Proceedings of the Subcommittee on Veterans Affairs
Issue 2 - Evidence - Meeting of December 6, 2006
OTTAWA, Wednesday, December 6, 2006
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:10 p.m. to study on the services and benefits provided to members of the Canadian Forces, veterans of war and peacekeeping missions and members of their families in recognition of their services to Canada.
Senator Michael A. Meighen (Chairman) in the chair.
[English]
The Chairman: Good afternoon to all of you and our guests. Welcome to the Subcommittee on Veterans Affairs. Our committee has been mandated by the Senate to examine the services and benefits provided to members of the Canadian Forces, veterans of war and peacekeeping missions and members of their families. We are focusing in on the range of services and programs offered to soldiers and their families as they return from duty in Afghanistan and until such time as they become veterans.
Appearing before us today is Retired Brigadier-General Joe Sharpe, replacing Retired Colonel Don Ethell who is chairman of the Operational Stress Injury Social Support Advisory Committee, which fortunately has an acronym. I will let you do an introduction.
I will introduce the members of the subcommittee. I am Michael Meighen, a senator from Ontario. I chair the subcommittee.
On my right is Senator Norman Atkins from Ontario who came to the Senate in 1986 with more than 27 years in the field of communications. He is the former president of Camp Associates Advertising Limited and served as an adviser to former Premier William Davis of Ontario and to former Leader of the Opposition, the Honourable Robert Stanfield. He is also a member of the Standing Senate Committee on National Security and Defence.
Senator Joseph Day, on my left, is from New Brunswick. He is chair of the Standing Senate Committee on National Finance, a member of the bars of New Brunswick, Ontario and Quebec, and a fellow of the Intellectual Property Institute of Canada. He is also a former president and CEO of New Brunswick Forest Products Association — a wide- ranging and distinguished career, Senator Day.
Senator Day: And a former president of the Royal Military Colleges Club, RMC, Alumni Association.
The Chairman: Senator Percy Downe is not a member of our subcommittee but is a regular attendee. He is from Prince Edward Island and was appointed to the Senate in 2003. Senator Downe is currently a member of the Standing Senate Committee on Foreign Affairs and International Trade and the Standing Senate Committee on Internal Economy, Budgets and Administration.
I see we have been joined by Senator Kenny. He chairs our parent committee, the Standing Senate Committee on National Security and Defence. He is also from Ontario. Senator Kenny is a member of the Standing Senate Committee on Internal Economy, Budgets and Administration, as well as the Standing Senate Committee on Energy, the Environment and Natural Resources.
We only have an hour and a quarter so, without further ado, I will turn the microphone over to Brigadier-General Sharpe.
Brigadier-General (Ret'd) Joe Sharpe, Member, Operational Stress Injury Social Support Committee, as an individual: Thank you for the opportunity to appear and talk about this particular organization which, from my personal experience in watching it, has saved lives and there are not a lot of organizations we can say that about today. This is a tremendously successful organization and we welcome the chance to talk about it.
The second point I would make before starting is to acknowledge our chairman, Colonel (Ret'd) Don Ethell who has had a serious medical issue interfere with him being here. I can assure you it would have to be a serious medical issue; he would have been here any other way and sends his strongest regrets. You are getting a relatively pale shadow of what Colonel Ethell would have talked about had he been here, but I will attempt to bring forward the points he would have made.
The Chairman: Brigadier-General Sharpe, would you convey to Colonel Ethell our regrets at his inability to be here and our best wishes for a complete and speedy recovery?
BGen. Sharpe: I will and I know he will be cheered by that.
I will introduce the team. We actually have you outnumbered slightly; that is a good sign. Colonel Ethell put together a team that represents most of the expertise we need to answer any questions you have. On my immediate right is Major Marianne LeBeau, the National Defence co-manager of the Operational Stress Injury Social Support Committee. On my left is Kathy Darte, the Veterans Affairs Canada representative co-manager. Ms. Darte and Major LeBeau co-manage the committee and, frankly, this is a tremendous example of interdepartmental cooperation in delivering an outstanding service to people.
Next to Ms. Darte is Dr. Don Richardson who works as a contractor for Veterans Affairs Canada. Dr. Richardson is a well-recognized psychiatrist in this field dealing with these injuries, and runs a number of other activities in the field. He is here to provide some expertise on that side but he is also a medical provider to OSISS — the acronym we will use — and is a key player.
On the right-hand side is Lieutenant-Colonel (Ret'd) Jim Jamieson who left the Forces as, I believe, Director of the Military Family Resource Activity. He is an adviser to the OSISS organization and is there to help monitor both the health of the participants and to conduct some of the basic education and training for the peer support coordinators when they come on board.
Behind us are two more members. Chief Warrant Officer (Ret'd) Dave McArdle is one of our peer support coordinators and is based in Halifax. He covers most of Eastern Canada. Next to him is Jennifer Inglis, the Veterans Affairs Canada District Director for Calgary.
That is the team and for any questions you have, perhaps I can serve as an orchestrator and direct the question to the right person.
You have the slide deck that Colonel Ethell prepared and I will not spend much time on the slides. Obviously, if you have questions feel free to raise them. I would like to highlight a few areas and proceed fairly quickly to the new activities and challenges towards the end.
I am sure most of you are familiar with the term ``operational stress injury'' or OSI so we will not spend a lot of time on that. To refresh your memory, however, this is not a diagnostic term. It is not a term in wide use in the medical community but has become increasingly used in the group that deals with our returning veterans, particularly those coming back with these kinds of injuries.
The reason we use the term OSI is that it allows us to focus on the injury aspect of this, which is very significant for the soldiers. One of the challenges we face in this activity is getting people to come forward to seek help, because the key is getting people forward quickly and accessing help quickly which allows us to get them back to health and, in fact, retain them in the military much longer.
So the key is to make this a welcoming type of term for the soldiers to feel comfortable coming forward. We will talk a bit about the culture in a few minutes.
This term is now being widely used by clinicians and they use it to encompass virtually all operationally related stress or mental health injuries. It covers a wide range, not just post-traumatic stress disorder, PTSD. It encompasses all the mental health issues that come out of deployments. The term has been adopted by militaries south of the border and Australia and a few other places as a direct result of the success of the program in Canada. That is one of the things we have been exporting, thanks largely to this group around me.
The package also contains background on the OSI advisory committee. The group was formed a few years ago to bring together people with an interest in this subject, to provide some advice to the people running OSISS, particularly the two co-managers here, and to take some messages from this advisory committee back up the chain of command.
Immediately after this briefing today, I will be filling in for Colonel Ethell and sitting down with the Chief of Military Personnel and Assistant Deputy Minister Brian Ferguson from Veterans Affairs Canada, VAC. We will brief them on some of the issues that have come forward to the committee in the last quarter or so. This serves strictly as an advisory committee. It has no executive authority but, in fact, does transfer a lot of information up and down the chain.
As you are aware, OSISS came into being in the spring of 2001. It was largely in response to some of the advice that came from the Standing Committee on National Defence and Veterans Affairs, SCONDVA. Also, the Croatia Board of Inquiry, with which I was involved, identified some of these issues, along with the DND/CF Ombudsman's Report. All of these things came together at about the same time and helped give OSISS a kick.
However, the real hero here was Lieutenant-Colonel Stéphane Grenier, the initial founder and the military co- manager who has talked to your committee. He is a tremendous officer who committed a lot of energy to this project. He subsequently moved on this past summer. Major LeBeau has replaced him and is doing an excellent job of trying to fill those shoes, but they are very large shoes indeed. We all owe a vote of thanks to Lieutenant-Colonel Grenier.
The mission of OSISS is twofold: first, to develop social support programs for the members, veterans and their families who have been affected by operational stress and, second, and increasingly most important, to provide education and training that will eventually change the culture within the Department of National Defence and Canadian Forces particularly — but also within Veterans Affairs Canada — toward psychological injuries. It is a culture that desperately needs to be changed.
The key to effective peer support, the heart of the OSISS program, is the initial selection of the right kind of people. For example, Chief Warrant Officer (Ret'd) Dave McArdle, whom I introduced earlier, is a classic peer support coordinator. He operates out of Halifax and is tremendously respected — both within the army and outside that circle now as well — for the work that he does on a daily basis.
Having selected him, he underwent — like all of the peer support coordinators — an extensive period of very intensive training. They undergo continuous training during the cycle of their involvement. This continuous education program is very well received.
In the end, it all comes down to developing trust with the members and the veterans who come forward. That is what the peer support coordinator's main purpose is — to develop that bond, that level of trust which allows the peers who come forward to proceed at their own pace in an unthreatening and non-judgemental environment. It is essential that peer support workers understand the role they play — and they do. They understand when to pull back from the situation, and they need to be willing to refer the peer to professional resources when that is called for.
The danger for the peer support coordinators, of course, is burnout, compassion stress — vicarious traumatization as Dr. Richardson would refer to it, and none of us is entirely sure what he means by that — depression and physical illness. These are all dangers of the peer support coordinator's job. Many of them have performed in dangerous jobs before they came there. This one is very demanding and the training keeps them focused on that.
What amazes me as an observer of this process since it started — and in fact it is an attestation to the quality of people selected, the professional job they are doing and the level of care provided — is the fact that we have had very few problems in terms of burnout or depression with this team of peer support coordinators. They have been doing a tremendous amount of work. I personally know of several lives that have been saved because of the work they are doing; that is really tough work and they have done a great job.
The Chairman: How many would you have across the country?
Major Marianne LeBeau, Project Manager, Operational Stress Injury Social Support, National Defence: There are 23 for veterans, serving members and families — six of those are specialized for families.
The Chairman: Do you consider that the right number or too little?
Maj. LeBeau: We are in the process of staffing new positions this year.
BGen. Sharpe: Resources are always a challenge here. Canada is a vast and demanding country. A lot of the young kids we are bringing back from Afghanistan right now, as you gentlemen are well aware, are reservists. They do not necessarily live where the major bases are. I think there is a map in there. If not, we can provide you with the locations of where the peer support coordinators and the family peer support coordinators are. They tend to be located near the major troop concentrations, in major bases — not in all cases, but pretty close.
If you are a young reservist from northern Saskatchewan, you are a long way away from the peer support network. Resources become a challenge, particularly dealing with reserve members and with families of reserve members.
There are some new initiatives to talk about in OSISS, which you are welcome to pursue during your question period. I can see my 10 minutes are running out quickly so I will speed up. There is a new bereavement peer support initiative, which will deliver peer support to the immediate families, next of kin of those members who die on duty. This exciting initiative is just getting off the ground; it can be followed up on in question period.
There has been considerable international interest in the success of the program. Again, Ms. Darte and Major LeBeau can talk to that at some length. Ms. Darte, in particular, has been involved in some of those initiatives.
The recent Third Location Decompression exercise in Cyprus is another new initiative. You are aware of the Third Location Decompression and its value in the redeployment phase on both the physical and mental health of our soldiers. OSISS was involved this last time extensively and C.W.O. McArdle was one of the OSISS members who travelled to Cyprus and actually bunked with the soldiers and dealt with them on a day-to-day basis. He has some interesting insights on that.
The Chairman: How long does that last?
BGen. Sharpe: I think it is five days.
Chief Warrant Officer (Ret'd) Dave McArdle, Peer Support Coordinator, Operational Stress Injury Social Support, National Defence: For each individual soldier coming back, it is about five days.
BGen. Sharpe: I think the activity stretches over seven to eight days.
The Chairman: I think CWO McArdle should come forward. I can see he will be a necessary resource, perhaps on the corner beside Senator Downe. I will deduct the time for my questions from your allotment.
BGen. Sharpe: If you have questions on that, please feel free to direct them toward CWO McArdle and Ms. Inglis, from the district director perspective.
The last point I want to touch on is what Major LeBeau has called ``key determinants to success and some of the challenges.'' I believe they are the last three or four slides.
There are several key determinants to success in a program like this. The first, and perhaps most important, is the need to involve peers from the very beginning in developing both the policy and the programs. This organization has done that. They have done a tremendous job of that, and it has worked extremely well. However, it would not be successful without the heavy involvement of peers in the development of the policies.
It is not always lined up necessarily with how either department would normally develop policy. However, it is an excellent example and has worked extremely well. It is also an excellent example of interdepartmental partnership, which is essential to make this work. I can not stress that more. When I first got involved in this activity, there was not nearly the interrelationship that we see now. There is always room for improvement but it is working extremely well.
The emphasis on self-care and realistic boundaries for the peer support coordinators is another important area. As I mentioned in the beginning, recruiting, screening and educating the peer support coordinators — Mr. Jamieson's primary area — are very important. These are all key determinants to success. To help provide relief for that key group of peer support personnel, the activity they are involved in now to develop, recruit, train and retain volunteers to work with the peer support coordinators is another important determinant.
In terms of challenges, I would be dishonest if I did not say there are still some systemic barriers in place to this activity. Some clinicians are still suspicious of having non-professionals meddle in this area. They prefer to keep it within the mental health community. However, I have watched some of these transitions and they have been phenomenal. Others have experienced the value of having a peer support coordinator working with them and within their district offices, as Jennifer has done, and they absolutely sing their praises. Once they are exposed to people like CWO McArdle, they become absolute fans. I do not understand that, personally, but it does seem to work, despite his patrician background. The challenge is being overcome by the people on the ground.
Earlier I touched briefly on the physical size of the territory covered. It is very challenging. This is a tremendously large country, and the people suffering from these kinds of injuries are scattered from east to west and from north to south. That is a enormous challenge for the 17 peer coordinators and six family coordinators. It is a tremendous piece of work that they do, especially for reservists, which CWO McArdle will deal with later.
Growing the volunteer network to which I referred earlier is another challenge they face each day. Once the investment has been made to find, train and get them experienced, retaining them is the another challenge.
The last challenge on the list, although certainly not the least, is the culture within the Canadian Forces in dealing with mental health issues. It has changed significantly over the last six years or so. I have watched that change from the time of the Croatia board, which I had the privilege of chairing, when it was kept in the closet to today. It is tremendous. I can not describe it but the difference is like night and day. Having said that, there is still a long way to go. There are still serious culture issues in accepting psychological injuries on a par with physical injuries in the Canadian Forces. Within VAC, the way in which they deal with this has changed tremendously. It is a much different story today for our young soldiers returning than it was for CWO McArdle coming back a few years ago.
Education and training are the key components to changing the culture. One of the concerns that I, as an individual watching this, would express is that longer-term investments like education and training are frequently the ones that are short-sheeted, if I may say, in the near term. When there are many different crises breaking out around us, we tend to forget about the long-term investment. We will never successfully change the culture of this organization at the Department of National Defence until we invest more in education and training at the front end. That happens to be one of the primary responsibilities of OSISS.
To sustain the gains that we have made over the last few years, great effort is required and this will remain a constant challenge. With that, senators, I would end my opening comments, which in navigator time were extended by roughly 10 minutes. I welcome any questions, which I can orchestrate or senators can direct to the members of OSISS.
The Chairman: Thank you, Brigadier-General Sharpe. There will not be any lack of questions I can assure you. These gentlemen are not reticent at all, although they have been slow getting their names on the list so I will jump in first.
Could you outline two things? First, what is the source and extent of your financial resources? Presumably it takes money to travel, train people, et cetera. Where does the money come from to do that and how much is it? Second, how do you measure success? Is it measured in anecdotal terms or otherwise?
BGen. Sharpe: Those are good questions. I will pass the first question to Ms. Darte and Major LeBeau because they have become very good at squeezing money out of rocks, Ms. Darte in particular. The second question is by far the toughest one to answer and we have been wrestling with that as outsiders and as insiders. I would ask Major LeBeau to proceed with the first question.
Maj. LeBeau: The OSISS program is a section of the Director of Casualty Support and Administration, DSCA, under the Chief of Military Personnel. It is set up to run as a normal business.
The Chairman: Is it within the Canadian Forces' arm of DND?
Maj. LeBeau: Yes. We go through the normal business planning process and submit requests for funding and each year our budget is renewed. Each year since the program first came into being, incremental resources have been devoted to OSISS. We are working on the current year to obtain more monies from the Chief of Military Personnel for staffing positions. In terms of VAC, I would ask Ms. Darte to respond.
Kathy Darte, Special Project Officer, Research and Information Directorate, Veterans Affairs Canada: OSISS is a partnership program so we both contribute financially to it. Those people working at the ground level, like CWO McArdle, are employees of the Department of National Defence. A big draw-down on the OSISS budget is for salaries and the operating costs that go along with individual employees. Looking at the budget overall, because they are employees of DND, it puts more money into the program than does VAC. Along with its financial contributions to OSISS, VAC contributes in other ways that also have a financial impact. All of the training that the coordinators receive is conducted by, or provided by, Veterans Affairs Canada at our one and only mental health hospital at Ste. Anne's. We also provide accommodations for these individuals to work from to the extent possible. In fact, of the 17 coordinators working with CF members and veterans, 15 of them work from VAC offices. That is another contribution made by VAC. One of the family coordinators is working from our operational stress injury clinics. Veterans Affairs provides money upfront as well as other kinds of resources. My being a co-manager is another contribution that Veterans Affairs Canada makes to OSISS.
BGen. Sharpe: Although according to Ms. Darte, she is not paid enough. That aside, the funding figure from DND is approximately $1.8 million.
Ms. Darte: The funding from VAC is $.5 million for the OSISS budget in our department.
BGen. Sharpe: I would point out that the Chief of Military Personnel asked the same question because the business planning process revolves around measures of success. It is a challenge. Mr. Jamieson, would you like to add anything?
Lieutenant-Colonel (Ret'd) Jim Jamieson, Medical Advisor, Operational Stress Injury Social Support, National Defence: First, on the academic side, following this meeting at 14:30 we will attend a meeting with representatives of the Canadian Forces Mental Health. We are standing up a research project to measure what OSISS contributes to the recovery. We will try to do a match project of people that receive mental health assistance from our clinics or from civilian resources, plus help from OSISS to try to measure this.
We have also made progress on measuring the effects of being a coordinator on the mental health of the people involved. Ms. Darte and Dr. Richardson might want to speak to that. Without getting into it too far, it is basically very positive when orchestrated properly.
More anecdotally, about 2,500 peers have come to us for help over the last four years. That in itself is an indication of success. We have been too popular and our peers are constantly on the edge of burnout. As Brigadier-General Sharpe mentioned, we have many testimonials, and specifically, we gave you one on Shawn Hearn. If you read that article, you will understand how successful the program has been. Mr. Hearn has been instrumental in setting up a mental telehealth network in Newfoundland and Labrador because so many of our veterans are isolated and can not be reached directly through mental health professionals.
I work in the mental health field and, as Brigadier-General Sharpe mentioned, each time a peer begins work with the mental health team, they basically wonder how we ever existed before without the program. There are a number of informal measurements of success. I would hope that, realistically in two years, this research project we are determined to do on matching people in receipt of OSISS help with those receiving mental health assistance will demonstrate the success even more. Perhaps someone else would care to add to that.
BGen. Sharpe: The second last slide is a statement from Senator Kirby's committee. I think it is a strong endorsement of the success of this particular program.
Also, the last anecdotal piece I would add to that in passing as an observer, again, is that I had an RCMP officer in Halifax tell me he would not be alive today if it were not for OSISS. Alternatively, he had friends who would be alive today had they been able to access OSISS. I take that as one of those strong — anecdotal granted — measures of success. As an outsider, I know this organization has saved lives.
Senator Atkins: First, I wish to congratulate you all for the work you are doing. I think it is tremendous. I am sure you are underfunded. It is up to us as a committee to try and help you get more resources because I am sure the number of cases is increasing and the demand on your services is becoming very important.
Dr. Richardson, can you tell me at what stage you release people from the military who have difficulty? Is there a time when you can establish whether or not a person is qualified to remain in the Forces or whether they should be discharged?
BGen. Sharpe: Perhaps I will jump in on that one first. Dr. Richardson, although extremely competent and qualified, is not involved with the Department of National Defence in terms of when people get released. However, he may want to talk about the comment about the number of cases increasing because he keeps a close eye on that and may have something to add in that area.
In terms of the stage at which we release people, that is something Major LeBeau can explain from her perspective, or Mr. Jamieson.
Mr. Jamieson: My boss, Brigadier-General Jaeger, addressed you earlier this month. This is a medical issue; OSISS does not get directly involved in it. In general terms however, as I believe you know, we have universality of service requirement of all Canadian Forces members. They must meet certain standards of employability and deployability — the G and O factors you may have heard about. Our goal, when a soldier suffers, is to get them back to work as well and as soon as possible. That is the number one goal.
We have mechanisms to help them called temporary medical categories, during which time they receive the treatment they need to get back. At some point, if it becomes clear they will not be able to go back to work, consideration must be given to a release procedure. I do not know if I am answering your question but those are the basics of it.
Having a mental health problem is not automatic. One outstanding example is Major Stéphane Grenier who started this program. He suffered, as he would tell you himself, seriously with post-traumatic stress disorder. He not only recovered but has been promoted since. He did an outstanding job and received a meritorious service award for his work. There is hope if we can get the people soon and get them on the right track.
Dr. Don Richardson, Medical Advisor, Veterans Affairs Canada: Whether someone is serving in the military or whether they are released, in clinical practice, when someone comes in for treatment the expectation is that they will recover and be able to return to their usual functioning whether it is in the military or civilian life. That would be our initial expectation.
We do know from the literature that, if people seek treatment earlier for most medical conditions, whether it is diabetes, cancer or psychiatric illness, the hope of recovery and sustained recovery is better. The benefit of programs like this is to encourage people to seek treatment earlier.
Senator Atkins: Are you saying that whether they are in the military or out, they are getting the same treatment or the treatment they require?
Dr. Richardson: I would expect, if you are seeking treatment, that the treatment would be the same whether you were still serving or not. My expectation would be that the person you would see, the clinician, would treat you the same way. Is that helpful?
Senator Atkins: Yes.
Maj. LeBeau: In terms of OSISS, whether people are serving or veterans makes absolutely no difference. They are OSISS clients. Therefore the services we offer are the same.
Senator Atkins: In terms of those who are coming back, whether it is from Afghanistan or wherever, can you give us some idea of what the numbers are?
BGen. Sharpe: Are you referring to people coming back with some form of mental health injury?
Senator Atkins: Yes.
BGen. Sharpe: Within the Canadian context there have not been extensive studies done yet, although there is some work that is at the beginning stages in Defence Research and Development Canada in Toronto. Dr. Richardson has shared with us information recently from large American studies that have been done dealing with soldiers coming out of Iraq, Afghanistan and then from other deployments not associated with those two areas. There are some interesting statistics and perhaps I could ask him to share those.
Dr. Richardson: It is controversial in terms of finding out exactly whether we are looking at numbers or rates. We do not have any specific stats on Canadian rates for deployments. The other aspect is that whether you are there at the beginning of a deployment, like for Bosnia, or near the end, or if there is something happening, the level of stress or potential for things to happen are different. The rate can change depending on how long the deployment is.
We do note from the literature that studies done on American soldiers who were deployed both to Iraq and Afghanistan and what they are coming out with, that roughly 19 per cent of those deployed to Iraq came back with a mental health condition. It was approximately 11 per cent for those who were deployed to Afghanistan. Those are studies that were published.
We do not have anything recent from those who were still in Iraq in the U.S. The number of 19 per cent was when they first went in so, as conditions change, the rates can also go up or down. We can have some estimates but getting clear numbers will always be a challenge.
We do know from research what some of the studies have shown is that the more you are exposed to combat-like conditions, the higher your rates of having mental health casualties, depression, PTSD and the like.
BGen. Sharpe: That is an important point. I am glad you raised the question because there was a perception at least that, perhaps in all-out combat, the numbers suffering mental health injuries would go down because you are allowed to fight back and so on. The studies to which Dr. Richardson refers seem to indicate that is not the case; in fact, it is the opposite. We should not anticipate a decrease in the mental health casualties coming out of Afghanistan compared, for example, to some of the peacekeeping operations we have experienced previously.
In terms of hard Canadian numbers, Ms. Darte has some numbers here that talk about the still-serving CF members and released veterans in terms of the OSISS peers — in other words, the soldiers and veterans that come forward and seek assistance from OSISS.
Ms. Darte: In the OSISS program, with the 17 peer support coordinators across the country, there are 123 Afghanistan veterans who have accessed the services of the OSISS program. When you look at the statistics we have gathered in our program, the Afghanistan veterans that are accessing the program are coming from areas like Edmonton. We have a peer support coordinator in Edmonton. He has a number of veterans from Afghanistan. Petawawa is another area. We know those are the bases sending troops to Afghanistan.
We have six family peer support coordinators who work with families of CF members or veterans. There are 92 families that came to OSISS because their spouse or family member has served in Afghanistan and is struggling with mental health issues.
Senator Atkins: When Senator Kenny and I were in Petawawa, we met with wives of service personnel whose husbands were departing. We sensed a tremendous stress level among these dependants.
Can you tell us how you are dealing with that?
BGen. Sharpe: I will let Major LeBeau answer.
Maj. LeBeau: The OSISS program is at the end of the process. The program offers peer support for people suffering from, or faced with, operational stress injuries.
The process is really prior to deployment. There are families who access our services at that time, but mainly they will go to the military resource centres. That will not fall under OSISS per se.
Mr. Jamieson: Three years ago, we conducted a major needs analysis of families across the country. It was orchestrated by a family peer support coordinator, Anne Préfontaine. It is a short but strong read.
I was involved. We interviewed about 96 people. Sixty-eight were spouses, all but one female. The rest were mental health professionals working with these families.
Four things happened to the people living with a member or veteran with a mental health problem like PTSD. They did not feel they were given enough information. In three years we have done a lot to improve the information with the military family resource centres and OSISS. They would tell us he came home a different man. ``I did not understand what was going on. I thought he did not love me or the kids anymore. I thought it was my fault. I did not want to talk to anyone. If someone had just told me this had nothing to do with me.''
That is something we can combat.
The second problem was compassion fatigue. They felt they had been left alone to care for this person. They felt they had been deserted by the Canadian Forces. They now had to take care of this person.
This was portrayed by a young woman in Trenton who came to meet with us. She was late because she had a hard time finding a babysitter for her two young children.
Someone said, ``Could your husband not look after them?'' She said, ``No, I can not leave them.'' He said, ``Do you not trust your husband?'' She said, ``It is not that. I am afraid he will kill himself.'' He had tried six times before. This was a young medic.
What scared me was this was her daily life. This compassion fatigue is a factor.
Third, they felt isolated. Their own family said, ``Leave him. He is a drunk. He is no good. He is abusive.''
They did not get support from their family.
We gave them a survey that indicated 90 per cent of them could be diagnosed with clinical depression. I am going by memory but I believe that number is correct.
These were volunteers that came to us. It is not representative of the entire population.
They were upset they were not eligible to direct mental health for themselves.
These were the concerns of families as expressed to us. This study is available. The literature of Charles Figley supports this. There is a lot of work to be done.
The Chairman: Is it possible to get a copy of that report?
Mr. Jamieson: Sure.
Maj. LeBeau: It is on our website.
Senator Day: My questions flow from your presentation. I thank you for an informative presentation.
We are talking about Afghanistan veterans. Do you need to have been in an operational situation to fit under your program? If not, could we go to a military resource centre?
Can you talk about your relationship with the military resource centres? Are there two silos and someone has to determine where he fits? Or is there a seamless fit between the two?
BGen. Sharpe: I will pass that to Major LeBeau and Ms. Darte.
I do not work for OSISS or the Department of National Defence. From my observation, no one has been turned away from OSISS. That includes the RCMP, city police and other people with these problems. The number of full-time RCMP peers is somewhere in the hundreds that are supported by this organization.
Senator Day: Did these RCMP members serve in Iraq or Afghanistan? Are they people that served in northern Alberta and experienced terrible trauma?
BGen. Sharpe: Across the spectrum. If I can be anecdotal, of the eight RCMP members who testified at the Croatia board, four members who were deployed were treated for post-traumatic stress disorder. There are a number of RCMP officers who experience the isolation, more so than serving members. Perhaps not quite as much as the reserve members when they go home. It is a variation.
There is no qualification on how you get the operational stress that brings you into the program. That is the navigator's simplistic answer. There is a more complex answer. I will ask Ms. Darte to address that.
Ms. Darte: The mandate of OSISS spells out who qualifies for the program. The program is available to CF members, veterans and to families of both groups. We say in OSISS, if you have worn the uniform, you qualify for this service.
As Brigadier-General Sharpe alluded to, our operational definition is for those struggling with operational stress injuries that occurred during operations. We do not define ``operations'' as being operations overseas.
We define ``operations'' broadly. It could have been on domestic operations in Canada. We had Swissair and the ice storms.
If you have gone into the military and sustained an injury which is a stress injury, such as post-traumatic stress disorder, depression and other anxiety disorders, this is what this program is for. Those folks come forward to us.
As Brigadier-General Sharpe has indicated, we do not turn anyone away in OSISS when they come to us. The coordinators like CWO McArdle sit and listen to the story the individual has to tell them. We may or may not be able to help them but because we know the services that are out there, because we have to work as a team with what is available in the provinces, what is available in the respective communities, we can help connect them with whoever can help them.
We do have a number of RCMP officers who are accessing the services of our program. To date, approximately 50 have come forward. I do not have the accurate statistics but the majority of the RCMP officers who have come forward for services from this program have a connection with the military or Veterans Affairs; they may be a client of Veterans Affairs. They do have that connection.
CWO McArdle: We are inclusive, not exclusive. We have members and peers who served in Vietnam and have come back to Canada after 35 years or have lived in Canada since the Tet offensive. They are peers of ours and are probably in their own VA system in the United States and were Canadian citizens or Americans who moved here. We have Royal Canadian Mounted Police, police officers, et cetera.
The peer support groups and the individuals say if it is what they need and want. If it is something they do not require, then we measure success when we re-socialize someone and he or she has moved on and does not need the program anymore. That is how we are measuring success.
Senator Day: How do you work with the military resource centre, MFRC, in determining whether you or the MFRC will handle the needs of this individual?
CWO McArdle: We have close cooperation with all the agencies out there, and of course military resource centres are vital. They deal primarily with the families. As was alluded to already, any family member that phones, we listen to what is being said, assess it and get the proper phone number, personnel and agency involved with them on the other side of the phone and get the right help for them. If it is a peer, someone who has served in the military, of course they stay with me. If it is someone on the family side, I try to get them to our family peer support coordinator, PSC, Ms. Inglis, in the Maritimes, so that she can assist.
MFRCs and all the agencies have our literature. We brief with them; we are not necessarily collocated. I am collocated with Veterans Affairs but we use their buildings for meetings. We have a close connection to all MFRCs throughout all the bases of Canada.
Senator Day: This committee has had a chance to visit with a member of the family resource centres on the bases and we see the good work being done there. If I wanted to find out about you and your organization, if I were in the Armed Forces or my family was and they went to the military family resource centre, might they refer the person to you?
CWO McArdle: That is right. All our family PSCs are connected to all the MFRCs as well as the PSCs. They have our information, cards and pamphlets. They know how to get hold of us or can give the information to the individuals.
Senator Day: You have talked about the military family resource centre and your relationship with them. Can you talk about how you fit in with the Veterans Charter and the initiatives under that charter? Is this one of them or are you separate from that?
BGen. Sharpe: We could have Ms. Inglis touch on that, as well as Ms. Darte or CWO McArdle.
CWO McArdle: I am collocated. I have had the privilege of being in two Veterans Affairs offices, Ontario and Nova Scotia. That cooperation you have with Veterans Affairs is essential because the proof is in the pudding. We want to help that peer. I am honest in saying the cooperation between Veterans Affairs Canada and myself personally in both offices has been outstanding.
Senator Day: I would like to hear that positive comment, but if there are any challenges, if there are any walls up that you think we can change, we would like to hear that too. Our objective is the same as yours — to look after the veterans, serving personnel and their families, to make sure they are being properly cared for.
BGen. Sharpe: This truly is one of those excellent examples of interdepartmental cooperation. I think, again, as an observer watching this for the last six years or so, that the walls have toppled. It has been tremendously successful.
Ms. Inglis may be able to add a few words. This works so well in the field. We have had a chance to visit in Calgary. It works so well out there it deserves being highlighted.
Jennifer Inglis, District Director, Veterans Affairs Canada: In Calgary we have only had our located peer support coordinator since February. She has almost 150 clients already, and advises me that in excess of 80 per cent were referred to her by Veterans Affairs Canada staff. That in itself speaks to the cooperation between the two departments.
Additionally, she does reside in our location and we work to supply her with everything required to do her work. The cooperation that exists between the area counsellors, our case managers, and her is quite significant. The clients are demonstrating to us that this is assisting them in making the changes they need in their lives.
Senator Day: I have talked to a number of Veterans Affairs Canada people in various parts of the country, and they are just going through the transition to adjust to the Veterans Charter, so presumably they are being briefed on OSISS at the same time or they already have previously. Are they aware of this other service that is out there?
Ms. Inglis: We are actually quite often briefed on it. Additionally, Ms. Darte shares information.
Senator Day: I was interested in your mandate, and you were talking about the institutional cultural change and your mandate there, which is important. The pre-deployment training module is another interesting aspect that fits in with what we were talking about earlier. You may want to work that into an answer to someone else's question.
My final question deals with how the culture is getting down to the men and women in the Armed Forces. It is very important that these structures are in place, but I am wondering if this culture change is being recognized.
I would be interested to know if you have statistics on how many of your clients are being referred by colleagues or family and how many are walking in by themselves. Have you done any analysis of that?
Ms. Darte: When an individual comes forward to a coordinator like Dave McArdle, he notes on his intake sheet as we call it, that this is a walk-in or has been referred by Veterans Affairs Canada, the MFRC or some of other source, perhaps the operational stress injury or the mental health clinics. We do have that, but I do not have those numbers with me today.
Senator Day: It might be interesting to analyze that to see if recently returned Armed Forces' personnel are prepared to admit to himself or herself that help is needed or if it is the family that is coming in. You had 92 families on your list. You talked about vicarious stress. Obviously, the family is really having a tough time; this person is not the same. He is saying, ``I am fine, I just have to get over this and try to fight it myself,'' but the family is coming to you and saying, ``We can not go on like this.''
That would be an indication that your mandate of changing the culture is starting to work.
Ms. Darte: If I may, senator, the 92 are 92 families of veterans from Afghanistan. We have over 400 families on our list. We have six coordinators located in B.C., Alberta, Winnipeg, Petawawa, Atlantic Canada and Montreal. Those six have over 400 families that they are helping.
When we collect our numbers, the family is the one unit but many times within the family it is not only the spouse that we are aiding, we are working with the parents.
Many parents are struggling with the stress of having their loved one overseas or having their loved one struggle with an operational stress injury. We are also working with children. We have found in this program that operational stress injury affects not only the individual but the entire family unit.
Senator Day: How many individuals are there in the 400 families?
Ms. Darte: I do not have that number with me today, but I could obtain it for you.
Senator Day: It would be helpful to know that. In five years it may be three times that number. It would be interesting to know what it is now.
CWO McArdle: Often people hear about this by word of mouth from another peer. He or she will bring someone to a meeting or to the office. It is vital for soldiers, sailors and airmen to get others involved in the program. Many times family members phone us because they do not know where to go for help. We then refer them to the appropriate organizations.
The program is confidential and voluntary so we have to ensure that we abide by those rules. We encourage and entice people to come to the program but, at the end of the day, the individuals have to make that decision.
Senator Kenny: I was reading a quotation from Stéphane Grenier where he said he was experiencing many conflicts at work with everyone around him. He said that, being a military officer, he felt compelled to minimize the impact of his tour.
Senator Day mentioned the training modules. This phenomenon seems to be widespread. It affects a great many people and seems to be associated with the self-image of individuals who put on a uniform. They seem to have a feeling that, by virtue of wearing the uniform, they should be something different from other human beings.
What could be done by way of training to prepare people in advance for the stressful period they will be going through? Even basic training will be stressful. They could be given a check list.
I was in my doctor's office the other day and saw a list with nine indicators of clinical depression. I checked off eight. The last one asked, ``Do you feel suicidal?'' By the time I got to that one, I was feeling suicidal.
Something seems to be missing at the beginning. You are doing things after the problem has occurred. What is missing at the beginning?
BGen. Sharpe: Education and training are missing. There has been significant progress in the last six or seven years in introducing the fundamental education aspect of this in the very early stages of training. We start out at basic training talking about self-awareness and expand it as individuals take advanced leadership courses. Senior officers learn how to deal with the problem as a unit, how to get people to come forward and so on.
It is the right direction to go. OSISS is heavily involved in helping to provide some of that education and training. The CF training establishments have been introducing that into their occupational standards and specifications. It will eventually make a difference.
There are still in the CF some people who did not experience post-traumatic stress from the junior stages upwards and they are part of our problem. They still feel threatened by this but it is changing. It takes a long time for education to pay benefits. The resources devoted to that need to be protected.
Senator Kenny: Everywhere I go I hear units being compared to families. Some people say, ``My regiment is my family.'' Everyone is going through this to one degree or another. It is not only in the military but is more acute and obvious in the military.
If everyone is going through it and no one wants their neighbour to know they are going through it, why are the families — the units — not recognizing and addressing it more, given that everyone is going through it and reacting differently depending on their personal makeup?
BGen. Sharpe: I began looking into this issue six or seven years ago. Since then, the regimental families have improved. However, if you have six kids around the table and only have enough food for four, it is hard to be too sensitive to number six. Sometimes that is the resource situation we have with our operational tempo.
Maj. LeBeau: In the OSISS program we have something called the Speaker's Bureau which was created recently to meet the mandate of providing education and training and to ultimately effect cultural change.
This summer we worked hard with the Canadian Defence Academy, which is the Canadian Forces' new training centre. We have come to an agreement for them to help us financially as well as with staff to develop new packages so that we can deliver training in operational stress injury at every level of leadership training, because culture is ultimately very much a chain of command issue. It is not an issue of only one section in the CF.
As of April 1, 2007, after gradual implementation, we are hoping to be delivering training on operational stress injury in all master corporal level leadership training courses throughout the Canadian Forces. After that, the training will be delivered higher up the chain to sergeants and warrant officers. We have already started doing some training informally, but at that time it will be more systematic.
The second facet is pre-deployment training. Some of our peer support coordinators have been involved in providing pre-deployment briefings to troops. The Canadian Defence Academy is looking at developing a standardized package as well as peer training so that troops being deployed can better help each other when they are on the ground. These are ongoing projects that testify to the reality that people recognize this as a need.
With regard to the cultural issue, culture takes a long time to change. Mental health issues are stigmatized in Canadian society at large. The Canadian Forces are a microcosm of Canadian society so it is present in our ranks as well. Indeed, it is doubled in strength because we have a very special mandate as soldiers. It is being tackled. There are indications it is working. I would use one example. Peer support coordinators report to us that it is starting. People are coming in earlier. They hear about it, recognize sooner that they need help, and are starting to seek and ask for help sooner than they used to in the 1990s. I see that as a very good sign, and I hope it will continue in that direction.
Ms. Inglis: We recently had veterans return from Afghanistan, still serving members return from Afghanistan. As an example of how much earlier it is, we had four veterans contact the local office within three weeks of returning from Afghanistan, indicating that they felt they were suffering from symptoms and asking where they could get help. We referred them both to OSISS and ourselves, obviously, for disability awards.
Senator Downe: Could you explain to the panel today what support you are giving for immediate family members of those that are killed in Afghanistan?
BGen. Sharpe: That is one of the new programs.
Maj. LeBeau: It is the bereavement initiative. I say this in the present tense. It is starting. It was launched by Lieutenant-Colonel Grenier before he left. I will let Ms. Darte speak to the needs analysis.
We have trained a small group of nine volunteers, and these volunteers have lost someone. Seven of them are widows and two are fathers. They are willing to provide peer support. OSISS is about peers, so it is peers to military and veterans, it is peers to family members, and it is peers in that same situation. The training took place this fall, and we have been proactive in referring, as current events unfold, through our assisting officers. The Canadian Forces always nominate an assisting officer to the family, and it is through the assisting officer that the service is offered. If the family is interested, then they contact us and we make the referral and the contact. So far, there have been, as of this morning, 16 families who have asked for this support.
Senator Downe: When you say families, I assume it is more than the spouse. It could be the parents and/or the siblings.
Maj. LeBeau: There is a mixture of parents and spouses so far. Ms. Darte can speak in terms of the needs because she was present last spring when the needs analysis was conducted.
Ms. Darte: Over the course of the last several years, we had family members who lost loved ones come to us and say, ``I think we need the services of OSISS because we have lost a loved one, but we also are struggling and suffering our own operational stress from what has happened to them, so to speak.''
We thought about that, and we called together a focus group comprising a number of individuals, mainly spouses but also two parents. We met and spent a day talking with them. Basically, we heard from them that even though family and friends and co-workers, whatever, can be extremely helpful, and everyone reaches out at these kinds of times, the most help they received was from someone who had gone through a very similar experience. They felt they truly understood and knew exactly where they were.
We thought about that and certainly approached both of our departments. We were seeing events in Afghanistan and the need was very clear. These individuals who are offering this bereavement support through our program are not paid staff members, they are volunteers, but they also wanted to have some kind of structure because they were doing it anyway. They felt if they were affiliated with us, we would provide the structure, the formal training and the guidance and direction that they would need, so we did. We provided formal training for them. They received the same kind of training that peer support coordinators receive, and then they received a component which was specific to loss and grieving.
They only received this training in mid-September. As my colleague Major LeBeau indicated, since then, out of those nine volunteers providing peer support, they have helped 16 families. That attests to the need out there.
I want to emphasize that they are volunteers, and our challenge as managers of the program right now is to sustain the capacity to carry out this particular initiative, because it is a volunteer component to the program.
Senator Downe: Is all the medical care performed in Canada or given in Canada, or are some sent outside the country for treatment?
Dr. Richardson: That is a good question. I do not know. I can only speak of the care that I am providing, which is obviously in Canada.
Mr. Jamieson: The care provided to who?
Senator Downe: Anyone who has had operational stress injury that may need detailed, prolonged care. Is that always done in Canada?
Mr. Jamieson: Almost all. There are very few exceptions where residential care is provided outside Canada for complex mental health problems. I could not give you an exact number, but I am sure that well into the 95-per-cent- plus would be in Canada.
For example, in just the last year-and-a-half, we have stood up authorized locations to specifically deal with post- traumatic stress disorder and substance abuse, because they are often together, for our military and veteran populations. That is where OSISS and the medical world meet, because our OSISS peer support coordinators tell us that their hardest cases were virtually street people. I am talking about senior officers in some cases who had become street people because of their addiction and post-traumatic stress disorder, and they try to deal with one and they needed both. OSISS identified this problem to the Canadian Forces Health Service and to Veterans Affairs Canada, and we sought contractors who could provide the service.
I do not know if I am answering your question.
Senator Downe: Yes, you are. I wanted to make sure that the care, if not available in Canada, is found for those rare cases where you really need it, and are you telling me you do that?
Mr. Jamieson: Yes, sir, on the medical side.
The Chairman: Major LeBeau, I want to clarify. You indicated that there is a fair amount of training going on now with people who are not at the level of Major or Chief or whatever. Can we be assured that in Afghanistan, as we speak, if someone exhibits signs of stress and reports themselves, or their immediate superior notices that problem, that there is some capacity to deal with them there?
Maj. LeBeau: In Afghanistan, there is the mental health nurse, one social worker and one psychiatrist as well on the ground. They are there.
The Chairman: Do you happen to know whether they are wildly overworked or whether most of these symptoms appear when they come home?
Maj. LeBeau: The symptoms, like you said, can occur there, but it can also wait until they come home. There is some mental health support in theatre.
The Chairman: Thank you very much, each and every one of you, for your valuable contributions. We have learned a great deal and are encouraged by what we are hearing. As Senator Day said, if there are problems, we would like to hear about them so we can perhaps be of assistance in moving your valuable work forward.
The committee adjourned.