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Good afternoon, everyone.
We have a very special guest with us today, Carl Castro, the director of the military operational medicine research program headquarters.
Sir, we're honoured and delighted that you've taken the time out of your busy schedule to be with us today.
I should let you know, sir, basically who we are. We're the Standing Committee on Veterans Affairs for the Parliament of Canada, and we're represented by the four political parties in the House of Commons. We have members of the Conservative Party, the governing party; the official opposition, the Liberal Party; the third party in the House of Commons, the Bloc Québécois; and ourselves, the NDP. Our chair, I'm sure, will be here at any moment. I'm Peter Stoffer, the vice-chair.
Normally, sir, the way we proceed is to allow our guests to make a 10- or 15-minute submission, and then we open it up to a round of questions. Again, sir, we thank you very much.
We are doing a health services study and a review of issues such as post-traumatic stress disorder and other issues that face soldiers, the men and women of our militaries, when they come back and become veterans, and how we can better advise the government on procedures and policies in the future.
Sir, please go right ahead.
I want to highlight maybe just three key things if I can. One of them is that the U.S. Army has officially adopted the battlemind training system as a mental health training program, and I really should emphasize that the battlemind training system is a mental health training program. It was adopted by Secretary Geren about a year ago. This year it became mandated, and it consists of a variety of training modules that soldiers go through pre-deployment, during deployment, and post-deployment. I just want to highlight that aspect.
And the third aspect I want to highlight, which is probably the most important for your purposes, is that it's the only mental health training program in the world that I am aware of--certainly in all of the NATO countries--that actually has randomized group trial validation studies supporting its use. And I highlight that, because it really is evidence-based. What we've shown conclusively now in three randomized group trials is that soldiers who go through the post-deployment battlemind training system up to nine months after having received the training report fewer post-traumatic stress disorder symptoms, fewer depression symptoms, and overall better transition at home.
I guess those are the things I would like to highlight, and I would just open up the rest of the time for questions from the panel.
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Okay. At the end of my answers to your questions, if I actually skip one, please remind me.
Let me first say that we started looking at changing the way we do mental health training because the way it went in 2001 and 2002, when the war in Afghanistan started, was that the U.S. military had no standardized mental health training program at all--neither the army nor the air force nor the marine corps nor the navy. So one of the things we thought would be useful was to standardize the training and at the same time to answer a fundamental question: is mental health training effective or useful?
So we took a step back and asked, what is it that soldiers need to know, and when do they need to know it? So if a soldier is getting ready to deploy to combat for six months or a year or longer, what should you tell them? What does a soldier, a marine, an airman, or a sailor need to know? And when they're in the combat environment, what do we need to tell them and how do we support them to sustain them for the period of the combat deployment? Then when they come home, what do we tell them? What are the things we should tell them?
In the U.S. Army, when soldiers come back they're basically in garrison for two weeks, and then they're kicked loose for a month of leave. So what do you tell a soldier who you're not going to see for a month about mental health?
One of the things we decided right up front is that we needed to take a strength-based approach. That is, we did not want to go in assuming that a soldier or a service member was going to have problems. In fact, what we tell them is that being in military service, they have lots of strengths, and what we want them to do is to use those skills, to use those strengths, to facilitate their transition home and to prepare themselves to go into combat and to sustain themselves there. So it focuses on skills and strengths, not on weaknesses and disorders.
As part of our ongoing assessment, what we always do is that we ask our soldiers, what did you think of the training? Was the training useful? Did you learn something? Was the instructor good?
So we go through a training evaluation, if you will. And across the board, anywhere from the high eighties to middle nineties, in terms of percentage, of soldiers rated the training as either good or excellent. If you can get junior enlisted soldiers to say mental health training is good to excellent at those rates, you've really hit a home run.
I should say also, and I'm sure you're aware of this, that the Canadian Forces actually employs the post-deployment battlemind training in their third location decompression site, and they're getting equally positive responses from those service members who attend that training.
Now, the training itself is unique in a couple of ways. One is that in the U.S. military before the introduction of battlemind training, we would bring soldiers in a battalion at a time. So there would be 700 to 800 soldiers in a noisy auditorium, and a mental health person would come in and talk for ten minutes and then leave. What we've done with this training is that it's designed to be done in small, platoon-sized groups of 25 to 30 service members per group. There is an instructor, a facilitator, but the facilitation is also interactive. While it's didactic in the sense that soldiers get a powerpoint presentation, they're also encouraged to interact and share their experiences.
So the veterans who deployed before can share their experiences of what they went through, how they transitioned and how they adjusted. And that serves to normalize the symptoms and reactions that other soldiers may have, because one of the things we really focus on, for example, in post-deployment is three elements. We focus on normalizing symptoms and reactions; we focus on safety, that is, soldier safety and the safety of families, because we don't want service members coming back and getting into trouble, through violence and stuff; and then we focus on taking care of each other.
So you may be fine, but look at your buddy; take care of your buddy. As a leader, look after your subordinates. So there's a self-aid component to it, and there's what we call in the military your “buddy aide”, or your “mate”, which I think is the word used in Canada. Then we also have the leadership, that junior leader responsibility of looking out for their subordinates as well.
We try to have all of those elements at every one of the training modules, to tell them things to focus on differently, whether it's pre-deployment, during deployment, or post-deployment.
I'm giving it to you in a nutshell, but that's sort of what the program consists of.
Did I answer all your questions? If not, I apologize for that.
:
Let me give you some data that we collected about six months ago looking at our pre-deployment training.
By the time the program came out a year ago, obviously a lot of soldiers had deployed to Iraq and didn't get the battlemind pre-deployment training, and some soldiers did get the pre-deployment training before they deployed to Iraq. While the soldiers were deployed--this was during the deployment--we did a survey and evaluation of the mental health status of the deployed force in Iraq. Of those soldiers who did not receive the battlemind training, about 20% to 22% screened positive for post-traumatic stress disorder. For those who did receive the battlemind training, only about 12% screened positive for post-traumatic stress disorder.
The number is still not zero, so it's not the silver bullet. It's not that you do this training and you are not going to have any mental health problems, but it does significantly reduce the symptoms for post-traumatic stress disorder.
Sir, I would just like to say that I completely agree with you that post-traumatic stress disorder is an injury, and it should be viewed as an injury. I don't know if you're following it at all, but within the U.S. military there's a very big debate going on concerning whether or not the Purple Heart should be awarded for psychological injuries just as it is for physical injuries. As you can imagine, those veterans who were physically wounded are not terribly supportive of that proposition, but it is being discussed.
:
That's a very good question. I probably should have started with this, given that your committee is focused on the veterans affairs.
We have been working very, very closely with the Department of Veterans Affairs. They have actually taken the battlemind training system, which we developed for active duty, and modified it for use for veterans who come to the Department of Veterans Affairs for psychological help. They have not done any systematic studies or evaluations, but they say that the soldiers....
They've used it for all the services. We developed it specifically for the army, because the army was my focus, but they have used it for marines, airmen, sailors, and of course soldiers. They all like it. It gets very high evaluations in terms of being relevant and hitting on the key issues.
One of the things we did not anticipate when we put together the battlemind training system is that it gave our service members a vocabulary to talk about mental health issues, which they were lacking. It didn't really occur to me that our soldiers didn't know how to talk about mental health issues because they lacked the proper vocabulary. So that was very, very important.
In our country, of course, we have the reservists, and when they come back from deployment, they go back to their regular civilian jobs, just like your National Guard does. How do you keep track of those folks?
My last question for you is how are the families involved in this training as well? We have heard that post-traumatic stress disorder can actually be transferred to a spouse or to children, if the individual who comes home is having a very, very difficult time dealing with their personal demons in that regard.
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The reservists and the National Guard in the United States also have to go through this three- to six-month post-deployment health evaluation, including the mental health screen, and they are also required to go through the second battlemind training.
Where we really stumble is with those service members who actually leave the military, because we lose track of them completely. So we don't do a really good job of following our veterans who leave military service, and we're trying to figure out a way to do that in a way that's not considered an invasion of privacy.
In terms of spouses, we do have what we call spouse and couples battlemind training, as well. We have a pre-deployment module for spouses and couples, and a module for post-deployment. Again, it follows the same principles. It's based on the strengths of the spouse, the strengths of the family, and also on the things to look out for when things aren't going well, and on knowing when to get help, either for yourself or the service member. But we don't follow their children at all.
:
Good afternoon, Colonel Castro, and thank you for being here today.
I read the brief, and I find your terms used in there to be very appropriate, that “Battlemind describes the soldier's inner strength to face fear and adversity with courage.” I think it's a very positive message that you're trying to be very supportive. Listening to some of your answers to the questions my colleagues have asked, I find them to have been very informative.
In Canada, we do follow our members who leave the military service; it's part and parcel of what the Department of Veterans Affairs does.
I also found it very interesting that you said that since you began this program, you've managed to cut the mental health problems in half, but you weren't satisfied with that achievement. I'm glad to hear you're not, because the numbers should be far better than that. But that's a pretty significant achievement, when you consider how long you've had this particular program in place. I think you're doing something right, and you should be quite proud of it.
What we're doing right now as a committee is a comparison study of veterans services offered by members of the Commonwealth and the G-8. We've just gone through a very extensive health care review, part and parcel of which was the issue of post-traumatic stress. So all of us are very interested in that.
I was also reading here that you have pamphlets and video presentations to help individual soldiers prepare to return home—which is really good—and that you even address the issue of soldiers who are jumping at loud noises, because that's also part of battle fatigue, or whatever you want to call it.
I want to ask you, is the participation of soldiers in battlemind training mandatory or optional? That's the first question.
Second, I went online to the battlemind program website, where there are links to various websites providing information for families. There are even links to children's websites. So how important is it to provide support for the families?
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Well, on the first question, I think it really is important to understand that a lot of the symptoms and reactions service members have when they are in a combat environment are actually quite adaptive. Being hyper-alert or hyper-vigilant when you're in a combat environment where someone is trying to kill you is actually, I would say, advantageous. But if you're coming home and jumping on the floor or startling at doors slamming, people can think you're a bit wacko—no pun intended—but it's completely understandable and usually goes away with time. So we really do think that normalizing those symptoms and reactions with the expectation of full recovery is key.
As for the video links for children, and stuff, we think that the more information people can get the better. There is a very vocal minority, I would say, who think that if you tell soldiers and family members what post-traumatic stress disorder is, they'll fake the injuries just to get compensation. I categorically reject that notion out of hand. My experience with soldiers has been that our soldiers are patriotic and hard-working, and they're not trying to get something for free—not that there aren't people who do that. But you don't build programs trying to ferret out the few people who are trying to take advantage of them at the expense of those who need help. So that's the approach we've propagated, not only throughout the army, but also throughout all of the services. We're trying to do this.
You had one other question. Did I answer your first question?
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Well, the chairman will not cut you off, sir, so you can take as long as you want to answer my questions, but he will cut me off.
I'm going to fire two quick ones at you. I heard you say in your earlier presentation that psychologists, etc., are handling 30 people at a time, which you say works really well in some cases. We haven't actually looked at doing that; we've been doing it one on one. But having 30 people at a time, if they all have the same symptoms, makes sense. It probably would be a very good way to do it.
You also mentioned that Canada was employing some of the aspects of this battlemind program after soldiers have come off the battlefield and have gone in for R and R. Could you give us a little bit of background on that, please?
:
Thank you very much, Mr. Chair.
Colonel Castro, thank you very much for being with us today. I should tell you at the outset that I am the daughter of a soldier who was in the front lines for six years. When my father came back, he had to be hospitalized for several months because people thought that he had gone mad. He died fighting for his rights. So I am very pleased to see that more effort is devoted to our soldiers coming back from active duty now than was the case in the 1950s.
You said that, instead of decompression, Canadian soldiers in Cyprus could benefit from the same training as is provided to Americans. You provide it before, during and after combat. Our soldiers, on the other hand, just receive training post-combat.
Do you think that the two other parts of the training are critical? I feel that the third part is not enough. A good number of young men and women coming back from Afghanistan suffer from post-traumatic stress disorder even though they have been through Cyprus.
Could they be helped by getting the other two parts of the training? Would it be easy to adapt the training so that we could provide it for our soldiers here?
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That's a very good question. Thank you, Ma'am.
Obviously, we think that we need to take a systems approach, so we now have data showing that the pre-deployment training is effective when assessed during the deployment. We do not have good outcome data from the battlemind psychological debriefings that occur during deployment, but we have anecdotal evidence that soldiers and care providers like them, and we certainly know that the post-deployment training is effective.
So we think that we need to take a systematic approach, where we get them at every phase, because, as I pointed out, just doing one by itself doesn't reduce the rates to zero. So our goal is to get the rates as low as we can. We will probably never get to zero, but it certainly is our goal still to make them as low as possible.
I think it can be transported to Canadian Forces, because the post-deployment has been transcribed and translated to, if you will, Canadian English as opposed to American English.
This is the civilized way to go about it. You have to do it like that, otherwise your head spins.
I go back to the question that my colleague, Ms. Demers, asked. I am 67 years old and I go to the Remembrance Day ceremonies on November 11. I see men of 80 or 85 standing, trembling and crying, and when the ceremonial guns go off, they cover their ears because they just cannot stand it.
I am no doctor or psychologist, but I try to be as informed as I can. Their wives tell me that these men drown their troubles in Beefeater gin. That is a psychological wound to me. I am not here to lecture people. Americans, Canadians, everyone in the capitalist world, the free world, must make some effort to take care of the psychological wounds from which these 80-year-old veterans are suffering.
Those are my comments. So can you comment on that order I have given to take care of elderly veterans?
Sir, you're absolutely correct. There are a lot of veterans from World War II on who have mental health issues, and are actually what we describe as high-functioning. They're able to do their job. They're able to raise a family. They're able to have a spouse who still stays with them and still have symptoms that, if they came in to mental health, could actually get help and feel better.
We try to tell all of the soldiers who are coming back that one of the things with having served your country in a combat environment is you deserve to enjoy life to its fullest without any remorse, and without any pain. You need to come in and get help if you have any of these things. If you're not enjoying life, come in and get help, because you're entitled to enjoy life. Soldiers sort of connect with that sense of they've sacrificed, and now we need to take care of them. The psychological stigma of admitting to a mental health problem is very real; it's large. Many soldiers consider it a character flaw, or character weakness.
One of the things that we do know for certain is when our veterans get older and start going to the Department of Veterans Affairs, one of the key things that they have to treat is post-traumatic stress in the veterans who never got help before, but they are there for other types of physical ailments that our Department of Veterans Affairs takes care of. Now it has really sort of launched this whole training effort within the Department of Veterans Affairs on how do you treat the elderly who have mental health problems. Before, it was always sort of the young to middle age veterans who came in, but as the population starts aging, now all of a sudden we have this very large elderly population with mental health issues, and we have to ask, you know, do the same treatments that work in 20-year-olds work in 80-year-olds? We don't know the answer, but it is being looked at. We need to do a better job. I completely agree with you.
:
That's a great question. This is an issue we're grappling with right now.
The buddy system, of course, is an integral part of the army culture. Looking after yourself and looking after your buddy is critical. We've tried to capitalize on that. But you're absolutely right that when soldiers come back, after three months or six months they are reassigned to different units or they leave the military, so they're no longer connected.
Now what we're looking at doing is starting a pilot project to see if we can have what's called a “virtual” commander or first sergeant. This would allow service members to stay connected via webcam, e-mail, telephone so that they can still talk about and share their experiences.
One thing we know about veterans is that someone who has been in combat doesn't want to talk to somebody who hasn't been in combat, and if they talk to somebody who has been in combat, they'd rather talk to somebody who was there with them. The reason for that is quite simple: sometimes it's painful to talk about experiences in combat. Soldiers who have deployed together have a way of using words that explain entire situations without going into detail.
So this is a very strong, powerful social support that we want to try to keep intact. We're going to try to do it through the framework of a virtual buddy, virtual commander, virtual first sergeant.
:
Yes, you're absolutely correct. One of the nice things, though, if there is a nice thing, about the Department of Veterans Affairs in the United States is that they are the single largest trainer of psychologists in the United States. They have this very robust training program, which you obviously could tap into. It's expanding now, because of the new need.
In terms of resources, early on, in the wars in Afghanistan and Iraq, all the services, and the Department of Veterans Affairs, were strapped for resources. But in the last couple of years the chequebook has come out and there's now plenty of money. Now it's training people and getting the clinicians in place to provide the support.
I think we're good for resources. Now folks are thinking about the long-term effect, as your colleague mentioned. These veterans, who become 60, 70, 80 years old, are also going to have problems. This isn't a five- or six- or seven-year problem. This is almost an entire generation problem of veterans who have to be looked after. So that has to be budgeted and resourced appropriately.
Colonel, once more, I thank you for being here. Post-traumatic stress is a taboo subject for some people. We only started talking about it a few years ago. Before that, it was not talked about, it was hidden. But post-traumatic stress is not just a result of war. For example, people can suffer post-traumatic stress after being raped or being robbed on street.
The battlemind training you mentioned reminds me of budotraining that was very popular in California in the 1980s. It focuses, not on people's weaknesses, but on their strengths and skills, and on learning to use them more effectively.
Could this training be put to other uses so that our soldiers and our veterans could benefit? If people could get the information during their training in psychology, the whole of society would benefit.
:
That's a very good question.
I think there are other groups that can benefit from the battlemind training. And actually, other groups in the United States are using it, particularly the Federal Bureau of Investigation, and our State Department, which also deploys a lot of civilians to Iraq and Afghanistan.
I think it will be useful for those occupations in which we expose people to traumatic events. If you think about the military as an occupation and about combat as being part of that occupation, then I think anything that has those features would be useful for battlemind training. I don't think it would be useful for rape victims, assault victims, children who have been molested, because they are victims through no fault of their own. It's different from combat or occupational PTSD.
Our diagnostic and statistical manuals do not make that distinction, but one of the things that's emerging very early in the research is that these are two different things. There are the victims, and then there's the occupational hazards, like being a police officer, a firefighter, a paramedic, etc. For those folks, I think battlemind training can work. For those people who are victims, I don't think so. They need something different. I think what we're doing for them is appropriate, but it shouldn't be the same thing we try to apply to our veterans, or our occupational injuries, if you will.
I know you have these occupational stress injury approaches. And it is an occupational injury. I think that's how we have to think about it as a military, as a country. You send people to combat, and the hazards of sending people to combat are not only physical injuries but psychological injuries as well.
I know that was a long-winded way to answer your question. I do think that it does have applicability, but not across the board.
:
Okay, I'm fine with that. I'd like everybody to maybe consider....
I'll let you speak, Mr. Shipley, but I just want to add this to the debate. Maybe Wednesday would be better than a Tuesday or a Thursday, just because the report has to be tabled in the House, and that's usually done after question period. There are exceptions to that, but I think it's on Mondays and Fridays, when attendance is relatively low.
So if I were to submit the report on a Wednesday, after question period, then we could hold a press conference, if we want, after the tabling of the report, because I don't think we could really hold the press conference prior to the tabling of the report. And if we have committees scheduled for 3:30 to 5:30, I think you will understand that given that question period ends at three o'clock, it's difficult to fit a press conference in that half hour—if that's what you want to do.
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I assume Mr. Stoffer would second that.
Fair enough then. Unless there's any debate or discussion on that, we'll take a vote on it. So all those in favour of the motion for tabling the report on Wednesday, May 28, with a press release.
(Motion agreed to) [See Minutes of Proceedings]
The Chair: Now I just want to go quickly to May 27, which of course will be the Tuesday. That will be televised and we will be having the minister. It's going to be on the main estimates.
The minister will be here on the main estimates. There also will be the supplementary estimates. If the committee wishes—and this is your prerogative, as it's your committee—to have a motion moved so that you can question the minister on both the main estimates and the supplementary estimates at the same time, then you can choose to do so.