Let me begin by saying that I really appreciate being invited to make a presentation to this committee, because the issue of soldiers and veterans returning to Canada is, in my perspective, one of the priorities in Canada at the moment.
Why do I say that? I say that because so much of the attention in the media is on, quote, PTSD and suicide and that kind of highly recognized injury, but there are whole other areas of costs to Canada that I think are not addressed. I'll address those in my presentation today.
I want to start with us recognizing that for every soldier who returns, if they have received an injury—and we call them war-related injuries, psychological injuries—not only does the trauma affect them, as you know, but it affects them, their families, and also the communities they return to. If these injuries are left untreated and unassisted, it's my perception from my work of the past 30 years that what happens is that not only do we lose this particular person's contributions to society, but there is a very serious impact on spouses, children, and the workplace.
One of the things I want to remind the committee of, to maybe put this into a term that they use in the health sector, in medicine, and so on, is that they talk about potential years of life lost. We can do cost estimates in our society. When people have injuries, whether physical or psychological, and are no longer able to contribute and function, not only do they lose, but society loses, and it has a tremendous cost to us.
So of course I am very interested in talking today about a program we're working with out here at UBC. It's sponsored by the Legion. It's called the Veterans Transition Program. You will notice the focus: it's the Veterans Transition Program. What I'm saying there is that it's about how we get these men and these women back into being productive, successful citizens of Canada. If they are injured, especially if it's a psychological injury, which the soldiers themselves refer to as an invisible injury, it's not often picked up, they don't access services for a whole lot of reasons that I'll address in a moment, and we are observing an enormous cost in our society. There's a moral issue and there's the economic issue. That's why I'm involved in this.
On the other hand, when in my work I see these same people have successful recoveries from their traumas, be reunited with their families and their children, get back to the workplace, go on to university, college, or technical school, and be productive citizens again, it is really very inspirational to me. So I am actually quite optimistic about what we can do in Canada with assisting veterans back into transitioning into Canadian society. Why do I say that? Because we do have the expertise. We have the medical expertise and we have the psychological expertise to achieve that.
Now, where did I get my training? I learned it in the trenches from the 85- and 90-year-old World War II veterans that I worked with 25 years ago in a project sponsored by Veterans Affairs Canada. I met with them in groups to find out their life stories and to find out how the war affected their lives and their transition back to Canada. There was no doubt in their minds when we finished the project....
In one of their biggest recommendations to me, they said, “Westwood”--they called me Westwood—“the problem with your program is that there's only one problem”. I asked, “What's that?” They said, “It's 50 years too late”. They said they needed to tell their stories and they needed assistance with transition 50 years ago. They said, “We wouldn't be where we are today, carrying the same baggage”.
And they refer to it as baggage, Mr. Chair. We don't use psychological terms too much today because soldiers don't use them. They call it “dropping the baggage”.
Some of these older veterans that both Dr. Kuhl and I.... Dr. Kuhl is a colleague of mine. He's from the Faculty of Medicine and was the director of the palliative care unit at St. Paul's Hospital. A lot of the patients on that unit were these 85-year-old men and women who had served in World War II and the Korean War. He observed--and it's well documented and researched--that if people don't deal with their war injuries, and I'm talking about the psychological injuries, their deaths are very difficult. The injuries are unresolved.
What we're doing now in working with the younger soldiers, based on the recommendations of the senior soldiers, is offering a place in the transition program where they start to drop the baggage by first telling their own stories about how the war has impacted them and their functioning.
I think I need to say that what's unique about the program compared with some programs we offer is that the program is really run by or supported, if you like, by other soldiers. In the team that works together with these modern-day soldiers coming back, we have physicians, psychologists, and therapists, but we have another important part of the team, and that's paraprofessionally trained soldiers. These are soldiers who have had deployments, have returned to Canada, have been through the transition program, and want to give back and be helpful. We train them to work with us. Hence, the soldiers coming into the program feel very confident that other soldiers are there on the helping team, and they have confidence and trust in that.
I've learned the hard way, as I'm sure some of you have who work with veterans, that by and large a lot of them do not trust us as civilians. There are two reasons they don't trust us. Number one is that they say to us as professional helpers, “You guys have not been there, and you haven't served, so how do you understand my story?” That's number one. Number two is that if these services are delivered through the Canadian Forces or through Veterans Affairs, many of the soldiers I meet won't go there, because they don't trust that the information will be kept confidential. So what do they do? They avoid. That's helping no one. It's not helping us and it's not helping them.
Now, some, of course, with the OSISS program...they have developed programs and ways to facilitate, and I really support that, but I have learned two points. Number one is that if you're going to be helping soldiers with war-related traumas, you need to involve returning soldiers. Why? It's because soldiers like helping soldiers. These men and women are highly experienced by the time they come back. They've been there. They have experienced what has occurred, and, with training, they're a tremendous support to any transition team like the one we have operating in this part of Canada.
It was humbling for me as a professional to find out that their respect for me came a great deal from my proving that I understood their lives. I understood their lives by listening to their stories. A veteran who goes to a VAC office sometimes will say to me, “I don't want to go there, because how do I know that the person who greets me at the door understands anything that happened to me?” I started learning very early from them what they need in order to have confidence and what they need to proceed, to feel like entering into some kind of treatment program.
That's the background.
So what have we done? Mostly, we are now serving veterans who are being released from the services. They have had deployments overseas and then they come into the Veterans Transition Program, which occurs over a three-month period, as you can see. It's residential. For the most part, they come into this program with the idea that they want to move away from their service in the military back into civilian life.
But if they have trauma-related injuries, it's almost impossible for them to move back into civilian life. Why? Because if you understand trauma, you will understand that what trauma does to people is alter their thinking. It leads to disorganized thought. They carry all the symptoms where they can be easily triggered and they don't feel safe. What we notice in many soldiers is that they want to isolate and retreat. I'm not telling you anything new, and I know that. You as a committee would be astute enough to know that a typical symptom of someone with a psychological trauma is that they want to go away, hide, and avoid. Why? It's because there is shame involved, especially for a soldier.
Now, we have to understand that soldiers come from a particular culture, and what is that culture? It is a culture that—and I like to think of it this way—values things such as being strong, self-sufficient, and not needing help. If they imbibe that culture and return to this country with an injury, we can all imagine how difficult it is to say, “I need assistance”. That violates everything they have been trained to do. So what my soldiers often would do is avoid getting help.
Well, but they're still suffering. What do they do? You know as well as I do. They avoid, they medicate, and in the worst-case scenarios, the pain is so enormous that they kill themselves.
Right away I think we have to recognize that we can build bridges with these people, these men and women, in different ways. We can also offer services. We have the PTSD clinics across Canada, and they certainly provide a service—symptom reduction—using their conventional methods. VAC's OSISS office helps, but when we look at the statistics of how many people visit those offices, it tends to be a low number.
Why? Because many of them are avoiding our services. We could stand on our heads and do cartwheels, and I still think that certain soldiers would never trust us to give service if they see us as representing a government agency. That's what we're dealing with.
That's by the way of background.
The program that I think I've been invited to talk about has been running now...close to 200 soldiers have been through it. To date, a majority of them are now reconnected with their families. They're showing progress, with many of them going back to school or upgrading employment. Why is that? Well, it works because--notice--the program we're talking about is a transition program rather than a PTSD program. Yes, we treat PTSD, but the latter part of the program is focusing on how you set new life goals and how you get the resources that are out there to get your life back on track.
It's my observation that the best way to help soldiers isn't to feel sorry for them and to give only our medical and psychological services to them, but to remind them that they are contributing citizens, that they can be productive again, and to give them the resources and skills to do that. I'm not pretending for a moment that the program I'm working with is something I'm recommending for everybody, but I think it began as a good pilot project, and it has promise.
Therefore, most recently, we received a lot of financial resources from the Royal Canadian Legion to begin to capacity-build and to train professionals as well as paraprofessional soldiers to create some other teams that could go to other parts of Canada--if invited--to deliver such a program with the soldiers.
It's a group-based program. Why is it a group program? It's because, as I said, soldiers help soldiers. Soldiers know very well how to help one another. They live in groups and they work in groups, so I find this modality highly effective. As the professional team, we set the guidance and the direction for them to move forward.
More recently, we have had follow-up groups for the soldiers. Soldiers are very keen to stay in touch with their unit. They would refer to our program here as a unit, a new unit, and they like to stay in touch with their units when they get home, so what we try to do is have monthly meetings. We're getting that going now.
That's by way of an introduction. There is more that I could say. I think I've said a lot.
I look forward to questions of clarification or more information as needed at this point.
You had a good line of questioning from my honourable colleagues. One of the things that I thought was interesting, which the previous speaker talked about, was lifelong care for the veterans and how that's what we're trying to achieve. We're trying to get to that point.
Mr. Westwood, this has been a very interesting topic this afternoon. You're bringing up the idea of this lifelong care and the fact that we have to do some trauma repair. I want to tell you about a case from St. John's, Newfoundland that I was dealing with. His name was Joe Hawco. He was a peacekeeper and, during his tour of duty, he had a number of peacekeepers die in his arms. He was in a fight and, unfortunately, there was loss of life.
The man went through his life. He had some issues, but he did make it through his life. When he turned about 70, the family started to notice a change. It was noticed that he was having more dementia, if I can say that, and eventually they thought it was Alzheimer's. So because modern-day veterans do not have access to pavilions, he ended up in a mental hospital in St. John's. He couldn't be held in an Alzheimer's unit because he regressed to when he was in the military serving as a peacekeeper, and he could actually pick the locks of the Alzheimer's unit.
I have two questions here. First of all, could you could talk about some of this trauma? When you've been tracking the success over the 14 years, are you finding that those later in life are not having as many challenges? Would it have any effect on the possible later onset of dementia? Two, could you answer that question of whether you're seeing any relationship?
The second question is about the veterans pavilions. Right now, we're housing modern-day veterans who are now growing older. As I said, Mr. Hawco was in his seventies when he passed. He died in the mental hospital, actually. I wonder if you could address where you think the best care is. Do you think there is some other mechanism or means to treat people in later stages of life who don't have access to the veterans pavilions? I'm concerned about that, because they are regressing to when they were soldiers.
I'll leave you with those two questions, if you could answer them, please.
I would first like to thank the Standing Committee on Veterans Affairs for this opportunity to discuss the issue of combat stress and its consequences on the mental health of veterans and their families.
As in all matters of health, research is critical for achieving the quality of health and health care that we wish for Canada's military veterans. In the preamble to the act that established CIHR in 2000, Parliament recognized that investment in health and the health care system is part of the Canadian vision of being a caring society.
The act went on to establish CIHR's objective: to excel according to internationally accepted standards of scientific excellence in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system.
I have believed since I became president of CIHR in 2008 that this vision means little if it does not include a responsibility for the health of those federal employees who put themselves in harm's way in defence of our country and in fulfillment of national security objectives.
Reducing the burdens of mental illness is one of the five research priorities in CIHR's latest five-year strategic plan. In order to address this priority, CIHR is relying on one of its 13 institutes, the Institute of Neurosciences, Mental Health and Addiction. The institute's mission is to promote and support research in order to improve mental health by developing new strategies for prevention, screening, diagnosis, treatment and service delivery. We often forget that Canada has excelled in this area of research. It is in fact ahead of the pack compared to the rest of OECD countries in terms of quantity, quality and the impact of its scientific publications in this field of research.
CIHR investments in mental health research have totalled more than $234.4 million since 2006—$65.2 million in 2009-10 alone. As to post-traumatic stress disorder, CIHR has invested $7.6 million in research since 2006, including $1.7 million in 2009-10. However, this figure can be deceptive, since operational stress injuries can include PTSD as well as a variety of other disorders ranging from depression to hormonal imbalance, for which CIHR is also providing research funding.
For example, new brain imaging techniques have been put to use in looking at the effects of post-traumatic stress disorder on the brain. Neuroendocrinology studies, which look at the relationships between the brain and the endocrine system, have demonstrated significantly lower levels of the stress hormone cortisol in individuals with PTSD. Finally, it is likely that genetics and epigenetics will be key in helping us better understand the factors underlying the susceptibility of certain individuals to post-traumatic stress reaction.
I would now like to turn to some of CIHR's efforts to advance research into the issues affecting military veterans and their families, as well as research in operational stress injuries. You will appreciate that while I am not a research expert on this subject matter, I am pleased to speak to CIHR's efforts to accelerate research in this area.
As the other witnesses mentioned, the mandate of a number of departments is to promote research on the health of soldiers and veterans. These departments have formed specific partnerships with CIHR in this area. The Department of Veterans Affairs and the Department of National Defence have joined us in funding various research initiatives. I think we should build on these first successes to expand and strengthen our framework for action, increase consistency and maximize impact.
To this end, CIHR has started discussions with the office of the surgeon general of the Department of National Defence in order to identify areas of possible cooperation as part of their research initiative on the health of soldiers and veterans.
More recently, I met with the associate deputy minister of Veterans Affairs Canada, and we agreed to get our staff members together as soon as possible in order to set joint research priorities on the health of soldiers and veterans, and to develop a long-term cooperation plan.
Although there is a significant body of American research on combat stress and its effects, the military culture and community in Canada are different, and so are the types of operations in which Canadian troops participate. It is therefore important that we develop a research program of our own to fit the Canadian context.
A particularly noteworthy development for Canadian research has arisen from the November 2010 Canadian military and veteran health research forum in Kingston, which is the creation of the Canadian Military and Veteran Health Research Network, a network dedicated to building a better understanding of the health and well-being of military personnel, veterans, and their families.
Together, CIHR and the network announced in the fall of 2010 a request for applications for knowledge synthesis grants to summarize existing research in this area and determine gaps within the knowledge base.
This call for applications recognizes that military personnel and veterans have unique experiences in the service of their country, which can impact their physical, mental, and social health in a manner not experienced by the rest of the population. It also recognizes the increased need for research on the health and well-being of military personnel, veterans, and their families. We anticipate announcing the results of this competition later this month and subsequently using the data to identify research priority areas.
One of Canada's leading researchers in veterans' health is Dr. Jitender Sareen. He receives funding from CIHR and he testified before you in November.
Dr. Sareen is leading a CIHR-funded team on the study of trauma and post-traumatic stress disorder among soldiers involved in peacekeeping operations. He is also examining soldiers' need to access mental health care and the obstacles they have to overcome in order to obtain care; one obstacle is the fear of stigma in the workplace. The findings of his research have helped the Canadian Forces to create programs for those who need treatment and also to develop strategies to improve the mental health of military personnel.
Also, at the University of Manitoba, Dr. Darren Campbell is using functional magnetic resonance imaging in conjunction with psychotherapy to look at the emotional responses of military personnel with post-traumatic stress syndrome.
Similarly, Dr. Alain Brunet at McGill has led a Montreal-based research team on mental health disorders, including PTSD and related problems resulting from traumatic events in high-risk workplaces, and has been funded to examine treatment available to military veterans with operational stress injuries.
Dr. Gordon Asmundson of the University of Regina led a multidisciplinary team of researchers from Regina and UBC who examined whether exposure therapy—where patients are exposed to prolonged and repeated images of trauma until the images no longer cause anxiety—may be more effective than other methods for treating the disorder. Dr. Asmundson and his team have also looked at delivery of treatment over the Internet.
In 2009-10, Dr. David Pedlar, the Director of Research at Veterans Affairs Canada and a professor at the University of Prince Edward Island, along with a team of experts, received CIHR funding to study the reintegration into the workplace of veterans with mental health conditions.
CIHR-funded researchers are also doing important neural investigation into the brain activity of individuals with post-traumatic stress disorder writ large. For example, Dr. Ruth Lanius is the director of the post-traumatic stress disorder research unit at the University of Western Ontario. Her research focus has been the neurobiology of post-traumatic stress disorder and treatment-outcome research examining various pharmacological and psychotherapeutic methods, including in patients with post-traumatic stress disorder or major depression following motor vehicle crashes.
I could cite other examples of funded research dating back to CIHR's inception to demonstrate our history of funding those with research interests in issues specific to military veterans. I would like, however, to conclude by looking forward and acknowledging that more research is needed.
Canada is approaching the completion of one of its longest and most intense military missions in recent history. The care of these young men and women who served our country in Afghanistan makes even more pressing the need to thoroughly understand the physical and mental demands of military operations. We need to better understand through research what sorts of unmet mental health needs there are for veterans so that we can meet them with outreach and treatment.
We need to recognize that Canadian health research in this area is growing but needs to move beyond its infancy. The old military saying that “no one should be left behind” should guide us in ensuring that we understand and are ready to help veterans with health issues when they have completed their service.
Your work in this study will help us to understand where the gaps are and to set directions for future health research, and I would like to thank the committee for its work. I am pleased to take your questions.