Veterans Affairs committee  I'll start with statistics. When I say 40% to 60%, it's based on different studies that have been published in terms of treatment outcomes. It's not necessarily 40% to 60% concerning those specific individuals, but multiple studies. I think one of the studies published in The American Journal of Psychiatry quoted that if individuals follow evidence-based treatment, about 50% will fully recover.

Veterans Affairs committee  I'd have to do some of my specific research, but I think there is data out there that patient or client attitude regarding seeking treatment behaviour has an impact on recovery. There is some research that's been published on patient choice as a predictor of treatment outcome. As a clinician, being non-military, we have to look at patient attitude as something that's fluid.

Veterans Affairs committee  In terms of a formal debrief, I'm not sure. Just to better understand, if we're looking at the clinical aspects, we have an interdisciplinary team meeting where we discuss the patients and the assessment and treatment plan.

Veterans Affairs committee  Do we have enough money to do what we need to do? That's a good question. You'd have to ask my manager. One of the challenges.... Probably what is needed is better statistics on where the veterans are currently living. My understanding is that's currently being done through the Canadian Institute for Military and Veteran Health Research.

Veterans Affairs committee  Just so I understand the question, are you talking about somebody transitioning out of the Canadian Forces into civilian life?

Veterans Affairs committee  That's a fascinating and interesting question. First, I don't think I have the data to provide an answer to that, but I can give you what my opinion would be, just so I clarify that. Not everyone who transitions out of the Canadian Forces necessarily needs a mental health worker.

Veterans Affairs committee  I think not only at our clinic but in the network of OSI clinics, we don't have an exclusion criteria. As long as individuals have a mental health condition, we can assess and treat them. When we look at our stats—and I don't have the exact stats but we can provide them for you in terms of the demographics—this is a treatment-seeking population referred by their VAC case manager or from National Defence from their medical officer.

Veterans Affairs committee  I'm probably not aware of the entire network across Canada, the challenge in recruiting and retaining clinicians. However, we haven't had that much difficulty. We provide a lot of education and training for new staff, and we also, in collaboration with the Canadian Psychiatric Association and the Canadian Psychological Association, so my colleague psychologists, provide education and training to civilian clinicians.

Veterans Affairs committee  Some of this has been published in The American Journal of Psychiatry. In research that specifically looked at our treatment outcome data, for both one-year and two-year treatment outcomes, for those who are receiving psychiatric care, that's medication treatment in addition to psychotherapy, the talking therapy, these are individuals who, on average, would have suffered with chronic PTSD and the vast majority, almost 80%, had major depressive disorder.

Veterans Affairs committee  In terms of medication treatment for PTSD, there's very little indicated other than the SSRIs, the selective serotonin reuptake inhibitors. What we would tend to do, as clinicians, is we would try to treat the comorbidities aggressively, so including treating major depression, other anxiety disorders and using general protocols that have been established for treating depression.

Veterans Affairs committee  I'd like to thank everyone here for inviting me to speak on this very important topic of mental health and suicide prevention in veterans. I'm not going to speak for a long time, because it might be more interesting to have a question and answer presentation. I'll give some information about my own background.

Veterans Affairs committee  I think so. We're getting a significant number of veterans who have been out for more than 10 years. We also get World War II vets, still, and Korean veterans who are seeking treatment for the first time. In our experience at Parkwood, what has helped is to have a media announcement or some sort of presentation.

Veterans Affairs committee  Well, I think that for more than 10 years the stigma has been decreasing and I think that the public in general is more supportive. There have been a lot of good public anti-stigma campaigns, so I think it is starting to inch away at it. I think it's still there. I think it was discussed already that as much as we have it in the public forum, it's still on the individual.

Veterans Affairs committee  I think that in those cases we have an obligation if somebody is acutely suicidal or acutely homicidal. As a psychiatrist, part of my role is that I may have to certify them, meaning I can contact the police and have them assessed and hospitalized against their will.

Veterans Affairs committee  I would agree in terms of working with the current national associations. Part of the mandate of the National Centre for Operational Stress Injuries at Ste. Anne's Hospital is to work with the Canadian Psychiatric Association, because they also have a mandate to provide education.