Mr. Chair, I think there is going to be one major decision that the committee is going to have to make with respect to this bill. Happily, it's kind of a nice decision to make. I don't think it's a question of intent, ideology, or difference, but one thing that has become very clear through the course of this testimony is that we have two possibilities in front of us with this bill.
One is to create a bill that deals comprehensively with PTSD, or in other words, to have the bill call for the creation of a federal framework on PTSD comprehensively. Or are we talking about creating a federal framework for workplace PTSD? Both are inherently worthy objectives, and both of them I think are important.
I had not planned on moving an amendment or raising that issue at this particular clause, except now that I quickly read it, I think this may be the first time that the committee will have to determine which path we're going to take, because under the definition of “federal framework”, the bill says that it “means a framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.”
As you'll see later on, I have two suites of amendments, depending on which way we want to go. I'm content with making this a bill to create a federal framework for workplace PTSD. I'm also content to create a framework that would deal with PTSD comprehensively. I will advocate later on for the latter, for a number of reasons that I'll go into then. I think this definition is the first time that we'll have to make that decision on which path we're going to take, because the way this definition is written, it adopts the comprehensive approach.
I'm going to move an amendment at this time. In fact, I'm going to invite my colleagues to have the debate now, because I think we have to do it here. If we do not intend this bill to be a comprehensive approach to PTSD with regard to all major population groups in Canada, not just those in the workplace, then we should insert the word “workplace” in front of “post-traumatic stress disorder”. I'll make the argument why I think we shouldn't do that, but we'll make this decision.
Obviously, workplace post-traumatic stress disorder is a serious issue in Canada. As you'll see later on in the bill, there are certain specific groups that are mentioned as being the front-line victims of post-traumatic stress disorder. They are listed in the bill as veterans, RCMP officers, health professionals, corrections officers....
Am I missing anybody?
Yes, first responders who are military personnel, as well as firefighters and corrections officers....
We've also heard evidence, of course, that PTSD can occur from episodic exposure: a woman who was exposed to a vicious sexual assault; refugees who are fleeing war zones and conflict zones and have come to Canada scarred and traumatized by that experience; or first nations, indigenous people. I think we can agree that those people are experiencing PTSD in much the same way as anybody else, but they didn't get that exposure through their workplace.
We heard very trenchant and powerful testimony from every witness, but in particular from our last panel, which told us about the delay that's happened in this area and how important it is to act quickly and in a timely manner for these people. We heard that it's extremely important for these victims to be heard and to be represented. If we take an approach of passing a framework on workplace PTSD, as laudable as that is, what would we be saying to those other groups—indigenous people, women, refugees, and others—who are not included in this federal framework? We would be sending one message to them, that they must wait.
I've heard a couple of arguments that it's better to get this going and not delay. With the greatest respect, Mr. Chair, that is a complete red herring, because nobody is asking for any delay. The amendments that would make this bill comprehensive won't cause any delay or difficulty whatsoever.
This bill essentially calls for the Minister of Health to convene a conference—within a year, I think—and spells out who should be around the table at that conference to begin the process of developing a framework on PTSD. The only question is who is at the table. This bill calls for the Minister of Health, the Minister of National Defence, and the Minister of Veterans Affairs to be present at that table. If we broaden that to include three other ministries, as you'll see later in my amendments, that does not delay anything. It just adds three seats to the table to develop the framework.
It's a chimera and a complete red herring for anybody to argue that broadening this bill at this point slows down anything. It does not. On the contrary, broadening this bill at this point is this committee's opportunity—right now, when the bill is in front of us—to give Canadians the comprehensive PTSD framework that all Canadians have been waiting for. I would argue that not adding these other groups now is actually playing right into the exact trauma that we're warned against. We're warned against not representing people, telling some groups they have to wait while we develop a PTSD framework for others.
Mr. Chairman, I am not going to repeat this argument at each of the different opportunities the committee will have to make this choice, but I will ask every member of this committee to remember that we sit on the committee for health. This bill came to the health committee. It didn't go to public safety; it didn't go to veterans affairs. It didn't go to the committees that one would think are charged with dealing with certain occupations. It came to the health committee, where we are entrusted to make policy for the health of all Canadians.
I would urge my colleagues here and say that, right now, we have a chance—brought by the wonderful work of Mr. Doherty, who has flagged an issue that has been ignored too long, an issue that has devastating impacts on people's lives—to make sure all these voices are heard.
I, for one, am going to very strongly urge that the health committee have this bill leave committee by saying that we have improved the bill by enlarging it slightly to make sure we develop a comprehensive federal framework for PTSD not only for these vital groups that have to deal with trauma every day, but also the three other major groups that have been identified by witnesses at this committee.
It's not a floodgate. We're not talking about 10 or 20 different groups. We're talking about three major groups—women, indigenous people, and refugees—and bringing those voices to the table when we have developed the framework.
I've also heard people say, “Let's just get this done and then we can deal with the rest of the groups later. This will be a framework. Let's just get this framework done.” Do you know what message that sends to the other groups? It tells the other groups that they can wait. That's the message it sends: “We could have dealt with you right here, but we deliberately decided that you can wait.” If I heard one message from these witnesses in this hearing, it's that we cannot wait.
Waiting costs lives. PTSD sufferers commit suicide. They attempt suicide. They lose jobs. They lose family. We heard the devastating testimony. I, for one, don't want to be a member of a committee who says to any of those groups that they have to wait, all because we didn't take the time to add a few words to this bill. Also, remember, just make sure those voices are at the table when the conference is convened.
I am going to raise this now, and I invite my colleagues' comments and look forward to your thoughts on this. If we don't broaden this framework now, if we do decide we're not going to add these other large demographic groups that are cited as suffering from PTSD, then I submit that we do have to put the word “workplace” in here, because that will then be consistent with what this bill is about. I'll point out for a moment that we heard testimony that women have PTSD at double the rate of men—double the rate—so we're not talking about marginal groups; we're actually talking about the main sufferers of PTSD.
I'm going to pause for a moment and just briefly make a case for the workplace aspect. Don't mistake my remarks for minimizing the importance of having a federal framework for workplace PTSD. That's a laudable goal. I'm going to let Mr. speak for himself later on if he wishes to, but I kind of think, after listening to everything and judging what I heard from speakers, that this is what he intended. I think maybe he intended his bill to be a bill that creates a federal framework for workplace PTSD, specifically for those people in uniform, in particular, or front-line health professionals, those people who deal with it every day in an ongoing way.
I also want to state, for the record, that I understand that there may be some differences in that PTSD, as these people are exposed to PTSD as a routine and regular part of their job. I'm not sure, at the end of the day, that the symptoms that any person with PTSD suffers with are any different, or that the treatment is any different, or that they need to be recognized any differently, but there is that one occupational difference.
I will urge the committee, though, that if we do seek to narrow this bill to this, that we make the necessary changes to insert the word “workplace” where it's necessary and to eliminate the phrasing in this bill that suggests that it's comprehensive, because that is not only incorrect, it's misleading.
I'm going to refer my colleagues to the summary of the bill. This was the start of some of my confusion. It says:
||This enactment requires the Minister of Health to convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, provincial and territorial government representatives responsible for health and representatives of the medical community and patients' groups
—note the reference to “patients' groups”—
||for the purpose of developing a comprehensive federal framework
—here I'm going to underline the word “comprehensive”—
||to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.
When you read that, it leads the reader to suggest that we're creating a federal framework on PTSD, period, comprehensively.
I want to refer my colleagues briefly to the preamble.
||Whereas post-traumatic stress disorder (PTSD) is a condition that is characterized by persistent emotional distress occurring as a result of physical injury or severe psychological shock and typically involves disturbance of sleep and constant vivid recall of the traumatic experience, with dulled responses to others and to the outside world.
That, my colleagues, is the comprehensive definition of PTSD. That applies to everybody—a first nations victim of residential schools, a woman who has been raped, a refugee, or our first responders.
But then it starts narrowing the scope:
||Whereas there is a clear need for persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP to receive direct and timely access to PTSD support;
Well, now we start grappling with this. Is there not a clear need for first nations women and refugees to receive direct and timely access to PTSD support? I don't think anybody at this table would suggest that there isn't, but now we start seeing the bill start to narrow.
I won't go through the third paragraph. It just talks about the need for resources. Then the last paragraph is confusing, because I think it attempts to do both, to be comprehensive and specific.
|| And whereas many Canadians, in particular persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP, suffer from PTSD and would greatly benefit from the development and implementation of a federal framework....
So there it's suggesting that many Canadians would benefit, including these people, suggesting that there are people who would benefit that aren't included.
By the way, I'm only going to make this speech once, because once we get the issues out and we talk about them, I think we'll get the committee's desire and then we'll make the amendments quickly. I don't plan on speaking to each one of them, but it's the same theme throughout.
Colleagues, we're going to have to change the preamble one way or the other, and I have amendments to do that. I have amendments that will clear this up so that it will deal with workplace PTSD, or provide the opportunity to broaden it to the other groups.
It's unfortunate that I have to bring it up right now in kind of an odd place, but we have to deal with it in the order that we deal with clauses. So, colleagues, with clause 2, I'm going to move, for the purposes of debate, that we include the word “workplace” before “post-traumatic stress disorder.”
We'll begin the process by suggesting that the word “workplace” be included within the following definition:
||federal framework means a framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of workplace post-traumatic stress disorder.
As you can tell, I don't support that addition, but now is the time to have that discussion, because if it is the will of the committee to narrow this to the workplace setting, then we should start there and put the word “workplace” in. If so, I will live with and respect the will of the majority of the committee.
I hope that we don't add the word “workplace” there, because I hope we can keep the bill comprehensive. Later on I'll be moving a couple of narrow amendments to add the ministry of women, Indigenous and Northern Affairs, and Citizenship and Immigration to the bill, then clearing up the preamble to be comprehensive, unless the committee at this stage decides to add the word “workplace.” If at this point we decide to add “workplace,” I will move those amendments, but I won't speak to them because I'll understand the direction of the committee at this point.
I will end by saying this, Mr. Chair. Once again, we have an opportunity right now to pass a comprehensive federal framework on PTSD. We have an ability to recognize that this affects a number of major groups and populations in Canada outside of those who wear the uniform, or suffer PTSD as a result of their work.
We have an opportunity to stop the delay. We have an opportunity to represent the major groups. We all know that this has taken too long. As Mr. Doherty and others testified in a very impactful way, time matters in this case. We don't want to have to come back in two, three, four, five, or ten years and then pass a PTSD framework for groups that we know from the testimony in this committee are suffering today.
I will conclude by saying that it's not a big deal to add a few ministers to this. I know I'm going to be hearing from some colleagues that this will complicate matters. It will not. Having the Minister of Veterans Affairs sitting beside the Minister of National Defence.... And by the way, we're going to have to add the Minister of Public Safety to this. I think that's an omission in this bill, because RCMP officers are mentioned, and they fall under the ministry of public safety and national security. We're already going to be adding another chair. We're talking about making sure that, as a committee, the right people are around that table. Whether there are three ministries represented or six, it will not make a difference other than to improve the process to make sure that we're comprehensive.
With that, Mr. Chair, I'll move the motion to add the word “workplace”, and I urge my colleagues to defeat it—
Thank you to our colleagues who are here.
Mr. Davies, I appreciate fully your comments with respect to those groups you feel should be included in this bill. I said this before: in no way, form, or fashion do I want to diminish the impacts facing other groups who are suffering from PTSD, whether it is our indigenous population, refugees, or the victims of sexual assault or violence.
My bill was intended for our first responders, our veterans, and our military. Even after having the bill drafted, I realize that perhaps the term “first responders” needed to be broadened. Indeed, in the public safety committee we understand that a first responder could be called a public safety officer. Who's captured in that? This goes to the goal of the bill. We need to make sure our terminology is correct as we move forward, as to who's included in that area.
I will bring it back to some other comments Mr. Davies made, that it is a confusing bill, and that it is misleading in its terminology. I would argue that it isn't, because as you read it, it is talking about a comprehensive framework with respect to first responders, military and veterans, and those who have experienced human tragedy every day. Again, in no way was it to diminish the impact on others who are facing mental health injuries.
My hopes were that we could have a broad discussion, as we have been over the last 18 months, regarding mental health injuries. Indeed we've had a number of different groups come before us, and we heard great testimony from Dr. Sareen that it is different in the workplace versus traumatic incidents, such as those in residential schools or those that refugees face. There was also agreement that getting something in place now—and learning from this process so that we can apply it as we move forward for the greater good—is what we should be doing.
I know that we probably have representatives listening in from those groups that Mr. Davies has mentioned today. Again, I offer my apologies, but my bill was focused on our first responders, our military, and our veterans. My hope was that we would be able to do something—not quickly, but thoughtfully and measured—for those who put their uniforms on every day and make a sacrifice for you and me.
I agree that healthy debate is important. I appreciate those who have written letters. I've had conversations with folks such as the nurses' union and other groups. I have to be completely honest that again, I keep drawing it back to the intent of this bill. Whether Mr. Davies believes it's misleading or not, this was drafted by legal counsel with the understanding of what my goal was. They drafted it with the best understanding of how we could achieve the goal.
I have to believe, Mr. Chair, that they're far more educated than I am, and far more adapted at getting legislation through and writing legislation. That's not saying that it's always perfect. I appreciate the conversation here. I appreciate the opportunity to be able to come and talk about amendments, but I will bring it back to its original intent. It was an act respecting a federal framework on post-traumatic stress disorder—a comprehensive framework for first responders, veterans, and military.
I was happy to hear that bill was really intended to be about workplaces and, in particular, first responders.
Thank you very much for identifying this issue and bringing it forward on behalf of first responders and those who are going into the military, the RCMP.
To Mr. Davies' points and the broader definition of PTSD as it relates to problems outside the workforce, I would point out that PTSD is already a recognized mental health problem in the U.S. in the DSM, Diagnostic and Statistical Manual of Mental Disorders, groupings. I haven't been able to find out whether it's part of the case mix groups in Canada, but it would go to the point that people who have terrible calamities in their lives, such as a tragic car accident, have ongoing PTSD symptoms because of it. They go into the mental health system and there are treatment protocols and processes there for them. There's clearly a triggering event. The failures of the mental health system, and the inadequacy of the funding of the mental health system, I don't think, are going to be changed by broadening the application of PTSD in this bill.
To my mind, the people who are struggling and suffering, and those committing suicide, are more the first responders, the military. I just had a mother of a soldier who had returned from, I think it was, Kuwait, who could not get treatment for his PTSD. He thought he had it. It related to the problem of causality. Was there a triggering event?
We heard as well from one of our key witnesses here that it's like the frog in the pot of water that slowly heats up; they don't even realize they're at the point of dying because of the gradual changes. In our first responders, the RCMP and the military, I think first of all there's a culture of their thinking that this is their life, that they should be tough and be able to handle these calamities as they experience them.
Then at the federal level there also seems to be a problem that if there isn't a culminating event, if there isn't a clear moment in time, then the PTSD isn't caused by someone's work. At that point, there seems to be a treatment gap. I think those who are going to benefit the most from the bill are in those groupings that Mr. Doherty identified. I think the best impact we can have is focusing on them.
I would like to see our moving federally to what the Province of Ontario did, which was a presumptive ruling that if you have PTSD and you've served in these areas, it is presumed to be workplace-related. I think this is the first step of this bill, to get to presumption of work-related injury. I think broadening it will take us away from that ultimate goal that I think we've all shared.
I would like to stay with the workplace. I don't know that it needs to be defined. I guess it will come down to what other groups we would ask the minister to include when she's doing the work. I would respect Mr. Doherty's advice to us on that without necessarily having to amend the bill to limit it to the workplace.
I will speak in French, just to to be quicker and clearer.
I appreciate Mr. Davies' comment. We received some letters. There are even amendments. We're talking about people who provide healthcare. We talked about including certain nurses.
When we try to be more specific, we end up forgetting certain people. If we don't name them, we forget them. We may feel that they're excluded, when this is likely not the case.
The written word remains, but the intentions don't remain. The initial intention will disappear if it's not written. As Mr. Doherty said, the initial intention was to address issues concerning first responders. I think that's what it says.
Ultimately, the bill requires a number of provincial and federal ministers to focus on the issue, participate in a conference, and table a report. I don't think this excludes the addition of people who feel affected by mental health and, in particular, by post-traumatic stress disorder. I think, around the table, we all have the same intention. There is general agreement in this area.
If we intend to broaden the scope of the bill, I think we must carefully choose the sentences, words and terms to amend it. I don't think this will change the essence of the bill. In my view, we don't prepare a bill for only one category of people. We prepare a bill for all Canadians. Currently, some people are more affected by post-traumatic stress issues. However, this doesn't exclude the others.
Unless we say it's exclusively for this category of workers, which isn't the case, we can only agree to include other people and broaden the scope of the bill from the start. I think we need to find a way to do so.
My question is for the clerk, since it's a technical question. Actually, it's a legal question. Would this create obstacles? Can the committee pass amendments, proceed with the legal amendment of a bill, move in the direction suggested by Mr. Davies, and ensure that no one is excluded, but without delaying the process?
I want the clerk's view. What steps must be taken to broaden the group of people concerned and include as many people as possible in the bill without delaying the process?
I have great respect for Mr. Oliver, but his reluctance to explain what his own amendment is intended to mean is somewhat surprising to me. They're his words.
Apparently, we don't have anybody here who can advise the committee on what the difference means, but we know that in legislation words matter. Courts could be called upon to interpret this legislation, and every word has a meaning. Before we vote on this, we need to know what the change means. I will make the argument to my colleagues that the words carry a plain meaning.
By the way, this has nothing to do with the intent of Mr. Doherty's bill. This has nothing to do with the issue we just discussed.
The amendment that Mr. Oliver proposes purports to restrict the issues that would be part of the conference convened by the Minister of Health and limit them to the items that are mentioned after the words “in relation to”—the items in paragraphs 3(a), 3(b), and 3(c).
That may be what's intended, but when you change the word.... As it is presently worded—they'll talk about issues “including” the following—it means they could talk about other things. If you change the word “includes” and say “for the purpose of developing a comprehensive federal framework in relation to” the following, then they are directed only to what follows.
I'm not quite sure why Mr. Oliver doesn't want to acknowledge that, because it's his amendment. The committee has to decide whether we are okay with that. My own view would be that what follows is pretty broad, in terms of directing the conference in what they will be talking about.
Right now, I can't think of anything particularly substantive beyond what's mentioned, but I don't want to restrict them either. When they have this conference, with people who, I presume, are much smarter than I, and who have much more experience with PTSD—presumably that's the purpose of convening a conference with “stakeholders”, “representatives responsible for health”, and “representatives of the medical community”—I wouldn't purport to limit them right now to what follows. I would direct them to discuss “the following” inclusively, but if something else comes up that they think is relevant, I don't think it's wise policy for the health committee to predetermine and limit that conference in advance, and restrict their framework to what follows, when I'm not sure that it's comprehensive.