National Defence committee  The recommendations we made in 2017 I think really encouraged trying to be very specific around suicide-specific interventions. There has been a lot of effort on improving access to treatment for depression and post-traumatic stress disorders, but there are specific suicide prevention strategies and psychological therapies.

National Defence committee  On Zoom?

National Defence committee  My role with the panel was really to chair the committee and make the recommendations, so I have not been following the specific changes that have occurred, but Dr. Harris may want to add something.

National Defence committee  It's a real honour and a pleasure to be here today, and the testimonies of the previous speakers were really heartfelt. Thank you to everyone. I'd like to also acknowledge that I'm a psychiatrist at the University of Manitoba, a department head, and I have worked at the Veterans Affairs Operational Stress Injuries Clinic in Winnipeg as a consulting psychiatrist since 2009.

Health committee  I don't know enough about the process, but I agree with you that PTSD affects many Canadians, and limiting it in some ways can be a challenge. I think one of the important things to consider is that this is a work-related mental health issue. It brings a different framework to it if the violence or assault is not at work.

Health committee  I think a broad framework can cover the range. There is now more recognition in the American Psychiatric Association's diagnostic and statistical manual. The most recent edition added the criteria of trauma exposure related to work. Before that, it wasn't really recognized. Repeated trauma exposure among paramedics, firefighters, or the police wasn't part of the criteria.

Health committee  No. This goes back to the point that PTSD is PTSD across the different populations, but certain types of work put the person into the situation over and over again. Senator Roméo Dallaire talked about the helplessness in observing and not being able to respond to the terror he saw in Rwanda.

Health committee  As Ms. Harris has pointed out, it's really important to move the conversation forward. The other issue is that it engages work-related injuries. That is a very important issue. We know that post-traumatic stress is very important. Children, women, first nations communities, and refugees all suffer from it.

Health committee  I just want to add one comment, that it is really important to evaluate any interventions around trauma. We do know that, for example, critical incident stress debriefing, which is a group-based intervention after someone is exposed to trauma, was created to prevent PTSD, but it turned out to actually not be helpful and potentially cause harm.

Health committee  It's really important that this federal framework encourages evidence-based policy in interventions, because the challenge in trauma and PTSD is to remember that trauma is 80% of the population. So we really need to think carefully about the interventions. However, I completely agree that training people when they're going in to work, to have skills to manage what they're going to be exposed to, is really important.

Health committee  I think the aim of the bill is really to increase the conversation about and awareness of PTSD in Canada. I really strongly support the bill. I think education is really important in differentiating between what is normal and what is abnormal. One of the things I've learned is that if someone is exposed to a serious, traumatic event, such as seeing a suicide or the sudden death of a close loved one, and they're still suffering and not back to their normal self about one month after the traumatic event, that one month is an important time point.

Health committee  As I think through it, I think it is very important to move it forward. We do know that first responders are at higher risk for PTSD than civilian populations. I'm absolutely supportive of moving the bill forward. I think the addition of indigenous women is an important one to consider.

Health committee  Yes, there is an urgency to this. I think the rate of PTSD among paramedics is not well known in Canada. Dr. Nick Carleton from the University of Regina is leading a study on this. Soon data will be available in Canada, but certainly there is much more recognition both in Canada and the U.S. that people are exposed to significant traumatic experiences as part of their work.

Health committee  There have been trials in the U.S. using virtual reality exposure treatments so people can have what's called stress inoculations so they can be prepared to go to war. We have recently reviewed the literature on resilience training. Most of the studies that have been done around those trials have not been shown to be effective.

Health committee  One of the first and most common barriers is not understanding that the symptoms the person is dealing with are related to a mental health problem. Often the symptoms start to come up as sleep difficulties or difficulties with irritability or concentration, so the person doesn't understand what they're dealing with and often blames themself.