Mr. Chair, I want to thank you for that eloquent introduction. I hope that I will not disappoint you.
Ladies and gentlemen, I have a prepared text and I have also distributed two charts to which I will refer later on. Certainly they're for public knowledge. They are not scientific; they are a soldier's view of a situation.
Mr. Chairman, ladies and gentlemen, thank you for the invitation to speak to you about a significant threat to the long-term well-being of the Canadian Forces, its members and veterans, as well as the operational effectiveness of the Canadian Forces. Losses of experienced serving veterans are a serious deficiency to the Canadian Forces' operational capabilities. The committee's excellent sixth report already covers much of what I wish to speak of today, and I hope to provide some updating and also some insight, as well as a few recommendations.
You have had witnesses testify to the failings of the Canadian Forces health services, and more particularly the mental health services, and you have had the commander of the Canadian Forces Health Services Group, Brigadier-General Hilary Jaeger, also testify to the tremendous hard work and the achievements of exceptional clinical results, particularly overseas. How can the same organization succeed and fail at the same time?
Let me begin with a bit of background based on my observations as the assistant deputy minister of military personnel in the late 1990s, as a soldier who was injured by operational stress and diagnosed with post-traumatic stress disorder, leading to subsequent medical release, as a veteran convalescing under continual treatment, and as a senator receiving e-mails and requests for support from Canadian Forces members, veterans, and families of both groups.
At the end of World War Two and on into the Korean War, the performance of the Royal Canadian Army Medical Corps and the Royal Canadian Dental Corps were the envy of our allies. At that time medical and dental schools were directed by former medical and dental officers and the armed forces were getting graduates who were the cream of crop. Over time, the prospect of administering a peacetime force composed of healthy young persons whose only problems were generally the odd cold or sports injury held less and less appeal to top graduates and while they still enrolled, recruitment became increasingly difficult.
With the end of the cold war and demands for a peace dividend, the structure of the medical services began to tumble with ever-increasing cutbacks. When I was the Assistant Deputy Minister of Human Resources, a band-aid solution called Operation Phoenix was applied which did nothing. We then launched RX 2000, a catchy name. Fortunately, it is still ongoing and is producing the results we find in Kandahar, in the theatre of operations.
In 1997, when I was under medical treatment, I made a painful but conscious decision to go public within the forces, and subsequently it was picked up by the general public about my injury of PTSD. Some referred to me as the poster boy of PTSD, a disparaging and hurtful appellation. However, the countless letters and e-mails I have received from families who declare that their spouses' lives and their marriages have been saved by my openness more than compensates for the lack of compassion shown by former colleagues and less than friendly editorialists.
When my book was published in the United States, the back-cover blurb indicated that I had been medically released with PTSD. When I inquired why this information had been added without my knowledge, I was told I was the only general officer to date who had acknowledged being affected by PTSD.
I bring this to your attention because one of the aspects of this injury is the compulsion to hide, to withdraw as if you have contracted some terribly devastating contagious disease such as HIV/AIDS or leprosy, and you believe you have failed and have let everyone down.
As a soldier you have recurring nightmares of placing your colleagues in situations where you actually become a burden, a hazard to their security. At first I thought I was the only one possessed with these nightmares, but others have told me they also have these terrible nights. Subsequently in my mission, I asked to be relieved because of the impact of that injury at that time.
Dr. James Obinski, who is head of Médecins sans frontières, operating out out of the King Faisal Hospital in Kigali during the height of the Rwandan genocide in 1994 describes his PTSD and the impact that it has even on an excellent and also professional medical practitioner:
|| I was driving along Highway 401 in Toronto as a blue Mazda Miata passed me. It was the same colour as the plastic tarp that I had been dreaming about for months without knowing why. Instantly, my car filled with the sweet semll of freshly killed flesh and blood. I saw sausages and then children's fingers in the red soil around the tarp. I veered as I tried to open the windows. The bumper scraped the guardrail as the car came to a full stop. I sat in the car, the smell and sausages gone. It was snowing outside. The wipers kept rhythm but I had fallen out of time. The worlds had not changed--I had. I sat there, counting pieces of roadside garbage and debris, and then I just drove for a while. I arrived at my parents' house three hours late.
In 1997 I was travelling with my family in Prince Edward Island. We were driving down a road where they had clearcut the sides of the road where there had been principally spruce trees. The large branches had been piled along the roads with the ends facing the road and the leaves or the quills had all rusted and turned brown.
As I drove down that I immediately fell into a trance in which it seemed to me like I was right back in Rwanda and what was piled beside the roads were the bodies of dead and decaying Rwandans. It was so overwhelming that I in fact had to stop and for a considerable amount of time took a lot of support from the family to be able to re-establish myself in my state.
PTSD is an injury. It is recurring. Whether you miss your medication or your therapy or at times even when you think you are fully taking the medication and therapy, you are continuously vulnerable to fall back into those states of shock, those states of horror, and you lose completely a sense of reality of where you are and ultimately you panic. If in a state of depression as you fall into that state, you are susceptible to suicide.
When the CF clinics were being established, two errors were committed. They insisted on calling them mental health clinics although they are now called operational trauma and stress support centres, which is a much preferred location to visit if you are a soldier with psychological problems, because of the stigma attached to mental health issues. PTSD is not an illness, it's an injury.
The second, and perhaps the most serious barrier, is the location of these clinics. The soldiers, as with anyone with a personal health issue, wish to maintain their anonymity. Being forced to report to a base location clearly identified for the treatment of psychiatric or psychological problems causes members to decline self-identification of poor psychological health or treatment. Some request release rather than undergoing the feeling of embarrassment of reporting to these locations and the perceived jeers of fellow soldiers. They are even willing to leave the Canadian Forces.
Early detection and treatment of operational stress injuries are absolutely essential to any recovery or state of “rationality”. The Canadian Forces have responded to this requirement very well and have established procedures to attempt to detect injuries. However you have read and have been told of cases falling through the cracks and this is a fact. This happens because the individual may want to fall through the cracks; some injured personnel wish to totally disappear from any sort of tracking system and contact with their former colleagues who remind them of the problems they are experiencing. This is the existing stigma of the injury taking over their thinking as they feel highly stigmatized even today.
The others are reservists who live far away from urban centres or military bases. There is no formal way to compel these individuals to continue to report or to provide funds for them to do so unless they are released and have come under the care of Veterans Affairs Canada. When it comes to care, they suffer from lethargy that could lead to serious behavioural problems and sometimes even cause them to be a danger to society.
I believe that the Canadian Forces Health Services are geared, in practice and thought, to a philosophy of repair and convalescence leading to rapid return to duty and this is how things should be to remain operational. But, operational stress injury repair is not a knee replacement followed by physiotherapy. This injury requires long-term and essential support before a reasonable amount of convalescence can be achieved, but it may also require specific assistance in order to allow individuals to survive on a daily basis without returning to a state of shock and stress.
I do not believe we have achieved the same level of excellence in this area of medical care that surgeons and dentists are demonstrating. This is a whole new dimension of military health care and something they are not, and may never be prepared to cope with, since wars continue to significantly change over time.
There are discussions about failure to attract the required specialists to the Canadian Forces because of low pay compared with their civilian counterparts. This is not entirely the case, because joining the Canadian Forces and serving Canada is a vocation, and remuneration has always been secondary for specialists, as well as for the general military population. However, responsible remuneration is required.
In any case, the large numbers of psychiatrists and psychologists required to treat the volume of soldiers returning with operational stress injury requires specialists in the civilian sector to pitch in significantly. There are civilian specialists working in some multidisciplinary Canadian Forces clinics, but I am told the turnover is high because the civilian specialists are not all geared to the Canadian Forces working environment, its rules and regulations, and a command hierarchy that from time to time overrules their expert opinion.
The matter of the various civilian pay scales has been mentioned to me. Apparently, a civilian specialist working for the Canadian Forces earns considerably less than one at a community clinic funded by provincial health plans in many parts of the country. Of interest from statistics provided, a psychiatrist in Alberta can earn as much as $195,000 a year, while the top salary in Quebec is $97,000 a year. The national average is $159,000, with Treasury Board topping out at $128,469. From this you can see that someone working full-time for the Canadian Forces will earn almost $29,000 less than the national average. Yet the Canadian Forces don't seem to have a problem in Quebec, seemingly.
Turning the problem over to external health care providers is not an ideal solution, because the Canadian Forces lose control of the service, and it is invariably more expensive than an in-house program.
I am not sure if the committee has been told of the spectrum of operational stress injuries. Not everyone has PTSD. I am told that, of the vast number of OSI cases, less than 8% are classified as PTSD.
However, I am told that a benign case of minor depression can become acute, then chronic, leading to addictions such as alcoholism, drug abuse, inappropriate compulsive behaviour and eventually PTSD, if not detected and treated as a matter or urgency. Treatments that cost a few thousands dollars in the early stages end up costing small fortunes and the individuals may well lose their family, employment and ultimately life as a result of a system's failure to act with the same urgency as for physical injuries. Regrettably, there are inherent delays in getting treatment because of scheduling delays with specialists' appointments. The multidisciplinary approach to treating stress trauma seems to be the most appropriate as it is used in the most successful clinics.
When the Canadian Forces introduced the requirement for a patient to have psychological analysis before being referred to a psychiatrist, some saw this as a method of determining if a soldier was faking the symptoms in order to claim PTSD benefits. Fortunately, specialists are very capable of determining who is genuinely ill or not; they rarely ever need a second opinion. However, the requirement to see a psychologist before a psychiatrist doubles or even triples the time required for treatment to begin because psychologists are in equally short supply, so in seeking the preferred solution we have exacerbated a serious situation by further delaying timely care to the injured.
I shall bring just a few rapid recommendations, if I may, to this committee. I take full note of the House of Commons veterans affairs committee's report and some excellent recommendations therein in regard to closer joint work between Veterans Affairs Canada and the Canadian Forces health services.
I believe it is absolutely essential that the Canadian Forces clinics be moved off the bases and that, if necessary, they even be co-located with either Veterans Affairs Canada clinics or other civilian clinics within the communities. The bottleneck of having patients only begin treatment after seeing a psychologist, to undergo a very lengthy evaluation before a psychiatrist can be seen, needs to be broken. There needs to be a more rapid way of treatment, of identifying those who need the support.
The health of reservists must be tracked for an extended period of time, even up to five years after returning from a special duty area. Of the twelve officers who joined me in Rwanda at the start of the genocide, nine of them have fallen to this injury, the last one nine years after the fact.
We should reduce the number of tours or give more time to family support.
Please look at the charts I have given you. These are not scientific; these are based on my tour when I was the assistant deputy minister of personnel and the results we were looking at then. One chart is sort of a normal chart of stress, which would be a simple curve with the families evolving over the normal period of careers. That was certainly during the Cold War, and you add a bit more stress when you have spousal employment or kids who don't want to move because they're in high school. However, in the 1990s we entered a completely different scenario that is continuing to be exacerbated today.
We are not bringing people down from the exponential curve of stress after these very complex and dangerous missions, with enough time and enough support for them to be able to evolve to the next mission, with this backdrop of saying it was tough, but we lived it, we have gained experience, and we're ready for the next one. What we are seeing, because of the rotations going so fast and the smallness of our forces and the tempo, is that one set of stresses simply leaps onto the other and ultimately it creates a scenario where families and individuals literally crash. And in fact we have even seen cases of suicide.
The Canadian Forces has instituted an excellent decompression program for groups returning from special duty areas such as Afghanistan, but it has no structured program for the large number of individual augmentees who deploy and reinforce these formed units and subsequently return. My son is due back in a couple of weeks from six months in Sierra Leone in Africa, and there is no such program established to bring them back into a level where we can assess them and also provide a level of normalcy.
It is recommended that the Canadian Forces be tasked to address this issue of the large number of individuals who are far more vulnerable than those within formed groups to actually feel the ultimate contagion of post-traumatic stress disorder. The issue is that they are not identified and subsequently not treated or treated too late, by which time they have probably self-destructed, destroyed themselves and their families.
DND and Veterans Affairs Canada should jointly build a national research training development centre in Ste. Anne. I would like to recommend that the institution at Sainte-Anne-de-Bellevue Hospital be a place that is the repository of the experience and the knowledge so that we don't fall into the same problem we did the last time, which is to take over ten years to be able to rebuild a system in order to take care of those injured by the psychological impacts of conflict. We have to maintain an expertise throughout.
My last point is there has to be a way of introducing the families in a formal way into the treatment process. Treating only the member, and not the families, is not going to achieve the operational levels we are hoping to achieve by bringing those members who have been injured to a level where we can reuse them.
I leave you with the following comment as my ending. When I came back in 1994 from Rwanda, my mother-in-law told me she would not have survived World War II if she had had to go through what my wife and children did.
In World War II my father-in-law commanded a regiment and was in the field throughout. On occasion they got a bit of information, and that little bit of information was often censored.
However, today our families live the missions with us. They are continually watching the TV, listening to the radio, and clicking to find out when it will be announced that their son, daughter, husband, or spouse has been killed, injured, abducted, or whatever. When we come back from those missions, they are not the same as they were before. Nor are we. A system that cannot absorb the responsibility of sending the individual into these mission areas, taking care of that individual when he comes back, and taking care of the family that we put through the wringer is a system that has a major deficiency.
I realize fully the problematics between federal and provincial, but that should not prevent us from maintaining operational effectiveness of our Canadian Forces by providing support not only to the members but also to their families. This makes our forces that much more effective.
In 1997, when I was chief of staff of personnel and then went public because we were misguiding our own people, let alone outside, I went to the U.S. Veterans Center for Post-traumatic Stress Clinics, which is in White River Junction, Vermont, to ask them whether all treatment should be the same, such as commanders with their stresses and training, versus soldiers. I also asked them how to help us mature our program rapidly, because they had the experience of Vietnam.
The answer was “We don't want you to go through what we lived in Vietnam, and we'll help you”, because in 1997 they had on the books a number of suicides directly related to Vietnam. They had lost 58,000 troops in Vietnam. By 1997 they had over 102,000 suicides directly related to Vietnam.
This is an injury that never leaves. You cannot get out of it, as Monsieur Bachand asked me, without professional therapy and medication and a bosom buddy. The OSISS program on operational stress with peers is absolutely critical. You need someone who is going to sit there for four hours and not ask you one question, and let you talk and talk. You need that at all times.
Your vulnerability is never guaranteed. It's like they take away your prosthesis all of a sudden. I will give you an example, if I may. I was in Sierra Leone doing work on demobilizing child soldiers--in fact, working for Madam Minna at the time--and I had come back from the rebel area and was crossing the street in Freetown. Out of the corner of my eye I see a coconut vendor who has a machete and he's setting up shop. I keep crossing the road, and all of a sudden he took the machete and lopped the top off a coconut. There was white liquid and brown, and between the sound and the sight, I went totally and completely berserk.
The three people with me sat on me to hold me down for at least five minutes, then slowly I was able to rebuild. About 20 minutes later, I actually gave a briefing. So you have no knowledge of the noise, the smell, the comment that will trigger these reactions.
We have troops in my old regiment, 5th Regiment Artillery, and when I went back last year to a golf game, there were sergeants there who had been ten years in the army. Now, you need at least a year to get them up to minimum strength and then other training, so let's say they had about nine years' operational use. They had been on seven missions!
We have soldiers in the Canadian Forces who have more combat time than veterans of World War II. In so doing, we will continue to see an attrition of them and their families, unless you get the numbers up. It is not about reducing the missions, because we should also be in Darfur and a couple of other places; it is getting the numbers up.
Rebuilding an army is a long-term exercise, so I fear there will be more casualties, simply by burning them out.
My last point is we will probably have people going overseas who are suffering from that injury. God knows, a noise or an event might trigger them back in, and how effective they will be, we don't know.
I'm Dr. Greg Passey. I served for 22 years in the Canadian Forces until September 2000, first as a general duty medical officer, then, in the last nine years, in psychiatry, with particular expertise in post-traumatic stress disorder and associated operational stress injuries.
I did the first large-scale research project in the world to investigate PTSD and major depressive disorders associated with peacekeeping deployments. This was conducted on Canadian military personnel in 1993-94 deployed for Operation Harmony and Operation Cavalier in the former Yugoslavia.
Prior to that, there was a general awareness that there were psychological injuries and costs associated with conduct in combat operations. In 1990, in their book Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939-1945, Copp and McAndrew detailed how about 25% of all Canadian military casualties during the Italian campaign in World War II were neuropsychiatric, or what we would now call operational stress injuries.
My research in 1993-94 for the Surgeon General and the Canadian Forces Medical Service revealed a depression rate of 12% and a PTSD rate of 15.5%, or an overall 20% rate of either or both of those disorders in one combat engineer regiment, the 2nd Battalion, Princess Patricia's Canadian Light Infantry, and the 2nd Battalion, Royal Canadian Regiment, upon their return home from peacekeeping duties. This established that there was a cost beyond the expenditure of money, equipment, and physical injuries when conducting peacekeeping or peacemaking military operations.
These figures shocked the military, and its upper echelon was very resistant to addressing these new findings initially. The immediate response seemed to be to try to find ways to ignore or question the validity of the numbers rather than starting to initiate a plan to acquire and reallocate medical resources to address a looming health care issue within the military.
Recommendations by me and other health specialists in regard to the acquisition and placement of multidisciplinary medical teams with the brigades and on deployments were largely ignored until the Croatia board of inquiry results were released and General Dallaire, in 1997, publicly disclosed his diagnosis of PTSD and became a strong advocate for mental health assessment and treatment within the CF. Even so, it was not until 1999 that the operational stress injury clinics were finally initiated, although CFB Petawawa did not receive one.
Recent research indicates that the PTSD rate in Canadian personnel returning from Afghanistan is about 5%. This would potentially generate 250 new PTSD cases per year. American casualty rates in Iraq indicate that their regular forces have a PTSD rate of 17%, and for the National Guard it's 25%. This duplicates my finding that reservists are more at risk of developing PTSD. In Canada we utilize a high proportion of reservists on our deployments, yet the medical system and follow-up for them is lacking compared with the regular forces.
Failure to provide access to military specialists who can diagnose and treat PTSD has significant cost to the units, individual soldiers, and their families, and potentially can result in lawsuits. In 1994 it was reported in The Medical Post that the Ministry of Defence for Britain agreed to pay 100,000 pounds to Corporal Alexander Findlay for not diagnosing and properly treating PTSD.
In 2002, in the National Post, it was reported that Sergeant Peter Duplessis launched a lawsuit against the Canadian Department of National Defence, and in particular Dr. Boddam, for failing to diagnose and treat his PTSD. This was particularly important because from 1995 until 2008, Colonel Boddam was the practice leader for psychiatry and mental health in the Canadian Forces. As such, he advised the CFMS on the size, placement, focus, and direction of mental health resources within the military.
Colonel Boddam admitted in the examination for discovery in 2003 that he did not ask questions that would enable him to diagnose PTSD. This case subsequently settled out of court for a sizeable amount, but Colonel Boddam retained his clinical and advisory positions. There were other individuals with similar circumstances who would have also launched lawsuits, but they were precluded from doing so because of the statute of limitations. At the present time, there are other lawsuits against the CF that are either proceeding through the courts or are in negotiations for settlement toward PTSD.
Competency remains an issue in the delivery of care to our injured soldiers. For example, Corporal A was recently assessed four months ago at an OSI clinic and diagnosed with PTSD. During the assessment he admitted to drinking alcohol a lot, but the specialist did not quantify how much, nor did he ask about the corporal's suicidal ideation. This is important, because excessive alcohol intake often precedes a suicide attempt.
Corporal A was quite suicidal and is fortunate to still be alive today, only because of the intervention by another experienced clinician. About 49% of individuals with PTSD have suicidal ideation, and about 19% will actually attempt suicide.
The CF has made significant progress with the establishment of the OTSSCs and the OSISS network screening procedures, and certainly General Hillier's recent CANFORGEN is spotlighting mental health before he leaves.
Nonetheless, there is evidence that the clinical resources are swamped. This was confirmed in my conversation two days ago with a doctor deploying to Afghanistan from CFB Valcartier, where there are wait lists for treatment. I educate all the medical staff who deploy to Afghanistan and who attend the Vancouver General Hospital traumatic treatment centre.
In addition, most of the assessment and treatment of OSI is now done by civilian specialists contracted to the CF or VAC. Acquisition of these resources is in direct competition with civilian health organizations, and as such many of the hired specialists do not necessarily have the clinical experience or military environment knowledge to provide optimal care.
There are a number of issues that I wanted to address. One is the stigma associated with mental health and OSI diagnosis. One recommendation is that the Canadian Forces should adopt a zero tolerance policy in regard to discrimination with OSI diagnoses in the same way they have instituted zero tolerance for either religious or gender discrimination. We need to change the terminology from “mental health”, which has a high stigma attached to it, to “neurological health”. We also need to develop a specific program to retain individuals within the CF when appropriate, such as reclassification to other military jobs.
In regard to experienced clinicians, I think it's important that the CF and VAC both sponsor a yearly national conference wherein all clinicians providing mental health care can attend and receive continuing education credits addressing assessment and treatment issues, military culture, deployment stressors, continuity of care, and transition to civilian life, with a forum for clinician feedback. There needs to be special orientation for civilians who are hired, and there needs to be ongoing recruitment of clinicians who have at least two to three years of experience. But beyond that, there needs to be a mentor program to help the less experienced clinicians.
There also needs to be the development of a quality assurance program in both the CF and VAC in regard to health care delivery that has input from the members, their families, and other clinicians.
In regard to reservist care, I would recommend that a health care specialist be appointed to specifically oversee the delivery of health care to reservists, and further, that there be the development of a tracking system and policy to ensure at least two years' follow-up, especially for those who leave the reserves.
Then there are ongoing issues in regard to continuity of care during transition, which we heard about from General Dallaire. There needs to be further development of resources for family members.
Thank you for your time.
Mr. Chair, I am the Reverend Captain (Retired) Allan Studd. I'm an Anglican priest and a retired Canadian Forces chaplain and a marriage and family therapist.
I am the son and grandson of career members of the Canadian Forces. I grew up on base at Wainwright, Borden, and Oakville.
I was ordained to the ministry in 1979. There were attempts at that point to get me into the military chaplaincy, but it was not until 1994 that I began to work as a chaplain at CFB Petawawa. I was commissioned as an officer and a chaplain on August 4, 1995, with the 1st Air Defence Regiment, which was a reserve unit in Pembroke, Ontario, and an asset of 2 Combat Mechanized Brigade Group at Petawawa at that time.
I served on continuous class B contracts as garrison chaplain and then chaplain to 2nd Combat Engineer Regiment and 1st Air Defence Regiment. Later I was posted to base chaplain and chapel life coordinator. I was medically released on October 30, 2002. I have PTSD comorbid with major depression and migraine headaches.
I concur with everything that General Delaire told us in his presentation. Very quickly, remember that between the years1994 and 2000, CFB Petawawa was returning from Somalia and saw the shutdown of the Airborne Regiment. They were just returning from mop-up operations in Rwanda. We were deployed in Croatia. Later on we deployed to Bosnia and did that twice. We deployed as well as aid to civil power, to Winnipeg during the Red River flood, and the ice storm in eastern Canada. We took the DART team to an earthquake in Turkey and Hurricane Mitch in Honduras. Finally, we deployed to Kosovo and managed another refugee crisis there. Somewhere in there, I was seconded as well to the American forces and I served as chaplain to Fort Sherman, the Panama Canal Zone, for a jungle operations training course.
I go through this because this is only a list of the extraordinary deployments. It says nothing of the regular training cycle of the Canadian Forces that takes soldiers away for extended periods of time. And through all of this, the military families suffered, and as chaplain I daily dealt with, counselled, and provided therapy to members, their spouses, and their families, as those families splintered under the strain.
Alcoholism, Internet chat rooms, infidelity, domestic violence, financial difficulties, brushes with the law, injuries as a result of automobile accidents, depression, mental illness, eating disorders, home sickness, illness of immediate family members, death of immediate family members, Gulf War syndrome, PTSD, suicide and the death of my own engineers while serving in Bosnia, all of these I dealt with daily, any time of the day or night.
In March 2000 I left the base exhausted, an exhaustion that after eight years I still have not fully recovered from, and I returned to a family that no longer knew me. The frenetic pace of operations, the breakdown of the day-to-day operation of the chaplain team in Petawawa, the constant stress of trying to be a caregiver, a 24/7 on-call work style, and a well-documented case of harassment left me a mere shell of who I had been in 1994.
This is a snapshot of the military family and what General Delaire was trying to impress upon us. When asked by SISIP what I would like to participate in for vocational retraining, I elected to attend a 24-month post-masters clinical training program in marriage and family therapy. I understood that I hadn't had the skills and training needed for the task of providing counselling therapy to the military families of CFB Petawawa.
I also knew from personal experience of the toll taken on the military family by members returning with post-traumatic stress disorder. So at my own expense I participated in a clinical week at the Veterans Administration National Center for PTSD in Palo Alto, California. Both my military and civilian training to this point had led me to become deeply concerned about this particular disorder. I was not yet ready, however, to admit that I was affected myself. That came later.
Today I sit before you as a marriage and family therapist. Family therapists are core mental health clinicians trained to treat disorders commonly faced by returning service members and veterans.
In my training I received 500 hours of supervised training in a clinical setting. In fact, as a discipline we received more supervision of our clinical work than any other discipline, including psychologists, psychiatrists, and social workers. Our supervision ratio is one hour for every five completed and it is not matched in any other profession. I have the professional equivalent of a PhD. I have completed almost another 500 hours of supervised counselling therapy since leaving there.
I had hoped I would be doing this so that I could get back to the military family. The Canadian military, however, views mental health care for our soldiers through a 1950s lens. It's a lens that says the only professional able to provide mental health care is a social worker, a clinical psychologist, or of course a psychiatrist, and there is a disturbing vacancy rate.
I want you to know that my colleagues are ready to offer professional mental health care to our CF members and their families. Marriage and family therapy has been recognized as a discipline since 1942. We have the only training where the focus is relational. It recognizes that all mental health problems exist within a system of relationships and what affects the individual affects the whole.
Marriage and family therapists are highly trained mental health professionals. We use evidence-based methods of therapy. That means that a method has been thoroughly studied and peer-reviewed before it goes into practice. We are able to work with a whole range of mental health problems, from depression, PTSD, and occupational stress injuries to relationship breakdown and mental illnesses such as schizophrenia. All of us have a master's degree and many of us have much more than that. We are collaborative as well, meaning that we work closely with all other health professionals. MFTs can be found in private practice, hospital settings, family health teams, and community based agencies. You name it, we're there. We're also inter-professional. Our initial training and experience can come from any of the helping professions. Mine came from the ministry. We are closely regulated through the American Association for Marriage and Family Therapy and we are required to have exhaustive core competencies.
It's deeply frustrating for me that after another five years of post-graduate training I have not been recognized as properly trained to do all the things I was expected to do as a chaplin. I have found it impossible to get myself hired to help in the mental health clinics for our soldiers.
The Americans have recognized us. We are recognized by both the Department of Defense and the Veterans Administration. The DOD has just recently opened 44 MFT positions across that country to work with its members. In fact, I myself have been asked during the past week to consider joining the mental health clinic at Fort Drum, New York, just a few hours south of this city, in order to fill one of those positions. I can tell you, I would much rather travel the 45 minutes to CFB Petawawa than the four hours to Fort Drum to do the same job.
I am here today as a person who grew up in PMQs. I'm here as an army brat and I'm also here as a chaplin who has agonized over how best to help our military members, veterans, and their families, and I am here as a person who himself is affected by post-traumatic stress.
The way I chose and the way I think would help solve a lot of the things we've heard spoken about today was the way of marriage and family therapists. We are extensively trained professionals who are the best of what the mental health profession has to offer.
My presence here today is endorsed by the Registry of Marriage and Family Therapists in Canada. I want you to know that there are 1,000 registered members in Canada. I know that many of them would want to work with the Canadian military.
I would like to recommend that the Department of National Defence institute as a policy the hiring of registered marriage and family therapists to work as psychotherapists in the mental health, PTSD, and occupational stress injury clinics. I would recommend as well that DND develop a relationship with the Canadian registry of MFTs and its training centres, so that military health providers can receive training in marriage and family therapy to better help the military members and families. As well, mental health positions could be filled with graduates from those centres.
l want only the best treatment for our soldiers who suffer from PTSD and OSI. This was my motivation in seeking out what l knew to be the best training. I want to assist our soldiers, veterans, and their families. l am so convinced of this that l would be happy to make some introductions between the National Defence staff, Veteran Affairs, and key voices in my profession.
Ultimately, I would like to pursue the goal of ensuring that there are registered marriage and family therapists on staff at every base and every regional veterans centre to fill the void that exists in most places today.
Thank you for your attention, and thank you for inviting me to be here today.