Veterans Affairs Committee on May 18th, 2023

[The Chair, Liberal, Emmanuel Dubourg]

We will now resume the meeting.

Welcome to the 53rd meeting of the Standing Committee on Veterans Affairs.

Today's meeting is taking place in a hybrid format. Some committee members and witnesses are therefore participating online.

Pursuant to Standing Order 108(2) and the motion adopted on Monday, October 3, 2022, the committee is resuming its study on the experience of women veterans.

I remind you that all comments should be addressed through the chair.

In accordance with our routine motion for connection tests, I wish to inform the committee that all witnesses have completed the connection tests with the exception of two members of the Canadian Veterans Chronic Pain Centre of Excellence team. We'll do those checks.

Given the study we are doing, and before we welcome our witnesses, I'd like to issue a warning. We will be discussing experiences related to mental health, which can be a trigger for people here with us, the viewers, members and their staff who have had similar experiences. If you feel distressed or if you need assistance, please let the clerk know.

Before welcoming our witnesses, I'd also like to welcome the people who are participating with us on this committee. Online we have MP Patricia Lattanzio, who is replacing Darrell Samson.

Welcome, Ms. Lattanzio.

We also have Randall Garrison, who is replacing Rachel Blaney.

I'd also like to acknowledge the presence of Naaman Sugrue as clerk, who is assisting Mr. Vassilev.

As for our guests, we're pleased to welcome them this evening:

MP Stephen Ellis is here for MP Terry Dowdall.

Welcome, colleagues.

as an individual, Dr. Alisha Henson, clinical psychologist, supervised practice, and Alana Jaquemet, registered social worker and registered psychotherapist.

By video conference, we have, from the Chronic Pain Centre of Excellence for Canadian Veterans, Dr. Ramesh Zacharias, chief executive officer; Hélène Le Scelleur, captain (retired), co-chair, Centre of Excellence advisory council for veterans; and Dr. Joy MacDermid, professor.

We're going to start with Ms. Henson.

You have five minutes. The floor is yours. Please go ahead.

[Dr. Alisha Henson, Clinical Psychologist, Supervised Practice, As an Individual]

We are actually going to be sharing our time today.

[The Chair, Liberal, Emmanuel Dubourg]

That's great.

[Alana Jaquemet, Registered Social Worker and Registered Psychotherapist, As an Individual]

I'll be starting.

[The Chair, Liberal, Emmanuel Dubourg]

Go ahead.

[Alana Jaquemet]

Chair, Vice-Chair, committee members and fellow speakers, thank you for this opportunity to participate in this important conversation regarding the experiences of women veterans.

We're happy that this committee has recognized the importance of including clinicians in the conversation regarding women veterans' experiences. My colleague and I have collectively spent 30 years working with veterans, CAF members and their families. As clinicians, we are often the knowledge brokers, trained to hold veterans' experiences without any agenda beyond healing, yet our collective voices are rarely heard.

We were invited here following a call of concern from a group of clinicians regarding the new Lifemark-PCVRS contract with Veterans Affairs for the rehab program. Our key apprehensions are, one, the program's lack of focus on cultural competency or trauma; two, the need for more transparency between VAC, PCVRS and the clinical service providers; and three, that the depreciation of the clinical expertise of current providers will have a negative implication for the veteran's treatment.

We will reserve the conversation regarding the lack of transparency in VAC programming and concerns about devaluing current service providers' expertise for future meetings. Today we will focus on the importance of cultural competency in women veterans' rehabilitation programming, and we will close by providing recommendations to the committee.

Since our initial communication with PCVRS, we have had multiple meetings with various stakeholders and have attempted to educate ourselves in all aspects of the program. The PCVRS program needs more detailed requirements for training backgrounds for those hired. We feel that clinicians hired for the new program must understand PTSD and complex PTSD, the sexual misconduct lawsuit and the institutional trauma experienced by many women veterans. We have provided definitions of these concerns in the end-notes of our statement.

Many women we work with release not because of deployment-related trauma but after experiencing sustained systemic trauma, feeling silenced or forced to soldier on despite moral and physical injuries, or they voluntarily release because they feel the slow release process increases their risk for suicidal ideation or attempts, thus creating trauma for their families, or they sense that they could no longer survive the process.

We want to quote a veteran who shared her experiences with us.

[Dr. Alisha Henson]

“I endured multiple traumatizing situations while I was deployed to Afghanistan. To this day, most of my comrades know that I was released for mental health reasons and most probably assume it's combat-related, which isn't true. It's 100% mental health issues stemming from prolonged military sexual misconduct. I could no longer be strong. So many years of unacknowledged trauma came flooding to the surface. I tried for almost seven years to get back to how I functioned before, where I could suppress everything and 'soldier on'. That led to years of depression, suicidal ideations, and multiple suicide attempts. No amount of therapy helped, and I eventually ended up with a medical release which I didn't have the strength to fight anymore.”

Currently, PCVRS has mandatory training, none of which speaks to the unique experiences of women veterans. We believe this is a glaring error that they should rectify. Although understanding women veterans' experiences can be learned over time, PCVRS's failure to prioritize women puts them at risk for sanctuary trauma.

Women veterans often report coming forward with their concerns, only to be met by non-culturally competent clinicians. We recognize that the new PCVRS rehab program is vocationally focused, not-trauma focused. Still, we do not want to risk retraumatizing women in a system that is supposed to focus on healing and new beginnings.

When clinicians are recruited who are not culturally competent and who do not understand the complexities of CAF releases, those clinicians are unable to treat women veterans holistically. We would like to bring forward this call for culturally competent clinicians from this spectrum of women and those in the Canadian military colleges, CAF members and veterans.

We will now present our five key recommendations.

We must engage women veterans, clinicians, case managers and other stakeholders when developing and modifying programs for women, using community-based participatory research methods. These methods will promote women veterans' knowledge mobilization in hopes of reducing gender blindness and honouring women's needs and experiences.

All clinicians should be required to have training in two to three trauma-focused modalities and have three years of experience with CAF or veterans. They should be required to participate in training focused on women veterans' experiences and have information regarding the LGBTQ+ community and the sexual misconduct lawsuits.

Clinicians should use progress monitoring measures to evaluate clinician-client relationships, such as the PCOMS.

There should be more shared resources and transparency in research with women veterans and CAF, and education and resource packages on VAC programs should be provided to clinicians.

Finally, we are recommending that CAF allow students of psychology and other accredited programs identified under the Psychotherapy Act to have the opportunity to participate in internships on Canadian Armed Forces bases. This would provide excellent training opportunities for trauma-informed and culturally competent care, increase resources on bases and help develop clinicians who can provide quality care to veterans and civilians upon graduation.

Thank you for your time. We look forward to your questions.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much.

Before going to our next witnesses, we're going to take a really short break. We have to make sure that the sound of our witnesses is okay for our interpreters.

Stay tuned.

I will suspend the meeting.

[The Chair, Liberal, Emmanuel Dubourg]

I call the meeting back to order.

I would like to welcome our two witnesses on Zoom.

We have with us Dr. Ramesh Zacharias, chief executive officer, and Dr. Joy MacDermid, professor. They are appearing by video conference.

I don't know which one would like to do the opening remarks. Previously it was supposed to be Dr. Zacharias or Madame Le Scelleur.

You have five minutes for your opening remarks. Please go ahead.

[Dr. Ramesh Zacharias, Chief Executive Officer, Chronic Pain Centre of Excellence for Canadian Veterans]

Thank you, Mr. Chairman and members of the committee. Thank you for the privilege of presenting to your committee today.

My name is Dr. Ramesh Zacharias. I am the president and CEO and medical director of the Chronic Pain Centre of Excellence for Canadian Veterans. We are an independent not-for-profit organization that was established on April 1, 2020. We are funded by Veterans Affairs Canada to study the effects of chronic pain in Canadian veterans and to focus on improving pain management and overall well-being of Canadian veterans and their families.

Chronic pain affects 20% of the general population of Canadians. That number increases to 40% of veterans, and sadly it affects 50% of female veterans. In addition, 60% of veterans suffering from chronic pain also suffer from mental health issues, and 63% of veterans suffering from mental health issues also suffer from chronic pain.

In the last three years, CPCoE has funded 43 research projects involving 24 institutions across Canada, including seven postgraduate research projects with master's and Ph.D. candidates. One candidate is our next presenter, Hélène Le Scelleur, a veteran of the Canadian Armed Forces. She will share her remarkable story shortly.

Sixty to seventy per cent of my clinical practice involves veterans at the Michael G. DeGroote Pain Clinic at Hamilton Health Sciences. The statistics I have presented are reflected in the population of patients I treat every day. It is critical that both pain and mental health issues be treated concurrently to achieve any relief from these debilitating chronic conditions. Our clinic has the best success in treating veterans through an interdisciplinary team using a biopsychosocial model of care.

I will now have the co-chair of the CPCoE's advisory council of veterans, Hélène Le Scelleur, share her amazing story of resilience.

[Hélène Le Scelleur, Captain (Retired), Co-Chair, Centre of Excellence Advisory Council for Veterans, Chronic Pain Centre of Excellence for Canadian Veterans]

Thank you, Mr. Chairman.

Thank you to all members of the committee for inviting me to testify on this important study for women veterans.

I joined the Canadian Armed Forces in 1990 at the age of 17, as one of the first women to join the combat arms in an effort to increase the number of women in service. Needless to say, our presence in the infantry was not welcome. As soon as I joined the forces, I had to work harder than any man just to be treated as their equal. In this very homogeneous male world, I shed my femininity to make room for the identity of being a soldier and gain respect.

I would like to mention that at the time, the harassment guidelines were not yet very developed, which kept the environment very toxic for us women. From the beginning and throughout my career of 26 years, I was subjected to misconduct by men. In the beginning, it was to make me give up, but later on it was to appropriate my body—from verbal harassment to touching to forced kissing by superiors. It was also the invasion of my private life as a way to force me to accept the unacceptable. However, I consider myself lucky: I am not one of those who was raped.

This introduction is important, because it represents the often forgotten reality of women veterans. This is in addition to other suffering that may be more predominant, such as psychological or physical injuries.

For my part, I live with both. I developed post-traumatic stress disorder following my mission in Afghanistan and I believed my chronic pain was directly linked to it. However, I realized that I had been abusing my body for a long time to perform and maintain my hard-earned position. For example, when I joined the forces, I had to accept boots that were too big for me and equipment that was inadequate for my size. I had to overtrain despite injuries and hide my physical pain so as not to be judged or rejected by my team. All this was because we had to succeed in the mission. We had a duty to “push through the pain”.

That being said, suffering in silence in order to perform becomes a huge barrier to seeking help. I am one of the many women who learned to keep our hurt, abuse and suffering quiet in order to gain respect as a military member—but what happens when our careers are forced to an end that we did not choose, and our wounds, whether physical or psychological, become symbols of the end?

I believe it is important to consider that this transition to civilian life is not without its challenges for women veterans, because in addition to coming out, they must also face justification that they are also wounded veterans and they deserve respect. It also becomes crucial to realize that it is impossible to address chronic pain without exploring the underlying suffering that is experienced in a career as a woman in the forces.

Once again, Mr. Chairman and members of this committee, I am extremely grateful for this opportunity to testify before you. I sincerely believe it is important to consider that the needs of female veterans differ from those of men and that the response to chronic pain must be adapted and allied to that for psychological pain.

I will now turn the floor over to Dr. Joy MacDermid.

[Dr. Joy MacDermid, Professor, Chronic Pain Centre of Excellence for Canadian Veterans]

Thank you.

I will echo the thoughts of thanks for sharing the work. I am actually one of the researchers funded by the Chronic Pain Centre of Excellence to investigate issues in chronic pain. I focus on understanding the impact of sexual harassment, using a recent confidential survey by which we surveyed 300 Canadian veterans.

What we found was that the odds of a woman veteran experiencing sexual harassment during her military service were more than 20:1 compared to the case for her male colleagues. Women were also at double the risk for verbal abuse.

Our research and other reports, and the lived experience you've just heard about from the female veterans, show that women who come forward are often dismissed or even punished for reporting these problems, so many stay silent, unlike the people we've heard from today.

Our research was unique in that we also measured psychological distress and the severity of chronic pain. What our study illustrated was that there is a pathway between sexual harassment and psychological distress, and there is a pathway between psychological distress and having persistent severe chronic pain. This data supports what you've just heard from the experiences of veterans: that sexual harassment and abuse result in not only long-standing psychological problems but also long-standing physical pain, so we cannot solve chronic pain without managing the underlying causes.

Therefore, we confirm that there is a need for protection for those who report discrimination, for systematic changes to culture and training, and for specialized interventions for people experiencing chronic pain that has been aggravated or caused by discrimination.

I thank you for listening.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much for your opening remarks.

I'd also like to take this opportunity to thank you for your service, ladies, which you shared with us in your opening remarks.

We will now go to the first round of questions. There will be six minutes per speaker.

I would like to invite Mrs. Cathay Wagantall for six minutes.

Go ahead, please.

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

Thank you very much, Chair.

I do thank you all for being here tonight and for sharing your life experiences and your concerns. I hope we can learn a great deal from you.

Ms. Le Scelleur, thank you. I've read your stories and what you've shared in the media. There was a Globe and Mail article in which you said, “so just as she was working on a hypothesis that the military exacerbates mental illness and suicidal thoughts by cutting soldiers off from their social support system.”—just as you were working on that—it says, “she turned in her ID card and was escorted to the door of National Defence Headquarters. 'I started to cry,' she said. 'It was hard to believe that's how it ends.'”

Were your superiors aware of what you were working on?

[Hélène Le Scelleur]

No. At the time I was still doing my master's, and it was afterwards, when I was transitioning totally out of the military—six months after—that I decided to pursue my work to the Ph.D. level.

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

Thank you.

You turned in your ID card. We don't know what that's all about. Did you suddenly get told, “Come here. Drop it here. Goodbye.” How does that happen?

[Hélène Le Scelleur]

Thank you for the question.

I hope that today it's different. I released in 2016, and back then when you were doing your last day as military personnel, you entered the building at 101 Colonel By Drive in Ottawa as a military person, so as a trusted person. The minute I went up the stairs and was meeting the last person with my piece of paper saying that I had quit—my quittance to every department—the civilian person who took my card in the ID section just said to me, “From now on you have to be escorted.”

I felt as though I was no longer trusted, as though I was no longer part of anything. It was like I was a prisoner or something and I couldn't be left alone in the building that five minutes earlier I was trusted to be in. My clearance level was top secret, and in a minute I had to be escorted out of this building, so it felt awful.

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

Okay. I understand what you're saying now. Thank you. It's hard to discern from this exactly what you're saying here. Thank you.

You had a desire then to work on finding ways to improve that transition so it wouldn't be so stark and whatnot.

[Hélène Le Scelleur]

Thank you again for the question.

It was mentioned in the opening remarks from the person before us. When you leave the military, it's....

Can you repeat the question again? I lost my thought.

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

I guess I was still basically making a comment about the fact that you want to see things improve, and I think that they are.

Do you want to explain just a little bit about how that encouraged you to go in the direction you wanted?

[Hélène Le Scelleur]

The person talked about that before. The vocational part of the transition is really well addressed and so was a portion of the health services, but for me, the psychosocial portion of it, the identity portion, was not addressed. When I left the military, I felt that I had been built as a soldier, but nobody helped me to become something different from the soldier I was. That was the identity crisis that I faced. I decided to study that and to do my research based on that.

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

Just on quick consideration of that, you say you were built into a solider. Does it require removal of that civilian sense of values to become that solider and then not have the opportunity to see yourself kind of made whole again as a civilian?

[Hélène Le Scelleur]

Thank you for the question.

I joined when I was 17. I was not even an adult. The army became my parent. The army became the family I needed, with the structure and all the guidance. When I got kicked out at 43 years old, I got kicked out without anything—nobody telling me where to go, what to do, how to behave. I was still waiting for my mission. I don't know if you can understand what I mean.

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

Can I just ask you why you are saying “kicked out”? That was kind of where I was heading with that first comment, but you indicated that you had to go through all those procedures to leave the building. When you say “kicked out”, do you mean basically you were no longer qualified to serve because of health issues? Was it a medical release? Is that what you're saying?

[Hélène Le Scelleur]

It was a medical release. At the time, in 2016, the fact that you received a diagnosis of post-traumatic stress syndrome automatically meant that you were being released for medical reasons with no way of being accommodated.