Good afternoon, and thank you for inviting me today.
Like most people, I have colleagues, friends, and family who have struggled with mental illness. I consider it a privilege to be invited to testify for this study.
As an introduction, I'll give a brief summary of why I am sitting here at the table today.
I've been an army reservist since 2004. I have 13 years of mixed part-time and full-time service, including a deployment to Afghanistan in 2008. For just over three years now, I've also served full time as a civilian police officer.
In December 2013, after four very public military suicides, I and other serving soldiers started an initiative called Send Up the Count. Our intent was just to push out a message to other soldiers to re-establish contact with those they had served with, try to maybe find some members who had fallen through the cracks, and drag them out with some friendly human contact. We accidentally ended up creating an online network of soldiers, veterans, and first responders with the dual purpose of suicide prevention and mental health peer support.
We've had many interventions with veterans in crisis, including a number of instances in which suicides have been stopped as they were occurring. Unfortunately, we've lost some too. This remains a right-now problem. In fact, just this morning I learned of another soldier here in Ontario lost to suicide over the weekend.
In 2015, as a result of my work, I was invited by the to join the newly formed ministerial advisory groups. Since then, I've periodically met with other veterans, researchers, and military and VAC staff to provide advice from the coal face, as it were, directly to the minister and senior levels of VAC. I presently sit on the mental health advisory group.
There is no standard for a veteran in crisis. Veterans can have the same mental health issues and face the same stressors as the civilian population: anxiety, depression, family trouble, financial or legal issues, accidents, violence, all potentially unrelated to service.
On top of that, they may struggle with traumatic experiences in their service and stressors unique to the military as well. These compound each other. When you add the normal stress that anyone faces and then throw in tours overseas, months away from home, and family disruption from moving, the stress can get considerably more burdensome and complex.
Our first suicide intervention involved a veteran who was medically released from the army after a training injury. He had no tours yet, but he went from being partway into what should have been a long career to being badly hurt, sidelined and forgotten at work, medically released, having his identity as a soldier stripped, and being punted into the bureaucracy of Veterans Affairs. He fell into deep despair.
One day he made several suicidal comments on Facebook and made reference to being armed. Several of us saw it, confirmed through family that he had access to a gun, and were able to contact police in time to intercept him. He was safely arrested in possession of a loaded handgun before he was able to carry out a plan to publicly shoot himself.
Social media let this veteran reach out to a support network that previously didn't exist and give enough warning signs for us to act. Those of us involved in the call were spread from Yukon and British Columbia to Ontario.
I will highlight a few points here.
Mental health problems and suicide don't have to be linked to operational trauma. The loss of identity that comes from release and transition is a huge risk factor. An informal peer network of veterans connected online with people awake at any hour of the day was also crucial for identifying a veteran in crisis and getting him help in an emergency. This has happened many times since.
Crisis and suicidality happen when stress or trauma surpasses a veteran's capacity to cope. While numerous resources exist, veterans face serious barriers in accessing them.
VAC is the gatekeeper to many treatments, and they insist on their own medical evaluation for disability determination. Other witnesses have brought this up as senseless and damaging, and you've acknowledged it. Add my voice to theirs, but I won't beat a dead horse.
Another major barrier is a profound shortage of veteran-specific care. A friend of mine was referred some years ago to full-time residential treatment for mental health. There this Afghanistan veteran, alongside a police officer, shared what was supposed to be a therapeutic environment with criminal gang members attending treatment on court order. This is disgustingly inappropriate, and dangerous for people expected to open up about trauma suffered in service to their country or community. The police officer, incidentally, has since died by suicide.
I'll echo my friend Debbie Lowther and the other witnesses who testified last week to the critical need for veteran-specific treatment facilities.
Stigma and discrimination against mental illness are still killing people. There is a pecking order in veterans' circles, even among the injured and ill.
Recently a veteran was going to execute a detailed and effective plan to kill herself. She has struggled with PTSD since working overseas in an intelligence role. She was responsible for identifying enemy targets, identified by unmanned aerial vehicles, and then watching them get killed on live video. She has faced scorn and skepticism from other veterans who developed their operational stress injuries from personal involvement in close-quarters combat. Neither injury is more or less legitimate than the other; they're just different. Just as a broken leg from playing football and a broken leg from slipping on the ice differ in how they happened, you have the same result. Despite this, she was hounded by other vets to the point where she became convinced she was faking her own PTSD, which had been diagnosed, and decided to kill herself. Luckily, she reached out to me in time, again through social media, and I talked her down and into accessing care.
I use this story to highlight how far we still have to go with stigma in the military, in the veteran community, and in society as a whole. External stigma from others becomes internalized. People who are simply injured come to believe that they are weak or useless. That's agonizing for anyone, never mind somebody who comes from an environment as utilitarian in attitude as the military.
A struggling or suicidal vet will often reach out to other vets first and perhaps last, reaching out to other people who they believe will “get it”. They may not survive long enough to walk into a doctor's office unless a buddy or a family member helps them through the crisis and gets them there.
I'm not a clinician or a researcher. I'm a part-time soldier and a full-time cop. Since I began to find myself intervening with veterans in crisis, I've had to get as much training as I could to catch up. I received training in mental health first aid, a course I've since helped the Mental Health Commission of Canada adapt for the veterans community. I instruct a course called “Road to Mental Readiness”, which teaches soldiers and first responders mental health resilience skills.
I've been lucky. These and other courses, plus professional experience, have given me tools for crisis intervention. Peers and first responders don't substitute for proper clinical care, but we constantly find ourselves as mental health first-aiders when we get a phone call or a text message or see a social media post at some ugly hour of the night and realize that a life is in danger right now.
The skills I learned in mental health first aid have saved lives. A slow start has been made in pushing this sort of training out to veterans and family members, but much more is desperately needed. None of us knows who is going to be awake and able to respond to the next suicidal comrade. We need to see increased mental health literacy and first aid training in the population at large and the veteran community specifically.
I want to touch very briefly on veteran suicide data.
On November 17, Mrs. Lockhart asked another witness if we have data on the suicide rate among veterans. We do not.
Every death ruled by a coroner as suicide is compiled provincially and sent to Statistics Canada for their mortality database, but the data is stripped of personally identifying information. At present, nothing causes a coroner's determination of suicide to be compared against a list of those who have served in the Canadian military. Nothing reliably and consistently flags the fact that a veteran has died by suicide.
There is, therefore, no comprehensive data available on the rates of suicide among veterans. Changing this could be straightforward if the name and date of birth of every recorded suicide were run against a database of former military members. That would get us close enough to 100% to be useful and valuable. All the necessary information exists; it just doesn't exist in the same place, so that concerned parties can turn it into data.
To sum up, veterans suffer from all the same mental health issues as the civilian population, plus unique challenges linked with service. Suicide and crisis are not always going to be linked to operational stress injuries, but may stem from depression, anxiety, or other mental health issues linked to normal life stressors that the military lifestyle adds to.
Veterans are going to their buddies first as a familiar source of support, and they're doing it using new modes of communication. Those of us providing the support need to be better trained to get that vet through the first few hours of an unexpected crisis while we guide them to appropriate professional care.
Veterans struggle to access care due to bureaucratic backlog, a massive residual problem with stigma, and a lack of dedicated residential treatment options tailored to their unique needs. The veteran suicide problem is a long way from going away and has yet to be even properly defined, but the data is within reach if the government decides to make it happen.
Canada as a whole has a lot of work to do in mental health. Injured and ill veterans are a very concentrated, high-need, high-risk target population for this work. We must learn how to save those in crisis, support them through recovery, and reintegrate them to or transition them from the workplace. Canada will advance in mental health; it's just a matter of how fast. Just as civilian paramedics learn from and use techniques developed on the battlefield, any and all effort put into helping the situation of veterans with mental health disorders will pay dividends for the rest of the Canadian population.
First I would like to thank the committee for letting me present here today.
My name is Marie-Claude Gagnon. I am a former naval reservist, a military sexual trauma survivor, and founder of the group It's Just 700.
Created in 2015, our group allows men and women suffering from military sexual trauma to connect with peers. We are the only network dedicated to MST survivors in Canada.
We offer meetings; inform people about VAC and other services, such as legal and financial aid; connect victims to the Canadian Armed Forces sexual misconduct response team; provide in-person support for depositions, medicals, and meetings; provide collaboration with therapists to develop services for MST survivors; and carry out consultation and awareness projects.
I would like to start with the definition of MST. Since there is no information about military sexual trauma on the VAC website, I had to borrow the definition from the American VA website. Military sexual trauma is defined as:
psychological trauma resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training.
Now I would like to address this topic by borrowing quotes from the 2014 “Caring for Canada's Ill and Injured Military Personnel: Report of the Standing Committee on National Defence”.
It is necessary to address prevention and treatment not only of combat-based PTSD in the CAF, but to address other causes of service-related PTSD such as sexual assault.
The link between sexual assault, either in theatre or at home, and PTSD is well established, particularly for female service members. We know practically nothing about other aspects of female veterans' experiences in Canada.
Colonel Gerry Blais assured the committee that all the programs offered by the CF joint personnel support unit are for everyone; however, Colonel Blais' statement that we treat all our injured and sick members in the same way does not reflect the specific psychological and social aspects of women service members experiencing PTSD and other mental health issues, particularly those who have suffered military sexual trauma.
Regardless of these recommendations, the 2014 Surgeon General's report on suicide mortality in the Canadian Armed Forces persisted in looking only at men. This report, approved by our newly appointed Surgeon General, did not include female suicide due to the very low number of females killing themselves while in service.
Since the majority of my group was forced to medically release after reporting their sexual assault, it is fair to advance that the 2015 research on mental health did not reflect MST survivors' reality.
The 2015 “External Review into Sexual Misconduct and Sexual Harassment in the CAF” stated:
a common response to allegations of sexual harassment or sexual assault seems to be to remove victims from their unit.
Doing so can potentially lead to an unanticipated and involuntary release.
Please allow me to quote members of my group who are currently going through this experience. One said, “My military doctor started pushing for a medical release at my first appointment with her, following the assault, before I had even seen a psychiatrist, started meds, started seeing a psychologist, or even wrapped my head around the fact that I had been raped.”
Another one stated, “How can I start to heal when on the one hand I am being pushed out the door, and on the other hand I am still seeking justice?”
I have another quote: “I had to take sick leave for four days this week. It is hard to cope with the demands of work and deal with the aftermath of the investigation. At times I feel that the organization is trying to break me.”
Research published in 2014 by the American Journal of Preventive Medicine, however, did look into military sexual trauma and suicide mortality and found a high risk of suicide associated with military sexual trauma. It was recommended to continue assessing and considering MST in a suicide prevention strategy.
According to the Journal of Military, Veteran and Family Health, learning from the Deschamps report, female veterans tend to be underdiagnosed and undertreated. Consequently, they may face challenges accessing appropriate health services and may experience victim blaming and secondary victimization when seeking help for MST.
I have another quote: “The medical personnel told me that rape victims were not sent to see psychologists and that the priority was given to soldiers with combat-related trauma.”
Regarding the consequences of lack of care, I have other quotes from people who have had experiences. This is from a mother: “My youngest son found me unconscious in my room after a suicide attempt. In 2012, I was forced to do some terrible things to provide for my two children.”
Approximately 85% of married female soldiers are married to military men. This is another set of specific stressors that are unique to female soldiers. When was the last time we heard a male spouse advocating on behalf of his female soldier wife?
Operational stress injury social support staff do not receive MST training and are not responsible for conducting assessments on MST survivors and their caregivers, as is done for combat-related OSIs. We all heard that OSISS includes MST, but here is what members have to say about that: “I have PTSD but was denied going to OSISS. I was told I would not fit in the program. It seems we get lumped in with all the Afghan vets when the PTSD diagnosis comes down. Not all trauma should be treated the same way. When you're constantly fighting for people to believe what happened to you, it is not beneficial.”
OSI clinic support groups are also based on goals, such as improving sleep, which does not allow people the ability to create groups for MST survivors.
My recommendations to this committee are to implement GBA+ throughout VAC policies, programs, priorities, and research; implement mandated female veterans gender representation at 15% as a minimum to all the DVA advisory committees, since right now female veterans represent only 3.5% of all the advisory groups for VAC; implement science and data collection to determine the sex-specific needs of female veterans, including on MST issues; train front-line and educator staff in gender-specific needs and treatments, including MST, ensuring that taxpayer-funded research is addressing both sexes; conduct a formal evaluation of the response process and support services available to MST survivors; post the services for veterans dealing with MST online; post online the number of medically released personnel who reported a sexual misconduct; and track how many MST claims are granted or denied every year, as acknowledged by retired General Natynczyk during the 2015 stakeholder meeting.
As an example, today I have somebody who is contemplating suicide. I'm dealing with this at the same time, so I may be looking at my phone once in a while just to make sure he's okay.
I left Afghanistan on March 24, or something like that, in 2009. We flew, briefly, through a staging base in the Middle East and turned in our guns, our ammunition, and all the fighting kit that we had. A bunch of our stuff went into boxes to get shipped home. They put us on a military airbus and we flew to Cyprus, where the Canadian Forces had contracted a hotel.
In that hotel we had the day we got there, three full days, and then the day we left. The first full day was a full day of mandatory briefings on various mental health and readaptation things. The second day was a half day of that and then a half day just to go and do your own thing. The third day was a full day of do your own thing.
Every two days a new batch would arrive—a plane full of soldiers—and a new batch would leave, which turned this thing into pure anarchy. Well, it wasn't quite that bad. A bunch of soldiers who have not been able to cut loose for six or eight or nine months made it a running, constantly refreshed party. It was good times. The training was not the worst, but I don't know if the timing was great.
I'm a reservist, so when I got home I was met at the airport by a couple of people from my unit and my parents, and then after that it was about how quickly I could find several friends and get out and party with them.
There was sporadic follow-up, mostly of a medical nature, and a token meeting with a social worker. With them, if you go in and just give them the right answers, they tick their boxes, and you go off and you don't have to worry about them again. Many members just did not disclose things, and in many cases issues had not emerged at that point either. We know that the mean incidence of mental health disorders can often be as long as five years after a trauma. My longest follow-up was, I believe, six months post-tour, so perhaps there's a vulnerability there.
It really felt as if they were ticking boxes just to say that they got this done. I'm not questioning the intent of those who put this in place, but I am questioning the effectiveness of the process and the lack of longer-term follow-up a few years down the road. I felt very few of the vets in crisis are still in that immediate post-deployment phase.