Thank you. I'm speaking today as the CEO of the Vanier Institute. As you know, the institute was founded over 50 years ago by the late general, the Right Honourable Georges P. Vanier and his wife Pauline, mother of his five children and, at times, his caregiver. He was one of Canada's most decorated military leaders, a veteran of both world wars who lost part of his leg in the Second World War.
I'm here with my colleague, retired Colonel Russ Mann, who's working with the institute on the military and veteran families in Canada initiative and coordinates the Canadian military and veteran families leadership circle. This is a consortium of over 40 diverse community organizations committed to working together to build a solid circle of support for families of those who choose to wear the uniform for Canada.
I'm not a suicide expert. I'm here to talk about families. I'm here to talk about the role that families play in suicide prevention. I'm here to talk about the diversity of families and the complexity of family life. I'm here to share the evidence from research related to the family's role in suicide prevention, which is particularly difficult because of the inherent challenges of measuring something that didn't happen.
First, families are our first group experience, and our parents are our first group leaders. Families are unique and diverse, family dynamics can be open or guarded, emotions can be suppressed or expressed, and adults can be nurturing or distant. Families can live with abundance or scarcity. Families can be part of a supportive community, or alone and even isolated. Families experience stress together when they move, when there's a change—a birth, a death, an illness, or an injury—when money is tight, when uncertainty is high, when they are separated by circumstance, or when they reunite after time apart.
We each play a role in our families as children and as adults. Some of us are peacemakers, others are troublemakers. Some of us are followers, others are leaders. Some of us are talkers, others are listeners. Some of us are quiet observers, while others test, experiment, and innovate. Families grow tighter and grow apart. They share love, concern, pain, and anguish. They also share joy, hopes, and dreams.
Some families are under stress, some are in distress, and some are in crisis. Research shows that people who are contemplating suicide are feeling despair, anger, fear, and pain—emotional or psychic pain. They're feeling a need to escape, a need to protect others. They feel like there are no other options. Families share that despair; they often bear the brunt of the anger and witness the fear. Families often experience and feel hopelessness and helplessness. People who contemplate suicide feel hopeless and helpless.
Families provide help and hope, but they also both provide and need support. Families that are well supported, functioning, and healthy can be a significant protective factor for those contemplating suicide. Few families are naturally resilient: most need support to become or remain resilient, and some need help to become resilient. The literature shows that strong relationships with family and friends can reduce social isolation. Families can be advocates and system navigators. They can be the centre or foundation of the system of support for people in distress: we've heard some people who have lived through distress—who have come out of the darkness to the other side—report that this was the result of somebody being in their lives who didn't give up.
Families are diverse. They can be effective in supporting a family member with mental illness, depression, or PTSD, but they need support, training, and resources to do so. They need to feel competent, and they need to feel confident that their loved ones will receive the care they need. They need to feel they are not alone. When they reach out on behalf of their loved ones, they need to feel they can focus on accessing need, not scrambling to look for services and spending time on Google. They need to feel that their loved ones get well, not that they have to go on a long wait-list. They need to be able to access services and not fight to be heard.
Families need to find compassion, not confrontation. They need to feel respected, not challenged, and they need to be trusted.
Families cannot be forgotten after somebody dies by suicide. Families need to heal after that experience, that grief, that loss. They need guidance, assistance, and support. Families without support can become part of the problem, rather than a key part of the solution. Families empowered, included, and resourced can be a powerful tool.
Suicide is an extreme end to the wellness spectrum. Suicide is preventable, suicide is complex. Effective suicide prevention isn't a single event, or action, or policy, or program. It's a long-term, comprehensive approach to helping individuals and their families get well, be well, and stay well. It's about care and compassion. It's about the system of government and community supports working with families from the time they become connected to the military, throughout a military career, transitioning out of the military, and living as a veteran.
The Vanier Institute is here as a national resource. We are here to offer our assistance in the research you are doing. We are here to assist you to find the right answers to support families who are experiencing the trauma of people considering suicide.
Thank you very much.
Thank you for having me here to speak to you today. This is a topic that I'm really grateful to have the opportunity to speak on. I'm really happy to hear that this committee exists and is looking into this topic.
I've been with the Distress Centre for three and a half years. I started as a volunteer on the phone lines, moved up into being a volunteer supervisor, and now I've been full-time staff for a year, so I have a bit of an idea of what we do from the front lines, and also now in a role supporting volunteers as well as our callers.
I'll tell you a bit about what we do at the Distress Centre. We're a 24-hour, telephone-based service offering crisis intervention, suicide prevention, emotional support, information, and referrals to those who need this. Our service area is quite large. It covers Ottawa; Gatineau; Prescott-Russell; Stormont, Dundas and Glengarry; Renfrew; Frontenac; Grey Bruce; and Nunavut and Nunavik in northern Quebec. We have over 220 active volunteers staffing our lines 24/7/365; and in 2016 we answered over 50,000 calls.
To give you an idea of where we fit in the province, Ontario has 14 distress centres, including Ottawa's, that answered over 302,000 calls in 2015, with over 1,800 active volunteers.
To tie in to why we're here today, I can tell you that in 2016, 1,118 of our calls had some mention of the caller or a family member experiencing PTSD; and 12,448 out of 50,000 mentioned a caller or family member with a mood disorder, which is the most common mental health concern we hear about next to schizophrenia and psychosis.
While we don't track military personnel or veterans specifically in our demographics, I did want to tell you a bit about a caller whom we hear from quite regularly, just to bring a face to this issue for you. In the interests of confidentiality, I'll refer to him as John.
John lives within our service area, and he's in his fifties. He is divorced and he lives alone. John has been on tours as an army captain in Afghanistan, Iraq, and Somalia. John has lost all the members of his squad, either in active duty or by suicide upon their return back to Canada. He is constantly haunted by the flashbacks of the experience he endured carrying his buddies off the battlefield in body bags. He was discharged from the army a few years ago without a pension, and is struggling financially, having blown through all his savings upon his return here. He struggles with drinking and smoking, which are his go-to coping strategies; and he often calls us when he's inebriated. He's been diagnosed with PTSD, as well as a host of other physical ailments that leave him in constant pain.
John's calls to us waver between feelings of strength and resiliency for getting through what he's experienced in his life, balanced with a constant suicidal ideation and helplessness at the fact that he very often feels discarded and left behind. John feels like he's the last man standing.
He has admitted to us that he needs counselling, but has told us many times that he doesn't want anything to do with Veterans Affairs. He's dealt with them in the past and expresses frustration at the fact that they just put him on medication when what he really wants is someone to talk to and to share his experience with. He's told us that he feels the military has thrown him on the trash heap.
John's story is one of too many veterans who are suffering, and we can learn a lot from him.
The Internet tells me that 85% of the Canadian military are men. Men's mental health is becoming an increasingly recognized area of concern in our society, with men dying by suicide at a rate four times higher than women. Given this statistic, combined with the proportion of men in the military, it would make sense then to spend some time looking into how men specifically could be supported—not to discount the women, of course, they're important, too.
It's often said that men are less likely than women to reach out for help when they need to. This is seemingly true, but our statistics at the Distress Centre show that 40% of our callers in 2016 were men, which is almost a half. From this number, we can conclude that men will reach out for help when they feel safe to do so.
Our service is confidential, judgment-free, and not directly linked to a specific workplace, the government, the military, or any other professional body. Callers know they will receive respect and an actively listening volunteer on every call and that their stories will be heard, but not shared. No matter what they've done in their lives or what's happened to them, our volunteers will extend the same kindness and support to every caller they speak to.
In preparing for this presentation, I spoke to some colleagues, as well as some current members of the reserves, who told me that there is a broad range of useful resources that currently exist within the military, and I think this is great. These resources are well promoted in the workplace and encouraged by employers. What we hear most often from our callers is that the stigma attached to getting help is the biggest barrier that prevents anyone from seeking help. It's the workplace culture: the peer pressure to be strong and unbreakable members of the military, or proud and resilient veterans.
It was not too long ago, 2009 in fact, that the American army forced suicidal soldiers in basic training to wear a bright orange vest to identify themselves so they could have an eye kept on them. While this was intended to increase safety, it had the opposite effect of stigmatizing those who were struggling.
We often hear of the worry that people will have their job compromised at any mention of weakness, and it's the loss of identity that a person feels when they are stripped of their duties and thrown back into life without any support that's the most devastating. The dedication, strength, and willingness to sacrifice their bodies, lives, and minds for their country is something we must all honour in our vets and military members.
At the same time, we need to respect that with the loss of that ability to serve in the military comes an extreme loss of the sense of identity and self. These men and women are trained to act at peak performance on minimal amounts of rest. They have no choice but to become hypersensitive to the sights, sounds, and smells around them. Otherwise, they risk their lives and the lives of their comrades.
How can we reasonably expect our military personnel to return from such extraordinary circumstances and assimilate peacefully back into an ordinary life in Canadian society without help in doing so? We simply can't ask that of them.
Good mental health is more than just the absence of mental illness. Mental well-being or lack thereof comes from a combination of factors, and in speaking to how we can best support the transition between a career in the military and veteranhood, we must address all the factors that contribute to mental well-being, including financial stability, meaningful work, supportive personal relationships, family, and physical well-being. Alongside the obvious need for trained professionals to provide counselling or therapy comes the need for skills training, family support, income support, employment assistance, and couples counselling.
When John cannot afford more than a bowl of rice for dinner, how can we possibly expect him to obtain or maintain a job, or form meaningful relationships that will nurture and fulfill him? Human beings need safety and security above all else to survive and thrive.
A proactive approach would be helpful in transitioning military personnel into life after the military. I would put forth the recommendation that perhaps we could focus some time and energy into looking into how to better the supports that already exist, instead of creating new ones. It seems to me that there are resources out there that could be bolstered to better serve and become more accessible to the population that needs them. To break the barrier of stigma and promote safety in seeking help, perhaps partnering with a third party outside the military to provide support would be an avenue to explore.
There are over 100 distress centres across Canada, and a study reported on by Distress and Crisis Ontario has shown that volunteer-based support outperforms paid professional support on suicide phone lines. When compared, volunteers conducted more risk assessments, had more empathy, and were more respectful of callers, which in turn produced significantly better call outcome ratings than paid professionals on phone lines. It makes sense then that perhaps a partnership between Veterans Affairs and some or all of these Canada-wide distress centres would be a good idea, in the interest of saving money and building on an existing, proven, and effective source of help.
This is certainly an area that we at the Distress Centre of Ottawa are open to investigating. In fact, our board has already begun to explore the avenue of how we can better support the military personnel and vets in our existing work.
In closing, I would like to offer my respect and honour for the sacrifices made by these men and women. They might need help, but that doesn't mean they are helpless. They might be hurt, but that doesn't mean they are broken.
Thank you, Chair, for the opportunity to appear before you. My associate executive director is with me.
Just at the outset, I'd like to say I've appeared before a large number of standing committee meetings over the last 40 years of my activities in Ottawa, and I am so happy to see the members taking such a terrific interest in this topic. Frequently, standing committees show up with four or five members and it's rather impromptu. It's obvious you take this seriously and I'm really happy to see that.
Mood Disorders Society of Canada is a national, not-for-profit charity managed and membered by people with lived experience in their families. We are active at the national level only, and we have been around since 2011. We are active in many areas, some of which Dave will mention. We become engaged when we think there is an opportunity to do something for the people who need help. Those are the people who live with mental illnesses, whether they're on the street, whether they're veterans, whether they're first responders—whoever we can be involved with to help.
We've focused on that primarily because you can become involved in Ottawa with an awful lot of meetings and a lot of consultations, a lot of round tables, that produce not a whole lot of effective knowledge translation that will assist the people who need help. The material is important, and if you're involved in that stuff, that's fine; it's just not our bag.
One of the things we have done in the past, and we currently do, is become involved with the research community. We became involved with them initially when CIHR came into existence and with Bill . We sat on their institute advisory board for many years. We're founders of the Canadian Depression Research and Intervention Network. The reason we did that is because there is a lot of research out there that I'm sure you've found is not translated into helping people who need help. We try to motivate the researchers and the community generally to pick up what we know will work and get it working, and still support research.
In 2004, we worked to help people with mental illness improve their quality of life. In 2011, we hosted a round table at the War Museum on PTSD. It was called Out of Sight, Not Out of Mind. The entire proceedings are on our website. It involved 75 people from all walks of life, including the Minister of Veterans Affairs, the military chief of staff, and a lot of people who were involved in the then-nascent discussion that PTSD is important.
Out of that came a report and many suggestions for improvement of our attention to PTSD. The recommendations presented in the report included addressing stigma; enhancing the knowledge of physicians and health care providers, which we think is number one on identification and treatment of PTSD; educating PTSD sufferers and their families on available support networks and resources; and promoting ongoing collaboration and dialogue among government and leaders in the field of mental illness specializing in PTSD.
We've looked at the presentations you've had in the last few days and they're terrific. You have a lot of really good information before you and there is no sense our repeating that information for you.
From our perspective, in order to address PTSD and prevent suicide, we would suggest you might look at early diagnosis of mental illness. Early diagnosis of mental illness will help us stop the movement into PTSD and into suicidal ideation. Early diagnosis requires the attention of the medical community to the issues of mental health, which is pathetically lacking at this time.
We would recommend that you increase mental health education among health care providers for the reason I just mentioned.
We strongly believe that peer support needs to be number one on your agenda. Whoever you talk to will tell you that it's the human touch, the human element. Research tells us that peer support needs to be there for you.
I'm going to turn it over to Dave Gallson to give you a bit of an overview of some of our programs.
About 70% of adults living with a mental illness have onset before the age of 18. We know that early intervention can reduce the severity of the illness. For chronic conditions, research indicates that many youth experience symptoms of their illness between the ages of 12 and 17 years. This is, therefore, the timeline where targeted treatment could significantly address mental illness.
Mental health problems in children and youth can, if not properly diagnosed and treated, lead to more serious adult mental health disorders, which are both more difficult and costlier to effectively address. When prior unaddressed mental health issues are compounded with PTSD later in life, then the path to wellness becomes much more difficult and lengthy. Investing in mental health services early would lead to more rapid recovery and symptom management, and would drastically reduce costs associated with chronic mental illness.
We believe strongly that investing in educational programs for Canada's health care providers to enhance their ability to better treat PTSD and other mental illnesses can significantly improve the quality of life of those suffering from PTSD, preventing suicide.
Expanding on educational programs will help train primary health care providers in urban, rural, and remote communities nationwide. In almost every case of PTSD, an associated condition is depression. Canadians are now coming to understand that depression alone is an epidemic in Canada. It is implicated in every aspect of Canadian life, from the workplace to death by suicide of over 4,000 Canadians every year.
Considering the societal, personal, and economic toll of PTSD, we believe that investing in a comprehensive program focused on Canada's primary health care providers to enhance their ability to provide early diagnosis and treatment of PTSD to their patients is a prudent use of public funds that will save significant health care and societal costs in the future, and greatly enhance the quality of life of those suffering from PTSD, their families, and caregivers.
We know working directly with veterans living with mental illness and providing supports to them is key to reducing suicide. I'd like to thank the federal government for its support in our transitions to communities program, a partnership program between MDSC, Employment and Social Development Canada, and Veterans Affairs Canada.
Through this skills development program, our goal is to assist nearly 450 veterans over three years who are experiencing obstacles within their communities. The program aims to provide the direct supports needed to address the emotional and coping strategy challenges of veterans, with a focus on employability skills, mental well-being, and peer support.
We've just opened three facilities in Montreal, Calgary, and Toronto. While we are at the beginning phase, we are looking forward to working closely with veteran organizations, community groups, and employers.
I'd also like to speak to you about the importance of peer support programs. As we've heard from veterans themselves, they are key to recovery.
For example, the national peer and trauma support training and the project trauma support programs are innovative approaches to addressing mental wellness that use a patient perspective approach. Their goals are to provide support, education, and programs for military personnel and first responders who have been impacted by PTSD and other mental health issues in order to support their healing and recovery.
Project trauma support, located in Perth, Ontario, is a week-long concentrated program for military and first responders who have had their lives ravaged by PTSD, and is delivered in a cohort of 12 of their peers. Project trauma support incorporates equine therapy, adventurous rope courses, and peer support to educate participants about their emotional environment, while creating trust and fostering help-seeking behaviour. The program allows participants to process their experiences and authentic emotions, and to improve the lives of their families and peers in the process.
As a brief example of the transformation this leads to, I offer two quick testimonials.
The first one is from an RCMP officer, who said, “I came away feeling that something had fundamentally changed in me and the way I would deal with my PTS. Not only have I noticed a difference in the way I now live my life, others around me have noticed as well. I only wish I could have had this 14 years ago.”
The wife of a military officer said, “I think the magnitude and impact of this past week can best be summed up by our nine-year-old daughter coming up to me and saying, 'It's weird, but it looks like Daddy's eyes are alive.'”
While professional help is very necessary, it's not always available at eight o'clock at night or midnight, when veterans need someone to talk to about their stresses or thoughts of suicide. With peer support programs, people have a network of peers who understand what they're going through, because they've experienced the same things and can relate on an equal level. Funding more programs like these, as well as effective research, would go a long way to supporting the mental health needs of veterans.
In closing, our veterans have placed their lives on the line for our country. Providing care to these men and women must be a priority for all Canadians. Working as a team in training is what they know and how they have been conditioned. Healing and recovery need to use the same team approach.
We thank you for allowing us to share our thoughts.
I think Nora hit perhaps the most important aspect, and that's to listen. Those who have gone through suicidal ideation who I have encountered and had the privilege of speaking with of course have come away and are in recovery, but they and I both agree that the common thread of success has always been that somebody who refused to give up on them and who had no judgment just sat there and listened to their story and listened to their perspective and tried to understand without judgment.
Listening has to be a part of the program that goes into place. I think the Distress Centre has a lot of experience with active listening. When you spoke about kindness, I thought of someone acknowledging that person, their feelings, and their position as they are in that state of distress or heightened anxiety has to be a fundamental part of any program that comes forward.
It does not have to be from Veterans Affairs. If you want to create safety, which I think is perhaps the second most important piece, then yes, peer support works, because we trust our buddies. We trust our peers. We've been through shared lived experience, so it's natural that we'll form a connection. There's a lot that doesn't have to be said, because we already have a set of ground rules that we understand.
Creating safety creates an opportunity for listening, for a dialogue, and for the next steps whether they are a referral, developing a mutual plan of action, trying to mitigate any sources of potential harm or danger by actively listening and then engaging the person about what they would like to do about the medication, or what they would like to do about the knife, the gun, or whatever form the suicidal ideation is taking at that point in time. Trying to mitigate that through peer support in a safe zone, I think, is another important element of the program.
Where I come from with the Vanier Institute of the Family, it's creating the opportunities for families to become informed, resourced, and supported. If I go back to what I said at the beginning of this, it's having somebody who doesn't give up on us. For me, it was my wife. For someone else, it might be an aunt, an uncle, a friend, or a sibling. It could be a son or a daughter. That person who doesn't give up needs the opportunity to be armed with knowledge, resources, and support.
Those are the three things that I think would be fundamental parts of any program.
Absolutely not. I am completely against fee-for-service services, to tell you the truth. I developed a program many years ago because of people in our community not being able to access services, just for that reason.
Our programs are funded by the federal government. We're a very collaborative organization. We believe strongly that programs, especially programs funded by the federal government, should be expandable programs that are shared across all organizations in Canada. There is too much of a silo effect out there whereby programs are developed and then an ownership issue arises: “This is my program”, and yada, yada, yada.
That hurts people. We have to make programs more available across Canada, to all organizations. That's something we do very well.
I can't say enough about the leadership circle and the networking that goes on within it. I'm having a meeting on Friday with another organization. There will probably end up being a new program in Canada for PTSD and for families. That's a direct result of the collaborative nature that this whole organization has. That's the way we have to move forward.
We've developed a PTSD program for the Canadian Bar Association for lawyers. It's been taken by more than 2,000 lawyers so far. We've developed programs with the Canadian Nurses Association for anti-stigma in hospitals, because we found that health care providers are, amongst others, one of the most stigmatizing associations around in terms of recognizing people who come into emergency rooms with potential mental health issues. They are triaged lower, there's a lot of hesitation to even recognize that there is a mental health issue, and many people have lost their lives because of this.
I'm sorry to make it a long answer.
We work with all organizations across Canada. We're fire-starters. We like taking projects, starting them, and then sharing them across Canada. We've been working with Public Safety over the last 18 months. Right now we have a proposal in front of the federal government for a national PTSD action plan. We're hoping that it gets a good look. It's a collaborative approach to doing this.
We are a meat-and-potatoes kind of organization. We like doing things, with the funds that are provided to us, that are going to make an impact on the family unit at the home.
Thank you to the witnesses.
I wanted to say to you, Mr. Upshall, it's interesting that you talked about the research that had to happen before the service dogs could be utilized, and the research took up all the money, so there were no service dogs. That question was asked early on of the assistant deputy minister, who said, “Well, the research is not conclusive with regard to how effective these dogs are.” I sympathize and understand your concern about this never-ending circle.
We're going to be writing a report here, and I want to underscore some of the things that I think should be in the report.
I'll start with you, Nora.
We're talking about the importance of the family. It's a critical part of a veteran's wellness. You talked about them dealing with the issues and the need to have the tools to deal with them. We've heard from spouses that they need training, specific training. How do I deal with and cope with and help this veteran, who is a different person from the one I met and married 10 years ago? We need marriage counselling, because marriages are unravelling, relationships are unravelling. We need mental health care for the spouses and the children, and that comes back to what you said about respite care, because you can't do this 24/7. Finally, we need access to VAC for better care with regard to the family's and spouse's needs. That should be in the report, yes.
The second thing—and it goes back to what Ms. Wagantall was talking about—is making sure, as the military ombudsman recommended, that everything is in place before that veteran leaves the military—the pension and the health care. Would more active involvement by mental health workers be an important thing to add in there? That's so that they're not financially vulnerable, so that they have these coping mechanisms for what is going to be a remarkably stressful, difficult change in life because they are, and always will be, military. They just don't have the accolades.
If we include those things, are we on the right track?