I will call this meeting to order.
Welcome to meeting number 10 of the House of Commons Standing Committee on National Defence.
Today's meeting is taking place in a hybrid format pursuant to the House order of September 23, 2020.
The proceedings will be made available via the House of Commons website.
Right now, we'll welcome our witnesses.
I'd like to welcome all our witnesses today.
Your presence is very important to us. We appreciate the time you've set aside for us.
We have four witnesses today.
We have Rear-Admiral Geneviève Bernatchez, who is the judge advocate general. With her today is Colonel Jill Wry, deputy judge advocate general; and Colonel Rakesh Jetly, senior psychiatrist, director of mental health, Canadian Forces health services group.
We also have Ms. Kyndra Rotunda, professor of military and international law at Chapman University.
We'll go in that order for the opening statements. Once the opening statements are completed, we will hand it over to the committee members for their questions.
I would ask Rear-Admiral Geneviève Bernatchez, judge advocate general, to begin, please.
Thank you, everyone. Unfortunately, we haven't fixed the issue.
It might be related to your computer, Rear-Admiral. Someone from the team will reach out to you and try to get this fixed.
In the meantime, I'll ask Colonel Rakesh Jetly to give his opening remarks and then Rear-Admiral Bernatchez. Hopefully, we'll fix this problem in the background.
Colonel Jetly, please go ahead.
Colonel, perhaps you could unplug and then plug back in again. We're not getting any of your feed at all.
Thank you. I'll try to be brief as well since we've lost a bit of time.
Madam Chair and members of the Standing Committee on National Defence, I am the chief of psychiatry at CAF. I have several key roles, including advising leadership on mental health issues. I'm the senior mental health clinician of the CAF. I conduct and facilitate a great deal of mental health research related to military members and serve as CAF mental health representative on international committees within NATO and beyond.
I thank you for your interest in the well-being of the men and women of the Canadian Armed Forces, in particular their mental health.
As we have learned through our high-quality research efforts over the years, mental illness is common within the Canadian Armed Forces just as it is in civilian society. Our studies, such as the 2002 and 2013 Canadian community health survey, mental health, CF version, allowed us to understand the burden of mental health illness within our organization compared to the civilian population. Our depression rates in both studies were higher than those in the civilian population. Our PTSD rates increased substantially between 2002 and 2013, which is not surprising after the conflicts in Afghanistan.
As an example, the 2013 survey found a 15.7% lifetime prevalence of depression in members of the CAF. Lifetime PTSD was estimated at 11.1%. Just as significant as the crude numbers, these studies also tell us a great deal about help-seeking, perceived barriers to care, and help us to understand what we call the need-care gap.
As we continue to evolve our programs, we are guided by these studies and science with the aim to provide CAF members with timely access to evidence-based care. The well-understood barriers to care include individuals being unaware that they have mental health illness that is amenable to care. People also prefer to handle things themselves. They fear for their careers. Of course, there is stigma. People may believe that they're weak if they seek mental health care.
The programs that we have developed over the years are specifically designed as countermeasures to these barriers. For example, Road to Mental Readiness aims to educate, teach coping skills, reduce stigma and increase help-seeking. The term OSI correctly legitimizes psychological injury alongside physical injury.
I understand this committee is also interested in discussing suicide prevention within the CAF. Suicide does occur in our society and the Canadian Armed Forces are not an exception. Depending on our source, but conservatively, using Statistics Canada numbers, 11 Canadians die by suicide each day. That's approximately 4,000 a year. Within Canada suicide is the second leading cause of death among young and young adults age 15 to 34 years and is three times higher in men than women. One-third of deaths by suicide occur in those age 45 to 59. After a quick look at these numbers, we see that the men and women of the Canadian Armed Forces are within this higher-risk demographic.
We have within CFHS the commitment to better understand suicide and to better manage and mitigate risk. We are in regular communication with our allies to leverage our collective wisdom to implement approaches we feel would be helpful. It is also important to remember that suicide is not as much a singularly health-related issue as it is a complex multifactorial condition that usually involves a mental health condition, diagnosed or not; stressor, usually interpersonal; certain personality factors, such as impulsivity; and of course access to lethal means.
I can expand further as desired but the model mentioned provides many opportunities for suicide intervention. As such, within the Canadian Armed Forces, we consider suicide prevention a collective responsibility that involves leadership, colleagues, peers, health care providers and our entire community.
In 2009 and 2016 we convened expert panels on suicide prevention in which we invited academic and military experts from within Canada and our allies to help assess and guide our efforts in this important area.
We have made recent changes that include working with the Canadian Psychiatric Association to create a CAF clinician handbook on suicide prevention, which is a comprehensive document that identifies risk, assessment and management of suicidality. We adapted the Columbia suicide severity rating scale to standardize our way to capture the elevated risk. We also introduced CBTS, cognitive behavioural therapy regarding suicide, through a training program across the country. It is cognitive behavioural therapy specifically aimed to address suicidal behaviour, not just the underlying mental health condition.
In March of this year, we within the Canadian Armed Forces faced an unprecedented stressor in the COVID-19 pandemic, as did all Canadians and indeed the entire world. That impacted all of us, as I know this committee has discussed. From a mental health care perspective, I would like to share the fact that the mental health services were never closed, in that from the outset our leadership considered the mental health care of the members of the Canadian Armed Forces a priority.
We faced challenges, as all health systems did. We had to comply with local, municipal and provincial policies and had to manage the risks of our patients and staff vis-à-vis the pandemic. Services continued and continue to be provided. Mental health care has been provided across the country in our clinics using a variety of means, ranging from in-person assessments, with both patient and clinician appropriately wearing PPE, to telephonic and virtual video platforms. There have been challenges in this implementation, based on technology and limited Wi-Fi in some of our buildings and the compatibility of commercial platforms. This is an area that we continue to refine.
We can discuss further as desired, but as someone who joined the Canadian Armed Forces at the end of the Cold War, I am one who remembers that health services exist not only to provide care to the ill and the injured, but also to maintain operational readiness for times when we are expected to respond and act on behalf of the people of Canada. During the pandemic, the CAF did respond both domestically and internationally when called upon, and health services supported those operations.
I am happy to take any questions that the committee may have for me and to let all of you know that this will be the last time you'll be meeting me in uniform, because I am well into my transition back to civilian society, which will occur in early 2021 after 31 years within the CAF.
It looks as though we're not going to be able to get this fixed this morning, so we will adjourn for today. We will reconvene on Friday. We will reach out to you with a notice of meeting. We will update the witnesses, and we'll go from there.
I'll also reach out to each of you via email to chat about the way ahead. We might need a steering committee meeting now. I'll be connecting with you after we finish here today.
I want to apologize to our witnesses and thank them.
I want to thank our witness in California for getting up so early in the morning to join us. We really appreciate it.
We apologize. I think a lot of what's been happening around the world has challenged a lot of us, but we'll find a way to make this happen.
To all of our witnesses, thank you for joining us. We'll be in contact very soon to provide the details for Friday's session. I just want to say thank you so much for being with us in committee. We'll be reaching out with more information for you very shortly.
With that, the meeting is adjourned.