:
You have been given a printed version of our brief. It's multi-coloured and it's in PowerPoint format, but it's very easy to read through. We will be referring to that as we go through our brief presentation at the beginning and then of course during the Q and A.
I'll not be reading all of the slides, obviously, but rather we'll just touch on a few of the high points and focus on what's new in the operational stress injuries social support program, the key determinants of its success, and the major challenges that face the organization.
I am sure most of you are familiar with the term “operational stress injury”. At the risk of digressing for a moment, that term in fact is a Canadian invention by the OSISS team, and it's been inherited internationally, which we'll get into when we talk about international activities.
As you know, OSI is not a diagnostic term, but rather a term developed by the OSI social support organization to put focus on the injury and to work towards destigmatizing the condition. The term is now in wide use by clinicians and non-clinicians as a way to encompass all operational-related mental health injuries—and, as I mentioned, nationally and internationally. I'm sure if the question comes up during the question period, these two officers with me here can attest to their participation on international forums in NATO, in Europe, and of course a lot of time in the United States, working with their colleagues who have served in the Iraq war.
The presentation package includes a background of the OSI advisory committee. This group was formed in 2002 and brings together a group of interested people from Veterans Affairs, Defence, veterans organizations, the RCMP, the ombudsman's office at DND, and various mental health professionals three times a year to provide advice to OSISS and feedback to senior management in both sponsoring departments.
The terms of reference are included in your package, but very briefly, it's to provide advice and guidance to the OSISS management team to improve delivery; to help identify systemic gaps or shortcomings in the peer support program; to assist the OSISS management team in coordinating the program; to deliver aspects of the peer support network with respect to agencies and departments; and to actively take part, where and when possible, in raising awareness of the OSISS program. As chair, I emphasize this to all of the committee members, recognizing that we don't have any executive authority, but they're encouraged, as they put it, to spread the gospel in regard to the outstanding success of the peer support program. The composition is 24 members, and they're listed in one of your handouts.
OSISS itself—you'll notice I switch from “committee” to “OSISS”—came into being within DND in the spring of 2001 in response to input from SCONDVA, the Croatia board of inquiry, and the DND ombudsman's office. Shortly thereafter, recognizing the shared responsibility for the welfare of Canadian Forces members and veterans, a partnership was formed with Veterans Affairs Canada.
OSISS was clearly the result of the vision and drive of one officer, Lieutenant-Colonel Stéphane Grenier. He is not here today because he has finished his tenure. He's a PTSD sufferer.
He served in Rwanda with General Dallaire for 10 months. He returned home, recognized he had a problem, but he lived with it. In fact, he was deployed to Cambodia, to Haiti, to Lebanon, and so forth, fighting that problem. Needless to say, at a certain point he did talk to sympathetic superiors, not the least of whom was the then General Dallaire, who was followed by General Couture—may he rest in peace—who became a champion of the OSISS program. By the way, although he's still a PTSD sufferer undergoing treatment, Colonel Stéphane Grenier is serving in Afghanistan as a public affairs officer. He says it's time to get back on the horse, and to his credit that's exactly what he's done. He has been decorated by the Governor General with the Meritorious Service Cross for his drive and initiative in establishing this program.
He's moved on, but he's been ably replaced by Major Mariane Le Beau, who, as I indicated, is an extremely hard-working officer and very dedicated, having spent many years—and has served in Afghanistan. The co-manager, of course, supported Stéphane Grenier from the start. Kathy Darte is one of the originals, as we call her, and works very closely with her colleague in DND.
The mission of OSISS is twofold: to develop social support programs for members, veterans, and their families who have been affected by operational stress, and to provide the education and training that will eventually change the culture toward psychological injuries in the CF. I emphasize “families” because families always have been important to those who have worn a uniform. Having served on 14 separate missions and having had to leave my family behind, for the most part, I can be very sympathetic with the emphasis on family as brought out with the recent passage of the new veterans charter.
The key to effective peer support, which is the heart of the OSISS program, is the initial selection of the right kind of people, the peer support coordinators and, recently, but gathering momentum, and rightfully so, as their peers, the family peer support coordinators. The numbers I will leave to the questions and answers, and they will be answered by my colleagues.
Aside from the basic two-week training course the peer support coordinators and family peer support coordinators always see, the OSISS program runs a far-reaching continuous education phase as well for both those groups, recognizing that they also have a need for self-care, which I'll leave to my colleagues in the Q and A.
In the end, it all comes down to developing trust with the members, veterans, and families who come forward to talk to a peer support coordinator, wherever they may be and wherever they are referred from, technically through DND and VAC. They may meet in an office, or, if they don't like that, maybe they'll meet in Tim Hortons, so they can talk the issues through and make the informal assessment and refer them accordingly, developing trust with members and veterans who come forward, allowing them to proceed at their own pace, and providing a supportive shoulder to lean on. If you wish, we can get into some personal experiences in the Q and A.
It's essential that the peer support workers understand the role they play, understand when to pull back, and be willing to refer the peer to a professional resource, a clinical resource. The danger of the peer support coordinator is burnout, compassion stress, trauma, depression, and physical illness. What is absolutely amazing and a testament to both the quality of the people involved and the level of care provided by both departments in this program is that there have been very few such problems in the five years this program has been running.
There are several new initiatives to talk about in OSISS, which you are welcome to pursue in the question period. The new bereavement peer support initiative delivers support to the immediate families of those who have lost a loved one in military service, again to be delivered by those who have been through a similar event. Notice the emphasis on the word “peer”.
There is considerable international interest in the success of this program, and, as I mentioned, both of the co-managers can talk on these approaches at some length.
The third location “decompression” operation in Cypress provides members rotating out of Afghanistan with an opportunity to spend a few days transiting from a theatre of war to their living rooms, all as part of a significantly enhanced redeployment program. Having personal experience with it, I can assure you that the program is successful. We have dragged in several people who were under my command who had been involved at the massacre sites and so forth. We were not going to send Captain X back to his wife 24 hours later. He had to be decompressed, which meant going away for three or four days and possibly being able to talk the issue through while receiving some peer support and a shoulder to lean on, as I indicated.
We have learned that there are several key determinants to success in a program like this. First, and perhaps most importantly, is the need to involve peers right from the beginning of the program development and policy. An excellent interdepartmental partnership is essential to success, as is the use of a multidisciplinary management team. The emphasis on self-care and realistic boundaries has been another key area.
As I mentioned in the beginning, the recruiting and screening of the right people is essential, and perhaps the area where this program has excelled, in my opinion. To help provide relief for that key group of peer support personnel, recruiting, training, and retaining a network of volunteers is vital.
This is all a fallout of this interdepartmental cooperation from ten years ago, when they were at both ends of the table. I guess they would talk, but since the new veterans charter, or starting with the Canadian Forces Advisory Council and the workups—and I'm getting off the subject here—a number of us in this room have been intimately involved in this process. It's very heartwarming to see that the two departments have come together. In other words, as recommended by the council, it's a seamless approach. That's where we are now, and these two officers here are examples.
In terms of challenges, there are certainly many out there. For example, there are still a number of systemic barriers in place. Some clinicians are still suspicious of non mental health professionals meddling in their business. I don't know if I'm allowed to say this, but having read some of the transcripts from previous witnesses here, I think you can understand that there is some hesitation by the professionals in regard to the peer support business. On the other hand, others who have experienced the value of working with a peer support coordinator literally sing their praises in both departments.
Just the physical size of the territory covered by this very small group of peer and family support coordinators is amazing when you recognize that there are currently only five OSI clinics from Veterans Affairs in place and a number of OTSSCs from DND. Especially for reservists who may live far from a major base, getting to where we have a peer support coordinator can be a real challenge.
Growing the volunteer network that I referred to is another challenge that our PSCs face each day—and I might add that it is their responsibility, in part. Once the investment has been made to find and train these folks, retaining them becomes another challenge. The peer support groups that are such an important part of this program also take a lot of effort and significant resources because many peers are reluctant to meet at on-base facilities. As I indicated earlier, even finding a place to meet can be a problem. That's why I indicated that sometimes they meet at McDonald's or Tim Hortons.
I'll just back up to that point because there are a lot of soldiers who will not admit they have a problem. They do not want to be seen going into a “mental health facility” or some facility like that on the base. They'll be identified, and in their mind, that's not good or it's not macho—if you want to use that term—since they have to stand up and brush it off. So there are avenues for them to approach.
The last challenge on the list is certainly not the least. Let there be no doubt that the culture of the Canadian Forces, in dealing with mental health issues, has changed significantly in the last six years or so. However, there's still a long haul ahead, and to my mind it will never completely go away. We have to continually fight the fact that there shouldn't be a stigma associated with an operational stress injury, including PTSD and the other subtitles.
Education and training are the key to cultural change, and as is often the case, the long-term investments are frequently overtaken by the shorter-term demands. To even sustain the gains made in the last few years, great effort is required, and this is, and will remain, a constant challenge.
Ladies and gentlemen, just before I finish, this very successful program is funded by both departments, of course, and 75% of those who are serviced are in fact veterans, and 25% are serving members, plus or minus a few percentage points, and I'll be corrected by these officers if I'm wrong on those figures. But it doesn't make much difference, because, Mr. Chairman, it's understandable that those percentages would be there because the uniqueness of this program is that a lot of the veterans, be they Korean War vets, be they Beirut war vets, be they vets of Yugoslavia or the former Yugoslavia and so forth, are coming forward: “I've got a problem”; “I was bombing out of Aviona and I've got a problem”; “I was part of the Swiss Air cleanup and I've got a problem”; “I was on that aircraft that crashed short of Alert and I've got a problem”; “I'm a SAR tech and I've got a problem”. These people are coming out of the woodwork, and they may be retired. So this program, in my mind, is literally an outstanding success.
Thank you for your attention. With that, I'd like to invite your questions. If you would address to them to myself, as required, I'll direct them to the appropriate officers, sir.
:
That's a good point. You can go back 40 years. I think back to when we were stationed in Germany—a young family—from 1960 to 1963 with a battalion. That was when the Berlin Wall was going up and the Cuban crisis was going on and so forth. When you were deployed, there was always a concern about what was going to happen to your family. Well, they had to find their way to the base and they would eventually get backloaded to Canada. That was the extent of the family support. Thank God for the regimental system, because it would kick in.
But since then, leaping ahead, as I keep bringing up, the Veterans Affairs and Canadian Forces advisory council was asked to come up with recommendations regarding a charter: either amend the old one or have a new one. During those deliberations, Mr. Pierre Allard, who is here today, from the Royal Canadian Legion, was a member of that council, as I was, and a number of us were tasked to go to various bases to talk to the troops informally, 30 to 40 people, privates to captains, a couple of ex-warrant officers, without any names taken, to have a round table discussion, with the consent of the base commander, with the consent of NDHQ, and so forth. We were supposed to do three—the army, navy, and air force—and we ended up doing eighteen of those.
Concurrent with our movements were two female members of our council who were there to talk to the families, sometimes at the military family resource centre, and sometimes they didn't want to meet there and would meet someplace else, at reduced numbers. It came out loud and clear, not only from the troops we talked to, that first of all they were grossly overtasked and stressed right out. They were stressed out, and the people who were left back were stressed out. When you have a section of four and three of them are gone, and one person has to do everything, what effect did that have on the family? Our family team brought it out loud and clear when we made the presentation to the deputy minister and others, and eventually to the minister, and it was accepted, that of all the things we were considering at that time, family would be at the top of the list. Believe it or not, ahead of the veteran, family would be first.
That report was passed and accepted by the minister and his department with the drafting of the new veterans charter, and so forth. So that's where it started. Since then, of course, as you've heard, this program has evolved in the last five years. It was written initially by Stéphane Grenier at his kitchen table: How am I going to influence the system to help my peers? And by the way, my wife has a problem too, because I have become a recluse. I've become a recluse, she's become a recluse, and there's an effect on the family.
That's not just unique to Grenier; it's unique to a number of us who have gone through that process: Where can we get some help? So the family has to come into it, but you have to walk before you run. The idea was, with the two champions of the OSISS program at the time, General Couture and ADM Brian Ferguson from the Department of Veterans Affairs, let's move forward, get the peers running, and we will address the family.
It may sound like, well, okay, bring the family along. They were brought along, and they're both together now and they're both being addressed. I'm getting into the business of the two co-managers here, but from my understanding, they're both being addressed. Sure, there's lots of work to be done.
Kathy or Mariane, do you want to add to that?
:
In response to your question on reservists, I just want to point out that, as I said earlier, everybody is welcomed into the OSISS program. We serve those in uniform and those out of uniform.
We have a number of reservists who have come forward and accessed services under the OSISS program. One of our trained peer support workers in the program is himself a reservist. His name is Vince Tytler, and he's working from Vancouver.
A large part of the coordinators' role is to make themselves known in their respective geographic areas, and part of that is networking. Part of that is going out and speaking to reserve units, telling them about the OSISS program and the services that are available, and just spreading the word in general.
Part of our program is not only providing one-on-one assistance to individuals, but also bringing veterans and members together in a group setting. Part of these group meetings involves reservists. They come and they meet with other peers, other buddies, other reserve members, other regular force members, and other veterans. So it's by word of mouth.
It is a challenge, because you're quite right, they do go back to their home locales. So we just have to continuously work on raising the awareness and education and on making the program known.
Regarding the international and best practices, that's a really good question. We—the managers, Lieutenant-Colonel Grenier, Major Le Beau, and I—have presented on our program internationally on a number of occasions. We know we have a really unique program.
There isn't a program anywhere in the world that's similar to this program in terms of how we've set it up. Other countries are looking to us. They want to hear about the program, so we've presented in Australia, in the U.S., in Europe. We are invited again to go back to Europe this year. We have presented to NATO.
There are a number of programs around the world that the militaries and veterans affairs have set up, but they're slightly different from ours. I think part of our success—and these other countries are identifying that—comes from both Veterans Affairs and National Defence's working together on this program. There's not a separate veterans program from the VA department and a separate Defence program. There's a program for all, in uniform or out of uniform, and families.
The other things we hear about from our international colleagues are the parameters and the emphasis that we put on this program. These individuals are very well trained. We do not just hire them and put them out to work. They all come with the same criteria for selection, namely that they must be a veteran—they must have been in the forces—and they must have an injury.
Then we train them. We provide extensive training, which is done by Ste. Anne's Hospital. Our Veterans Affairs mental health staff at Ste. Anne's Hospital, along with other individuals from Defence and from Veterans Affairs, provides training. It's almost continuous training. It's ongoing. We continuously reinforce.
The other things we emphasize in our program are boundaries—you have to stick within your role—and self-care, because in order to work with others you have to take care of yourself.
So I think the other countries are noticing that this is a very formalized program. It's formalized in how we've set it up and in how we continue to monitor these people. We continually need to watch them. Dr. Richardson—who's the medical advisor for Veterans Affairs to the program and who unfortunately couldn't be with us today because he's on holidays—and I are following these people through long-term research, looking at their health and well-being. We measure their health when they start to conduct this work for us, and then we continuously measure their health over the course of their employment with us.
Basically, what we're finding is that there is no decrease in the level of health of these individuals. In fact, they are getting better, and it's because they are now able to get back into the workforce, contribute to society, and help others who are in the same situation they were in.
:
Thank you. That's an excellent question.
First of all, thank you for your kind remarks. I appreciate them.
I'll get around to your question in a minute, but just to go back to your point on experience in regard to clinical staff, psychologists and so forth, as you may be aware, the first ones went out to the field for two to three weeks initially in Bosnia, which wasn't long enough. Having been there, the troops viewed them with a bit of a jaundiced eye—that “I'm from NDHQ and I'm here to help you” kind of thing. The troops would much rather talk to their peers.
Having said that, it's my understanding—and this is a personal opinion—that the Canadian Forces health system is intentionally pushing clinical staff out into the field in Afghanistan, as you've heard. There's one there. The chief psychiatrist just came back from a four-month tour, and there are two psychiatrists who have replaced him. There is an individual in Halifax who was at one time a unit medical officer in Rwanda and a unit medical officer on the Golan Heights, who has specialist training and has spent one, if not two, tours in Afghanistan as the psychiatrist. He is the kind of guy who will take off his rank and talk to the soldiers; he is very, very good at it. So experience is building among the clinical staff, in addition to the experienced field soldiers who are talking to each other. But thank you for making that a point.
The change for the VAC or Veterans Affairs—and I'm saying this more as an individual rather than as a departmental employee of either department, which I'm not—has been dramatic, you could almost say, from ten years ago in regard to a caring attitude. Ten years ago there was almost an adversarial approach when somebody came forward to VAC for some type of annuity, treatment, and so forth. It's changed dramatically because the benefit of the doubt now goes to the individual—and obviously there's a certain bureaucracy individuals have to go through.
The culture is different, in my opinion, and that started with some significant changes within VAC six to eight years ago, when the emphasis was put on the individual rather than the system, with the benefit of the doubt now going to the individual. So I'm very positive that this type of activity will continue. With the example of the two circles overlapping, as Mr. Stoffer has indicated, or the seamless approach I mentioned, people are less likely to drop through the cracks than they were a number of years ago. Are there going to be people who will drop through the cracks? Of course. No system is perfect. But at least we've made significant inroads.
I don't know if that answers the question or not, Ms. Hinton, but thank you for asking it.