Ladies and gentlemen, good afternoon.
I would like to begin by thanking the committee for inviting me to testify this afternoon on the state of mental health in the Canadian Forces, particularly as it relates to operational stress injuries.
As we said in our December 2008 special report, operational stress injuries will remain a significant challenge for the Canadian Forces and a real hardship for Canada’s soldiers, sailors, airmen, airwomen, and their families for many years to come.
[Translation]
In June 2009, the House of Commons Standing Committee on National Defence estimated that, of the 27,000 Canadian Forces members who had served in Afghanistan between 2002 and 2008, approximately 1,120 would exhibit symptoms of post-traumatic stress disorder and 3,640 could exhibit some sort of mental health concern.
These statistics do not take into account those Canadians Forces members who have served in Afghanistan after 2008, nor do they consider they military personnel who served in dangerous and demanding military operations before the Afghanistan mission, including in the Balkans, Rwanda and elsewhere.
In many respects, operational stress injuries will be a generational challenge for the Department of National Defence and Veterans Affairs Canada, the Canadian Forces and the Government of Canada as a whole.
So I am pleased that this committee is studying these issues. Your work is incredibly important for our serving members, our veterans and their families who have given so much of themselves in service to Canada.
[English]
Mr. Chair, joining me today is Mary McFadyen, our general counsel. She has worked on these issues for many years now. Mrs. McFadyen was the interim ombudsman for 14 months before I took the position.
We have provided committee members with a brief paper meant to summarize the work undertaken by our office in the area of operational stress injuries. Over the next few minutes, I will discuss some of the progress that has been made by National Defence and the Canadian Forces and a number of areas that need more urgent attention. I will also describe our intentions vis-à-vis operational stress injuries in the months to come.
Before getting started, I would like to be clear that our evidence-based research regarding operational stress injuries is from 2008. I took my position in 2009. Our research is dated 2008. We have monitored the issue closely since then, but we have not yet undertaken a third substantive follow-up review. Still, I believe a number of the concerns raised by our office in 2008 remain relevant.
Mr. Chair, our office has been engaged in these critical mental health issues since 2002. We have released four different reports and more than 40 recommendations meant to improve the care and treatment received by Canadian Forces members suffering from post-traumatic stress disorder or other operational stress injuries.
In our December 2008 report, we found that National Defence and the Canadian Forces have made progress in identifying, preventing, and treating post-traumatic stress disorder and other operational stress injuries. However, we also found a number of cases in which military members and/or their families did not get access to the care they so desperately needed, and we have seen that the consequences for individuals who fall through the cracks are often devastating and long-lasting.
[Translation]
One of our most pressing concerns was the fact that the negative stigma associated with operational stress injuries remains a real problem at a number of military establishments across the country. In fact, mental health caregivers from every region in Canada raise this as one of the biggest challenges still facing the Canadian Forces.
So I was pleased to see the launch of the Mental Health Awareness Campaign in the summer of 2009 to address the stigma associated with operational stress injuries.
I was also pleased to see some of the other initiatives undertaken by Defence since we released our latest special report in 2008—including the creation of the Joint Personnel Support Unit to ensure a more coordinated and integrated approach to addressing operational stress injuries.
[English]
At the same time, we know there are areas that still need more attention. For example, the first recommendation made by our office in the 2002 special report was for the Canadian Forces to develop a database that accurately reflects the number of Canadian Forces personnel affected by stress-related injuries.
Without reliable data, it is very difficult to understand the extent and seriousness of the problem and to design and implement effective national programs to help those suffering from an operational stress injury. The data could also be used to target education and training initiatives to where they are most needed. I would say, also, that these data could help to better identify the requirements for additional caregivers and additional infrastructure. It is unfortunate that National Defence has been so slow in addressing this recommendation.
Another issue that we continue to track is the care and treatment available to the families of military members suffering from operational stress injuries. In December 2008 our office was unable to find any evidence of a coordinated national approach to ensuring timely access to care and treatment for the families of military members suffering from post-traumatic stress disorder or other operational stress injuries. The availability, quality, and timeliness of care varied greatly from military establishment to military establishment.
When a Canadian Forces member has an operational stress injury, it is a significant challenge for the whole family, not just the member.
[Translation]
We also remain concerned about the stress and burnout in the military caregiver community, including chaplains, social workers, physicians, psychologists, psychiatrists and mental health nurses.
Mr. Chair, these issues will be a priority for our office as we look to launch a third follow-up investigation into the issue of operational stress injuries in the Canadian Forces.
We recognize and welcome the progress that has been made by the Canadian Forces to prevent, identify and treat military personnel suffering from mental health injuries. At the same time, the large number of current military sufferers—and even larger number of anticipated sufferers—have led us to the conclusion that this issue demands additional review and evaluation by our office.
I expect to launch this follow-up investigation in the next few months.
[English]
Mr. Chair, as I mentioned earlier, we believe that operational stress injuries will be a generational challenge for our country, so I am pleased that this committee has turned its attention to addressing this challenge.
At this time, we stand ready to provide any assistance we can to the committee.
Merci. Thank you.
Mr. Chair, with reference to the database, as I said, we've done some work in this particular subject. We produced our report in 2008. For the past two years there hasn't been too much follow-up on some of those issues. I must say, though, that since I took my appointment in 2009, I've been going on outreach visits to bases and so on.
There have been some creations, such the joint personnel support units in all kinds of organizations, in order to coordinate the care and services provided to members and their families. Still, to create a database, it seems that it's easier for DND or the CF to have a database on physical injury than on mental injury. I don't have the proper means to provide some intelligent recommendations here, but to me the database of people suffering from post-traumatic stress injuries is key.
As a lot of the committee has identified, this is not going to go away in the near future. It's going to increase in the future, and people see great demands on our medical care and everything. This database will be very useful in identifying how many people are suffering, not only in order to deliver the proper care but also to dictate additional infrastructure or additional requirements for health caregivers.
So I think it is important, and we've been asking the department for the last eight years, to make sure they have this database in order to treat this psychological injury as early as possible in order to prevent, as much as possible, the result of suicide. It is not necessarily linked with it, but it is definitely better to address the issue at the origin rather than to treat it at the end.
:
Good afternoon, Mr. Daigle. I am pleased to hear you speak both French and English. It's interesting, because this sometimes helps us understand better.
I have a few questions with regard to some of the testimony the committee has already heard.
Take the case of Frédéric Couture. This young man came back from Afghanistan, where unfortunately one of his limbs had to be amputated. He tried to commit suicide in the theatre of operations, when he was with a few of his colleagues. After that incident, he was hospitalized.
Last week, we learned that he had come back to Quebec without having received any psychological treatment in the theatre of operations. I imagine that you know the story. His mother, who is looking after him, never really found out what had happened. He ultimately took his own life.
I imagine that, in your capacity as ombudsman of the Department of National Defence and the Canadian Forces, you have heard this kind of testimony many times.
It is often the case that those who suffer from post-traumatic stress syndrome do not readily reveal their symptoms. It's not like a pimple appearing at the end of your nose overnight. The process involves therapy to screen out the condition in a person. Generally speaking, men are the ones who are afflicted with PTSD, and we know that they are less inclined to seek treatment than women are.
I would like to know what you think about this matter, even though we have heard others speak to the issue several times. When people are in the armed forces, we look after them. However when a person leaves the armed forces, it's as if they cease to exist, they do not have access to services anymore, they are ignored, as are their needs, especially the psychological ones.
Have you received many complaints about this type of thing?
:
Mr. Chair, I will answer the more specific questions, because these are the issues that I am dealing with now, whereas the report was published in 2008.
To answer your question, I would say that our office is currently reviewing complaints. What you alluded to is something that I felt when I visited certain military bases.
First of all, although the department did launch an awareness campaign in 2009, the stigmatization still exists.
I meet young mothers who confide in me and tell me that their husband would never want them to say that they are ill, because they would never want to come out and explain the problem. When these people are sick, their first respondent, their first service provider, is the family. The wife and children look after the spouse—or the husband looks after his spouse. This is a tremendous burden for the actual families.
Right now we have families who have not yet grieved
[English]
--they have no closure yet--
[Translation]
for their spouse or their son. Some of them, as you mentioned, committed suicide.
We are asking people to come to our office about these things. So if you are aware of any... We are continuing to monitor some of these families closely. I am corresponding with the minister on these files.
So that is one thing that exists. Despite the stigmatization, young people, as you correctly said, are not going to confess to having any weakness, because they have the warrior spirit.
Families suffer a great deal as a result. After an operational deployment, if families need help, whether it be the closest family member, the mother, father or spouse, we bring them together for a debriefing. At that time, we tell the family what indicators to observe in their injured family member.
I'm not sure if you've had a chance to see it yet, but last Sunday The Chronicle Herald, a newspaper in Nova Scotia, did a really interesting article on military personnel who had been more or less forced out of the military.
One of the biggest problems I find for service personnel is that when they're no longer deployable, it means they're no longer employable within the military. They get, in their words, “kicked out” of the military. Some veterans have even said that what DND has done is offload the problem onto VAC.
In the private sector, where I used to work, in the Canadian airlines there was a thing called “duty to accommodate”. When you became injured, there was a responsibility on the company to try, as well as it could, to accommodate you to go back to work. I don't think that applies to the military, because many service personnel who believe they can still work in DND have been asked to leave. They're being “3(b)'d”, which means medically released from the military. That adds a tremendous amount of stress to them and their families.
As you know, sir, the DND is a culture. It's a way of life. It's in their DNA. It's who they are, and all of the sudden that is gone, for whatever reason, through no fault of their own and because of an injury. Now they have to go into a completely different world that they haven't been adjusted to for quite some time.
I'd like you to expand on something for a second. If you don't have the answer for it now, could you provide it later?
First, how many DND personnel who are serving right now receive a VAC pension? Then, on the question of the duty to accommodate, is DND doing a good enough job of keeping injured soldiers within the department, or are you finding a rush out the door--once you're injured, you're no longer employable with DND?
:
I must admit that since we did those three reports.... That's the 2002 report, the follow-up in December 2002, and the other follow-up in December 2008. And I'll do another one, because this is not going to go away, and it's very important.
If I can share my own first impression, I must admit that there is a lot of writing but not enough acting. We write a lot of things. We produce a lot of CanForGen, “We will do that. We will produce a policy to address this.” But what happens on the ground, and the reality of things, is that it's still not there.
There are issues where, I'm sorry, a bureaucratic answer, to me, is.... You know, there are issues that could be looked at as having more priority.
Families, more and more, need to be looked at. Families are not getting the care and services that we all say they will get. They're not part of the armed forces, but they are very much linked to everything that the spouses are going through.
The database—I'm going back to that—is important. We're looking at what comes ahead, but it seems to me that we don't move enough on that. In 2002, eight years ago, we were asking for work on the database to identify the scope of the problem.
Again, with all those budget cuts, we need to bring in enough money and resources to increase the number of caregivers, because they will need more caregivers in the near future. The caregivers are very important. We all talk about what's happening now, but if you don't have the professional health caregivers, it's not going to go away. It might be worse, because people won't come forward and you'll lose them too.
So the database is very important. Then we need to take care of the caregivers by taking away their administrative function and putting the emphasis on the clinical duties that they were hired to do. Then, obviously, there is family. We cannot dissociate any of those things from the family anymore. They're really part of the issue and the challenge.
:
Thank you so much for allowing me to appear before you. I greatly appreciate this opportunity and can confirm that, by simply having undertaken this study, your committee is bringing a lot of hope to veterans who are suffering in silence at home.
I was fortunate to be able to serve my country for 14 years. Had I not been injured during a mission, I would still be serving our great country. The last mission I had the honour of serving in was in East Timor; I was there as an infantry soldier in an airborne division. I was injured in the field. When I arrived at the Quebec City airport, nobody was there waiting for me. And yet, I was repatriated from Australia for medical reasons. Let me tell you that I quickly understood what it feels like going from a hero to a zero when I arrived at the Quebec City airport and saw no one there to greet me.
That led to a lot of distress, both physical and psychological. We know that soldiers think of themselves as the strongest of the strong, those who are admired, feared and respected. Once we become a problem for medical reasons, we do not feel like speaking out because we will have to face both the judgment of our peers and of the chain of command, which will consider us as soldiers who no longer want to work. Unfortunately, I can confirm that is the reaction we face.
Despite my many problems, both physical and psychological, I went to the armed forces for help. They told me that if I asked for too much, they would force me to leave, because the army did not need problem cases in its ranks. So you either put up or leave. That does not make you want to ask for help; therefore, you suck it in and try to keep on marching to the beat.
Later on, when you come before the Department of Veterans Affairs, you are asked to prove that your condition is service-related, because there is nothing written down in your file. No, there is nothing in the file, because no one wants to say that they are sick. The moment you are declared sick, you are no longer a hero, but rather a zero.
I even went to the Department of Veterans Affairs to say that I needed psychological help, that I was afraid to hurt myself. A bureaucrat looked me in the eyes and told me—excuse the term—that I was a welfare bum in uniform and that I only wanted a bigger pay cheque. He told me to leave him alone.
Imagine that you are a highly capable soldier and that, within nine days' time, you fall physically and mentally ill. You no longer understand who you are and you need to muster all your courage to admit that you have medical issues. Admitting you have post-traumatic stress disorder is not an easy thing to do. I admit that I have a psychological illness. It is extremely hard to admit that to yourself. Not only do I admit that, but I have gone to look for help; but the army has told me that my stress is related to my childhood.
When I then go to the Department of National Defence, the bureaucrats there treat me like someone who wants a bigger welfare cheque and imply that my uniform is but a disguise. That is enough to keep you from returning to ask for help. You just feel like staying home and not asking for anything because you are made to feel like a costly nuisance.
People wonder why soldiers do not ask for help. It is because they are frowned upon; they are only seen as an expense. When I signed up, I did not think how much it would cost me; I gave everything that I could. I was pleased to do so. If I had to do it all over again, I would because I love my country. When I was finally diagnosed with post-traumatic stress disorder, I had the honour of receiving care. Things were quite complicated. It took over three years to recognize that I had post-traumatic stress disorder. My spouse was the one who supported me during that time. When you hear people say that family is important, that is so true.
When you enter the armed forces, as long as you are operational, you are commended for being good and strong and told to keep it up, and that your superiors have confidence in you and give you new challenges. What I love about the army is that they give you as much as you can ask for, and they will keep on asking for more as long as you can give it to them. That is highly motivating. But the day you become ill, you are told not to bother them, and they no longer want to hear from you. Therefore, the love you once felt in your work now comes from your social network.
But you have to be careful, because there are limits to what your social network and family can give. My spouse was diagnosed with burn-out, because she was the only one who took care of me, while the armed forces and the Department of Veterans Affairs told me that I did not have a problem and that my stress was childhood-related. During my childhood, I never used a C7 or sniper gun.
Finally, I was hospitalized at Ste. Anne's Hospital, after my spouse had been diagnosed as suffering from burn-out because she had taken care of me. She was a sound-minded woman, an ambulance attendant by profession. So she already had medical knowledge.
I was hospitalized in the only hospital for Canada's veterans, where there were only four beds for people in my generation. They only accept what they refer to as nice cases for these four beds. If you have any addictions to drugs, alcohol or medication, they do not want you. If they feel that you are aggressive, they do not want to hospitalize you in Ste. Anne de Bellevue. So the only places where you can go are the civilian hospitals. However, the staff working in civilian hospitals are afraid of us when we arrive because we have been labelled as individuals suffering from post-traumatic stress syndrome.
I told them that I was terrified, that I didn't feel like hurting anyone, that I was a man who was essentially gentle, but that I was afraid. I asked them to help me. They asked me what my problem was. I answered that I was suffering from post-traumatic stress syndrome. They confined me to my room, where I was kept in a bed and injected with tranquilizers. And yet, I had done absolutely nothing, I had not been violent in any way whatsoever. I had voluntarily asked for assistance. When you ask for help, you are confined to your room, so that does not make you want to ask for assistance again. All you feel like doing is to remain silent, to shut up.
When I was hospitalized in the veterans' hospital for physical problems, I was told that I required too much care, that I could not be given any help washing myself, etc. I replied that the hospital looked after Second World War veterans. I have the greatest respect for them, but why were they entitled to such care, but not me? I was told that these veterans were from another generation, that they had these entitlements and that young veterans had others, but not the same. I suppose that the bullets that whistled by our ears did not hurt as much as those that whistled by theirs. I have a great deal of respect for them, but I do believe that one serves one's country in accordance with one's generation, in accordance with the place where our country sends us. Why should we be treated any differently from them when we need care? Why should we beg for this care?
Despite all of this, I transferred my passion to my spouse, who joined the Canadian Forces as a reservist. She served in Afghanistan. She came back in November 2009. I supported her during 10 months. Throughout this time, when we called the Canadian Forces to inform them that Sabrina was not feeling well, that she was experiencing anxiety attacks, they told me that I knew what was happening, that I should support her as she went through these difficulties, that I was strong and that I should continue. After supporting her for six months, despite my physical and mental state of health, my spouse and I were both suffering from post-traumatic stress syndrome. Supporting a spouse is already very demanding. In my situation, I was unable to do this, but I did manage because of my love for her.
Six months later, Sabrina tried to commit suicide. I sacrificed my physical and mental health for my country, and I almost sacrificed my wife for my country. That is a heavy price to pay. When I called the Canadian Forces to request assistance and to say that I was the first responder and that I was trying to resuscitate my spouse, I was told to go to the civilian hospital and that they could not do anything for me. So I went there.
Once at the hospital, I called the commanding officer of her regiment, because she was a reservist. Earlier, the ombudsman said that this was part of the commanding officer's job. She did go to the hospital, but the only thing she told me was that she was restricted to making suggestions. It was up to the Department of Veterans Affairs to decide who should be hospitalized. My spouse was unstable and she was not entitled to be hospitalized in the only veterans' hospital in Canada. She had to be put into a civilian hospital. In the civilian hospital, we were told that she was suffering from post-traumatic stress syndrome and that they did not know what to do for her and that she should be hospitalized in a veterans' hospital. Where were we to go? Nobody wants to look after us. I brought my spouse back home and I took care of her as best I could until she was granted the great privilege of being admitted to Ste. Anne's Hospital, the only hospital for veterans in Canada. It is too late, I am no longer able to look after her. I had to leave her. We told each other that, although we loved each other a great deal, neither of us were in any state of health to be able to look after each other.
Sabrina came back from Afghanistan in November of last year. Today, the Department of Veterans Affairs is still studying how to help us. I'm sorry, it is too late.
Sabrina has gone back to her family, in the Beauce, and I am alone at home.
I am not the type of person who complains for fun. I can attest that I have had a great deal of time to think about real solutions.
I have been fighting with the Department of Veterans Affairs in order to receive treatment for 11 years—this member of Parliament helped me tremendously with my file and I would like to thank him—and this is the first time that I have been asked, as a veteran, what I think would be good for me. I really appreciate this opportunity as I have been wanting to do this for 11 years.
Why does the department simply not ask us this question? It is very simple: we would like to be treated like human beings.
Some people say that going to war is the greatest act of love one can show to a person as you are saying that I am prepared to die for you. When you come back to your country and you ask for help, after having been prepared to make the greatest sacrifice possible, you are told that there is no money for the "welfare recipients" in uniform who are after a bigger cheque.
I even asked government officials whether or not I could sign a form saying that I was not entitled to a pension, but that I was entitled to care. If there is a money problem, what do I need to do in order to restore my dignity? I am still waiting for the answer.
I have been submitting requests to the Department of Veterans Affairs for more than 11 years and it is still studying how it can help us.
Given these circumstances, do you believe that soldiers feel like saying that they too are ill? No. The person who says this will be dragged into the mud. The law of silence prevails. You must never say that you are sick, because you will lose your job. No one will want to hire you if you are suffering from post-traumatic stress. You must never make this mistake. And this is the message that we pass amongst ourselves.
Do you want to know the truth? You must give us an opportunity to speak. If a child speaks and is punished every time he opens his mouth, he will no longer speak.
That is all. Thank you.
:
We have an enormous problem, because the four beds in Ste. Anne's Hospital are only for what the officials call “nice cases”, which means that these cases have no problems with aggressiveness, drug dependency or alcohol. Civilian hospitals do not want to have anything to do with us.
Earlier, the lady said that by resorting to alcohol and such things, soldiers try to medicate themselves to relieve the pain, to extinguish that little voice within them that is crying out. It is true that many people will try to find solutions by themselves.
This is because of the way the system is built. First, you must not talk. Secondly, if you need help, your file will be reviewed for an indeterminate period of time. During that period of time, the family has to put up with you.
One thing that people must know is that we are contagious. This means that when someone is living with you and suffering from post-traumatic stress disorder, and if he is always awake, he suffers from insomnia and from many painful emotions, the people around him suffer enormously from a feeling of helplessness. They would so much want to help us, but they cannot do it, they have neither the tools nor the knowledge to help us.
The longer we wait before taking care of the soldiers, the more people around them get contaminated, and the more the problem spreads. As time goes on, veterans are getting less social support, because people are no longer able to put up with us. I had to tell my spouse that she had to leave, that I no longer had the energy to take care of her, that we were actually destroying each other. And so much for the family.
The Department of Veterans Affairs should open new beds and, especially, it should open crisis centres. When a soldier has flashbacks of combat as soon as he gets home, it means that he is really not well. There are flashbacks of combat, the smell comes back. He becomes dangerous for himself and for others. He has nowhere to go.
I am one of the veterans working with the OSISS. I was trained as a volunteer peer helper. All that we can do for that person is to try to contain the problem and to bring him back to the here and now. All we have are improvised treatments that we administer to each other.
Another proof that there are gaps and that there is not enough care for us, is that we, as veterans, have to found groups like Veterans Canada to help each other. There are no adequate tools for us.
:
Mr. Chairman, thank you very much.
To Pascal, thank you very much, sir, for coming today--and for bringing your good friend Daniel. If he's your buddy, you can't be all bad, I'll tell you. He's one of the best around.
I have a couple of questions for you. You talked about the psychological and physical concerns that you're going through. The people who are supposed to help you talked, in my view, very demeaningly of you. They were not very respectful of what you had done to serve our country.
Not now, but in the future, can you give us some of the names of those people who you were talking about and the things they said to you? I would love to have those names.
We hear from Mr. Natynczyk, the CDS, and that the “Be the Difference” campaign was very successful. It is obvious that there are some people in the military who didn't get the message. This has to stop, and the only way it's going to stop is if we can identify who these people are and have a little chat with them to make sure that the next veteran does not get treated this way.
Even the ombudsman said that there are consequences for individuals who fall through the cracks. It's often devastating and long-lasting.
It is obvious, by your testimony, that you and your wife have fallen through the cracks. And it's obvious that the difficulties you're having are very devastating to you and your family. I'm very, very sorry for what you and your wife are going through.
I was wondering, sir, if it would be possible for you to advise us of what you're getting financially from the department in terms of your pensions and your pay at this time.