Proceedings of the Subcommittee on
Veterans Affairs
Issue 2 - Evidence - February 12, 2014
OTTAWA, Wednesday, February 12, 2014
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:07 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 to their families (topic: military and veterans' mental health).
Senator Roméo Antonius Dallaire (Chair) in the chair.
[English]
The Chair: Welcome to this session of the Subcommittee on Veterans Affairs, a subcommittee of the Standing Senate Committee on National Security and Defence. On this particular day, we are launching an exhaustive, in-depth analysis of what is often coined "operational stress injuries" on the troops who are being deployed and those who are supporting the forces overseas.
It is looking not purely at what we're doing about such injuries — that is to say the services and benefits provided by the Canadian Armed Forces and National Defence as well as Veterans Affairs Canada — but also outside agencies that are interested in the subject, be it from a research point of view right through to providing services.
We also want to dissect the injury, as a number of other studies have raised it but haven't really gone into the entrails of the injury to grasp how it's affecting the operational effectiveness of our troops. From there, we will move through what we're doing about it now, particularly with our current veterans. We will also look at what we plan to do in the future to reduce the impact of this injury on our forces and on their families.
We are honoured to have before us Dr. Alice Aiken, the Director of the Canadian Institute for Military and Veteran Health Research. It is an extraordinary initiative that has come out of academia and the research world. It is an extraordinary tool for us to look into the future, and I hope you'll prove me right with your testimony. In fact, now that I've said all that, I don't think we need your testimony; we can carry on. But we had better get some hard facts from you, as you introduce your role in all this and your institutions, both Queen's and RMC, as well as the way ahead.
Colleagues, Dr. Aiken has a short presentation, and then we'll open it up to questions as per usual, starting with the deputy chair, Senator Wells.
Alice Aiken, Director, Canadian Institute for Military and Veteran Health Research: Thank you, Senator Dallaire and honourable senators, for having me here today. As Senator Dallaire said, I'm the director of the Canadian Institute for Military and Veteran Health Research. I'm also a university professor at Queen's and an adjunct professor at the Royal Military College. I'm also a proud veteran, having served 14 years in the Royal Canadian Navy.
This institute and what it represents is very near and dear to my heart, and I'm excited to be able to tell you about CIMVHR and the role it plays in advancing research that benefits military personnel, veterans and their families.
In November 2010, Queen's and the Royal Military College established the institute, with the full support of Veterans Affairs Canada and the Department of National Defence. Until that time, we were alone among our major military allies in not having such an institute. This academic institute actually extends from east to west, right across Canada. It now includes 30 universities, and if any of you have worked in academia, you will know that even getting two universities to agree to something is impressive, let alone 30. We have 800 researchers enlisted, and we're still growing.
We've joined together to respond to government priorities for research on the unique health and social consequences that impact military personnel, veterans and their families.
[Translation]
With over 700,000 veterans in Canada and more than 100,000 serving personnel, we have a significant population with unique risks, exposures and experiences that demands new standards of protection, prevention and care for ill and injured military personnel, veterans and their families.
[English]
More Canadians served in Afghanistan than in Korea. We have the largest number of injuries since the Korean War, and these injuries are far more complex. Parliament has been advised that one in five of those who served in Afghanistan and our other recent missions will suffer from mental health issues, and we have no idea if this is the scope of the problem or if it is this limited.
The Canadian Institute for Military and Veteran Health Research is an innovative organization that engages existing academic research resources and facilitates the development of new research, research capacity and affective knowledge exchange. This institute serves as a base for all Canadian stakeholders interested in military and veteran health research and provides a channel between the academic community, government organizations, industry and similar international organizations.
Our mission is to enhance the lives of Canadian military personnel, veterans and their families by harnessing the national capacity for research.
The research done under the auspices of CIMVHR focuses on outcomes that will quickly translate into treatments, programs and policies. In addition to focusing on prevention, treatment and rehabilitation, the research also has a technology development focus that speaks to the broader public health interests. We also work diligently with all stakeholders to ensure that new programs and treatments that are cropping up for the treatment of veterans have the appropriate research built in, so we can be sure that they are doing what they say they are doing.
CIMVHR is focused in ensuring that Canada's best researchers are engaged in these research projects, which are fully coordinated with national and international agencies to ensure that they complement, not duplicate, existing research activity.
The Canadian government has provided our military going into battle with the best training and equipment in the world. We must ensure that when these soldiers return to their new battlefield — a personal battlefield that's marked by mental and physical injuries, and social challenges in reintegrating into family and civilian life — that we provide them with the same level of support. This support must be based on the best evidence possible, resulting from research by the best and brightest researchers Canada has to offer.
Our vision is that the health and well-being of Canadian military personnel, veterans and their families will be maximized through world-class research, resulting in evidence-informed practices, policies and programs. In order to see this vision through, CIMVHR has focused on building support and partnerships with individuals and organizations such as the various professional associations. These organizations include the Canadian Medical Association; Canadian Psychiatric Association; research institutes such as the Centre for Addiction and Mental Health; the Royal Canadian Legion; the Congress of Social Sciences and Humanities; as well as numerous senators, members of Parliament and ministers.
We're also collaborating closely with our international colleagues in the United States, the United Kingdom, Australia, the Netherlands and New Zealand, and are in the process of forming new connections with Israel, Germany and France. Around the world, we are now considered to have set the gold standard for what an academic consortium focused on military and veteran health should be.
CIMVHR is continuously creating ways to collaborate. One example is through our national research forum that we hold every year. To date, we have hosted four such forums, engaged over 1,700 researchers and stakeholders, have had over 400 scientific presentations and engaged 10 different countries. And we continue to grow.
The research presented has focused on significant aspects of mental health, operational environmental health protection, both physical and mental rehabilitation, combat casualty care, transition from military to civilian life, family health and well-being, and health care policies and programs. We've published three volumes of research and are in the process of starting a new journal of military and veteran studies. We expect to launch this online, open-access journal in January 2015 and anticipate that it will continue the unprecedented growth in military and veteran health research that we've built in Canada. We also have a comprehensive website and are now on Facebook and Twitter.
In addition to this, and in order to ensure our sustainability, we are building a pan-Canadian graduate program in military and veteran health research. Through the Royal Military College and Queen's, we have offered a very successful webinar graduate course for the last two years, and one of our partner universities will offer a second course this coming September with a focus on military and veteran families.
We have also brokered donations of $400,000 from Wounded Warrior Canada for the next 10 years of doctoral scholarships, and we have a standing masters scholarship of $30,000 a year from the Royal Canadian Legion. This will all help to build the next generation of researchers in this important area, so the work can continue long past the time when public sentiment fades.
Our country has a social covenant with these Canadians — sons and daughters, husbands and wives, mothers and fathers — we send into harm's way in defence of the freedom and quality of life we all enjoy. The academic community is mobilized, our partners are committed and Canadian military pride is strong. Just as our soldiers have served side by side in troubled spots around the globe, we work together in a strong academic coalition to help them as they come home to their own personal battlefield.
Thank you.
The Chair: Thank you, and thank you for being so succinct.
Colleagues, I feel it essential to indicate that Dr. Aiken did mention in her presentation some of her sources of funding, which I would argue are limited. One of them is the $400,000 coming from Wounded Warriors. Your chair has to tell you — and you must decide if it is a problem — that I am the patron of Wounded Warriors. I hope that does not create an ethical problem for us as we look at continuing the discussion with Dr. Aiken. Is there any objection from my colleagues?
Senator Wells: Thanks for letting us know that. I trust you'll guide yourself accordingly with that conflict in mind.
The Chair: Any other comments?
Senator Lang: Similar to Senator Wells, we appreciate you bringing it to our attention but quite frankly I see very little conflict from where I sit. I think sometimes the rules are broadly put and sometimes they should be narrowly put. As Senator Wells says, conduct yourself accordingly, which I'm sure the chair will do because he always does.
Senator Day: Thank you, Mr. Chair. I don't have any objection at all. In fact, I would be disappointed if you weren't a patron of the Wounded Warriors and I'm glad that you are serving in that regard as well as in many other aspects, and we thank you for that.
[Translation]
Senator Rivard: Mr. Chair, I share my colleagues' view. I do not feel that you are getting any personal benefit because of it.
The Chair: Thank you! Financially, none at all. I assure you that the only benefit I get is between my ears. Thank you very much indeed.
[English]
With that mandate I shall continue to chair this session with the idea, as you see in your notes, to bring Dr. Aiken here to show you the scope of what can be required to not only meet the past but to project into the future.
Senator Wells: Thank you for your long history of good work for Canada, both in the military and in your current role. I want to get into the subject of PTSD and the more recent events we've seen, but before I do that I want to build a foundation. I read with interest your presentation to the Standing Committee on Veterans Affairs from the House of Commons almost exactly two years ago with a colleague, Mr. Pedlar, as well. How much progress has been made with respect to CIMVHR's relationship and collaboration with DND and Department of Veterans Affairs Canada?
Ms. Aiken: I would say we have been progressing pretty much on a vertical trajectory for the last four years so there has been tremendous growth from two years ago. This is not only in the number of universities we have engaged, but also in terms of our capacity to work with the government. We were about 16 universities and on the handouts you'll see all the university logos on the bottom, so we have all the major universities engaged. Several things have changed in that regard. The research directorate, through primarily Canadian Forces Health Services group and Veterans Affairs Canada, are working more closely now as a result of working with us in terms of research prioritization, moving forward with common themes. That has helped tremendously.
We have also had the opportunity to operationalize a fairly large standing offer through Public Works on behalf of National Defence and Veterans Affairs. Because we are a consortium of 30 universities, if they come up with a research idea and have $25,000 or $200,000 to put into this standing offer, we can turn it around for them and have the research started in about 30 days, from a peer-reviewed process, versus about two years going through the standard RFP process. Now the government is able to be much more proactive instead of just reactive. When we started this in 2010, Veterans Affairs was still doing research on Agent Orange. I know why, but, really? We needed to move forward, so we've progressed in leaps and bounds.
What has also been interesting is in engaging the academic community, people had the money to do the research and they just wanted access to the data and the populations. We have been able to facilitate that as well.
Senator Wells: That's really good. If I may follow up, with the research that you do it's always beneficial to have a product from that that leads to action. How has the uptake been on the advice or suggestions you've provided to DND and Veterans Affairs?
Ms. Aiken: It has been extremely well-received, so we've seen direct change based on research that has come out of the institute. Not only do we have our conference every year that engages academia but we always have a very robust military presence as well as veterans and veterans organizations and our publications as well as our website, where a lot of information travels through. But we have been able to see new programs start up, and new policies formed. For example, right now, we know that the Minister of Veterans Affairs is under a lot of pressure about service dogs. They have a contract through us and we anticipate a comprehensive paper about service dogs by the end of March, and a way forward for the Canadian context. The minister will be using that directly to influence how Veterans Affairs proceeds with respect to service dogs.
I would say we're having a very direct impact.
Senator Wells: That's good. I was going to ask for an example but you provided that. That's terrific. I will go to round two if we can get that far.
The Chair: We count on it, Senator Wells.
Senator Lang: Thank you very much. As I said to you privately, I've heard a lot about you and it's a pleasure to meet you in person. I appreciate the commitment you've made in respect to your institute and the work that you're doing.
Could you give us an idea in respect to the combination of government money, along with university money and private money? What kind of dollar figure are we talking about in a global sense that's being dedicated to the work you're doing here?
Ms. Aiken: In terms of being dedicated to the research at all of our partner universities, I would say it is in the tens of millions of dollars' worth of research being done in Canada related to military and veteran health.
For our institute, for example, we don't see any of that $400,000 we spoke about from Wounded Warriors Canada. That flows through to doctoral scholars to help them finish their studies. In terms of our institute, we don't see any money other than what I'm able to make fundraising and through support from Queen's University, so none specifically for the central part of the institute. But in terms of research, I would say there are tens of millions of dollars of research going on right now.
Senator Lang: Mr. Chair, if I could pursue this as a supplementary question, do you think we could get a fairly accurate picture financially of what's being dedicated to this area? Now, whether it would be through you or representatives of the Department of National Defence or Veterans Affairs, I'm not sure.
Ms. Aiken: I haven't included Veterans Affairs and National Defence in that; I'm just talking about the academic community. I can absolutely try to get an accurate picture. When we came on board we realized people were doing small chunks of research around the country and there was no way to communicate that back to the government, so they had gone to a local base to do some work. We're still busy capturing the full Canadian picture. We have a fairly good grasp on it now. I could probably get a much more accurate estimate of the amount being spent on research.
A lot of that is from existing granting agencies so it would be people who have a grant from CIHR, the Canadian Institutes for Health Research or SSHRC, Social Sciences and Humanities Research Council. It would be people who have their own money. We have also been able to help researchers get U.S. DoD money for studies. We recently helped a researcher at McGill get $1 million for a study.
It's a moving target. In terms of actual research dollars that have come from the government, it's $3 million through the contract.
Senator Lang: I want to get an idea of what various departments are putting in in-kind and financially, what is coming from the world of academia, private foundations and other institutions.
I think that would give us a sense of what is dedicated at the end of the day. I want to follow up on another entirely different area, but I'll wait until the second round.
The Chair: Thank you. As you're doing this, can you also provide what portion of the DND and Veterans Canada research pot is going to this arena, to see what proportion is put to that, knowing that Veterans Canada doesn't have much research money, but with the DND one, comparing research it does on all kinds of other things, and research on the health side, if that's possible.
Also, have you actually come forward to the government with a structured requirement to continue to build your capacity? I think it's a good follow-through to give us a complete picture of that.
Ms. Aiken: Yes. For the last three years, we have submitted to the Finance Committee to receive core funding through the budget.
The Chair: Directly to the Finance Committee?
Ms. Aiken: Directly to the Finance Committee, and we have not received that yet.
The Chair: Would you mind giving us those figures or what your proposal will be?
Ms. Aiken: For the most recent budget, we asked for $5 million over five years, so $1 million per year, to maintain operations and to continue. While you can get funding for research, it's a lot harder to get the funding to translate that immediately into practices and programs or to provide an evaluation for existing practices and programs to ensure they're working. That's what we wanted to do with that money, but we were not in the budget last night.
The Chair: You're very kind, and I hope I have not offended anyone by asking that supplementary question.
Senator Day: Thank you very much for being here, Dr. Aiken. We should have had you here long ago. I should tell colleagues that I was made aware of this initiative three years ago and I have been very excited to follow the development of your institute ever since then.
Most colleagues know that I attended the Royal Military College, along with our chair, and I also attended Queen's University; so this program is very close to my heart. I am so pleased to see how quickly your initiative has grown, which must have some governance challenges. Thirty different universities, 450 researchers now, and you've explained that you're reaching outside of Canada.
Can your secretariat handle that? How much of the money that you're raising from various sources is going to this secretariat?
Ms. Aiken: We can. We work hard. The associate director, Dr. Stéphanie Bélanger, from the Royal Military College, and I do the work. We have a small staff of three and a half people so we're busy. We've been able to move this forward and continue to grow the academic community. I think what's different about this, because we're focused around a different population, is they've come to the table in good faith; so they are part of our governance.
They advise our board of directors, and they have representatives on our board of directors. They've really come to the table in good faith. We have a meeting once a year at our big conference, and they have a say in future directions, their vision for the research.
What we've asked universities is to take their piece of CIMVHR and make it into what you want it to be for your university. We have to have a central coordinating hub, but if the University of Alberta wants to have a chair and UOIT in Oshawa wants to have a program in their kinesiology department focused on military and veterans, that's great; it all works. It all ups the research that's happening.
We have a memorandum of understanding signed with all our partner universities, and it's really a gentlemen's agreement that we will work together collaboratively and in good faith. That's how it's worked.
Senator Day: It has worked well, obviously, the way you're growing.
Mr. Chairman, we may want to consider attending one of the annual sessions in Kingston.
The Chair: Thank you. The chair has attended the last four. The last one was in Edmonton, in fact, and it's usually in the fall. We'll take that under advisement as we look at this.
Senator Day: I was aware that you were a guest speaker at at least one of those meetings, and I was thinking it would give the entire group a good chance to talk to the other participants and all of the people in attendance.
I've almost used up my time, but I want to make another comment that I think it was very important from the beginning that you bridged the two solitudes of the military and veterans.
We've gone through so many sessions here where we've talked to veterans and say "Oh, yes, we're doing something," and then at the end of military career and families, we say, "Yes, we're doing something," but there was not this cross-fertilization that was absolutely critical in order to serve the families and the personnel, whether or not they are still in uniform. I think you have started out in the right way on this one, and your success is obviously an indication that you've done so.
Ms. Aiken: Yes. We have worked very closely with them. Everybody comes to the table with the right intention, and they realized that they worked together in good faith as well. We did get caught in a few bun fights early on, but it was great; it all worked out well, and we learned as we went.
To let everybody know, our conference this year will be from November 24 to 26, and we will be hosting it in Toronto because we're a little too big for Kingston now, unfortunately, although we love Kingston. It will be in Toronto at the Sheraton Centre from November 24 to 26. Senator Dallaire has attended all four, and this will be number five.
Senator Day: Excellent. I'd like to be on round two.
[Translation]
Senator Rivard: Unfortunately, I am not a permanent member of this subcommittee. I am substituting for another senator. The question I am about to ask may be obvious for someone more familiar with the committee's work. In addition to the financial support you receive from the Department of National Defence and Veterans Affairs Canada, what is the nature of the co-operation, the collaboration between your institute and the government?
[English]
Ms. Aiken: I'll be very frank with you: It's something we struggle with looking at the direct financial support from National Defence or Veterans Affairs, because I think part of the reason we stood up and part of the reason that we've been successful and that the government needed us is that we operate at arm's length.
So if we receive direct operations funding from National Defence and Veterans Affairs, people might question that. I don't think I need to explain to any of you that the government does some great research, but if they do their own research and it's not what the public wants to hear, they're roundly criticized for it, regardless of how rigorous the research was.
We have not asked them for direct funding to support our operations. The research funding is completely separate, and that's great; it goes into research and works well. I think it's something we've struggled with.
At their request, we also don't have any active members of the military or people who work for DND or Veterans Affairs on our board of directors. We have academics. We have retired military. General Natynczyk is on our board of directors. Commodore Jung, the former Surgeon General, but there is an arm's length there. Does that answer your question?
[Translation]
Senator Rivard: Financial assistance aside, what could the government do to help military personnel suffering from OSIs, from operational stress injuries?
[English]
Ms. Aiken: Well, I think the other big thing that government can do is help provide access for the researchers to the populations and the data.
That's the other thing. A lot of researchers do come with their own money, and we're working on ways to smooth that transition. We're working very well with DND, getting access to populations. It's a little trickier with Veterans Affairs because the data is obviously a lot more private and relates to specific medical conditions, so it's a bit more difficult with Veterans Affairs.
Aside from the money, that is the big thing. That's what researchers want; they want access to populations and data, and they'll find the money.
The Chair: If I may, as we go to the second round, remember, of course, that the troops can only handle so many surveys in a month or a year, so that also has an impact on accessibility.
When you have gone to, for example, DND, both regular and reserve, what's the response rate for your database or your metrics? Do you get 100 per cent response or 50 per cent? Can you give us a feel for the different research initiatives that have been done to get that data?
Ms. Aiken: Yes. I would say if researchers come through CIMVHR for access to National Defence populations, we have a single route in, and they will look at it very carefully. If they think it's something that hasn't been over studied, as you say, and it's something they can easily access, they will approve it.
It's tricky knowing where to go. If it's something to do with a health condition, it's the surgeon-general who decides, so that's easy. If it's new technology, we've done that. We had an engineer developing a new backpack that used human kinetic energy, the energy from walking, and converted it to battery power so you can carry fewer batteries in the field. For that, we had to go to the head of the army for permission to do testing. It wasn't about being a patient; it was about being a soldier. It's figuring out the processes.
Unless something is very controversial, almost 100 per cent of the proposals we've put through have been accepted by National Defence.
The Chair: What is the response from the troops?
Ms. Aiken: The response from the troops has been outstanding. The feedback that we hear from the troops is that they appreciate that the academic community is behind them. They appreciate that the treatments and the programs they are availing themselves of have been studied independently, that this actually is evidence-based health care and evidence-informed health care.
After our last conference in Edmonton, I was out with my staff, and the commanding officer of two reserve units came up and told us that he knew of three people who had not committed suicide because of the work we were doing, and they knew the right help was on its way — very impactful.
The Chair: Thank you for that. That is quite something.
Senator Wells: Again, thank you. I want to let you know that I'm now following CIMVHR on Twitter.
Ms. Aiken: Did you see that I'm here today?
Senator Wells: Yes, and I re-tweeted it. I would encourage you to post reports and I encourage whatever viewers we have, public viewers of this committee meeting who have an interest in this — obviously, if they're watching the committee in session, they have an interest — to follow CIMVHR on Twitter and for you to post reports.
Ms. Aiken: Thank you.
Senator Wells: You're very welcome.
In light of the recent suicides in the Canadian Armed Forces, I'd like you to comment on some of the research that CIMVHR has been doing and maybe give an overall view of suicides in the general public versus suicides in the military. I recognize it's a sensitive topic for many people, but I think it should be discussed.
Ms. Aiken: I would say that fully a third of the research being done around the country in relation to military and veteran health is with respect to mental health. A good portion of what we have been promoting is the evaluation of the programs and treatment methods that are used. There has been a plethora of new programs that have come out of almost every mental health organization that purports to focus on veterans. Once again, people mean well, they don't mean any harm, but until those programs are appropriately evaluated, it's not that you don't start them, but you start them with the research built in.
So I would say that the amount of mental health research being done around the country is enormous. For instance, at Queen's University, Bell Canada gave $1 million for a chair in anti-stigma and mental health, and she's focusing a lot of her work on military veterans and veterans' families. There's a tremendous amount of work being done in that regard.
Specifically with respect to suicides, not as much is being done in that area, I would say. It's more post-traumatic stress disorder, operational stress injuries, depression, anxiety and substance abuse. However, I do think that will start to grow and we anticipate having a full session on suicide research at our conference next year. That is one of our goals next year.
In terms of numbers, the statistics are still in line with the Canadian norms for the regular force.
We don't have a good handle on the reserve forces. I think that's a growth area as well. We need to focus on the reserve forces. I am personally engaged with researchers from Defence Research and Development Canada, my university, and 31 Brigade, which is out of London, Ontario. We're doing a retrospective of all the 31 Brigade soldiers who have deployed in the last 20 years to see what has happened to them and to try to get an idea — I know it's only one brigade — of what's happening in the reserves.
What has been interesting is that Australia has engaged in a large study like that, so we're using similar metrics to what the Australians use so we can start doing international comparisons also to see where we are.
Senator Wells: How much collaboration is there with other countries that we partner militarily with?
Ms. Aiken: A lot, and CIMVHR has been the one to bring them to the table. At our conference last year, we had all of our major partners presenting on their research topics. It's a little harder to grasp the U.S. because it's so large. There are many organizations there.
The institute in the U.K. is very engaged with us as well as the institute in Australia; New Zealand was on board; and the Netherlands, to talk about their research programs and where they're going. We've made an agreement to share methodologies as much as we can, so we don't have to reinvent the wheel. If the Australians or the Brits have done a fabulous study, we don't have to reinvent it in the Canadian context. We can say that that worked out for them, they got the outcomes they were looking for, so let's use the same methodology because you can't just take the results. We train differently, we deploy differently and we live in a different environment, but we can use that to compare. We have very good collaborations, again, all in good faith and gentlemen's agreements, but everyone wants to see this move forward.
Senator Wells: A lot of the time gentlemen's agreements and good faith work better than anything you can put on paper. Thank you very much.
Ms. Aiken: I think so, too.
The Chair: The work Dr. Aiken is talking about at 31 Brigade will be unique because although the statistics demonstrate that we're not much different than the civilian world, the statistics do not cover reservists who have left the forces and maybe don't even have a file with Veterans Affairs. So we don't know how many of those there are. Nor does it cover regular force people who don't go to Veterans Affairs, because some don't. We don't have those figures. Veterans Affairs doesn't have figures. It doesn't sustain that. I often say they just don't get the information back from families and so on that it was a suicide somewhere — God knows where — simply that the person died. So the comparisons with the civilian world are, in my humble opinion, something that we should really not even look at until we can actually cover the whole spectrum of our requirements.
My last point is that in the statistics that have been published, we haven't identified the difference between those who have been in combat and the population at large. If you're going to those who have actually been through combat and look at the statistics of that, that might also bring you a different proportion.
I'm overjoyed at hearing you're going to be launching a far more significant effort in that regard.
Senator Lang: I was very pleased to hear about the results of that conversation with that reservist, speaking about the three armed service members who were able to prevent suicide taking place. You always hear on the other side when it does occur; you don't hear about situations where it doesn't. That type of information, I think it is important that the public be aware of that as well, that there is work being done, and it is having some effect. Even if someone might say it's generic, you can't really prove it. The fact is, people are working with people, and they are getting those results. Obviously, we're moving ahead from where we were before.
What does concern me — and I liked your comment on this — I read your comments from 2010 which Senator Wells referred to. I don't see any real direct relationship or observations made about provincial responsibilities.
We can talk about all the research in the world, and we can talk about the world of academia and the results that we get there, but the reality of it is the federal government isn't in the health business. Quite frankly, I'm glad they're not. I live three time zones away from here, and I'd just as soon be taken care of at home, not from Ottawa.
Where does this tie in with respect to your institute, all the research being done with respect to the provinces and the responsibilities they have from the day-to-day offering of programs that can help people from, in this case, the Armed Forces?
Quite frankly, I come from Yukon, and anyone who has a mental problem or whatever, they have to deal with the Government of Yukon. That's how it works in the Yukon health system, and rightfully so.
How does this relate so that those who will actually implement a change in program or a change in philosophy, especially in the mental health area or the health area in general, how does this relate? Are they involved at this stage with your institute? Are they going to your conferences so they know what is available and how they can effect change?
Ms. Aiken: That's a fantastic question. You've hit one of the big problems right on the head. Yes, because our academics are often clinicians as well, they are at our conferences. So they are there. They are from all the different provinces and working in the system, so we're reaching out that way.
I think a very big problem in Canada is that people don't understand the specific nuances of veterans' health. To get that information into the hands of primary care practitioners across Canada is a tremendous effort. We're working on it, I guess is the best way to say it.
I'll give you an example. One of my research projects, we look at ways of getting information into the hands of primary care physicians. We've developed a method, and the Canadian Medical Association liked it so much, they distributed it to all 50,000 primary physicians across Canada. This was focused on spinal cord injury. We had funding from the Rick Hansen Institute to do it.
We now have all of the groundwork done to do a set of knowledge translation products on veterans' health, and we can't get the grant money or the funding to do it. The federal granting agencies don't understand. We get comments back like, "Why would you do this on veterans? Why don't you do it on seniors?" Well, not all veterans are seniors. We have 25-year-old veterans in Canada. There's a lack of basic understanding out there about what a veteran is.
We decided to tackle it from a different angle. We have a brilliant Ph.D. student at Queen's University who works with the health data from each province that is anonymized and centralized from the health databases. So whenever you use your OHIP card in a hospital or elsewhere, that data is all kept in Ontario. One of the Ph.D. students found a code that's used specifically for veterans. When I got out of the military and went and got my OHIP card, I didn't have a three-month waiting period, because I had just gotten out of the military. They put a code that I was a veteran.
Senator Lang: "V."
Ms. Aiken: I don't know what the code is. That would make sense.
There's a specific code, so now we have a way to access that in the Ontario provincial database. We're in a queue waiting for permission, but they're going to add that to the database. Once it's done in Ontario, we want to roll that out to all provinces in Canada.
We've solved a huge problem in Canada of having 750,000 veterans of whom about 120,000 are followed by Veterans Affairs because they suffered injuries in service, and the rest of us are out in the wind. We don't have a concept of veterans' health in Canada. It's a big problem, but we're hoping this will go one step towards solving that and getting the relevant information into the hands of the practitioners who need it.
When I got a new family doctor, she didn't ask me if I was a veteran. I don't "look" like a veteran, whatever a veteran looks like, but people's concept of a veteran. Having served on board ship, I had to learn how to fight fires. I served on all ships that were older than me, so not great insulation, et cetera. Who knows what exposures we had.
Senator Lang: I'd like to ask a general question. You speak about the institution, and you're taking some responsibility reviewing what's happening with military families and those responsibilities as well as the veterans. Obviously, you have those that are still active in national defence.
A number of meetings ago, we had information provided to us, and I think the number was there were 37 programs that were available one way or the other for veterans through one or two or four or five departments. As I said at that time, I went through them. By the time I got to the fifteenth program, I was confused of what was what and where would I apply if I were eligible.
I'm wondering if your organization or some other organization is taking a hard look at this, because there are billions of dollars being spent here. The taxpayer, in my opinion, is stepping up to the plate to ensure we assume our responsibilities. At the same time, we see all these programs. Probably each one has its own merits, but at the same time, it's confusing to those eligible for them.
I'm wondering, is that part of your mandate to look at that and determine how to simplify this and meet the obligations we have to counteract, which in part affects the mental health and physical health side of these veterans?
Ms. Aiken: I would say that it's probably not within our mandate to simplify access to programs for veterans. What's really within our mandate is to ensure that those programs are fulfilling the needs they say they're fulfilling, through ongoing research and data collection, as those programs are used.
We've been asked to evaluate or build in research to a lot of the civilian-based programs but not the government-based ones. If we were asked, we would happily do that.
One of the biggest problems with the government-based programs is you're asking somebody to read through and access them, as you just said, who is already struggling with an issue, a mental health issue or a physical health issue. They're probably not feeling 100 per cent, and they have to try to wade through all of this information. They are the only point of access. Families don't have access, right? Often it's a family who will identify the problem and say, "You need to talk to somebody about this," especially a mental health problem. But they're not allowed access to find out about any of the programs that could be of benefit.
I think that the issue is an access one, probably. Not that they're terrible, but in 2009 I published a monograph on the New Veterans Charter, comparing financial compensation for seriously disabled veterans. I got in a lot of trouble for that, but it led to some changes in the New Veterans Charter. I have a Ph.D., which doesn't make me smarter but it certainly means I can read, and I could not get through it either. I thought, "This is crazy. I'm a healthy veteran with a Ph.D. and I can't figure this out."
I think it's an issue of access. I think Veterans Affairs recognizes that. I think they understand that that's a problem, but simplifying that is probably not within our mandate: it's within theirs. But they're working with us to ensure they have the right programs at the table.
The Chair: It is a question that will open up some future witnesses to that.
Senator Day: Again, I'm going to get somewhat clinical here because I have a question but I don't have all the right terminology, if you can help me through it. I notice that your institute addresses both physical and mental health; you don't differentiate. We've talked a lot about mental health, but we've seen over the last while boxers who have a health problem that is in part physical and in part mental, concussions from hockey players and football players that may not be concussions but who are being banged around a lot. Is there any work going on to look into the physical aspect of the brain and how that impacts on a lot of what we're seeing manifested in behaviour?
Ms. Aiken: There's a tremendous amount of work going on in that area. Some of it we're really proud to have directly facilitated.
What we recognized is that the military had a range of research in what they call "blast injury." Exposure to repetitive blasts is similar to what you're talking about: hockey players being hit and boxers being punched. We were able to link the blast-injury community and the military with the sport concussion community. There's a lot of money going into it because the NHL is backing it. There is a lot of money in the sport concussion world.
Some of the research bubbling up includes actual diagnostic methods, because the symptoms of post-traumatic stress disorder and mild traumatic brain injury or concussion are very similar but they look different, they map differently in your brain. There is a lot of work going on right now mapping the blood flow in the brain to distinguish between post-traumatic stress disorder and mild traumatic brain injury, or looking at other biological markers in the brain or in the body and just the parts of your brain that are firing at particular times. This would be looking at a functional MRI while you're exposed to different things that would fire differently if it was mild traumatic brain injury versus post-traumatic stress disorder.
Often the people who are not responding to treatment are being treated for the wrong thing.
It has been one of the huge fields, and we were very proud to link the sport concussion world with the post-traumatic stress disorder and mild traumatic brain injury world from the military. In fact, at our conference the year before last the Ontario concussion network came and did a briefing for a whole bunch of military physicians to teach them to recognize the signs of mild traumatic brain injury versus post-traumatic stress disorder, so getting it right down to the clinical level as well.
Senator Day: This is very interesting. Once we get some conclusive research and information, you can come to some conclusions that would help with policy decisions, help the soldiers in the field and maybe help some of those veterans after their service understand why they're having the problem they're having.
Ms. Aiken: Absolutely, yes. It has been a focus for some years. We're getting some great results out of it in terms of diagnostics and focused treatments.
Senator Day: Do we have time to go one step further, Mr. Chair?
The Chair: The chair asks for an opportunity of asking questions subsequently.
Senator Day: I'll try to be brief with this one.
It's a question of taking that information and moving it forward. You indicated earlier that some people can raise their own funds; they come with their own ideas and want to be part of your institute. You facilitate getting the clinical information for them maybe, or getting National Defence or Veterans Affairs information.
In other cases you would initiate a concept or an idea and look for researchers who might want to take on this project. My question is, just to get a bit of a flavour for how you coordinate this, who is the owner of what comes out of this and do you have any control over content?
Ms. Aiken: No, the researchers own all their own intellectual property. And we've even negotiated that with the standing offer we have with the government. That was the one caveat we had. For researchers like me, it's a publish-or-perish world in the university environment, so we own all our intellectual property.
You're right; it has been a two-way street. People have come with the money and said, "We want access to the population," so that's happened. Also through the standing offer, National Defence has funded quite a bit of the functional magnetic resonance imaging, the functional MRI testing. There's a team housed at Western University, a bunch of researchers there looking at really refining the biological markers in the brain that are related to the post-traumatic stress disorder versus mild traumatic brain injury. National Defence is funding that.
It's an independent team of researchers doing it. They own the intellectual property, but we have agreed that, especially if the government is funding the research, they have unlimited free access to the results to use as they wish. That makes everybody happy. That keeps everybody happy and content.
It is working both ways. It's a big area of focus. Concussion, mild traumatic brain injury and post-traumatic stress are a big area of research. Does that answer your question?
Senator Day: Yes.
The Chair: The chair wishes to ask a question, and then I have a comment regarding our future work, if I may.
Your mission statement says your organization enhances the lives of Canadian military personnel, veterans and their families in harnessing the national capacity of research. My question is twofold. How are you doing with handling the families, and how far can you mandate in that area, as the families are living the missions with the troops now and to the extent that they are also being affected psychologically through the media and communications?
The other side of that is you're saying "to enhance the lives of Canadian military personnel." Do you include research in how we reduce the possibility of people being injured with operational stress injuries? Are you being inventive or do you have people actually looking at how we will be able to reduce the numbers of casualties in the future to this type of injury?
Ms. Aiken: Yes. The prevention and injury, especially prevention of mental health injuries, is ongoing. A lot of it is piloted actually by National Defence, the Road to Mental Readiness the R2MR program. They've done a tremendous job.
What is happening now is they're taking that out of the military, they've allowed researchers, via us, to take it out of the military to try it with civilian populations who may have similar exposure, so with police, firefighters, people who also have high-stress jobs.
The Chair: First responders.
Ms. Aiken: First responders. We're helping them to validate that program around the country within different populations to ensure that it's working the way they think it's working, not only working because people are ordered to attend the sessions, which happens in the military.
We're also sharing it internationally, so other militaries are trying to use the Road to Mental Readiness program as well. Yes, there is ongoing work in regard to prevention. Obviously the old adage, "An ounce of prevention is worth a pound of cure," is true. It costs much less to prevent an injury than it ever does to treat it. I think that's well recognized.
And you can train the military in a way you can't train the civilian population, because you don't know what's going to happen to the civilian population, but you have a pretty good idea what's going to happen to the military.
The Chair: I looked at it more as an operational effectiveness capability of our forces that you're going to enhance. I find it difficult at times not to have people understand that you are enhancing the operational effectiveness of the forces and not only taking care of sick people. That's another story. I would like to know about the families.
Ms. Aiken: The families have been a big focus. I'd say it really came to light after the first year we started up that the family-based health consequences are enormous, and, really, nobody was following the families.
So we started with awareness. We started working with the Vanier Institute for the Family that is working on programming and resources for military and veterans' families. And we have researchers right across the country doing work with military families as well. We're actually looking at bringing some programming up from the U.S. to try it out here for military families as well and evaluating it in a Canadian context because it's working so well down there.
Yes, families are a big focus of what we do. As Senator Day mentioned, we look at physical and mental, but we also look at social. We take health to be a complete state of physical, mental and social well-being, and a critical piece of it is family. Kingston is ideally suited to be the hub because we have the largest army base and the largest air base in our catchment area. The highest number of veterans per capita in the country live in southeastern Ontario. We have a children's outpatient centre at one of our hospitals, and they see a disproportionate number of children from military families with symptoms of mild stress — chronic stomachaches, chronic headaches and things like that — that are not explained by straightforward physical symptoms, so we have a team of psychiatrists, psychologists and occupational therapists doing work with them now as well. The family is very much a focus for us.
The Chair: Thank you very much. Remembering and coming back to Senator Lang's point, in the American forces, the families are medically supported by the forces, while here our families are supported provincially, so it's a different context. In fact, it's a different philosophy in regard to families and their link to the operational requirement.
Dr. Aiken, you've been first class, and I thank you very much because, when we stumbled into the 1990s, we had nothing. We had done no research or follow-up since Korea. Now that we've finished one major operational theatre, Afghanistan, knowing that an institute like yours is actually looking into the future and taking care of the present is a massive step forward for our forces, not only for the individuals but also for the actual operational effectiveness of the forces to meet future demands. Well done to you, and well done to your colleague from RMC, which I omitted to include in the invitation. I hope you will pass on our comments to them.
Ms. Aiken: Absolutely, I will.
The Chair: Having both those schools leading this is extraordinary. Thank you for that.
If I may, colleagues, just to confirm, you all received the 12-page study proposal that we've started, and I'm asking for permission for steering to now sit with that proposal and start working out the details of the future breakdown of witnesses according to content.
Can I have agreement from the committee for that?
Hon. Senators: Agreed.
The Chair: With that said, steering will build the actual day-to-day plan from here on in.
Dr. Aiken was — and Senator Lang proposed it — a first class idea to start the exercise of getting a feel for where we seem to be intellectually, gathering the requirements and trying to find responses, not only today but also in the future. Well done. And thank you, colleagues.
(The committee adjourned.)