Thank you.
Good morning, Madam Chair and honourable members of the committee. It is an honour to be here speaking with you today.
My name is Dr. Nicholas Held. I serve as the interim scientific director of the Canadian Institute for Military and Veteran Health Research, otherwise known as CIMVHR.
CIMVHR exists to enhance the lives of Canadian military personnel, veterans and their families by harnessing the national capacity for research and mobilizing this evidence into care, policy and practice. We were established by Veterans Affairs Canada as an arm's-length, expert knowledge mobilization centre that facilitates research to address the unique demands of military and veteran health.
Since 2010, CIMVHR has built a network of 50 Canadian universities and colleges, in addition to global partners, which have agreed to work together to address the health research requirements of the military, veterans and families.
For the sake of time, I will just highlight a couple of things but will try to skip through some of this.
We lead competitive calls for research and conduct independent peer review. We also have a large scientific conference known as the CIMVHR forum. It was in Ottawa a couple of weeks ago. We had about 800 people come in from Canada and all across the world. I want to highlight that suicide risk and support continues to be an area of work at these conferences. This year, there were eight dedicated presentations and a suicide theme to understand the impact on military and veteran health.
We also founded the Journal of Military, Veteran and Family Health, which is a peer-reviewed academic journal. It's through these avenues that we connect the research, care and policy systems so that evidence moves into clinical practice, policy and community practice. The journal itself has published a body of work related to suicide risk and prevention across serving members, veterans and families.
A search of the journal will yield over 160 items that mention suicide. A quick summary of those, since I don't think anyone has probably read all 160, is that key areas of focus might be the military-to-civilian transition, complex comorbidities of other health-related challenges, the impact and support of families, improving the cultural competency of our health care providers and improving data linkages to larger datasets that we need available in this country. There needs to be continued investment into this population data so that we can understand the health needs and outcomes of service members throughout their service, across various conflict cohorts and in the years of life after service.
Suicide among veterans continues to be a persistent challenge that deserves considerable attention. It has been reported that male veterans are 1.4 times more likely to die by suicide compared to civilian men, and female veterans are 1.9 times more likely to die by suicide compared to civilian females. Further research suggests that when that occurrence of suicide might happen is at a different time point. Male veterans die by suicide, roughly—on average—three years after transitioning from service, while females, on average, die by suicide 20 years after service. This is one example of a critical point.
These differences point to two important areas of understanding. First, exploring veteran suicide as an entire group is not enough, as we need to understand that diverse experiences in service can relate to ideation, attempts and death by suicide. Second, there needs to be a continued investment in suicide prevention that does not consider suicide as a single point in time but as a long-term approach to understanding and managing risk.
The literature pinpoints many different factors that increase the risk of suicide, such as traumatic brain injury, chronic pain and depression, to name a few, but it's critical that we consider suicide from a whole health and whole life course perspective.
In 2018, CIMVHR co-led a round table with Veterans Affairs Canada and the Canadian Armed Forces to engage a whole-of-community approach to suicide prevention. A lot of this was based on Dr. Jitender Sareen's work and funded by CIMVHR. Recommendations that came from this round table—and again, this was 2018—were that we need to provide education, training and information for practitioners; improve support for transition across the life course; provide support for identity challenges across transition; promote whole-of-community communication, collaboration and knowledge sharing; explore policy considerations for suicide prevention; evolve whole-of-community approaches to care for the suicidal person; and reduce barriers to services. At that time, seven years ago, it was highlighted that we need more information in several areas. That includes people who need the care, the role of families, understanding gender differences, developing methods for improving the listening skills of our health care providers and finding ways to effectively turn research into action.
More recently, we co-lead the Five Eyes mental health research and innovation collaboration with Phoenix Australia, aligning research priorities and bringing policy-facing synthesis to ministers across Canada, Australia, New Zealand, the U.K. and the United States. In 2024, the collaboration published a concise Five Eyes view on suicide in military and veteran populations. The report highlighted that, while numerous risks have been identified, it remains challenging to determine who will attempt suicide. After decades of investigation, understanding of the causes, prediction and prevention of suicide among military personnel and veterans are still limited. The report highlighted risk factors. They include the presence of mental and physical health problems, cumulative trauma exposure and medical or involuntary discharge from the military.
The report did highlight recommended next steps during service, which might include early identification of mental health problems and suicidality, starting from enlistment with interventions throughout the career and life cycle; easy access to evidence-based personalized care; reducing stigma and other barriers to help-seeking; and education for the individuals, peers, families and communities.
Following service, similar prevention strategies have been recommended, including providing support during and after the transition from military to civilian life; considering the specific circumstances and environments that veterans are transitioning into; and strengthening our support system for families, equipping them with knowledge and skills to aid in this transition.
Thank you.