like, “I'm not good enough,” “I feel rejected,” “I have a weakness,” and “My body is failing me,” and so they move into isolation.

You all know that moving into isolation and retreat from attachment to other groups of people can spiral down into depression. Depression, as we know, is correlated with higher levels of suicidal ideation.

The other one I refer to is burdensomeness, which is a heaviness or responsibility. From my point of view as a psychologist, what happens is that they go quiet. They keep all of their thoughts and emotions inside, and that is destructive to the person over time.

We all know many examples of people who return, and the way they cope is to live in their parents' basement in isolation for a number of years because they can't speak out. They've lost their group. That's a downward spiral and then the risk begins to increase.

Another thing I want to comment on is identified by John Whelan in his book. He is a psychologist of former serving military personnel with whom I have also worked in Halifax. This came back from the U.S. clinicians who are paying much more attention to what are called the moral traumatic injuries to the members.

Most Canadian citizens don't understand that when they come back, they not only have lost their group, feel they are a burden, and so on, but many of them are dealing with and are haunted by things that they have done and should probably not have done.

They see it as a violation of their own ethics and morality arising from the occupational requirements of being in the Canadian Forces. Moreover, these breaches of ethics are often not shared with others due to shame and self-muzzling. The term is, “I've done a terrible thing.”

As we begin to think upstream, when we meet people coming from the culture of the military back into civilian culture, we can begin to understand the interpersonal nature of the stresses that eventually could move them toward the health facilities, but that is early on. In my opinion, the most effective means for the decompression of soldiers returning from deployment includes those that are delivered. From talking to many veterans and our researchers, I would like to say it's a model so that when people come back, they come back into debriefing very soon after that.

What do we mean by debriefing? We don't mean an R and R session where people get a chance to just relax after combat, but a place where they are actually taken care of. It's facilitated in small groups, with several goals in mind.

The goal that I could see in the re-entry transition—and that's what we try to do with our program—is that, before problems develop, you shoot for a healthy transition, because re-entry is a normal kind of adjustment, and we can use knowledge and skills to help people navigate that. Also useful is sustaining connections with serving and former serving members. What I find most useful is to keep military personnel connected with one another and staying in touch when they're back. They will often say that those are the people who know, who have served, and who understand them, but in a country such as Canada, when people come back, they spread. They disperse all the way from the Maritimes to the west coast and everywhere in between, because they don't go back into their intact units, of course.

These small briefing and re-entry debriefing groups could focus on knowledge and skills for development toward civilian work and life and family. Of course, these groups would be staffed by paraprofessionals. Soldiers who have been through successful re-entry would be helping us as well. Also, a chance to have them come back into the small group format for debriefing and accessing knowledge for success would give us a chance to help with assessment for those who need different kinds of services as they move forward.

By promoting increased resiliency and reducing these mentioned risk factors of suicide, and while keeping the previously mentioned goals in mind to ensure that members are connected throughout transition, only then can we help retain capable and healthy members of our Canadian military.

That's my statement.

[The Chair, Liberal, Neil Ellis]

Dr. Westwood, that is excellent testimony.

I have to apologize. The bells are ringing here. We're being called back to the House for a vote. We have to be there for the next 20 minutes.

Procedure-wise, we are at the end of our meeting here and at the end of our study. I think it's the consensus of the committee that we all have a lot of questions we'd like to ask you. We could get those questions to the clerk.

We have them in front of us now, but we won't have time for you to answer them. If we could ask our MPs here to get them to the clerk, the clerk will email them to you tomorrow. Would you be able to get those back to us by the end of the week? I know that's a lot to ask.

[A voice]

It can be later.

[The Chair, Liberal, Neil Ellis]

It could be later, within two weeks, and then we could get them into our report.

[Dr. Marvin Westwood]

Yes.

[The Chair, Liberal, Neil Ellis]

If that's fine with the committee, members, I'll ask you to try to do your questions so that he can answer them in seven minutes in a five-minute time frame.

[Voices]

Oh, oh!

[The Chair, Liberal, Neil Ellis]

I'll make this quick. This is the end of our report. You are the last witness. We are trying to wrap things up. I know that we have a new study coming.

We are missing three members today who have missed the last two or three meetings due to travel and representing our men and women overseas. If there is anything that anybody has to add to the report or anything that you want, or any articles that anybody sees, could you get them to the clerk by Thursday at 3:30 p.m.? I'd like to have everything wrapped up by then. The clerk will distribute everything to the committee.

At our next meeting, we will start our next report. Then we travel.

Again, on behalf of the committee, thank you for everything you do for our men and women to make them better, and thank you for understanding that we have to go and cast a vote today.

[Dr. Marvin Westwood]

I just want to say goodbye to you and thank you for the opportunity to present. You guys are called to service now. I understand.

[The Chair, Liberal, Neil Ellis]

Thank you for those comments.

We have a motion to adjourn from Mr. Bratina. All in favour?

(Motion agreed to)

Thank you. The meeting is adjourned.