[Translation]
I would like to begin by thanking the committee for inviting me to testify this afternoon. I am pleased and honoured to be here today in my capacity as General Counsel for the Office of the Ombudsman for the Department of National Defence and the Canadian Forces to discuss our recent report on operational stress injuries.
[English]
The ombudsman's office has been helping to ensure the fair treatment of Canadian Forces members suffering from post-traumatic stress disorder and other operational stress injuries since 2002.
At that time, our office made 31 recommendations aimed at helping the Canadian Forces identify and treat operational stress injuries, while at the same time ensuring the fair treatment of all Canadian Forces members.
[Translation]
Over the next few minutes, I will highlight some of the key findings from our most recent report released in December 2008 and the areas where we have found progress has been made by the Department and the Canadian Forces.
I will also underscore some of the areas where we feel more work is required.
Finally, I will highlight some new and evolving issues and problems identified during our most recent investigation.
[English]
It is clear from our most recent review that the Canadian Forces has made progress over the past few years in the way it approaches individuals with operational stress injuries. We found evidence of improvements in the Canadian Forces' attempts to prevent, identify, and treat operational stress injuries. Unfortunately, it is also clear that there continue to be cases where injured soldiers, sailors, and airmen and airwomen who have served our country with courage and dedication are slipping through the cracks of an ad hoc system.
During our investigation we discovered that more than half of our original 31 recommendations had not been implemented, either in practice or intent. I believe this has hampered the consistency of care received by the military members across the country who are suffering from mental health injuries.
We also identified a number of areas where progress continues to be slow, particularly with respect to high-level direction and national coordination, the efforts to standardize care and treatment across the Canadian Forces, and the collection of national data and statistics.
Access to quality care still depends on a number of arbitrary factors, including where the military member lives, the distance of the member's base from the nearest large city, the availability of mental health care professionals, and the attitude of the member's superiors and peers.
We were also disappointed to learn that a national database has yet to be created. This database would accurately reflect the number of Canadian Forces personnel who are affected by operational stress injuries. A tool of this kind is critical to understanding the number of Canadian Forces personnel affected by mental health injuries, the extent of the problem, and what needs to be done. Without a national database, the Canadian Forces is unable to evaluate the impact of various clinical interventions and to target education and training initiatives where they are most needed.
[Translation]
Regardless of where they are located, what their duties are, or who they work and train with, all Canadian Forces members are entitled to quality, consistent and timely care when they are injured—whether the injury is physical or psychological.
Some of the problems identified by our office likely could have been prevented with the full implementation of our original 31 recommendations.
[English]
At the same time, when we conducted the latest investigation, it became clear to us that new areas of concern had emerged in the six years following our original report. The environment in which Canada's military has been operating in recent years has changed dramatically, particularly in light of the level and intensity of combat operations in Afghanistan. And it is evident that the Canadian Forces and its members are strained almost to the breaking point. This strain also significantly increases the demands on families, caregivers, and mental health care providers.
[Translation]
Taken into account these current realities and problems, we focused on three issues that we considered to be critical in insuring quality and timely care for military members suffering from operational stress injuries.
[English]
First, there is a need to strengthen national governance and leadership related to the identification, prevention, and treatment of post-traumatic stress disorder and other operational stress injuries.
Our original report in 2002 stressed the need to appoint a senior officer of significant rank reporting directly to the Chief of the Defence Staff. This officer's primary duty would be to act as a national coordinator for all issues related to operational stress injuries, including the quality and consistency of care, diagnosis and treatment, and training and education across the Canadian Forces. The position would also serve an important practical and symbolic role in helping to put an end to the ongoing stigma associated with operational stress injuries.
[Translation]
Second, it is now apparent that the challenges and difficulties associated with operational stress injuries are not restricted to military personnel alone. When a Canadian Forces member suffers from post-traumatic stress disorder or another mental health injury, the whole family suffers. It may also require support and assistance for each family member.
[English]
Our investigators found a number of quality programs offered by provincial and municipal governments, local military family resource centres, and local base chaplains to support military families. Unfortunately, we found no evidence of a coordinated national approach that would ensure that military families are able to consistently access the mental health care and support they may need.
Although the department and the Canadian Forces do not have a legal responsibility in this area, there are compelling reasons for them to ensure that military families have access to timely and appropriate services and support.
[Translation]
First, as mental health injuries are enough the result of military service, and the direct cause of family stress, the Canadian Forces have a moral responsibility to ensure that care and treatment are provided to families.
A second, more practical reason for ensuring the care of military family members is that it could reduce the level of stress on the operational stress injury sufferer and speed up recovery time.
[English]
Finally, as part of the broader investigation we also found that much more needs to be done to deal with stress and burnout among Canadian Forces caregivers. This stress is created by a lack of resources and high caseloads. The majority of caregivers interviewed by our office stated that personal stress or burnout was a pressing concern to them, to the point that it was leading some of them to quit the military.
The department and Canadian Forces had informed us, during our investigation, of their intention to hire an additional 218 mental health professionals by the end of March 2009. I understand now that the deadline has been extended to 2010.
Hiring more mental health care workers would be a positive step towards resolving the issue. However, we have concerns that it may be difficult for the Canadian Forces, as just one of the employers across the country vying for health care professionals, to fulfill this commitment, even with this extension to 2010. This makes it even more essential for the military to retain the mental health care professionals already working in the defence community.
Given the very dangerous and demanding nature of the current mission in Afghanistan, it is clear that post-traumatic stress disorder and other operational stress injuries will become an even greater challenge for the military for many years to come. In many respects, this will be a generational challenge for the department, the Canadian Forces, and the Government of Canada as a whole.
We acknowledge that the Canadian Forces has made some progress over the past six years in generally dealing with the issues and challenges related to post-traumatic stress disorder and other operational stress injuries. However, much more needs to be done to ensure that Canadian Forces members suffering from operational stress injuries are diagnosed and receive the care and treatment they need.
Addressing these outstanding issues and implementing the recommendations made in our report will help our Canadian Forces members in many years to come, whether in the Canadian Forces, if they stay, or in their lives as civilians.
At this time, Mr. Chair, I stand ready to take any questions you have. Thank you.
Mrs. McFadyen, I would like to welcome you back to the Standing Committee on National Defence. This is our first meeting on the study that we began last spring in 2008. Sometimes, delays are good, because we will be able to incorporate the recommendations from your report published in December 2008 into our study. This will give new momentum to your recommendations, and I am sure that our researcher, Mr. Cox, will be very pleased.
Something new and exciting has happened over the past year: the number of operational stress injury treatment clinics set up by National Defence and Veterans Affairs will increase from five to ten this spring. So, as you indicated in your report, there have been improvements.
I would like to come back to your report. You said that 13 of the 31 recommendations made in your initial 2002 report were taken into account by DND. You also pointed out that the challenge of post-traumatic stress disorder is linked to intensive use of our Canadian Forces during various missions, in particular the Afghanistan mission, for which you state that our Forces are stretched to the breaking point.
Something else that I appreciated in your report: you mention that it is not only military personnel who are affected, but also their family members. You pointed out that there is no coordinated approach to help families living with someone suffering from PTSD. I am sure that we will be taking this into account in our study, because it has also been raised by witnesses who have appeared before the committee.
However, what surprised me in your presentation is this: you state that in many respects, the Canadian government, the Canadian Forces and DND are faced with what you call an generational challenge. Could you explain what you mean by this when you refer to the improvements to be made to assisting victims of post-traumatic stress disorder?
[Translation]
Mr. Chair, members of the committee, good afternoon. I am happy to have the opportunity to appear once more before you to provide some information that I believe will be of interest and value to you. I have assumed that the major focus remains on mental health care. It has been many months since I last appeared before this committee, and there is quite a bit of new information to pass along. Due to the unavoidable absence of Major General Semianiw, I would present some information about initiatives outside the health services, as well as inside, to try to provide as complete a picture as possible.
[English]
The first thing I thought worth presenting is our most recent data about the size of the CF's mental health challenge. We have continued to collate the results of the enhanced post-deployment screening, which you will remember is done three to six months after return from deployment.
We now have results from over 8,200 completed screening questionnaires, which show 4% responding in a manner consistent with PTSD; 4.2% consistent with depression; a total of 5.8% consistent with either or both of these conditions; and 13% consistent with any mental health diagnosis.
We do see a correlation between the intensity of the operational stresses and the rate of positive screenings for PTSD. If the results were broken down by smaller groups, it would be expected that some platoons and companies would have higher rates. It is also true that some people experienced problems later on, even though they appeared well at the time of the screening. But it is worth emphasizing that 87% of those screened reported doing well.
[Translation]
It is also worth remembering that the overall mental health problem in the Canadian Forces is not limited to PTSD or OSI. We have some recent information about the overall number of mental health patients currently being seen. The eight largest Canadian Forces clinics tracked new patients over the 5-month period from August to December 2008. This data shows an average monthly total of 530 new patients, of whom roughly 250 were seen by the psychosocial programs—which deal with less complex, more transient issues—about 210 by the general mental health programs and an average of 76 by the OTSSC programs. If you assume these numbers carry on year-round, you can forecast that roughly 6,000 new cases will present to these eight clinics in a year—and most of these will be unrelated to deployment.
[English]
The second type of new information I want to present to you involves measuring results. How do we know whether the care we offer is of high quality?
I'll admit we have not yet progressed to where we want to be with performance measurement, so we cannot yet report on direct clinical outcomes. But to provide one indicator of quality, we have conducted periodic patient satisfaction surveys.
Our most recent data were gathered anonymously from our five OTSSCs between January 12 and 23 of this year. Every patient being seen was invited to complete a survey containing 19 questions, plus an opportunity for free-text comments. One hundred and seventeen responses were received.
In summary, we found that overall, 96% agreed or strongly agreed with the statement, “Overall I am satisfied with the support and care I receive”, while only one person disagreed or strongly disagreed. Eighty-eight per cent agreed or strongly agreed that “The amount of support and care I receive is sufficient for my needs”, while 2% disagreed or strongly disagreed.
In a separate assessment of patient satisfaction, the general mental health program in Halifax has also been collecting feedback. When it came to whether they felt they were making progress, 88% of the 288 patients who responded said “some progress”, 27%; “moderate progress”, 23%; or “considerable progress”, 38%; while 12 stated they had gotten worse--that was 3%--or they were not getting anywhere, the other 9%. A higher percentage felt that their counsellor was “somewhat helpful”, at 18%; “pretty helpful”, at 34%; or “very helpful”, at 45%.
[Translation]
We also have evidence that our efforts to combat stigma seem to be paying off. Indeed, the Global Business and Economic Round-table on Addiction and Mental Health recently cited the Canadian Forces as an example in this respect. While there is no task to directly measure stigma, we have been collecting survey data about certain beliefs linked to stigma from our returning personnel. Over 9,000 personnel have now responded to these questions and my analysts have been pleasantly surprised by the what they found.
[English]
Twenty-four percent admitted to being concerned that members of their unit might have less confidence in them if they were to develop a mental health disorder. This was the highest of any of the 10 questions asked. Only 14% admitted a concern that they might be seen as weak, 12% had concerns about harming their career, 10% expressed distrust of mental health professionals, and only 6% felt that mental health care doesn't work. Perhaps the most interesting result was the response to whether the respondent would think less of a colleague who was receiving counselling. Only 7% admitted they would do so.
In reality, the situation is probably not quite that rosy. But what this response tells us—and I want to emphasize that this was an anonymous survey of a large number of people—is that the vast majority of our personnel are unwilling to admit to this bias. It seems clear to me that the CF cultural norm is now to be supportive of those with mental health problems.
The third area I want to touch upon is what changes have been or are currently being put into place. The Rx 2000 mental health initiative has made substantial progress in hiring, and we now have a total of 361 mental health providers across the country. This is still short of our goal of 447, but represents a very real improvement on the 229 that existed at the outset. I know there has been particular interest in Petawawa, so I am happy to report that significant progress has been made there, and there's more to come.
In spring 2008 a senior CF social worker was posted to become the mental health manager and provide clear leadership. Additional clinical support has been and continues to be provided by Ottawa-based clinicians travelling to Petawawa at frequent intervals, and a tele-mental health connection is being installed that should become operational this spring. This coming summer we will post three additional CF social workers and a CF psychiatrist to Petawawa.
[Translation]
Thanks to the fact that Colonel Allan Darch—who is with us today—was appointed to be the Director of Mental Health of the Canadian armed forces, there will be a better coordination of efforts among all our mental health care providers. Since Colonel Darch's work will be entirely committed to mental health care, these services will be directed more attentively and there will be an improvement in the communication among the stakeholders. Lieutenant-Colonel Grenier, who is also at the table with us, is the Special Advisor regarding Operational Stress Injuries and he regularly and directly advises the Chief of Military Personnel about the non-clinical aspects of the care provided to members of our personnel who suffer from mental health disorders. Lieutenant-Colonel Grenier is focusing his efforts on education with the help of the DND Speakers Bureau, which reached out to 8,000 members of the Canadian Forces in 2008, and is intending to serve more than 12,000 this year. His upcoming project will deal with the social determinants of mental health. Together, Colonel Darch and Lieutenant-Colonel Grenier are actively trying to establish connections with their counterparts in the United States, especially with the Chief of the Centre of Excellence on Mental Health of the United States Defence Secretariat.
[English]
We have re-oriented the OSISS advisory committee and broadened its mandate. It has become the DND/VAC/RCMP mental health advisory committee, and it had its inaugural meeting last week. The chairman of that committee, Colonel (Retired) Don Ethell, is also here today. You can see that there are open channels of communication and means for various points of view to be brought forward. As an aside, I know that Colonel Ethell has a direct line to the chief of military personnel, and they have a long history of working together.
To better reflect the range of people affected by tragedies, the CF members assistance plan, which is the confidential 1-800 service that provides access to up to eight counseling sessions, has been extended to parents and siblings of those killed or injured while in service. Of note, there has been no detectable growth in demand for this service over the past decade. Regular force members are the most frequent users, followed closely by family members. The most common reason for accessing this service remains marital problems, followed by psychological concerns.
All in all, I believe the CF now enjoys an excellent capability linked to overlapping proactive approaches to detecting members in need, but I'm willing to guess that what I've described to you today may not be in line with testimony you have heard from others. The natural conclusion might be that someone has been less than forthcoming. I do not believe this is the case, and in the last part of my remarks I'll try to explain why this apparent gap can exist, when everybody is speaking the truth as they know it and when everybody has the best of intentions.
The first point I will make, and I think I've made it before, is that no matter how much we care about the well-being of our patients or how well we are organized, staffed, and equipped to care for them, the unfortunate fact is that not all of them will get better. This is not the system's fault, it's not the provider's fault, and it's certainly not the patient's fault; it's because these are tough disorders to treat. The state of medical science at the moment just doesn't allow for mental health treatments that are perfect.
When someone being treated for coronary artery disease goes on to have a heart attack, the assumption is not made that their care was inadequate or their cardiologist negligent. Some people just have more serious cases than others. Mental health care and mental illness should be viewed in much the same way.
I suspect that you have spoken to patients or to families of patients who are in the unfortunate position of continuing to struggle. Remember that our own data shows about 12% of patients at one clinic did not feel they were making any progress. I don't mean to belittle their difficulties, but concluding that there's a systemic problem on the basis of extrapolating from a few anecdotes, no matter how compelling, is erroneous, and in fact may put at risk that which you seek to improve.
There is a phenomenon known as the “availability heuristic”, which produces a powerful cognitive bias. Basically, it states that our perception of the extent of a problem is strongly influenced by how readily an example can be brought to mind. If everyone knows of one or two examples of people who feel their care did not meet their expectations, that fact leads us to conclude there's a systemic problem.
Given the widespread media reporting about some cases, it's evident that interested observers can all think of at least one patient whose situation has not yet improved. Objective data, however, may reveal a very different picture. Individual problems should be addressed on a case-by-case basis while care is taken to preserve the system as a whole. Systemic problems obviously demand systemic solutions.
I'm spending quite a bit of time on this point because I firmly believe the CF is served by an excellent system of mental health care. But it requires two things in order to, most importantly, continue to function, and secondly, to make the local or incremental changes that may be warranted: we need to retain the trust and confidence of the members of the CF so that they will readily come forward to seek our care, and we need to retain the commitment of our health care professionals. Continuing to portray the glass as mostly empty when in reality it's over 90% full places both of these critical things at risk.
I ask that the members of the committee weigh all of the objective data presented before reaching any conclusions.
Thank you for your attention. I now look forward to addressing your questions.
General, colonel, thank you for coming.
It is important that the 10% be taken care of and that this does not turn into a chronicle gap.
[English]
We were talking to the ombudsman in the interim before this, as you noticed, and they were talking a lot about issues falling into the cracks. We're not dealing with statistics, of course; we're dealing with human beings, and that's important to note.
There are several issues I'd like to talk about. I know we don't want to go into personal issues, but the first one is an incident that happened in Valcartier a few weeks ago. The thing we have to realize is that because there was an important rotation that started on February 20, up to March, there was one case, and then another case, and then a third case in a row. Once is an incident. Twice, it might be a coincidence. But as for three times, I don't want to say it's a trend, but it's a bit scary.
You spoke not only about the patient, but also about the sake of the family, and rightfully so. We have to take a look at that. How do you explain that? Is it from the stress? Is it because we might have forgotten some of the prevention tools? We can never know when it will blow up, of course. We already spoke about that the first time you came here. I think it may be important for the benefit of our colleagues here to address that question specifically regarding rotation and the impact on our troops.
:
These situations are not isolated cases. In fact, in 2000-2001, we launched a social support program among peers. More communication was established since Colonel Darch and Lieutenant-Colonel Jetly, a psychiatrist, arrived. At my level, we now have very close communication between the non-clinical support program and the clinical mental health care programs. I would be lying if I told you that over the past 10 years there has been total harmony between our perception of the experiences we lived through as soldiers and peers and, on the other hand, the solutions proposed by the clinical workers.
Nevertheless, I think that the events, especially the fact that the right people were appointed to the right place at the right time, have led to closer communication. Personally, I am envisaging closer coordination between the non-clinical interventions for which I am responsible and the clinical interventions. This might offer a systemic solution.
Regarding the patients, we have been saying for many years that soldiers have private lives between their assignments. We do not want the doctors to infringe on the private lives of their patients. Besides, we favour an approach that takes the individual's life more into account. Benchmarks and supportive measures have been implemented to make sure that once a patient has left the clinic, he continues to follow the treatments and therapies properly.
[English]
The treatment compliance, I think, is a huge issue.
[Translation]
I do not mean to say that this closer communication is the solution. As you know, during these past years, I saw that as a glass that is half empty. Today, I see this more like a glass that is half full, not only by reason of the improved functioning of my therapy, but also due to this closer communication. We no longer seem to belong to adversarial camps, and I am proud of it. Finally, our coordinators on the ground can rely on somewhat more solid support. That will repair a big hole in this net that is, after all, rather broad. I am not saying that that is the solution, but from my point of view, it is a positive factor.
:
Thank you, Mr. Chairman.
I want to welcome the General and his aids.
On February 5, 2002, the ombudsman published a report entitled Systemic Treatment of CF Members with PTSD. Several months later, in December 2002, the Department of National Defence responded to each of the 31 recommendations. I have the document with me. This is a profile of the response to the recommendations. Amendments were suggested for only 3 of the 31 recommendations. As for the 28 remaining ones they received support, even full or entire support.
How do you explain the fact that seven years later, only 13 of the recommendations have been implemented? Moreover, 7 have been partially implemented and 11 have not been implemented at all.
It is important for me to say this right after your presentation. I do not think that this is a superficial problem. Instead, I think that it is a fundamental problem. I want to know what it can be attributed to. For example, could this be conceivably a cultural problem, with a predominating stereotype of the resilient man? I tried very hard to find a dictionary here. It says that resilience was at the outset a term that referred to the resistance of material to shock. It was first published in the field of psychology in 1939-1945, and Boris Cyrulnik developed the concept of psychological resilience based on his observations of concentration camp survivors. Thus, resilience could be the result of many processes that disrupt the negative trends.
At the Canadian Defence staff, they are so intent on developing resilience that they end up denying the real problem, which is present everywhere. Many witnesses have confirmed to us that these are not nearly small exceptions. What we heard is the contrary to what you are saying. It is false to say that 98% of the witnesses said that they had received adequate treatment. It was more like the contrary. Perhaps you were taking a preventive measure when you yourself said that this could sometimes seem to contradict what we have heard.
At the Canadian Defence staff there is so much emphasis on the resilience of the armed forces that there is an attempt to minimize the fundamental process and the reality of post-traumatic stress disorder. Do you agree with me?
:
Mr. Chairman, I'll be sharing my time with Mr. Hawn.
First, I'd like to commend Colonel Ethell for his work with OSIs and now his expanded duties with the full range of mental health issues for our soldiers.
I congratulate Colonel Grenier. For many years you were the lone voice in the wilderness when it came to PTSD, and through your tenacity in pursuit of helping your fellow soldier you have brought the issue right to the House of Commons Standing Committee on Defence.
On April 15 of last year the veterans affairs committee travelled to Base Petawawa, and among the different forums we had some soldiers who had suffered PTSD. They related their experiences to us in a private forum. One soldier had been injured over a year ago. He had been travelling in a troop carrier, and other people died. He lived. He had been asking for psychological/psychiatric help for over a year, and it wasn't until that day, when the veterans affairs committee just happened to be coming, that he got his first appointment with a specialist. It was too late for him because he'd already applied for medical release.
Last week we had General Semianiw who said:
A decision was made, not in the last four years but before that, not to put an operational stress injury clinic in Petawawa. In hindsight, it was probably a bad decision. What we see here today is that having an OSI clinic in Petawawa would have been the right thing to do. It was not done, but we're dealing with that issue to ensure the men and women in uniform get the support they need in Petawawa.
The military ombudsman just related to us today that over 8,500 soldiers have deployed out of Base Petawawa to Afghanistan. How can you assure this committee, and, more importantly, the mothers, the fathers, the spouses, the children of our soldiers who are starting to return right now, that they will obtain the proper medical care they need, be that physical or psychological care?
With Petawawa, one of the problems, as General Jaeger said, is getting enough mental health care professionals there. Part of the problem is the number of mental health care professionals we depend on who are civilians. With Petawawa, we're dealing with the fact that there is a general shortage of mental health care professionals across Canada. There is a lot of competition for those mental health care professionals. Petawawa is a semi-isolated location, and the amount of money we can pay under Treasury Board guidelines is not competitive with what some civilian organizations can pay. We're just having a lot of difficulty getting civilian mental health care professionals to work there.
To improve that, our Ottawa OTSSC is operating satellite clinics in Petawawa, and the health care professionals go there. One of our senior Canadian Forces psychiatrists is spending a minimum of one day a week in Petawawa. We have a tele-medicine pilot project that will link Ottawa with Petawawa. Through high-definition medical cameras, soldiers will be able to have tele-medicine consults with mental health care professionals in Ottawa. While we wouldn't recommend that for initial assessments, it would be useful for ongoing care.
We posted a major social work officer to Petawawa this last summer who is taking the lead as a mental health care professional there and leading the clinic, and that has made a big difference by itself. This summer we'll post in three more social workers and a military psychiatrist, which will augment their capability significantly. Along with that, we've not been able to fill all the civilian positions, so we're going to transfer five of those to Ottawa: one psychiatrist, two psychologists, and two social worker positions that are not filled. We'll be able to fill them in Ottawa. Those people will then be used to run the tele-medicine capability that will link Ottawa and Petawawa. They will also do satellite clinics in Petawawa.
In addition to this, I have a lieutenant-colonel within the new mental health care directorate who is capable of spending up to two days a week in Petawawa as a psychiatrist.
As well, we still have the capability for patients to come to Ottawa to get help. It's not that far down the road. So where that works out for them, we can manage that.
:
Sir, I've been around the forces a long time--and I don't work for DND or VAC; I'm a volunteer. I now chair the Mental Health Advisory Committee. In the past I had two legs; now I have to grow a third one, because the RCMP last week came on board.
The mental health OSI--let's just stay with OSI for the time being--has come light years from where we were 10 years ago when Grenier appeared before the Canadian Forces Advisory Council and explained what OSI and OSSIS were. And that was built into the Neary report , which led to the new Veterans Charter, which the Canadian Forces are reaping the benefits from.
The point I'm making, which you brought out and which General Jaeger brought out, is that it doesn't happen right away.
I'm not a clinician. I looked in the mirror five years after I got out and said, like many of them, “I have a problem”. I had seen some very horrendous things. The kids coming out of Afghanistan or coming back from Zaire, or wherever, six months or a year from now may look in the mirror or may talk to one of the OSSIS people and say, “Who can I talk to?” Then they'll be going to the professionals: the clinicians, the psychiatrists, the psychologists, and so forth.
There are not only the OTSSCs, but there are the OSI clinics from Veterans Affairs. It's a dual process. In fact, it's a crossover between the two, and that's being organized between the two departments, thank God, where a soldier can walk into either clinic, and the same with a veteran. There are veterans coming out of the woodwork, going back to Korea, who have said, “ I have a problem”. The reason for that is the publicity for PTSD and OSI.
I'm not saying this because these three people are in uniform, but the mental health thinking--the facilities and so forth that you've heard about today--has come a tremendously long way from where it was 8 or 10 years ago. There's not only a cultural change, but certainly a physical change to the benefit of the troops and their families, and I haven't heard that mentioned yet--the families--because that's also in the mandate of either DND or VAC, but it's certainly being considered.