Proceedings of the Subcommittee on Veterans Affairs
Issue 5 - Evidence - May 2, 2012
OTTAWA, Wednesday, May 2, 2012
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:08 p.m. to study the services and benefits provided to members of the Canadian Forces; to veterans; to members and former members of the Royal Canadian Mounted Police and their families.
Senator Roméo Antonius Dallaire (Chair) in the chair.
The Chair: Ladies and gentlemen, welcome to another meeting of the Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence.
The subcommittee is currently carrying out a study — initiated by Senator Plett — on the transition of veterans to civilian life. The study looks at the tools available for helping veterans, and their family, in the transition, so that they can become citizens who feel comfortable in their own skin and are capable of living comfortably with their injuries. It also looks at the services provided to them.
Today we will be talking about OSISS, the program of support. My initial comment is that this whole program was started by the initiative of a major who served with me in Rwanda and created it. Stéphane Grenier is now a lieutenant- colonel who has been seconded to Senator Kirby to implement this program nationally in the civilian world. It is a demonstration that some of the work done in DND can be transferable to the civilian population and to those involved in a variety of similar exercises, be they police, firemen and the like.
Colonel, we are listening.
Colonel Gérard Blais, Director, Casualty Support Management, National Defence: Mr. Chair and members of the subcommittee, thank you for the invitation to meet with you today to speak about the Operational Stress Injury Social Support Program, commonly referred to as OSISS — or SSBSO in French. I am Colonel Gerry Blais, Director of Casualty Support Management at Canadian Forces and the Commanding Officer of the network of integrated personnel support centres across the country.
Founded in 2001, the OSISS Program was established as a complement to the clinical care provided by Canadian Forces mental health professionals. A group of military members and veterans who had served in theatres of operation recognized the potential benefits of sharing their experiences and set up a peer-based support network. Since then, OSISS has developed into a well-established program managed in partnership by the Department of National Defence and Veterans Affairs Canada. It is a strong community organization coordinated by screened and trained peers. Coordinators have learned to cope with their own problems and now work to help others.
Every member of the network has first-hand experience and practical knowledge of what it is like to struggle with an operational stress injury or to live with someone who is struggling with such an injury.
As serious as an operational stress injury may be for affected Canadian Forces personnel or veterans, there are also repercussions for their families. Through OSISS, peer support is also available to members of the families of OSI sufferers. Members of the immediate family are often the first to notice personality changes and uncharacteristic behaviours in their loved ones. Family members can invest considerable effort in trying to understand the injury, being supportive during recovery, and maintaining family stability. Over time, these demands can become major stressors on family members who try to adapt to the long-term effects of the injury, and because of these stressors, it is important that family members should also seek help and support so they can safeguard their own well-being, that of their children and that of the injured person.
In addition to these two forms of peer support, since 2006 the Canadian Forces also offers a peer support program for the families of deceased Canadian Forces personnel, and it is called Helping Others by Providing Empathy, commonly known as HOPE. This program was developed with input from bereaved families who wanted to help others. Even though family, friends and in some cases, professional counsellors are available for support, many bereaved individuals also express a desire to speak with someone who can share similar experiences.
In many cases, connecting and identifying with a trained peer can make a significant difference in the grieving process. HOPE offers support, a sympathetic ear, understanding of the grief journey, shared experiences and new options. In addition, the HOPE program sponsors a series of resilience and growth workshops for families dealing with the loss of a loved one.
In addition to the DND budget of $3.4 million, which includes the salaries of 54 full-time public service employees, all three programs are bolstered by trained volunteers who have previously benefited from the programs and choose to volunteer to support others. We have approximately 80 volunteers in the OSISS program and 20 or so in the HOPE program. Being able to assist others can be a significant part of the recovery process, and many of our volunteers are quite active in providing support. They are a key component of the program's success.
I will be pleased to answer your questions following my colleagues' comments.
Colonel Jean-Robert Bernier, Deputy Surgeon General, National Defence: Ladies and gentlemen members of the subcommittee, I am Colonel Jean-Robert Bernier, Deputy Surgeon General. The Canadian Forces Directorate of Mental Health falls under my jurisdiction, and I can answer questions about the importance of peer support to mental health.
As my colleague Colonel Blais discussed, OSISS is an important component of the overall CF mental health program and a great example of soldiers reaching out and looking out for one another. It is a significant evolution beyond earlier peer support efforts such as the navy's divisional and the army's regimental systems, or the CF's critical incident peer support program of the early 1990s.
Although peer support is not treatment, OSISS has had a major impact in helping those with operational stress injuries acknowledge their conditions and get the clinical care they need. As a result of reductions in stigma and barriers to mental health care over the past decade, many soldiers are now also comfortable to meet and normalize their reactions within their own natural peer groups. For example, some CF members who deployed together are currently supporting each other occurring during their treatment and recovery.
In combination with our mental health screening, awareness, education and treatment programs, this program and other peer support efforts continue to be important elements in helping members obtain the care they need.
Raymond Lalonde, Director, Operational Stress Injury National Network, Veterans Affairs Canada: I am happy to be joined by my two colleagues from Canadian Forces. I am here to testify on behalf of Veterans Affairs Canada regarding the services the OSISS Program offers veterans and their families. I am the Director General of the Operational Stress Injury National Network Division. As such, I am in charge of the operational stress injury treatment clinics. I was recently made responsible for the OSISS Program partnership with Canadian Forces.
I would like to recognize two of my colleagues who are in the room today: Major Carl Walsh, the CF OSISS program manager, and Serge Arseneault, the VAC OSISS partnership manager. They are instrumental in ensuring the OSISS program can achieve its objectives.
The partnership is based on having the two organizations involved in the overall management of the program, whereas the Canadian Forces ensures the day-to-day operation on the ground.
The OSISS program partnership is a very good example of how the Canadian Forces and Veterans Affairs Canada can collaborate to better leverage each other's strengths and resources to provide seamless services to members of the Canadian Forces and their families as they transition to civilian life.
With a mix of competent staff, commitment, structure, training and vision, OSISS has become a world-class leader in peer support for the military and veterans.
OSISS has contributed to improving the wellness of more than 6,002 Canadian Forces members, veterans and their families since the program was launched in 2001.
Posted in key locations — Canadian Forces bases, joint personnel support units, integrated personnel support centres, Veterans Affairs Canada district offices and operational stress injury clinics — peer support coordinators are well-positioned to reach those in need and support the continuity of service as Canadian Forces members transition to civilian life.
In addition to the public service employees working in OSISS, close to 100 trained volunteers extend the reach of the program in communities.
Thank you very much.
The Chair: As I always do, I have a list of senators who wish to ask questions. Let us begin.
Senator Plett: Thank you, gentlemen, for being here this morning. We appreciate it.
You mentioned, colonel, that the OSISS program complemented the Canadian Forces Mental Health Services. Is this, then, not a duplication of systems? Talk to me a bit about that, if you do not mind.
What are the qualifications of the people who are working there? You say they are screened and trained peers, and I think that is wonderful, but do these people also have training in mental health and experience working with people who have mental injuries? How are they trained; and is this a bit of a duplication of the two programs?
Col. Blais: No, there is definitely no duplication between the two. The staff in the Canadian Forces Health Services are trained social workers, psychologists and psychiatrists, whereas the peers are CF personnel who themselves have suffered from an operational stress injury, a mental health issue that relates to their service. They are trained in how to best interact and not to get themselves dragged back into the problems they faced, and they do so by trying to help others with their issues.
They are best suited to listen and refer. Very often the person suffering from the mental health injury will not be as open to listening as others might be. However, with someone who has walked a mile in his shoes, he will open up and listen. That can perhaps open the gateway to obtaining treatment from the Canadian Forces Health Services.
Senator Plett: The person working in the OSISS program would do more listening than anything else and then would refer. They would not offer counselling; is that what you are saying?
Col. Blais: Not counselling, per se, no.
Senator Plett: You also say they work with the families. We had an individual call our office and work with my executive assistant in our office, and with me, from Shilo. She was quite open in sharing some of her problems, but she also said that she could not officially talk to us; she did so unofficially, because she said her husband, who was the veteran suffering from an operational stress disorder, needed to ask for help. He was the one who needed to say, "We need help." She could not do it on her own.
Would you go listen to a person like that without the veteran actually asking for it? Do you talk to family members by themselves?
Col. Blais: Absolutely. There are two different types of coordinators in the program. There is the strict peer support for military members, and then there is another group of peers who are family members who have lived with someone who suffered from an OSI. They are ideally suited to deal with family members, such as the one you described, to explain to them and give them advice as to how they can guide their loved one to treatment because they have lived the same experiences.
Senator Plett: They would do this confidentially?
Col. Blais: Absolutely.
Senator Plett: This lady said: "I cannot even bring this up with my husband because he gets quite angry and says he does not need help." She could go get confidential help?
Col. Blais: Yes, OSISS is a 100 per cent confidential service.
The Chair: Thank you. These are very insightful questions on the nature of the beast. Having been the recipient of the original OSISS work, what the injured personnel seek between formal treatments is being able to also vet between that and have someone sit there for three or four hours and just listen. The peer support at OSISS has provided that supplemental to the formal therapy that keeps people level instead of going down between treatments.
Senator Plett: If I could ask one supplementary on that, how would this individual contact OSISS? Is there a helpline that she can look up on the Internet? How would this lady make contact?
Col. Blais: Yes there is, senator. Also, if they would like, there are Integrated Personnel Support Centres now on bases across the country. If she simply went to the Integrated Personnel Support Centre, she could get the help she needs there, in addition to help in a number of areas, as well.
The Chair: And she would not have to give her name?
Col. Blais: No.
Senator Day: I have a supplementary on that. I would like clarification. When going to the Integrated Personnel Support Centre, you go up to the front desk and say, "I need help"? Not many people will be prepared to do that. It is the matter of confidentiality that Senator Plett talked about that is important here.
Col. Blais: Once the person goes into the centre, it is completely confidential. The centres themselves are, for the most part, in individual buildings away from other Canadian Forces buildings. We are now serving more than 4,000 clients CF-wide, and confidentiality is not an issue.
The Chair: There are also the phone and the Internet.
Col. Blais: Yes.
Senator Nolin: Mr. Chair, I have a question before we move on. A while ago, you distributed a video that talks about the clinics where peers interact. Are we talking about the same program?
The Chair: Yes.
Senator Nolin: For the benefit of my colleagues and the listeners who have not seen the video — which is a testament to the effectiveness of the work done under the program you have implemented — I would like you to explain how it works. Tell us about a typical meeting in those clinics, whose objective is not to replace medical treatment but to help military members. It is an amazing process, and Canadians need to understand the efforts you are making to help and support military members struggling with that type of injury.
Col. Blais: There are two aspects to the process. The first aspect is of an individual nature. As Senator Dallaire said so well, people can meet on an individual basis, one on one, and go out for a coffee in a quiet location, for instance. The injured person can talk about his or her feelings, worries and other issues. Sometimes, just getting things off their chest helps.
In addition, every peer support coordinator also organizes group sessions.
Senator Nolin: That is the one I saw.
Col. Blais: Exactly. In those sessions, people share information, give each other tips on how to manage their stress in a non-clinical way, once again.
Senator Nolin: There is an odd game at some point where the military member or veteran is encouraged to verbally express the impact of their injury. That scene is moving, and it really shows us how effective your program is.
Col. Blais: Expressing how we feel is very beneficial. People are not ready to seek the help they need until they can identify and admit what they feel. The peer support program helps the person reach that level, and it is often at that point that members will turn to health services to obtain the medical care they need so much.
Senator Nolin: I am trying not to use the term "patient." I prefer to talk about members or participants.
Col. Blais: We call them "peers."
Senator Nolin: I see that you also try to avoid terms such as "patient," "beneficiary" or "sick person." But we are talking about people who definitely need help.
Col. Blais: Yes.
Senator Nolin: Why did it take so long to set up what I feel is such a beneficial and effective program that is so inexpensive? The program needs $3.4 million, 54 public service employees and about 100 volunteers. Perhaps your program is not sufficiently known, and if the publicity garnered through today's broadcast does its job, you may have to increase your budgets.
Col. Blais: We have noted an increase in the use of services. Since the beginning of the year, it has increased by about 17 per cent.
Senator Nolin: That must be due to Senator Dallaire's video!
Col. Blais: The services are well known. However, people must admit that they need help. As Senator Plett said, if a member's family comes to us and says that the person is suffering, perhaps the member's regional peer coordinator will visit them and say something like, "I heard that you served at so and so". Starting the conversation may help break the ice and encourage the person to become part of the group.
Senator Nolin: However, as Senator Plett was saying, those family members may also be suffering. I am thinking of a spouse or children who may be suffering because of the father's impulsiveness. Those are some of the indirect effects of that type of injury.
Col. Blais: Absolutely.
Senator Nolin: Do you have the clinical experience and training you need to deal with that type of situation?
Col. Blais: Alongside peer participation groups, we organize the same kind of group sessions for spouses and children.
Senator Nolin: I have one last question about the program's funding. Are you saying that the $3.4 million covers the wages of 54 public servants?
Col. Blais: Yes.
Senator Nolin: I assume the amount covers more than just wages. Could you break down that $3.4-million amount and tell us where it comes from?
Col. Blais: The $3.4 million is contributed by the Department of National Defence. Veterans Affairs Canada also has a budget for the program. We spend much of the money on peer training and travel expenses. The 54 peer coordinators have to travel to meet with members.
Senator Nolin: Could you send that information to the chair, so we can have the details of this financial structure on file and be able to understand where the money comes from and how it is spent?
Col. Blais: Absolutely.
Senator Nolin: What is the program's history? It probably did not start at this level. Would it be possible to provide us with information on the progress made over the last five years, or since the program was launched?
Col. Blais: Absolutely.
Senator Nolin: Thank you, Mr. Chair.
Senator Plett: Maybe when you send that along with that report you would tell us where these 54 people are located, at what bases, and I would appreciate that.
Col. Blais: Absolutely, senator.
The Chair: Let us bring this package, if I may. It started with people volunteering, paying out of their own pocket, and has over the years evolved to now where we have people paid to do it, although sometimes they are still paying out of their own pocket to buy the coffee at Tim Hortons, and some of that, I gather, is not always clear.
However, the structure is still based a lot on volunteers reinforcing those permanent staff to try to handle the large caseload that they do have. I would also be interested in seeing the volunteer structure complementing what Senator Plett and Senator Nolin have asked.
As an example, if I may just before handing it over to Senator Wallin, I would like to know how many officers are in the peer support system versus NCOs and other ranks in actually being peer support, both volunteers and permanent staff.
The reason I ask is that the last time I queried there were none, and that, to me, is not a healthy indication.
Senator Wallin: Gentlemen, I am seeking your views rather than answers because you are so well versed in this field. This has to do with the larger question of transition to civilian life. Just the other day at the Defence Committee we were discussing the issue of suicide, and the CDS said one is too many. That was his opening statement, but also despite everyone's best screening efforts and everything else, you cannot tell in advance who will have a problem, who will survive mentally, no more than you can tell who will survive physically the situation in war.
Are there any lessons learned from this ex post facto work you do with operational stress injury that you think could be somehow injected into the front end of the process after screening, after recruitment?
Col. Bernier: Thank you, senator. You will be aware that there have been recent media reports this year that we have 19 cases of male regular force suicides, which is the number we have to use.
Although every single one of them is a grave tragedy to all of us and we would like to achieve a zero suicide rate, that is impossible because of human biology, and our expectations have to be limited by trying to do the maximum possible, and we have done that through the implementation of all the recommendations of the Canadian Forces Expert Panel on Suicide Prevention which included independent civilian and military academics from within Canada and abroad.
However, the problem is that even quality assurance mental health audits, even with patients in treatment, only about one quarter of completed suicides are assessed to have been preventable.
Therefore, living with that reality, we have to do the absolute maximum that evidence has shown, or even intuition or logic suggests, may make a difference. I assume you are probably already aware of all the educational awareness efforts. Specifically one thing we started since April 2010 is after each individual suicide not only is there a board of inquiry but there is also a professional mental health professional technical review of each suicide, an in-depth review, to look at quality assurance, look at all the factors, the individual motivational factors, family, et cetera. That is completed as soon as possible rather than awaiting the outcome of the board of inquiry, which can take a very long time. It has been generally welcomed by family members and others who knew the individual. We look in great detail at trends, at specifically what happened in that case to see if there was any possible factor that might have been modified in the clinical treatment, in the chain of command treatment, the occupational.
The latest thing we have been trying to impress, and the leadership has been particularly effective and committed, is suicide awareness and reducing stigma for the presentation for care of mental health illnesses, the professional technical reviews as well as a hand-off policy. In doing these analyses, we find that some are directly related to deployment and post-traumatic stress disorder, but up until 2010 the majority of our suicide cases were among people who had never deployed anywhere. We have a higher number this year, but because the numbers are still so low bio- statistically, epidemiologically to get statistical meaning out of those numbers, we have to lump them all together in five-year blocks. This could mean the beginning of a trend or it could be that after we collect a five-year block, an adequate number with an adequate denominator of suicides, it turns out it is the same as the previous five-year blocks. Looking up until 2010, including the five-year block of the height of operations in Afghanistan, the rate has remained the same. There has not been a change since 1995.
Senator Wallin: I did not mean to ask narrowly about that issue but about PTSD. Would you have the ability to have the same assessment? As you say, most people you could not predict, there were no indicators, et cetera.
In my questioning, is there anything we could do before the fact, is there anything about PTSD in general that might be easier to detect — I do not know if that is even the right word. Broaden it out a bit, if you can.
Col. Bernier: The three key factors in mental health have been strong leadership, committed leadership, and we have that — they have been magnificent, and that is one of the key factors; committed and engaged members so that they go to treatment and they stay with treatment; and high-quality treatment. One of the key factors, particularly in that final point, has been OSISS. There have been many redundancies, so we have basically peers, everyone in the Armed Forces, particularly supervisors in the chain of command, looking out and educated and aware of the risk factors, to look out for suicide and mental illness in general, to identify cases of PTSD or symptoms that would call for individuals to be referred either to an OSISS peer or directly to the mental health community.
We have the Military Family Resource Centres, the Canadian Forces Member Assistance Plan, where people can call directly, totally confidentially, outside of the visibility of the Armed Forces for those who do not want anything to be known at all, with up to 10 counselling sessions, VAC resources, and there is a whole system of different groups, including the chaplains.
There is redundancy built in to try to identify symptoms early on of people with PTSD. We are always looking out for additional things we may be able to do better or more of, capacity wise. So far we have essentially implemented and we are not perfect; there are still cases that will fall through the cracks, particularly in areas that may be underserviced or where we have attrition problems or difficulty having enough people present.
However, overall we are currently applying the best practices, according to the U.S. RAND Corporation, which just did a huge study on best practices in suicide, which reflect what we have already been implementing since 2001 with OSISS, since the 2009 CF Expert Panel on Suicide Prevention.
Senator Wallin: Any other comments?
Mr. Lalonde: I am not, I would say, involved directly with the suicide prevention file in the department, but we have worked with the Canadian Forces on the same panel and we have a similar strategy around suicide. I am not knowledgeable enough to talk about it, however.
Senator Wallin: Thank you.
The Chair: I have a supplementary: First of all, your Canadian Forces document that you produced about the 19 suicides this year is based on regular force people. It does not include women, because you say there are very few women. It does not include the reservists or the people who have retired or have been released and are now in the hands of Veterans Affairs, which does not, until recently, tabulate any of the suicides or do an analysis of whether it was a suicide, an accident, or whatever. It was never done with the old vets, and I do not believe it has the system going.
That number 19 is a number that you manage within DND, but only part of DND and not the full of DND.
I think also to know what those numbers would be or how you will capture them in order to help the prevention in the reservists, and also how Veterans Affairs will continue the effort you are making for prevention of veterans once they are in their care would be certainly of interest to us.
Lastly, if I may, for your response, for the first decade in the new era, the clinical side has been very reticent in attributing suicide to operational missions. In 1997, when I was ADM(Per), we had 11 suicides and we were trying to convince people that it was not because of the operational missions, although we knew damn well that it was because they had been committed from the Gulf War right through to Yugoslavia or Rwanda. Your maturing of the program is of great significance, as you have described, but it is still new-ish in the overall scheme of things. Would I be wrong in any of those statements?
Col. Bernier: I could clarify certain points, but yes, you are absolutely right. We still face significant challenges, particularly with reservists. The 19 does not include the one lady who committed suicide last year.
We assess in great detail every one of them including the reservists. Even those who have maybe paraded maybe two times as class A reservists, if it comes to our attention, we will conduct a complete, professional, technical review.
The problem with those numbers, despite the tragedy, and particularly to the family of any individual suicide, from the epidemiological or statistical point of view, one woman suicide every two or three years, we cannot determine because they are so low. It is the same thing with the reserves. The data is so difficult. We do not know if we are capturing them all because so many reservists will only parade a little while and then release.
As I mentioned, even if they have been away for two years but are still on the books we will still investigate those in great detail, the same as the regular force ones. It is a challenge, both for investigation and for the provision of care. We have link teams for each of the reservists, field AMs and case managers, who reach out and try to make sure the same standard of care is provided to reservists who have been identified in one way or another with mental health problems.
Senator Wallin: I do not know how you could distinguish between what was going on in the reservists' day job versus —
The Chair: Exactly, and if he is retired, too. That is a good point.
Col. Bernier: The attribution of whether it is related to military service or not is difficult because we find they are the same causes, even for the regular forces folks who have deployed to Afghanistan. They tend to be the same causes: financial, legal or disciplinary, relationship issues, the same kind of issues that have been identified as causing suicide. However, you are absolutely right, sir, deployment, particularly combat, makes one more susceptible to the development of PTSD, which secondarily could lead to some of those problems. It is very difficult to make that direct attribution.
We conducted a cumulative OSI incident study from 2001 to 2008 of everyone who he deployed. We had clinicians look at every individual case and try to attribute it to whether it was related to the deployment or not. We had 8 per cent, probably the most reliable in the world of all our NATO allies, as far as proportion of folks who develop PTSD as a result of deployment. This is a significant proportion.
We also did a sub-study of one particular battle group that had a lot of combat exposure, and 20 per cent of everyone in that battle group developed PTSD at some point over a four-and-a-half-year follow-up period. It is a significant burden that we expect to continue into the next decade because of the latency period for the presentation of some of these things.
As for veterans, we also led, in conjunction with Veterans Affairs and Statistics Canada, the Canadian Forces Cancer and Mortality Study. They did find overall, combined serving and retired Canadian Forces members, a similar rate as the general public.
However, the cohort, particularly the retired cohort, had a 1.5 times higher rate, particularly those NCMs, people who had served in the army, people who had served before 1986, people who had served briefly, less than 10 years, and particularly those who had been released involuntarily or because of a medical condition.
There are still subgroup analyses going on and ongoing analysis of that database to determine more precisely.
I point out that before 1986, none of the programs we currently have in place existed. We have matured and come a long way. We still have some way to go, which may account for some of those problems. The existence of stigma at the time was also far greater.
The Chair: That is very complete. Thank you.
Senator Plett: Out of these 19, how many did you say were not preventable?
Col. Bernier: That determination is made case by case.
Senator Plett: Did you not cite a number?
Col. Bernier: Yes, I did; one quarter, but not specifically to the Canadian Forces. This is general mental health quality assurance audits that have been reviewed in the literature by the CF Expert Panel on Suicide, which included academics and all kinds of experts on suicide.
Senator Plett: It was not specific to the Canadian Forces?
Col. Bernier: No. We would expect to have fewer because our program is so robust compared to civilian programs. However, looking at the data that does exist on mental health quality assurance audits for suicide prevention in those kinds of cases, in all the scientific literature, generally the finding is that where they have been investigated in some detail, they find that only about a quarter of them were potentially preventable.
Senator Nolin: Preventable. I thought it was the reverse.
Senator Plett: I also understood that it was the reverse.
Col. Bernier: That means three quarters, even with mental health treatment, were probably not preventable. It is like some cancers; if you wait too long to present for care, your chances of being cured decrease significantly. Certain cancers, even with the best chemotherapy and radiotherapy, are not curable and lead to death.
Unfortunately, as far as we know now, based on the measures that are applied today and based on the existing mental health quality assurance audit information, only about a quarter are preventable.
We think we could do better than that because we have such a robust system. We have the added advantage, compared to the civilian community, of having an occupational oversight with supervisors involved and aware, and with peers playing a role in trying to get people into treatment. One of the key factors that lead to suicide is untreated mental illness.
Senator Plett: I am glad I asked the question, because it is the reverse of what I understood you to say initially. Thank you for clearing that up.
The Chair: I would like to make a final comment on this. Of the 12 officers who served with me in Rwanda, 9 have had major operational stress injuries, and there has been one suicide, 14 years after. The board of inquiry, which took two years, identified that it was directly related to the operational commitment.
However, going back to OSISS, at one point there was a statistic floating around that said that OSISS prevents a suicide a day amongst veterans. Is that a realistic number, or can you give us a feel for that?
Col. Blais: I would say that is anecdotal. However, there is no doubt that they do have a great influence on getting people into treatment. As Col. Bernier pointed out, the sooner you can get someone into treatment, the better their chances of recovery. Therefore, there is no doubt that it does help in preventing suicide to a certain extent.
Senator Day: I will go to other matters, not that this is not important; in fact, it is very important for us to hear from you on the topic of suicide. Actually, it is very good to hear the information you have given us in terms of the programs you have in place.
Col. Bernier, you talked about the predecessor programs, the navy divisional and army regimental systems. That was quite informal, I am assuming, and that is what happened after the Second World War and the Korean War.
Col. Bernier: And longer. The navy's divisional and regimental systems are simply the family element, so there is complete informality. That has not been enough historically.
When the Bosnia campaign began in 1991-92, there was a disconnected, ad hoc effort to establish critical incident stress debriefing after people returned from operations or were exposed to specific traumatic incidents overseas. In that program there was usually a mental health professional or a medical person and a peer member of the unit who would undergo one or two days of training. That peer was particularly critical in giving credibility and a link to the individuals from that unit as to the mental health education and encouragement they were receiving to identify symptoms that would suggest presentation for care.
Although a policy was established at one point regarding critical incident stress debriefing across the country, later on it was still not a national program and it was disjointed. It led to literature as well, because it was exercised also by many of our allies, who demonstrated that, in some cases, mandatorily having people undergo critical incident stress debriefing when they were not ready for it had an adverse mental health effect. Therefore, we do not mandatorily do that now.
That was the first semi-formal effort whereby peer counsellors were trained. However, it was very limited. It did not have the degree of training that OSISS personnel have now. It did not have the breadth. It was temporary and ad hoc across the different army areas and brigades.
The way it is done now, OSISS plays a significant role. People are selected, to some extent, based on having survived a mental health condition themselves, which carries great credibility in helping individuals acknowledge that they have their own condition. That is one of our biggest problems. Many people who do not present for care are people who simply do not recognize that there is anything abnormal with their behaviour.
Senator Day: Is there not still a problem? Tell me how you are changing this. In the past, commanding officers and senior non-commissioned officers have not been very sympathetic to someone who has any type of operational stress injury, and therefore there is the stigma of even attending or participating in one of these programs. Even if you can keep it confidential, it never is fully confidential that you have a problem and that you are trying to deal with the injury.
What are you doing to change the mentality with respect to this stigma?
Col. Blais: I am happy to say that it has changed a great deal, senator. There are a number of methods by which we achieve this. On every leadership training course now in the Canadian Forces, there is a mental health component where someone provides education. There are both a clinic and a non-clinical component to that education. Much as we have people who have suffered operational stress injuries who work as peers, we also have others who work as speakers, who provide their experience to these training courses. That is backed up with a clinical component, where you get both sides of the story. We found that is very helpful in breaking the stigma.
Also, two years ago, the Chief of the Defence Staff launched a campaign called "Be the Difference" across the Canadian Forces, where the chief himself spoke to the entire Canadian Forces, asking everyone to take an active part in helping each other live through these difficult experiences.
Col. Bernier: I can also add that we have hard evidence as well. The study comparing five nations — Australia, Britain, Canada, New Zealand, and the U.S., published in the Journal of the Royal Society of Medicine in the U.K. — found that we had the lowest rate of stigma in the Canadian Forces. U.S. investigators found that we had less than one third the degree of stigma reported by soldiers in the U.S. Armed Forces. Our own evaluation found that less than 7 per cent of CF members would think less of a colleague who presented for mental health care.
There have been many things through the various awareness and educational programs that have led now to the point where people will speak openly in the Armed Forces about their mental health problems. One of the key factors that launched this move towards reducing stigma is the chair's public comments.
It has become socially unacceptable in the military culture to be condescending toward or disparage in any way individuals seeking mental health care. There has been a countercultural shift, which has been extremely beneficial. OSISS has been critical to that by virtue of getting people to talk and having peers present that there is a light at the end of the tunnel. People acknowledge their care and the possibility of recovering.
Senator Day: That includes the whole family.
Col. Bernier: Yes. Confidentiality is critical. Our mental health research folks tell us that overall — although they cannot prove it with hard data — enhancements, which the Chief of the Defence Staff directed, and the Privacy Act have helped us to enforce within the Canadian Forces in terms of the mental health record, condition and diagnosis of individuals and may have been the most important factor in getting people to be willing to present for care, as well as factors like greater career protection of individuals who present for care.
Senator Day: I have another area I want to go into but I will wait for the second round.
The Chair: The recruit course that my youngest son went through had a three-hour session given by a peer, a sergeant, who came to tell them about operational stress injury. He and his colleagues felt that it was the most significant course they had in preparing them for the future. Of course, the next day four guys asked for their release because they felt it was maybe a little too much. That might be what we want to do.
Senator Nolin: We are very proud to have General Dallaire as our chair. This way, we can sort of share in his military history, of which we are also very proud.
We do not have much time, but I want to play a bit of a devil's advocate. After each unfortunate event, you try to determine its causes. I would like to understand how that investigation works. Who talks? Who does not talk? Why? If someone is questioned, do they have the right to a lawyer? How does it work?
The Chair: The investigation office deals with all that.
That is an important inquiry.
Senator Nolin: Exactly. I am trying to understand why the figure is 75 per cent. I understand that the literature helps us — in purely practical terms — to understand what is happening in civilian life and to compare that reality with military life. When trying to determine the cause of such an atrocious act, there is a risk of failing to loosen the tongues of those who might talk in other situations. I am trying to figure out what the process is for understanding what has happened. Are you sure that those who have some information share it?
Col. Bernier: Senator, I can only talk about professional medical investigations. In that case, everything is done on a volunteer basis. We proceed immediately, as soon as military police contacts us or civilian police allows us to begin questioning those people. We do not want to interfere in their business if it has not yet been determined that the person committed suicide and did not die of natural causes or was a victim of a disaster. We are then provided with the military police records and all the available information.
At that point, the medical staff — a doctor, or sometimes a psychiatrist or a psychologist — will question the family, friends, chain of command and anyone else who was involved, if they are ready. Normally, those people are more than happy to co-operate. The medical investigation is much more targeted than the general investigation. They simply try to determine the quality of care the individual received. They also look into whether something in their personal motivations — stress at work or in their personal life — may have contributed. That is something we call psychological post-mortem. It is a very specific field. We use data and formulas that have been shown to be very useful in identifying the probable cause, if there is one.
Following all those interviews, assessments of medical records, assessments of the care the person received, answers provided by the chain of command and military police — basically, all relevant information — we often do not find anything that indicates the probable cause. Normally, we may note some stress related to financial, legal, disciplinary or relationship issues. However, sometimes there are no indications.
So far, we have no statistics for Canadian Forces regarding how many suicides may have been prevented if someone had stepped in. Very often, the problem is that no one was aware of the stress an individual was under, or the person showed no signs at all. Nothing was noticed by the family members, friends, the chain of command, medical staff or OSISS staff.
The statistics regarding the quarter of suicides that are unpreventable come from civil society data.
Senator Nolin: You are talking about a quarter? I thought it was three quarters.
Col. Bernier: Only one quarter of cases have been deemed preventable.
Senator Nolin: Okay. I wanted to make sure we had not come back to the same issue.
Col. Blais: In terms of the administration involved in the investigation we are trying to conduct, we are not qualified to determine causes as such. That role belongs to the medical staff. However, we try to determine if there is anything we can do — for instance, as a supervisor or as unit — to prevent something similar from happening again. We try to determine the causes or factors that may have contributed, and we make sure to eliminate them.
Senator Nolin: Do you ever come across correctable causes?
Col. Blais: Yes.
Senator Nolin: What happens to individuals who have committed acts that could, ultimately, be deemed reprehensible?
Col. Blais: If the investigation leads us to something, the facts are submitted to the commanding officer. The commanding officer is the one who makes the decision, based on the seriousness of the action.
Senator Nolin: Or the failure.
Col. Blais: Or the failure. The commanding officer decides what administrative or disciplinary measures are to be taken.
Senator Nolin: Does that happen?
Col. Blais: Yes.
The Chair: The board also helps determine whether the cause of the suicide has to do with a mission. That aspect is important in terms of other benefits that follow.
Senator Nolin: Could the training be too difficult?
Col. Blais: I would say that the opposite is more often true. Having people who are well-trained helps prevent such situations.
Senator Nolin: Surely.
Senator Day: I am sitting here as a lawyer thinking that you may establish that you should have done something and you could have prevented this suicide. How are you absolved from a potential liability claim?
Col. Bernier: Even if we find something that could have been done better, it does not necessarily mean that the suicide could have been prevented. We have many cases where everything was done in terms of best practice, and yet the suicide still occurred. As the civilian literature demonstrates, three quarters will continue on to suicide, even with good treatment.
From the medical perspective, the professional technical evaluation is primarily for quality assurance and quality improvement of the overall program.
Senator Day: I understand entirely. I was just wondering if perhaps you are not exposing yourself — and I hope you are not because it is so important to do that analysis. Maybe I should not have mentioned it, but the issue jumped out at me as you were having your discussion with Senator Nolin.
Col. Bernier: If we found that there were questions about the practice of a clinician, for example inadequacies in the way that an individual's clinical care was provided, we would report, as we periodically do, our own people to the respective college of physicians and surgeons or college of nurses, or other, for that kind of evaluation. We have our own internal ability to revoke practice privileges until that individual is brought up to standard.
Col. Blais: On the administrative side, for every board of inquiry there is a medical adviser to the board and there is also a legal adviser to the board. As things progress, they are able to get the advice in both areas to ensure that we are in full compliance.
Senator Day: I will leave it at that.
I want to ask Mr. Lalonde a question in relation to Veterans Affairs. We have from the military side an undertaking to give us an analysis of how the $3.4 million is being used and divided. Does Veterans Affairs just make a contribution to the budget for this program? If so, how much is that contribution?
Mr. Lalonde: The budget for the program over the last couple of years has been around $800,000 to $900,000, but this year, as I am new to the job, I received more money.
Senator Day: You brought more money with you.
Mr. Lalonde: It should be around $1.2 million. Most of it will go to fund resources that are under the leadership of the Canadian Forces.
Senator Day: The 54 full-time public service employees combine the partnership employees, or do you have a separate group?
Mr. Lalonde: No, we have 10 full-time equivalents. Eight of them are employed with the operation of OSISS on the ground.
Senator Day: Are they in addition to the 54?
Mr. Lalonde: Yes.
Senator Day: We have heard from a number of witnesses that oftentimes mental injuries as a result of being deployed do not often happen until maybe even after someone is out of the Armed Forces for a number of years and then the symptoms start to come out.
Mr. Lalonde: Yes.
Senator Day: Presumably that is the main concentration of Veterans Affairs. Once that person has been identified as needing help, are you feeding them back into the military system? Do they have to go back to a military base? It is not always easy to go back to a place you used to work after you are no longer employed there. Can you tell me what you are doing?
Mr. Lalonde: The veterans do not have to go back to base to receive services. OSISS peer volunteers or coordinators work out of many areas. They can meet at a Tim Hortons. They do not have to go back to base.
A lot of the peer support coordinators and family peer support coordinators are located in district offices. We have them in operational stress injury clinics. They go where they need to be, but if someone is not comfortable about going onto a base they do not have to do so to receive services.
Senator Day: How do they make their first contact with members?
Mr. Lalonde: There is a phone number and an OSISS website: osiss.ca.
Senator Day: That is really the military website, is it not?
Mr. Lalonde: It is both. There is only one organization that provides the services on the ground; it is the CF. The overall management of the program is a partnership. We look at the policies, the business process, the performance management and such together. The operations on the ground are under the responsibility of the Canadian Forces for the members and for the veterans and their families.
The Chair: I am led to believe that your OSISS people are extensively worked, if not overworked. Do they have enough resources to handle the volume reasonably without burning themselves out? How are you taking care of them?
Also, the family side is still new and you have 20 people, but is there not a need for increasing that capability? Do you have things in the mill to look at that?
There has also been talk that since these OSISS people are now salaried there is a bit of a fonctionnaire syndrome with eight o'clock to four o'clock availability versus 24-7 that used to exist. Is that creeping in by any chance? Have you received any complaints about that?
Finally, OSISS used to intervene a lot when the police used to arrest our guys and girls who, because of the injury, were being rambunctious and tearing places apart and getting into fights. Is OSISS still being called upon to participate in getting people out of jail and also perhaps intervening as assisting officers in cases where people are brought in front of the courts?
Col. Blais: I will take your first question first. The peers are very busy. There is no doubt about that. However, I would say that the resources we have at our disposal are adequate. On a continual basis we produce statistics monthly. As we see numbers going up in one area, we can request additional resources if we feel they are required. However, if we see that one area is perhaps over-serviced or that the peer is not as busy as they would be in another, we first try to transfer a position to another area where there is greater need.
As far as time goes, we have seen no indication. For people who go into this type of work it is a labour of love and it is something they feel very deeply about. The nine-to-five syndrome is definitely not there. As a matter of fact, I would say that a lot of the work is done after hours because that is when they can meet with the peers, conduct group sessions and things of that nature.
Senator Plett: Are these people salaried or hourly?
Col. Blais: They are salaried.
Finally, with respect to the police, OSISS still gets some calls, especially in more remote areas. However, for the most part, now that the network of personnel support centres is up, the commanding officer will get a call and either the person's platoon commander or platoon warrant officer will go out to look after the needs of the individual.
The Chair: Does the integrated support centre get the call?
Col. Blais: Yes.
The Chair: Do the judicial system and police know of them?
Col. Blais: Yes.
The Chair: Are there any final comments?
This program has matured immensely and was started at the initiative of peers. It has matured to the extent that the Canadian population will benefit from this as we move forward.
One element brought forward by OSISS that reinforces their position and culture change is the fact that PTSD was determined to be an operational stress injury and not a disease or a sickness. On Monday I will be speaking to the American Psychiatric Association in Philadelphia to explain why we went that route in order to make the work of OSISS more acceptable to the troops versus being the black box fear stigma that it used to be. OSISS is an absolutely innovative but essential component of permitting people to transition to civilian life in a much more stable way. Well done to you and to all the volunteers who work at this and drink all those coffees in Tim Hortons so often. Thank you very much.
(The committee adjourned.)