THE SUBCOMMITTEE ON VETERANS AFFAIRS
EVIDENCE
OTTAWA, Wednesday, February 15, 2023
The Subcommittee on Veterans Affairs met with videoconference this day at 12 p.m. [ET] to examine and report on issues relating to Veterans Affairs, including services and benefits provided, commemorative activities, and the continuing implementation of the Veteran’s Well-being Act.
Senator Pierre-Hugues Boisvenu (Deputy Chair) in the chair.
[Translation]
The Deputy Chair: I am Senator Pierre-Hugues Boisvenu from Quebec, and I am the deputy chair of the committee. Unfortunately, our chair, Senator Richards, cannot be here today due to personal obligations. Therefore, I am acting as chair of the committee. Before I begin, I would ask my colleagues to introduce themselves.
[English]
Senator Busson: My name is Bev Busson. I’m from British Columbia.
Senator R. Patterson: I’m Rebecca Patterson, and I’m from Ontario.
Senator Yussuff: Hassan Yussuff, senator from Ontario.
Senator Anderson: Margaret Dawn Anderson, Northwest Territories.
Senator M. Deacon: Good afternoon. Marty Deacon, senator from Ontario.
The Deputy Chair: Thank you, colleagues.
[Translation]
Today, we continue our study of emerging treatments for Canadian Armed Forces and Royal Canadian Mounted Police veterans suffering from occupational stress injuries.
It is our great honour and pleasure to welcome today, by video conference, retired Lieutenant-General, The Honourable Roméo Dallaire and, here with us, Mr. Oliver Thorne, Executive Director of the Veterans Transition Network.
Without further ado, I would ask our two witnesses to make a short presentation of about five to six minutes, and then each senator will have about the same amount of time to ask you questions.
Lieutenant-General (Ret'd) Hon. Roméo A. Dallaire, as an individual: Hello everyone, hello colleagues. This is the first time I am before the committee since I chaired it, but I am delighted to have the opportunity to talk to you about the updates on the support we provide to our veterans. We have five to six minutes to then take questions, so hopefully when I take questions I can give more information.
Essentially, I would like to tell you that I have been the honorary chair of Wounded Warriors Canada since its inception. I was the senator who brought in the Veterans Charter in 2005. I had only been in office for two months. The charter did not reflect the work of the previous six years that led to its creation. Dr. Neary and I were flabbergasted by the recommendations in the charter, because a lot of it did not take into account the years of extraordinary study that we were able to do together, at the request of Deputy Minister Larry Murray.
[English]
I’m also part of CIMVHR, the Canadian Institute for Military and Veteran Health Research — part of the original group. I’ve kept my hand in this and was very happy to see Ralph Goodale when he created a similar research institute based out of Regina for first responders, which include RCMP and police forces that are not only federal but also police forces across the country. It is for first responders who need research on how to handle mental health.
What we’re facing is much more complex than what we originally even saw. We were able to break some of the stigmas of going to get help, and we were able to create centres through Veterans Affairs, the Department of National Defence, or DND, and through the family support centres to help veterans and, in particular, to bring in support for the families. Family-based injuries due to members who suffer from PTSD or moral injuries are of enormous significance and require an immediate injection of increased support.
Organizations like Wounded Warriors, for example, have created programs for families through information listed in the Warrior Health program. Other elements they’ve worked on were programs for couples overcoming post-traumatic stress disorder, or PTSD, everyday living, resiliency programs for couples, spousal resiliency and surviving spouse programs. There were even ones for children, because we have seen children, particularly teenagers, commit suicide because they can’t live in a family with a member who is hurting.
The big leap forward that is screaming for much more research, engagement and understanding is the arena of the moral injury. Moral injuries are different from PTSD, which is often much more punctual in nature as a trauma. A moral injury is when you are ethically, morally and sometimes even legally caught up in dilemmas to which there are no easy solutions, or you’re faced with scenarios that go beyond what you have lived and all the parameters of your life. An example of this is shooting children who are child soldiers. Ultimately, child soldiers were in the past — and still are today — too often treated as combatants. We have been doing work out of the Dallaire Institute for Children, Peace and Security at Dalhousie in training and educating, and doing research on tactics and methods to make them ineffective and prevent recruitment without simply killing the children, as had been the case.
But the trauma that causes has brought us to this level called the moral injury. The moral injury is so much more profound and is in need of extensive work. I would just like to quote the following:
One of the key issues that impact mental health of veterans is differentiating between PTSD and moral injury. They’re separate mental health challenges. The veterans and the community at large are now aware and living with and assisting in the PTSD dimension but are not well informed on the impact of moral injury.
So an enormous amount of work needs to be done in trying to grasp both the dimensions of moral injury and also the different possibilities of cures.
[Translation]
In conclusion, there is research being done, both in Canada and in Holland, in particular, and treatments are being approved through the Five Eyes Alliance. I have a study here that I can provide you with that calls for a profound new dimension in how to treat this much deeper wound. The part dealing with the use of pharmaceuticals, hallucinogenic drugs is an option. These are dimensions that deserve much more effort and funding.
I will leave it at that and be happy to answer your questions.
The Deputy Chair: Thank you very much, Lieutenant-General Dallaire.
[English]
Oliver Thorne, Executive Director, Veterans Transition Network: Hello, and thank you for the opportunity to be here today.
The focus of my testimony today will be on psychedelic-assisted psychotherapy, which I understand to be one of the focuses of this committee. Given the sensitivity of this subject, it’s important to start by being very clear about who I am and who I am not. I am not a doctor, a registered mental health professional or a researcher in psychedelic-assisted psychotherapy. I will provide the perspective of a long-standing veterans service provider, with the needs of veterans in mind.
The Veterans Transition Network is a registered Canadian charity that provides counselling and trauma programs for Canadian Forces members across Canada, free of charge to them. The programs we deliver were researched and developed over a 15-year period at the University of British Columbia. In 2013, our charity was incorporated with the mission of expanding those programs across Canada to make them accessible to veterans.
During those 10 years, we have established a national network of operational and clinical staff so that we can provide these services to veterans free of charge, for men and women, in English and French, from coast to coast. Over those 10 years, we have seen a number of new services for veterans emerge. These include new group therapy programs like ours, PTSD service dogs, equine therapy and medical marijuana, to name a few. Each time a new service emerges, it’s followed by an explosion of new organizations dedicated to delivering that service. There is always a range of ability and motivation within those organizations.
Today, we are at the beginning of an explosion of interest in psychedelic interventions for veterans. Already, new organizations, interest groups and businesses are entering this space, and many more will follow in the coming years. Some of them will be well intentioned; some of them will be professional; some of them will be ethical; others will not be.
The challenge for the Canadian government is setting regulations and policy that will allow ethical and professional groups to research and potentially deliver these interventions while deterring organizations that do not meet the appropriate standards of practice. With that challenge in mind, I have several recommendations to make, again, from the perspective of a veterans service provider. These are focused on two key areas: research and regulation.
Initial research of psychedelic-assisted psychotherapy seems to be promising. It appears to show that certain psychedelics may lower the barrier and enhance the outcomes of psychotherapy for PTSD and depression. However, this research is still very much in its infancy, and we need more research to inform if and how psychedelics may be used to help veterans.
Firstly, we need research to better understand not only if, but how, these treatments work. These studies should have large populations and long-term follow-up, and they should be funded by sources that do not have commercial interests.
Secondly, more research is needed to better understand the potential negative effects of specific psychedelics and when and for whom they should not be used. In answering that question, we need to not only consider the potential physical but also the psychological harm they could cause.
Third, veterans are a unique population with unique needs, and we need research to understand if these interventions are safe and effective for veterans and the particular mental health challenges they face.
If psychedelic-assisted psychotherapy is ever approved as a treatment option for veterans, good policy and regulation is essential to ensure that it is not practised poorly or abused, as it does have the potential to hurt veterans.
Firstly, clinics or individuals that practise psychedelic-assisted psychotherapy should be monitored and regulated by an external body.
Secondly, the government should work with researchers to develop standards regarding the maximum frequencies and dosages of these psychedelics.
Third, and perhaps most importantly, psychedelics should only be made available in a monitored psychotherapeutic setting, not as a self-administered, stand-alone treatment.
In closing, I’ll say that this field should be advanced by the research and medical communities, not by the wellness movement, not by social pressure and not by commercial interests.
Thank you for your time. I welcome your questions.
[Translation]
The Deputy Chair: Thank you very much to our two witnesses.
[English]
I will ask a question for our witnesses. If we go over one o’clock, is it possible to stay with the members of the committee?
Mr. Thorne: Yes.
[Translation]
The Deputy Chair: Lieutenant-General Dallaire, you agree; thank you very much. We appreciate your availability.
My first question is this. As you said at the outset, you chaired this subcommittee. You have defended veterans with courage and energy. You have always favoured a whole-of-government approach to ease the transition of military personnel to civilian life, especially when it was suspected that they might be suffering from mental health problems.
Do you believe that this whole-of-government approach is currently well integrated within the federal government or is there still a lot of work to be done to ensure that our veterans are better treated, better cared for?
LGen. Dallaire: In my opinion, the possibility that some veterans may be hired into positions even if they have a mental health disorder or operational injuries is accepted by some departments, while for others it is really not in their best interest.
As far as I can tell, deputy ministers still have a great deal of authority over who is employed in the organization and who is not. Does the government, as an employer, specifically refer injured veterans and their family members who are also injured and suffering?
I would say that for government institutions, it is not necessarily second nature to adapt or modify hiring policies to meet particular needs. This is done more by exception or local initiative rather than through a government-wide policy.
The Deputy Chair: Here is my other question. Over the past 20 years, the government has invested heavily in suicide prevention. We know that the suicide rate for men is twice as high as in the general population of Canada. Our military and veterans are no exception to this statistic.
My question is very general in nature. Is it possible to do more to help young people find meaning in their lives after a military career? Do you have any solutions regarding suicide prevention?
LGen. Dallaire: That is interesting. I would like to tell you a short story. Jean Baril, the Chief of the Defence Staff at the time, was visiting a young soldier who was only 23 years old and had lost a leg. He was trying to comfort him, encourage him and make him see the positive side of the future. It had been a year since the young soldier had returned and he was wearing a prosthesis, but he seemed quite well.
After the visit, within 24 hours, the youngster committed suicide. Following this, we wondered whether we had really studied the problem that lay between the two ears, beyond the physical problem, and with the same sense of urgency. What we realized was that the young man could no longer live with the idea of no longer being able to serve, no longer being able to be part of the airborne regiment.
The dismissal of members of the Armed Forces, because they are psychologically injured, is done within a three-year period. In my opinion, these people still have a lot to offer, even if they are no longer operationally deployable. The transition to civilian life, where everything becomes much more individualized, very often causes trauma for the individual and their family members; the trauma is so difficult that the Armed Forces should have plenty of positions available for wounded veterans who can still wear the uniform and perform other duties.
That would enable those who are in good health to continue to serve without worrying about being injured in the line of duty. If a soldier is injured then basically they are no longer useful and the Canadian Forces gets rid of them. However, if soldiers know that they can take risks because they will still have the opportunity to serve even if they are injured, then that would be a major change in terms of the choices available to them.
With regard to suicide, a head of National Defence once told me that the rate of suicide in the Armed Forces was no higher than in the general population. Personally, I think that if the suicide rate is the same in the military as it is for civilians, given the selection, training, and so on that members of the Armed Forces go through, then that means there is a major problem. The problem is not necessarily access to therapy. It is that the leadership has transferred the responsibility of monitoring individuals who are likely to commit suicide to therapists.
At one time, the leadership was not really able to talk about the files of injured soldiers, and the medical service insisted on confidentiality, which isolated injured soldiers. All too often, that isolation led to suicide, so the leadership has a responsibility in all of this.
The Deputy Chair: That is very interesting, Senator Dallaire, or rather Lieutenant-General Dallaire. I am always getting your two titles mixed up.
LGen. Dallaire: Either one is fine.
[English]
Senator M. Deacon: Thank you to our guests for being here today, with specific reference to the Honourable Roméo Dallaire. We’re thrilled to have you here. We appreciate your observations here at this table and the many conversations you had while you were here supporting colleagues and garnering their understanding.
We are in an interesting time, as you say, in terms of leadership, support and, really, who needs to be doing what. At this moment, I’m trying to pare down to one question. I think what I’d like to do is follow up on something you talked about in your introduction around moral injury. I’d like to go deeper into this idea of moral injury and any important distinctions that might exist from what we generally associate with an operational stress injury.
The research, as you say, is new, but are there any differences emerging now on how moral injury should be treated? Do you think it generally falls under the broader heading of operational stress injuries? Is it yet recognized as the kind of injury that is covered by our veterans’ health care?
LGen. Dallaire: The information I have been able to glean is that, in fact, moral injury is still not fully quantified by the professional therapeutic world in regards to the depth of that injury and how it affects the individual. I was treated for nearly 20 years for PTSD, only to realize during that time that what I had seen, the decisions I had taken, the ethical dilemmas I had found myself in — of nearly playing God about who would live and who would not — facing child soldiers and making decisions — those scenarios and dilemmas attack the core of what we are. They attack our fundamental premises of our life, societies, values, religious beliefs and the nature of what we believe humanity is.
That depth of injury cannot simply be handled by medication and purely therapeutics. It is my belief that there is much more research to be done by organizations like CIMVHR and other institutes. My Dallaire Institute for Children, Peace, and Security, in fact, is doing a five-year research program on how soldiers who have faced and used force against child soldiers have been affected in order to grasp the nature of what that injury is and whether or not the new exploding exercises on the hallucinogenic drugs might, in fact, be a route to follow, particularly for the moral injuries. I want to always be optimistic that this research can provide us with more.
I will give you one last example, if I may. I had a sergeant who met with me a few years back in a shopping centre and introduced himself. He had been in for 12 years, served in an infantry regiment and had experience overseas. I asked him if he had deployed. He said that he had: five times between Yugoslavia and Afghanistan. I asked him what his job was in the regiment. At that moment, he instantaneously broke down — tears, unable to speak and trembling. I had to take him aside to the hallway, and we spoke, and it took about five or six minutes to get him back. He said that he had been back for over five years, and he still had not hugged his children because he was a sniper, and he had to take out the children — girls, some of them pregnant — who were used as suicide bombers.
That’s the depth of what this injury is. More research and more profound work has got to be done. Yes, we’re moving ahead very well on PTSD, and I’m very proud of that and of the peer support program that exists in the forces and that Veterans Affairs is supporting. But in moral injuries, we have not fully grasped the extraordinary breakdown of the individual’s capability of coming back to normalcy — to the normal life — because everything that they live by has been attacked.
Senator Yussuff: Thank you, honourable former senator and colleague Dallaire, for being here today. I can’t say enough about your leadership but equally about your efforts previously on this committee to try to focus our work to try to help veterans in this country. Of course, we are trying to follow in your footsteps in a small way on the work we are doing here. You being here today is truly an honour.
One of the areas we have focused on in regard to our work is to try to deal with PTSD. It’s still a big issue for veterans who come back and have been back from tour. But fundamentally, there are evolving treatments. Psychedelics has been one of our focuses as we try to understand their development, the therapies out there and, more importantly, what we can recommend as a senate committee and hopefully complement other efforts the government has been utilizing.
Is there any opinion you want to share with us? We see this as a developing area that’s worthy of effort but equally has support from the government. However, our work has not yet concluded, so anything you can offer will be extremely important to the committee.
LGen. Dallaire: Thank you very much. I want to indicate to you, colleagues — if I can even still use the term; if I’m allowed — that we can’t treat only the individual who is injured. We must include the family, for the family is also suffering from these injuries — the impact of these injuries on family life — and so are the children.
My wife was the general manager of the Valcartier Military Family Resource Centre for 25 years. The first step, as the defence policy in 2017 was able to influence, is to recognize that the families are part of the operational capability of the forces. They’re not in support; they’re part of it; they live it. We had a case of a soldier talking to his family on Skype. An hour later, he was deployed and two hours later he was killed in action. The families are on the front lines, and whatever we’re producing has to have that sort of attachment to the family.
Specifically in regards to your question on the different drugs and so on, the history I have is that marijuana, depending on what type, was not a cure but simply sort of a camouflage — a sort of settling of the individual so they hopefully get therapy and to stabilize them. That was certainly the most critical point.
I was at the University of Southern California at the centre of research they’re doing for the U.S. forces. I have been treated by the American veterans administration out of White River Junction in Vermont. They have five huge clinics on PTSD in the States. The world of the new drugs that they and the other witness here today are speaking of — I believe we have to do serious research on that, absolutely. It is an arena that goes beyond the pills and can be extraordinarily helpful in stabilizing and bringing people to a level where the more classic therapeutic instruments can then finesse it and bring it closer.
We should be encouraging research in drugs such as hallucinogens, LSD and so on. In fact, when I was serving in Germany, they used to create a lot of problems for us with guys driving tanks in little villages and plowing because they had flashbacks. I believe that, yes, you have to reinforce the research on these drugs with the appropriate procedures through institutions that have the ethical framework to do it and not purely through the industrial side, that is to say, the pharmaceutical side. I believe that medical research in academia, particularly, would be exceptionally welcome in order to advance that side of trying to bring us to grips with what we are living with and being able to attenuate it in a way that would permit us to evolve more positively to a certain level of normalcy.
Senator Anderson: Thank you to both of you for your presentations. My question is for Mr. Thorne.
You spoke of the importance of research, policy and regulation as it pertains to psychedelic drugs. We have heard from other witnesses about a shortage or a lack of professional resources for veterans.
In your work as a veteran service provider, is this a factor we need to consider in psychedelic drugs as a treatment?
Mr. Thorne: Could you clarify what you mean by “lack of professional resources”? Do you mean in terms of employment or —
Senator Anderson: Therapeutic resources to monitor the use of psychedelic drugs.
Mr. Thorne: Yes. Absolutely. First and foremost, that is where I think the government should place a large amount of its effort, making services more available and more accessible.
The most recent Veterans Ombud report told us that the median wait time for a Canadian Armed Forces veteran to have their claim reviewed and approved is 43 weeks. For RCMP members it is 39 weeks.
We know from doing this work for years that because of the cultural stigma, the components that the lieutenant-general spoke of in his testimony, veterans are often hesitant to ask for help. When they finally do reach out for help, it’s because their suffering is reaching an intolerable level. The fact that they may then have to wait months and months in order to receive support, we need to bridge that gap.
First and foremost, the best thing the government can do is reduce the barriers between the existing services that are there. Certainly, in any work around research for the delivery of psychedelic-assisted psychotherapy, it should be done through licensed professional mental health providers.
I hope that answers the question.
Senator Anderson: Thank you.
[Translation]
The Deputy Chair: I have a question for Mr. Thorne. Knowing that Veterans Affairs Canada just reorganized all of its services, particularly those related to mental health, do you still provide services to veterans?
[English]
Mr. Thorne: Yes, we are. We have been a registered service provider for Veterans Affairs Canada for 10 years. What that means is that the cost of attendance for veterans who attend our program can be covered by Veterans Affairs if they have the type of claim that makes them eligible for our program and if the paperwork gets done in time, essentially.
Historically, that has made up about a third of the veterans that we see. The remaining two thirds either do not have a claim with Veterans Affairs Canada at all or their claim does not meet the criteria for their participation to be funded.
As a matter of policy and charitable aim, we never turn those individuals away. If they ask for the program and our clinicians deem that it is safe, we will put them through the program. We absorb those costs through charitable funds.
What we have seen is that that historical third of our clients who have been funded by Veterans Affairs has been falling year over year, particularly throughout the course of the pandemic. I would say that at present, at most 10% of our clients are funded by Veterans Affairs.
It seems to be that there is a lack of awareness within Veterans Affairs staff about what our program is and the fact that it is even a registered service that is eligible for funding. My coordinators across Canada have been really struggling to essentially get Veterans Affairs to cover the clients that they should be covering.
[Translation]
The Deputy Chair: You provide services to veterans, but only a portion of those services are covered by the government. Is that correct?
[English]
Mr. Thorne: That’s right.
[Translation]
The Deputy Chair: How do you finance the services for veterans that are not covered by the federal government?
[English]
Mr. Thorne: Charitable funds. Our programs are supported by organizations such as the Royal Canadian Legion across Canada, True Patriot Love and other charitable organizations. Wounded Warriors was a supporter of ours for a number of years. We invest a lot of time and effort to raise those funds so that we can deliver the program to any veteran who asks for it, regardless of whether they have government funding. We never turn them away, and they never pay to attend the program.
Senator Busson: My question is for Lieutenant-General Dallaire.
It is certainly an honour, lieutenant-general, to have you here today. I have followed your amazing career. I used to be in the RCMP, and you spoke at a leadership conference that I sponsored years ago in British Columbia. People still remark about your lived experience and how much you have dedicated to veterans in both the Armed Forces and other first responders, including the RCMP.
My question speaks generally to Veterans Affairs and is a part of your lived experience.
It seems to me that the culture of the Armed Forces and the RCMP is a culture that is built on strength and courage and the “white knight syndrome”: believing that you are out there doing good things. Then you come upon people who have had their heart and soul ripped out of them in situations where post-traumatic stress disorder becomes an issue.
Do you have any comments, observations or recommendations for this committee about how we could perhaps be more proactive in finding ways to get these folks to self-identify? Generally, when it comes to post-traumatic stress and moral injury, most people hide those injuries until they cannot stand it anymore.
This is Veterans Affairs, but it seems to me that a lot of people who are the walking wounded are still employed, doing the job of protecting the world in the Armed Forces or communities in the RCMP. These folks, by the time they become “veterans,” are manifestly damaged to a point where they may have been helped much earlier.
Could you comment on that? I have perhaps made it convoluted, but could you comment upon how we could become more proactive and create a better environment for diagnosis and assistance to these people?
LGen. Dallaire: That is an excellent question. First of all, the organizations that you are speaking of are very male-dominated organizations. The egos are very strong. They are very visual organizations and Darwinian, which is to say that they don’t necessarily have much respect for those who are injured, particularly if it is an injury that is not visible, like PTSD and such.
The essence of the response to your concern that they are not coming forward, that we are not necessarily easily attenuating the impacts that these individuals are living with, is that the leadership is still not educated to show the compassion and empathy fundamental to their responsibilities to people who are put in harm’s way in one way or another, being traumas or operations. That leadership education and that respect for those who are walking wounded is still weak and not easily passed on from one generation to another. There has got to be a far more concentrated effort in recognizing that it is honourable to be injured psychologically, just as it is honourable to have an injury to your physical body. There should not be any stigma within the institutions; on the contrary, they should be proactive from the leadership side, the seniors to the juniors, to help out those who need it.
The second arena is that operational stress injuries, be it PTSD or even more so moral injuries, need the same sense of urgency of care that we give to physical injuries. Maybe you have seen the movie M*A*S*H. We have “MASH” out there deployed, which save 98% of the cases that are brought to them. We have handled the physical side magnificently, but we have not instituted within the medical professions, nor within the organizations that need these medical professions, this sense of urgency about the injuries of a moral or of a psychological nature. Until they are caught up, we will still be trying to catch up with a cancer that is growing inside of those individuals.
Last, things like the family support centres, as the other witness has indicated. Family support centres, only after years, were able to handle the cases of veterans. They are also handling the cases of families. They have to be reinforced and supported in order to attenuate the impact of the injury on the family and help the family assist the injured person in making their way through it.
Those are the core of the problems.
Senator Busson: Thank you.
[Translation]
The Deputy Chair: I would like to make a comment, Lieutenant-General Dallaire. Civilian medicine has made great progress in terms of treating physical injuries. However, both military medicine and civilian medicine are lagging behind in terms of treating psychological illnesses. That lag is affecting soldiers and society in general.
LGen. Dallaire: Mr. Chair, I spoke to many doctors about the COVID-19 pandemic. Human beings and doctors have the ability to function despite fatigue, despite injury and despite decisional or ethical trauma. They have the same attitude, which is that they do not recognize that they have been injured. Our organizations have that same tendency. They fail to recognize those who have been injured and fail to respect them. They minimize the consequences in order to try to bring them back. You are absolutely right in saying that these professions are negatively affected by this.
[English]
Senator R. Patterson: General Dallaire, it is wonderful to see you. I am your next veteran in the Senate, so I have big shoes to fill.
Thank you for all that you have said today. It is spot on. We really need to look after those who choose to serve, whether it’s with the Canadian Armed Forces, the RCMP or any of our first responders. And Mr. Thorne, thank you for all of the work that you have done.
I would like to target the conversation on psychedelics specifically. Both of you have made comments about culture. I can only speak of the Canadian Armed Forces, but we come from a culture of obedience. We know that when you are talking about the Arbour Report and the concept of consent, that consent can be a very challenging domain when it comes to rigidly hierarchical power-based structures, as militaries and police forces can be. When we are dealing with psychedelics, which are still in the research phase, and we start to talk about them in the context of veterans or serving members, this is the culture that they come from. One of the things that I wonder is, can they truly give consent when it is in the research phase?
Mr. Thorne, I really appreciate your comments on looking at policy and structure and what government can do in terms of this. I would like to get both of your perspectives on how we can advise on creating the right policy framework rather than targeting veterans as a subject group. How can we do it better so that we truly do protect their best interests while giving them the ability to consent in order to move forward with this type of therapy, because we know it is needed? Thank you.
Mr. Thorne: Your point is absolutely correct. Informed consent is a difficult component in research, but particularly for veterans who exist in such a strong organizational hierarchical structure.
It is a difficult question to answer. Certainly, we have experienced it when we deliver programs for veterans. We ask them, would you mind filling out this survey? Would you mind telling us about your experience? We always have to be very clear that this will, in no way, affect your ability to participate, and it will in no way affect the outcome for you. It is something that we’re well aware of when working with veterans.
It may be more difficult to research and to have good informed consent for people who are still actively in uniform who may perceive that their participation or the way that they interact with the study could affect their career. That is just a comment off the top of my head. I would have to think more in-depth as to whether or not that is accurate. For veterans who have left the military structure, their employment is independent from their ability to participate in the study, and they choose and volunteer to participate in that study, so it seems to me that, in that environment, you would have a greater sense of informed consent.
It is a difficult component for any research, but in particular for this type of research, given the nature and the effect of the substance. I am glad that you brought that up. That is actually something that I should have included in my testimony. But, yes, informed consent is going to be an incredibly important piece to get right and there should be government recommendations or policy to bolster it.
Senator R. Patterson: Thank you.
LGen. Dallaire: The question is absolutely pertinent to the extent that, in fact, the military — using that as a reference point — is still a very male-dominated, egocentric and probably misogynist organization. There is no proof that that has significantly shifted. Yes, there have been inroads made, but I would argue that the culture there is one where they have an operational leadership style, which is to achieve the mission no matter what. They do not have a garrison under a societal leadership style that would permit the flexibility that people need in order to be able to participate in full cognizance, and with no retribution or commentary, in research that could advance things like these new drugs or whatever instruments that we want to bring forward to assist them in being more effective and reducing the level of casualties later on.
I tend to hold veterans like myself accountable; we should be doing more today to assist the research in order to reduce the level of casualties in the future. Things are going to get more complex and ambiguous in the future. We should be encouraged to participate in the research and advance that.
In the Canadian Armed Forces, there is nearly an abuse of the operational essentiality context of leadership versus a leadership that has the flexibility to be more bienveillant, much more aware of the human being individually — not necessarily in an operational context but that is being prepared for that and also that is living within that sort of profession. That side of the house does not exist right now. That is why there is a need for reform in the leadership philosophy of the forces.
Senator M. Deacon: Thank you. To the lieutenant-general first: I think we might know the title of your next book. You certainly are sharing so much with us. We have read your books, and we look forward to you being unfinished in that work. It is a very important topic.
Mr. Thorne, I refer to an article we saw in The Globe and Mail a week ago with the mindset that we need to tap the brakes on promoting the use of psychedelics. I heard your comments at the beginning, and I want to come back to this. The article in The Globe and Mail, quotes a paper done by three scholars at Johns Hopkins University.
I would like your opinion on some of the quotes from these scholars at Johns Hopkins:
Psychedelic research currently appears to be trapped in a hype bubble driven largely by media and industry interests. . . .
. . . However, in the past few years, a disturbingly large number of articles have touted psychedelics as a cure or miracle drug. . . .
. . . The potential for blowback is real.
Given the state of mental health care for our veterans and given the urgency, would you agree with their caution, as you highlighted at the beginning of your comments, or do you think the potential rewards — and I hate the word “rewards,” but the potential benefits, urgent benefits — outweigh the known risks of these substances at this point?
Mr. Thorne: That is a fantastic question. I read that article as well, and I have thought about this question or a question similar to this. It is difficult to wrestle with, knowing that there is still very much a mental health crisis amongst veterans and in the Canadian Armed Forces as well. The need for services is there, absolutely.
Counterbalancing the need for research and progress is the need for it to be well informed, professional and ethical. The fact is that it cannot be done that way unless it is slowed down to some degree. Counterbalancing this with the need is really difficult.
My answer would be that we have services that we know work currently existing today. The best thing that the government can do, if it is worried about the urgent need of mental health, is to reduce the existing barriers to those services.
A service time of 43 weeks means that there are barriers between veterans and the help that they need. Those barriers need to be reduced. That is one of the best things the government can do in terms of investing time and resources.
By no means do I think we should ignore new and emerging potential treatments, because some of the research does look promising; however, the potential for harm is very real.
I would be inclined to agree that, yes, the process needs to be slow; it needs to be professional and ethical, and it cannot be driven by hype.
Any time we see a new intervention or any new wellness product — whether it is the keto diet, cold plunges or anything like that — there is always an enormous amount of interest and hype behind it. The potential for harm here is very real. If we do not get the standards, research and policy right, the risk is that industry and the people who are seeking help and who need help may end up investing in or pursuing treatments that could have a damaging effect.
We still do not understand the long-term effect of taking these substances. We still do not understand fully when they should not be used, what the contraindications are.
Again, it is about balancing that difficult question. Yes, I think it needs to be slowed down and it needs to be professional. In the meantime, if we are looking to meet the urgent needs of veterans, there are many existing services that we know can help. The big challenge is the administrative barrier between the veteran and those services.
Senator M. Deacon: Thank you for that.
General, you talked about the impact and the attention and care that needs to be integrated with the families of our military and veterans.
Last Veterans Day, I had the opportunity to visit a model in the States where families, including the veteran who had returned home recently, were in a 90-day program. That program included everything: mental health, physiotherapy, massage therapy, counselling and family and financial counselling. It was a vigorous and thorough attempt during this transition period.
I know we have some of these programs in Canada. I have heard the names of some of them.
From your viewpoint, do you think we are getting that right, that we are moving slowly on it, or are there pieces of this that keep you awake at night?
LGen. Dallaire: I still have dreams that keep me awake at night, so this is just adding to that.
If I may, firstly, to Mr. Thorne, to comment on the drug side. I do not think we want to stall or reduce the speed of research on this material, but it has to be done in what I consider to be the most intellectually rigorous institutions, the ones who know about the problems of veterans, such as some of the universities and institutes that are engaged.
This cannot be a commercial exercise. It has to be an intellectually rigorous one and one with ethical standards. We cannot reduce it or stall it. We have to move forward. That is a difficult scenario to meet.
With regard to the families, thank you very much for raising that. I joined the army when they used to tell us that if the army wanted you to have a family, they would have issued you one. Then, we finally permitted people to go home when their wives were having babies, and so on.
Today, Veterans Affairs are looking more at the family side of things; however, the Veterans Charter — which we had suggested should be the “veterans and family charter” — does not have that same power with regard to the families.
If you treat only the member and not the family, you will not achieve the aim. So many families have had their futures destroyed because we have not, as an example, reinforced the family support centres and Veterans Affairs’ input into the family support centres.
During my wife’s latter years, they finally started to take care of veterans. They were getting veterans from World War II coming in, but the families were not part of it. When a member leaves the forces, the family gets no support from the family support centre. To me, that is an area that needs to be reinforced. Because they are integrated into the local communities, this can be a great stepping stone in terms of helping the families come forward. Not putting the families on par with the injured individual is putting the families and the individual at a disadvantage in terms of actually seeing a positive result.
Lastly, the Americans have the GI Bill, so the families are taken care of by the military. In Canada, we do not have that.
Senator Yussuff: Mr. Thorne, you offered some recommendations and guidance as to how psychedelics could be studied properly and in a way that would be evidence-based and have rigour in the context of its use, if the evidence base confirmed its use.
We have heard from those who have testified before the committee that there seem to be positive results when it is done in the right way, with therapists, and ensuring that it is the proper way of doing it. The suffering of veterans is something we all want to get at and, ultimately, help. No one knows for certain and the evidence should prove that this is the right way to address this issue, given the deep-seated challenges involved, to overcome the PTSD that veterans are struggling with. In absence of doing that, people will continue to suffer forever, and we can’t accept that anymore.
Would it be helpful for you to submit your recommendations to the committee in writing so that we could have it for evidence and so that we could include it in the recommendations that we will put forth when we do our bill?
It’s always a challenge in the context of this work that one does on behalf of the men and women who have sacrificed so much for our country. I want to thank you not only for being here but also for the work you are doing on behalf of our military personnel across the country and the care you take when they come to ask for services. You don’t treat them differently because they don’t have resources or because the government is not funding these services. Thank you so much.
Former senator Dallaire, this is a rare occasion for us. It’s encouraging in terms of the ongoing work you are doing. You have said that the Veterans Charter, as wonderful as it may be, needs to be updated to include families. We are living in 2023 and, ultimately, our country can evolve in trying to ensure that families, who are an equal part of the support of the men and women of this country, should have the same access to service as they do in the United States. That should be something we can tackle as a Veterans Affairs Committee going forward. Thank you so much for recommending that.
It’s always good to see you. I think the last time I saw you, you were speaking at a union event at my union in Toronto.
LGen. Dallaire: Well, I hope you didn’t go on strike after that.
Senator Yussuff: I don’t think you dissuaded us from doing so.
[Translation]
The Deputy Chair: In closing, I thank you, Mr. Thorne, for the outstanding work that you do with veterans. I was surprised to learn that your organization has to fund some of its services. The committee has taken note of that.
Lieutenant-General Dallaire, we have something in common. You championed the Veterans Charter and I did the same for the Canadian Victims Bill of Rights. A charter or bill of rights is not an end in itself but a means to an end.
Today we saw that a lot of work still needs to be done to improve the Veterans Charter so that families are included. We know the sacrifices that families make when soldiers serve for 30 or 40 years, when they serve on the battlefield and when they are away from home for months at a time. When soldiers return home mentally and physically exhausted, the family is often their safe place to land while they rebuild their lives.
I think that your testimony was very helpful and I want to thank you for the service you give to the country, that you gave to the Senate and that you continue to give.
That ends our meeting, honourable senators. Our next meeting will be held on March 8 at noon. I wish you a restful two weeks. I think we are going to have a very busy spring, and we are counting on your cooperation.
I also want to thank our interpreters who always do a very professional job. We really appreciate it and we thank you for sticking around even though we went a bit over time.
Honourable senators, I thank you for your questions and commitment.
(The meeting is adjourned.)