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I would like to call the Standing Committee on National Defence meeting 19 to order. I believe we have a quorum, so we can start.
The orders of the day for today are pursuant to Standing Order 108(2), the study of the care of ill and injured Canadian Armed Forces members.
Our witnesses today are from the Department of National Defence. We have Brigadier-General Jean-Robert Bernier, Surgeon General, Commander Canadian Forces health services group and Jacqueline Rigg, director general, civilian human resources management operations, assistant deputy minister, human resources - civilian.
I am sitting in for the chair, who is unavailable today. Mr. Kent is unable to make it.
I guess we can proceed. Mr. Bezan can come along when he is ready.
We have written remarks from General Bernier.
Sir, welcome to the committee to you and to Ms. Rigg. You may proceed, sir, with your opening remarks.
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Thank you very much, Mr. Chair.
[Translation]
Hello, honourable members of the committee.
[English]
Thank you very much for the opportunity to appear before you again and especially for your ongoing focus on the health of Canadian Armed Forces members.
The welfare of those who are willing to sacrifice their lives for the protection of Canadians deeply merits your attention, and your committee's commitment to studying it so closely sends military personnel a positive message that helps make the risks and sacrifices they accept more tolerable to bear. In saying that, I include all of my medical personnel, most of whom served in operations overseas, saw far more trauma in Afghanistan than any other arm in treating daily horrific casualties, and suffered the most physical and mental health casualties after the combat arms. Given that their own health so directly depends on the quality of their own work, they are powerfully motivated beyond just their duty and compassion for others to provide the best possible health care, research, policies, and programs.
You've already been briefed by me and some of my senior medical officers on the uniquely comprehensive extent of the health programs available to Canadian Armed Forces members, but there have been many developments since I last appeared before you in November 2012 to further address areas that could be improved.
Perhaps most relevant to your current focus was the development and launch last fall of my updated military mental health strategy based on a detailed year-long analysis of accumulated experience, data, lessons learned, and research over the past few years.
The existing military mental health program had been based on extensive research and analysis over several years, but it predated combat operations in Afghanistan. It was incrementally enhanced through annual reviews, but a longer-term and more detailed strategy was needed to guide and prioritize our efforts given the end of Afghanistan operations, the major increase in the military mental health budget from $38.6 million to $50 million, clinical and technological developments, a collective review of previous recommendations from your committee and other external bodies, and our greater understanding of mental health in the Canadian Armed Forces through accumulated health surveillance data and research.
Our analysis of the “Medical Professional Technical Suicide Review Report”, our operational stress injury incidence and outcomes study, as well as the ongoing analysis of the 2013 health and lifestyle information survey, and the Statistics Canada mental health survey will further enhance the strategy's implementation over the next five years. They will also help us more objectively re-evaluate whether the professional composition and capacity of our targeted cadre of 452 mental health staff are appropriate to our current and projected mental health care demands. The strategy and its supporting analysis will help us further optimize use of our resources and data in dealing not only with our Afghanistan-related mental health burden, but also with our much larger baseline toll of mental illness arising from the normal stresses of military service and those that affect Canadians generally. At least four of Canada's top national mental health organizations have publicly praised the strategy as a comprehensive model.
[Translation]
The strategy and our mental health program were also praised by representatives of the major national mental health organizations at a recent meeting with the Defence and Veterans Affairs ministers and senior officials. They made excellent suggestions for enhancing our programs, and all of their recommendations were either already implemented or are part of our mental health strategy, particularly their emphasis on the critical need for mental health prevention and treatment measures to be based on solid evidence.
[English]
Other significant developments include greater success in the recruitment and hiring of public service mental health staff, which my colleague Ms. Rigg can address in greater detail. We are now much closer to our target of 452, which will help reduce our reliance on contracted mental health staff and on our external referral network of up to 4,000 clinicians.
Although our wait times for assessment and care have, in general, long been far below those in any other health jurisdictions, this is helping reduce the number of local situations where wait times exceed my aggressive targets, in concert with other measures to enhance efficiency through staff reallocation, process modifications, the use of tele-mental health, and others. Reaching and maintaining our staffing targets will unfortunately remain a persistent challenge, given the national shortage of mental health professionals.
Since 2013 our procurement of high-definition tele-mental health technology is also helping us accelerate care to underserved locations and reduce patient inconvenience of travel for care, while our procurement and trial of virtual reality technology for PTSD exposure therapy is promising. In parallel with the Canadianization of the virtual reality software through our partnership with the True Patriot Love Foundation , we plan to provide the technology to all our operational trauma and stress support centres.
[Translation]
There have also been beneficial new developments with some of our other external partners since 2012. We have now twice partnered with Bell's national Let's Talk campaign which, along with many other efforts by the Chief of Defence Staff and senior military leaders, is helping further reduce stigma surrounding mental illness in the military culture.
The Canadian Psychiatric Association has established a special military and veterans section to support its military and civilian members with an interest in the mental health of serving and retired military personnel.
[English]
The Canadian Institute for Military and Veteran Health Research, established at the behest of my predecessor, has added several more universities to its network and is receiving additional support from the Wounded Warriors project and the Royal Canadian Legion in the form of mental health research scholarships. The Legion is also expanding its efforts to disseminate information throughout the country about support programs available from the Defence and Veterans Affairs departments, an initiative that will help better inform veterans and reservists distant from military bases and Veteran Affairs offices.
With respect to research, several joint projects with our partners are providing new insights and technological applications that will help enhance understanding and treatment such as two ongoing joint projects on the use of transcranial magnetic stimulation for the treatment of mental disorders, a validation study of our road to mental readiness education and resiliency program, neuroimaging studies with magnetoencephalography and functional magnetic resonance imaging, and a military-civilian symposium hosted last month by the Toronto Hospital for Sick Children's research centre on neuroimaging for the diagnosis and treatment of PTSD and traumatic brain injury. The Canadian deputy surgeon general continues to chair NATO's health research committee and mentor its military suicide research task group, Canadians continue to have a leadership role in almost all its mental health-related research activities, and a year ago a royal Canadian medical service expert was asked by NATO to co-chair its international symposium on best practices in post-combat rehabilitation and reintegration of patients suffering physical and mental injuries.
Despite the need to focus continually on improving our mental health programs, I also have to maintain capabilities and improve them in all areas necessary to protect health and lives in humanitarian and combat operations as well as in routine domestic care. To that end, one of my surgeons, Colonel Homer Tien, continues to head Canada's top trauma centre and hold the military trauma research chair at Sunnybrook in Toronto.
In 2013, I also established a new military critical care research chair affiliated with Western University that is held by Naval Captain Ray Kao, one of the world's top critical care researchers, and other military health research chairs are under consideration. Through collaboration, training, collaboration with allies, and other measures, we have also enhanced capabilities and readiness in deployed surgical and critical care; medical defence against chemical, biological, and radiological threats; and health care in Arctic, humanitarian, and special operations.
With respect to the care provided by our domestic health system, we received accreditation with distinction last fall following a three-year assessment by Accreditation Canada, the National Health Service quality authority, and we recently established a more robust quality assurance and patient safety program in collaboration with the Canadian Patient Safety Institute.
I have noted only a few examples of improvements and recognition by national and international health authorities highlighting Canada's leadership in military medicine and mental health. The greatest recognition and the rarest of honours came from our sovereign last October with the presentation of a royal banner by Princess Anne to the royal Canadian medical service in recognition of the valour, sacrifice, and clinical excellence of its members during a decade of operations in Afghanistan. It was only the third royal banner ever presented to a Canadian Armed Forces element since Confederation, and the second royal banner had also been presented to the medical service by Her Majesty the Queen Mother.
It's the quantitative burden of mental illness. Mental illness affects anywhere from one in four to one in five Canadians in their lifetimes according to the Mental Health Commission of Canada. So it's purely the math.
We experience a similar prevalence of mental illness in the Canadian forces. The one study we have from 2002 shows double the risk of depression in Canadian forces members related and unrelated to military operations. So from the pure quantitative perspective overwhelmingly we have a far greater burden resulting from mental illness that we have to treat that's not related to combat or deployment operations.
There is an increased risk, proportionately, among those who do deploy to operations, particularly operations that involve the risk factors of combat and risk to life and threat to not just themselves but particularly, as you described, the inability to respond when atrocities are being committed. So there is a general consensus in the mental health community that the risks of being deployed in operations where you have rules of engagement and a mandate that permits you to intervene when innocent people are being harmed is somewhat less stressful than being deployed in operations where rules of engagement are imposed, for example by the United Nations authorities, in order to maintain a neutrality and the perception of neutrality; that is more stressful on soldiers who are prevented from intervening except where their own personal lives are at risk.
So that was a major stressor for people who deployed in operations in the 1990s, particularly where the rules of engagement were very difficult. One particular case for example is the Dutch commanding officer of the battalion at Srebrenica. That was the Dutch battalion during Bosnian operations that was charged with the protection of the Muslim population that was subsequently massacred when the Serb army arrived. That individual was directed... It is well-documented that many people at that time suffered mental illness as a result of their inability...in fact, their direction not to intervene.
So you are absolutely right, the inability to intervene when atrocities are being committed against innocent people is an extreme stressor.
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Every study we do, and we do a lot, we specifically include reservists. So far, consistently, all the research has been demonstrating that the rate of mental illness among reservists, whether related to deployed operations or not, is actually lower than it is among the regular force. Up to half in one study—half the rate of certain prevalent mental illnesses.
However, they're at greater risk because they don't have the social supports when they're demobilized, when they come back from deployed operations. Particularly those who return to units where they were the only person deployed on that operation, or a unit that's distant from a military base with a military clinic and the social setting, the social supports, that would help them either resolve their issues or encourage them to get into care.
For that reason, we have various things like the field ambulance medical link teams or the reserve field ambs whose job is to educate and to try to identify those individuals and get them into care.
There's education of all the chain of command for the same purpose. The Royal Canadian Legion has joined us as a partner because they have—I can't remember—2,400 or 1,400 centres across the country in every community. So they've agreed to set themselves up as a storefront for all of the programs available. They already do that to some extent, but they're going to expand that to all of the programs available to get people into care from within the armed forces or from Veterans Affairs, for those released from the reserve force.
We recognize that it is a special vulnerability that we have to pay particular attention to, and we have measures to try to get the word to them, identify them, and bring them into care and, if necessary, transport them. We permit them to get local care, if necessary, but the ideal is to get them to our specialized military mental health centres.
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I would like to come back to another aspect of how services are provided to our soldiers in French.
Last week, Colonel Gerry Blais, Director of Casualty Support Management of the Canadian Forces, appeared before our committee. I asked him if it was possible for all military bases to provide services in French, considering the needs, whether this involves volunteers or staff.
Is that the case or not? Is it possible for all military personnel to receive mental health services in French on every base in the country?
Although this is not linked to mental health, I have seen cases where people have been sent to certain bases to take a course that was supposed to be bilingual, but since most of the people on site were anglophone, the course was given entirely in English. Even when a service was supposed to be offered in French, that is not what actually happened. This really worries me.
I wonder if you could talk about the situation on all bases across the country.
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Absolutely, there have been some challenges in filling these positions. We'd identified a gap of 54 positions that needed to be filled and we've been working very hard to do that.
One of the first challenges is our limited labour market availability of these professionals in Canada. That's why it spread. DND falls into that same challenge of finding the right skilled professionals.
We also have a challenge because we are staffing these positions in remote locations or non-metropolitan areas. For example, staffing in Cold Lake, Alberta, in Shilo, Manitoba, are quite challenging for us to get folks who are willing to relocate to do that.
We're also competing with the private sector. Notwithstanding that we offer the top of the scale salary in our wage bands for these positions, it doesn't make us fully competitive with the private sector salary bands. To do this, we realize that we need some mitigating strategies to have this happen, so we are running specific processes in these remote areas to attract them.
We have partnered and worked with Treasury Board Secretariat and the Public Service Commission. We went to Treasury Board Secretariat, so that we can increase the amount of money that we can offer to external hires for relocation. That's often a barrier. Previously, we could only offer $5,000 to support external hires to the public service. We got it increased. Until March 31, 2015, we can offer up to $40,000. This we feel will help us in our remote locations, which has been a very big barrier.
With the Public Service Commission, you cannot make any hires unless you check all the priorities in the system. We've created an expedited process with them, basically telling them, “Because we have such a shortage in this area, just refer to us any priorities who have that skill set and we can automatically bring them on board”. Also, for the priority clearances that we require before making a letter of offer, we ask them, “Can you please give us a faster process to get this done because we can't wait?”
While we're waiting for some information as well, we moved to giving a lot of conditional letters of offer because you've got to get your official languages done, you've got to get your medical done. We figure that by providing a conditional letter of offer we're getting a bit more stickability to the person who may be getting another offer while we're trying to get those ducks lined up.
As I mentioned earlier, by early 2015 we expect to receive the results of the Statistics Canada mental health survey and the health and lifestyle information survey, which will give us better global data to help guide the optimum distribution and requirement.
We already have some good data. The operational stress injury cumulative incidence study permits us to project out, over about a decade, what we can expect for Afghanistan-specific related operational stress injuries. But we need more than that. We're trying to now update what we did in 2002 and 2003 for the global Canadian Forces requirement. As I mentioned, Afghanistan-related operational stress injuries constitute a minority of our global mental health problems.
We have adjusted incrementally over the years. It has crept up from 447 to 452, based on our evaluation of the success of the road to mental readiness program and various other evaluations, including the operational stress injury cumulative incidence study, but these have been piecemeal evaluations and tweaks based on limited data. Now we have spent the last year, before producing this strategy, to look at all the available data. We are now just waiting for these two missing pieces, these comprehensive studies, to give us everything we need to get the best possible determination of the distribution in the future and the number, the volume of care.
We're already at double, on average, what the civilian population has per capita and we have the highest ratio per capita of mental health clinicians within NATO. But is that enough, or is it too much, or will technology permit us to change things because things have changed?
Sorry, Ms. Murray, your time is now up, in fact it exceeded by a fair bit.
Based on the time that we have left in our meeting, there appears not to be time for another round. We would go back to our first round which is four speakers. There not being time for that, I think we'll end the rounds. As is the tradition, there's a prerogative for the chair to ask a few questions. So I would seek to use some of that time to do that.
So Colonel Bernier, I was interested first of all in your assessment of the overall mental health expectations for members of the Canadian Armed Forces and you suggested that it was one in four, or one in five of the general population would have a mental health episode in their lifetime.
Can I suggest to you first of all, you don't really have people for their lifetime, you only have them from, say, 18 to 40 or 45? Secondly, you screen people presumably at the beginning of this period for any sign of mental health issues. You're not dealing obviously with the issues that relate to seniors and mental health as well. So your baseline for expectations would be lower than the general population to start with. Am I correct about that?