Thank you, Mr. Chair, and ladies and gentlemen, for receiving me in these opulent surroundings. I could barely find my way around the place. I'm very glad for you, in fact. It was high time that it was done. So well done, for bringing you the ability to work with a certain quality of life with your staff to achieve your missions.
I will read a short statement. I hope it's short, or I'll do as my Marine Corps friends have taught me: I'll power talk through it.
I have two colleagues here.
Joe Sharpe and I were intimately involved in the writing of the Liberal Party policy on veterans and have been engaged with veterans for over 10 years in specifics and policy, and also individual cases and the like, and 10 years before that, with the deputy minister at the time, Admiral Murray. He had an advisory committee, chaired by Dr. Neary, who wrote the book on the first Veterans Charter, dated 1943. We spent 10 years working together on that multidisciplinary team. We were also classmates from RMC—but he passed.
Scott Maxwell is the executive director of Wounded Warriors Canada. I am the patron of Wounded Warriors Canada, which, by far, to me, is the body of altruism and philanthropy that is putting so much of its capabilities into the field in the hands of those who are wounded—mostly psychologically. I speak of programs such as animal assistance programs, the equine program, and the veterans training program that we run out of Dalhousie University with my child soldiers initiative, where we train veterans to go back into the field and serve by training other armies on how to handle child soldiers and reduce casualties on the sides of both the child soldiers and us. They take a formal one-month program with us at Dalhousie. We can go into that as we go into the possibility of programs.
I'm going to use as a reference, if I may, my correspondence with the commander-in-chief—that being the Governor General—when I was a senator in the post-time, when I had a number of activities going on with him—his wife was also quite involved—in regard to care and concern for injured veterans, particularly with psychological injuries, as they are quite engaged in that side. I want to use it to give you a feel from there as we move forward.
I'll start by thanking you very much for permitting me and my colleagues to join you today on this matter of suicide prevention in the Canadian Armed Forces and amongst our veterans, both those who serve in the Canadian Forces still—and a large number do—and those who have been released and are in Canadian society. I commend your commitment to the welfare of these individuals and their families, and I am honoured to share my thoughts on how we can make more progress in finding solutions to this problem of people killing themselves because they're injured.
As I mentioned at other times, both publicly and in different forums, I had assembled over the years a team of advisers from diverse backgrounds and with deep knowledge of both the forces and Veterans Affairs. This group of advisers worked to develop policy recommendations and advocacy tools that have allowed us to maintain a well-researched and well-informed outlook on the issues facing our military—especially those who have, in fact, taken the uniform off—particularly related to operational stress injuries. I emphasize that I'm not necessarily always touching on all of mental health; I'm focusing on the operational stress injury part. That is the crux of those who are injured. That is the heart of the problem. That's the operational deficiency that we are seeing right now.
Some of those who are involved—just to get their names out there because they've been so committed—are Sergeant Tom Hoppe and Major Bruce Henwood, both retired; Dr. Victor Marshall; Mrs. Muriel Westmorland; Joe Sharpe, who is here with us; and Christian Barabé. Over the years, they have all been engaged with me in bringing forward the veterans scenario and have also helped me when I was chair of the veterans affairs subcommittee in the Senate.
Our research, thought, and work have led us to the conclusion that operational stress injuries, OSIs, in particular, can be and are too often fatal to those affected. Also, the consequences often last a lifetime for those who do not succeed in trying to kill themselves. From peer support organizations in the past, we've had statistics showing that peers have been able to prevent a suicide attempt a day, through the peer support program, let alone the more formal structures of the medical system.
Of course, this includes the devastating consequences for the families and those affected by OSIs. It is my belief that a comprehensive, whole-of-government approach that is engaged with society can bring significant solutions to this crucial problem of people destroying themselves, and bring them to meaningful progress instead, and, in the long run, give them a decent way of life.
The mental health of veterans and current members of the forces, and also with Veterans Affairs Canada, is a continuum that has been presented as a clinical matter with very little involvement of the overall command structure, that is to say, the essence of what people are used to living, their cultural framework, which is a chain of command and a very structured way of life. The clinical and therapeutic and medical dimensions have taken over the problem of OSI, but have also taken over the potential resolution of conflicts that would bring people to ultimately destroy themselves. The chain of command was left on the sidelines, so it was impossible for it to know what was going on. They would get troops coming back to their units with no information on their state of mind because of confidentiality or not being able to work around the access to information system or the individual's privacy rights in regards to the charter.
Using that to the extent of abuse has disconnected the chain of command from the injured, which is totally contrary to all the education we've received in command. I spent my life in command, from a platoon or a troop of 30, to the 1st Canadian Division of 12,000, in peace and in war. The command is like being pregnant. You are in command all the time, while you have a command function. It's day and night and then, when the baby's born, you're still there, just like in command. Whether you're in garrison or in operational theatres, you cannot divorce the chain of command from the ultimate responsibility of ensuring the well-being of the individuals and the command structure to ensure that the families are integrated within that support structure.
I repeat: the families must be integrated into that support structure. It's not about co-operating with the families or assisting the families, but about integrating them into the operational effectiveness of the forces. Why? It is because the families live the missions with us. In my case, I came back injured. I was thrown out of the forces injured. My family was injured. It wasn't the same family that I had left behind because the media make them live the missions with us.
Therefore, if you employ any of these policies that don't totally integrate families, including policies from DND or the Canadian Armed Forces, for veterans serving, veterans out of service, and through Veterans Affairs Canada, you're going to end up with some of the statistics I mentioned—though still anecdotal.
I was at the last military mental health research forum in Vancouver presenting a paper in which we argued that the families suffering from stresses and strains, families where individuals are suffering from mental health issues, and the individuals involved are not getting the support needed. We're now seeing teenagers who are pushed to the limit in these conditions of extreme stress and who are committing suicide. We have not only the individual members, but we're also now seeing family members who can't live with what they've seen, and in fact are committing suicide.
It is essential that we identify the early warning signs of psychological distress, and that we encourage members to seek help through support programs offered by the military, by Veterans Affairs Canada, by outside agencies like Wounded Warriors Canada and the veterans transition training programs we have. These programs give them gainful employment close to, as much as possible, their background. Why try to convert a person completely when you can build on a person? Why not find gainful employment in, around, surrounding, contractually or otherwise, what veterans have grown up with, what they have given their loyalty to, namely, the armed forces? The uniform is off, but we wear it underneath, and we wear it in our hearts. Why divorce them from that? Why not find programs that bring you much closer?
I'm going to curtail this because of time. My presentation is only to indicate that there are initiatives moving forward. Certainly, the January 2017 CDS strategic directive on suicide prevention has to be the best piece of work we've seen in a long time. He makes it clear that the chain of command is the essence of prevention. However, when you start reading the nuts and bolts, you will see that the medical people have put their finger into the pie and are, I would say, watering it down. What they're supposed to be doing is supporting the chain of chain of command, not creating the chain of command.
I will leave you with the following recommendations so that there is enough time to speak. My colleagues will amplify these and they are free to respond to your questions. I hope you will feel at ease with that.
First, the Canadian Armed Forces directive on suicide prevention strategy has to be funded, implemented, and validated. If necessary, go to what we used after Somalia. Create ministerial oversight committees that report to the minister. We did that for nearly three years. I was ADM of personnel at the time. For three years we had six oversight committees that reported every two months to the minister on how we were implementing this kind of stuff. There's nothing wrong with the political oversight getting closer to the actual implementation when you have a crisis like this.
As for the Veterans Affairs suicide prevention framework and strategy, I haven't seen it. I don't know if it's written. It had better be out there. It is critical, because they have veterans who are outside of the forces, and they have a whole whack of veterans who are inside the forces. That is critical, and it should be funded and implemented.
The third leg of that strategic focus is what is called the Canadian Forces-VAC joint suicide prevention strategy. That's where we want the two departments to come together. Certainly, in the DND one, that's what they articulate. It's what the CAF wants. I haven't seen that one either. That one is going to prevent people from falling through the cracks. That's going to permit the continuum. That's where the loyalty is not lost and where people will continue to commit.
That third strategy has to be out there—implemented, evaluated, but also validated, six months, eight months down the road. That validation has to be of such a nature to hold people accountable. That's why I come forward again with the recommendation that in these oversight committees by the minister there's nothing wrong with bringing that online and helping out.
I think the recognition of casualties caused by operational stress injuries has to be advanced at Veterans Affairs Canada to the level of the 158 who were killed overseas or any of our members who were killed in action. If we prove that an operational stress injury has caused the death an individual, that individual is part of the numbers. We didn't lose 158. We're up to 200-some-odd now. So why not use that number?
Imagine having somebody come back for four years and then losing them. After four years of striving and working hard to save them, you lose them, and you get nothing of any great significance. You don't even get recognition, apart from a medal.
Now that you've moved Veterans Affairs Canada into the military family resource centres, move the families and help the families through those centres too. Reinforce that capability. It's used to taking care of families. Let them take on that angle for both Veterans Affairs Canada and for CAF, because they're already doing it.
Finally, give them gainful employment as close as you can to their history, to their loyalty to the military or military milieu. Why try to change them at a time when they're already in crisis?
Thank you very much.
We've been working for two years with the Canadian Army, in particular, and with NATO. We've been in Africa getting research because my institute, the Roméo Dallaire Child Soldiers Initiative, based at Dalhousie University, is field focused. We train armies and police forces in countries to send them—military and police forces—into conflict zones.
We were able to influence the content of the Canadian Army by being the first army in the world to formally put into its new doctrine.... Doctrine is a reference from which you deduce tactics, organization, equipment, and the training you need to do the job, the mission. By creating that doctrine, it is now leading the world in formally recognizing it. We are going start implementing the training of trainers to then bring that forward.
This doctrine is particularly important because there isn't one conflict in the world that is not using children as the primary weapon system. The children may be nine years old, 10, 12, 13, 14, or 15. Every one of those conflicts creates not only an ethical but a moral dilemma for the members. That's what blows us further....
We always thought it was the ambush or the accident that was the hardest point. The hardest one is the moral dilemma and the moral destruction of having to face children.
A sergeant came to me in Quebec City, where I live. He looked good and spoke of five missions, and things were going well. I asked him what his job in the battalion was, and he broke down right there in the middle of the shopping centre. He couldn't talk. He stammered, and he was weak-kneed and crying. I took him aside and so on, and he said, “I was in the recce platoon, and my job was to make sure the suicide bombers didn't get to the convoys”. He said, “You know, I've been back for four years, and I still haven't hugged my children”.
We are taking significant casualties because we don't know how to handle child soldiers. This doctrine will move us a long way that way, and we'll be part of the training program.
With mental health—and particularly the operational stress injury side of it—you are facing an injury that gets worse with time. If you lose an arm, you know that you've lost it, so the aim is to try to build a prosthesis that will be as effective as possible. If you don't intervene with the same sense of urgency an operational stress injury by recognizing it first and then providing for it, it gets deeper and more difficult to get at and to resolve.
It took four years before I crashed. I lost one of my officers 15 years afterwards and having been treated. So there is a vacuum of how to get at them so that they don't continue to walk around as if they're not injured, without there being a stigma there.
We thought we had broken the stigma by having a veteran armed forces—and we did until not so long ago, but now have a lot more non-veterans in there. We're living what we lived in the fifties. In the fifties we had a lot of veterans, but we had a lot of non-veterans, and there was friction between the two, and they would say, “Oh, I wouldn't be injured like that”. We didn't recognize operational stress injury, so those guys simply drank themselves to death or got out. They were the rubbydubs who died on the streets because we had abandoned them. The exception was the Legion, which did help a lot, but there was also a lot of alcoholism.
We lack the ability to discern them early and to then follow it through in a progressive way.
The first time I went out for treatment, I was given eight sessions. I've been in treatment for 14 years. I still have a psychiatrist and a psychologist. I still take nine pills a day. It keeps me like this.
There are moments, though, like last week. My book was launched in French, and it was catastrophic. Writing those books is like going back to hell. There is no real value to me, but I hope it will be useful to others.
You have to find a way because you need to prevent the injury from getting worse—not just recognizing it, but preventing it from getting worse. Unless you get in there early, it's going to get worse.
Thank you very much for being here. We appreciate your expertise and candour, because this is very important.
We need to get to the bottom of this. We have heard so much and got so much information from veterans that is contradicted by experts or people from VAC or DND, it's frustrating and renders our ability to do the right thing questionable. I want to get down to some brass tacks.
I was with veterans on the west coast over the weekend. They told me that of course they're masking and denying their injury because to admit it means that they're out, that they will be on the outside of a brotherhood or sisterhood, a family that they need to stay connected with.
They also told me that members within the Canadian Forces are suicidal too. It's not just when they're thrown out. They're suicidal too, but all of that information is being managed and they're transitioned out so that if they are going to commit suicide, they're not in the Canadian Forces. They're on the outside and DND doesn't have to account for those deaths.
All of this is frustrating. I'm sure there are various opinions on this, but the point is that the trust has been broken. These were angry veterans and they talked about the triggers, the mountain of paperwork, the fact that they were financially insecure. They left without pensions or financial supports and they didn't know what to do and they felt that the only way out was to end it all, that they were of no use to their families, and they were either hiding in somebody's basement or they were lashing out.
What do we do? It's a catch-22. How do we re-engage those veterans? How do we re-establish that trust?
General, you talked about this study. Is that study available to us, the CDS study, the strategy you talked about? Is that available to us?
You also talked about things that should be happening with mental health and you don't know where they are. All of this combines to make us wonder what is going on, where are the support services, and when can we expect that there will be a genuine response that meets the needs of these veterans.
I know that that's a lot and there's not really a question in there, but please respond.
Brevity is not my strength either, so don't worry about it.
Let me put it this way first. We have articulated after years of working on it that unless there is an atmosphere within Canada and the Canadian people, and within government circles—and I speak of parliamentary circles too, which seems to be there, but also within the bureaucracy, which doesn't necessarily seem to be there—such that you feel a covenant, not a social contract because that means you've negotiated stuff, just like the current Veterans Charter….
I'm the one who in a day and a half pushed it through the Senate and I've regretted it ever since, because it didn't reflect the 10 years of work we had done before. It was a bureaucratic piece to try to save cash and it hamstrung the minister with all kinds of regulations. That is a new phenomenon in legislation. Before there weren't many, but now they're throwing a whole whack of them with legislation.
That new Veterans Charter doesn't need a new one. It needs a significant reform. In there you will find in the reform a lot of the answers these guys and girls need in order to get the appropriate responses and a timely response. Until you hit that target deliberately, you're going to have a problem.
The only way you can convince people to go that far is if you actually believe that there's a cradle-to-grave responsibility, not to the age of 65, not with a reduced way of life, but an actual covenant that they have committed themselves to unlimited liability, recognizing that they've come back injured, that their families are being affected, and that some of them are dead and their families are obviously affected, and then you've got them for life.
If you don't sell that, then you will not gain their trust. I'll tell you, it started right rotten with the Gulf War syndrome. We did everything to prevent them from getting anything. Every lawyer in town, every medical staffer, gave us arguments why we couldn't take care of them. That undermines the operational commitment of individuals. Do I want to get injured? It undermines also the families, and they're the ones who are creating a vacuum of experienced people because they're pulling their spouses out.
The VAC has signed an agreement now with the Canadian Forces that we can take care—I say “we”, there you go, proof—
Some hon. members: Oh, oh!
Hon. Roméo Dallaire: —and I say that after 10 years in the Senate—of injured veterans who are no more in the service, and their families.
I would consider that family support centre is one of those pivotal bridges they can cross, and survive, into a new world. The family support resource centres have a lot of the expertise and have access both provincially and locally, let alone within the military and within VAC, to influence the battle and get people more timely support.
However, they're hurting because the money is not going there and they can't hire and veterans can't then get that special support. The horrible scenario that I think is still unresolved is that we are improving the individual members, the forces members who are still serving, and we're improving the case of the veterans who are out there with our different clinics and so on, but we're not improving the case of the families.
You have one half of the problem solved; the other half is not, and that half is hurting. It's going to drag down everything you're doing. Until you look at the family as also deploying.... I would argue that the days are now here when the family is part of the operational effectiveness of the forces, and not just in support of the operational effectiveness of the forces. They're on Skype with them an hour before they go on patrol. Come on, how is it possible to disconnect them?
If the family is intrinsic to the operational effectiveness of the forces, they should have access to the same level of care. That means, yes, more money into VAC and more money into DND to take care of the families. We're already transferring a whack of money to the provinces. We're telling the provinces that we're going to clean up our own mess. We created these injured people and we're going to take care of them. We'll buy the resources from you instead of simply dumping them and having that very serious disconnect.
Mr. Chair, members of the committee and Mr. Dallaire, we want to begin by thanking you for inviting us to participate in this consultation. We know that the Canadian Armed Forces and Veterans Affairs Canada are already working on mental health and suicide prevention. We thank you for your interest in going even further.
For 30 years, our association has been advocating for suicide prevention in Quebec. It brings together researchers, responders, clinicians, survivors of suicide loss, as well as private, public and community organizations.
Our main areas of activity are education, citizen engagement, and training for responders and citizens. As you can see, our association has no military expertise. Our appearance before the committee today stems from our experience in advising various community stakeholders and developing prevention strategies for a wide range of settings. We did that recently for agricultural producers and for detention centres.
How do we reduce the number of suicides among our veterans? What we all know is that there is no simple answer and that a multi-pronged approach is required. The few approaches that we could propose during this hour and that we feel are essential have to do with education, training and the services provided.
I will begin with education, or cultural and mentality changes.
Thanks to repeated awareness-raising campaigns, mentalities have started to change on the issues of suicide and mental health. Taboos are less entrenched and are starting to fade. Unlike 10, 15 or 20 years ago, suicide is no longer seen—or is less so—as inevitable and as an individual problem. People are more aware that it is a collective problem and that prevention is possible.
People talk more about their mental health issues and asking for help is more valued. We have come a long way in this area, but there is still much work to be done. That is why we are here today.
We have a few suggestions to make with regard to education. We are convinced that it should begin with proactive education of active armed forces members, especially those who belong to units at higher risk of suicide, such as combat trades.
There are all sorts of initiatives. For instance, we may be talking about strengthening the cohesion around an individual who is experiencing difficulties or is separated from their unit for health reasons. There are messages reiterating that taking care of our mental health is just as important as taking care of our physical health. There are also campaigns promoting existing help resources.
We must also work on reducing the social acceptability of suicide. That acceptability appears to be stronger among men who conform to the traditional male role. Certain therapeutic approaches are aimed at reducing that acceptability and manage to make suicide less acceptable and to highlight the fact that, by finding other ways to put an end to their suffering, they can become models for their children and models of resiliency for their community.
We firmly believe that suicide must not be an option, on an individual or a collective level. That is why we support messages to that effect inviting people to find other ways to deal with their distress and suffering.
We also believe that, as part of education, society should avoid glorifying individuals who have died by suicide, since that involves a risk of contagion. To avoid that, the media must be educated. I know that is being done already, but the message must constantly be repeated, as newsrooms and journalists are always changing.
We must also educate people in charge of ceremonies when a death by suicide occurs, as well as grieving families. That is a very delicate thing to do, but we must pay attention to that if we want to save the lives of suffering veterans. Some practices can have consequences, such as the erection of monuments honouring military members who died by suicide. We see them as a real risk to veterans who are suffering, who are vulnerable to suicide and who have lost a tremendous amount of recognition and value. Those veterans could see suicide as a way to regain some honour and recognition. Let us be clear: appropriate funeral services must be provided for military members who have taken their lives, just like for military members who died of other causes, but attention must be paid to the potential glorification and contagion aspect.
To properly evaluate the services and training to be provided, we have to understand the suicidal individual's state of mind.
All suicidal individuals, be they military members or not, believe that they are worthless, that their situation will never change and that no one can help them. In that context, it becomes extremely difficult to seek help, to find it and to take a step toward a resource. It is even more difficult for men who conform to the traditional male role, where physical strength, autonomy, independence and solving one's own problems are valued. For someone who is going through a difficult time in their life when they think that they are worthless, that no one can help them and that the situation will never change, all those obstacles make it extremely difficult and painful to seek help.
However, in spite of their suffering, the individual will always feel ambivalent. This means that a part of them wants to stop suffering, and that is why they think about ending their life, but there is always a part of them that wants to live. That is the part that must be recognized by the individual in distress, and it is the responders' and professionals' job to help that part grow. Every time a suicidal person asks for help and shows their distress, the part that wants to live is expressing itself and continuing to hope.
As for many veterans—who are generally men—the characteristics of their way to seek help must be taken into consideration. That is true for suicide in general, and it is also true in the armed forces. A call for help will not manifest in the same way, and the way services are provided to them must also be adapted.
Research shows that, when a man conforms to the traditional male role, he is five times more likely to attempt suicide than a member of the general population. In the armed forces, a medical release is a failure of the system, but it is also a failure for the man who finds himself in a vulnerable situation. As that perception is generalized within himself and within his unit, he feels shame and has difficulty seeking help, as we were saying. Therefore, going from active military service to civilian life and becoming a veteran is a critical moment when the vulnerable soldier loses the strong and unified network with which he identified and participated in. So that will be an extremely difficult moment that must be anticipated and monitored, and that is why this consultation is important.
As you know, many services are provided by Veterans Affairs Canada. However, is sufficient training provided for the professionals who work in suicide prevention, the responders to whom our veterans can turn? Are they able to recognize signs of distress and act quickly?
A training initiative for Quebec citizens has a proven track record. “Agir en sentinelle pour la prévention du suicide”—acting as sentinels to prevent suicide—is a training initiative that is intended not for professionals but for anyone who wants to play a role in their community, in their spare time, with their work colleagues and their peers. It enables people to be proactive, identify signs of distress, refer the individual to help resources and go with them. That training works. It is effective and has already become entrenched in some military communities. It promotes timely identification and proactiveness.
In civil society as in specific communities, those sentinels must be able to rely on a designated responder. They must be supported in order to play their role and then be able to quickly help the suicidal individual connect with a responder who will provide a full intervention and decide what steps should be taken next.
Suicide prevention training is essential for responders and mental health professionals, as well as for physicians who work with military members and veterans. It should not be taken for granted that a physician, a nurse or a psychologist has received specialized training in suicide prevention. However, that type of training does exist, and it works.
The Quebec male suicide rate decreased significantly in the 2000s specifically thanks to a national strategy with training at its core. So we suggest that you make training a cornerstone of the next strategy for veterans.
Furthermore, we want to draw your attention to three major elements to consider with regard to the current services provided or with regard to what you could implement. General Dallaire referred to this earlier. I am talking about the importance of streamlining the services available to our active military members and veterans. That transition must go as smoothly as possible, so that, ultimately, the suicidal individual or military member who needs services, having successfully asked for help and found someone to help them and guide them in that endeavour, does not have to change responders or treatment teams and does not have to repeat their story, either before or after a suicide attempt.
To avoid that disconnect, we suggest that you consider a consolidation of Canadian Forces operational stress injury treatment centres and veterans centres, so that the treatment team would be the same. The therapeutic alliance is important. Veterans sometimes even go back to the same team and health professionals they dealt with when they were in active service.
We also talked about social support. General Dallaire mentioned that. We are talking about social support from families and peers, but also about support from the unit, as well as gathering around the forces and active military members. That support must be an integral part of care and of what professionals and responders propose to military members.
Men mainly turn to their spouse—sometimes exclusively—when they need emotional support. A separation occasionally occurs when they are not doing well. There may be additional problems, including mental health issues, alcoholism and substance abuse. All that puts considerable pressure on loved ones. That is why it is so important to take into account this reality in order to help military members and veterans recover.
The Canadian Armed Forces are a large and strong family. Each member can count on the others for their survival. The idea is to make sure that this strength and mutual support continue after release, whether that release has to do with medical issues or not.
In addition, we make recommendations when it comes to web-based prevention and online responses. Distress is increasingly manifesting on various platforms. People share their suicidal ideas and their distress on the web. That is especially true in the case of young people and isolated individuals, but that behaviour is becoming more prevalent among a variety of individuals. We feel that suicide prevention strategies must now take into account this reality by including a web component. That would enable people to share prevention messages, identify cases, be proactive and propose full response services online.
In closing, I want to reiterate the required elements of an effective suicide prevention strategy. First, all the stakeholders are concerned. Second, managers at various levels of the chain of command must undergo training, uphold the principle and demonstrate leadership. Third, professionals and responders must be provided with specific suicide prevention training. Fourth, the creation of sentinel networks must be supported. Fifth, strong and widespread social support must be established. Sixth, people must be provided with better education on mental health issues and be better informed on the help that may be provided. Calls for help must be encouraged to ultimately change cultures and mentalities. It is also important to pay attention to the messages and ceremonies, so that they would not increase the social acceptability of suicide. Of course, adequate funding is required to implement the proposed measures. Finally, accessible care adapted to the clientele for which it is intended is obviously required.
Thank you very much.