Veterans Affairs Committee on May 18th, 2023

[Dr. Alisha Henson]

I often work from an approach of acceptance and commitment therapy. A lot of pieces of that practice are first to help someone identify their emotions, understand and identify their physiological challenges, and understand their nervous system responses. The stages that follow are around “What do you value? What is your purpose? What is your meaning?”

As we heard from our other presenters today, when they leave the military, they're lacking in direction. Even for some of their transferable skills, they don't understand how those fit into a civilian context. Understanding who they are as an individual—as a civilian—becomes quite a challenge.

One piece, as well, because I work up in Renfrew county, is that there is a lot of isolation. PTSD becomes a very isolated disorder, and when you've had systems that have created more sanctuary trauma, it's very easy to get lost in a rural place. It takes a long time to seek out that help.

As I said before, I'm often spending a lot of time helping with those pieces before we can even do the trauma-specific therapies.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

Thank you.

Ms. Jaquemet, what are some common barriers or stigmas that you've observed women veterans facing when they're trying to seek mental health support?

[Alana Jaquemet]

Thank you for the question.

As some of the barriers they face, oftentimes there's shame associated. There are a lot of feelings. Some of that is the self-stigma they have. There are also some psychosocial issues, some difficulty just navigating the system. That's a difficulty for people in coming forward to seek help.

Do you have anything, Alisha?

[Dr. Alisha Henson]

I think one of the other challenges.... Although Veterans Affairs provides some child care services.... A lot of women veterans I work with have small children, and they're trying to balance how to go to all these different places and their different treatment modalities while having small children at home. Especially if they're a single parent, it's quite difficult to navigate all of those pieces. It becomes, “Do I support my children and focus on them, or do I focus on myself?” Most of the time, being a mom is going to outweigh the system.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

I think my time is up.

Thank you so much.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mrs. Valdez.

Now we're going to have two short interventions of two and a half minutes.

I therefore invite Luc Desilets to take the floor for two and a half minutes.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

Ms. Le Scelleur, to help guide your research, the Chronic Pain Centre of Excellence for Canadian Veterans has established an advisory council.

When I look on the Internet, I see that there are only two women, one of whom is a veteran, out of 10 or 12 people. Is that correct?

[Hélène Le Scelleur]

Yes, you're right. However, efforts are already being made to attract more women, more representation from various backgrounds, be it people from the navy or the air force, or diverse people.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

I'm glad to hear that because, based on the numbers Dr. Zacharias gave earlier, 40% of men and 50% of women experience chronic pain. Hearing from women, especially female veterans, would be very relevant.

Ms. Le Scelleur, what recommendations would you like to see in our report?

[Hélène Le Scelleur]

Thank you for your question.

First, as mentioned, the issue of chronic pain in relation to pain and mental suffering definitely needs to be further addressed.

Second, as other speakers have mentioned, women, who have a maternal role, often give priority to the services they provide to others instead of caring for themselves. I think that's what we need to look at. How can we reach women in their reality?

For example, women must always score higher to be equal to men—I was one of them. They don't talk about the abuse so they don't get left out. However, women should be able to earn the respect they deserve. Even today, it's sad to see that in Quebec, we have a beautiful licence plate that only includes the masculine form, “vétéran”. I would have liked to see the word “vétérane” there, because some women veterans are still being asked if it's their spouse's car.

We really need to put some effort into recognizing the role women play in the Canadian Armed Forces, as well as the reality they experience while they are serving.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

My time is up. Thank you, Ms. Le Scelleur.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Desilets.

Now I will go to Mr. Garrison for two and a half minutes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you, Mr. Chair, although of course that's not enough.

I want to go back to something that Ms. Henson said, which I found very striking.

I'm going to ask you a question. We have heard from serving women veterans that there's a failure.... If your image of a soldier is of a cisgendered straight white guy and you don't acknowledge that women's health needs are different, that will lead to misdiagnosis or overdiagnosis of problems that women veterans face. Is that something you see?

[Dr. Alisha Henson]

Definitely. There is a very clear line between women presenting with personality concerns—depression, anxiety and then PTSD—whereas when the men come in, the PTSD sort of drives the bus, so to speak.

For a lot of the chronic pain, I know that a lot of the women I work with—the gentlemen as well, but more so the women—seem to have more difficulties in getting approvals and in getting the more long-standing treatments they need for the challenges they're having on a physiological level. They seem to get a lot more things coming back, so that they need to apply again and again.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Very quickly, to go back to the chronic pain centre, on the same question of the visibility of the less well-represented parts of the military and veterans community, I know that this committee has heard some testimony that the chronic pain centre has done better in paying attention to women's health needs and to racialized and indigenous needs. Can you tell us something about what it is in your approach that has gotten you more success in dealing with the less visible parts of the community?

[Dr. Joy MacDermid]

I can start.

I think there are a couple of important things the centre has done.

One, it has funded studies specifically about sex and gender, and about how they affect chronic pain. That's been an important thing.

Two, in the evidence synthesis that we've done, we've mandated that sex and gender be considered when we look at the literature. Sadly, one of the first studies we did was to try to look at whether there were different outcomes for multidisciplinary pain treatment for men and women veterans, and we found that none of the studies had actually separated the data for the men and the women. Therefore, we don't know because researchers haven't been reporting that.

As we go forward, one of the things we're mandating is that researchers always report their data for the men and the women separately so we can tell if there are different treatment outcomes for different sexes and genders.

The third thing the centre does is to have very active engagement of people with lived experience in all of the research projects. For example, on the project that I talked to you about, there is a co-author on that paper who is a woman veteran. She has a lived experience of sexual assault and was very engaged in the project at every stage. We're getting, as you see, the valuable experiences that people have to share. It's important that those be part of the research process.

Those are the things I've noticed. I'll ask Dr. Zacharias again, because he can speak from a centre perspective, but in my experiences as a researcher, that's what I've seen.

[The Chair, Liberal, Emmanuel Dubourg]

Dr. Zacharias, please be really quick, because the time is over.

[Dr. Ramesh Zacharias]

I have two things, really quickly.

One is that we insist on veteran partners with all the researchers in every project, because they need that perspective of the veteran.

Finally, the last comment I'd make, Mr. Chairman, is that pain is never just the problem with the individual; it's a family problem. If it's a female veteran, it will affect their partner and it will affect their children. We have been funding a project looking at the impact of chronic pain on the children of veterans suffering from chronic pain. That should be coming out later this year.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much.

Now let's go to Mr. Stephen Ellis for five minutes, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thank you to the witnesses.

Just by way of being absolutely transparent, I served in the military for nine years, but I got out a very long time ago. I'm a physician, and I had a chronic pain clinic. My worlds are crashing together here this evening in a very strange way.

To Madame Le Scelleur, you talked about the transition to civilian life and somebody on the team.... I'm not sure what the focus of your research is. Are you working on any topic around resilience?

[Hélène Le Scelleur]

Thank you for your question.

I'm focusing on the identity crisis that military personnel are going through while transitioning out of the military based on a personal stress injury.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Okay. Thank you for that. Maybe I'll focus on that.

The interesting part of it is that, as I was discussing with one of my colleagues, when you're in the military, you belong to a club, and then, the next day, you're out of the club. I would imagine that for female veterans it's perhaps somewhat more difficult. I can only suspect that, because I'm not a female veteran.

My question is this: Are there times when you were really a part of the club and other times when you felt like you were looking into the club?

[Hélène Le Scelleur]

That's a good question. Thank you.

I would say that I had to prove I was reliable as part of the men's group. From the beginning, I pushed myself to the limits. I was told I was part of the club, but for sure, in some portion of my career when I was going up the ranks and changing positions, it was always that I had to prove myself again and make sure everybody had my back instead of stabbing me in the back.

It was not an easy journey, and it's something that I think every woman who is in the service is experiencing.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much.

Through you, Chair, to Madame Le Scelleur, after that it doesn't matter where you're posted after you leave the military, because you're never a part of that club.

Is that part of the difficulty with the transition? Is it that civilians in general just really do not understand what it was that you experienced and then what you are experiencing in a very unusual way when you are transitioning out of the military?

[Hélène Le Scelleur]

Part of it is also being recognized as a veteran. As a female, I find that people often don't believe that I'm a veteran, that I went to Afghanistan, that I was on the terrain over there, that an IED exploded on me. People look at me like I'm lying or telling the story of somebody else.

I guess the main thing is being recognized in our own experience. That's the difficulty.