Proceedings of the Subcommittee on
Veterans Affairs
Issue 6 - Evidence - June 11, 2014
OTTAWA, Wednesday, June 11, 2014
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 the medical, social and operational impacts of mental health issues affecting serving and retired members of the Canadian Armed Forces, including operational stress injuries (OSIs) such as post- traumatic stress disorder (PTSD).
Senator David M. Wells (Deputy Chair) in the chair.
The Deputy Chair: Ladies and gentlemen, welcome to this meeting of the Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence. This is the subcommittee's third meeting for its study on mental health issues affecting serving and retired military personnel. My name is David Wells, deputy chair of the committee, sitting as chair today.
Today we are hearing from Dr. Wayne Corneil, Affiliate Scientist at the Institute of Population Health and a Teaching and Research Fellow in Community Medicine and Epidemiology at the University of Ottawa. He is involved in several major research projects on executive health, leadership during crisis, psychosocial aspects of disasters and terrorism and on emergency management for high-risk populations, including those with disabilities. His more recent research has focused on resilience in response organizations.
Prior to his retirement from the Public Service of Canada in 2004, he spent 32 years in various senior positions in Health Canada at the regional, national and international levels, with responsibilities for occupational safety and health, quarantine and emergency health services.
His field experience includes work related to the crash of the Swiss Air flight, work with the National Capital Chemical, Biological, Radiological and Nuclear Defence team and work related to the trauma and false alarms associated with 9/11.
Welcome, Dr. Corneil. Prior to your opening remarks, I would like to introduce Ms. Josée Thérien, clerk of the committee, and to my right, Martin Auger, our analyst from the Library of Parliament. I would now like to go around the table for our senators to introduce themselves, please.
Senator Mitchell: Grant Mitchell from Alberta.
Senator White: Vern White, Ontario.
Senator Lang: Dan Lang, Yukon.
Senator Campbell: Larry Campbell, British Columbia.
The Deputy Chair: Dr. Corneil, the floor is yours.
Wayne Corneil, Affiliate Scientist, Institute of Population Health, University of Ottawa: Thank you very much. I appreciate the opportunity to be here with you today.
I will start with some contextual remarks and then get into my notes. As the chair mentioned, I have a fairly extensive background in a number of different areas, primarily both as a researcher and as a clinician. My clinical practice focused on the emergency services workers: police, fire, EMS, physicians, nurses, as well as some military in the treatment of post-traumatic stress disorder and other operational stress injuries.
I have been carrying on that work more recently with the private sector in looking at people who have a combination of both PTSD and traumatic brain injury. We have been doing some work in that particular area.
Today, I want to talk about what we consider the psychosocial or social support dynamics. I know you have heard from my colleague, Dr. Greg Passey, on the biology, neurology and some of the treatment, so I thought I would try and focus on the continuum of what we call psychosocial behaviours in preparation, preparedness, mitigation, recovery and rehabilitation.
PTSD and other occupational or operational stress injuries always occur in a social context. Many times, when looking at treatment, we tend to forget about the social context and the milieu in which people get injured and the milieu in which their behaviours manifest and their recovery takes place.
One of the things that I learned early on was that there is no such thing as a soldier without a family. When a soldier deploys, the whole family serves; when a soldier returns, the whole family is impacted; and when a soldier is injured, so is the whole family injured. We want to look at the psychosocial context — not just the exposure to the trauma or to the horrific events that people experience, but how they respond to it with others or, in some instances, not and withdraw from others.
We are social beings. The quality of our lives is really tied to the quality of our relationships. That's the part I'm going to focus on and talk about in the context primarily of families, but when I talk about family I'm not talking simply about the immediate nuclear family but also about the extended family and the family that the soldiers and vets find themselves in within their units, in their companies and in the presence of their colleagues. That, too, is a family, and we need to look at those kinds of family dynamics and how things come about for them.
Any experience, good or bad, shapes and reshapes those families. Almost all military personnel, whether active or vets, are in relationships — many of them with children who are very young or with adolescents. When talking about family, we are talking about close spouse, partner, parents, siblings, others, even pets, because we know of the extraordinary impact they have on the well-being and recovery of those with PTSD.
We are all familiar with the notion of six degrees of separation. In that context, each one of us has a network around us. When we take a look at both the serving military and the vets, we find that, on average, they have seven close family members, all of whom are affected in some way or another with the various behaviours and disorders that they are coming from.
Both soldiers and vets worry tremendously about the impact they are having on their family and their children. That adds to their difficulties in seeking and staying in treatment because they are always concerned about what impact that's having on those they love and are concerned about.
I want to talk a bit about the research I've been privy to, as well as that of my colleagues both here in Canada and in the United States and particularly the American Psychological Association.
During their careers, soldiers spend 24-7 in their units in preparation and training, as well as when they're deployed. When they come back, particularly if they're injured or experiencing PTSD or another operational stress injury, they tend to become isolated and cut off from that family. We see their family members as well, who have been part of the military community and living together with other military families. They, too, become isolated and separated. That adds to the difficulties. The family is withdrawn and they are not able to provide the support that many of these individuals need in addressing PTSD and the other operational stress issues.
They're undergoing major transitions — not just the fact that their loved one has been away and served, but now they're coming back to a totally different environment and how they're adjusting to that. Many times, they are left to deal with those behaviours on their own. In fact, some of the symptoms that we see from OSIs erode their social support. People tend to avoid, to be withdrawn, to be irritable and angry as a result of the symptom cluster that I'm sure Dr. Passey explained to you. That tends to sometimes push other people away or certainly erodes the social support around them.
That loss of social support is really critical because we know, from all of the treatment and the research, that intimate relationships are a primary source of support for most people. Though high levels of social support have been associated with a decreased intensity of PTSD and a more robust recovery, it's important that we see this as a package, not just as focusing on an individual.
Take a look at some of those things like the re-experiencing syndromes. The nightmares and the flashbacks create confusion and fear in the family because they don't know what's going on with the loved one or how to relate to them. It creates anxiety on the part of the soldier or the vet as they perceive their environment as somehow unsafe and unpredictable. So how can they deal with that? They tend to avoid anything that will trigger those kinds of symptoms or those kinds of reactions. They do that through emotional numbing or withdrawal, which can lead to a loss of intimacy and closeness with the very people they need in order to get better. That can be their colleagues, their fellow vets, but also their families.
We tend to see the hyper arousal in which they become overprotective parents. They have difficulties with their children, and it's really important that we focus on some of those children because there is a legacy there. I'll come back to that in a moment.
Then there are a lot of behaviours that we know are already associated with that. Whether they're serving members or vets, there's increased risk for substance abuse. We have well-documented risks for family violence. Then, there is risk-taking behaviour and, certainly, the risk of suicide.
You can see those relationship issues. If someone is going through those kinds of symptoms, it's obviously going to create some impacts on the family members. Living with traumatized vets and soldiers is traumatizing. Families are the most likely people to observe the signs of difficulty because they're trying to hide it from everyone else. Yet, what do they do with this? How do they respond and help that person deal with it? Often, they seek out help in the community where the people they're seeking help from don't have the background to be able to identify either with the disorder or, more particularly, with the military culture. Sometimes, they'll just say to them, "You just need to get out of there, out of that environment," which is absolutely the wrong thing to do. They need to be part of that environment because that's what kept them healthy, and that's what will keep them healthy in the long term.
We need to look at how our clinical approach is bolstered with social support and collective treatment. As I have said, social support is critical to recovery, first and foremost, with the family and then with their fellow vets. Friends and non-vets aren't as significant in terms of that recovery process. We know that we need to maintain that cohesion and network for them. The peer social support has a greater impact. It provides for the social interaction. It also reduces their symptoms, and what's really interesting is the role of what we call reciprocity. In fact, their ability to help others helps them. The fact that they can provide support to their colleagues who are going through this provides more support for them. We need to make sure that we're not isolating them in their treatment and that we're not isolating their families in the treatment because that interaction helps them to recover and heal as well.
We have some significant groups that we need to think about, particularly those who are reservists who may not have had as much contact. They may be going back to smaller communities where the network isn't as great, and they need to be connected to that larger network. They may be the only ones from their particular reserve unit who have served in this kind of context. So how do they get additional strength and support from that?
A number of years ago, when I was working here in Ottawa with the Ottawa Fire Service, I was working a lot with firefighters who were injured in the line of duty. One of the things that we discovered is that how you treat the family predicts how soon they come back to work. What happens is that, when they're at home, suffering through all of this and not getting any support from the department, the spouse is there saying, "Why should you go back to work? They don't care about you. Why should you care about them?" They're trying to protect their partner, but one of the really critical things is that family needs support as well so that they can encourage that person to go back and know that they will be well treated and well taken care of. That's what they are; they're the caregivers.
Some of the outcomes are — and I will just quote you a few of the statistics — that those with PTSD are twice as likely to divorce and four times as likely to be in some kind of marital or family distress. There's an increased incidence of intimate partner violence. There's increased incidence of sexual dysfunction, and the partners are less disclosing and less expressive. What we see is what we call secondary traumatic syndrome, what's known, typically, as vicarious trauma, secondary trauma or compassion fatigue. They're listening to their partner relive these horrible moments, and it's arousing them as well. It's creating similar symptoms in them.
The impacts that we see in the children and partners are a lower level of well-being; more somatic complaints, in other words, physical complaints; aches and pains; neurotic symptoms. Up to 50 per cent of the partners report feeling on the verge of a nervous breakdown in trying to deal with this. We also see them with depression, sleep problems and what we call the caregiver burden. Remember, it is the families who are the primary caregivers. They're the ones who are looking after them in the home and away from the home, and yet they're often excluded from the process and not considered part of the treatment team. Yet, they play an incredible role in enabling that treatment. They need to have the adequate education, information and training that will enable them to care for the injured, not only those who have OSIs but also people with physical disabilities. Those issues, things like chronic pain or things that we don't understand well interfere with people's ability to function on a day-to-day basis.
That caregiver burden includes all of those objective difficulties, the physical demands of trying to help someone with a disability, fatigue and financial strain, as well as the subjective ones, the emotional strain that's there and the psychological issues that go along with it in wanting to care for your loved one.
The research has demonstrated clearly that the degree of caregiver burden increases with the severity of a serving soldier or vet's PTSD. In other words, the worse the symptoms, the more severe they are, the more likely and severe the caregiver burden.
When we see people suffering with PTSD or traumatic brain injury or major depression, it impairs their relationships and disrupts their marriage, but it also aggravates the difficulties in parenting and causes problems in the children, which may extend the consequence of combat experience across generations. People we know whose parents had untreated PTSD or unresolved PTSD are more likely at risk themselves to develop PTSD.
We have to treat trauma to stop it spreading from one generation to the next. We saw a great deal of this from our World War II and Korean War vets, whose children struggled with some of the things that weren't recognized. We saw it very clearly in the data from the Vietnam vets, and we are starting to see it now in the current context, in how these children and adolescents are trying to deal with things.
So what is the effect of treatment? You have already heard, I'm sure, from Dr. Passey and others about some of the direct clinical work, but we also need to combine that with what we call family psycho-education, support for groups, partners and vets, concurrent individual and couple or family therapy. What is the psycho-education to do? Teach coping strategies to educate them about the effects of trauma on individuals and family and to help them to create the social support that they need in order to be able to support their loved ones to get through all of this.
We take a look across it, and I certainly would point out that the Canadian Forces and Veterans Affairs are trying to address this. But it is such an immense issue, trying to pull all of those webs together. The availability, the coherence and the quality of such programs vary tremendously across the country from site to site. It depends on the number of mental health professionals available but also on their training and experience. A lot of clinicians don't have an orientation toward family care. They are trying to do couples counselling, but they are also not able to carry that through as much.
We need to look at the training for those individuals to make sure that they have that and also understand the military culture and how people are responding to this.
We have the task of ensuring that there is an adequate supply of well-trained mental health providers and specialists and also those people who can help to train the family members, who can help support them and educate them. A lot of clinicians don't have that kind of background. They are very good at doing what they do, which is individual therapy or perhaps some couples therapy, but their ability to take it beyond that and educate others and help them to learn the skills to be supportive is something that we really want to encourage.
There is certainly the stigma that surrounds all of this, and that continues, whether it's in the military or outside of the military, in the public, around some of these mental health issues. The work that you and others are doing to promote that and to educate people is tremendous. At the same time, if we can get these family members and the vets and the others to stand up and speak out about what they are doing, the positive messages that get across are particularly important.
Even if we had all of the providers, all of the trained people and everything else, and if seeking treatment were deemed acceptable, often the services themselves are not as accessible as perhaps we might want. There are factors in that. There are long waiting lists. There are limited clinic hours. There's the referral process itself. The paperwork burden creates difficulties, particularly with people who are not functioning well. That's not only the vets and the soldiers; it's also their family members.
I don't know if you've ever tried to fill out a form when you've been under a tremendous amount of stress, but it just adds to your stress and your inability to get it. Navigating the website can be very difficult. Making those things easier so that people have access to get at them is a very important process.
Part of this, too, is the preparation. The return of an injured parent is not something that a child of any age can be fully prepared for. That includes not only the wounds but amputation, disfigurement, traumatic brain injury and mental health disorders.
Those injuries may oblige the family to relocate to get closer to treatment; or it may mean that the person suffering is going for treatment and leaving the family behind, so they're not sure how they can be. It disrupts the family and the children. The family or the spouse may be caught between the needs of the service member or the vet and the needs of the children, including emotional needs. How better can we support them to be able to do that?
As I mentioned, the service member and the vet, their own level of adjustment and grief as well as their reaction to the injury impacts their ability to relate to their children and to care for their own emotional needs. We don't have a lot of literature on that. The clinicians don't have a lot of direction on how to help them deal with those kinds of issues. There's a very clear area for education and training for family members and for those suffering from PTSD and OSIs.
There are some practical issues that serve as barriers as well. Lack of reliable transportation, financial difficulties with the family and even things like child care come into play with all of this. For cancer victims we have this incredible system set up to help them. We have drivers who get them to the clinic. We have navigators who help them get through the maze of different treatments and everything else. Yet in this instance, where people are already having difficulties because of traumatic brain injury, PTSD or another OSI, they're on their own to navigate the maze. They need some Sherpas. They need some people who can guide them through the process and help them along because it's a very complex system. When you're not thinking clearly and getting emotionally aroused, your ability to get through that is limited; and that's not something we want. Even if we have the services there, how do we make it easier for them to get from where they are to where the services are and be able to stay within those services?
It's about increasing the ease of access to the information and the ability to navigate all the various portals, and having more direct contact with each other around peer to peer support. We're looking at how we can make this system and the approach more comprehensive. Certainly, we need more data and evidence to help us tailor that, but we already know some things to help facilitate this and make it much easier to do. How do we find the systemic ways that will get people to the services they need and keep them there? That's one of the key factors we want to look at.
It's about creating a network of social support, a safety net, if you will, that will hold them in place and enable them not only to continue their recovery but also to grow and to reassume their roles as active citizens and participants and to ensure that their families aren't damaged any further and that the next generation is not impacted as well.
Thank you for listening. I'd be happy to entertain your comments or questions.
The Deputy Chair: Thank you, Dr. Corneil. You said some very compelling things and covered a lot of territory. I'm sure senators have many questions.
Senator Mitchell: Dr. Corneil, you made a very compelling presentation.
I don't know whether you know Stéphane Grenier, but he was instrumental in setting up the peer support group. I heard him speak once. He said that contrary to what would seem obvious and a popular belief, PTSD isn't caused by trauma, combat or coming upon accidents as first responders do. While those may cause it, they may not be the most pernicious reasons for it. He made the point that the most pernicious reason for or cause of PTSD can be a disconnect between your values and your actions, that is, either being forced to do something that is contrary to your values or not being able to do something that's consistent with your values, such as happened in Rwanda.
In the RCMP, there might be a variation on that. I would ask you to comment. People go into the RCMP because they believe so fundamentally in the values that institution elevated — intrinsically good, one would think — and that they'll be doing things that are intrinsically good. Combine that with your idea about the social context, and they get bullied. All of a sudden, not only are they being bullied but also that feature of their family, as you said it's a family, a powerful concept, is letting them down. It is fundamentally inconsistent with the values they depend upon when they work in that organization. Can you see there is an exacerbating influence or theme in that observation?
Mr. Corneil: There certainly is, and I can refer to some of the work that my colleague did at the University of Washington with the Seattle, Everton and Tacoma fire departments. We found that the rates for PTSD were most significant among the officers and not the regular firefighters. We found a number of things. First, they were put into leadership for which they had no training. They were promoted on their professional and technical competency, which we see in a lot of organizations, such as the military and paramilitary. They didn't get the leadership training they need to be thrust into a leadership role.
Second was the amount of conflict that goes on within a unit, whether it's a fire crew or a military unit. People are people and there's conflict. Your ability to resolve conflict is very important. Some of that comes down to this notion of bullying or harassment or that sort of thing that goes on between members in these high-intensity organizations. However, they didn't know how to resolve it or address it.
Third, they didn't have training in crisis intervention, not so much in doing the technical stuff but how to deal with the bystanders, the families and others. We saw this repeated not only with the firefighters but also with other responders in the police and EMS.
Those background factors created a greater level of vulnerability for them because they had a greater sense of responsibility. When they were exposed to something, it impacted them so much more because they felt more responsible. They felt they should be able to do something about it and resolve it. That comes back to Stéphane Grenier's point about that moral issue. You will see this more and more in the literature about what we call "moral injury" where these things are set up.
I have a good example of that, and I'm sure Senator White will recall this. An officer who served here in Ottawa by the name of Syd Gravel created a group called Robin's Blue Circle for police officers who were either shot in the line of duty or who shot and killed someone in the line of duty. They come into this, as you say, with this real sense of serving the public and wanting to give their all. As we've seen so dramatically over the last week, they're willing to put their lives on the line for others. We talk about morals; there's a huge moral imperative that the rest of us I don't think get but certainly they do. Firefighters, paramedics and the military get that because they do it.
Syd Gravel was in a situation where he thought that the individual he was pursuing was armed and that the individual did not drop what he believed to be a weapon. So Syd Gravel had to use force and he shot and killed him. He struggled with that over his entire career. Part of the reason is that moral sense and moral imperative they have. We see the same thing with others, for example soldiers in situations where they have made a decision based on the information that they had; but that information was not the entire picture. They struggle with that. That's part of what they live with. So we do see those kinds of impacts. Those are the kinds of things we need to have in place to be able to support these individuals because that never, ever goes away.
Syd Gravel has done a tremendous job of talking to other officers and has done amazing work in helping police officers who have been through that to recover, return to their force and be effective officers again. We've seen some of that in the military as well. That's the sort of thing I'm talking about in terms of peer support and their ability to support each other. Here's a classic example of that kind of pure support and knowledge that has moved things forward.
Senator Mitchell: You mentioned the importance of adequate health care, and there's a very precise or specific kind of expertise. I know the military has a good deal of it in house. The RCMP Commissioner has recently written saying there are all kinds of health care facilities outside.
Do you think that, given the quite precise nature of this kind of trauma — PTSD in first responders' organizations — there should be health care services inside the organization, or can it be adequately taken care of by the public health care system?
Mr. Corneil: I wouldn't accept that it's an either-or. I think it's a both-and, in part because you need people inside who are close to it who understand the dynamics and the culture. As I mentioned, culture plays a very important part in this. So they need to be inside. But you also need to have a link to the outside, because we simply wouldn't have enough places to put all of those resources inside. For example, they need a link to the schools and the guidance counsellors dealing with these children and the adolescents. We need a link to people and organizations in the community that will continue to support these individuals as they go on, in their career, in terms of their recovery or returning to civilian life.
It's really a combination of both of those. I don't think we can make it an either-or. If we do, we'll lose, and we won't cover the kind of safety net that needs to be there, again, for those individuals and their families.
Senator White: As always, it is good to see you again, doctor. In relation to Syd Gravel, I do want to mention that he did a great job with the police and continues to do that outside the Ottawa Police Service. It's interesting that when he retired — I don't know how many years it was — but I think he said, "I've been waiting 27 years to leave this," because he felt every day it was almost impossible to go to work, even though he could have left at any time. The manner in which he handled it is quite extraordinary, and it was by continuing to do it, even though he felt he couldn't do it anymore.
You talked in particular about the secretive nature, and Robin's Blue Circle was secretive in nature. Many leaders in policing are challenged by the secretive nature of Robin's Blue Circle — unfairly, but they are challenged by it.
We listened to a witness last week, and certainly I've spoken to people in the past, about the re-entry. And you said that the last place you need to be is not here. In fact, reservists may be one of our biggest challenges.
Have you done or seen any work on the re-entry? By that I mean returning from a mission, for example. It is less so for police. But in returning from a mission and almost the need to keep them engaged for extended periods of time if they are showing indicators, and I understand indicators are pretty easy to determine, to ensure that re-entry doesn't leave them without that team, the atmosphere of camaraderie and an understanding of everyone around the table knowing where you came from and what you just did.
Would that help deal with some of this, or do you think that's such a long period of time that you would end up with the same issue inevitably anyway?
Mr. Corneil: You are absolutely right. One of the things we know from taking a look at successful treatment and reintegration — in fact, things have changed dramatically. We just need to go back and take a look at what happened, for example, with the vets from World War I and World War II. We would have had many more with PTSD — what they called "shell shock" or "combat fatigue" — had they not gone back to England and spent time together. I'm not sure how many pubs they spent it in.
Then there were the troop ships. We know from interviewing and talking to the vets that they did a tremendous amount of peer support and, if you will, "therapy" on that.
Then we get to the modern context where one day you're in theatre, and the next day you're walking down the mall. That disconnect is there. The Canadian Forces has started doing something similar now: As they were bringing people back from Afghanistan and other places, they had these centres where they had a bit of time to do that, but there does need to be that extended piece that goes on.
The other thing is that we forget about the family and the rest of the support network. They need that time to adjust, as well, and to be active and involved in things.
The other group is those who have been physically injured. Again, they're transported immediately out of theatre into a hospital or some kind of facility, but then they end up in a rehab facility that is away from their unit and from their families and communities. We need to figure out how we can create that social support network they need, because even as they go through therapy — and some of them are absolutely amazing. I've had the great pleasure of talking with a number of them on this disability project I've been working on, and their determination is incredible. But they all talk about that sense of isolation and of wanting to be with their comrades and their colleagues, and wanting to be close. Their families feel the same way, because they're uprooted out of that community that they have been so much a part and that has been integral to their well-being.
The sort of thing we need to look at is how to continue that forward.
Senator White: Someone referred to the idea as being "one day, you're in theatre, and the next day, you're in a theatre."
Have you also done any work on, or do you have any recommendations around, predictors for people and what they bring before they go in theatre, from a practical perspective, so that you understand better who is more likely to face these challenges when they return? I realize anybody could face those challenges, though.
Mr. Corneil: Some work has been done on that; however, there is no litmus test, if you will, that we can put people through. The best way of looking at it is in terms of preparation and pre-deployment training. We see a great deal of that, primarily with the U.S. forces but also now with the Canadian Forces. It is the notion of what they call "battle mind" or that sort of thing that is helping them to do that.
If we go back to the folks in emergency services — police, fire, EMS, physicians, nurses — they spend a tremendous amount of time in training, simulations, exercises and rehearsals. That's how they determine how well people do. It's the same thing with the military. That training determines how well people do and makes sure the officers and others are observing their behaviour and providing support. Somebody may be having some difficulties. People always have issues in day-to-day life, and some of those can rattle you and some of them can't. Even things like having to renegotiate your mortgage when you suddenly realize the interest rates are going up — they're currently good right now, but if all of a sudden they took a spike, that's going to create a tremendous amount of strain on someone and they're sitting, trying to deploy, thinking about how their family will deal with that and what the financial issues are. Their attention is not necessarily focused on the task at hand.
Those are the kinds of things to be aware of. It's not any one personality test or anything like that, but it's looking at what's going on with your personnel and your people, and making sure they've got the support to get through this stuff.
Senator Lang: I just want to follow up with respect to Senator White, perhaps from a different perspective. It's looking more from a perspective of how we run the military presently and what changes internally within the military in order to be able to promote at least a sense of independence.
If you will just bear with me, I'm thinking of a young member signing up at the age of 18. He's in the military for 25 or 30 years and has known nothing else but the military. He has maybe done a number of tours in theatres outside of Canada. All of a sudden, he comes back here and is going to leave the military, and he doesn't even know what a mortgage is. He's going to walk across the street and become a civilian.
Do you know if there are any studies or any work being done either in Canada or other countries looking at exactly how we run the military, where we can help encourage that individual to be somewhat independent but yet knowing that he's in an environment that requires taking orders and responding accordingly? But at the same time, he or she and their family are able to have some sense of being able to cope themselves, without the military being the father and the mother. Have you given that any thought?
Mr. Corneil: I have and certainly there is some information, some data that we need to look south of the border for. Our colleagues there have looked at this from a network standpoint. They've started investing heavily. Initially they were investing in pre-deployment for the troops themselves and their leadership, but then they realized that was only part of the equation. What they're doing now is their program where strong families mean a strong military. It's addressing exactly the points you're talking about. How do they help those folks deal with not only military life, because you're moving constantly? Every couple of years you're being transferred. It's also looking at the parenting, special kinds of programs for them. They've really tried to bolster that part of it so the individual soldier can feel that if they are being deployed, their family is ready, capable and they're going to manage quite fine while that soldier is away.
That becomes part of the investment. As I said, when a soldier serves, the family serves, too. It's really acknowledging that and making sure that we've got the things in place beforehand. Much of this is, as you rightly point out, what we can do beforehand in order to prepare people and make them more resilient so when they do have to engage, they can. Even if they do experience a traumatic event and have impacts from that, they will be better prepared with greater resiliency to bounce back. That's going to take some adaptation. I'm not suggesting for a moment that will wipe it all away, but that will form a strong foundation for them to be able to move forward. It starts in the military and continues on from that.
Senator Lang: I don't want to belabour this too long, but are you basically saying that there should be changes in the military culture, how we do the day-to-day running of the military to be able to help accommodate that independence so there's that resilience at the end of the day when the time comes to move on?
Mr. Corneil: Certainly there will be some addressing of the culture. One of the big issues is dealing with the stigma around this, with people have anxieties and fears and helping them understand that. It is also, as I say, acknowledging the role of the family. The Canadian Forces are certainly moving more in that direction, and I would urge them to continue because I think it will benefit in the long run.
The other thing it will do is benefit the fact that a lot of the children are having difficulties, and they want to see those kids perform and prosper and be well. They don't want to have to be taking care of them as well. We want to look at this from the standpoint of prevention; what can we do so people are prepared? That's just a good way of going about it. This all comes out in performance. If you're worried about something, you're not paying attention to what you're doing. So if you want performance, you have to make sure you have all the underpinnings to make that happen.
Senator Campbell: Thank you very much for coming today, doctor. I have two questions. I'm continually confused by what we read and see. On one hand, we have the Minister of Defence saying that the ability to care for our veterans is greater and greater, despite closing down actual physical locations.
Then on the other hand, we see the families and the soldiers, as evidenced by the wife on TV the other day. I'm quite confused as to whether we're moving forward or, in the interests of perhaps saving money, are we regressing? I would be interested in your comments because you're sitting in a position of being of it, but not of it. I'd be interested in your comments. I don't want move away from helping these people. Canadians don't want to do that. We need to find the truth, and I don't think we've found it yet.
Mr. Corneil: I'm not sure that I can shed light on the truth in terms of where the money is going or what's happening. What I can comment on is that the system in place now is not as comprehensive as it needs to be. I think I made that point clearly in my earlier remarks. That's one of the issues people are struggling with. There is a nexus of that kind of system, but it hasn't reached out to all of the places where it needs to be. I've identified for you some of the issues with that. Perhaps if you're on a major base, such as Petawawa, Gagetown or Edmonton, you have more access. But if you're on a smaller base or in a smaller community, that's limited. It creates a strain and burden on the families to try to get to treatment or to the resources and support they need.
We need to relook at the delivery and access mechanism, and I'm not sure what that will take in terms of budget. It will probably take some, but I would think that's one of the places we need to look at. What we are doing to reinforce the access and the availability? Our soldiers and vets don't all live in large communities. Even if you're in Petawawa, you've got to get to Ottawa to the Royal Ottawa Hospital. As I said, that can create practical issues in terms of child care and transportation. What are we doing about that? Not all of that burden is going to be on Veterans Affairs or the military.
One of the things we would want to think about is how to engage those families, because they're a tremendous resource. One of the things we have a great reputation for in this country is that of volunteerism and their ability to support each other. Those families on the base support each other. How do we leverage that? It may take an investment in helping to prepare and educate and, as I talked about, that psycho-education, to invest in them so they can deliver more. They can provide that. In so doing, they will get more out of this.
Senator Campbell: On that note, when I was in the RCMP, we went to Shaughnessy Hospital in Vancouver, also known as a veterans' hospital, and they were spread across Canada. When you went to Shaughnessy Hospital, you were surrounded by veterans. Some people were there with what they called "shell shock" and probably at that time would never get out of there. You went and had everything done there. There was a sense of being taken care of. There was a sense that everybody knew what was going on. We got rid of those because the number of veterans was declining. I understand all that.
But I'm wondering if there might not be a place for that. In Vancouver we have a fellow named Allan De Genova who started a place called Honour House. Honour House has, I think, 16 suites in it, and families come and stay there while their loved one is being treated. I'm wondering if we shouldn't take a look at that model again with a specific veterans' hospital but, I agree with you, with an attachment where the family is there and can be taken care of. Their only point is to be with their loved ones. Is that something that is worthwhile, or is it just pie in the sky, too expensive?
Mr. Corneil: I'm not so sure bricks and mortar, building new hospitals will do it, but certainly looking at the existing facilities and some specialized units within them. We have seen that, the OSI clinics and units across the country.
Again, we take a look at this, and just think of the models that we have. I don't mean to do this in a way that sounds in any way pejorative, but we have Roger's House; we have Ronald McDonald House, for families whose children are in hospital, but who need to be there. That provides that kind of basis.
That kind of place in Vancouver, if people have to travel to get to an OSI clinic, we don't want just the one individual there without the rest of their support system, so if we can bring the support system, the family and the others, they're going to be in an environment that is supportive and understanding. I don't know whether you've ever visited Roger's House or Ronald McDonald House, but they are amazing places because they have families there who are struggling, in life-and-death situations, just as some of these vets and military personnel are; yet there is an environment that is supportive, which helps them get through that, which keeps them healthy so that the whole family doesn't disintegrate, the kids don't fall off the wayside. If mom and dad go to Vancouver or Ottawa, where are the kids? What's happening for them? There is something there.
That is not a tremendous investment, but it's looking at what are we investing in and what are we putting in place that will leave a legacy for these families and for the vets so they can return to full functioning and in as much capacity as they have. That's what we're looking for.
The Deputy Chair: Dr. Corneil, you mentioned the concept of using Sherpas. Could you expand a little on that? First, are there other countries employing that practice? How would you see it employed within the existing system?
Mr. Corneil: I'm not familiar with another country that's using it. It's a concept that I have seen used with other major disabilities or illnesses. I referred to cancer victims as one group and another group is folks with Alzheimer's and dementia. Again, I'm not suggesting PTSD or OSI, but there are some similarities there in terms of which people are struggling with a variety of physical, mental and emotional difficulties. Their ability to be able to navigate the system is impaired because of that. It's complex. It's difficult to understand. In some cases it's just something simple like being able to retain information about what kinds of things you need to do, the behaviours that the therapist is giving you, multiple appointments. Those are the kinds of things.
There is a probability that that kind of Sherpa or navigator will help them get through the system. I know they have case managers, but their job is to feed the beast of the administration. They need folks who have been through the system or are close to it who can work through it.
Again, I'm hearing it clearly from those folks that I interact with that family members and other vets who have gone through this are willing to get involved in it, but they need some support; they need some education and training. I don't think it's going to be a huge, complicated matter or a huge investment to do it, but you have people who are willing, able and capable of doing that and willing to help folks through this process.
The Deputy Chair: It seems a very simple and elegant way to address one of the support necessities that veterans or RCMP veterans with PTSD have.
You mentioned their ability to help others helps them. When you said that, the first thing I thought of was the pets program. Someone who has a pet, whether they have an OSI or not, they care for the pet; they feed the pet; they make sure the pet gets exercise; they have comfort with their pet, whether they have an illness or not. A pet owner would look after the general health and well-being of the pet.
Could you tell me a bit about that aspect and how that can help the veteran with PTSD or an OSI?
Mr. Corneil: Perhaps you touched on some of this. Going back to Senator Mitchell's point about the sense of values and beliefs, lots of people who are experiencing PTSD feel dissociated, disconnected, so they're looking for some kind of grounded connection, but they're also looking for a sense of meaning, a sense of purpose. Remember, these are people who have contributed. They're used to contributing. They are used to giving and now all of a sudden they are put in a place where they feel that they're not valued; they feel like their contribution is not respected or considered. What we see is that that gives them a sense of meaning. All the work that I've done over the years, the folks I have found who have been most committed are those who have been through the process who have had one of these disabilities or an issue. They manage to get their recovery or on the road to recovery and what they want to do is give it back, because it strengthens them in their pathway and their ability to do it.
You may think this kind of trivial to start with, but a number of years ago a study was done in the United States at the University of Florida, and they had people who were asked to give massages to other individuals who were having difficulties. They measured the improvement of not only the physical but also the mental health of the people who were getting the massage, and also the people giving it. Lo and behold, they found that those who were giving it got more benefit than those who were getting it. This laid the groundwork for the area called reciprocity, in terms of looking at if you can give something there is a tremendous sense of well-being and satisfaction that comes with that, not only from an emotional standpoint but it also has a physiological impact.
I think that speaks to the notion of why it's so important to have peers, why it's so important to have them being able to make a meaningful contribution and to be able to be involved in this in a very healthy way that not only supports their colleagues and families but also supports them, because they get that kind of outcome.
Senator White: Doctor, I think you're referring to the Maplesoft survivorship centre when you talk about coaching with regard to cancer. Are there any systems in Canada or elsewhere you know of where there are coaches for vets who are challenged with PTSD or other mental health issues and almost an advocate, I guess is what you are talking about, somebody who can help walk through some of the challenges? Are there systems in place anywhere that we're seeing?
Mr. Corneil: I am not familiar with any sort of formal systems. We are seeing a number of these ad hoc ones, and we are seeing them springing up as and when across the country. There is not, to my knowledge, a network of those, but I'm willing to predict that probably very shortly there will be, simply because people who are in this see this as a need. They've seen the impact that they've had in being able to do things locally. That's going to spread. We're seeing I think more and more involvement on the part of the vets but also on the part of their families and also the active members. I think you're going to see that evolve.
It would be good timing, if you will, to be able to support that and to provide it with some structure and systemic support so that it can have the impact that it certainly can.
Senator White: If it's of interest, Mr. Chair, at the Maplesoft survivorship centre, probably the biggest success they've had has been their coaching program, which is pretty grassroots. It's literally, how do I fill out a form? Who do I call? If I'm receiving radiation, can I be around a microwave? It's those types of questions. Many of the questions we get from people with PTSD or who are fearful they are going to have PTSD in some cases are pretty basic questions: Who do I call? Where do I go? Are there forms? How do I get from Petawawa to the Royal? They are pretty basic, rote- based responses.
Mr. Corneil: The professionals don't have time for that. We understand that that's not the role of the social worker, the psychologist or the chaplain or the others because they need to focus on what they need to do best. We've got this whole other piece that's missing. That's the critical part that's going to help people get into and through the system and out the other end in a much more effective and appropriate way.
Senator Mitchell: I wanted to pursue a point you made. It struck me and reminded me of a statistic that I had heard. It was the point about the organization set up by Mr. Gravel for people who have been shot or have shot somebody. In our society today we see so much gratuitous violence on TV, movies, cops and robbers, that we become really inured to it. I saw a statistic that said on average after a police officer shoots someone, they last about two years in their career. The trauma to them is much greater than we really have acknowledged. Is that consistent with what you are saying or is it that we need better support for people like that, better techniques and better health care? Is it something that's overlooked?
Mr. Corneil: I'm not sure about the statistic. I'm not familiar with that. However, in my work with police services in Canada and abroad, those individuals who have been in that situation are struggling with it. The one thing we do know is that if they get the support from their organization, from their leadership, from their families and their colleagues, they will be back and will continue to serve. If that's not there, then the likelihood is that they will not continue in their career. It goes back to this whole network and support process. If it's there and it's solid, they continue on and, in some instances, are as remarkable as Syd Gravel. For other people, when it's not there, as a result they don't make it.
The Deputy Chair: I have one final question, Dr. Corneil. Are there statistics that quantify the success of various treatments?
Mr. Corneil: In terms of what?
The Deputy Chair: In terms of PTSD. Do we know what works best in general, or is there anything quantifiable?
Mr. Corneil: There is. There is a considerable body of knowledge, not that much in Canada but certainly from our colleagues in the United States. The National Center for PTSD in the United States has a vast amount of that kind of information.
Again, they look at two things. One is the clinical treatment. Most of it is cognitive behavioural therapy, along with some medication. The other part of that, and they're the ones who, along with, say, the American Psychological Association, APA, have determined that clinical treatment in and of itself will only take them so far. It's the psychosocial support that will get them the rest of the way, rehab and functioning. That's the model that's pretty much put in place to ensure people get through it.
In answer to your question, yes, there is research and a fair amount of data. There is very little in the Canadian context because we don't have many researchers getting funded for that kind of work in Canada.
The Deputy Chair: Dr. Corneil, thank you very much for your presentation today.
Senator Lang: I think the chair asked an important question. The information that you referred to which happens to have been acquired and compiled in the United States would be relevant for us in respect to the subject we're talking about, so we don't necessarily have to reinvent the wheel.
Mr. Corneil: There are a couple of things we want to be careful of, and that is that would be appropriate to a certain point. However, the culture in the United States is far different than ours. It has a different kind of context, both in terms of the social culture that revolves around the military and their families and also their health care system. Having worked both in Canada and the United States, I can tell you that their health care system is not exactly the same as ours. You want to look at what are the social values — again I come back to that social and cultural piece. We have to be careful that we take the principles we find in the research in the United States. We bring those over, but we don't bring across the exact way they do it because it's not a cookie cutter. If you do that, you will not get the outcomes you want to get. Use the research to informs us; we want evidence-based research. At the same time, how do we fit that into the Canadian context and make that work for us, for our soldiers and for the vets and families here.
The Deputy Chair: Thank you, Dr. Corneil. That's interesting information. You're right; we can't equate it necessarily to the United States. The United States looks very much like Canada in many ways, but their systems are different.
Thank you very much for your presentation today and for answering our questions. It will help us greatly in our study. Thank you also for the long service you have provided to Canada and our veterans.
Mr. Corneil: Thank you.
The Deputy Chair: This meeting is adjourned.
(The committee adjourned.)