Proceedings of the Subcommittee on Veterans Affairs
Issue 9 - Evidence - December 15, 2010
OTTAWA, Wednesday, December 15, 2010
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:02 p.m. to study the services and benefits provided to members of the Canadian Forces; to veterans; to members and former members of the Royal Canadian Mounted Police, and their families.
Senator Roméo Antonius Dallaire (Chair) in the chair.
[English]
The Chair: The Subcommittee on Veterans Affairs is studying the New Veterans' Charter and the evolution of that document as it applies, in particular, to the new generation of veterans.
Today, we have Dr. Deborah Norris, who is Chair and Associate Professor at the Department of Family Studies and Gerontology at Mount Saint Vincent University. She has a PhD in education, and undergraduate and master's degrees in family studies. She is involved in a number of investigative arenas of family and family relations, family education, family support and family violence.
Dr. Norris has been involved in the family violence study project in the Canadian Forces, which I remember well. I was on the recipient end of that study. Also she is involved studies in family caregiving relationships with the military, experiences with female military partners and older parents caring for sons and daughters with lifelong disabilities.
She is an applied researcher, which is of great pertinence. She commonly works with key informants in the community. The results of her work have informed the development of programs and policies that provide social support to families.
With this study of the New Veterans' Charter we are keen on knowing how the charter will impact on families and members with injuries, and how we are handling that interrelationship, particularly through Veterans Affairs Canada but also the Department of National Defence.
Professor Norris, do you have an opening statement?
Deborah Norris, Associate Professor, Family Studies and Gerontology, Mount Saint Vincent University, as an individual: Yes, I do.
Thank you, Senator Dallaire, for that lovely introduction; and thank you all for the opportunity to speak with you today.
As the senator has noted, I have had long-standing involvement with the military community and I thought it would be important to open by noting the assumptions that I work from with respect to my connection to research and practice with the military and veteran community.
There are three basic assumptions. First, there is reciprocity between military members, veterans and their families, and the military institution. There is an inextricably important relationship between the two.
Second, the definition of "family" that we use in our research with military families is broad and includes both "core" family, which includes the member, veteran, and immediate family members, particularly partners and all dependants; and moving out one level to the "immediate family, which includes children, dependants, siblings and parents of the military member or veteran.
I thought it might be relevant to note that while the question of what is a "family" is always controversial and up for debate, that is the definition we work from in our research program.
The third assumption we work from, and perhaps most significant for our conversation here today, is that the military member and his or her family have an immense capacity for resilience. We also take the point that resilience is not necessarily an outcome but a process. It is a way of being in the world that requires daily work and daily commitment to withstanding the pressures of life and making the most out of the opportunities that are available.
Speaking of the charter, I was heartened to see that the focus on resilience, and also resilience as a process, was front and centre as an implication underpinning many of the components of the charter. I also see reference to the social determinants of health and an ecological model, which seem to be the theoretical, practical frameworks that have been used to develop the charter.
It is worth noting that the way we approach our work at Mount Saint Vincent University with the military community also is predicated on those two organizing frameworks: the social determinants of health and the ecological approach.
Speaking of resilience, developing and maintaining resilience, of course, can be a challenge for military members, veterans and their families. My research over the years, first, began with an emphasis on the cycle of deployment, particularly as it is experienced by female military partners. Over time I moved from the emphasis on management of deployment by the female partner at home to the psychological adjustments required in balancing motherhood and the expectations of the military for female military members. We reported on that study at the Military and Veteran Health Research Forum in Kingston about a month ago. I know that some senators were there as well.
It is important to note that there is minimal research in Canada on the impact of military service on military family members. Most of the research on that has been conducted in the United States, Australia, the United Kingdom and Israel.
In the Canadian context, this has profound implications for veterans and their families. In the last few years, we have invested time in studying the economic, health and social consequences experienced by those diagnosed with service-related disabilities, most notably, post-traumatic stress syndrome, or PTSD.
At Mount Saint Vincent, we have focused our research on the care that is provided to children and aging family members throughout their life course while also managing and supporting an adult or vulnerable family members. These tasks are complicated by the consequences of military service, which, as we know today, could also involve the diagnosis of PTSD.
The consequences of PTSD for the military member and the veteran can be profound. A study examining the impact of the diagnosis of a service-related disability on Canadian veterans of the Vietnam War exposed ongoing problems with family and marital adjustment. These findings were corroborated by other studies, and in some of the documentation that I have provided as a backdrop to this presentation, I have cited some of those other studies. It is worth noting that not many of the documents up to this point are Canadian.
These studies reveal issues with expressiveness and self-disclosure, and establishing or re-establishing intimacy in the primary relationship when the member veteran is coping with the diagnosis and the outcome of the diagnosis of PTSD. Other researchers, particularly in one of the largest studies of mental health problems of veterans of the Vietnam War, found that rates of divorce are twice as high for veterans with PTSD. Again, I note that this is not Canadian data, but to the best of my knowledge, we do not yet know the story in this country.
I want to make it clear that the research we are doing in Halifax on this topic is in its initial stages. However, we are finding so far that there is a chain reaction within the families of those who are diagnosed with PTSD. Couples in which the male serving member sustained a combat stress injury, particularly PTSD, report more conflict, less intimacy, less consensus, less cohesion and less expressiveness than other couples. Partners of veterans with PTSD also experience higher levels of emotional distress, lower levels of marital adjustment, and increased mental health problems, not only in the veteran with the health issue but also in the partner. This has been documented.
As a side bar, I was at a meeting in Halifax on Monday with some colleagues from Dalhousie University who focus on disability broadly defined. They are finding some outcomes that cause concern as well. Not only are there mental health issues related to providing care to someone in your family with a disability, but there also seems to be a corollary effect of actual physical manifestations. The mind-body connection seems to be coming into focus, to the extent that we are able to document it to this point.
The consequences extend to the children. Children of veterans diagnosed with PTSD are more likely to have behavioural problems. This is based on research coming out of the United States. Some of these problems include both what psychologists refer to as internalizing behaviours — withdrawal, depression, changes in school performance and school behaviour — and externalizing behaviours that involve such things as acting out and sudden behaviour changes.
The Israeli work that I cited earlier notes that members of the family unit, including children and their partners and other family members, risk being consumed by what is referred to as the burden of care that is associated with the illness and the struggle to maintain their independence and autonomy. Again referencing the Israeli work, female partners of veterans diagnosed with PTSD reported that their lives revolved around their husbands. The phrase that the researchers used was "the illness as navigating living." The illness became the central organizing feature of the family's life, shaping both the physical and the emotional lives of the women involved.
The women in that Israeli study also reported tension between fusing and losing their identity in their husband's illness and the struggle to maintain some independence. The balance is referred to in their study as "the tension between merging and individuation." The tendency is to get totally involved in the illness such that there is a loss of self. The women in that study talked about how they had to work very hard to keep their identity in the face of the illness.
Again in a preliminary way, the work that one of my graduates students and I have done and on which we reported at the forum last month echoes some of the findings of this research. In our small qualitative study of Halifax women who were married to veterans, which we released within the last two years, they reported that they were beginning to mimic some of the symptoms of the PTSD, exaggerated startle response being one that came to mind.
The women with whom we worked noted that they worked very hard to redefine the relationship. They have to cope with the need to be hyper-vigilant, to be always watchful and mindful of any signs that show that there is distress or something that is not going well for the partner with the diagnosis.
A very intriguing finding about which we want to learn more is the notion of ambiguous loss. The women we worked with in Halifax indicated that they married or partnered originally with a different person and that in the aftermath of the diagnosis, which resulted, of course, from the service, they were dealing with the loss of the person with whom they had originally fallen in love, married and formed a life. We refer to this, as do the Israeli researchers, as an ambiguous loss.
One of the women in our study referred to it as a present absence. The person who was is no longer there. While the person is still there physically, and visible to them, emotionally and psychologically the person who was is no longer available to them.
Psychologists refer to this as secondary traumatic response syndrome. Dr. Charles Figley, an American psychologist, coined that term. In fact, STSR, secondary traumatic response syndrome, is now recognized as a health outcome for partners and family members of members and veterans diagnosed with PTSD.
In conclusion, before engaging in discussion and dialogue with you, there is little known about how the family members of members and veterans diagnosed with PTSD experience secondary trauma, and there is not full understanding of the processes by which it occurs. The research I have cited does tell us something about it, but, again, very little of it is Canadian and we still have many unanswered questions. I think that some of those unanswered questions have implications for the charter, which brings this back full circle.
In the face of all this, as is noted in the Israeli study and in our preliminary work in Halifax, some women did report some life satisfaction associated with being the primary caregiver. They felt they were doing what they were called to do: They were finding new strengths, capacities and opportunities for developing and maintaining resilience. As hard as it was in the face of that situation, there were moments when they felt they were discovering new things about themselves that worked to their advantage, as well as to the advantage of the others.
Essentially, as one of the women in our study noted, being the strong one can be empowering, and in some cases they drew incredible strength from their partners because they saw what actual work was invested by them on a daily basis in being well and healthy.
Questions emerge. One of the recommendations that I see in the report of the advisory committee, tasked with working with the New Veterans' Charter, is the need for a needs-based philosophy of services. More questions and research need to be done to support that outcome, which is of course central to the charter.
There are other questions that I think can be addressed that will support the implementation of the charter. How does military service affect serving members, veterans and their families over the life course? In particular, what are the negative consequences but also what are the positive consequences? Do these consequences develop over time? If so, how? How do personal attributes, interpersonal relationships, resources, policies and entitlements affect the life course and combat-related outcomes of military service for members, veterans and their families?
A question that we are interested in pursuing in our research in Halifax is: What are the pathways to resilience across the life course for members, veterans and their families? What strengths and challenges emerge along the way? What do military members, veterans and their families need to develop and maintain resilience?
Of course, the central question is: Is there value in developing a mandate for policy and program development organized around a resilience-based model that will empower families to seek, recognize and benefit from their capacities and strengths? Essentially, of course, I agree that this goal is indeed worthwhile, and one that can be pursued through the interplay of those of us involved in research, practitioners and so on.
I am heartened by the reference in the report of the New Veterans' Charter by the advisory group in recommending the social determinants of health and an ecological model for program, policy and research, and growth in all those areas in the future.
Thank you for your attention, and I welcome any feedback or questions.
The Chair: Thank you very much. To inform our colleagues, we have to end this session at about a quarter to one o'clock at the latest, as we started a little late. I have three introductory comments from my colleagues for you.
First, you have often used the term "illness" when talking about operational stress injuries. I guess that is a technical term. However, it is not the term that the soldiers, sailors or airpersons are at ease with. I feel I have lived with an injury and not an illness. I suppose there is a qualifier there somewhere.
The New Veterans' Charter has been ambiguous on how far it goes in helping the family. I am interested in your definition of "family" and what support it should receive, as we move on with that issue.
A few words on the research side: that is a deficiency that is also seemingly not apparent in the charter, but yet it wants to use sophisticated instruments, for which we do not necessarily have the research in that forum.
First let me go to my colleagues for questions; to the deputy chair, Senator Manning.
Senator Manning: Thank you for your presentation today. In the interests of time, you have given us a lot of information in your opening remarks. It would be nice to have much more time than what we have today to delve into those remarks.
I want to follow up on the last comment by the chair. You referred to the Israeli study and other studies that have been done, and you also made reference to the lack of research in Canada in relation to military families. Can you give us an idea of whether there is research that we can refer to as a committee that you are aware of in regard to the Canadian component? Have you been involved in work, or are you aware of work that others have been involved in, to give us an idea of what is out there, and, more important, what is not out there? Then we can follow up from there.
Ms. Norris: For sure: In Canada, if you are referring to Canadian research, colleagues at the University of Alberta, Dr. Janet Fast and Dr. Norah Keating conducted research — I think it was upwards of 200 telephone interviews — with family members of severely injured — and I take your point, Senator Dallaire — veterans. The report was entitled Wounded Veterans, Wounded Families. Some of you may have come across that report. It has received rightly a lot of attention within VAC, because it is a credible piece of research. I most notably flag that piece of work.
Of course, Dr. Deborah Harrison has conducted work over the years on military families, most notably looking at the cycle of deployment and a family violence study. I understand from that there were recommendations for Directorate Quality of Life, DQOL. I am not sure if it still lives with that acronym.
The Chair: It has come back.
Ms. Norris: I know there was a concerted effort by DQOL researchers and policy developers to implement the recommendations that came out of her work. I certainly flag Dr. Harrison's work. She is a retired professor from University of New Brunswick, but her work is still relevant to some of the experience we see in Canada with members particularly, not so much with veterans; for example, it is relevant to the Keating and Fast work coming out of Alberta.
The Chair: The vacuum areas that the senator referred to?
Ms. Norris: The areas where we do not know a lot: We do not know a lot about the impact of service on veterans and their families, military members and their families. To the extent we can call the response secondary trauma, we do not know how that is experienced or understood within the family or by those who try to provide support to them. We do not know a lot about models of care yet, if we want to talk about the practical side.
One thing I was interested in seeing in the charter, and I mentioned this point to Senator Pépin prior to our meeting here, was the extent to which the well-developed military family resource network can be used as a way to provide some kind of support, at the least in the transition from active service to life as a veteran.
Again, I think we need to have, as researchers, policy-makers and program developers, conversations about models of care and strategies for using the infrastructures that we already have: perhaps building on them, but at least beginning with what we have, and seeing what is working and what could work.
Senator Manning: I am interested in your comments with regard to the burden of care and maintaining independence, and who is responsible for the burden of care. In some of the testimony we have received here in the past several months, we talked to soldiers at the end of the table here. Almost without a doubt, with every one of them, I had the feeling it is not about them personally; it is about the family. It is about their spouse, their children, and everyone else who is involved, once they return from somewhere like Afghanistan with a serious injury.
In many cases, for me as an untrained person, I felt that many of the injuries were not visible injuries; they are injuries beyond that.
In the work you have done, do I have a proper read from what we are hearing is the major concern out there? If so, is there any work you know of, in regard to research, that has addressed that issue?
Ms. Norris: If I understand the issue you are referring to, you mean the stigmatization that goes along with having an invisible injury? The general mental health community has been trying to address that one.
I am not a psychologist. I am more on the sociological side of things, so I am not as well versed in the strategies for trying to deal with stigmatization. I say this with the greatest deference because I have no personal connection to the military other than being a researcher for the last 20 years. Everyone asks me why I do this research, because I have no familial connection past or present but a very strong interest in the military community. However, I do know that when I meet with families and staff, there is still a great deal of conversation about military members, men and women, having some reluctance to bring forward any kind of invisible injury, such as a PTSD diagnosis or the thought that there might be a diagnosis.
The general issues we see in our culture overall around stigmatization anecdotally from what I know to this point are real in a particularly acute way within the military community, and I say with the greatest of respect to those here who have been or are military members, because of the ethos of the military about combat readiness and being strong and self reliant, which are vitally important attributes to have when you wear the uniform.
Senator Pépin: Welcome and thank you for coming. I know there is a network of specialists, psychologists and psychiatrists across the country to look after veterans. Who are those experts and is the network well established across the country?
Ms. Norris: To the best of my knowledge, the network and system of support has great promise. From some anecdotal information I have from the families, mostly women who are military partners or former military partners, is the peer-counselling model seems to work the best, particularly the one implemented by the OSISS group, which is intriguing in other ways because it represents a connection between DND and VAC.
Senator Pépin: They say they have a 1-800 phone line open 24 hours a day seven days a week to veterans and their families.
Ms. Norris: Yes, and that is through the OSISS Program as well as the one-to-one peer counselling model.
Senator Pépin: They announced in 2007 some clinics, and there were only five or 10 clinics; and in 2009, there were 10 clinics across the country. Do you know how many we have in 2010?
Ms. Norris: That I do not know. I do not know how many clinics we have across the country. Do you mean clinics that focus PTSD?
Senator Pépin: Yes, clinics that military and family can go to when it is very important and urgent.
Ms. Norris: I do not have that information.
Senator Pépin: There was a meeting with the Veterans Ombudsman, and one person said that the New Veterans' Charter does not favour bachelors or certain categories of widows.
What do you think about that? Do you agree? If it is true, what could be done to have it better organized and more available?
Ms. Norris: That is interesting because there is often a gap between the spirit of a policy, such as the charter, and how it is implemented. When you read the charter, when you read the report of the advisory group, there seems to be an indication of a broad definition of family, such as I brought forward for consideration at the top of my remarks today, that families should be broadly defined. There is always an issue of getting it too broadly defined because then some people who really need the help may not get it.
Senator Wallin: Senator Dallaire and I were thrilled by what we saw going on at Kingston and that there is a real possibility that this might work with universities coming together and collecting this research, because it is bleak in terms of uniquely Canadian studies.
My question is on the flipside, and I always try to pose it with great caution. As we discuss this in greater and greater depth and detail, I am worried about the "medicalization" or the "psychologization," whatever the word will be, of service to country, of family, of family issues. We can all name 14 other professions that make the professionals' lives stressful. These professions cause marriages to break up, and cause the kids to suffer the consequences. Journalists fly around the world on a minute's notice and go away from home.
While I want to ensure we are not letting anybody drop through the cracks, I also do not want to feel we are putting a stamp on anyone and everyone who has ever served their country and gone to Afghanistan or war. I do not want to stamp those people that somehow, something might be wrong with them.
I know you have to cast your net broadly when doing research. How do we achieve that balance?
Ms. Norris: One of the ways in which I have tried to think about that — in some cases this might be justified, but at the risk of being labelled a Pollyanna — is I try to enter my understanding of the military community by asking myself what is working with the people I work with. What are the strengths and capacities here?
Not to sound over the top about this, but some of the strongest people I have met in my life have been military women, women who are married or partnered into the military. They are incredibly self-reliant and resilient women, managing babies, shovelling snow, and moving their household in the middle of the six-month deployment. These women can be living in Halifax, perhaps a francophone far away from her family of origin, whatever. It has been inspiring for me as a woman to see how some of these other women do it.
That does not mean we do not deny the issues and places where there are problems. I have had the privilege of working with a number of women in the military community who have struggled and are continuing to struggle.
However, on the flipside, there is interest not just from my own sense of things but more broadly, and I think I saw this at the conference, the forum in Kingston, with using a resilience framework, using a model wherein our entry point is what is working and what are the strengths.
Senator Wallin: I think that is important. I have had some psychological training, and I would like to see that reflected in the research as well because I think that is a really important strength.
Senator Plett: I will make just a few comments before I ask a question, and I will try to be brief, chair. The comments are in light of, I suppose, the chair's opening remarks into his opinion of the New Veterans' Charter. I want to briefly touch on some of the things this government has done.
We restored the 1995 cuts to allied veterans and have extended these vital benefits and services to allied veterans from the Korean War and some family members. We successfully implemented the New Veterans' Charter that represents the most sweeping changes to the way we have cared for our veterans in 60 years.
In addition to maintaining full financial supports for our modern-day veterans, the New Veterans' Charter breaks new ground by focusing on the wellness of our veterans and their families. Approximately 20,000 veterans have received New Veterans' Charter benefits as of December 31, 2009. As part of this new approach, our government compassionately approved lump-sum death benefits of $250,000 to the survivors of four fallen Canadian soldiers who died between the passage of the New Veterans' Charter, on May 13, 2005, and the day prior to its coming into force, on April 1, 2006.
Veterans Affairs Canada is doubling the number of operational stress injury clinics we operate bringing the total to 10.
That is only a few of the things that this government has done for veterans, and the list goes on.
My question is related to a visit that many of us around this table had to Edmonton, about a week ago. We saw many of the veterans. We visited with many of the injured veterans, whether they had injuries that were visible or not visible.
We visited a wonderful facility. I am not sure of the name of it, but it is where veterans go to seek help and to be put on the list. We saw the facility. We were talking to the veterans there. One veteran mentioned to me that he waited six months before he received help. When we visited the facility, I asked a question about that wait. They knew the veteran I was talking about. He did not need to wait six months for help or to be seen. However, because it was an injury that was not visible, they put him on a six-month program where they needed to see what the advancement of his injury would be before they could properly prescribe help.
The biggest thing that I noticed there — and I am wondering whether this situation is common amongst families as well — was a lack of knowledge. Sitting at a lunch table with a number of the young veterans, I asked that same question. They said, yes, but I was talking to young 25-year-old men and women who thought they were invincible and did not think that they would ever have a problem. They were veterans but they had not been injured. The comment was made that, rather than going to these seminars where they will tell us this and our eyes will glaze over, we would rather be doing something else.
Do the families receive the information they need — not the help? I am convinced that they receive help, but do they receive the information they need so that they know where to go and what kind of help they can access?
Ms. Norris: My response is that I concur. I think the help is there. However, there is no doubt that more needs to be done. That is why, when we look at gaps, I speak to models of care and try to figure out what we are doing well and what we can do differently.
I think there is a deficit in our communication about what is ongoing and what is available to military members and their families and veterans.
Senator Plett: How do we overcome that deficit? Until I went to Edmonton, I believed that it was our fault. Then these young people tell me: no, we have these programs; we can go and get the information; I would rather be out drinking beer than going to that seminar.
It was a 25-year-old man who said that.
How can we ensure they receive the information?
Ms. Norris: In the case of the 25-year-old person, one advantage or disadvantage of youth is that they think these things will never happen to them. When the injury is an invisible one, it is even harder to put a finger on it.
What I understand from my friends in psychology is that some of these injuries do not manifest until months or years down the road. That delay complicates things as well. It is not like breaking an arm or a physical injury.
How do we do it? At the risk of sounding like I am speaking from my own standpoint, which perhaps I am, we need to have research. It is our job, as researchers — and I am an applied researcher — to ensure that we help, as researchers and as practitioners, to ensure that good messages are conveyed about not only what the issues are but also what can be done about them.
We need, researchers, policy makers and practitioners both within the military community and, as what I would call myself, outside the military community, so that we all work as members of a team with a well-developed communication plan to ensure people know that, first, it is okay. That is not to say that we will not still cope with those 25-year-olds who will never imagine that they have an injury that requires a psychological intervention.
I think a concerted effort by many people who have their eye on the same outcome, which is positive help in growth and resilience for members, veterans and their families would be the way to go. We will not fix the problem overnight but we can start.
The Chair: A 25-year-old who is injured and is coming back from operations cannot be considered the person where we take the normal process of informing. We have discovered some of the terrible mistakes they make when released. How do we handle that injured person who is psychologically injured so they understand what is available and so they receive that help is still a new phenomenon that they are trying to work on and that is being experienced by the family support centres or the joint support units.
Do you agree, then, that these people are not necessarily in a frame of mind to comprehend what is happening to them and that we do not necessarily have the tools to make them comprehend what is happening to them?
Ms. Norris: I agree. Speaking from my own place in the world, this issue speaks to the need for more research. How do we understand that 25-year-old, to break that process, and what are the best models of prevention and intervention?
The Chair: The ratio is one to six of physical to psychological injuries, where we have programs in the New Veterans' Charter to handle houses and modify the houses, and so on. Are the families who are affected by modifying the houses to help the physically injured receiving equal support from the charter as those who are psychologically affected? That is to say, the families may not have their house rebuilt, but are their needs defined enough so that we can respond to them?
Ms. Norris: I see a great interest in defining those needs, particularly in that report authored in 2009 by the advisory group. There are many heartening references to the family and how the families can and should be implicated in the care, but also how they should receive care in their own right. Again, there may be a gap between the intent and how things are implemented.
It is good to know that the charter is described as a living document. Even those directly in the middle of developing it talk about it that way, in my interpretation of it. That tells me there is interest in looking at some of those issues and saying, we have the basis; now what do we do to make it better for everyone, including families?
The Chair: Senator Wallin and I attended that forum, where we hope the country will create a research institute for this subject. If we base a charter on the resilience of the family but do not have research data behind it, should the charter call for us to conduct that research and to put funding and capabilities to that research?
Ms. Norris: Yes.
Senator Wallin: Who do you mean when you say "we"?
The Chair: The "we" is the government managing the charter. Should they articulate a need for that research to provide the data for the resiliency to provide the service?
Ms. Norris: I would say yes. There is a small reference in the report of the advisory group about the need for research but it is near the end.
Senator Pépin: If I understood well, you said that when a young soldier comes back, they could experience a psychological impact after one or two years?
Ms. Norris: It is not only a young member or veteran but also anyone of any age. That is what I understand from the psychology literature. The manifestation of post-traumatic stress disorder, in particular, may not be clear until significant time has elapsed.
The Chair: Thank you very much, Ms. Norris. Thank you for your references to Dr. Harrison's work. We will obtain those references, as well as the study by Alberta group. Thank you enormously for that information.
Colleagues, we will now go in camera to discuss the work plan for the new year, which was distributed in English and in French and in draft format in order to review it and to finalize it.
(The committee continued in camera.)