Proceedings of the Standing Senate Committee on
National Security and Defence
Issue No. 28 - Evidence - Meeting of June 4, 2018
OTTAWA, Monday, June 4, 2018
The Standing Senate Committee on National Security and Defence, to which was referred Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder, met this day at 1 p.m. to give consideration to the bill; and to examine and report on Canada’s national security and defence policies, practices, circumstances and capabilities (Topic: Elsie Initiative on Women in Peace Operations).
Senator Gwen Boniface (Chair) in the chair.
[English]
The Chair: Honourable senators, welcome to the Standing Senate Committee on National Security and Defence. Before we begin, I would ask my colleagues to introduce themselves.
[Translation]
Senator Dagenais: Senator Jean-Guy Dagenais from Quebec.
Senator Boisvenu: Senator Pierre-Hugues Boisvenu from Quebec.
[English]
Senator Griffin: Diane Griffin, Prince Edward Island.
Senator Oh: Victor Oh, Ontario.
[Translation]
Senator Housakos: Leo Housakos from Quebec.
[English]
Senator Bernard: Wanda Thomas Bernard, Nova Scotia.
Senator McIntyre: Paul McIntyre, New Brunswick.
Senator Richards: David Richards, New Brunswick.
Senator Jaffer: Mobina Jaffer, British Columbia.
The Chair: I’m Gwen Boniface from Ontario.
This afternoon we will begin our study of Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder. In our first session on the bill, we are most pleased to welcome the sponsor of the bill, Todd Doherty, member of Parliament for Cariboo—Prince George.
Mr. Doherty, we will hear your opening remarks, after which we’ll have some questions. Welcome to the committee.
Todd Doherty, M.P., sponsor of the bill: Honourable senators, I want to first take a moment to thank each and every one of you for allowing us to get to this point today. It has been a long journey. It has been 859 days since I first tabled my bill in January of 2016. I am truly honoured to have been afforded the opportunity to present to you my bill, Bill C-211.
Senators, if I told you your actions today could save a life, would you choose to act? If I told you that your actions today could save thousands of lives, how quickly would you choose to act? This is the magnitude of what we are dealing with today.
PTSD, post-traumatic stress disorder, does not discriminate. Whether you are a man or a woman, White, Black, First Nations or other, everyone is susceptible.
This is not a partisan issue. It is not a Liberal, Conservative, NDP or an independent issue. This is our issue as leaders of our nation, and it is one that we should be seized with.
PTSD is debilitating. Those who are fighting can be well for years, and then it might be a sight, a smell, a sound, a song, a noise or a colour that triggers an episode. Those who are in the fight are truly in the fight of their lives.
Every day I receive a text message, an email, a social media message or call of another veteran, another active military, paramedic, firefighter, police officer, emergency dispatch who has taken their lives. As I am talking to you right now, literally as I was walking here, only an hour ago, I had an email that said another warrior goes down. These messages never get easier, but they almost always end with Bill C-211 must pass. It has to pass.
Last December, a young man by the name of Brandon Babin reached me through Facebook. He left a Facebook message. He told me he was having troubles, messed up from the stuff he encountered as a volunteer firefighter first in his hometown of Fraser Lake, near my hometown, and then as a firefighter in Fort McMurray during the fires. He didn’t know where to turn. He had heard of my bill, and he just wanted to talk. At the end of his message, he thanked me for understanding and for fighting for him and others who are suffering.
Only days later, on Boxing Day, I received a message from a friend of mine who is his fire chief, and he asked me to go to Brandon’s Facebook page. Brandon had filmed a video, and then he climbed five storeys and jumped to his death in Prince George. This video was his goodbye, and it was heartbreaking. Regrettably, I didn’t reach Brandon in time, and these are the photos of Brandon and his friends. This is Brandon only three years ago, in October of 2015 when I was elected.
Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder, requires the Minister of Health to convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, provincial and territorial government representatives, representatives of the medical community and patients’ groups for the purpose of developing a comprehensive federal framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.
That paragraph is very important for those around this table and those who are listening today. Bill C-211 is not the framework. Bill C-211 is the vehicle to get us to the framework so that we can save lives.
It calls for the development of a consistent terminology, diagnosis and care with respect to the mental health injuries that our first responders, veterans and military face in their service to our country and our communities. It will lead to early access to evidence-based assessment, early intervention, stigma reduction, mitigating risk of burnout and, in turn, further leading to a positive treatment outcome and better prognosis, and a return to a healthier level of functioning. It will increase the likelihood of successful return to work and increased productivity.
Senators, did you know that mental illness has a significant impact on our national economy? The estimated annual health care costs are about $51 billion, and they’re driven in part by the fact that mental health problems are associated with reduced productivity at work, increased absenteeism, sick leave, short-term and long-term disability. The costs associated with mental health disabilities are also higher than those of physical-related disabilities, and they are seven times more likely to reoccur.
Today, as it stands, Canada does not have a federal piece of legislation that deals with post-traumatic stress disorder. As a matter of fact, Bill C-211 may very well be unique as it may be the first national piece of legislation of its kind ever.
Senators, the world is watching how we proceed. Countries around the world are waiting for this legislation to pass. Currently, we have piecemeal provincial legislation but nothing coordinated and consistent that would ensure that a police officer serving in Atlantic Canada receives the same care and attention that a police officer serving across our nation in Western Canada receives.
We have inconsistent terminology, diagnosis and care that leads to confusion, perpetuates the stigma of mental health injuries, and, ultimately, leads to loss of life. Are we talking about PTSD or is it OSI, operational stress injury, or is it a PTSI? Are we talking about first responders or public safety officers?
There are some that say my bill does not go far enough. It does not include certain groups. Bill C-211 was not intended to be prescriptive or onerous so that we fail in our goal. Our goal is to get us to that framework. It was developed to mandate federal ministers to act along with their provincial and territorial ministers, industry, academics and the medical community to together create a solution to an epidemic that is being experienced globally, yet no one seems to have the answer, except for Canada. Today we have a piece of legislation that has been unanimously supported by all members of Parliament.
What that framework looks like when completed and who is included ultimately is the responsibility of the ministers and their provincial and territorial colleagues, and the industry representatives that are convened with them.
Senators, I’ve seen first-hand the conditions our nurses and doctors work in. My daughter is working to become a nurse. My aunt, grandmother and cousins were all nurses. My mom and my brother are care aides.
I have met with and now proudly call Mark Farrant a friend. He shared with me his experience as a juror on a horrendous court case. Our jurors sit for weeks and months on end, and then we expect them to go back into society under the condition of confidentiality and just deal with whatever it is that they learnt and heard and saw.
Bill C-211 was developed to build this discussion. It was built on the headlines and the personal stories of tragedy and of triumph. Just in my riding, Paul and Terry Nichols, of Communities for Veterans, set off on horseback in 2015 from Quesnel, British Columbia, to raise awareness of the changing face of veterans and PTSD. They rode all across Canada on horseback raising awareness.
Bill C-211 was built off the pain that I have witnessed. I received a note a while back from a mom who lost her son. She asked me to remind my colleagues that beyond the badge, beyond their uniforms, beyond their smocks, they are someone’s mom, dad, brother or sister. They are someone’s sons and daughters. They are just human, and they hurt like you and me. But who is there for them when they need help? Who rescues the rescuers?
Those that sign up to heal us, protect us and serve our country and our communities are incredibly special humans. They put their uniforms on every day knowing full well they will experience human tragedy. They may have to take a life and, ultimately, in their service, they know they may lose theirs. Think about that. They put their uniforms on every day knowing full well they may lose their life in service to you and me. That’s incredible.
They are our real-life heroes. They run towards gunfire. They run into burning buildings. They restart your heart. They heal our wounds. While we sleep, they are our silent sentinels. Stories are written and movies are made about them. We can be forgiven for forgetting that they are just human, but we have failed them as leaders. When we call 911 for help, we know they will be there to protect us or to rescue us, regardless of their own health or safety. They are altruistic individuals who want nothing more than to go to work so that they can help others when they need it the most. At the end of their shift, they go home and reflect on their day. They try to process the day’s events and try to enjoy some semblance of normalcy with their families. Then they get up and do it all over again.
Bill C-211 was borne out of the stories we see and hear all too often — stories of another veteran, paramedic, emergency dispatcher, firefighter, police officer, who just could not fight any longer. Bill C-211 was developed to look at the overwhelming issues and the epidemic that we have with respect to our first responders, our veterans and our military.
We are losing our warriors at a staggering rate. In the U.S., it is estimated that 22 veterans commit suicide every day. Over the last two years since tabling my bill, I have heard thousands of stories from those who are fighting and those who have been left behind — the friends, the family and the colleagues of the fallen. The stories are heartbreaking.
I met a giant of a man who was injured rescuing a fellow firefighter. Trembling and in tears, his voice shook as he managed to get out the words, after second reading in the house, that for the first time, because of Bill C-211, he had hope. When he introduced his son to me, he told him that I was a hero. Isn’t that incredible? And that is shameful. Doesn’t that say something? I assure you all that I am not a hero. The heroes are the brave men and women we are fighting for today.
Over the course of the last two years, I have met some incredible mental health champions, one being Natalie Harris, a former advanced care paramedic with the County of Simcoe. Natalie appeared before the Parliamentary Standing Committee on Health when they were studying Bill C-211 and gave one of the most powerful speeches I have ever heard. She explained to the committee that she went to school to be a paramedic to realize her dream. Yet, as much as she loved her career, it became tougher to deal with the daily experiences. She kept telling herself, “I’ll be okay.” She fought the feelings and was afraid to come forward, as she feared she would lose the career she loved so much. Natalie told the committee, “It’s not normal to have a person ask you to just take their leg or arm off because they’re in so much pain from being trapped in a car with multiple open fractures all over their body.” She continued, “It’s not normal to witness a young woman who is seven months pregnant rub her belly with the only limb she could move as the stroke she just had left her disabled.”
It’s not normal to experience and see the look of true evil when you learn how an innocent child has been murdered. Yet this is what our warriors do every day in service to us all. When they answer the call of duty, they do so knowing full well they will face sights, smells and sounds that will stay with them for a lifetime.
We need to develop a national framework that includes early recruit training building off successful programs, such as the Canadian military’s R2MR, or Road to Mental Readiness, which can be adapted to fit first responders and other sectors, so that we can ensure that our brave men and women that we trust to heal us and protect us and to serve our country are better prepared to meet the mental and physical demands of their chosen field.
Just as we arm them with the tools of the trade, weapons to fight crime or equipment to save lives, we arm them with the tools needed to be mentally healthy. We need to ensure that our frontline soldiers, officers, firefighters, paramedics, military and veterans have the resources to ensure they get the help they need when they need it, where they need it and whenever they need it. Education and awareness is vital.
We need to ensure that these resources expand to the families of those who kiss them goodbye in the morning or at the start of a shift or deployment, not knowing whether they will return. Families are often forgotten in this fight. They are left to pick up the pieces, and the impact is devastating.
Honourable senators, as leaders in our nation, we must do what is necessary to ensure our first responders have those tools and resources to properly do their jobs and look after their teams. It is no longer enough to be physically healthy. We know this. We need everyone to be mentally healthy.
A friend of mine who is a high-ranking police officer came forward to me with his own struggles with PTSD. I’ve known him for almost 19 years. I had no idea. He explained, “I thrived on chaos. I threw myself more and more into my career. As I rose through the ranks, everyone would see me as a success, but the sad reality was the more I struggled with PTSD, the more I became a workaholic. As a top serious crime cop in my community, there aren’t many places in town that I am not reminded of a murder or of some sort of terrible thing.” He went on to tell me that just while taking his little girl to school, he passes three sites where he had investigated serious crimes. He continued, “I shouldn’t have anything to complain about. I’m at the top of my game, I am in great shape, yet I am completely messed up.” I am happy to say he is healthy now and he is getting the help he needs, but unfortunately he is in the minority.
We need the government to seriously look at PTSD and develop a framework as soon as possible. We need to ensure that the next government, whoever that is, can continue the work. We need to learn to recognize the signs when someone is not feeling well. We need to be able to ask that simple question — three words: Are you okay? We don’t do that enough anymore. No one wants to meddle; no one wants to pry. We tell ourselves that it’s not our business. We tell ourselves that if they needed help, they’d ask. Far too often, they don’t ask and we find out far too late.
How many friends, colleagues or family members have we lost to suicide? Recognizing the signs and symptoms of mental illness, how to effectively respond to and support those who are suffering must be paramount. They often find themselves in situations that nothing can prepare them for. To say that it’s difficult to imagine is an understatement.
As legislators, we can pass Bill C-211 and work with the government and industry stakeholders to facilitate a culture of transformation. Collectively, we need to be better in developing a workplace culture where it is supported and encouraged to come forward with mental health concerns. A national framework would help facilitate this change.
With that, the Honourable Minister for Public Safety said, on January 29, 2016, in Regina, regarding PTSD that:
We’re all in this together. The Government of Canada cannot do it alone.
The development of a national action plan on PTSD must be rooted in an evidence-based, coordinated approach that involves all the impacted stakeholders.
It is shameful, but I still encounter leadership who tell me that people should know what they’re getting themselves into when they sign their employment papers. I still have police officers, paramedics, nurses, emergency dispatchers and firefighters who tell me in confidence that they do not do critical incident debriefing. They far too often are told to suck it up, saddle up and ride, that they are seen as weak for coming forward and they somehow to blame for showcasing the dangers of the industry. No one is going to willingly come forward if they believe there is a chance they will be ridiculed or lose standing in the workplace. The stigma of dealing with mental health issues — not only PTSD but any mental health issues — is real and unfortunately can lead people to withdraw and suffer in silence. And this needs to change.
I am hopeful that once we pass Bill C-211, issues such as these will be discussed and planned out as part of our national strategy. Our first responders, veterans, military, those who serve, need to know that coming forward and asking for help is not a sign of weakness but, rather, a sign of strength. We need to give their colleagues and the industry the tools so that they can help. We need to encourage the open and honest dialogue for anyone struggling with mental health challenges, going forward as a nation to lay down the groundwork and cultivate an environment in which those living with mental illness feel comfortable seeking help, treatment and support. That should be the ultimate end — they feel comfortable coming forward. This is the overarching goal of Bill C-211, not just talk but to act and do something about this terrible epidemic.
Suicide has greatly impacted my life as well. For a time, I worked with at risk youth and young adults, teaching crisis intervention and suicide prevention at a time when no one wanted to talk about suicide for fear that others may do it. I have sat with those contemplating suicide, and I have shed tears with those left behind. Although I had training, I have missed the signs myself.
My first emergency debate as a member of Parliament was about the suicide epidemic in the Attawapiskat First Nation. As leaders, how can we go about our lives when we have children, some as young as four, choosing death over life? How can we as leaders sit idly by when the headlines scream of yet another unnecessary loss of life?
Madam Chair, the former member of Parliament for my riding, Dick Harris, told me after I received the nomination to run in 2015 that this is an incredible opportunity to do something that has real impact on people’s lives. Mr. Harris told me not to waste this opportunity.
I chose to act and I’ve asked my parliamentary colleagues to join me. On June 16, 2017, 284 members of Parliament stood today together and unanimously passed Bill C-211. It currently sits with you, honourable senators, and today I’m asking you to act. Today, as I sit here before you, it has been 353 days since the house passed Bill C-211. It has been 859 days, as I mentioned, since I first tabled Bill C-211. In that time, countless lives have been lost. It touches all of us.
Our parliamentary family is not immune to this horrible epidemic either. Earlier this year, we lost one of our protective service officers, who struggled with PTSD arising from the October 2014 terrorist incident. We still have officers off work and struggling to get their lives back. In 2016, just steps from these doors of this room, an RCMP officer committed suicide.
I truly believe it would be a shame to lose all the work that went into this bill, from conception to passage, through all the stages in this house to where we are today. Together, we have created so much hope, but we must do more.
Honourable senators, Bill C-211 is not the framework. It is the vehicle to which we can get to the framework. If you do amend this bill, you will essentially be sealing its fate. I envisioned this bill as being all-inclusive and, once passed, I’m confident that the government will call all interested parties to the conference so no voices are silenced. Every minute delayed, every hour wasted, every day lost means another day we as leaders have failed those we ask to answer the call of duty.
So, honourable senators, 859 days, 353 days, countless lives lost. Today it has been 365 days since Peel paramedic Christopher Rix lost his fight with PTSD. His parents, Mary and Stephen, and family are here today and they will tell you that Bill C-211 will save lives.
In conclusion, I will bring you back to the question I asked at the beginning. Bill C-211 will save lives here at home, and ultimately the framework developed will serve nations around the world. How will you choose to act?
The Chair: Thank you, Mr. Doherty. We will now move to questions.
[Translation]
Senator Dagenais: Thank you, Mr. Doherty, for your very moving testimony. As a police officer, I was a first responder on the roads for 24 years. I witnessed accidents, suicides in progress, and three shootings. I even found my best friend’s body with his service revolver in his mouth. You speak with emotion and are evoking certain memories for me. First responders do not have it easy. When you put your uniform on in the morning, you do not think you will have to tell a parent that their son has died in an accident, which is extremely difficult.
How have the provinces and territories outside Quebec responded to your bill? I expect you have spoken to them about your bill.
[English]
Mr. Doherty: Thank you, senator. I want to say thank you for your service as well, too.
It is emotional. You take the weight of the world from the stories you hear and the people you meet.
Bill C-211 is welcomed provincially. As a matter of fact, I have had many provinces reach out to us for the piece of legislation. There are seven provinces currently working towards or have PTSD legislation. However, they need a federal leader on that.
Senator, it is still piecemeal. We have provincial legislation that is still not consistent from coast to coast to coast. You could have an RCMP member serving in Nova Scotia and get transferred to British Columbia and they may not be eligible for the services they were receiving in Nova Scotia. This is something that must change. We need a consistent framework with consistent terminology. As I mentioned, are we talking about an OSI or PTSD or PTSI?
There are things that have changed even in the last three years, but we need consistency to make sure people aren’t falling through the cracks. That’s what is happening every day, and they need leadership from us.
[Translation]
Senator Dagenais: Do you have any examples of international programs that we could draw on to achieve our goal more quickly? In my opinion, this bill is urgent. Can you give us any examples of what is done in other countries?
[English]
Mr. Doherty: In truth, senator, many countries are watching us. I was speaking with a gentleman from Australia just last week. I was supposed to speak at a forum in Washington a couple of weeks ago on this very issue. They are hopeful for us to move forward with this so they, too, can then show a Commonwealth country taking the lead. The U.S. may have some programs in various states, but there is not a coordinated effort. The U.K. is still struggling. Really, Canada will be leading the way, and countries are watching how we move forward.
[Translation]
Senator Dagenais: Thank you, Mr. Doherty.
[English]
Senator Jaffer: Mr. Doherty, thank you. I have no words to thank you for the work you’ve done and the people that have supported you. It’s obvious with the people sitting here that some are really hurting, and I can just imagine how tough it is. You’ve put tremendous effort into this, and I want to thank you for that.
While you were speaking, I couldn’t help but think of my colleague Senator Dallaire. Day in and day out, I saw how much he suffered first-hand. He had some tough nights and it is difficult for him even now. He has since resigned from the Senate, but we’ve seen it first-hand, and with others as well.
I’m going to be honest with you. I was looking at suggesting some amendments, but when I hear you — and tell me if I heard you properly — you’re saying to pass this, and that doesn’t mean this is final. We can still work on it.
I have many questions, and the chair will tell me how far I can go, but my first question to you is we’ve heard from nurses, and you have too, and they want an amendment to be included. You did speak about family members who are nurses, so you know the profession well. They will be speaking to us today as well. Can you restate what your position is as to why nurses were not included?
Mr. Doherty: It’s not that they were excluded, senator. First, I want to say thank you for your kind words. The people who have followed along the way, the people I’ve met and the families I’ve talked to, the survivors, the ones with whom we started a conversation and we lost, they are what drives me every day. The message I wish I could have pulled up, the pictures and the stories that we get time and again, those are what drives me.
I’ll tell you the same thing I mentioned to the nurses. This legislation is not the framework. When we pass this and the framework gets developed by the federal ministers, those who are in power, and their provincial and territorial colleagues, the industry and the academics, what does this framework look like? Who will be included? I’m embarrassed to say that when we wrote this and we included first responders — you’ll notice first responders — it’s not first responders and then a dash to explain who it is. To me, it’s all-inclusive. However, this is not the framework. The framework comes afterwards. This is the vehicle to get us to that framework.
Senator Jaffer: Mr. Doherty, I understand what you’re saying. You’re using a very wide sense of “first responders.” It’s who defines first responders, but I won’t go into that any further. I get it; you’re talking about a framework. You spoke about mental health, and this committee studies issues of PTSD. For years and years, we’ve looked at it, so we are familiar with the challenges that you’ve spoken about. But obviously, when you speak with such a lot of feeling, it comes back to us that this is also important.
PTSD can also, we’ve heard, result from harassment or sexual misconduct that the people who work here and other places suffer. My concern is that the framework should look at, for example, the RCMP and the Canadian Armed Forces members who suffer from mental issues as a result of harassment and sexual misconduct that they experience, and instead the preamble seems to shift the focus to PTSD. I’m not asking you to change the bill, but I’m sure you will be part of the discussions on the framework. Would you see that being included in the framework?
Mr. Doherty: That is a great question. As I mentioned, as we’ve gone through this process, I’ve said consistent terminology, consistent messaging. It changes. Again, as we go through, my hope is that when this passes, I’m not letting it go. Obviously you can see this is a passion for me. We are fighting for those people who are behind us. We are fighting for those people who put their uniforms on and serve us every day. This is not something that I’m going to let go. We are going to make sure that it is the right framework.
Holistically, my hope for this — and I think I said it when I mentioned the Attawapiskat suicide emergency debate — I think we’ve started to hear more. We’ve only just begun to understand what PTSD really means in the last 10 years. In that time, it’s gone more from PTSD to PTSI to OSI, so we need to get the right people around the table to develop this nationally so that we have a consistent framework, who is included and what that looks like.
Senator Jaffer: You used the term “OSI,” which is operational stress injury, for the benefit of the people watching.
Mr. Doherty: Thank you.
Senator Richards: Thank you for your very impassioned declaration and speech.
My question was already asked by Senator Jaffer, for the most part. I know why you don’t want another amendment, and I understand that. My question — and it might have been answered by you already — could nurses be a complement to the first responders? They have to be in there somewhere.
Mr. Doherty: I will tell you this: If you look at the definition of a “first responder” in Canada, there is no definition. It differs. If you go to the U.S., they have not adopted a legal definition of “first responder.” But it very well could be there. That is not for me to decide. That is for, once the bill is passed, who is there, absolutely.
Senator Richards: Yes, but of course you recognize how important nurses are to our well-being.
Mr. Doherty: Senator, as I’ve told you, I’ve seen the conditions that our nurses have endured. My grandmother and my cousins are nurses, and my daughter is currently training to be a nurse. My uncle is a doctor and was an emergency room doctor. I full well know it, and as I said, in my mind, they weren’t excluded.
Senator Richards: Thank you.
Senator McIntyre: Thank you, Mr. Doherty, for your excellent presentation. Your bill is good legislation, and I will definitely support it, no question about that.
Mr. Doherty: Thank you.
Senator McIntyre: What bothers me a little bit is that time is of the essence. As you’ve indicated, we have to move forward with this bill. Provincially, my understanding is that provinces such as New Brunswick, Manitoba, Alberta and British Columbia have adopted legislation regarding PTSD, and I further understand that Ontario is moving forward with legislation on PTSD. But as you’ve indicated, there’s not a coordinated federal-provincial strategy.
Mr. Doherty: No.
Senator McIntyre: The problem I can see is that looking at the summary of the bill, it states that the Minister of Health is to convene a conference with other stakeholders, such as the Minister of National Defence, the Minister of Veterans Affairs, the Minister of Public Safety and Emergency Preparedness, provincial and territorial government representatives responsible for health, representatives of the medical community and patients’ groups for the purpose of creating this framework.
Aall of this is going to take some time. I don’t know how fast the Minister of Health can work. I hope he or she will work quickly on this important piece of legislation. In the meantime, how much work is being done by the provinces and territories to move forward with PTSD?
Mr. Doherty: I can’t speak to specific individual provinces. I can tell you that all provinces are seized with this issue. It is an epidemic from coast to coast to coast, and it is top of mind. I understand in the next couple of days we will be having an election in Ontario, and I know that PTSD is a campaign promise. PTSD legislation is on the minds and the mouths of the politicians that are running.
Senator, I will offer you this: The time is now. Parliament sent the message of the importance of this bill 353 days ago. All members of Parliament supported this, including ministers. Everyone stood up, 284 members of Parliament. We have been waiting for this bill to get to this point today, and I can tell you this: You can see the importance and the people that are behind us today. This is such an important issue that people will move mountains. Sectors, industry, academics, medical professionals, provinces, ministers and leaders will all move mountains to try to get something done.
Senator McIntyre: The idea is to convene a conference and then, following the conference, the Minister of Health has to prepare a report setting out the federal framework and cause it to be laid before Parliament, before the House of Commons and Senate, within 18 months after the day on which the act comes into force. I’m concerned about all this time, and I’m sure you’re concerned about as well.
Mr. Doherty: Senator, that was done on purpose because, as I stated a number of times through my speech, the time is now for action. Parliament, and indeed the Senate, and legislatures all across our nation, have shelves filled with reports and studies. We need action. The reason we put that reporting in there is that it is important to come back and say what is working, what isn’t working and what are things we need to do?
The other thing about it is this: Whether it is this government or the next government or the government after that, if they choose to scrap or repeal this, they have to come before Parliament and tell Canadians why they’re doing that. We must be accountable. As leaders, we must be accountable to those that we ask to serve, we ask to protect us and we ask to heal us. That is why we put specifically reporting duties in there. Senator, I would offer that I think our ministers would be able to find a way to get that done.
Senator McIntyre: Perhaps a final question: All I wanted to know, really, was how long will it take to get the framework together?
Mr. Doherty: Sorry, senator. That was a long-winded way to answer, and I apologize. I can’t tell you that. That is something that is up to the ministers and industry and academics to go through. That’s not my area of expertise.
Senator Bernard: Thank you, Mr. Doherty, for your speech today but, more importantly, for the passion that you bring to this work, for the voices that you speak for and for bringing national attention to the issues. I certainly believe and agree that any life lost to suicide is one too many.
In your opening remarks, you said that everyone is susceptible, and you listed a number of people, including people who are marginalized — LGBTQ, persons with disabilities, Indigenous. I’m wondering if you’ve had evidence that would speak to ways that members of these groups may be uniquely impacted by PTSD in any way.
Mr. Doherty: Senator, I will have to offer that I do have statistics. I don’t have them with me. But over the course of the last 800 and some days, we have met with other groups on that. We have heard that information. I don’t have it with me.
Senator Bernard: A follow-up question: You repeatedly said the bill is a vehicle, not the framework. It’s a vehicle to build the framework. I’m assuming you’d want the best possible vehicle doing that work. Others have referenced the absence of some people, even in the preamble. While we respectfully hear your deep commitment to this, I’m not sure if that means it will actually happen, that the bill will be totally inclusive. One of the groups that hasn’t been mentioned is actually social workers. I think you may have heard from the Canadian Association of Social Workers. Sometimes social workers are the first responders, particularly those who work in child welfare, protecting the nation’s children from harm, and they’re often witnesses to horrific abuse of children. In addition to that, they’re working in many other sectors as well where they become part of that first responding team. So that’s just one of the groups that’s not referenced. If the preamble were a bit more inclusive, I would feel much better about this in terms of moving forward.
Mr. Doherty: Senator, I really appreciate your comments, and I would offer this: I’m a new member of Parliament.
Senator Bernard: I’m a new senator.
Mr. Doherty: You’re a new senator. The wheels of bureaucracy turn very slowly. Bill C-211 was developed in a non-prescriptive and non-onerous way so that we could get to that goal of having that framework developed.
I would offer you this: Rather than amending this, perhaps without amendments but offering suggestions or comments, once it’s passed, that all groups are invited to participate in the framework or in the convention, so that everyone has a voice to talk about their sector.
As I said before, I worked at a time when you couldn’t talk about suicide. You couldn’t go into a school and mention the word “suicide,” although they wanted us to go in and talk about crises and counselling and talk about making sure that your friend and your best friend is okay. But you couldn’t mention the word “suicide.” Today we’re able to actually have this mental health discussion.
Bill C-211 for me was the vehicle so that we could grow that national discussion and so that we could get the people that can enact change and affect the most people around a table. In trying to find the best way of doing that, we created a bill that — as an opposition member of Parliament, somebody who is not in government, and a new member of Parliament — we managed to get all members of Parliament to unanimously support that.
Today, my worry is not to minimize anybody’s suffering or their sector, but what is our ultimate goal? It is to get to that place where we are convening that meeting where the ministers can actually develop the framework. Who is around the table, that’s not for me to decide. It’s to get this passed and get that discussion going.
Senator Bernard: Senator Jaffer mentioned retired Senator Dallaire, who now lives in Halifax part-time and is at Dalhousie leading an initiative for child soldiers. I reached out to him about this bill, and he supports it.
Mr. Doherty: Senator, I want to tell you that while I was contemplating running for politics, Senator Roméo Dallaire spoke at an event in Prince George, and he talked about his struggles and the things that he witnessed. While I was already moving forward with this, I have to tell you that it was a key piece and driver for me moving forward. I’ve shared that with him as well personally.
Senator Housakos: I will offer a comment to the committee rather than a question.
I’d like to thank Mr. Doherty for giving me the privilege to be the sponsor of the bill in the Senate. As a senator now who has been here for a number of years, I guess I fall into the category of the older senators. I just want to point out, colleagues, and it’s important for all of us who have been here for a while, that we know Parliaments have a timeline and they have expiration dates. Of course, bills face those pressures all the time as they go through the house and the Senate. So I think we have to be cognizant of that fact as well.
Also, for a bill like this, which is going into uncharted territory, coming from a private member on the house side, getting unanimous support from the House of Commons, those of us who have been here for a long time know how hard that is to achieve. It speaks volumes on the importance of this bill to all political parties and parliamentarians, and we have to give kudos to the government for stepping up and accepting this. I think we also have to be cognizant of those facts.
The bill has been drafted, in my opinion, in a very broad spectrum for a reason. I think it’s trying to be more inclusive rather than exclusive. Because we’re going into such uncharted territory, we don’t have a clear definition of what a first responder is. I think we have to have some faith in the government and in the ministers of the day in order to get started on this pressing issue.
The ultimate thing we have to highlight here is that this bill has a review clause. Parliamentarians, senators and members of the house will get an opportunity after that first meeting of the framework to review and have input at that particular stage on an ongoing basis.
I wanted to highlight those points.
Mr. Doherty: Senator, I forgot to mention one thing. I’m not taking credit for this. Where we are today is the work of members on all sides of the house. I worked very closely with the parliamentary secretary and the Minister of Health as well, and with the Health and Safety Committee as well. All members of Parliament supported this, and we worked closely with them on this.
Senator Housakos: Mr. Doherty, I also want to point out for the Senate this is very important. I know 365 days seems like a long time for a private member’s bill, but I can assure you it isn’t. We’re working at lightning speed. My compliments also to the chair of this committee, as we’ve gotten here quickly because we think it’s important. I want to highlight that as well.
Senator McPhedran: Thank you for your work on this and for working in such a collaborative fashion.
As I understand it, and I’m also a relatively new senator, this is really the strength of what we, as senators, can bring to a process like this. I don’t think it’s necessary to cause additional delay, and it might actually smooth the way for a much broader embracing of exactly what it is you want to do here.
There’s a lot of time and energy and resources that have come to us from many different organizations, many different points of view, who share one clear conclusion at this point, and that is they feel excluded from this bill.
I’m wondering if we might just pause for a moment and learn from our Constitution and learn from the Canadian Charter of Rights and Freedoms. In section 15 of the Charter, we have a rather long list of protected characteristics, but with the addition of two words in that section, we’ve been able, as a country, to respond to changes in our society and much greater inclusion than those specific characteristics that are listed in section 15. Those two little words are “in particular.”
In your drafting, you have “with” and then you have a very closed list. If we were to insert those two little words, it would open up this whole discussion without a major amendment and hopefully would allow people to redirect their energy, which right now is battling their sense of exclusion from your bill, and point their energy towards how they can be included and how they can actually participate and strengthen the framework.
So if I may ask: Would you be open to that, to one simple amendment that added just those two words?
Mr. Doherty: Senator, I would offer this: When the bill was before Parliament and at committee in Parliament, we worked with the parliamentary secretary and the Minister of Health. We worked with many. There were some minor tweaks that they had asked. We had to go back to the legislative group. As you know, an insertion of one or two words here can change the meaning of it.
I would offer this: Senator, I’m worried. I’m worried that if we move with this bill with amendments right now, whether it is one word or two words, that we are going to lose this bill. Senator, I’m challenged with this, that every day that we delay, we’re going to lose another veteran or first responder or somebody who serves us.
Senator McPhedran: Sir, your argument can be turned also to those that feel excluded and who can make exactly the same point you just made.
Mr. Doherty: I would apologize, but again it’s not for me.
Senator McPhedran: Please, sir, you interrupted me.
Mr. Doherty: I’m sorry.
Senator McPhedran: The standard that I’m proposing and the precedent that I’m proposing is the Constitution of Canada. To your concern about inadequate legal advice, this is the standard that has operated very successfully for 35 years now and has done exactly what we are hearing from those who feel excluded and who clearly are first responders.
I won’t debate this further with you. I hope you’ll think about it, and I hope you’ll think about the value of redirecting the energy that’s been triggered to try to become included. You stated for the record, “I envisioned this bill as all-inclusive,” but you’ve had a lot of feedback to indicate to you that, in fact, you have not achieved your vision on this. These two words demonstrably have been able to do that for the Constitution, and they could do that for your bill.
Mr. Doherty: Senator, I will offer one final comment. Again, it’s not for me to decide who is included in this framework. It is for the ministers once this bill passes to decide and to invite those groups around the table.
Senator Jaffer: You’ve done a tremendous amount of work. I have to tell you, not just you but people who are sitting here and others who are listening really. I laud the efforts. As I said to you, I was thinking of making a lot of amendments and worked on it, but I rethought that. One of the things, and you yourself said it, was the operational stress injury, people going through traumatic experiences, so we’re looking at using a broader spectrum.
Would you be open to talking to the minister to look at things linked with depression, anxiety disorder, adjustment disorder and the full range of substance disorders that people may face as a result of being in a high-stress work environment to be part of the framework? Operational stress injury is not just limited to PTSD. Perhaps we could look at making an observation on that.
Mr. Doherty: Absolutely, senator. When I talk in public about this, I don’t just talk about post-traumatic stress disorder. As I said, we’ve grown over the last couple of years with this, learning more. I don’t just talk about post-traumatic stress disorder; I talk about the mental health injuries that those who are serving face.
The Chair: Mr. Doherty, let me take the opportunity to thank you for appearing before our committee. We all see the passion you have shown and the energy you have put into this bill. As a former first responder, I appreciate your efforts.
In our second panel, we welcome officials from government departments and agencies from the government. I’ll ask each of you to introduce yourselves.
Stéphanie Durand, Director General, Policy and Outreach, Public Safety Canada: I am Stéphanie Durand, and I am Director General, Policy and Outreach at Public Safety Canada.
Anna Romano, Director General, Centre for Health Promotion, Public Health Agency of Canada: My name is Anna Romano, and I am the Director General, Centre for Health Promotion at the Public Health Agency of Canada.
Colonel Rakesh Jetly, Senior Psychiatrist and Mental Health Advisor, Canadian Forces Health Services Group, National Defence and the Canadian Armed Forces: I am Rakesh Jetly. I’m the senior psychiatrist for CAF.
Lina Carrese, Acting Director of Mental Health, Health Professionals Division, Veterans Affairs Canada: I am Lina Carrese, Acting Director of Mental Health for Veterans Affairs Canada.
The Chair: I understand, Ms. Romano, you have some opening comments. We’ll welcome those at this point and then move to questions.
Ms. Romano: I think all four of us have a few very brief comments. We won’t take up more than our allotted time.
Honourable senators, thank you for the invitation to address this committee regarding its study of Bill C-211. I’m pleased to contribute to this examination by speaking about the Public Health Agency of Canada’s role in supporting individuals with PTSD and their families.
As the committee knows, mental health, mental illness and PTSD are complex issues. In the case of PTSD, persistent psychological symptoms are as a result of experiencing or witnessing one or more traumatic events, such as a major accident, crime, war, natural disaster or intimate partner violence.
The Public Health Agency is just one player in addressing these complex issues. For our part, we invest in a range of programs and initiatives that promote positive mental health and improve our understanding of risk factors for mental illness and suicide. This work includes surveillance and support to community-based programs for vulnerable populations such as children, youth and survivors of violence.
I will focus my remarks today on the core public health function of surveillance and data collection.
Currently, mental illness monitoring relies on national population surveys, such as those conducted by Statistics Canada, and on medical data collected by the provinces and territories. For example, the 2012 Canadian Community Health Survey included a question on PTSD, which indicated that 1.7 per cent of the general adult population had experienced PTSD.
Currently, however, there are no data that precisely identify the number of Canadians diagnosed with PTSD. Medical data on mental illness do not distinguish PTSD from other mental disorders and do not include those who seek support from professionals outside of the medical system. Furthermore, there are inconsistencies in the ways data are collected across jurisdictions. We are currently exploring the possibility of initiating new surveillance activities to track the prevalence of PTSD.
In terms of the bill, the Government of Canada supports efforts to align federal activities to address PTSD, to convene a conference with federal, provincial and territorial ministers and key stakeholders, including those with lived experience, to inform the development of a federal framework on PTSD.
We also recognize that specific populations, such as public safety officers and Canadian Armed Forces personnel and veterans are at risk of PTSD or operational stress injuries. My colleagues who are here with me today can speak to the work already underway to increase existing supports for these at-risk populations.
In conclusion, given the wide-ranging risk factors for PTSD, such as violence, discrimination and other forms of trauma, it is important to recognize that all Canadians can be at risk for developing PTSD as a result of exposure to traumatic events. The outcomes of initiatives for at-risk populations could assist in shaping a federal framework and could be applied to support the wider population impacted by PTSD.
Thank you for your time. I will be pleased to answer questions following the other remarks.
[Translation]
Ms. Durand: Madam Chair, honourable senators, thank you for the opportunity to appear before you today. I am pleased to be able to speak to the important work that Public Safety Canada is undertaking, in close partnership with our federal colleagues and key national stakeholders, to support the mental health and resilience of Canada’s public safety officers.
[English]
Canada’s public safety officers, including police, firefighters ,paramedics as well as others such as Indigenous emergency managers, correctional officers, dispatchers, border guards — and I could go on — put themselves in harm’s way to safeguard our communities. In doing so, they are repeatedly exposed to situations and events that can take a serious and sometimes debilitating toll on their physical and mental health and well-being.
This is why, as per the mandate commitment of the Minister of Public Safety and Emergency Preparedness, Public Safety Canada, in close collaboration with the health portfolio, is working closely with national stakeholders to develop an action plan to support the mental health of public safety officers, particularly as it relates to post-traumatic stress injuries incurred as part of their duties.
[Translation]
In the course of our national consultations, we consistently heard the need around three themes. First, there is a lack of research and data on the extent to which public safety officers are affected by PTSI. Second, there is limited prevention and support to address the stigma that is unfortunately still present. Third, there continues to be a critical need for tailored care and treatment.
[English]
Budget 2018 has recognized this priority by proposing $30 million over five years in funding to facilitate and consolidate research efforts on public safety officers’ mental health. The proposed funding will establish a national baseline of evidence to support decision making at all levels and in doing so would support the important objectives proposed in Bill C-211.
[Translation]
Budget 2018 also proposed $21.4 million over five years for the Royal Canadian Mounted Police to support the mental health needs of its officers.
[English]
As we continue to advance our collaborative efforts to support public safety officers, we remain aware they are not the only ones deeply affected by traumatic events and that, regardless of who you are, all Canadians can be affected. That is why Public Safety Canada is continuing to work closely with the departments represented here today to leverage the knowledge and expertise as well as maximize investments to address mental health issues in Canada.
[Translation]
Together, we are working to ensure that investments in research are aligned with, and support, broader mental health objectives.
I look forward to continuing the collaboration with my colleagues here at the table to address this complex, urgent issue.
Thank you again for the opportunity to speak to you today.
[English]
I will be happy to answer any questions following the remarks.
Ms. Carrese: Honourable senators, thank you for the opportunity to speak to you.
Veterans are men and women who have served to build our nation to defend our freedom and to contribute to world peace. As a result of traumatic events experienced during their service, some veterans go on to develop operational stress injuries. This term, which was coined by the Canadian Armed Forces and our own department, refers to any persistent psychological difficulty resulting from operational duties. It is similar to the new term appearing in Bill C-211, post-traumatic stress injury.
Given our mandate to contribute to the re-establishment of veterans into civilian life, Veterans Affairs Canada has developed some expertise in the last few years in the area of PTSD and other operational stress injuries. The department has, for example, established an important continuum of mental health services to assist our Canadian Armed Forces veterans, our other clients and their families. This involves funding a network of 11 operational stress injury clinics across the country, which includes tele-mental health services and satellite service sites to ensure services close to where the veterans live. Each clinic has a multi-disciplinary team of seasoned mental health experts who provide treatment to veterans but also to Canadian Armed Forces members and the RCMP.
This network is complemented by the Canadian Armed Forces network of seven Operational Trauma and Stress Support Centres that serve military personnel. The combined networks allow for standardized OSI treatment across the country based on the latest scientific evidence, and it aims to optimize continuity of care for military members as they transition into post-service life. This model of collaboration has no equal, I believe, in Canadian health care.
In addition, 4,000 independent mental health professionals across Canada are registered with our department to also deliver mental health treatment to veterans.
Veterans Affairs has also collaborated with the Canadian Armed Forces to create the important Operational Stress Injury Social Support Peer Support Network where professionally strained peers, some of them also suffering from an operational stress injury, offer support and assistance to other members and veterans with a similar condition. OSISS, as it is called, has been successful in addressing the stigma related to mental illness. It is often an OSISS worker who will convince a veteran who has been suffering for years in silence to enter into treatment.
Supporting families is also key. The VAC assistance service provides a 24-7 service where veterans and their family members can call a toll-free line to speak to a mental health professional and to be matched with a provider in their local community for up to 20 sessions per counselling per issue.
Finally, VAC has recently partnered with the Royal Ottawa Mental Health Centre on the creation of a centre of excellence for PTSD and other mental health conditions. This centre will consist of partnerships with academics and non-profit organizations and will focus on building and disseminating research evidence to clinicians, others working with clinics, and between the federal partners, some of us being here today.
We at Veterans Affairs Canada are happy to provide our support and our expertise for moving forward with this bill and a possible federal framework for PTSD.
Thank you.
Col. Jetly: Thank you, Madam Chair, senators, ladies and gentlemen, for the opportunity to make these brief introductory remarks regarding this important topic.
I am Colonel Rakesh Jetly, Senior Psychiatrist in the Canadian Armed Forces. I have various roles within the forces, including Mental Health Advisor to the Surgeon General. I have been fortunate enough to serve since the late 1980s in various roles, including general duty medical officer and psychiatrist in several deployed settings such as our recent mission in Kandahar.
The Canadian Armed Forces has spent years creating a cultural understanding about mental health and mental illness that starts with the CDS and permeates our entire leadership. The CAF has been investing in mental illness, including PTSD and the enhancement our mental health programs, for about two decades. We have greatly increased the number of mental health professionals available to our members as well as conducted high-quality studies on the illnesses that predominate our military population. We understand why military members seek care and why they don’t. Based on these studies, we have built our mental health programs such as Road to Mental Readiness, to educate all CAF members about mental health, coping skills and the help they can seek out if needed.
Militaries have been dealing with PTSD as far back as wars have been fought. Often it’s been called something else. We have several ongoing research thrusts that will work on better developing the understanding of mental illness and treatment approaches. We understand that leveraging technology will also play a key role.
Perhaps the most important thing that we have learned about our population is that singular focus on a single diagnosis PTSD is an error. Not all trauma leads to mental illness, and mental illness related to trauma does not only lead to PTSD. Mental illness, like depression, can be debilitating and, in fact, major depressive disorder has been the number one illness that impacts our CAF personnel. This hasn’t changed even after a decade of war.
The CAF is specifically excluded from the Canada Health Plan. We have invested a great deal in the area of mental health and have learned a great deal along the way. We share our lessons and best practices with our international allies and our Canadian partners.
This specific bill will have little impact on the day-to-day business of the CAF or our health services, but the CAF’s leadership, clinicians, educators and scientists stand by to support this initiative and look forward to the exchange of ideas that can occur at planned conferences and collaboration on research initiatives.
I look forward to answering questions. Thank you.
The Chair: Thank you for your presentations. We will now turn to questions from senators.
Senator McPhedran: Thank you to each of you for being here today.
I will ask each of you to respond, if you wish, to a question that’s really about when you’ve worked together in the past in a cooperative way to reach a particular goal, as is the case for the vision in this bill. What are some of the learnings that you already have from previous attempts? What would be the most important steps — let’s say two steps — in order to launch within this pretty tight timeline that the bill gives to you? What would your recommendations be, based on your past experience, for the best possible and most inclusive outcomes?
Ms. Romano: Thank you, senator, for the question.
The way the bill is currently set up in terms of asking the Minister of Health to lead with several of her colleagues, it forces a bit of a governance effort on the part of public servants to work together. One real example of that is the four of us here before you today.
In terms of past experience, it sounds a bit bureaucratic, but even setting up a committee that involves a number of different federal departments working together to achieve one goal is an important first step in terms of sharing information, making sure that we’re aligned, that we’re addressing the gaps and not duplicating.
I would say having that type of governance in place would be an important element, and having all of the ministers named in the bill would be an important step in that regard.
Senator McPhedran: For clarification, am I correct in understanding, then, based on your comments, Ms. Romano, that you actually haven’t cooperated together previously?
Ms. Romano: I would say that it’s on a more informal basis. Stéphanie and I speak, and maybe I have a conversation with Veterans Affairs. There has been some governance that perhaps Stéphanie would like to speak to in terms of the national action plan on PTSI, but I would say that we can always use a bit of a reminder to formally work together.
Ms. Durand: As a segue to what Anna just mentioned, at Public Safety Canada, we very much work in close collaboration with many departments and agencies, given our mandate. Whether it be for wildfires or floods, we bring together different expertise at the table to achieve a common objective.
For this particular initiative with the mandate priority that Minister Goodale received for working in close collaboration with the Minister of Health to advance a national action plan, we did stand up a governance so we can leverage expertise by our colleagues from CAF, by Veterans and Public Health. We did stand up a committee where we could share best practices, identify synergies and also zone in on gaps.
For our department, with respect to advance of this work, while there is a tremendous need for first responders, it is a new area of work for Public Safety Canada to champion this work on behalf of the public safety officer community.
From a federal perspective, the issues facing our country are less and less the mandate of only one department. Collaboration and creating that proper governance becomes so fundamental to achieve areas of work that touch more than one area of responsibility. I would echo that governance is important in making sure we’re not starting from scratch but tapping the expertise in each of our respective departments and agencies.
Col. Jetly: For Veterans Affairs and CAF, we’ve worked together for many years, and I think that in terms of the modelling, we’ve gone so far as to embed people in each other’s departments and headquarters. It’s an ongoing conversation, as opposed to saying, “Let’s work on this.” It works well with clear leadership and clear definition of deliverables. If we’re going to have a conference, what are we going to deliver and what will the end product look like. If somebody walks in thinking it’s about clinical care and somebody else walks in thinking it’s about research, you will end up with mixed results.
The commitment to ongoing cooperation, ongoing dialogue, clear leadership and deliverables will probably be the way to go to make it successful.
Ms. Carrese: I believe we did work together for the federal framework for suicide prevention among different departments. It is true the Canadian Armed Forces is our closest partner and we have lots of experience working together as two departments. I will echo what Dr. Jetly is sharing: As we have a definite lead and very clear objectives, I think we’re good to go.
Senator Jaffer: I have a question for both Colonel Jetly and Ms. Carrese.
First, Colonel Jetly, I chaired the Veterans Affairs Subcommittee and now I’m a member, and we heard about the issue of stigma. People did not want to admit that they were suffering, and they tried to deal with it themselves. I would appreciate if you would explain how we deal with this issue. For me, and I know for you, it’s a disease. If you had cancer, you would admit to it and you would get treated. Unfortunately, PTSD and mental disorders are not seen that way. I would like your opinion on that.
Ms. Carrese, transition issues are huge. What we’ve heard from Veterans Affairs is not everybody starts the day they become a veteran. When you go to another life, these things come upon you slowly. Different people react at different stages on mental health issues.
I was very appreciative of what you spoke about will be in place, but every day I think of that family, that young man who I think came to the end of his tether and took his family. He is in my psyche all the time. He was in Montreal, and then it wasn’t that he was getting more help in Nova Scotia. That’s what I feel when I hear you. You’re going to put something in place, but people are suffering now.
Col. Jetly: That’s a great question. It really speaks to the need for good research. Stigma is but one barrier to care. Ultimately, we want to think about what’s stopping people from getting care. In fact, stigma, the attitude people think I’m weak, whether it’s our military or other militaries, isn’t actually a number one reason.
Senator Jaffer: And promotion issues.
Col. Jetly: Sure. The number one reason is, and was in 2002 when we did our survey, not understanding they have a mental illness. Other barriers to care include, “I don’t trust professionals. I’d rather handle things myself.” Our countermeasures we’ve developed by creating continuum, educating people, if you’re 40 years old and you’re dragging ass, you don’t have the energy, just to think that it could be an illness, it’s just not getting old. So the key to it is to understand your population, why they’re seeking care, why they’re not seeking care and to fill the gap with education and training. If people would rather deal with things themselves, let’s put good things online so they can deal with it themselves.
Stigma itself is a fascinating area because when you study stigma, even people who go for care feel stigma, and it sometimes gets worse when they’re in care. It’s not necessarily something that’s going to stop. We countermeasure stigma by challenging the traditional beliefs, encountering people who are mentally ill, seeing them as competent ,and then that challenges the idea that they’re all dangerous. We put out a call for making a video about mental illness, and we had hundreds of people willing to tell their stories. The real countermeasure to stigma is creating a cognitive dissonance, the difference between what you think about mentally ill people and the person in the room with you, and sometimes it requires high-level disclosures of people saying, “Hey, I’ve been struggling with this for years.” That’s the most effective thing within our organizations. It is why we like athletes and soldiers to stand up and say, “I went for care as well.” If your hero can be ill and get care and go back to being your hero, that’s a positive thing as well.
Stigma as a barrier of care is certainly an issue. In fact, our Canadian Armed Forces members’ attitudes towards mental illness is better than most of our allies. Canadian Forces members seek care at higher rates than their civilian counterparts. We’ve done something to improve that. It’s going to be a journey. It’s persistence and the cultural change and the continuous focus on it.
Senator Jaffer: I like your ads, with the athlete and it’s within you. Of course, you don’t want to say it’s within you, mental health, but maybe an ad like that. Your ad is so effective. We don’t want this to be seen as a stigma issue.
Col. Jetly: Sure, it is. The same with a back ache. People have back disease and can be in a wheelchair or other people could be running marathons. It’s within you if you cooperate, get the treatment, be your best, and that’s the athlete performance approach that we take on these things.
Ms. Carrese: Thank you for your question.
I would like, first of all, to acknowledge what you started your question with. You are absolutely right. Despite all our efforts and all the services we put in place, we have much more to do. Every time we lose a life, it wakes us up to this very big reality that we need to do more. So thank you for that.
On the question of stigma, I do agree. I think it’s the narrative that our society speaks, and we need to work on the narrative so that it is a “we” rather than an “us versus them.” I do agree that testimonials and peer support workers that are very courageous in speaking their stories have helped tremendously, and we need to continue.
As Dr. Jetly said, it’s not only about the personal stigma of I’m ill, I’m weak, those kinds of beliefs that we have when we’re struggling. It is also about the stigma around care. Although we are doing better in terms of getting access to care, we also need to stay in care. So, as clinicians, we also need to do better in terms of understanding what works at what pace, what is needed from an individual perspective, opening up to innovative therapies in terms of online services if we’re not ready for the face-to-face, modules online. All those kinds of things can help.
Senator Jaffer: Colonel Jetly and Ms. Carrese, one of the things we heard in committee is that the professionals do not know the nuances of the trauma that they experience in their field. That’s one of the things we’ve heard a lot. I leave that with you, because others have to ask questions.
Senator McIntyre: Thank you all for your presentations.
We know that Veterans Affairs Canada has established a network of specialized clinics to treat veterans and members of the Canadian Armed Forces from PTSD. We also know that active members of the RCMP also have access to these clinics. My question is this: What about other federal employees who have experienced PTSD, such as correctional officers, border officers or security intelligence officers? Are there similar resources available to them?
Ms. Durand: The RCMP is not here to speak, nor the other agencies. Budget 2018, with respect to the RCMP, did provide $21.4 million over five years to support the mental health of its officers. The action plan that we are working on is to capture the public safety officers within the federal public service, and they are playing an active role in advancing the work that we are doing with Public Health Agency and other federal departments.
As far as having access to the expertise from CAF or veterans, I’ll let my colleague speak to the admissibility of those officers.
Col. Jetly: That’s an interesting question that has come up over the years. It’s very difficult for CAF. Of course, a mandated government can change anything, but in terms of resources, mandates, the Canada Health Act, whom we are responsible to care for and not, we don’t look after the spouses and children of our armed forces members either. So it’s the mandate and resources, and that’s where it is right now. What it would take for the CAF clinics to open up, it would be massive changes that would be required.
Senator McIntyre: My question is this: What’s happening in the meantime? Are those federal employees using mental health programs provided by their home province?
Col. Jetly: Yes, provincial systems.
Senator McIntyre: Community mental health centres? Is that what is happening?
Ms. Carrese: Our OSI clinics do serve the RCMP. However, you are correct; they do not serve the other populations. It is a question of mandates. I believe they do use the provincial system.
Senator McIntyre: I know in my home province of New Brunswick, we have the community mental health centres, and if I’m not mistaken, Fredericton, New Brunswick, has the Veterans Affairs Canada specialized clinic.
Ms. Carrese: Yes.
[Translation]
Senator Dagenais: I would like to thank our witnesses. My question is for Colonel Jetly. You have been in the armed forces for some time. Do you think the problems addressed in the armed forces can be addressed in the same way in civil society? I am still referring to first responders.
[English]
Col. Jetly: That’s an excellent question. We’ll have to test it. The military has some unique challenges and opportunities in the sense that the challenges, of course, are what we expose our members to. The advantages, of course, are the cohesive unit with leadership and chain of command. We have a fair amount of control of our population stressors.
For most of us — except for a few specific occupations like search and rescue — most of us leave home, go to some bad stuff, then come back and have time in between. That whole deployment cycle is something that is to our advantage in terms of the exposure recovery.
Our colleagues in the other departments have varying elements of this in their culture. They certainly have leadership, the uniform and fitting in. They tend to be a little bit more isolated in pockets across the country, not on large bases.
I think it certainly is possible, but I think stepping back and looking at mental illness overall and looking at a psychologically healthier workforce, certainly any workforce can do, but there will be a knowledge translation challenge of how to take some of the things that we brought into civilian society.
[Translation]
Senator Dagenais: I would like to tell you about my experience as a police officer. When police officers witnessed a shooting, the employer met with them the very next day and asked them questions to detect symptoms of post-traumatic shock.
When members of the armed forces return from an operation — you mentioned operations in Afghanistan —, does someone meet with them to discuss their experiences during the operation? Not everyone experiences things the same way. Is there a budget for that?
[English]
Col. Jetly: Yes, there are budgets.
In terms of when an incident occurs, we have actually gone into long strength to train our leaders. So we don’t actually wait until people come back at the end of the day during the time people can speak. If the leadership feels to the limit, then usually we have mental health professionals available. In Kandahar, we had a mental health family.
Not everybody is going to react the same way. After returning, people have access to mental health services and they are encouraged. When they come back, they don’t just disappear on holiday; they have to go back to work for a few days, meet, and then we do a formal screening afterwards. We do what’s called an enhanced post-deployment screening, which is mental health questionnaires, but you also sit with a professional who will say, “You’ve been through a difficult time.” We’ve been doing that since the early 2000s. We continue doing that for each deployment, and in fact, we’re doing a nice piece of research looking at whether or not that accelerates people getting into care, if needed. Everybody gets an enhanced post-deployment screening after returning from operations.
Senator Oh: Thank you, panel, for the very informative work you have been doing.
Do you think Bill C-211 is very important? All of you are doing the work now. Every department is doing the best they can. This bill, if it passes, means that within 12 months, the ministers will get together, the provinces and you guys will get involved. You will come in and feed more information to together make a better act. We are leading the way in the world now. I think there’s no other country, from what I heard earlier, that has this kind of a bill. I think this will not only benefit our country, first responders and everyone, but overall, the whole world will be following Canada’s example. Can you comment on this?
Col. Jetly: I believe that there’s merit in doing this, to align one of the other questions about stigma. It’s a concrete example of the government sort of saying, “Hey, we heard you, we get this, we’re going to do something.” In many ways, these concrete things, like General Natynczyk starting the “Be the Difference” campaigns, leadership showing that definite commitment, is important.
I also think we would, within CAF, welcome a conference. One of the challenges — and I discuss it on almost a daily basis — we do this incredible research, but there is that knowledge translation piece. How does the cool stuff that we do get out to other people? So a formal kind of sitting down. I think those two pieces, the definite message from leadership, which is the government in this case, and a formal chance to exchange knowledge as opposed to just over a coffee sometime, are two concrete things that would be a benefit from something like this.
Ms. Carrese: I believe there is room for all the shared experiences and the expertise developed over time to be shared, or there’s a benefit of other populations to be shared. I think the synergy that can be created from that can move all of us forward, even those of us who have been in the area for a while. I think there is room to be learned from each other.
Ms. Durand: If I may add, when we conducted our national consultation, the themes that came out resonate with the existing work that’s taking place by both Veterans Affairs and CAF.
If I may just mention, research and data collection is a gap that has been resoundingly highlighted by first responders. I would say as well that prevention, early detection and stigma also were areas where more was needed to support public safety officers. Lastly, the third key theme that was raised was the support for care and treatment and how they can get the appropriate care that they need across the country.
You see there are synergies that resonate across the different disciplines, and I think from that holistic type of conversation, while there are differences, there are also some similarities that can be learned and leveraged.
Ms. Romano: Thank you for the question, senator.
Yes, the government has indicated its support for the bill. We do have experience in other areas where a conference has been convened at a national level that’s very inclusive in terms of consulting various stakeholders, including those with lived experience. Normally, then, the outcome is a framework or a strategy that is fairly inclusive, aligned and coherent. Those would be my comments on that.
Senator Oh: I’m sure all of you will play an important role in Bill C-211. I think it’s an important bill. Thank you.
Senator Bernard: Thank you all for being here today and for your testimony.
I was quite impressed to hear about the initiatives that each of your departments is already doing in terms of addressing post-traumatic stress and post-traumatic illness. Some people are using the term “post-traumatic syndrome.”
I’d like to ask, though, what are the best practices in interventions that may be addressing these issues from a culturally specific lens? Before you respond, I’ll give you a bit of context to my question. It picks up on Senator Jaffer’s statement about the Nova Scotia family. I want to bring the name into the record: Lionel Desmond, who shot his mother, his wife and his daughter and then committed suicide. When I spoke to this bill at second reading, I talked about the intersectionality. In addition to dealing with those issues as a veteran who had been to Afghanistan, the post-traumatic stress was also interspersed with the racism that he had experienced prior to going into the forces, while in the forces and post-release. What are the best practices in terms of culturally specific interventions to address PTSD?
Col. Jetly: I can start, if you wish. I think the real importance is to have an individualized approach to each case as a clinician. You raise a great point. I’m first generation from India serving in the Canadian Armed Forces, deploying to places like the Middle East and Afghanistan, so my experience may not be the exact same as the person next to me. We’re often asked questions from a female perspective and from a Muslim perspective. So the best practice is really to understand your patient and not to assume what’s traumatic for them.
It’s funny. In a meeting I had last week, we had professional development, and the key really is to listen to your person, listen to their beliefs and listen to what’s been traumatic for them. Being in an IED explosion may not be as traumatic as the comments people made to you after you came back to the camp.
Best practice really is an individualized, not a cookbook, kind of approach. That’s really what we encourage within our system, to not assume somebody else’s traumatic experiences.
[Translation]
Ms. Durand: Allow me to continue.
[English]
Thank you for your question, senator.
What I would offer is that as we develop new programming, we are also very much inclusive and focus on the diversity. In our consultation, we also made sure to consult with a range of public safety officers, from rural to urban to also Indigenous communities, to really understand the range of differences, including access to care and what were some of those challenges.
I would offer that from best practices and how we develop programs. We always think of gender equality and what are some particular areas that require a different lens to make sure that what we develop will reach all who are in need and not leave anyone behind. We’re very much focused on that inclusivity but also the diversity and not to have a cookie cutter approach because the needs are so different across our country.
Ms. Carrese: I can possibly add. Thank you for your question.
I think what is key is in the assessment phase and that it is important that individuals do not live in isolation. It’s really a systemic approach. We live in groups and we have different experiences based on our background, based on our identity and a multitude of factors. It is key in the assessment phase that we ask the questions. Sometimes, in our world of veterans, we also need the clinicians to ask: Have you served? Because unless you ask the question, you may not get the answer. The cultural sensitivity is important. We need to work with clinicians, as we do, and we need to continue to do that in order to have comprehensive assessments and culturally sensitive treatments. The treatment plans are individualized treatment plans. Even if I had the same experience within the military, I did have a life previous to that and I do come into a community that is particular to me. I really think it is in the assessment and in the treatment.
Senator Bernard: Through research that I have done, I have heard from many people who have experienced racism, for example, and they suffer in silence because they are worried that they won’t receive treatment that’s culturally sensitive. I’m wondering about education that would inform people what’s available and policies. Are there specific policies, or is it an approach?
Ms. Durand: As far as the action plan that we are working on, public awareness is certainly one of the areas that is being considered as part of that action plan so that there is more information available. Again, when we talk about public awareness, we’re going to want to make sure that it is segmented so that it’s not, again, generalized. That is part of some potential actions that are part of the work that we will be embarking on with our colleagues and other experts across the country.
Senator Jaffer: I want to once again thank you all. I want to follow up on what Senator Bernard said. This is more of a comment, which I’d like you to take and think about.
I was making a presentation last Friday to CAF members as to how to increase diversity. One of the things that Senator Bernard was saying that is of great concern is sometimes people with mental issues, for example, the Proud Boys who interrupted the Aboriginal functions, and then we still have 70 people identified as a group who are part of a hate group, they are still part of the military and none of them have been condemned. When I speak to young men and women who look like me and encourage them to join, they say to me that 70 of them are still sitting at CAF.
I want people to understand that racism is very serious within the Armed Forces as well, and it becomes part of all the issues. That’s another addition that shouldn’t exist, especially when 70 have been found to have done misdeeds and they’re not condemned and they’re sitting as part of the Canadian Armed Forces. This is a serious issue. I don’t want to put you in the position, Colonel Jetly, to speak on this, but I want to share with you what I hear from young people.
I had a question for you, Ms. Durand. I understand that the minister’s mandate letter calls for development of a national action plan for PTSD. While I have seen a few national round tables and a few studies being conducted by the department, and it might be not having done enough work, but I haven’t really seen where the round table discussions have gone and if anything significant has been done with that mandate letter. I’d like to know practical things, like how many round tables there have been, where they have been held, who is part of those round tables, and where do we go next.
Ms. Durand: Thank you so much for your question.
As far as the round table, we held one national round table in Regina where we invited experts from academia as well as first responders. We invited our provinces and territories to get to a common understanding of the issue at hand.
Since the round table, we continued our national consultation to zone in on the areas of priority. I’ve alluded to those three themes that continue to come out as priorities.
I will also offer that the department, since the round table, has invested in doing a research survey to better understand the prevalence. We’ve worked with CIPSRT, the Canadian Institute for Public Safety Research and Treatment, where there was a survey that was conducted. We also partnered with CAF on training, Road to Mental Readiness.
As well, as we will now be advancing, with the announcement in Budget 2018, two significant initiatives. The first one is to work on a new national research consortium, again to better understand and to highlight some similarities between veterans and military personnel but to zone in on public safety officers. We’ll be working with the Canadian Institutes of Health Research as well as the Canadian Institute for Public Safety Research and Treatment on this new consortium so we’ll be able to better understand the data and the evidence to make more informed decisions and to make more relevant programming.
The second important element that we will be embarking on is an Internet-based cognitive behavioural therapy pilot that will allow first responders to have direct access to resources, to support, especially given the range of public safety officers. It’s not just in urban centres but in rural and northern communities.
Those are the two things we are advancing. I’d be happy to provide you with additional information on what we’ve done since the national round table, if that would be helpful.
Senator Jaffer: Thank you very much. I appreciate your thoroughly explaining the round table. You and Ms. Carrese spoke earlier, and I want to say this politely and respectfully. Please take my comments respectfully. I don’t mean to be rude. When I hear this and when I hear of the young — and I’m saying “young” because I’m old now — men and women who are serving us, they are hearing “you’re going to do, you’re going to do, you’re going to do.” They are suffering now. “Going to do” is not going to help them now. I want to say to all of you it has to be now. I don’t hear the “now.”
Colonel Jetly, I know that you and the men you work with in the medical field are trying, but, as I said to you, there’s the issue of nuances and not understanding military experience. Even in many normal lives, we don’t have enough psychiatrists and psychologists to help, and it gets even worse. You’re doing your best, but what about now? That’s the challenge.
The Chair: Let me take this opportunity on behalf of all senators to thank you for your appearance today before the committee. We very much appreciate the candour with which you’ve shared, so thank you very much.
For our third panel today, we welcome Linda Silas, President of the Canadian Federation of Nurses Unions. From the Canadian Psychological Association, we have Patrick Baillie, President; and Karen Cohen, Chief Executive Officer.
We will hear your presentations, after which we will have questions for you. Please go ahead.
Linda Silas, President, Canadian Federation of Nurses Unions: Thank you, senators, for inviting me to attend on behalf of the Canadian Federation of Nurses Unions and our nearly 200,000 members. We didn’t get this opportunity in front of the Standing Committee on Health, HESA, so we are very appreciative.
I’m the president of CFNU, a registered nurse and a proud New Brunswicker. I am here today to speak to you about an issue that is near and dear to the hearts of front-line nurses across the country: workplace-related mental health injuries and PTSD.
According to the Canadian Psychological Association:
PTSD is not limited to combat and disaster experiences. It also occurs following sexual or physical assault, transportation or industrial accidents, life-threatening illnesses such as cancer, war zone experiences, and repeated exposure to others’ physical trauma (e.g., emergency room nurses and ambulance attendants).
Day and night, Canada’s nurses work in emergency rooms, trauma units, palliative care, neonatal intensive care, operating rooms and psychiatric wards. They work on the streets and in people’s lives during the opioid epidemic, in addiction clinics, in long-term care facilities and in people’s homes. Nurses take over from paramedics in the ER when patients arrive with bodies broken by car accidents, gunshots, industrial accidents and physical and sexual assault, and suicide attempts. Nurses work with patients suffering with severe mental illness, addictions, living through deep depression, withdrawal symptoms and violent outbursts.
As well, workplace violence is a growing epidemic suffered by nurses. As staffing levels decline and patient acuity increases, weak security protocols fail to protect us. Indeed, in 2017, a Canada-wide survey found that 61 per cent of nurses reported abuse, harassment and assault on the job during the last one-year period.
In 2015, the first Canadian report came out on PTSD in nurses. It was by the Manitoba Nurses Union and was entitled Helping Manitoba’s Wounded Healers. It found that one in four nurses experience PTSD symptoms. Yes, that is one in four.
Research also suggests that PTSD symptoms present differently in women versus men. Ninety per cent of Canadian nurses are women, and we must not lose sight of the particular and distinct presentation of PTSD among nurses versus workers in a more male-dominated profession.
Senators, I am here today to ask for the inclusion of nurses and other relevant health and emergency workers in Bill C-211. There is no question that the initiative by the bill’s sponsor, member of Parliament Todd Doherty, to create a federal framework on PTSD in principle is a good one. However, Canada’s nurses stand by and watch our members that are arbitrarily excluded from workplace-related PTSD legislation. If this legislation is to be successful, we must do it right.
As senators will note, the second and fourth paragraphs in the preamble of Bill C-211 specifically enumerate the types of workers to whom this bill should apply. The second paragraph states there is a clear need for persons who have served as first responders, firefighters, military, corrections officers and members of the RCMP to receive direct and timely access to PTSD support.
When questioned about the scope of this bill, Mr. Doherty repeated four times in five minutes that the intent of Bill C-211 was to focus on first responders, military and veterans. This is short-sighted, and this is why we’re here today.
Inclusiveness of Bill C-211 would also ensure that it aligns with the PTSD legislation that is growing in a number of provinces, which include nurses. In the last year, workplace PTSD legislation in Ontario and Nova Scotia was updated to include nurses. Similar legislation has also been adopted in Manitoba and P.E.I.
Therefore, borrowing from the statutory language from PTSD legislation in Ontario and Nova Scotia, I’d like to propose two different options for amendments for the committee’s consideration.
Option one: Add the term “front-line and emergency response workers” to the definitions section of the bill and define this term as “first responders, firefighters, military personnel, corrections officers, members of the RCMP, nurses and other relevant health and emergency workers as prescribed.”
And then add the words “among front-line and emergency response workers” to the end of clause 2(a) and to the end of clause 2(b).
To make it even simpler, option two would be to amend paragraphs 2 and 4 in the preamble to add “nurses and other health care and emergency response workers” to the list of workplaces covered.
If and only if the effect of both of these proposed amendments is achieved in legislation, the committee can be assured that Canada’s nurses will support and be protected by Bill C-211 and Canada’s PTSD framework.
Senators, do we really believe that MPs will vote down improvements to make this bill more inclusive and more reflective of what is happening in the provinces and territories in 2018? Re-examining proposed government bills is part of the Senate’s work and is part of our democratic process. There is nothing wrong with taking our time to do it right.
Let’s not forget that in just the last two months, nurses in Saskatoon and Toronto worked around the clock with their colleagues to take care and save the lives of the victims of the horrific Toronto Yonge Street van attack and the Humboldt Broncos bus crash.
Let’s make Bill C-211 right and inclusive with other relevant health and emergency response workers.
Thank you.
Dr. Patrick Baillie, President, Canadian Psychological Association: Good afternoon, madam chair and committe members. My name is Patrick Baillie and I’m the President of the Canadian Psychological Association, and with me today is Dr. Karen Cohen, Chief Executive Officer.
The Canadian Psychological Association is the national organization for the science, practice and education of psychology, and I want to refer to each of those three pillars when I talk about how we can work together to strengthen this bill. I appreciate the opportunity to talk to you about this legislation.
First, the science. There is a significant difference between the symptoms of post-traumatic stress disorder and the actual diagnosis that relates to the degree of impairment that an individual may be experiencing. But the symptoms, as you have probably heard from other people, include the flashbacks, nightmares and intrusive thoughts, the hyper-vigilance or hyper-arousal, the avoidance strategies and some interference with cognition and memory. These symptoms, for many individuals who are exposed to traumatic events, will go away in a relatively short period of time. But for some individuals, those symptoms linger and cause significant disability and despair, with impact on themselves, their families and their communities. We used to assume that it was the power of the initial stress that made the difference, but research, largely undertaken by psychologists, has shown that it’s not necessarily the form of the stress that makes the difference as much as it is that individual’s initial response to that stressor.
In addition to my role of the president of CPA, I am a consulting psychologist with the Calgary Police Service. I can tell you that many of the police officers, who have clearly chosen to pursue that career, are exposed to a variety of events, and what triggers PTSD for one may be completely different than what triggers PTSD for another. We can’t know, simply on the basis of the initial trauma, what it is that the outcome is likely to be down the road. Again, this is something that the science tells us.
We also know that there are some people who are more vulnerable to PTSD than others. This includes people who have experienced a period of depression in the past; women being more vulnerable than men; people with particular personality styles or dispositions; and in terms of the people who are targeted by this particular piece of legislation, those who tend not to talk about their traumatic events and try to pretend that it’s just part of the job and something that does not need to be discussed openly.
Second, there is the issue of how we do practice. Again, significant research in this area has shown us the type of treatments that can make a difference. There are pharmacological treatments, drug treatments that use the new generation of antidepressant medications, but we know that medication alone is never enough to address a problem that an individual may be facing in the mental health realm.
Treatments such as short-term cognitive behaviour therapy and others have been recommended by the American Psychological Association in their treatment framework and again, the research shows that for a relatively minor cost — an initial exposure of perhaps as many as 30 sessions of therapy — we can avoid the long-term consequences of acute disability associated with PTSD.
We also have measures, checklists and interview techniques that allow for more rapid and more accurate assessment than has typically been present in the past.
We know that with other strategies, like critical incident debriefings that are so common and popular across the country, the research has shown that they have very little impact on reducing the incidence of PTSD. And there is actually some research that says that for some first responders, those sorts of strategies can increase the likelihood of PTSD.
We know things that work and we know things that don’t work, and we can combine our research and practice, but the last point that I’d like to talk about before turning the chair over to my colleague is the issue of education.
When you establish a national standard, you also establish national expectations. We set a goal for what we want to achieve, but the question then becomes: Who is going to deliver those services and how are those costs going to be covered? Will every RCMP member in the country be able to get the same quality of service? Will every corrections officer working in diverse areas across the country get access? What about food and aviation inspectors who deal with disease outbreaks or airplane crashes? The list goes on in terms of people who may be expecting access.
And so we need to make sure that there is a qualified contingent of mental health service providers, including psychologists, who can then provide those services at the standard that has now been established. There are many people who are looking to this legislation to move us forward in terms of the quality of care, both assessment and treatment, and so we need to make sure that the people are in place for how to address that in the best possible way.
My colleague has some additional comments.
Dr. Karen Cohen, Chief Executive Officer, Canadian Psychological Association: I will add that the CPA is very pleased about a bill that is calling for the creation of a comprehensive federal framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of PTSD. Indeed, a framework that calls for a Canadian commitment to early identification and accessible treatment for all psychological disorders in Canada is long overdue.
Relatedly, the recent report commissioned by the Minister of Health entitledFit for Purpose: Findings and Recommendations of the External Review of the Pan-Canadian Health Organizations makes this point clearly. Canada should integrate evidence-based treatment for mental disorders into its insured delivery systems. We welcome improved tracking of the incidence rate and the associated economic and social costs of PTSD, and the sharing of best practices related to treatment and management. We also support the creation and distribution of standardized educational materials to increase national awareness.
However, CPA is very concerned with the section of the bill that requires the establishment of guidelines regarding the diagnosis, treatment and management of PTSD. The development of guidelines is the responsibility of health professionals, their associations, accreditors and regulators, and not government. Such guidelines are based on best research evidence, which can change over time as new treatments are trialled and evaluated. Guidelines must be updated regularly as research evolves. This is the core activity of the health professions and the research upon which their practice relies.
Accordingly, we leave you with three recommendations. The first is that clause 3 of the bill should include representatives from the health provider community, not just the medical community.
The second is that clause 3(b) should promote the establishment and dissemination of guidelines for diagnosis, treatment and management of PTSD rather than establish those guidelines.
And three, clause 3(d) should be added to call for the enhancement of accessibility of evidence-based treatment for PTSD within Canada’s public health systems.
Thank you for this opportunity. The CPA and its members would be very pleased to assist in the development of a federal framework for post-traumatic stress disorder.
Thank you.
The Chair: Thank you very much.
Senator Jaffer: Thank you to all of you for being here.
I’ve heard you very clearly, but we have some political realities — that is the best way I can put it — that mean we have to get this bill done fast. I understand that you will feel that we should do it properly. I heard what you said, but I would like to hear from all of you one reason why you think not being included in this bill is going to leave you out and that the issues that you have addressed will not be addressed in the framework and in the round table.
I also heard Mr. Doherty talking about first responders, but I’m also a lawyer, so first responders can be nurses when you first arrive. I know it’s stretching the word. My colleague Senator McPhedran had a very good way of dealing with it, which I will leave to her to explain again.
Let me tell you that the reality is the House of Commons is only sitting for another week or so, although we will be here longer. The idea is to get this bill in and start working on this. We heard the urgency from Mr. Doherty. There are people sitting here who understand how important it is we move. This is always evolving. We can always add more. We can always do another bill.
I’ve talked enough. I’d like to hear from all of you, starting with Dr. Baillie.
Dr. Baillie: I think it’s important in the discussion to be looking at the treatment providers as well. The vast majority of these mental health services are going to be provided by psychologists or people working under psychologists, so to have the conference restricted to medical professionals limits a number of those other health-related professionals who have a lot to contribute to the discussion.
Dr. Cohen: I would echo that and just add to it to leverage the work that’s already been done. We just realized as Patrick shared earlier that the American Psychological Association has 130-some pages of guidelines for the treatment of PTSD. There may be a lot of work that can be leveraged.
Senator Jaffer: One thing I did not say is that we definitely have a method of looking at the bill. I will share with you that the Senate can make observations about the things you said and include those so that when the bill goes to the minister, he will know that this committee wanted these things added.
Ms. Silas: The political reality is also that if the bill is not clear, it will be up to the interpretation and will of whoever is Minister of Health, as in clause 3. You have heard from my colleagues here that it’s very restrictive to the medical field which, when talking about mental health, is limiting to treatment and diagnostics.
You’ve heard from the nurses that it is very limiting to only high level, high profile first responders, and I would say highly male-dominated first responders. If we leave it as is, it is up to the political interpretation of the Minister of Health. That is clear, that is our fear and that is what we will continue seeing.
Also, it is clear that if Mr. Doherty, the bill’s sponsor, would have consulted two years ago, not just wanting his bill to pass, we wouldn’t be here today trying to make amendments at the last minute, a year-and-a-half into the process.
If the HESA committee would have opened up their consultation to all stakeholders and all victim groups, the Senate wouldn’t be faced with what they call a time crunch.
I think the Senate has a great responsibility here to make it clear, fair and inclusive so that the powers that be, after you’re done, do it right.
Senator McIntyre: Thank you all for your presentations.
Dr. Baillie, as you have indicated, PTSD has different classes of symptoms, and these symptoms may appear directly following a traumatic experience or they may appear later. As I understand, and correct me if I am wrong, PTSD is one of the most common operational stress injuries, better known as OSIs, but there are other OSIs such as anxiety disorders, depression and substance use disorders. Could you elaborate a bit on the difference between these classes?
Dr. Baillie: As a provider within our psychological services division of Calgary Police Service, the most common presenting problems that we see are depression, anxiety and substance abuse. Post-traumatic stress disorder is a little bit lower down the list in terms of presenting symptoms, in part because some of those individuals may go through the WCB system as a workplace-related injury or through other clinics.
What often happens with depression, anxiety or substance abuse is those symptoms may be related back to the post-traumatic stress disorder. We end up with what are called concurrent disorders. The individual may be drinking too much or using other drugs as a way of self-medicating due to the symptoms that they’re experiencing with post-traumatic stress disorder. One of the ways of taking care of the intrusive thoughts and the nightmares is to numb yourself so either you pass out and fall asleep or you’re just so numb during the day that you don’t get many intrusive thoughts, or any at all.
So there is an interplay that starts to happen between the various disorders. While other disorders may be more prevalent as OSIs, they’re sometimes masking what might be an underlying post-traumatic stress disorder.
Senator McIntyre: How high on the list of OSIs are substance use disorders?
Dr. Baillie: I will share with you one of the challenges I faced in my 22 years of service with Calgary Police Service, and that is the tendency of first responders to compare themselves to somebody else: “I don’t drink as much as he does. I haven’t missed as much work as he has missed.” There tends to be a habit of discounting how much self-medication an individual is doing.
An individual coming to us by choice and acknowledging that they have a substance-abuse problem is relatively rare. An individual being referred to us by our occupational health department or through our professional standards department becomes a more common occurrence because the person is told, “You’re now part of our substance abuse policy.”
There are two different categories: the folks ordered to do treatment and those voluntarily seeking treatment. Those who are voluntarily seeking treatment and substance abuse is first list on their list of concerns are relatively rare.
Senator McIntyre: These are all related disorders, depression, anxiety and substance use disorders, but as I read about this, substance abuse disorders will automatically bring in depression and anxiety.
Dr. Baillie: I wouldn’t say they do so automatically. If I go back to one of the basics of psychology, most people engage in behaviour because there is some reinforcement or payoff for them, so the substance abuse serves a purpose. Why is this person abusing this drug? It may be to deal with the symptoms of depression or anxiety, but it may be as simple as the complicated issue of addiction and that this has become a habit.
For example, we know that with smokers, if you tell somebody to quit smoking, they experience an initial spike in anxiety, so they often go back to smoking because they haven’t had some other crutch provided to them as a strategy. In reality, smokers are at a higher level of anxiety prior to their smoking. What the smoking does is reduce them to the same level of anxiety the general population typically sees.
The substance abuse may be serving a purpose, but it may also be simply that repetitive pattern of, “This is what I always used in the past and I can’t really remember why I do it.”
[Translation]
Senator Dagenais: I want to thank the witnesses. Ms. Silas, I would like to ask for a clarification. The bill establishes a federal framework to study post-traumatic stress and the public safety minister has undertaken to hold a conference or consultation in the next 12 months, which would include members of the medical community. If the minister has undertaken to hold a conference including members of the medical community, why do you say you are excluded? If the minister meets with you, you are among the people who will be consulted. Why do you say you are excluded?
Ms. Silas: It depends on the consultations. Will we be consulted in terms of treatment, diagnosis or as victims? The argument being made today is as victims of post-traumatic stress. If it is so important not to include nurses and other health workers who have been diagnosed with the syndrome, why not mention their names? Senators can eliminate all occupations. If we want to be neutral and place our trust in the minister over the coming months, let us eliminate all occupations then if we are to be inclusive. The bill before you is not inclusive. It is limited to four or five occupations. That is why we are here before you today.
Senator Dagenais: My second question is for Dr. Baillie. Given the differences in the problems and treatments that you mentioned, how can we set out a national framework and establish services in a country as large as Canada? Do you not think it could vary by province or territory? When we establish guidelines, that does not mean that they will be the same right across the country. I would like to hear your thoughts on that.
[English]
Dr. Baillie: To be clear, I think there is value in having guidelines. The concern that Dr. Cohen has articulated is about stepping on the territory of provincial regulatory bodies that are responsible for looking at how members are providing services. So that’s one of our concerns.
The other concern that I would have is setting a standard that works very well in large, potentially well-serviced urban areas but that struggles to provide resources to that three-member detachment in Onion Lake, Saskatchewan, where there isn’t a local psychologist or mental health therapist who can provide the services. We may be looking at 1-800 numbers and employee family assistance programs. How do we make sure that the same quality of service is being provided in some of those under-resourced areas? By establishing a national standard, again, you may be setting yourself up for people’s expectation that, regardless of where they are in the country, they’re going to obtain the same level of service. I think that everybody should be entitled to an excellence in their service, but beware that you need to make sure that you have proper service providers to be able to deliver that.
[Translation]
Senator Dagenais: Ms. Silas, in your experience, are there programs in hospitals to help people with post-traumatic stress disorder? How do you bring together nurses and first responders in the field, such as ambulance attendants who attend accident sites? Are there programs in hospitals to help workers with post-traumatic stress disorder?
Ms. Silas: I will answer your second question. It is not up to nurses to compare people depending on whether they are health care workers, military or police officers, or firefighters. They all face difficult situations. Once an employee has been diagnosed, they are seen by a team of psychologists and psychiatrists. When this syndrome is involved, nurses, police and military officers are all part of the same team. I have worked in emergency wards. I have probably seen things as horrible as what you have seen. I have worked in intensive care. I have probably seen things as horrible as what other ambulance attendants and health professionals have seen. Our goal is not to compare. In terms of treatment, it is a sad story. I am from New Brunswick and I was in British Columbia last week. The ultimate goal of the nurses’ union is to have nurses recognized in the new law in British Columbia because they have once again been overlooked. Why? Because it has never been a priority for us to conduct public campaigns, to lobby politicians to raise awareness of this syndrome. Nurses secretly suffer from major depression. We have the highest number of sick days. That is why I consider this bill discriminatory. The Senate has the responsibility to bring it up to date. Thank you.
Senator Dagenais: Thank you very much, Ms. Silas.
[English]
Senator Housakos: My question is specific to Ms. Silas. I’ve listened very attentively to your perspective, and we’ve met on your perspective. My objective here, as is that of MP Doherty and, I think, of all senators, is to deal with this national crisis and to make sure that everyone affected is around the table. When I look carefully at the legislation, I think it has been intentionally put together to be as malleable as possible in order to do exactly that.
If you look at the preamble, it starts off, right in paragraph 2, by saying, “persons who have served as first responders.” For me, automatically, a first responder would be a paramedic, a nurse, somebody in the emergency room. There’s no definition that I’ve seen of “first responder” that would exclude people from the medical profession.
Then, you’re right, the preamble goes on to mention specifically firefighters, military personnel and so on and so forth. Again, if you look at the nuts and bolts of the bill, when you go into the details of the bill after the preamble, I think, intentionally, the members of the House of Commons did not mention any particular group in the actual content of the bill.
If you look at the most relevant explanation of who is going to be around the table, it puts the onus on the Public Health Agency of Canada. You look at paragraph 3, and it says, “The Minister must, no later than 12 months after the day on which this Act comes into force, convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, provincial and territorial government representatives responsible for health and stakeholders. . . .” The ministry that will lead the parade is Health Canada. If that doesn’t encompass health workers, I don’t know what would, a ministry that you fall under the direct responsibility of. Just like the Minister of National Defence would encompass our military personnel, and Veterans Affairs Canada would encompass our veterans. I think they’ve done a masterful job in putting together a content of this bill that’s very malleable, very flexible, and the onus, of course, is on the government agency to take the important steps to make sure that that conference is all encompassing.
Furthermore, there’s a review clause in this bill, which is so important for Parliament. After 12 months, these agencies are going to have to come before us and present a report, and we’re going to review their work. Believe you me, if there’s anybody who is excluded, we are going to be the first to raise a flag.
I certainly will not entertain at all your amendment as you proposed it today because, based on the points I just made, your amendment actually becomes more exclusionary than what it is currently because you are actually going to highlight a particular group and exclude all of the others in the core nuts and bolts of this bill. So that, certainly, I don’t find acceptable.
Can you comment on that?
Ms. Silas: First of all, with all due respect, senator — and we’ve had this discussion before — nurses are not recognized in most governments, by governments. Just in Ontario, Nurses Week was the first week of May. First Responders Day was there. Nurses weren’t invited. They are very separate events in recognition. So we can’t take it.
As for the review process, I’ve been in this job a long time, both nationally and provincially, and, once again, you’re telling Canada’s nurses, “Oh, don’t worry. Just wait. If you’re forgotten, we’ll do something about it.” It’s not a “just wait” situation. Nurses and health care providers that are diagnosed with PTSD should be involved with this, just as any other provincial, territorial and federal workers who are paid should be part of this. It shouldn’t at the whim of any federal minister.
Senator Housakos: What if we propose as a committee to have strong observations instructing Health Canada and the various ministries to make sure that nurses are not excluded right off the get-go in the first conference? Would that be a positive step, without us sending back an amendment, as you propose, which might actually risk our nation, for the next two and a half years, not having any framework whatsoever?
Ms. Silas: I think you heard from the previous panel what’s already happening on PTSD. Ten years ago, no one was talking about PTSD except for the military. Then very evident accidents happened in other professions, and now everyone is talking about it. So the federal government is already moving on some kind of standardizing. How far will they go? My colleague on the Fit for Purpose that the minister just announced the report recently, how far will they go? We don’t know. But we’re saying this bill is flawed in identifying who should be included, and if you feel so strongly, then your recommendation should be to eliminate all the professions and just go with PTSD victims.
Senator Housakos: You’re not answering my question. If we put in an observation that strengthens the requirement of making sure nurses are present, and, of course, that guarantees this framework and passing this bill as is, rather than risk this bill, amending it and sending it back, and risking it being defeated and having no national framework for two and a half years, what would you prefer?
Ms. Silas: Honestly, I don’t know the procedures, and that’s why I’m hesitating on what is an observation coming from the Senate committee and how much weight it has. If you guarantee it has as much weight as an amendment, then I support it. The goal here is not to stop. My first meeting with MP Doherty and the Minister of Health and secretaries of health — we’ve had two since this has been introduced on both sides — it’s not to stop it. It’s just to make it inclusive and, honestly, not insulting to a very large profession in this country.
Senator Housakos: We agree. Thank you.
Senator McPhedran: Thank you so much not only for being here with us today, but for the hours and hours of work that you’ve put into addressing what you’re experiencing as exclusion in this bill.
I’m going to ask you to travel with me to the fourth paragraph of the preamble of the bill. I’m going to quickly read the first two lines:
“And whereas many Canadians, in particular persons who have served as first responders, . . .”
I know, Ms. Silas, that you were here, but I don’t know if Dr. Cohen and Dr. Baillie were also here when I had the discussion with the originator of the bill. I still believe that to address your concerns — and I think they’re legitimate concerns — I think your concerns reside primarily in paragraph 2 of the preamble. I don’t know why this happened. The way it’s set up in paragraph 4 really follows that precedent of the Canadian Charter of Rights and Freedoms and makes it clear that these specified professions are just examples and leaves that list more open. That’s what “in particular” means. It means we’re giving you some examples, but there are a whole range of analogous occupations that aren’t specifically listed here. Yet it’s missing from the second paragraph.
That’s why, when I was speaking to the originator of the bill, I was trying to convey that two more words in the second paragraph would align this preamble; and then, just to be safe, I’m also suggesting that there be an observation. We can’t guarantee you that an observation has the same strength as an amendment. It doesn’t. But it does have some influence in terms of how legislation is rolled out and what is actually done.
So the observation would be, and this has to be decided by colleagues on the committee, the use of the term “in particular” in the preamble of this bill indicates that the conference convened and any comprehensive federal framework on PTSD produced must include a wide range of occupations that experience PTSD and related symptoms or concurrent disorders, including nurses and other health care and emergency response workers.
I just offer that for your consideration and for consideration of my colleagues on the committee.
Ms. Silas: Honestly, senator, it is up to all of you. The red flag for us was MP Doherty’s testimony in the HESA committee on insisting that it was only for those professions. So if the wisdom of this committee believes that changing and adding “in particular,” as you just stated, and an observation statement is appropriate, we would be very grateful.
Senator Bernard: Let me state for the record that I support the proposed observation by my colleague Senator McPhedran. I do have a couple of questions, though, and one statement.
Let me start with a question for you, Ms. Silas. You said one in four nurses have experience of PTSD. You also talked about this being a woman-dominated profession, as is social work, I might add. Social workers weren’t even mentioned at all today other than by me, so we want to make sure we’re including them as well. It’s very easy to forget some of those very invisible professions who are also impacted by trauma in their work. Back to the question: Why do you think professions like nursing and social work and psychology perhaps may be excluded from what may be covered under the term “first responders”?
Ms. Silas: I have no idea.
The one in four is symptoms of PTSD, not one in four nurses with a diagnosis of PTSD.
Nurses, social workers — and the list goes on — are often seen as the angels of mercy. They’re seen like those angels floating around, and you forget to give attention to them. We questioned the minister in Ontario when First Responders Day was: How come nurses weren’t there? It will be corrected next time. But I don’t know. I worked in the emergency department. I travelled those ambulances from Moncton to Halifax with cardiac patients. I would put myself in that situation, like many others.
I was stunned this weekend when we heard about the clerk in the court in Toronto. It really struck a chord with me to say: It’s true. It’s a she in this situation, but it could be a he. She is sitting there, taking the notes of the court, and she’s been off sick with PTSD for two years. That could be any of us, because we do not know how we will react to a trauma or a repeated event. That’s what we’re seeing with female-dominated professions. It’s not the trauma; it’s the repeated child that dies. It’s the repeated family member that can’t cope with mental illness or a suicide. It’s those repetitive incidents that we have to deal with.
Senator Bernard: And also the vicarious trauma, which some of these professions would be more likely to experience as well.
Ms. Silas: Yes.
Senator Bernard: I’d like to ask a question of our two psychologists. You mentioned the American Psychological Association and their guidelines. I’m wondering: Do those guidelines reference culturally specific interventions?
Dr. Baillie: Just as a bit of background, the guidelines were adopted last year as a result of research looking into the effectiveness of various treatments. They are purely guidelines treatment, not assessment or generally pharmacological interventions because that’s not the purview of psychologists. The research basis doesn’t necessarily include the culture-specific element.
So when we talk about cognitive behaviour therapy, we’re talking about the results of a research study that found that cognitive behaviour therapy works particularly well for the treatment of post-traumatic stress disorder. We’re not looking in particular populations where that might have surfaced.
There wasn’t any independent research the committee did in order to come up with the guidelines; they’re looking at the published research. There might be some published research about different groups and populations, but generally, the research will be much broader than that and lacking the kind of specificity that, by your question, I would agree is an important issue to raise.
One of the examples I thought of when we were talking about a national framework is those administrators working in First Nations communities who deal with increased rates of suicide. Again, to your point about vicarious trauma, we don’t see them as first responders, but those are the types of individuals who might be impacted by this.
[Translation]
Senator Boisvenu: Welcome to our witnesses. Ms. Silas, this bill will affect workers under federal jurisdiction only, is that correct?
Ms. Silas: No.
Senator Boisvenu: If this bill is applied to all provinces and all forces— We do not see the Sûreté du Québec or local police officers. There are 34 police forces in Quebec. So, if you are here so to make sure the bill includes an occupational group that includes nurses, you would have to include everyone. The Sûreté du Québec and the Ontario Provincial Police are not included, which adds up to 10,000 employees.
Ms. Silas: Yes.
Senator Boisvenu: I my opinion, there should be a consultation between the provinces and the federal government and people should be invited to broaden the scope to include other forces, not just nurses or psychologists. There would be others as well. I understand that you want to defend your own interests. Three of my sisters are nurses. I am very familiar with the profession. I also studied psychology. If one or two occupations are included, then twenty or so would have to be included.
So it would be much wiser to invite politicians to broaden the scope of application to include other occupational groups that have a highly stressful workplace, such as nurses. A study has just been published about the rate of absenteeism among nurses in Quebec; their working conditions are much more difficult. There is a shortage of nurses. They work very long days.
Should a recommendation not be made in connection with the bill to give people a broader view than what is in the preamble?
Ms. Silas: I agree, senator. It is inclusive.
Senator Boisvenu: Thank you.
[English]
Senator Griffin: My question will be very short. The comments made by Senator Housakos were the issues I wanted to raise, so I’ll just leave it with a quick reinforcement.
The bill has a preamble, but that’s not the force of law. The force of law is what’s actually in the body of the bill. That’s something very important to consider. This is a bill that’s asking for a framework.
If an observation is made out of the report of this committee, that will carry a lot of weight. It’s not a guarantee, as you would wish, but it will carry a lot of weight. At the end of the day, the testimony of all the groups before this committee, as well as what’s happening in debate in the Senate and what’s happened in the House of Commons, will be taken into account.
You’ve been heard, is what we’re saying. You may not get quite the result you want, but you will be heard.
The Chair: I want to thank our witnesses very much for appearing today. We appreciate both your time and effort to join us on this very important bill. Thank you very much.
Senators, in our final panel of the day, we move to a different topic. From Global Affairs Canada, we’re pleased to welcome Larisa Galadza, Director General, Peace and Stabilization Operations Program, who will be speaking to us today about the Elsie Initiative on Women in Peace Operations.
The floor is yours, after which we will have some questions for you.
Larisa Galadza, Director General, Peace and Stabilization Operations Program, Global Affairs Canada: Thank you, senators, for inviting me to be here today to talk about one of the many exciting things that I do as Director General of the Peace and Stabilization Operations Program at Global Affairs. I’m also Canada’s focal point on women, peace and security. I’m so grateful to be here today.
The Elsie Initiative on Women in Peace Operations was launched by Prime Minister Trudeau at the November 2017 UN Peacekeeping Defence Ministerial Conference, which Canada hosted in Vancouver. The Elsie Initiative is one of the elements of Canada’s overall strategy for engaging in UN peace operations, a strategy that aims to enhance the effectiveness of those operations.
The Elsie Initiative is also a clear manifestation of Canada’s commitment to the global women, peace and security agenda as set out in UN Security Council Resolution 1325 and seven subsequent resolutions.
Finally, the Elsie Initiative embodies Canada’s feminist foreign policy approach, which asserts that advancing gender equality is both the right thing to do and the smart thing to do.
The idea for the Elsie Initiative stemmed from a conviction borne out of evidence and experience that women’s inclusion in peace operations makes those operations more effective and that progress towards achieving the UN’s targets for women’s participation has been too slow.
You may be aware that in 2015, the UN Security Council adopted resolution 2242, which set the goal to double the number of women serving in UN peace operations. Unfortunately, since then, the percentage has increased only slightly, from 4.2 per cent to 4.4 per cent, and all of that was owing entirely to increase in police women, not military members. At that rate of change, we’ve calculated that it would take until 2054 to reach the goal of resolution 2242.
The mandate of our five-year pilot initiative, the Elsie Initiative, is to find ways of moving from incrementalism to a breakthrough. Our goal is to catalyze transformative and holistic change. Global Affairs Canada is leading the effort, with strong support from the Department of National Defence, the Canadian Armed Forces, Public Safety Canada and the Royal Canadian Mounted Police.
We have also engaged women peacekeepers, experts, academics and representatives from the United Nations and UN member states to inform our thinking as we move ahead with project design. Canada is leading this initiative, but it is most definitely a collective effort.
The Elsie Initiative has two substantive components. The first is to deliver technical assistance and training to one or two troop- and police-contributing countries who share our ambition for increasing women’s participation and representation in peace operations. In partnership with the chosen countries, our first step will be to comprehensively assess the barriers to women’s inclusion in peace operations. Subsequently, Canada will provide tailored training and technical assistance to bring down key barriers. We expect that this training and assistance will be delivered in large part by the Canadian Armed Forces and the Royal Canadian Mounted Police.
A consultative and evidence-driven process is underway to determine which country or countries we will partner with. Once the decisions are made and partnerships are established, we expect to start the barrier assessment process with our partner countries and complete those by the end of the year. Training and technical assistance activities should begin in earnest in 2019.
The second substantive component of the Elsie Initiative is the financial mechanism to provide assistance and incentives for countries to deploy more women to UN peace operations. This financial mechanism is in the early phases of design. The establishment of the mechanism is based on the idea that financial wherewithal should not be an impediment to advancing gender equality, and access to these financial resources will help to accelerate and incentivize increased women’s participation and representation in peace operations. Canada has already committed to providing $15 million in seed funding. We are mindful that establishing this mechanism will take time and careful planning to ensure that this does not create unintended consequences or perverse incentives.
The Elsie Initiative is a pilot project, and research, monitoring and evaluation are crucial components. We will be measuring progress closely and making course corrections where required. One of our primary goals is to increase knowledge and awareness of what works. This will allow the UN and member states to replicate effective approaches and thus catalyze further change. We will be building our monitoring and evaluation framework in the coming months, and we will support research to address key knowledge gaps.
Recognizing the importance of political leadership, the initiative includes undertaking significant advocacy efforts over the duration of the five-year mandate to increase awareness of barriers to women’s participation. To this end, we have established a contact group of like-minded countries that will support us with these advocacy efforts and will also provide advice and experience to help us design and implement the initiative.
The contact group is made up of countries that have already made great strides in increasing women’s participation in their military and police forces. The group includes Argentina, Ghana, France, The Netherlands, Norway, Senegal, South Africa, South Korea, Sweden, Uruguay and the United Kingdom.
We have already called upon their experts to help us with designing the initiative, and Minister Freeland will be calling upon her counterparts in these countries to help build institutional and political momentum for transformative change.
[Translation]
This group will be integral to driving attitudinal shifts that will be required to make progress and to keep this issue front of mind in the UN system and among member states.
[English]
In developing this pilot project, we are guided by three principles. The first is sustainability. We will take a comprehensive approach to identifying and addressing barriers, identifying not just the symptoms but underlying causes, even if these reside at earlier stages in women’s policing or military careers or even if the barriers are tied to counterproductive cultural norms.
[Translation]
The second principle is complementarity. We recognize that the United Nations, and many military and police organizations such as CAF and the RCMP, have for years been working to increase women’s participation and representation. The Elsie Initiative will work hand in glove with our colleagues and likeminded stakeholders to reinforce each other’s strategies and successes.
[English]
The third principle is innovation. We will channel the collective impatience with the current pace of change, and we will test new ideas.
Over the past seven months, we have shared our vision for and approach to the Elsie Initiative widely.
[Translation]
I want to highlight the strong support we have received from key stakeholders, including the United Nations, contact member groups and other countries that we have consulted on the design. Most importantly, I want to highlight the support from women peacekeepers themselves.
[English]
One of the most powerful elements of the Elsie Initiative design workshop that took place here in Ottawa in February was a panel of women peacekeepers from around the world speaking of their experiences. They were extremely proud of the work they did, and they want to be deployed again. They shared their ideas and their advice on how peacekeeping missions could better support women and use them more effectively and the challenges they faced in getting selected for deployments or getting recruited or promoted in their own organizations.
[Translation]
We hear these same stories the world over, from women peacekeepers themselves, from security organizations that want to make positive changes, and from UN stakeholders who want to make UN missions more diverse.
[English]
I will conclude with one final point. I want to highlight that increasing the number of women deployed on peacekeeping operations is not just a numbers game. As Minister Freeland said when she hosted an Elsie Initiative event at the UN in March on the margins of the Commission of Status of Women:
We are carefully designing this mechanism to incentivize the change that is needed, while also supporting women to ensure they are participating in meaningful roles, with proper training.
We want to ensure a healthy and vibrant pipeline of uniformed women across ranks and roles, including in influential and leadership positions, and to ensure that women who are deployed to UN peace operations are used effectively.
[Translation]
We have a long way to go as UN member states to achieve these goals, but the Elsie Initiative will make a positive contribution, one that we are proud to lead.
[English]
There is so much more I could say about the Elsie Initiative, but at this point I’d like to stop. Thank you again for the invitation, and I look forward to taking the discussion in any direction that is of most interest to you.
The Chair: Thank you very much. We will now turn to questions.
Senator McPhedran: This may sound like far too obvious a question, but I’m going to ask it anyway. Could you tell us, please, why it’s named the Elsie Initiative?
Ms. Galadza: I’d love to, thanks. I will tell you who Elsie MacGill was, and I think it will become clear why she is the patron of this initiative.
Elsie MacGill was born in Vancouver in 1905, and at that time she chose a particularly nontraditional path as a woman to follow. She was the first Canadian woman to graduate with a degree in electrical engineering in 1927, and she was the first in North America to earn a Master’s Degree in aeronautical engineering in 1929.
She was remarkable for many reasons, and her 50-year career in engineering was just one of those reasons. Here are some more: When she was in her 20s, she was diagnosed with a form of polio and was told she would never walk again, but she did and, with the help of two metal canes, she was able to walk for the rest of her life.
She had a reputation for bravery. As an engineer, she designed planes. She was not a pilot, yet she insisted on being on every test flight of the planes she designed, including the especially risky first flight.
With time, she had a comic book character named after her, and she was called the Queen of the Hurricanes.
Elsie was also a feminist. She wrote a book about the work her mother and grandmother did to get the vote for Canadian women, and she became a commissioner of the Royal Commission on the Status of Women.
I think that she was a first in many respects, a woman who broke many barriers and overcame many challenges in her personal and professional life, and that is why, in Vancouver, the Prime Minister announced that this initiative will be called the Elsie Initiative.
The Chair: I made a commitment to Senator McIntyre to let him ask a question before he left for another committee, if you don’t mind. My apologies.
Senator McIntyre: I apologize. It won’t take long. I have two short questions, one to do with the pilot project and the other with the fund.
As far as the pilot project is concerned, what other countries have expressed an interest in participating? Are they part of the list of countries that you’ve mentioned?
Ms. Galadza: That’s right. Yes, they are.
Senator McIntyre: Regarding the global fund, I understand it is to support the deployment of women peacekeepers. I further understand that Canada promised to contribute $15 million to this fund. What other countries promised to contribute to the fund, and if so, which ones?
Ms. Galadza: At present, we’re still designing the financial mechanism to understand who will run it and what the requirements will be for access to that fund.
We have had some inquiries from some of our contact group countries, the ones that I listed. We believe that once the details of the financial mechanism are better understood and its design is little further down the road, there will be countries who either we will solicit to see if they would like to contribute or will volunteer to contribute. At this point, they need to know a little bit more about how it will work before they can make a commitment to it, and I would say that Canada would be asking the same questions that they are.
We’re keeping these countries apprised of the kinds of considerations around the financial mechanism. We have talked to them about the possibilities for who would administer that mechanism. We are bringing the countries in that contact group along with us so that they always understand the latest developments. We hope that in the coming months we’ll be in a position to have enough details that countries can make that commitment to support it if they so wish.
Senator McIntyre: Thank you for your answer and fine presentation. I apologize, I have to attend another committee. I wish I could stay longer.
Senator McPhedran: Those were among the questions I wanted to ask, so that’s great.
You’ve been very specific here about the $15 million in seed funding, which is part of the financial mechanism. Can you tell us a bit more about the budget for the other aspects of the overall Elsie Initiative?
Ms. Galadza: Yes. The funding that’s been provided is covering the following elements:
We’ve received funding for grants and contributions, so vote 10 funding, that will largely go to the United Nations system to improve what we are calling the receptive environments for women peacekeepers. The infrastructure and other policies and frameworks at the UN for peace operations are designed largely without consideration that women might be present in large numbers.
We’ve already committed about $4.5 million to projects that will support women’s increased participation from the UN, so the UN can do what it needs to do. It is responsible for training standards, for infrastructure standards and in some cases for building the infrastructure. We’re helping the UN put those things in place.
We’ve also received funding to hire the people we need to do this work, and a team of about six now is in place to support the development of the partnerships, the diplomatic work and the work around measurement and evaluation, which will be very important.
We will also be contracting with third parties for things like the barrier assessments that need to be done. We think it’s really important that, once we get into a partnership with a country, the barrier assessment be done by a third party, people who are experts in security sector reform and gender issues. We’ve received the funding for that.
I don’t have the global figure off the top of my head, but we could provide that to the committee in writing and the breakdown of which votes it’s in.
Senator Jaffer: Thank you very much for being here.
I think I held your job from 2002 to 2005. Senator Wilson was the first one, and then me. I was the chair of Women’s Peace and Security. Different title, but I think it was the same job. When I was chair, we took RCMP officers to Juba and Darfur to teach how to do rape investigations. It’s still in place there. We had women in Darfur, women from the Armed Forces, running camps in Al-Fashir, just when the conflict started. There is a whole history of what Canada has done, and I’m sure you know about that.
We have done a study here, and we have said that it is important to ensure that we contribute some women to go into the UN leadership. I haven’t seen that much of Canada contributing for us to send women to UN leadership. This is one area where Canada can truly contribute, we believe — the committee had a report on this — because we have qualified women who can truly make a difference and bring innovative gender-sensitive approaches to UN peace operations.
You may not have this information, but maybe you can provide it. Have any women that are in our Armed Forces, RCMP, firefighters gone to train? Minister Freeland promised to train 200 police officer members for UN peace missions last November. Has that happened? If you don’t have the answer, I respect that. Please provide that for us. What we felt was that we have very competent women here, but it doesn’t translate into the UN peacekeeping force. Can you provide that information?
I am so many questions that I will go long, and then the chair will stop me and I’ll go on second round.
I’m very happy with the Elsie Initiative, but I’m concerned that we are preaching to other countries to contribute. Where are our women? We don’t have the women here. I don’t think we have the moral high road. In this committee, we are always looking at what poor representation we have in our Armed Forces, in our RCMP, especially in peacekeeping. For us to say “Bravo” to other countries when we don’t have the moral high ground, I would really like you to take that message. I can’t say from the committee because the committee hasn’t agreed to that, but certainly from me. It’s fine to laud and contribute, but what about us? From my understanding, there are only two women in the Canadian Armed Forces who are in the peacekeeping operations. I could be wrong, but that’s my understanding. If we are going to tell other countries to recruit more women into peace operations, we should walk the talk. Please tell the minister that that’s how I feel.
I believe that our upcoming mission to Mali will be a great opportunity for this, especially since Minister Freeland promised that women would be well represented in the deployment. Once you know, we would really like to know what that is. Exactly how many women is “well represented?” What is that going to be?
Does Canada have any plans to contribute more women for other missions we’re participating in? I have asked you a lot of questions, and I don’t expect you to have answers because they’re very specific, but you may want to comment before I go to my next question.
Ms. Galadza: Thank you, Senator Jaffer.
I would say that, with everything you’ve said about the importance of demonstrating our commitment with increased numbers of women ourselves, you’re also preaching to the converted. We, in our meetings with the Canadian Armed Forces and with the RCMP and amongst ourselves, are always challenging ourselves to do what we’re asking other countries to do.
I would say that, as of April 2018, if you want some current statistics, we have 26 police deployed in UN missions, and seven of those are women. The percentage there is almost 37 per cent.
Senator Jaffer: Where are they deployed?
Ms. Galadza: Let me get that for you in just a second. Sorry. Those would be mostly, probably, in Haiti.
Among the military, we have 10 staff officers deployed and three women, so three out of a total of 13.
Our numbers, as a percentage, are pretty good but, as absolutes, they are not, when we’re talking about potential partner countries who deploy in the thousands. Minister Freeland did highlight that the deployment of women would be important when we deployed the contingent to Mali, and I believe that those numbers will be available very soon. I know that the Canadian Armed Forces are working actively on that.
I can say, generally speaking, that our percentage of women deployed through the Canadian police arrangement is excellent. I think it hovers around 20 per cent, which is about what the UN is asking for. I think we will continue to push. I think we’re not going to be happy just meeting the UN numbers, and we do have a lot of women to contribute on the policing side as well, so we’re looking to advance those numbers.
In terms of the military, I think that you can read, in the Defence policy and also in Canada’s National Action Plan on Women, Peace and Security, some very clear goals that the Chief of the Defence staff has set for increasing the number of women in the Canadian Armed Forces, very clear numbers, very clear time frames.
Senator Jaffer: But that we know. We could tell you in our sleep. This is what the committee does. That doesn’t help us. Those figures, we’ve done a whole report. We know those are very poor, very bad. That’s not for your responsibility. You’ve given us figures. I appreciate that, but it’s not clear, and that’s not your fault because you didn’t know I was going to ask you this question.
May I please ask that you send exactly which mission and where the women are. It would also be helpful for the UN. Our record, generally, has not been very good on UN operations, even how many men are going. This committee is not just about women. If we could get the real details, it would really help us.
Ms. Galadza: Absolutely.
Senator Jaffer: I appreciate it.
Ms. Galadza: Not a problem.
[Translation]
Senator Dagenais: In your remarks, you mentioned a small percentage of women, 27 per cent. Is it difficult to recruit women for this kind of mission? When they accept a mission, are there special circumstances or are they the same for all participating members?
Ms. Galadza: Thank you for your question. I was speaking in general terms because the recruitment conditions vary from country to country. As to the United Nations, the needs are the same for women and men.
[English]
The number of years of experience for police and for military are the same. When you talk to different police and different countries, they can add their own requirements. They have their own, for instance, number of years of experience that a police officer needs to have. Sometimes it’s three, sometimes it’s five and sometimes it’s 10.
In some respects, those can be a barrier to women’s deployment on peace operations because a police force that has only been recruiting women for seven years that says 10 years is the minimum you need to have to be deployed automatically excludes all the women that may have had some great experience for the past seven years, and seven is greater than what the UN requires. The requirements are different in every country but, from the UN perspective, they are the same for everyone.
[Translation]
Senator Dagenais: Do you have any information on the successes or challenges of this kind of program, from the United Kingdom in particular?
Ms. Galadza: A program like the Elsie Initiative?
Senator Dagenais: Yes.
Ms. Galadza: This is the first time a UN member country has agreed to do this kind of thing.
[English]
The discussion around the need to try new things, to have incentives, to really understand what the barriers are, those discussions have been around for a good number of years, but the questions have never been taken up in earnest by a member state outside the UN system. That’s what Canada has stepped forward to do, to look at this in a holistic way, to put some funding into technical assistance and training, and to have more of a base of evidence on which anyone who is interested in this endeavour can do more research and design other projects.
That’s one reason that when we went to the United Nations and presented them with this idea and that we would do it, it was very much welcomed and considered quite timely and welcomed, in particular, coming from Canada.
[Translation]
Senator Dagenais: Thank you very much, madam.
[English]
Senator Richards: Thank you for being here today.
How many women soldiers will be deployed to Mali? Do you know?
Ms. Galadza: I can’t tell you that right now, no.
Senator Richards: It’s going to be a pretty dangerous UN operation, don’t you think? Just your opinion. It’s kind of a war-torn area. Do you really think they will be able to keep the peace? This is just a personal observation.
Ms. Galadza: I would defer those questions to the members of the Canadian Armed Forces who have the latest information on the risks that will exist for the kind of mission they are undertaking. They will soon also have a better idea of how many women are going to be part of the contingent that is going to be deployed.
Senator Richards: When does this operation begin? When will they be deployed?
Ms. Galadza: I believe the latest dates are that the initial capability will be present in Mali at the beginning of August, with the full capability up and running by mid-August.
Senator Jaffer: It’s very hard for you to write down all the questions I’ve asked, but what I will do is ask the clerk to send you a transcript so it’s easier for you. Don’t worry about writing it down. You can’t do two things at once, or at least I can’t. He will send it to you so then you can respond.
When the Elsie Initiative was launched by the government last year as part of Minister Freeland’s platform of feminist foreign policy, we were following the lead of Sweden, Norway and others, and I’m very appreciative of this. The initiative seeks to support efforts to increase women’s participation in UN peacekeeping across the globe. I’m hearing that it’s great that we are wanting to do it across the globe, but we need to do some things as well. You will send us information as to what we are doing. We also, of course, can ask the Chief of the Defence Staff, but it’s also the RCMP. There may be others besides the Chief of Defence. Sometimes I’ve heard firefighters go, but you will have all that, so if you can, please.
Currently we know that women represent 3.7 per cent of military and 9.5 per cent of police personnel deployed by the UN. The UN, according to Resolution 2242, obviously wants to double this. If I’m not mistaken, and correct me if I am, the Elsie Initiative is trying to help the UN with that. Is that the idea with the Elsie Initiative?
Ms. Galadza: That’s exactly the idea.
Senator Jaffer: There is no detailed information of how the money will be spent. Let me give you an example: $6 million to help designated UN missions recruit more women. What does that mean and $6 million how? It may be that it’s work in progress, so when you know, it would be helpful if we found out how this will be spent.
Further, to launch a global fund to reward countries that contribute more women peacekeepers with the investment of $15 million. As I already said, it’s not fair to ask you this question. We are not sending many men or women into UN peacekeeping, so it would be difficult.
When I was holding a position like yours, I used to go to New York a lot, and we worked with the peacekeeping operations, the DPKO, to look at the training manuals. Are we spending some time looking at the training manuals, how we are training, especially with a gender lens?
Ms. Galadza: Absolutely. We do a lot of that kind of work with the United Nations. When we provide you with the information, I will give you a breakdown of the projects that we’re supporting at the United Nations with DPKO, Department of Peacekeeping Operations, specifically to create the conditions for women to be present in greater numbers in the missions. We’ve already made some of those commitments, and we can describe those projects for you in detail.
The United Nations is a key partner for us. The targets have been set by the United Nations, by the Security Council, and there’s a lot of work already underway within the UN system on training, on doing gender analysis of existing structures, on understanding how women can be used effectively or how women can be placed effectively in operational roles.
Because of everything that’s going on there, we’re engaging them constantly to make sure that we’re not working against them, to make sure that our efforts are complementary to the United Nations and that we are moving in the same direction. Under the Secretary-General’s leadership in his gender parity strategy, there is a high level of ambition on the part of the UN, and they are among our closest partners in this initiative.
Senator Jaffer: You know better than anyone that peacekeeping is not just about how many soldiers we send and how many police we send. It’s also civilians. I don’t know if it’s the Elsie Initiative or others where you are helping to train women defenders in the area, peace mediators and the work of civilian communities.
The Canadian Armed Forces and RCMP is one part of it, and sending them for training is a very important part of it. I think we have some real leadership knowledge and competencies that we can share, even if the numbers aren’t great. For example, when I was in your position and I was in Darfur, we only had four RCMP officers and four military, but they were helping to train the military on the ground. It’s not just the numbers; it’s how many. I’d like to know what kind of initiatives we are doing with women defenders and mediators. How are we training mediators?
Ms. Galadza: I can speak to what we’re doing through the Peace and Stabilization Operations Program that is also at Global Affairs Canada. Over the first three years of that program, we have committed over $95 million to the UN system in particular on everything from training for uniformed peacekeepers through to paying for gender advisors in key positions and in missions and training for women police officers before they have to take their test to qualify to be deployed. There are also mediators, the strategic analysis unit in UN headquarters and the mediation that the UN does. It is a significant package of support to the many ways that the United Nations works to support peace.
I can give you another good example. This week and next week, Canada is hosting a Senior Mission Leaders Course. You’ve talked about military, you’ve talked about police and you’ve talked about civilians. One of the most important things we need to do is get the military police and civilians working together in an integrated way, because the problems are complex and need to be dealt with with all of the tools that we have. So this week and next week, the Senior Mission Leaders Course the UN puts on is actually taking place here in Ottawa at the RCMP facilities, and there you have people from all over the world who are going to be leaders of UN missions getting together to train together on how to execute those missions, how to work in difficult environments and how to be integrated in the work that they do once they are posted into these positions. It’s a small but really important way that Canada is supporting the UN to be more effective in the peacekeeping space.
Senator Jaffer: That’s very useful. All I ask is not to rush. We’ll soon be adjourning until September, but by September, can we have real specific details of all the things you’re doing?
Ms. Galadza: Sure.
Senator Jaffer: If you can kindly send it to the clerk, when we come back we can study it and see how we can support the work.
Ms. Galadza: Absolutely. I’d be happy to.
Senator McPhedran: You know that in my past life I had some involvement with the training of women peacekeepers through the UN DPKO, the Department of Peacekeeping Operations. In that training, it was women only. What came up as a very strong issue, both in terms of attrition and in terms of conditions like PTSD, was a lack of safety and resources when women peacekeepers themselves were assaulted, including, sometimes, sexually assaulted by their colleagues within the same peacekeeping unit. Can you share with us whether this is part of the planning that’s going on? If there’s any more detail you’re able to share, I’d be grateful.
Ms. Galadza: Sure. Thank you for the question.
The short answer is it is absolutely part of the planning and why we need to work closely with the United Nations, because it’s the UN that is, in most cases, responsible for the policies and procedures that apply, for the standards, for physical infrastructure such as lighting, and for the rules of conduct and what happens in cases of misconduct. So we’re working closely with the UN, but we’re also talking to women peacekeepers everywhere we go to help us understand what those challenges are and what the priorities are from their perspective.
The challenge we face is that everywhere, in every camp and every mission, the situation is going to be different. Newer missions already have better facilities. Older missions, perhaps not so much. There’s only so much that can be done, for instance, in remote camps as opposed to major UN bases.
What’s required here is a very granular look at what those challenges are and what the experiences are of women from specific countries in specific locations. That’s what we’re equipping the Elsie Initiative to do. We have to avoid generalizing because, as we have done our work to date, there are a lot of very context-specific challenges that arise. We want to understand those well to make sure that the support, training and technical assistance we provide addresses relevant problems.
The Chair: Thank you very much for appearing before us. I think you have a number of follow-up issues. If you could send them on to the clerk, we’d appreciate it. We also appreciate very much your presence here today, so thank you.
Ms. Galadza: You’re welcome. Thank you for having me.
(The committee adjourned.)