Proceedings of the Subcommittee on
Veterans Affairs
Issue 8 - Evidence - October 29, 2014
OTTAWA, Wednesday, October 29, 2014
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:12 p.m. to continue its study on 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 Joseph A. Day (Chair) in the chair.
[Translation]
The Chair: Honourable senators, today we are continuing our study on operational stress injuries and other mental health issues affecting veterans.
[English]
Today's meeting focuses more specifically on the mental health programs, services and support offered through the Joint Personnel Support Unit and the Integrated Personnel Support Centres, the Military Family Resource Centres and the Operational Trauma and Stress Support Centres. We should have these names up on the wall because you start talking in acronyms, and we're lost.
We will be hearing from three representatives from the Department of National Defence: Colonel Gerry Blais, Director, Casualty Support Management and Joint Personnel Support Unit; Colonel Russell Mann, Director, Military Family Services; and Lieutenant-Colonel Alexandra Heber, MD, FRCPC, Psychiatrist and Section Head of Clinical Programs, Directorate of Mental Health, Canadian Forces Health Services Group.
I understand that each of you has some background information to provide to us to help us to understand these support units. We'll start with Colonel Blais, then go to Colonel Mann, followed up by Lieutenant-Colonel Heber.
Before we do, Senator White, Senator Stewart Olsen and I would like to welcome special guests. I will ask Senator Stewart Olsen, the deputy chair of this committee, to let us know who our special guests are who are here.
Senator Stewart Olsen: Thank you, senator. I'm pleased to welcome today members from Courageous Companions who are here with their service dogs in support of establishing standards for service dogs for help in the treatment of PTSD. I welcome them very much. I'm very glad you could join us today. Thank you.
The Chair: Thank you. We're very pleased you're here. Okay, shall we begin?
[Translation]
Colonel Gerry Blais, Director, Casualty Support Management and Joint Personnel Support Unit, National Defence and Canadian Armed Forces: Mr. Chair and members of the committee, I am very pleased to have the opportunity to talk to you about the programs and services available to Canadian Armed Forces personnel and their families as they heal from, and deal with, operational stress injuries. Joining me today are Colonel Russ Mann, the director of military family services, and Lieutenant Colonel Alex Heber, a highly respected psychiatrist with the Directorate of Mental Health.
[English]
When a Canadian Armed Forces member is either physically or mentally injured or suffers an illness to the extent that they cannot function in their regular duties, they are admitted into our Caring for Our Own program, consisting of three phases: recovery, rehabilitation and reintegration. The program is compassionate and tailored to the member's needs and has no set timeline, as recovery from injury or illness doesn't occur according to a fixed schedule.
The recovery and rehabilitation phases are mostly in the hands of our medical experts who lead in the fields of both physical and mental recovery and rehabilitation. The reintegration phase becomes a shared responsibility between the member, the medical staff and the chain of command. The focal point for the reintegration phase is the Joint Personnel Support Unit and its network of 24 Integrated Personnel Support Centres, employing 177 civilian and 199 military staff. The centres also house family, spiritual, social and financial support specialists, along with Canadian Forces Health Services case managers and Veterans Affairs Canada staff, all in one location. This collaboration has greatly facilitated the comprehensive care provided to military personnel and their families.
Families are a key component to the successful completion of each of the three phases. As serious as a physical or mental health issue is for the military member or veteran, the pain and suffering is shared by their families. In order to ensure that they are part of the process, are well informed and have access to support, family members are always welcome to attend appointments and meetings with their loved one. The Integrated Personnel Support Centres also house a family liaison officer, a social worker who works in harmony with the local Military Family Resource Centre to ensure that the family is aware of and has access to all available programs and services.
[Translation]
The Soldier On program provides access to equipment, training and participation in activities, including mentorship from experienced teammates, world-class athletes, coaches and trainers, and is specifically geared to ensuring that ill and injured personnel continue to pursue a healthy, active lifestyle post injury. Participation in the program is growing and the results are truly encouraging for cases of both physical and mental injury.
[English]
More specific to those suffering from mental injury and illness, the Operational Stress Injury Social Support Program complements the clinical care provided by the Canadian Armed Forces mental health professionals. A group of military members and veterans who served in theatres of operation recognized the benefits of sharing their experiences and launched a peer-based support network. From those roots, OSISS has now developed into a well-established program, managed in partnership with Veterans Affairs Canada, and includes a component geared to family members living with those suffering the effects of an operational stress injury. Services are delivered by 54 screened and trained peers employed as public servants, as well as a robust network of trained volunteers. Every member of the network brings first-hand experience and practical knowledge of what it is like to struggle with an operational stress injury or to live with someone who has an operational stress injury.
[Translation]
For those transitioning from our care into the hands of Veterans Affairs Canada, we offer an extensive variety of programs and services to meet their specific needs in job retraining, skills upgrading and coaching as they pursue a new career.
We also offer employment opportunities through a variety of partnerships with the private sector and registered charities that include job placement, entrepreneurial skills development and franchising.
Regrettably, time does not permit me to describe in detail the full breadth and scope of the programs in place to assist our ill and injured, but I will be pleased to address any questions that you may have.
The Chair: Thank you, Colonel Blais.
[English]
Colonel Russell Mann, Director, Military Family Services, National Defence and Canadian Armed Forces: Good afternoon members of the committee, ladies and gentlemen. I want to begin by thanking you for your invitation to appear today in order to bring some insight into the Military Family Services Program and the role of family liaison officers.
While we know that the majority of families are doing well and thriving, many continue to struggle despite the programs and services in place for them. To address the evolving and complex needs of military families, family liaison officers were introduced in 2008. These social workers, who are employed by the Military Family Resource Centres but operate within the Integrated Personnel Support Centres, provide care to families of the ill and injured throughout the recovery, rehabilitation and reintegration process.
We know that mental health injuries are never suffered alone or in isolation. That is why family liaison officers endeavour to support the IPSC team in delivering family-centred, consistent care, service and support to families of Canadian Armed Forces personnel coping with illness, an injury and/or special need, or who have died while serving. Their services include crisis counselling, community outreach and education, as well as consultation and coaching to ill and injured family members. We currently have 32 family liaison officers who work out of 28 locations across Canada.
In the fiscal year 2013-14, the total number of IPSC families served by a family liaison officer was 1,585 family units. The cost of the program was $2.7 million to the department. Since 2008, utilization rates of the family liaison officers have risen to the level they are today.
Despite the end of major combat operations in Afghanistan, family liaison officers continue to be routinely confronted with military families who are facing family relationship difficulties, physical injuries, mental health challenges, periods of grief and transition difficulties, which may include financial and/or employment issues. Families are being referred to the family liaison officer through a wide variety of local service providers such as base or wing surgeon, base padre, OSISS, to name a few, who are mandated to provide different levels of mental health care: medical, spiritual, psychiatric, psychological or social work, to families and dependent children.
Injury to a parent, partner or child is a major threat even to the most resilient of military families. The family liaison officer is an essential resource to help highlight, promote and facilitate evidence-based approaches that can support healthy growth and recovery of the military family unit.
Lieutenant-Colonel Alexandra Heber, Psychiatrist and Section Head of Clinical Programs, Directorate of Mental Health, Canadian Forces Health Services Group, National Defence and Canadian Armed Forces: Mr. Chairman and committee members, thank you for inviting me here today and thank you for all the good work you're doing studying the care of our ill and injured members of the Canadian Armed Forces, our veterans and their families.
To give some context for my remarks today, I'd like to tell you a bit of my background. I've worked in health care and mental health care for nearly 40 years, first as a nurse and then as a psychiatrist. I took a position first with the CF mental health clinic in Ottawa in 2003 as a civilian psychiatrist. Three years later, I put on the uniform.
Part of my motivation for joining the CF was to deploy to Afghanistan, which I did in 2009. This experience was the high point of my military career. But in fact, the past 11 years serving our military members has been the greatest privilege of my professional life.
Before moving to our mental health headquarters a year ago, I spent 10 years as clinical leader of mental health and the Operational Trauma and Stress Support Centre here in Ottawa. With my experience working in both civilian and military health care systems, I must tell you that I'm impressed every day with the level of accessibility, the quality of care, the cooperation and open communication among the different people in our health care system. I can assure you there is nothing comparable in civilian health care in Canada.
For instance, in the civilian world, I never had the kind of close relationships with the family doctors of my patients that I enjoy in the CAF. The family doctors at the Ottawa clinic live one floor above us, and it was not unusual during my years there to see one of my clinicians running upstairs or one of the family doctors running downstairs to have a quick case consultation about a patient that they shared. It is a very close working relationship.
Our goal in our 26 CF mental health clinics across Canada is to return members to full duty if at all possible. To accomplish this, we must provide the best treatment available for the conditions from which our members suffer. To this end, we work in multidisciplinary teams, and our teams include psychiatrists, psychologists, social workers, mental health nurses, specially trained addictions counsellors and clinically trained chaplains, as well as other people at certain points. Each team member brings their unique experience and skill set to bear on every one of the members that we treat.
I'd like to focus for a minute on the Operational Trauma and Stress Support Centres, or OTSSCs, one of our favourite acronyms. These specialized clinics for treating PTSD and other operational stress injuries were first stood up in 1999 on the order of General Roméo Dallaire, who was then ADM-HR MIL, and were created to serve the mental health needs of our members following those difficult deployments of the early 1990s to Rwanda, Somalia and Bosnia.
We currently have seven OTSSCs located across Canada. Each has a regional mandate, a regional responsibility, as well as an outreach function to coordinate care to support all rehabilitation and reintegration efforts. To this end, we work quite closely with the IPSCs, as Colonel Blais as already described.
The OTSSC is a multidisciplinary team of highly skilled, flexible and creative clinicians who assess, diagnose and treat members referred for mental health problems related to their deployments. But the OTSSC also responds to any barriers to care that it identifies. For example, one of the things we started doing many years ago, although according to the National Defence Act we do not have a mandate to directly treat spouses or family members, is provide care and support that we can provide under the phrase ''in the service of the member'' because we know that when we help the family and the spouse that also helps our members who are suffering. We provide couple and family counselling, as well as support and education about operational stress injuries to the partners and family members of our patients.
Also in the Ottawa OTSSC for a number of years now, we ask every CAF member whom we assess to invite his or her spouse along for their first appointment. This way we include the family in the treatment process right from the beginning.
We've established partnerships as well with many organizations outside of the CAF, including the Veterans Affairs OSI clinics across Canada. Here in Ottawa, we have an especially close working relationship with the OSI clinic at the Royal Ottawa Hospital.
When members are preparing for release, we often refer them to the VAC OSI clinic some months before they leave so that they can start working with their new doctors and therapists before they actually depart from our care. Also, we are approached regularly by sister organizations with whom we share a similar culture, like police forces, the RCMP and, more recently, Ottawa Fire Services to teach them our approach to dealing with operational stress and suicide and to managing mental health issues in the workplace.
There is an old saying in medicine that our patients are our best teachers. I am delighted to be here today to share with you what my patients have taught me.
The Chair: Thank you very much, Colonel Heber. We appreciate the background that each of you has given us. Before I go to honourable senators, and I have a list of those who would like to engage in the discussion, could you describe for us how you fit into the military hierarchy?
Lt.-Col. Heber: I'm a psychiatrist by training. I work in the Directorate of Mental Health, which is our headquarters directorate that oversees mental health care across the country as well as mental health research and training. My job is to oversee clinical care across the country.
The Chair: Are they the Operational Trauma and Stress Support Centres?
Lt.-Col. Heber: We have 26 mental health clinics across Canada that range in size. One that has 40 clinicians working in it would be large, like the one in Ottawa. Large clinics have embedded within them specialty Operational Trauma and Stress Support Centres that were started up in 1999. They are part of our overall mental health service.
In my directorate, my job is to oversee all the mental health care. Of course, people in the military don't only have PTSD from deployment but, like the general public, also can suffer from depression and anxiety. They can have all kinds of issues, such as couple problems, for which they need to see somebody; so we service all of that.
The Chair: Do you report up through the Canadian Forces Health Services?
Lt.-Col. Heber: That's right. I'm part of Canadian Forces Health Services, so I report to my boss and my boss reports to the Surgeon General.
The Chair: Okay.
Col. Blais: As the Commanding Officer of the Joint Personnel Support Unit, I report directly to the Chief of Military Personnel, who reports to the Chief of the Defence Staff. We have very close interactions. It's very near and dear to the hearts of senior leadership, so that's why they establish such a close structure.
Col. Mann: Military Family Services is part of the Canadian Forces Morale and Welfare Services program. Commodore Mark Watson is Director General Morale and Welfare Services and reports directly to Chief of Military Personnel, Lieutenant-General David Millar.
The Chair: You both answer up the line to the Chief of Military Personnel. I'll begin with the deputy chair of the subcommittee, Senator Stewart Olsen.
Senator Stewart Olsen: Thank you for coming; it's a great pleasure to have you here. I have some fairly different questions. What's your transition time? I know you assist military personnel when they're leaving the forces. What's the transition time before they go to Veterans Affairs? Is there a gap in the services that you identified?
Col. Blais: It is a topical and good question. Transition services are the number one priority of my organization to make sure we get it right. As I said in my opening comments, each case is different and there is no specific time at which we would transition a member to Veterans Affairs. The process works such that when a person goes to see the doctors, if the injury is serious enough, they are assigned a temporary medical category, which lasts for about six months and then it's reviewed. There can be a series of these temporary categories until such time as the condition stabilizes. At that point, a permanent category is assigned. It can be as far forward as up to three years before a permanent category is established.
Once that category is established, the employment limitations are sent to the Director of Military Careers Administration. Based on the universality of service standards, they decide if the person can remain in their current occupation, or if they should be employed in another occupation if they can be, or if the only option is release. From that point, depending on the situation, the person can be given up to another three years to complete their transition to ensure that all their care is in place.
With respect to the gap with Veterans Affairs, the Integrated Personnel Support Centres of Veterans Affairs work directly with our staff. Within six months of the person being released, a handover begins from the case managers at Canadian Forces Health Services to the case managers at Veterans Affairs. We ensure that the transition is as seamless as possible.
Senator Stewart Olsen: The family liaison offices that you mentioned are in 28 locations across the country. Are they mostly urban or rural locations?
Col. Blais: They're found in every location where there is a Canadian Forces establishment.
Senator Stewart Olsen: They are on the bases.
Col. Blais: Exactly.
Senator Stewart Olsen: Have you found there is some difficulty with the provision of care in rural areas?
Col. Blais: When you say ''care,'' do you mean health care or services on the administration side?
Senator Stewart Olsen: Health care and mental health care in particular, because that is what we're studying.
Lt.-Col. Heber: Wherever we have folks posted, we have health services and, therefore, mental health services. As I said before, we have 26 discrete mental health clinics across the country. They can range in size from quite small where there may be one or two social workers in the mental health clinic to a full-blown large clinic that has 30 to 40 clinicians. Again, it really depends on the size of the base or the detachment. Even in places where we wouldn't have those kinds of mental health resources, there is a family doctor or a general duty medical officer who is trained, like family doctors in the community, to diagnose and treat mental health conditions. If they need help and assistance, we have a number of things we can do.
I mentioned the OTSSCs. If somebody is on a smaller base, they can send their patient to an OTSSC for an assessment and to get recommendations about care. We also have the ability to contract with providers in the community. If we're in an area where we don't have enough people in-house to see our patients, we can pay for providers or psychologists in the community to provide the therapy.
Senator Stewart Olsen: As a follow-up, where does the veteran fit into this? I'm seeing active serving members associated with bases, but where do veterans fit in, or do they? Can they use your services on the base, or what happens?
Lt.-Col. Heber: Veterans Affairs Canada, I guess about five years ago, set up their series of nine or ten OSI clinics across the country. They are our sister clinics. They did that to meet the needs of veterans, especially, as Colonel Blais said, those who were having a lot of struggles. That's why we formed close partnerships with those OSI clinics. In particular, for people with complex problems, we make sure that even before they leave our care we've hooked them up with somebody in the OSI clinic. You're right in that it's not like the military, where basically most services are delivered by provincial health care. However, Veterans Affairs does fund these clinics.
The Chair: That was helpful.
Senator White: Thanks to each of you for being here today.
I have two questions. Psychologists often talk about psychological tool building sessions that you can have pre-deployment, which allows you to better manage and identify who should not be going. What is the military doing today, in relation to pre-deployment psychological tool building?
Lt.-Col. Heber: We have a program that has been developed, which also works out of my directorate, called the Road to Mental Readiness. This program started as pre-deployment mental health training, but it has expanded from there. We realize that we should not be waiting until just before somebody deploys to teach them these skills of how to help calm yourself down, what to do when you're in a situation where you're feeling really stressed, and how to identify problems that you may need help with.
Road to Mental Readiness and that whole training package are taught in our leadership courses; that means from the time people start in the military until the time they end. Leaders can also help to identify when some of their members are struggling.
Senator White: Is it possible to get documentation in relation to that program so it can be shared with the committee?
Lt.-Col. Heber: Absolutely. We can.
The Chair: Send that to the clerk.
Senator White: That wasn't my second question, Mr. Chair.
The Chair: It was just a friendly comment.
Senator White: The second question is about the coaching mechanism. When we talk about any illness — I'll remove the word ''mental'' — there are very successful coaching mechanisms, for example when dealing with cancer patients. For a lot of people, when you talk about stigma, they talk about being left alone. That stigma grows because you're by yourself. The stigma grows when having to arrange a day away from work, for example, if you're living in Petawawa and you've got an appointment at the Royal Ottawa. Has the military engaged in a true coaching program, and if so, can you describe it to us? What would a day of coaching look like? If not, then why not?
Lt.-Col. Heber: You have to define for me what you mean by a coaching program.
Senator White: The coaching mechanism would be, for example, that Vern White has identified that I'm having some post-deployment challenges. I just returned from wherever we happened to be. I have been identified and need to look for some help and treatment. I've been told what that looks like. It is like having someone, hand in glove, to say, ''Okay, I can give you a drive down to the Royal Ottawa and here is what you are going to see when you arrive.'' If you go to the Cancer Coaching program here in Ottawa, the front desk clerk is a trained social worker who talks to you differently than if they were a typical clerk. It's walking people through this maze, when they're already dealing with other issues.
Col. Blais: It is a very good question. I'm glad to say that we have attacked this on two fronts. When it's recognized that a person's illness or injury is going to last more than six months, they are posted to the Joint Personnel Support Unit, which I have the privilege of commanding. We have a little bit more than 2,000 people posted to that unit. When they are posted there, there is a team dedicated to looking after those individuals. We have public servants who look after all the services side of things, and military people posted to act as their chain of command. That service is there for them in case they need anything, such as getting to appointments or needing other administrative services.
What also exists is the Operational Stress Injury Social Support Program. That is peer support from people who have been in theatre and have themselves suffered mental health issues. After they have left the military and have gotten much better, we get medical certification that they are well. They are then trained and they provide peer support to individuals, to refer them, listen, and make sure that they are getting to the help that they need.
Senator White: I've heard that is where they have the opportunity to be literally matched with someone. Is that how it works?
Col. Blais: Yes.
Senator White: They are matched with an individual. Whoever shows up in the morning says something like, ''That is not who I'm dealing with. I know that I have someone there —''
Col. Blais: Exactly, it is a specific, one-on-one relationship.
Senator White: Is it possible for us to get information on that as well?
Col. Blais: Absolutely.
The Chair: That would be helpful. We are trying to understand all these programs. It's sometimes difficult for someone who isn't in uniform and doesn't hear a lot about these things. I suspect someone in uniform who is busy doing their occupational work maybe realizes they need some help and they don't know where to go. We are hoping that you can help us understand that they're not going to be lost, and that they will be able to find out where they can get help.
Senator Enverga: We're studying stress injuries of Canada's veterans. Is there any collaboration between you and other countries, with the United States, Australia or the United Kingdom? How would you compare them against our services?
Lt.-Col. Heber: In many ways, for health services we are often the envy of our allies. At the risk of not sounding very humble, when we sit on NATO panels, other people are looking at what we've innovated and what we've put in place, such as the OSISS program, and the way we've distributed our health care services so that we are working with Veterans Affairs, making sure we hand over patients. We tend to stack up very well.
Col. Blais: We've had visits from a number of our allies and we have visited them. Among the other countries, I would say that we are one of the leaders in the way that we deliver services to our individuals and with the amount of resources that we've dedicated to make sure that they get the help they need.
Senator Enverga: That's very good. It looks like we're on the top of the heap. Are there any other recommendations? What other things should we do for our soldiers?
Col. Blais: From our perspective, I think we're providing services in most if not all of the areas we need to. We're trying to make them better. We're trying to work with Veterans Affairs even more closely to make sure that when you do leave the Canadian Forces that there is absolutely no gap when you go into the care of Veterans Affairs. We are trying to make the programs align as much as possible so that there's not varying standards of care between the two organizations.
Senator Enverga: They will be ready for the real world?
Col. Blais: Exactly.
Lt.-Col. Heber: There is another program where we are collaborating closely with Veterans Affairs and their network of OSI clinics. We are introducing an outcome measurement system that is related to therapy and to treatment. Every time the patient comes in, they fill out some information. It is then analyzed and it goes to their provider and to their clinician. It's looked at in terms of how they are progressing in their treatment. Then the clinician and the patient work together to ensure that the outcomes are what we're expecting.
We have very skilled clinicians. We've done a lot of training for them. Now we're putting in a system to show that we're having the kind of outcomes that we would like to have. Veterans Affairs first worked on this system with the company that developed it. They are now helping us to introduce this system. By the end of 2015, it will have been introduced into all of our clinics across Canada.
Senator Enverga: When they are finished with a program and they are ready, do their names go into a database, so that people can be given a job in the outside world?
Col. Blais: We have a transition program. We work with a large charitable organization called Canada Company. We have the Military Employment Transition Program where there are now in excess of 200 private sector employers, members of the program, and they post their job opportunities on the site. We also have our members' CVs there, and they can actively search. The companies can move through the CVs, and we match people together to help them secure employment.
Senator Enverga: Is follow-up being done?
Col. Blais: Yes. We have partnered in this endeavour with Veterans Affairs Canada, which has three staff members embedded with mine, so we are working this program together.
The Chair: I appreciate your participation.
Col. Mann: I would like to add that there's a family dimension to continuity which is non-clinical but we know from our research is very important. That really applies to caregivers and to spouses and partners of those suffering OSI or PTS. Employment and household income issues become the number one concern for families, and we know from our most recent quality-of-life survey that self-reported household income and spousal employment are important.
Our family resource centres are a network of 32 centres at bases across the country. They're not-for-profit organizations, but the Director of Military Family Services is able to provide the bulk of the funding and nationally mandated programming, and we just recently met with the executive directors in Cornwall this past weekend to express that we need to do more in employment support and to development an employer network, much the way Military Employment Transition Program has done for two cohorts. One is families who are moving, which is our military lifestyle. But when you touch on transition, senator, it really is about changing the household income equation by having academic upgrading, good contacts with employers in sectors that are well-suited to spousal skills and experience.
That has been underused. Our research shows us that our spouses could contribute more to household income, and we're committed to doing that. We're committed to doing that through transition by trying to work with Veterans Affairs.
On the other piece, Military Family Resource Centres have a host of services, and we've been working with Veterans Affairs to find ways to extend those services not just to veterans' families but to veterans themselves as they transition. We're committed to making those services more accessible and available to the veteran part of our military community.
The Chair: We had a representative from Queen's University, Dr. Alice Aiken, who told us about the work being done at Queen's as the focal point for 32 different organizations, if I remember the number correctly, doing research with respect to veterans, families and military personnel. This is research activity, some clinical, some more basic research, that would help you and all these different organizations you're representing for the different services you're offering.
How do you stay in touch with all this work that's going on so that you know you are offering the best practices possible? It's a very rapidly changing field.
Lt.-Col. Heber: It's true. First, in terms of CIMVHR, the Canadian Institute for Military and Veteran Health Research, which is the organization that Alice was talking to you about, it looks at health research, so it's very much to do with both mental health and physical health research. They hold a meeting every year. Sometimes when we want to partner with somebody, we can put money through CIMVHR to get researchers to do a piece of research we're interested in.
We also have partners in other universities who, through CIMVHR, want to do research, but also our members. There's a research project that I and some of my fellow psychiatrists have been doing on a medication for PTSD nightmares, for example, and what we try to do within health services is pick topics that are clinically driven, in other words, something that is relevant that we see with our patients, a question that has been raised for us.
Again, in the Directorate of Mental Health, we have a mental health research section, and their job is to help direct research and look at what kind of questions we need to have answered. We present every year at the CIMVHR annual meeting.
The Chair: Are you doing any work before the symptoms are manifest, maybe even before deployment, which help the Armed Forces in recognizing some potential weaknesses or an area where the soldier needs to have a bit more counselling before he or she goes into a combat situation or a traumatic situation and is therefore better able to handle it? Are you doing anything to help better practices in that regard?
Lt.-Col. Heber: Again, the program I was speaking to Senator White about is related to that. The Road to Mental Readiness is all about preparing people for combat, for stressful situations, but also for members and leadership to be able to identify when somebody is starting to struggle. We're hoping to catch people early. It's also a program that helps to decrease stigma. Again, we want to teach everybody that mental health is something we should all pay attention to. It's like physical health. Rather than stigmatizing it, if a person begins to have trouble sleeping, they're more anxious, they don't want to leave the house for whatever reason, they can say, ''Okay, maybe this is something that I learned about, and I can go see somebody about this and get it fixed.'' That's what we're aiming for.
The Chair: How do you reach people with the message that there is some place they can go and they should not be influenced by the stigma that seems to be there?
Lt.-Col. Heber: The educational program of Road to Mental Readiness is delivered to people throughout their military career, so every time somebody goes for their next promotion, there will be a number of courses they take, and now mental health training is embedded in those courses. We expect our leadership to be fluent, if you like, in understanding mental health and how to look for and identify when people are having some issues that they're struggling with. It is done through the teaching that we do in the military to make sure that we reach everybody.
The Chair: Do either of you gentlemen have anything you want to add to that?
Col. Blais: The other way we reach people is also as part of the Joint Personnel Support Unit. Each of the Integrated Personnel Support Centres has an outreach coordinator, and they go to each unit every two years. We reach every unit in the Canadian Forces, including Reserve Force units, and they get briefings on all the programs and services available to them.
Col. Mann: It's very similar for Military Family Resource Centres. Again, we are dealing more with the non-clinical, but we say that spouses and partners are really the strength behind the uniform, and we say that for a reason. When there's a stable home front, there is mission focus when it comes down for us to deploy. We work hand in glove with health services on Road to Mental Readiness, but we have developed it for families both pre- and post-deployment.
Family resource centres are service delivery partners with health care workers at bases and installations across the country. They maintain a deployment support mandate while the member is deployed to make sure the family stays resilient, stays connected and has access to services that are directly related to deployment, including casualty support, child care, respite care, emergency child care, employment support, social work counselling. Those are all things that help us get ahead of the curve by making them available, making families aware prior to the member ever packing their barrack box to go out the door.
The Chair: We've been hosting a group of cadets from the Royal Military College. Can I assume that the knowledge base you're building here will be transferred to these future leaders and commanders in the Armed Forces at an early stage when they're still at college?
Col. Blais: Absolutely. As early as basic officer training, they start to receive this information.
The Chair: Glad to hear that.
Col. Mann: Our family services team is also working with the recruiting cells, so we can actually get to recruiting centres with basic information about the lifestyle and what to expect. It has been extremely well received by those recruiting centres we've approached to date, so we intend to go further and attempt to reach all of them.
The Chair: It will be interesting for us to hear from some of those recruiting personnel as to what the message is that they're getting from you and then what they are passing on. We'll follow up on that. Thank you very much for bringing that to our attention.
Senators, this is second round. We still have some time, and sometimes there are follow-up questions from some of the questions that have been asked. These are intended to be short, snappy questions with equally short, snappy answers so that we can get on with things. I will start with Senator Stewart Olsen from New Brunswick.
Senator Stewart Olsen: Just a point of clarification: You mentioned two names, family liaison officers and family resource centres. Is there a difference, or are they the same thing?
Col. Mann: Military Family Resources Centres are non-profit, charitable organizations, but they are a derivative of a mandate that the Government of Canada established about 23 years ago. We have a federally funded Military Family Services Program, which disburses $27 million to the 32 centres. Within some of those centres, they employ a family liaison officer or more, depending on the case demand. For example, Valcartier would have two family liaison officers. They're co-located at the Integrated Personnel Support Centre because we understand the concept of a one-stop shop for the member and family who are suffering PTS or OSI or who are posted to the Integrated Personnel Support Centre. We make it very easy for the family liaison officer to reach out and connect with the family who accompanies the member through the door or for the member to become aware of what's available for their family through outreach to the family liaison officer. They're an integral part of the Military Family Resource Centre, but they're located with a different unit because of the need to connect with families as they come through the door.
Senator Stewart Olsen: What is your position if members are actively serving and are dealing with PTSD? Are they encouraged to be able to have their service dogs with them? Does the military support that? If not, why not?
Col. Blais: There are two components to that. One is a health component and one is an administration and career component. When the treatment begins, if a doctor has determined as treatment progresses that an individual would benefit from a service animal, at that point the doctor will indicate that, but there are employment limitations assigned at the same time. If a doctor has certified that an animal is required or would be beneficial, at that point we receive that information, and if an individual has a certified dog, they are allowed to bring it into the workplace.
The Chair: These are dogs that help injured soldiers in a number of different ways. Did you say those dogs are being provided for under the program that is supported by the military?
Col. Blais: No, senator, I did not.
The Chair: I didn't think you did.
Col. Blais: We allow them into the workplace, but we are not providing funding for the animals themselves.
The Chair: Is that for a budget reason or some other reason?
Col. Blais: Research is ongoing. Veterans Affairs Canada is conducting research into service dogs. Our health services are very much a science-based organization. There's not quite enough research, and I don't want to speak for Colonel Heber. I'll probably let you go down this one.
Lt.-Col. Heber: Let me add to that. Regarding one of the issues about a member getting a service dog, one of the things we encourage members to do is, first of all, if they're symptomatic, to come forward so we can do a proper assessment and we can give them the treatment that will help them. There are a couple of things about this.
First of all, is this in fact post-traumatic stress disorder? The treatment for that is somewhat different than for somebody suffering from a major depression or some other mental illness. We want to make sure that we are providing the right treatment for the right condition.
Once a member obtains a service dog, they are, by definition, not going to stay in the military long-term because it's incompatible with universality of service. That's why I'm saying we encourage members to come forward first. If you're thinking about getting a service dog, come and see us; let's talk about why you're thinking about it. What are the problems you're having? Are you already in care? If you're not in care, let's get you in care, let's treat you and let's see how things go. There are some members, unfortunately, where the PTSD will become a chronic condition and where they will then benefit from aids to that disability, if you like. Often a service dog can be a very effective aid for those people.
What we don't want is for people to kind of short-circuit their future career by not coming forward first and getting treatment because then there's a good chance that, in fact, they will recover and they will be able to stay in the military.
As I was to Senator Stewart Olsen a few minutes ago, one of the things that I've personally been very involved in is working with many of the service dog organizations in Canada and the Canadian General Standards Board, who are meeting today to start a process to set up national standards for service dog organizations and their training. Also important to us is the intake process and how people are screened before they get a service dog. If somebody comes forward and they are still a serving member, it's really important that some screening is taking place to see whether they have been in treatment yet. Do they need something else before we consider a service dog?
The Chair: Thank you. That was helpful.
Senator Enverga: We have top-of-the-line services. What is our success rate? Is there a success rate? How many people will be able to move on, and how many have to go back after we release them? Are there any statistics about that?
Col. Blais: Do you mean health-wise? For example, we have a return-to-work program, so as soon as a person is posted to the Joint Personnel Support Unit, the doctor and the individual discuss how quickly they can return to work and how much they can do. They then come back, and those recommendations come to us. We work with the doctor and the individual to find an employment opportunity that is suitable to them either in the military or, for some, that happens to be in the local community. That can be at first as little as going to the gym three hours a week on different days and building right back up to five full days a week. Our goal is always to return them to their units to full service.
Right now, our success rate for those entering a return-to-work program and returning to their units to full service is approximately 35 per cent.
Senator Enverga: It is 35 per cent.
Col. Blais: Yes.
Lt.-Col. Heber: I can give you some figures about treatment of PTSD and results from that. Again, I have to put this in context.
This was a study done in Gagetown, and it was based on an infantry battle group, 792 soldiers. These were people who had deployed in 2007 and later came forward for treatment. It's one of the studies we have that looks at actual treatment outcome.
Again, it's important to remember that this is an infantry battle group. They had probably the highest rates of PTSD of members who are deployed. We deploy members to all kinds of jobs and all kinds of positions, but this group, of course, would have been the ones who were outside the wire, on the front lines. They would be the ones who would have been most traumatized.
Based on this group, after they had treatment, during treatment and then follow-up, 45 per cent recovered, went into full remission and were able to return to full duty.
Another 28 per cent improved — were not in full remission but improved — and were able to return to some duties. Again, for that group of people, they would continue to be treated ongoing, and time would tell whether they were going to be people who would end up in full remission or would end up with some symptom, some disability.
Then about 27 per cent had minimal improvement. For that group of people, basically what we'd do is we'd treat them to help maximize their quality of life and then we work with the IPSCs to help coordinate a transition as smooth as possible to civilian life.
I want to say something, though, if you don't mind, even looking at that 45 per cent. Again, close to half of the people returned to full duties, were in full remission, which I think is actually an amazing rate, especially for this population of people who were really the ones on the front lines.
When somebody goes into full remission, one of the things I, as their psychiatrist, or whoever their provider is, do is sit down with them and talk to them about whether they want to continue: Here are your choices now and what do you want to do with your life?
We know that even people in full remission who get re-traumatized have an increased risk of developing symptoms again. We want to make sure that our members are fully cognizant of the risks if they decide to remain in the military and continue in their careers. So we always have that conversation with them.
Senator Enverga: How long is the average treatment for a person?
Lt.-Col. Heber: That's a hard one to say. It can go from 12 sessions of psychotherapy, and maybe three to six months on some medication, to a few years.
Senator White: Thank you very much. I think the information is actually quite helpful. I do have a question around embedded behavioural health professionals and whether or not we actually have embedded in our deployment psychiatric and psychological help. If not, why not? Have we seen success?
I know in the United States, at Fort Drum and others, they've had spectacular success, they would say. The first question is, do we do this? Second, how successful has that been?
Lt.-Col. Heber: I can't tell you exactly what year, but when we went down to the Kandahar region we started deploying a mental health team. During the time we had lead nation status in the Role 3 unit, we were the mental health team basically for all the NATO countries. After we gave up lead nation status to the Americans, we continued to deploy a mental health team and we looked after mostly Canadians, though we would see other people if there was a need. This team was a psychiatrist, usually one, two or three social workers and/or mental health nurses.
Senator White: Does it make a difference?
Lt.-Col. Heber: I can't quote you research on that. Quite frankly, I don't know about what Fort Drum has done in terms of research. This is very difficult stuff to research because it's hard to control the groups. But personally do I think it made a difference? Absolutely, I do.
We have known since the First World War that sending mental health experts out to the front makes a difference for people. We're able to see them quicker; we're able to help people where we can help get their symptoms under control quickly and keep them there which, of course, for military members, is the most important thing. The last thing they want is to have to be repatriated.
Senator White: After 100 years I guess we've learned. Thank you.
Lt.-Col. Heber: That's what we've learned.
[Translation]
The Chair: Colonel Blais, you mentioned the Sans limites program.
[English]
In English, the Soldier On Program. We would like more detail on how you provide access to equipment training and how you get funding for that. Do you have something in writing you can send to us, or in half a minute could you tell us everything we want to know?
Col. Blais: I think that might be stretching it a bit, Mr. Chair, but I can certainly provide that in writing for you.
The Chair: That would be very helpful.
On behalf of the Subcommittee on Veterans Affairs, we'd like to thank you very much for being here and for the work you're doing for the soldiers and families.
(The committee adjourned.)