Proceedings of the Subcommittee on Veterans Affairs
Issue 3 - Evidence, February 26, 2003
OTTAWA, Wednesday, February 26, 2003
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12 p.m. to examine the health care provided to veterans of war and of peacekeeping missions; the implementation of the recommendations made in its previous reports on such matters; the terms of service, post- discharge benefits and health care of members of the regular and reserve forces as well as members of the RCMP and of civilians who have served in close support of uniformed peacekeepers; and all related matters.
Senator Michael A. Meighen (Chairman) in the Chair.
[English]
The Chairman: Honourable senators, today, in our continuing examination of the question of post-traumatic stress disorder, we are fortunate to have with us a witness who has appeared before us once before. I refer to Lieutenant- Colonel Stéphane Grenier who, when he appeared before us last, bore the title of Major.
Appearing with Lieutenant-Colonel Grenier from the Department of Veterans Affairs Canada is Ms. Diane Huard, Director, Canadian Forces Services Directorate, and Ms. Kathy Darte, Special Project Officer, Research and Information Directorate.
Please proceed, Lieutenant-Colonel Grenier.
Lieutenant-Colonel Stéphane Grenier, Project Manager — Operational Stress Injury Social Support, Department of National Defence: Honourable senators, I will endeavour to provide you with the context in which I now find myself in the position of managing a program to help injured veterans and serving members. I will start by saying a few words as to what brought us to putting the program together.
Until the war on terrorism started, members of the Canadian military had not been involved in a high intensity conflict since the Korean War. I say this in the context of the high intensity battlefield that we came to know during World War II and what then was traditional soldiering. However, that is not to say that Canadian soldiers have not suffered the consequences of conflicts around the world. Canadian Forces personnel from all elements have played an important role in practically all the United Nations and NATO peace missions since the inception of the Lester B. Pearson peacekeeping model.
Over the course of the last decade, our sailors, soldiers and air personnel have participated in an ever-growing and demanding number of military operations around the world.
Although they have served Canada with great distinction, the service to world stability and peace has not been without a price. This price of Canadian involvement in peacekeeping and peace support operations has been calculated in many ways. We can count the number of ships we send overseas and how many bullets and rations we buy. Another way to calculate the price of these missions is to look at the number of lives we have lost. We have lost over 100 soldiers since the peacekeeping model began.
Beyond this official casualty list, however, we can no longer ignore that these operations cost Canada and the Canadian Forces an incalculable and significant number of wounded service personnel. These casualties are not the victims of stray bullets, land mines or vehicle accidents; they suffer from operational stress injuries, or OSI. Unlike physical wounds, operational stress injuries are not outwardly apparent. They often go unnoticed for months or years by superiors, peers and, in many cases, the injured members themselves. To those who eventually come to realize that they have been injured as a result of operational stress, coming forward for help is not a viable solution due to the negative stigma associated with this type of illness or ailment.
Operational stress injuries such as anxiety, depression and, of course, post-traumatic stress disorder translate into very real symptomatic responses which cause various types of difficulties, including substance abuse, decreased performance, decreased concentration, family problems, divorce, violent outbursts, anger and suicide.
In many cases, leaders and peers interpret these behaviour changes without realizing that these soldiers are affected by operational stress injuries. They do not scratch below the surface but look at the symptoms. I have often heard, "Well, the guy is a drunk;'' or, "He's a wife beater.'' Those who suffer from OSI have had their image of fairness or stability of the world so disrupted that they are forced to devote much of their time and energy adjusting to the emotional disturbances that this has caused and continues to cause long after their return home.
Research has shown that the likelihood of developing chronic post-traumatic stress disorder depends on pre and post factors, in addition to the features of the trauma and the experiences themselves. The severity of the trauma is certainly a big factor in determining the outcome of the illness.
There are other things such as social support and individual coping skills that also help pre-determine the outcome of the illness. According to this research, something as simple as social support has shown to have a consistent, protective effect against psychological distress, as well as reducing the risk for functional disability.
In combining this with my own experience in dealing with trauma and stress over a 10-month tour in Rwanda, and in shorter deployments in Haiti, Cambodia, the Arabian Gulf, and other troubled areas, I designed and proposed a simple project that would assist those affected by operational stress injuries, such as myself. The Department of National Defence and Veterans Affairs Canada accepted the proposal and have supported my efforts in implementing a simple concept.
The operational stress injury social support, which I call the OSISS project, was initially launched under the authority of General Couture, who is my boss, in May, 2001, after I sent him a long-winded e-mail, and I proposed this concept out of the blue, overstepping the chain of command. I sent him an e-mail directly, and he responded. It was launched in May 2001. It later received Armed Forces Council endorsement in October 2001. Shortly after, Veterans Affairs came on board as a partner in the project and, as you said, I have with me today Ms. Huard and Ms. Darte who are with Veterans Affairs Canada.
The Chairman: Could you tell us who makes up the Armed Forces Council?
LCol. Grenier: The Armed Forces Council is chaired by, if I am not mistaken, the Chief of the Defence Staff and the commanders of the navy, army and air force. All three elements have recognized that this is a reality that everyone has to deal with, whether you fly planes, sail ships or drive tanks.
The mandate of my project is divided into three large parts. The first part is to create a nation-wide peer support program for CF members, veterans and their families. This element of the project provides social support enhancements as the intervention mechanism for military members, veterans and their families. Simply said, we are trying to reach out to those who do not come forward. The people who have sought medical help, we will, of course, continue to help. However, our primary concern is those people who are in their basements, isolated, and do not want to come out and seek help.
The second part of my mandate is to help the Canadian Forces validate the development and further development of education packages and pre-deployment training modules. I will not do this alone. I am doing this in partnership with other organizations within the department. Certainly, the peer support network is important, but we need to better understand this within the military community.
The third part of my mandate is about attitude changes. People around me in 1994 thought I was a basket case, and no one around me recognized what had happened. Therefore, we need to change those attitudes, in the course of education, in order to better understand and cope with and support our people in defence, as opposed to relying on a peer support network only.
The peer support network component of my project is the element that has been developed most since the beginning of my project. Clearly, both General Couture and I agreed it was an important need to be filled, and that is going well. To date, the network has reached out to well over 400 serving members, and I would point out that we have not advertised. We have not circulated pamphlets and posters. This has been achieved by word of mouth, mainly by the individuals who work for me. They are good at beating the jungle drums, reaching out to those people who need help.
Currently, we have eight peer support coordinators. These are injured veterans who I have hired through the employment equity program of National Defence to conduct peer support activities, which involve a wide range of activities, from the simple task of having coffee with somebody at Tim Horton's, giving the veteran a tap on the back for treatment compliance and giving hope to the member that he will get over the secondary effect of the medication, all the way to full-fledged suicide interventions. Eight sites are active.
I said that our network has reached out to 400, but our official statistics this morning indicate that we have reached 432 people.
Ms. Huard, Ms. Darte and I are open for questions and discussion.
The Chairman: As you can see, there is a great deal of interest. Our best and our brightest are here listening to you. They all have questions for you.
Senator Day: We appreciate your second visit with us.
LCol. Grenier, in describing what you did, the fact that you did not follow the normal chain of command, that was symptomatic, in part, of the fact that you were suffering from a serious problem and you felt you had to take control; is that correct?
LCol. Grenier: That is partly right. I went to General Couture when I produced a video called Witness the Evil in which people who served with me in Rwanda appeared. General Dallaire could not be at the launch of the video, so General Couture came in his place.
For about half an hour in 1998, we talked about what was missing. He basically told me to put pen to paper. I did not go around the chain of command because I did not trust people. I went to him because, unofficially, he told me to flesh this out and give him some substance. He said that he liked where I was going. He made several generic comments like those that I hope he remembers.
Since I had a bit of spare time, I started reading and doing some research, and I came up with this. It is when Christian McEachern drove his SUV through a building that I decided that this had taken too long. That was the catalyst for me to put it on paper. That is how it happened.
Senator Day: We are glad you did.
What you have described, the reaction and the sympathy that you found in General Couture confirms our knowledge of the General. He has been before our committee on occasion, and we are pleased that you had that source to go to.
From a definition point of view, could you help me with the difference between an operational stress injury and post-traumatic stress disorder?
LCol. Grenier: I cannot give you an accurate definition of post-traumatic stress disorder. As you know, I am not a medical doctor, and I would refer to, perhaps, psychiatrists and others. It is fully defined. However, in my layman's interpretation, post-traumatic stress disorder is a medical condition. In developing this program, I think it is important for those of us who are not doctors to "demedicalize'' all of this for the soldier. Critical to me was the fact that it should not be called an "illness.'' When I came back from Africa, I had not contracted an illness; I was injured.
We have defined operational stress injury, so perhaps I can give you what might be half an answer to your question. The official definition of an operational stress injury, or OSI, is any persistent psychological difficulty resulting from operational duties performed by a Canadian Forces member.
The term OSI is used to describe a broad range of problems that usually result in impairment of functioning. OSIs include diagnosed medical conditions such as anxiety, depression and post-traumatic stress disorder, as well as a range of less severe conditions; but the term OSI is not intended to be used in a medical or legal context.
"Operational stress injury'' is a term that our project branded to give it a non-medical name and to catch a wider array of people presenting problems. When we created this program, I did not want to simply target people who were diagnosed with post-traumatic stress disorder because we know there are wider problems.
Senator Day: For the purposes of this committee hearing, can we assume that any Armed Forces person, active or retired, who has been diagnosed with post-traumatic stress disorder, has and is suffering from operational stress injury?
LCol. Grenier: Yes. That was my intention when I created the term OSI.
Senator Day: You have eight peer support coordinators at the present time. Where are they located?
LCol. Grenier: They are located, from west to east, one person in each of Victoria, Edmonton, Winnipeg, Petawawa, Val Cartier, Quebec City, Gagetown and St. John's, Newfoundland. We plan on expanding this summer to five additional locations. It is difficult to recruit the perfect match for the job, but we are hoping to set up sites in Vancouver, Halifax, Borden, Montreal and the southwest part of Ontario.
Senator Day: What kind of training would these individuals need to be recruited for this particular job? Are they trained by the Armed Forces?
LCol. Grenier: We have put together a two-week training course with three main elements to it. The first and easy element is to explain the OSISS Project, our mandate, how we operate, who I am, what I do and how they report to me — all of the administrative side of how we do business.
The second element is how to broadening our veterans' understanding of the services and programs. Over the last couple of years, many services have been developed. If they were released in 1993 or 1994, those services may not have been available. We want to broaden their knowledge of what is available and how to connect to the services for the injured community. There is a fairly significant range of information to widen the horizons on the array of services and programs that are available.
The third component, which is mainly taken over by Ste. Anne's Hospital, the Veterans Affairs side of the shop, is what we call skills development. We do not want to take a veteran and turn him into a mental health professional, but there are certain things we need to emphasize such as communications skill, listening, empathy, boundaries and how not to breach them, how not to diagnose, and, mainly, self-care. Most of the peer support coordinators are diagnosed with post-traumatic stress disorder and self-care is a huge component. If I want to keep this program alive and well, I need to ensure my peer support coordinators do not work too much. I have no doubt that these people put in an honest day's work. My challenge as a manager is to rein them in and to slow them down because they often want to save the world. Self-care is a huge component.
Ms. Darte, who has a nursing background, can develop the self-care issue.
Ms. Kathy Darte, Special Project Officer, Research and Information Directorate, Department of Veterans Affairs: Following up on the training aspect, the two-week course is the basic course that is given when people enter the program. We provide more advanced training anywhere from six weeks to two months after the initial training. We then focus on things such as crisis intervention and suicide intervention.
We again focus on the self-care component. Self-care is a very important part of this project because, as LCol. Grenier has stated, all of these individuals have been diagnosed with post-traumatic stress disorder or another operational stress injury. They are all in various phases of recovery themselves. Before we take them into the program, we screen them. We have information from their treating therapist, whether that be a psychiatrist or a psychologist, to find out whether these individuals are well enough and far long enough in their own recovery to do this kind of work. We want to keep them healthy so that they can do this important work. We do not want to traumatize them. Self-care is extremely important. We focus on that.
Through our veterans' hospitals in Ste-Anne-de-Bellevue, we provide a strong self-care component whereby one of the psychologists is directly involved with the program. Every two weeks, he has a teleconference with the coordinators and he focuses, not so much on the work that they are doing, but on their own health and well-being.
The door is always open at Ste. Anne's. The phone line is always open. Peer support coordinators can call there at any time for any kind of information, whether it relates to their work or to their own health and well-being.
The Chairman: The committee is hoping to visit the hospital early in April.
Senator Day: The eight who are currently employed were all serving military at one time who were recruited, I think you said, from the military's employment equity program?
LCol. Grenier: I hire them through the government hiring process, because they have a disability that is recognized by the government.
Senator Day: Are they still in uniform?
LCol. Grenier: No, they are not, with the exception of one individual in Petawawa, Rick Noseworthy. He is still serving. The military has allowed him to invest his time in the program, as opposed to in other things. When he is released in a month and a half from now, I will hire him into the job. He has been doing this for a year now.
Senator Day: Do you expect to hire the five others with a similar approach?
LCol. Grenier: Yes. The employment equity program, as far as I know, works miracles. We do our own screening. It is not a formal competitive process with exams, but it is competitive in the sense that the medical community is actively engaged in identifying suitable candidates. I do not freelance out there. I do not look in the injured community for someone I want to employ. I am not the one to judge whether they are healthy enough to do this. There is management of expectations. The first level of screening is medical. Then Ms. Darte and Jim Jamieson, who is our appointed liaison within DND, and I interview candidates. We pick the best person for the job. The employment equity program is the mechanism I use to actually hire them.
Senator Day: Presumably you would have quite a pool of people from which to hire. We received evidence that, because of the frequency of deployment in the past, in excess of 50 per cent of returning soldiers are suffering from some level of operational injury.
LCol. Grenier: There is no doubt that there are many injured people out there. I am not sure if a 20 per cent range or a 50 per cent range is accurate. You are right; there are a lot of people out there. Everyone who has an operational stress injury wants to help someone else. However, there is a safe way to do it.
Boundaries are very important because we do not exchange war stories like hockey cards. We just do not do that. It is not healthy for us or the person we are trying to help. We do not pretend that the world is rosy and that this will be an easy path to recovery. We certainly encourage people to look ahead and not to look back, but we try not to slip into the war story part because it is not conducive to what needs to be done.
Although many injured members out there want to help and get involved, it is a very delicate process to pick the right person at the right time in his or her recovery, because we all go through an anger stage. Anger is part of the symptomatology, I gather. At first I was diagnosed with a personality disorder. I could not get along with people.
Senator Day: How long were you in the Armed Forces by that time?
LCol. Grenier: I was a captain then, and I had been in for 14 years. I had been able to get along with everyone all my career, and all of a sudden I was diagnosed with a personality disorder. Well, no wonder. Now that I know what I know, of course I did not get along with people. To be quite frank I was a basket case. The people around me who I used to work for must have thought: "What the hell happened to him, all of a sudden? He comes back, we give him a month off, and he comes back and he is yelling at people and slamming doors and taking off.'' That is what happens.
Once a person is over that, those are the people we are looking for, not because we do not want to deal with the angry people, but because they need to get over that in order to help others.
You are right, senator, there are many people to pick from.
Senator Day: This has been helpful.
Senator Banks: I should like to congratulate you on your promotion. Good for you. More important, thank you for taking the initiative to pursuing this. That cannot always have been the easiest thing to do.
Who pays the salaries of the peer support coordinators? Are they working for DND?
LCol. Grenier: They work for National Defence and they are paid through the centre, the Directorate of Casualty Support Administration, which is a joint venture between VAC and DND.
Senator Banks: You are a VA person. Are you seconded to this program, which is essentially a DND program?
I am looking for the governance link.
Ms. Darte: It is a partnership program. I am still working with Veterans Affairs. Veterans Affairs has made a number of contributions to the project overall, such as human resources, and I would be included in that. We also make a financial contribution. The training and the support come from Ste. Anne's Hospital. The peer support coordinators, where appropriate, are working from Veterans Affairs' offices. For example, the peer support coordinator in Victoria is working from the Veterans Affairs' office, as are the coordinators in Edmonton and Winnipeg. Six out of the eight are working out of VAC offices and two are working from bases.
Again, that adds to the support we want to put around these individuals because, as you well know, there are health professionals in the VAC offices and they provide support to the peer support coordinators.
Senator Banks: When we visited what I believed to be a peer support group in Edmonton, at CFB Edmonton, it was on the base. Are we talking about a different group?
LCol. Grenier: Most likely. Our program does not really focus on group work. Peer support is not a term that I own. Peer support happens naturally within units. Social support happens naturally in society, so there are various clusters of this type of activity happening across the country. One of the selling points of this program was that there are safe ways of conducting these types of activities and there are unsafe ways.
You cannot prevent a bunch of veterans getting together at a Tim Horton's and exchanging war stories like hockey cards. Do we know it is healthy? It is probably not the best thing to do. Is it happening? Yes. What we have tried to do is formalize a program because it is happening, and the peer support groups will get together under the auspices of mental health professionals, which is a safe route to take. It will happen under our auspices in some cases, and in some cases it happens ad hoc. A bunch of guys get together and they have dinner and they chit-chat about old times.
You could have bumped into a peer support group, which is either self-started or sponsored by a mental health professional, and this is not separate, it is the same kind of function, but our sole focus is to reach out to those veterans, encourage them to come out in the open, and encourage them to get on the path to recovery.
Senator Banks: I will use the Edmonton example specifically. Is there a synergistic relationship between these groups? The one that we saw, which I believe was a function of the base commander, on the base, in the community centre, consisted of about five people who dealt with operational stress injuries. They obviously know that other groups exist and they cooperate.
I am very interested in the distinction you make between illness on the one hand, which is how these kinds of things used to be generally regarded, and injury on the other, which is quite a different thing.
My question relates to the existence of OSIs, as you describe them. PTSD we have heard about for a long time and it certainly cannot be a surprise to any member of the Armed Forces of this or any other country. I am wondering what your take is on why there is still — and you suggest there still is — a stigma attached to this diagnosis, whereas someone who hammers a nail through his thumb would clearly accept that he was injured and there would be no stigma attached to that.
LCol. Grenier: Senator, you started by saying that PTSD is no longer a surprise. I can tell you that it was a surprise to me. It was easy for me to take the plane and go overseas. It was easy for me to do everything I was asked to do overseas. However, as the mission went on, it became harder and harder for me to put my boots on in the morning. It was very difficult to come back home, and very difficult to reintegrate into my family. When I became suicidal, it was very difficult to drive to the hospital one morning in uniform, and argue with a health professional about whether I could see someone.
Things have changed for the better. However, it is certainly a surprise for the member who comes back home to discover that nothing works any more. He cannot concentrate. He has headaches all the time. He feels sick to his stomach, and he wonders if he is falling apart. He is snapping at his kids.
Senator Banks: Did it occur to you at that time that this could be an operational stress injury?
LCol. Grenier: No, I had no idea. One night when I was lining up a telephone pole and wanting to drive into it, in a moment of lucidity I asked myself what the heck was I doing there. The next morning I went to the hospital. However, I sat in my car for half an hour wondering whether I should go in and what I would say. That leads me to the other part of your question, which is related to why we act that way.
We are no different from other Canadians. Recently Kathy and I went to a meeting in Toronto with the Canadian Psychiatric Research Foundation, who just launched — and you will have seen this — an ad campaign in The Globe and Mail or on Global Television to de-stigmatize mental illness in this country.
We recruit our people from Canadian society. We take them into a very macho society to do difficult jobs. In a sense, I would compare us to professional hockey players. If a player dislocates a knee on the rink, everyone recognizes that for what it is. However, if a player becomes depressed and becomes addicted to gambling or alcohol, people will look at that hockey player and simply say that he is weird or that he is becoming a drunk. No one knows how to deal with those types of problems.
We are no different from other members of Canadian society. What we have done now, though, through this — and I am happy that I am getting all the support I am — is we have realized that we have a moral obligation to support these people because we will continue to injure people. You cannot send people overseas and think that they will all come back as healthy as they were when they went over. Of course, physical injuries are a possibility. This is anecdotal, perhaps, but we are bringing a lot of injured soldiers back. We just do not see the injuries until they are far advanced.
I am not defending the department, senator, but the reality is that Canadian society does not understand mental illness as a whole. There is a Canada-wide stigma, and we are no different. We have a separate challenge because our culture is a bit harder and a little harder to get to. However, that is the third part of my mandate, and I will get there.
Senator Banks: I do not know whether you have looked this far yet, but with both illness on the one hand and injury on the other, programs are still being developed to do preventive things. On the one hand, we do certain things to prevent illness that do not deal with specific incidents of accident, for example. On the other hand, there are injury protection programs that deal with very specific situations for farm workers, firemen and people who work in steel mills. Since this has been defined by you as an injury, do you think there is a way, during the training process, in which a measure of some kind might be taken or to prevent this kind of injury in the same way that we say to people, "You must put on your safety goggles when you operate that grinder?'' That is oversimplified and an exaggeration, but is there a possibility of that down the road?
L-Col. Grenier: In answer to prevention, my answer today would be, no, in the same way that you cannot prevent a soldier from getting shot, or from stepping on a mine, or from getting shot by a sniper, or from a roll-over in the field and getting injuries. If I can use a simple analogy, when I was in Africa, I remember noticing changes in the field and wondering what was happening to me. The key is coping skills. That is my personal impression.
Senator Banks: Or early detection?
LCol. Grenier: Early detection, recognition and coping skills. We teach soldiers to face all sorts of threats. We give them coping skills to face threats. A simple analogy would be cold. When we deploy to the Arctic, winter warfare training has it that there are simple things soldiers can do as buddies to prevent the onset of frost bite. We teach soldiers to look for white spots. We stop every 20 minutes or half an hour — I am not aware of the latest practice — we pull the boot off and we look for white spots. We move the toes, and all this, and take a break and look after each other. Those spots are a little easier to look for because we can see them.
If we teach ourselves to look at people in the eyes after a traumatic event, after a long haul, after three full days of grinding work or bone-crushing patrols, and detect the early signs, we can then implement the right mechanisms in the field to intervene early and not deny the soldier the fact that he or she is not doing well.
A grenade was lobbed yesterday into the section's OP. The flack went all over the place. No blood had been shed, but then what? What do we do then? What do we look for?
That is key. I do not think you can prevent it, but early intervention is important, not from medical people but from the chain of command itself — the master corporal, the warrant officer, the lieutenant, the captain. If we operate in an environment within a culture that says it is not a bad thing not to be able to sleep or not to be able to put your boots on as fast as you did yesterday, people understand.
I remember a corporal who was my driver for a while in Africa. At one point, he ended up driving a vehicle alone, which was not part of standard practice. By mistake, he ended up cutting into a Rwandan patriotic army presidential convoy. He did not know because it was a bunch of beaten up trucks. They pulled him over, beat him and threatened to shoot him.
Senator Banks: I remember that.
LCol. Grenier: When he came back, the corporal came to see me and my warrant officer because we stayed together in the stadium there. He was breaking down, not because of what happened, but because everyone was making fun of him. They were all saying, "You should have reached for your frigging weapon; you should have shot these guys; you should not have done that.'' My opinion at the time was that that caused him more injury than the actual incident. He survived that quite well, but the culture to which he returned contributed to his situation. He was not able to communicate with anyone who understood. I did not know any better at the time. Although you do not develop a true friendship between officers, we listened and we said, "It will be okay.'' We did what we could, but officially we did not know what to say to this corporal. I did not know. Maybe I should have known. Maybe it should have been part of my leadership training to know what to do and what to say, and everyone else around him, because he did not recognize what was happening.
That would be my answer to the question. This is where I would like to carry the second part of my mandate, which is to validate education and training, to look at a particular situation from a veteran's point of view and ask, "What lessons can we learn here and what coping skills would have helped me better cope when I was there?''
These people are injured, but they are not crazy. They can still contribute. These are people I am pulling information from for the future.
Senator Cordy: As my colleagues have stated, you deserve a lot of credit for taking the bull by the horns and doing the work you have done. When you started, it was not, I guess, politically correct; that is to say, not everyone was jumping on the bandwagon.
You talked about helping people to heal and working in peer support groups. You talked about the process. You said there are safe and unsafe ways to do it. Who determines the process? Do you get together with people in the peer support group to determine the process or do the medical personnel do it? How do you determine the process to best help the individuals who need help?
LCol. Grenier: We have a psychiatrist from Veterans Affairs Canada who has contributed a whole lot to the program. This is another contribution VAC has made through the year. The psychiatrist works within VAC and treats serving members. As well, mental health nurses influence how we do things. We have psychologists from Ste. Anne's. Ms. Darte is not from a mental health background but she complements me very well. I come at this issue in a pragmatic, goal-oriented way, and Ms. Darte is saying from a health care perspective that we should consult this person. Through Ms. Darte and Veterans Affairs, we have been able to bring in the appropriate mental health professionals to ensure that we develop and do business in a safe way.
Senator Cordy: Another committee I am on is studying mental health and mental illness. You said that you are drawing military personnel from the mainstream of society, and you talked about the stigma of mental illness and how that is still a concern in our society. I know that the military is working on officers from the top, trying to instil in them the idea that people need help, and looking for signs of people who may need help.
Part of your mandate is to develop a methodology to effect cultural change within the military. How do you go about that? As you said earlier, this is occurring not only in the military but also in the mainstream of society, although it is certainly getting better.
LCol Grenier: I have a plan that we will look at in April to see if it makes sense. In fact, on April 9 I am holding our first Attitudinal Change Working Group; we chose that title. I am pulling together a wide array of people, some of whom are well in tune with the OSISS project, as it stands, but most importantly, veterans will be included. Ultimately, the mechanisms we put into place to explain to the chain of command and to soldiers in uniform, the realities of this threat to injury, are a delicate process.
We just cannot speak from one side of our mouth. We have to speak in a way in which soldiers can understand and not have to question. It has to be done in a credible way. My plan is not to put bureaucrats or medical people in place to destigmatize this but rather to put veterans up front — people who have gone through it. We have seen this occur in many kinds of issues. Mainly, it will be select people who unquestionably have the credibility and the respect from the people to whom they speak.
We live in an artificial world, unfortunately, in the military. We wear our pay scales on our sleeves, our degrees on our foreheads and our experiences on our chests. Therefore, the people that I think should deliver this information must have unquestionable credibility with the people to whom they speak. Fundamentally, we want to change the mentality that someone may be looking for another excuse not to show up to work or that someone is just a wimp.
I have people that have come to me that are not wimps. They are ranger-qualified and were paratroopers; they have eight medals, not three like I do but eight or nine medals on their chests. They have been out there and have all the credibility and the courses on their CVs, which show that they are not wimps. Therefore, to me, that is an easy solution, perhaps, but it is the key. It is not that the doctor is not credible but the doctor speaks in words that sometimes do not make much sense to me. If we are to reach people, the words need to be their kind of language delivered by a person that really gets it.
Now, we are developing these messages. It is one thing to talk about personal experience but we need to know what to say and in what format, forum and context, which will truly make a difference. Then evaluate that. I do not know but perhaps we could do a poll before and after, although our people are becoming tired of polls and surveys. We also want to develop a mechanism to measure the success of the effort.
Senator Cordy: If veterans are involved, they are more likely to realize that, if it could happen to this person whom they respect, then it could happen also to them.
LCol Grenier: That is right. No one is immune to this.
Senator Cordy: Would the pre-deployment education for the military individual include family members? This is along the lines of preventative measures that Senator Banks mentioned. You spoke earlier to your leaving, and that it was not so difficult, but coming home was the tough part. Do you involve family members so that they know what could happen? Could that make re-entry into the household a bit easier?
LCol Grenier: When I spoke about the peer support network earlier, I mentioned the eight peer support coordinators. A couple of weeks ago, we called in some spouses of injured soldiers to a two-day gathering. Four spouses, including my own, came to this meeting.
I would like to see a peer support program for spouses, simply because it is not easy for them; that is our plan. Part of the program would be to explain to spouses what happens when people deploy and what to expect. We are not there yet but it is in the plan. We hope that it will be a reality.
There are two important reasons for this: We owe it to those families and it will benefit our members. It is a part of the social support that they need when they return home.
I am not doing this for self-serving reasons for the member alone. Rather, there are fundamental reasons why the spouse deserves an opportunity to connect with people and to understand and normalize everything that is happening. There are also benefits for members. When they go home at night, they will experience an understanding environment, and that is worth gold.
That is in the plan but there is so much to do and so little time to do it. We are not there yet.
Senator Cordy: It sounds like such a practical plan that it has to work. It seems that you are headed in the right direction.
Senator Atkins: We know about attention deficit hyperactivity disorder, ADHD, which is a chemical imbalance, and that medication is prescribed for it. It is my understanding that there is not a medication to assist in this process of treatment but there are other measures.
LCol Grenier: No, senator, I do not like to disagree but medication is certainly part of the process. We, in the peer support program, do not advocate what worked for us because there is a plethora of medications, treatment practices and protocols. We leave the decisions, on how to treat and what medication to prescribe, to the mental health professionals.
We all have our own biases about what worked for us and what did not work for us. However, that is part of a boundary. Certainly, some medication did not work well for me. For a time, I was a zombie. I would take pills at eight o'clock at night and would start waking up at three o'clock the next afternoon. I would get lost on the way to work and get lost on the way home. It did not do me much good but other medication did help.
When some peers come to us and say that the doctor just prescribed a certain medication, we bite our lips. We may say that although it did not work for us, we know someone it did work for. We do not get into that simply because it is a boundary issue for us. Ultimately, we trust the medical system to do the right thing. We get involved actually in the reverse, which Kathy refers to often as treatment compliance. Even though a medication did not work miracles for me, we have to give it a chance when the doctor prescribes it because it may work for someone else. It may take a couple of weeks and the symptoms may go away. Trust the doctor and give it a chance.
The instinct, quite frankly, is to take the bag of pills and flush it down the toilet. I do not want to anger taxpayers but I flushed a lot of expensive pills down the drain. I hate to say it but that is the reality. However, it did not help me.
With respect to medication, we do not become involved. We stay out of that altogether because it is ultimately a medical issue.
Senator Atkins: Are there medications that can help?
LCol Grenier: Yes, definitely there are. I am on medication right now — on and off, depending on what happens. Yes, medication is part of the treatment but is it the solution for everyone? Probably it is not the perfect solution but medication works in many cases.
Senator Atkins: Are the people that you are treating still in uniform or are there many that are now retired?
LCol Grenier: We have a database and we keep track of how we do business. Of the 400, senator, our statistics show that it is, for discussion purposes, a 50/50 split. Of the people that have come to us, roughly 50 per cent are still in the military and 50 per cent are out of the military and are veterans. We do have, for the record, some RCMP members that have come to us.
Senator Atkins: I was going to ask you about that.
LCol Grenier: There are RCMP, WWII veterans, Korean veterans and Canadian Vietnam veterans.
Senator Atkins: You are treating people that might not even have been in an operational theatre?
LCol. Grenier: I want to ensure that I give the right impression. We do not treat people. I want to make that distinction because I know some doctors will wonder, what the hell is Grenier doing treating people.
We do not have a checklist of questions to decide to help somebody. If somebody calls us, we figure that they need help. Therefore, we will not check, Which deployment and did this really happen?
When I say operational stress injury, it does not necessarily equate to being deployed in the peacekeeping theatre of operations. As an example, consider somebody who has fallen overboard from a ship. I do not know how that would feel, but I do not think that it would be a great experience to think that you will be left in the middle of the Atlantic Ocean in a storm. You do not know if your shipmates recognize the fact that you have fallen overboard.
That is potentially an operational stress injury. It has nothing to do with flying bullets. Certainly, a pilot who ejects from an aircraft might think that he will die. I am not sure that is a great experience either. That is the context of the people that we are trying to help.
Senator Atkins: What about basic training?
LCol. Grenier: Exactly. Military operations start the day you join the military. You are on the range. We have an individual, as an example, who had to stand up on a target practice range to lift and lower targets. Bullets started coming down range because there was a miscommunication. This was part of a series of things that happened to this soldier that caused him to be injured.
Therefore, there is no discrimination based on how the injury occurred. Once you have been injured, your life perspective changes.
We would rather be more conservative and catch everyone than start pigeon-holing and stove-piping and saying no and yes. We accept most everyone that comes to us.
Senator Atkins: You see this as a problem for people who are fire fighters, police, the RCMP or whatever.
LCol. Grenier: Definitely.
The Chairman: Even a senator.
LCol. Grenier: I will give you my number, senator.
Senator Atkins: I think the chair is suggesting that I need it.
Senator Forrestall: I want to congratulate you. I want to ask a technical question.
You omitted Halifax. Do we send them downtown to the local doctor? That service is there even though your group has not been extended to that area yet.
Take heart. What you are doing is doable. I draw your attention to the work done, with a struggle albeit in the beginning, by people who recognized that some children learn differently. It was a massive problem, not really in the medical field but not outside of it either. It is similar to the area in which you work.
These people managed to convince many other people of that difference. They were leaders and unheralded to my knowledge. Without great fanfare, thousands of schoolteachers now know how to identify a child who does not hear well or who does not read in the same way as his buddies. Hundreds of thousands of children have benefited from non- professional but concerned help.
We have Boy Scout leaders, teachers and youth support leaders who can identify certain symptoms because they have been trained. Three weeks of training goes a long way.
Your job is not necessarily to teach somebody, but to draw to their attention what something different could mean, and probably does mean.
Draw heart from what you are doing. You will get the answers and the resolutions to your problems.
In your comments and what I have heard, I find an enormous gap with respect to that soldier who comes home, has a chat with the doctor and goes back to his job in the warehouse. It would be a reservist. I am sure you have not forgotten about the reservist, but is he or she part of the early stages of your project?
LCol. Grenier: We did not target anybody specifically. When I came up with this plan, I did not say that we will target the regular force first, and then we will go to the reserves afterwards. To be honest, I looked at the map of Canada and wondered where I would employ these peer support coordinators. Although I knew there are reserve units in northern Saskatchewan that often augment our regular force units, I also knew that we have large clusters of regular force people.
My decision to position the peer support coordinators in Edmonton, as an example, versus northern Saskatchewan was not because my motivation was that the reservist does not count. It was simply to position the peer support coordinator in an environment where there is lots of business and give him or her the flexibility to travel and outreach into those rural communities.
These people are hard to get to. We are doing our best.
I was speaking to Senator Banks earlier. I mentioned that our peer support coordinators, in some cases, are deliberately and systematically going after units. They are giving briefings and spreading the word in their own ways and allowing people to make the decision to call.
It is hard to reach out to somebody who is locked in his basement and will not call anybody. We can reach out and say, "My hand is here if you want to grab it.'' This exercise is happening as we speak.
In the prelude to your question you used the word, "recognition.'' I would beat myself after this if I did not take the opportunity to talk about recognition with people like you.
The lack of recognition of what soldiers do overseas is part of the lack of social support when soldiers come back. The amount of social support the troops received when they returned from Afghanistan — perhaps it was caused by the friendly fire incident and media coverage — should be provided to every soldier who comes back from overseas. However, it does not.
It is not because DND does not want to provide that social support. It is because there is no understanding of what our soldiers do overseas.
I do not want to appear critical of Canadian policy or what we put on our ten-dollar bill. However, ultimately, the image that people have of peacekeeping every time they spend the ten-dollar bill is not the image that I have in my mind. It is not the image that most veterans who are injured have in their mind when they have trouble sleeping. It is a very sanitized and pretty image of what we do.
Do we merely hand out candies? Sure, I gave candies to little children, but the recognition for the reservist going back to northern Saskatchewan, reintegrating into his or her unit is when people say, "Welcome home, go on a month's holidays and you can go back to your old job.'' This is part of the recognition but really, on the street, you do not see or feel it, and that hurts.
I know there is no magic solution, but I did not want to walk out of this place today and say that I had an opportunity to talk to senators and tell them that Canadians at large do not understand and recognize what these people do, and I did not. I am sorry. I went off on a tangent there.
Senator Banks: You are not talking about just the support of the direct community, of your family and the other people in your unit. You are talking about civic support.
LCol. Grenier: Yes, definitely. I think that I should like to meet the soldier who would call me a liar, who does not feel — when he is walking in the mall, picking up some milk or underwear on his way back home, and wearing combats because he is being deployed — that the serving soldier today is not supported by Canadians at large. It is hard to pinpoint, but certainly, the people who went to Afghanistan had a specific purpose. Everyone was riled up. There was a cause. They came back and everyone was treated like a hero. That is great, but it left a lot of people thinking, "When I came back, I took a cab home and when I crossed the door of my home, I fainted.'' What will there be for the people coming back from Sierra Leone and Bosnia? Not much. It is not that soldiers want to be treated as heroes on a day-to- day basis, but it is a big deal for a soldier to come back to Canada and re-become a Canadian citizen after what happened to them.
I would slap myself silly if I walked out of here without making that point.
Senator Forrestall: I would feel bad if I did not tell you to remember the veterans who are reservists and to remember one other thing somebody mentioned here today. A veteran is somebody who has served in the Canadian Armed Forces, but he is not a veteran and he knows he is not a veteran, because he is not necessarily entitled to the perks of being a veteran. If you are shot at, you are a veteran. That is all there is to it. Why do they not get all the perks that veterans are entitled to?
The Chairman: We had best wrap up. However, before we do, I will use the chair's prerogative to ask a question or two.
Can you tell me whether you are in touch with the armed forces of any other countries to see what they are doing? Is there any ongoing exchange of information from elsewhere?
LCol. Grenier: Yes. Through my old trade in armoured corps, we have always had close links, not because we are close in proximity, but because they have a comparable size and comparable challenges, with the Australian Defence Force. We have initiated dialogue informally at my level.
I have also put in calls south of the border, because there are programs there, like The Bullet-Proof Mind, which say they have the ability to "bullet-proof'' the mind.
I am doing a bit of that. Some of the research I did brought me to Israel as well, because they have put in some pragmatic processes within their chain of command to deal with this issue. I do not know if it works, but it makes a lot of sense and it is in the same vein as coping skills.
We are at the stage where we might have something interesting to say to our allies. We have initiated that dialogue.
The Chairman: This question is not just to say, "In an ideal world, here is what I would have,'' but what is the primary resource you lack? It could be money, trained people or something else. I would be interested in knowing what you could put your finger on, as something or some things you would find useful and helpful at this point.
LCol. Grenier: If I put my perfect world hat on —
The Chairman: We could say $10 million, but that will not happen. Let us say "within the real world.''
LCol. Grenier: More flexibility to go further and faster with the program would be good.
The Chairman: That would be a decision of DND.
LCol. Grenier: It would be DND and Veterans Affairs. It is not because there is a deliberate action to slow me down, but clearly government bureaucracies are slow. I understand that; however, it is tough.
The Chairman: You do not have to like it.
LCol. Grenier: If you are asking me, what I could get with more dollars, more decisiveness, the ability to move quicker on some fronts and a bit more support staff to launch this — there are many dollars being spent in all sorts of programs, which is great. I am competing for those dollars. You are asking me the question, senator, and I will answer it. We have come a long way and I have to say that, in the context of that answer, we are well funded and this program is supported.
Senator Day: To clarify, you indicated that you were hoping that the program would expand to family. At the family support unit we visited most recently in Edmonton, I was led to believe that they were already doing what you had indicated they are not. Does the reason they are not doing this have anything to do with finances? Is it that you do not have enough money, but you wish to expand the program?
LCol. Grenier: I do not want to do things for the sake of doing things. There is a certain path we need to follow to ensure the mechanisms we put in place for spouses produce positive outcomes. Therefore, what the military family resource centres are doing is providing a range of services that are essential to a family coping with the absence of the main breadwinner, in some cases.
When it comes to this topic, dealing with a spouse who comes back with an operational stress injury, it is tricky. We are pushing the envelope and not saying that what is being done now is inappropriate or bad, but saying we can bring another tool and enhance our ability to connect with those spouses. As it was for members or veterans, in my opinion there was something missing: that ability to connect to people. You can have all the groups you want, but are you reaching out to the spouse who is really suffering, because that person is hard to reach? Our solution is not the be-all and end-all, but it complements the existing programs. I would like to expand this program to spouses as well. It might not be as large; we are talking about taking, and we will take, the necessary steps to get there. If I could have a perfect world, we would have spouses in the network now.
Does that answer your question?
Senator Day: It does. If we came to the conclusion that this committee should encourage the federal government and the Department of National Defence to continue financially to support and encourage the program you are developing, would that be helpful to you?
LCol. Grenier: One thing that is important to know is that to our knowledge, this kind of program does not exist anywhere else. There are peer support programs everywhere; Labatt has one; CNCP has one; the Toronto police, New York police and firefighters all have them. It is ad hoc, and normally falls under the members assistance program and it is a 1-800 line. We have defined a foundation of peer support or social support for when everything else fails. When your spouse leaves you, when your boss does not understand you and wants to fire you, when your friends abandon you and your brothers do not want to talk to you any more, what do you have? You have us, if you want to turn to us.
As a government program, the Canadian government is at the leading edge in this. They are supporting something we do not think exists anywhere else in the world, where a federal government has taken on the job of extending this support through a formal program. I think that is the beauty of it — that we really are leading around the world. I might be proven wrong this afternoon — perhaps there is a similar program somewhere else — but not to our knowledge.
The Chairman: Thank you. I think it is fair to say that we admire what you are doing and applaud your efforts. We congratulate you on the success you have achieved.
We are all members of the larger committee on National Security and Defence. When we visit any military establishment across the country, we always indicate — forcefully on numerous occasions — how proud we are of the job done by the Canadian Armed Forces. We think they are second to none.
Hopefully, that recognition is growing. It is too bad that it took Afghanistan to bring it to the forefront. It would be nice to see more of you people in uniform around and about and not kept off in remote locations where you are out of sight and out of mind. That, too, is improving.
We will be issuing a report, hopefully by the end of June. In the meantime, if anything further comes to mind about this or any other victories you want to let us know about, please communicate with our clerk. Hopefully, we will be able to have something in your hands, and in the hands of the government and the public, by the end of June this year, outlining our thoughts and views on the program that you so ably put into place and are carrying out with distinction.
The committee adjourned.