Good afternoon, everyone.
We are continuing with our study on the care of our ill and injured members of the Canadian armed forces.
Joining us today, appearing as an individual, is Lieutenant-Colonel Stéphane Grenier, who is retired. He served in the Canadian military since 1983. He has served in several missions abroad, most notably in Rwanda and Kandahar, and has also been deployed to Cambodia, Kuwait, the Arabian Gulf, Lebanon, and Haiti, just to name a few.
He was faced with his own undiagnosed PTSD and related depression upon return from Rwanda and took a personal interest in the way the Canadian armed forces was dealing with mental health issues. In 2001, Lieutenant-Colonel Grenier coined the term “operational stress injury”, and conceived, developed, implemented, and managed a government-based national peer support program for the Canadian military, namely the operational stress injury social support, OSISS, program.
In 2009 he spearheaded the development of the corporate mental health awareness campaign that was launched nationally by the Canadian Forces Chief of the Defence Staff. He had that campaign endorsed by the Mental Health Commission of Canada, with whom he works today on a volunteer basis. As well, that campaign was endorsed by the Canadian Mental Health Association and the Canadian Alliance on Mental Illness and Mental Health, using his example of corporate leadership in reducing the stigma that is often associated with mental health illnesses.
Lieutenant-Colonel Grenier was awarded the Meritorious Service Cross by the Governor General of Canada for taking the concept of peer support and driving it from the grassroots up to a formal federal government program.
He has been retired for the past year, but is still playing a leading role with the Mental Health Commission, as I mentioned earlier, on its workforce advisory committee.
Lieutenant-Colonel Grenier, welcome to committee. We look forward to your opening comments. If you could keep them to 10 minutes, that would be great.
Ladies and gentlemen, merci beaucoup de m'inviter ici.
As some of you may know, this is the first time I have come here as a civilian. I've been here three or four times in the past decade, always in uniform, however.
I have chosen to share with you some thoughts on the last couple of years of my military service and what I observed was happening. Of course, it's very important to me that everyone on the committee know that I am retired, and more important, that I was seconded to the Mental Health Commission of Canada for the last two years of my military career, which means that I may be outdated by a couple of years.
However, my goal today is not to get into the specifics of issues, but perhaps discuss more strategically some of the long-standing concerns that I had while I was in the military that I maintained in my role as operational stress injury special adviser for General Semianiw, in his tenure as Chief Military Personnel. To this date I still have concerns about several issues, and these issues are the ones I feel I can share with you today.
Very broadly, and I will stick to five or six minutes, I simply want to whet everyone's appetite on some issues that the committee may wish to explore further as you continue your work.
First, I would like to mention to you that one strategic concern I've always had is the care and support of military families. I start with that because I'm very passionate about making the point that, when we speak about families of military personnel and veterans suffering from stress injuries, we should stop mentioning families last because families are the pillar of our military force, to a great extent. They are the ones who literally stitch us back together when we come back from deployments and have a really hard time integrating.
While soldiers keep going back to their regiments and units and battalions, and in plain English, suck it up every day—and it is a good thing that soldiers are attempting to be resilient—it's mostly at home that things fall apart.
I wish to mention to you that many of my colleagues and I have attempted many, many times to raise the issue of the military reality with military members repeatedly moving around Canada. We know that our health care system in Canada is stretched in some provinces more than others. For a family member who is dealing with a very complex mental health condition in the family, the impact of the mental health condition on the family is very well documented. Therefore, what is the responsibility of the federal government and the Department of National Defence to take care of families in their own right?
My suggestion to the committee is perhaps that may be worthwhile looking into. Is it appropriate to simply assume that the health care system inside a new community where a family has been moved will be able to rapidly absorb and seamlessly continue the mental health care of the spouses and perhaps children? That is one point I thought I would share with you.
Switching gears now, going into some policy matters perhaps, there is a concept that I feel has not been explored sufficiently. Even in my tenure in the military, I failed to make the point in a way that would galvanize senior leadership's interest in exploring new ways of retaining military personnel with operational stress injuries.
In around 2003-04, we developed a concept of remustering, or allowing soldiers to be retained in the military through an occupational transfer but on a provisional basis. We know that in the military, after several years of career, soldiers can change classifications or change trades. There comes a point in a soldier's career, and I'm talking mainly of the combat arms, when a soldier has been on a few too many deployments, clinicians have expressed to me their concern that the soldier is no longer capable of being around cordite, explosives, and things like that, but the person would likely thrive if he or she were offered the opportunity to continue to serve in the military and carry on with his or her military career, but in another occupation.
The issue that the military confronts is that, sadly, if the soldier who wishes to transfer from one occupation to the next has a medical limitation of any kind, that makes him or her unsuitable for service in his or her current occupation. In other words, as an example, the infantry medical classification is fairly high. In order for that soldier to be able to remuster to a position that has a lesser medical category, a category that is easier to achieve, that soldier cannot remuster because the soldier must be healthy or deemed healthy in his current trade.
It's a weird logic that the system has been built that way. Nevertheless, it is built that way, and what I saw during my tenure were dozens, if not hundreds, of soldiers who were literally medically released who might have been able to continue in the military, which would essentially allow the military to maintain that corporate expertise or experience that had been garnered and gathered over the first part of that soldier's career.
I worked on that provisional occupational transfer policy for years and never got that off the ground, really. I failed at it myself, and I wish that soldiers in the future would or could benefit from that.
Clinicians have shared with me that being medically released sometimes is a good thing. Of course, not everyone would fit in that category. For many, facing a medical release is not always happy times, of course, and having that opportunity to serve in another capacity is something we should seriously consider.
Let me speak a bit about physical injuries and operational stress injuries. As the opening remarks indicated, I did coin the term “stress injury” years ago.
When the heavy fighting started in Afghanistan in the mid-2000s, as you're aware, we started repatriating a lot of physical casualties. From that moment on, there was a school of thought that we needed to create support programs for these physically injured soldiers. I attempted to ensure that we would not create two streams. An injured soldier is an injured soldier. It doesn't matter if it's an injury of the brain or an injury of the leg or the foot. If you lose a foot, you lose a foot; if you lose your marbles, you lose your marbles.
Unfortunately, what I've noticed since I've been retired is that there are two streams. While the military continues to attempt to combat the stigma around stress injuries and mental health and post-traumatic stress disorder, I believe it is a strategic mistake to create two separate programs. As long as we continue to separate the injured, we are continuing to emphasize or indirectly support and really endorse the fact that there are legitimate injuries and there are injuries of the mind that could be imagined, and so on and so forth.
I'm not suggesting that somebody who has post-traumatic stress disorder could support an amputee. However, from a structural perspective, I believe it's a strategic mistake to have separated these programs as opposed to integrating them into one. It's one thing to say that an injured soldier is an injured soldier, but the military needs to behave like they truly believe that.
Moving on, I am simply making the point that when I started the peer support program 12 or 13 years ago, I was a major back then. I remember a full colonel telling me here in Ottawa, “Stéphane, you're too late. We don't need this any more because the tough Bosnia days are over.” I looked at the colonel and said, “I'm not a historian, but history has demonstrated that after periods of reconstitution and strategic pauses, the military is re-engaged in yet another conflict. So now that we are in strategic pause, it is time to build these programs.” Despite his opinion, the leadership made a decision. We launched these non-clinical programs, which are still alive today. I am just hoping that through all these cuts we're not going to make that mistake and start shaving the ice cube and end up as we were after Rwanda, when I came back, where we had literally nothing to support the soldiers.
Despite the cuts, and I can understand the austerity measures in the government and at National Defence, I'm hoping that some of these programs will be protected.
I have a few thoughts on my own transition out of the military. I was not pleasantly surprised to go through the military release process. I must say that I wish I were here today to tell you that we have come a long way because my military release was a very seamless, smooth process. I share this with you not to complain, making the point that if it happened to a colonel, who was the OSI special adviser, who the surgeon general knew and who Veterans Affairs Canada knew, imagine the corporal from Valcartier or Petawawa who is being medically released today, who doesn't know anybody. If these things happened to me, such as medication coverage stopped, my doctors' bills, which I receive at home and I'm sorting those out now.... This is not a complaint. I'm making the point. There are nice people at DND and Veterans Affairs who are fixing the matter. However, I was very surprised to see that because I've been in so many meetings and boardrooms where, you know, people would look at each other and say, “We've come such a long way.”
Well, I remember supporting soldiers who were literally going postal who were very angry at the system in 2001-02, thinking, “What am I going to do to afford these medications; my psychiatrist is too expensive, I can't pay him and I'm getting the bills ” Well, in 2013 I have my own medication bill and my own doctors' bills. It will get sorted out; however, it's very disappointing for me to see that we have not come a long way.
I have a couple of last, quick remarks. I encourage this committee to find the clinicians who have left medical practice at National Defence. I, out of respect, will not share the names of those clinicians, but I encourage you to do so, and invite them here so that you may ask them why they left the medical practice for the military. They will probably tell you stories of inefficiencies in the medical system in the military and the fact that they cannot live with themselves making more money, seeing fewer patients every day. I, out of integrity, am here to encourage you to have a look at that issue and potentially find clinicians who have left the practice.
I also encourage you to look at the in-patient treatment issues. Despite clinicians and treatment facilities that will tell you that everything is fine, you will rapidly notice, if you delve into the issue, that the criteria are so strict and stringent, that you're either too sick or too healthy to be in those programs.
I will stop here and am open for questions.
Thank you, Lieutenant-Colonel Grenier, for your testimony.
I'm going to posit the civilian side of this. I actually have experience around the civilian side, coming out of a trade union movement, where I represented workers. I don't want to suggest by any stretch of the imagination that the occupations are similar, or the cultures, or the sense of duty of what has to happen or not. Clearly, the military has a different sense of what it needs as preparedness versus a worker in a work environment, but the work environment, at least in the province of Ontario, has what's called the duty to accommodate. This simply means that if you're injured, regardless of the injury, physical or mental, an employer has the duty to accommodate within certain parameters. It's not at all costs, clearly. Sometimes a worker is not able to return to any work that the employer has.
Help me if I went down the wrong path with this. What I heard from you earlier, and I'll use your example of someone who's in the armoured corps, was that the duty to accommodate, if I can use that term in the military sense, is you must be able to do the piece that you're in rather than something else. You must be fit for the armoured corps, period, or sorry.
If the military took the position within the confines of the things it needs to do—and I'll grant it's a limited field versus perhaps that of civilian employers, in that their field might be wider in some but not all cases, but it seems the military one might be a narrower place—is there not a sense that folks sign up voluntarily? They're looking for careers. They're looking to put in their time, whatever that is, 25 or 30 years. These are not folks who want to serve one term and go. These are folks who've opted to continue. Is there not a duty to accommodate them somehow, give them opportunities? Should we not have a system that checks the boxes off along the way: can this person from the armoured corps go to this position; if not that one why not this one; and if not that one, why not this one; and then sorry, there are no more other places and the person will have to be transitioned out. The debate about the transition services is a different piece.
In your sense, sir, is that something perhaps this committee needs to think about in recommendations when it comes to folks who have limitations, whatever those limitations happen to be, because of an injury?
I think what your question alludes to is the core of the definition of the four causes of operational stress injury, the four causes that we developed in cooperation with the U.S. Marine Corps in the 2007-08 era.
Very clearly one is trauma. I believe it's very fair for me to say that if you are in a combat situation, you are experiencing high-intensity trauma. That's the trauma perspective, or the trauma lens, that allows, unfortunately, some people to develop mental health conditions from traumatic events.
The three other causes of operational stress injury are those causes that are under-endorsed, misunderstood, and often ignored. This goes back to an earlier question. These are the three other causes which, by the way, remain to this date, despite years of fighting in Afghanistan, I believe, the top causes of why soldiers decompensate. They are fatigue, the cumulative wear and tear on the soul.... I'm not talking about being tired and wanting to sleep. I'm talking about the fatigue of really having a hard time continuing to do what you're doing because there have been too many mass graves.
There's grief. Grief is that sense of loss. When you look at grief as a cause of stress injury, you don't need to know your friend or you don't need to know the person who died. It's a sense of loss. It's a corporate sense of loss. Mr. Alexander was in Afghanistan. There were a lot of ramp ceremonies, weren't there? The entire contingent grieves. I lost only two soldiers on my tour of duty. I knew them very well. I grieved at a different level. But every time a coffin came back to Canada, there was institutional grieving, and there's a cost to that.
Finally, there's the moral conflict. Moral conflict is probably the most important cause of stress injuries, and I think it's what you're alluding to. You went overseas thinking you would do x, y, and z, and all of a sudden you're confronted with situations that don't quite fit. You're not too sure what to make of all of this. It causes moral conflict, questioning, and it opens a Pandora's box.
Whether you need treatment, sir, I couldn't say, but the fact that you're talking is a good thing, and it just shows your humanity. For that, I applaud you.
I mean by the leadership itself to recognize that the mental health of its members is not a clinical matter.
When somebody is ill, it's definitely a clinical issue. Somebody needs proper treatment, etc. But the mental health of any employee in Canada is not a doctor's responsibility; it is a leadership responsibility. Corporate CEOs and vice-presidents have the mental health of the employees in this country in their hands. What they choose to do with it is up to them.
Until we started this peer support revolution, I would contend that we had a very dogmatic clinical paradigm, which was the only paradigm through which the military looked at mental health. Therefore, the minute people exhibited behavioural signs that were not acceptable, they were told to go see the shrink. That to me is the fundamental problem.
The minute people start decompensating, it doesn't mean they need a diagnosis and they need to take pills. They might need to have a chat. They might need their boss to put an arm around them and say, “Let's talk.” Whatever happened to human interaction in the workplace? The only human interaction we have nowadays is, “Did you get my e-mail?”
Essentially we have dehumanized workplaces in the military and probably everywhere else in Canada. This whole movement for peer support strategically, as I now do my work with civilian industry, was to literally re-humanize workplaces, one after the next. That was the impetus.
The barrier was the clinical paradigm of thinking that an injured soldier.... God forbid an injured soldier would be able to wear his pants, show up at work on time, and support somebody else without getting further injured. And I think, 13 years later, they're all still doing this job—well, not all of them. Some left the program, and that's a good thing. But do you know what? Nobody committed suicide, and things have been fine.
Measurement is another issue. I'll share with the committee that since I retired from the military, I created a non-profit organization in this country, mandated through Industry Canada, to validate and measure the efficacy of peer support in this country. I'm a volunteer board member. If DND wants to measure, they can contribute to this non-profit organization and we'll be happy to measure. So the measurement matrixes are there.