ACVA Committee Meeting

     I call this meeting to order.

    Welcome to meeting number 13 of the House of Commons Standing Committee on Veterans Affairs.

     Pursuant to Standing Order 108(2) and the motion adopted by the committee on September 18, 2025, the committee is resuming its study on suicide prevention among veterans.

    Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders.

    Before we continue, I would ask all in-person participants to consult the guidelines written on the cards on the table. These measures are in place to help prevent audio feedback incidents and to protect the health and safety of all participants, including our interpreters.

    I would like to make a few comments for the benefit of our witnesses who are with us today and for members. Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic, and please mute yourself when you are not speaking. For those on Zoom, at the bottom of your screen, you can select the appropriate channel for interpretation: floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

    This is a reminder that all comments should be addressed through the chair.

     For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function.

    The committee clerk and I will manage the speaking order as best we can. We would like to thank you for your patience and understanding.

     I would now like to welcome our witnesses.

    I know you're in Australia, so first I want to say thank you very much to both of you.

    We have Professor Ben Wadham of Flinders University, who is the director of the Open Door initiative for improving the well-being of veterans, public safety personnel and their families. From the Government of Australia's Department of Veterans' Affairs, we have Professor Jonathan Lane, chief psychiatrist. Thank you for being with us again.

    We will start by giving each of you approximately five minutes to present your opening remarks. The rest of the hour will be dedicated to a question and answer session with the members of the committee.

    I would like to start with Professor Wadham.

    I would invite you to speak for five minutes. Thank you very much.

    Thank you.

    Good morning, everyone.

     I'm Professor Ben Wadham. I'm the director of the Open Door research initiative for improving the well-being of veterans, public safety personnel, and their families in South Australia.

    I am a veteran. I served in the Australian Defence Force from 1987 to 1995. I had a very good career, obviously with some absolutely brilliant experiences and some difficult experiences, as you do in the military. I began really researching the military very strongly in 2003, so I've been doing that for 20 years. I've focused on some issues that really address veteran suicidality.

    I'm currently conducting an Australian Research Council discovery project called “Veteran Suicide: Investigating the Social and Historical Dimensions”. The main focus of our research is not only to encapsulate the biopsychological elements of the research, but also to provide a different perspective or a more holistic perspective by looking at the social implications of veteran suicidality.

    We know that when people come out of deployment, or even while in service, they have experiences that may have exposed them to trauma, but we can increase our preventative efforts by focusing on some really key issues. Transition is one of them, which is a key point of opportunity and challenge. We need to ensure that we have the right systems and services in place to do that. We recently had a royal commission in Australia, and that certainly has been one of their main recommendations—to produce a very strong transition element.

    The research I've done has looked at veterans who have been overseas or in service. There are a number of reasons they are led to contemplate taking their own lives. There are two issues. There is the deployment and service side of things, but there is also the institutional side of things. I think that's a main point, and it's one that, when we testified to the royal commission, was an absolutely central point. We have to look at systems and cultures as much as we look at the more accepted issues around deployment.

    Issues of system and culture mean that we have to look at the way in which the military justice system is used. Recently in Australia, we had an inquiry into the weaponization of the military justice system, which I sat on. The key point there was that in any military, there is significant command discretion. There's a strong class system between commissioned and non-commissioned officers, and if that is not regulated effectively, it can lead to the exploitation of that power and then lead to bad outcomes for our veterans. While PTSD is a very significant issue for veterans, particularly if they're exposed to trauma, the other side of things is institutional betrayal and moral injury.

    Another big focus of the royal commission—and one that we brought to them—was that we not only have to look at what we expect when we join the military—that is the cost of war—but also incorporate an understanding of the costs of service.

    The royal commission had 122 recommendations. They focused on things such as a national study into military sexual assault and the establishment of an independent body—that's recommendation 122—to oversee the recommendations, the rolling out, and also to hear other issues that come forth at the time.

    We've looked at moving transition away from defence and into the DVA. We've looked at a well-being work group that will oversee well-being. We have also looked at the reconstruction of the veterans sector, and we're looking at developing a peak body to oversee that.

    There's a whole range of other issues, as well. For example, veteran employment is a big piece. That's the focus we bring to this area. There may be mental health issues, but if we can get employment, education, housing, mobility, identity, purpose and belonging right, then those are major preventative issues for veteran suicidality.

    I would say that, in my research, with over 300 interviews now, social disconnection is, for me, the overwhelming issue. That is an issue that we can prevent really effectively just by wrapping services, knowledge, wisdom, experience and empathy around veterans when they're in service, when they leave service and even years after their service when they're out, well into their civilian lives.

    Thank you.

     Thank you very much, Professor Wadham.

    I would like to invite Professor Lane to speak for five minutes, please.

    Good morning, Madam Chair and members of the committee.

     As some background, like Ben, I joined the army at the ripe old age of 17, in 1989, and had 10 years as a soldier. During that time, I did an arts degree in English lit and psychology part-time, and then an honours degree in psychology, before being sponsored as a full-time medical student with the army. I then served in the army as a doctor for a period of time, before transferring to the reserves and doing my training as a psychiatrist.

     I deployed to Afghanistan in 2013 and was embedded at the role 3 in Kandahar as a mental health provider. After finishing my fellowship, I completed a Ph.D. looking at culturally specific transdiagnostic and peer-led programs for military veterans and emergency services personnel. Through this, along with my other clinical work, I ended up being involved in the royal commission into veteran suicide, the same as Ben, and eventually I started working with our veterans' affairs department. Last year, in July, Secretary Alison Frame created the position of chief psychiatrist, and I was appointed to that.

     In my clinical work and my history and engagement as a soldier, and then as a doctor and a psychiatrist, I've had to be deeply involved in suicide and suicidality because it's so commonly associated with mental health problems. As Ben identified, there are also a number of other key factors that need to be addressed when we look at this particular population group, such as service culture, cultural conditioning and service identity.

    As Ben also identified, those become vulnerabilities either when service systems and processes are weaponized, which includes military sexual abuse, or when the person transitions out. This involves how they navigate that process, which is actually a transition of identity, a transition of community and a transition of culture, along with needing to find some new sense of purpose and meaning. This can be particularly difficult when the person has mental health concerns or physical injuries, such as wounds and things like that.

     My work in the department around suicide and suicidality has come from a number of different positions. This is primarily because, to a psychiatrist, mental health concerns and suicide are obviously not uncommon things. That was something I saw first-hand in my uniformed service as well.

    When we're talking about suicide, we absolutely need to talk at the individual level, but we also need to include community, as Ben identified, and then services and processes from the government and from the wider health systems themselves. On suicide itself, in Australia, for example, our Australian Institute of Health and Welfare has been collecting suicide data for defence and the veterans community since 2017. The figures for 2023 were 78 serving and ex-serving members who unfortunately died by suicide. That was actually lower than it had been in previous years, and the numbers have been trending down, which does suggest that we're doing something good.

     The problem with these numbers, even though that's a high figure, is that they're actually relatively low. Suicide in general is significantly complex and very nuanced in terms of what happens when, how and why, in particular. The data we've seen from Australia shows that up to 70% of people who do end up dying by suicide aren't actually engaged in our veterans' affairs system at all. While it's really important to have veteran-friendly services, we also need to ensure that services in the wider system, both in the public and the private systems, are engaged in things as well.

     One of the things I'm very proud to say I've been working on is our department's national suicide prevention plan. This has been developed in conjunction with the national suicide prevention office for Australia and their plan as well. I've provided copies of that to the clerk for your information, which we can discuss at a later date.

    Thank you.

     Thank you very much to both of you, again.

     Thank you for your service to your country, sirs. We've been looking forward to hearing your perspective from Australia.

     On that note, I will invite MP Wagantall to go ahead for six minutes to start the conversation.

     Thank you so much, Chair.

    Thank you for being here today. I'm very excited to be able to ask you some questions.

    We have a lot in common, Canada and Australia. An issue I have been exposed to—for the last decade, actually—is the mental health impact on those of our serving members and veterans who were exposed to mefloquine. I notice that, in recommendation 61, you talk specifically about establishing a brain injury program that covers the various sections of the military “and serving and ex-serving members exposed to mefloquine and/or tafenoquine.”

    In 61(b), you say, “assess and treat neurocognitive issues affecting serving and ex-serving members, whatever their cause”. Has the Australian government—the Department of Veterans' Affairs—identified, specifically, mefloquine toxicity as a cause in treating mental health and brain stem injuries?

     Thank you. That's an interesting question.

    Both mefloquine and tafenoquine were prescribed and used during our Australian campaigns in Southeast Asia, and in Pacific areas as well. There was a significant amount of distress, in the 2000s, about the potential harms from both of these medications. As a result of that, a cognitive testing program was actually established. Unfortunately, it wasn't taken up very well, and there wasn't a significant amount of data that came from that.

    That sort of research in that era, though, then led to one of the signature issues around service in the military, in particular during periods of high operational tempo. In Australia, just like in Canada, the great war on terror has meant two decades of exposure to significant low-level blast injuries and potential traumatic brain injuries as well, and in—

    Can I interrupt? I'm sorry. I want to ask about that, then. You indicate that, with this particular issue, you should “record members' exposure to traumatic brain injury and minor traumatic brain injury, including in medical records”. Obviously, it has been established that mefloquine does cause a brain stem injury. For those who have had concerns, do you have actual records, then, indicating that they were impacted by taking that particular antimalarial drug?

     No, I'm afraid we don't, as far as I'm aware.

     Why would that be?

    Basically, long story short, there are a range of potential causes for cognitive decline and, then, various other sorts of injuries as well. When you're talking about cognitive functioning, that was the primary complaint from people who were being prescribed those medications. The actual mechanism of injury for a physical injury, like the blast from a blast overpressure, which might cause mild traumatic brain injury or something more significant, causes physical lesions because of the physical mechanism of injury, as opposed to pharmacological, chemical, hormonal and so on.

     I do understand that. The reality is that there is significant information around the world now in regard to this, so I would love to see Canada do far more to identify and to take responsibility for our soldiers, who have been impacted by that drug since Somalia, for sure, right up until Afghanistan. Now our surgeon general has indicated it as a drug of last resort rather than first resort.

    I appreciate that. I think we need to work together on this particular issue.

    That being said, I have a question, then, about one of the other issues, around privacy. In your study, recommendation 74 is “Clarify the application of the Privacy Act to veterans to determine whether amendments are necessary”.

    Quite often, at this committee, we're trying to determine how many veterans have been in certain circumstances and whatnot, and we often hear that we can't really know, because it's up to them. We don't have that opportunity, because of the Privacy Act. Is this something, then, that you're also experiencing?

     Absolutely, and it's the bane of my life as an academic, as a clinician and as a member of our Department of Veterans' Affairs. When we talk about privacy, this includes serving personnel and their health records. That data can't leave Defence, unfortunately, which means that, when someone leaves Defence, that data is given to them in a file, and that's it; there are no systematic records kept. Going forward as well, we don't have a veteran specifier or identifier, so we can't track health care usage and various other things.

     On that point, looking at this privacy issue, have you considered making it a requirement that...or is there a way to give people who are leaving and becoming veterans the opportunity to agree that they want their privacy to be somewhat limited to allow Veterans' Affairs to be able to deal with their needs after they leave service?

     Be very brief, sir, because our time has expired. I'll leave you maybe 10 seconds to answer Mrs. Wagantall, please.

     Yes, very much so. People leaving Defence have a veteran identifier in terms of their card so that they can access services, and then we can collect health usage data around that.

    Thank you very much, Professor.

    Mr. Casey, you have six minutes.

     Thank you very much, Madam Chair.

     Thank you to our witnesses for being with us. It's a challenge for that to happen from the other side of the globe, and we appreciate that you've made that effort and shown your interest in our study. We appreciate it very much.

    We had a witness testify before us a couple of days ago who was passionate about psilocybin-aided therapy. He basically pointed to Australia as the global gold standard for the implementation and acceptance of this.

     I'd be interested to know a bit more about it. What is the status of psilocybin-assisted therapy in your country? Can you take us through how you were able to get social licence for this to happen? There is undoubtedly a stigma in this country around psychedelics and a stigma around alternative therapies. I'd be interested in the Australian experience in that regard.

    Thank you, sir.

     That's a very interesting question and a very timely question, because our Therapeutic Goods Administration allowed the use of psilocybin for treatment-resistant depression, and MDMA, the party drug, for treatment-resistant post-traumatic stress disorder. This is effectively under clinical trial-type conditions and as a means of last resort.

    Our Department of Veterans' Affairs opened up applications to fund treatment for this literally two weeks ago. This is basically the first time, I think, that a government agency has funded this kind of treatment, and it's not cheap. We're talking about $30,000 to $35,000 per course of treatment for each individual, and the requirements that we're using to manage this are relatively strict as well.

    From a departmental perspective, our guidelines are that the person has to currently have a treating psychiatrist and a treating psychologist. They have to have been in treatment over the last 12 months continuously, at a minimum, but typically longer. They have to have tried other therapies, and there must be evidence that there's been an effective duration at an effective dose for the psychological therapies and the pharmacotherapies, and that they're not using other medications, in particular psychoactives—medicinal cannabis and ketamine being the two primary ones that would be disallowed while someone is undergoing these sorts of therapies.

    The evidence isn't where the public would like it to be, unfortunately. As clinicians, we are talking about treatments that are publicly funded and that are significantly expensive. The body of evidence isn't necessarily there to say that they work to the standard that people would like them to work. You can see this from the applications through the federal drug administration in the U.S. and the fact that this still hasn't gained traction in the U.S. in that particular way.

     This is an early intervention and an early form of experiment, and we're requiring quite significant outcome evidence to be able to demonstrate whether this is going to be effective over the longer term and, therefore, whether it would continue to be funded.

     Thank you very much.

     Professor Wadham, in your opening remarks you talked about moving transition from Defence to Veterans' Affairs. I'm quite interested to hear the rationale behind that, and the challenges that led up to arriving at that solution.

     Sure, and I'll just say that Jonathan might be able to fill in a bit more on the departmental side of that.

    We've recognized that transition has been a challenge probably for a very long time, but particularly during the last 10 to 12 years there has been a lot of government activity around understanding transition. We had “The Constant Battle” report in 2016, which really honed in on that subject matter due to some veterans who had taken their lives.

     There is a challenge broadly about what the interests of Defence are in being the key piece in veteran transition. One of the narratives that come out is that Defence is focused on retention and serving those who are serving. The belief, then, is that they don't have all the interests in the right place to be actually leading transition.

    Out of “The Constant Battle” report, there was the development of a departmental transition body. I'm forgetting the acronym now. Do you remember what they were called, Jon?

    It was the joint transition authority.

    Yes, JTA, that's it. That had a shelf life of maybe five to six years, but it wasn't achieving the outcomes that we were looking at.

    There are a range of issues that we need to consider in transition. One of them is thinking about transition well before you leave. Another one is about the sharing of information between Defence and DVA. We have a card system in Australia—white, orange and gold cards—so part of that discussion was about trying to get veterans at least onto their white card and get their claims sorted before they left.

    Another focus of transition is RPL or credit transfer. That's understanding the skills and experiences of veterans in different roles in the military, and obviously it's a bit more difficult when you're in a combat corps to translate those skills when you get out into civvy street. Obviously, if you can recognize those skills and then find a pathway of education and employment in transition, then that's a better outcome than not being able to achieve that translation, so Australia is doing a lot of work in that. The Department of Veterans' Affairs has established a three-round RPL process to try to get universities and post-secondary institutions to facilitate that RPL and—

    Mr. Wadham, I sincerely apologize. Just out of respect for all our members, I'm going to have to interrupt this wonderful train of thought. Keep this for the next round, sir.

    On that note, now I will advise you that Madame Gaudreau will be asking her question in French, so please make sure that you have the right setting. She will speak for six minutes, asking you questions.

    Thank you, Madam Chair.

    Mr. Wadham, please feel free to ask me to repeat anything, if necessary. Your comments are valuable. Thank you for joining us.

    Incidentally, I had the honour of visiting Australia to learn more about the country's democratic system and best practices.

    I don't have much time. I'll get straight to the point.

    Of the 122 recommendations made by the Australian Royal Commission into Defence and Veteran Suicide, which three matter the most to you and which ones do you think are most likely to help our veterans?

     It is agreed on in Australia that the most important recommendation is recommendation 122. We've had a lot of inquiries. One of the things the royal commission found out was there had been 57 inquiries since the mid-nineties. There have been 750 recommendations, and very few of them have been met. We have a cycle in Australia, which I don't think is dissimilar to Canada, where we have an incident, an inquiry, a report and then silence. That's also called a policy graveyard.

    In 2005, after 10 years of deliberating on military justice, we recommended that there should be an independent body to oversee redresses of grievance and some other issues like that. The fundamental point here is that all militaries are insular, inward-looking institutions that are somewhat skeptical of taking outsider advice.

    The argument goes straight away.... We look very strongly at the Canadian system to ask, how do we create an independent mechanism of scrutiny? Recommendation 122 is an attempt to achieve that independent mechanism of scrutiny. What it will do is look at how the recommendations are rolling out. For any more cases that come up, it won't have prosecutorial powers, but it will have the ability to refer. I believe Jon can correct me on that.

    The other key recommendation, I think, is the call for a national study on military sexual assault. My research has personally led the way on this in Australia. We have multiple publications and a few books on this subject matter. This one has been very hard, very intractable and very difficult to move. I can't even begin to tell you the history of it.

    What we have in Australia is a class action. That's something that Canada has done in the past. We also have begun to change the language away from “sexual misconduct” to really naming what it is, which is sexual violence.

    These are the top two. There are a bunch of other ones that are really important. Probably the other one that's important is the transition piece.

    Madam Chair, I assume that we have access to the commission's 122 recommendations. I don't have them with me right now.

    Mr. Lane, you have lived a rich life as a soldier, doctor and chief psychiatrist. I believe that we can learn a great deal from your advice.

    After our meeting, if you have any further information to share, please send it to us. It will contribute to our recommendations in our report.

    Clearly, 78 active armed forces members who completed suicide is 78 too many. I'm also pleased to see that you have been collecting data since 2017. I imagine that this contributed significantly to the report.

    My question is more about the national report on suicide. I gather that it's forthcoming.

    Is that right?

    If so, when will you have the full report?

     Thank you.

    That report—the plan—has actually been released. I have sent that to the clerk. In the interest of saving your time, the clerk has copies of the suicide prevention plan and the implementation plan to go along with it.

    Just to touch on what Ben said, for me, the most important thing is an independent body that collects data and oversees both suicide attempts and completed suicides, both from the serving community and from the veteran community. As Ben said, service cultures, service organizations and government departments can be quite opaque, protective and secretive by definition and by operation. Having an independent body actually allows the community to have faith that those services and those organizations are doing the best thing they can for their personnel.

    Since I have only 30 seconds left, I just want to confirm something with you.

    In Australia, once armed forces members complete their service, they aren't abandoned. You make sure that veterans receive support and tools. They don't need to try to navigate the public system to get help.

    Is that right? You can answer yes or no.

     Yes, and those well-being measures of finance, health, education and community still remain the biggest priorities at the individual and community levels for the well-being of any individual, and therefore for the prevention of suicide down the track, as well as—

    Thank you, Madam Chair.

    I've allowed each member a little extra time, and I want to make sure I'm fair to Madame Gaudreau.

    Would you want maybe 15 seconds to comment on Madame Gaudreau's question?

     Thank you.

    These well-being matters aren't just about health care. They're about having productive members of our society who have done so much and have so much more to give. The more support we give in terms of employment, the more they give back to the community, and the better we are as a society going forward.

    May I have two seconds?

     We recognize our veterans as national assets that we placed a lot of investment in and that we must invest in afterwards in order to give back to society. That's a return on the financial investment into them, but it's also a return on investment in their and their families' well-being. It's very important for us to support veterans on the way out and afterwards.

     Thank you very much.

    For five minutes, we have Mr. Viersen.

    Thank you, Madam Chair.

     Thanks to our witnesses.

    Mr. Wadham, many people who have come to our committee have talked about what's going on in Australia as a bright light in the world. From your perspective, is what Australia is doing working in order to prevent the suicide epidemic?

     It's a hard question. In the first instance, I think we had a royal commission because it wasn't working. I think that's the main point.

    Since the rollout, and the work and the psilocybin and all these things, have you seen it change, or is it too early to tell?

    No, I don't think it's too early to tell. I think that for the community—and there will be those who don't agree—the royal commission was a very positive outcome. It really brought a lot of issues to the table, a lot of things that had been going through a cycle of being identified, looked at and then forgotten. I think this has really put all of that on the table.

     We have a complete sheet now to go from in order to address things, and things are starting to happen. From outside of the community, we'd like greater transparency about how those things are evolving, but that's understandable. The departments are getting down and doing the work. We have a very versatile and diverse understanding of the issues, as you mentioned—issues like TBI and different forms of alternative therapy.

     It's also focusing, as I mentioned before, on the social aspects, on the DVA well-being wheel. If you can give people the pathways to success after service, then they're not going to create as much health care cost burden.

     I think the future looks bright. I think there are many challenges. Institutions take time to change. DVA, I think, is leading the way. From an outside perspective, I'm quite impressed with DVA. I think the defence level has a bunch of different challenges that they're working through.

     Overall, we've identified the range of issues, and we've decided to tackle them. You have to remember that out of 122 recommendations, only one was rejected. The rest were either agreed to or agreed to in principle. I feel like we're on a good platform and we have a—

     I think you're using an acronym that is not working for me. Is it DVA?

    Yes, it's the Department of Veterans' Affairs.

    Arnold Viersen: Okay.

    Ben Wadham: I think we've identified the issues. I think we have a strong sense of consensus, and I think we're moving forward. I'm positive about the future.

    All right.

     One of the challenges we hear about is.... At every meeting, we get a new group in front of us with a new solution, but it feels like our department is saying that they have this one track to go through, or they have to be aligned with this particular organization in order to get funding.

     I imagine there was a similar problem in Australia. Have you been able to capture the range of different methods that work for different people?

     I've had positive conversations with Alison Frame, who is the secretary of the Department of Veterans' Affairs, and with other commissioners who say that they want to diversify the approach, that we've probably overfocused on the biomedical and that we need to place stronger emphasis on understanding culture, systems and the social elements of it, so—

     Has there been any particular system change to that end?

    Yes.

    What does that look like?

     Well, recently—this is a little bit on the downside—the Department of Veterans' Affairs issued a $25-million tender for something called VF-LINK, veteran and family learning and innovation network of knowledge. The idea was to take away the decisions about research that were being centred within DVA and to canvass the broader academic community. The principle of that was around real change. I think we might have decided to stay with the same sort of model, as opposed to really enhancing and improving the social health element of things. That's my bias, I admit.

    We have brilliant work in psychiatry, psychology and allied health. We need to do better in the preventative space, and I'm not sure we've taken that up as much as I'd like just yet.

    All right.

    There are a few seconds left here.

    Mr. Lane, do you have anything to add?

     Yes. I think one of our biggest strengths at the moment is the way we've engaged the community. This is personnel with lived experience, family members and then ex-service organizations like your Legion.

    How have you done that? That's what we all say, but how did you do that?

    Yes. It has to be done at a local.... The systems within the policies and programs have to specifically and deliberately incorporate that lived experience voice. Something doesn't happen unless there is someone with lived experience in the co-development of whatever program is being rolled out. Rather than have one particular ex-service organization, you go to the strengths of the communities that are there. Part of the program has been rolling out what we've been calling veterans hubs. These are centres where you have services from whomever and for whomever and for whatever, including medical, including housing, all of those well-being sorts of services. That's the centre of gravity, and a base for them to operate from so that they can then serve the community they're based in.

    This is actually really good, because you can have government services working out of the same building. You can have all the other support agencies, but because it's local and in the community, it doesn't have to be huge. It can work with and for the community. I think that's the centre of it, because our geography is like yours. It's a big country with lots of urban centres, but what happens everywhere else? So—

    Thank you very much.

    I'm going to have to interrupt again. I sincerely apologize.

    We have Mrs. Hirtle for five minutes.

     Thank you, Madam Chair.

    Good evening, gentlemen. Thank you for being here. Again, thank you for staying up late for us today.

    I'd like to start with everyone's favourite topic, last thing of the day—statistics and data. In Canada, suicide data covers a longer period, 1976 to 2014. I gather the Australian data covers 1997 to 2021. Can you speak to the slope of the data over time? Are there peaks and troughs that stand out as trends, which may have been a result of policy issues?

     I'll let Jon speak to that, but one important piece is that we began lobbying for a royal commission, understanding that there were around 380 veteran suicides since 1997. My numbers won't be exactly precise, but over the period of that royal commission, over three years, we went from 400 to 700 to 1,200 to 1,700, and now we're around 2,000. What we have embarked upon is a strong centralization of our data so that we have a much more representative understanding of the issue.

     Note also that this data is collected by an independent body that does data collection, analysis and evaluation for a whole range of other metrics for the federal government as well, so it's reputable. I think the collection of that data was a watershed moment in Australia because, again, we weren't actually collecting data, so people couldn't say how bad the problem was.

    I think the royal commission itself was huge and was another turning point. Because of the work done during the commission, and then subsequently since the report was handed down 15 months ago now, the numbers are going down.

    However, I think we need more nuance in the data about what a person's situation is when those kinds of tragic things occur. For example, I was involved in calls to our 911 equivalent from military and veterans in one of our provinces, our state called Queensland. The polypharmacy rates in veterans were enormous. Something like 80% of veterans were on three different medications, which included psychotropics and sedatives like benzodiazepines and opiates, these kinds of drugs. We're now seeing more along the lines of the same with medicinal cannabis. It makes people impulsive and disinhibited and then more likely to do something quite risky at a specific moment, which massively increases the risk of a negative outcome for them. That kind of data coming out and looking at what situations are prompting people to engage in those kinds of quite harmful and potentially lethal behaviours, that's what we need to see more of.

    Could I just mention one more point? The suicide rate data does not include unverified suicides, such as single-vehicle car accidents, or attempts, so we're only getting a piece of the picture.

     That's a good point; thank you for that.

    I have another question about numbers. The excess risk of suicide in the veteran community versus the overall population is two to three times higher for female veterans than for male veterans. Is this a result of suicides of men in the general population being much higher as a baseline? What, in your view, is the reason for the disparity in the excess risk found for female veterans?

     I'll just give you some quick data. The rates of suicide in female veterans can be up to 10 times higher because the population of women in service is only roughly 15%, so the rates can actually.... With some people, particularly those who've experienced military sexual abuse, and I'm sure Ben would talk to that.... Again, we're looking at the sort of vulnerabilities and risk factors that someone takes with them from service. This particular cohort, which has significantly more vulnerabilities, is much more likely to end up having a more adverse outcome than their male counterparts.

     Yes, and I would just say that the research we've done identifies that women have quite different experiences.

     Thank you very much.

     Thank you very much.

    The next speaker is Ms. Gaudreau.

    Again, she will be addressing both of you in French for two and a half minutes.

    Madame Gaudreau, go ahead.

    Thank you, Madam Chair.

    I gather from your comments that a specific recommendation says that individuals who haven't gone through training, military service and post‑military life shouldn't consider themselves qualified to provide support services to veterans.

    I have done a great deal of work in the areas of substance abuse and suicide prevention. However, the fact remains that, while veterans are human beings, they have a completely different culture and life experience.

    People who haven't served in the military can't fully understand this culture and experience. As a result, they can't connect with veterans and help them effectively.

    Did I understand correctly that the recommendation says that support services for veterans must be provided by peers, by brothers in arms?

     Yes, exactly, the recommendations were about access to culturally appropriate health services. That's been a big feature of funding from our Department of Veterans' Affairs. It's a personal hobby horse of mine. You cannot give a clinician that kind of lived service experience, but you can give someone with lived experience a paraprofessional clinical role to help deliver community-based programs that are focused around skills for improved functioning and improved interpersonal relationships.

    Those factors, in and of themselves, are significantly protective for really poor outcomes, such as suicide, but for other things as well: depression, anxiety, post-traumatic stress disorder, anger and all those sorts of things.

     Thank you, Mr. Lane.

    Mr. Wadham, do you agree? There are 20 seconds left.

     Yes. Military service is unique. We're heavily socialized going into the Australian Defence Force, or any military. We spend 12 weeks to 12 months being socialized in strong service experience, and then we can be out in a flash. One thing we've done in Australia is establish peer workers in Open Arms. Open Arms is our counselling service. It brings in veterans who have that experience to work with other veterans to provide pathways to a successful transition.

    Thank you, Mr. Wadham.

    Thank you for giving me a bit more time, Madam Chair.

    I'm feeling generous today.

     Mr. Tolmie, you have five minutes.

     Thank you, Madam Chair.

    Thank you to our witnesses. I'm grateful for your service. I went to university with a former Australian officer. We did a degree in war studies at King's in London, England. I have some fond stories of university that I probably won't share, but he was a good lad. He kept his end up, let me just say.

    Professor Lane, you said in your opening statement that 70% of your veterans are not “engaged”. Could you please unpack that and explain it to me?

     Yes. Roughly 70% of the people who died from suicide weren't concurrently engaged in or getting services from our Veterans' Affairs. That can be interpreted in a few different ways, but one way in particular is with regard to the people who are being helped. We have roughly 600,000 veterans in Australia. Roughly 400,000 to 450,000 of those are accessing Veterans' Affairs services and benefits. We are helping a large proportion of the population, but there is still a proportion of them missing out. By definition, they become more vulnerable. That shows up in that particular statistic.

     Mr. Wadham, do you have any comments in regard to that?

     I think we understand that in-service identity and belonging, as a bit of a maxim, is generally absolutely rock solid—not for everyone, obviously, but as a rule. Leaving is maybe a bit of a precipice or a bit of a void where we don't have that identity, purpose and belonging. Many of those who engage with DVA or with the veterans sector will engage in what I call “serving after service”. It means running programs or working with veterans to support them. It provides that support and that buffer for those veterans. Those who go completely free don't have the same level of support. They have a level of social disconnection. To me, social disconnection leads to a vulnerability to suicide.

     Okay.

    I'm asking this out of ignorance, because I'm unaware of how your system works down there. One thing we've gotten from our recent study experiences is that there's a blind spot. When serving members leave the military, they're left to basically fend for themselves.

    Are your veterans sat down with Veterans' Affairs upon release, or is it something they have to go online and access, and it's up to them?

    The joint transition authority was a program that was specifically set up to engage people with Veterans' Affairs before they leave Defence to make sure that they have medical coverage and the other sorts of things they need. That access is then guaranteed in terms of their being able to put in claims for compensation through the department, but it's also supported from the other side by primary health care and extra funding for general practitioners to see veterans now and coordinate care as well.

    We have those fundamental things like financial support in terms of a pension or whatever else is needed and health support in terms of that primary care, so that the general practitioner, the GP, can refer people out to other specialists as needed, and non-liability mental health care. What we mean by that is that Defence or DVA doesn't have to take responsibility for causing that condition; it just gets treated anyway. That includes substance abuse as well, which is really important in terms of access and engagement in care.

     Just quickly, we have something called transition cells. Every brigade will have a transition cell. Veterans can go to that transition cell. There are social transition seminars, where they go to see different organizations that might offer them different pathways.

    Transition is very variable. We know that the high rates of suicide are with involuntary discharge and medical discharge. We know that those who have voluntarily left have better outcomes, and we know that if you don't provide any sort of planning and preparation for veterans, then they're more vulnerable than if they did have that support.

     Thank you very much, Mr. Tolmie.

    Thanks to both of you.

    For our last questions, Madame Auguste will also be addressing you in French. She will have five minutes.

    Thank you, Madam Chair.

    I want to thank the witnesses for joining us. Their comments will be a great help to us.

    I would like to talk about the national suicide prevention plan that you referred to earlier.

    How does this plan work in your country?

    What has been the outcome for veterans?

     I can't really speak to the outcomes with veterans, given that the strategy was only released a few weeks ago, but as I said, that document has been provided.

    To talk about it very briefly, well-being underpins the individual and the community, and it is driven by policy as well, policy and services at the government level. When we think about suicide, it's not just about how, when and who it happens to and all those sorts of things. It needs to be taken from a systemic perspective that talks about the individual, the community they came from, the services they engaged with and the agencies that supported those services through policies and various things as well.

    Prevention is a primary focus in terms of early help-seeking, reduction of stigma and early access to care. Again, this was discussed, but we look at military competency and training—not just in service-related things, but in suicide and suicidality—for health care providers and members of the community as well.

    Then we talk about intervention and aftercare, and then postvention too, because what happens after someone is suicided is that bereavement can impact up to 134 other people in their immediate community. This is family, friends and various other things. That, unfortunately, can have a ripple effect, and we need to deal with the grief response that suicide has caused. Family members, community members, individuals, workplaces and all the other sorts of things need to have access to those resources and tools as well. This relies on a number of critical enablers like governance, embedded lived experience, available and translated evidence, which we talked about before, and then having a capable and integrated workforce to deliver those programs that we talked about before.

    That's kind of what we're talking about, in a nutshell.

    Thank you.

    I would like to talk about the community aspect.

    A number of the witnesses who spoke to us said that some military members, when they leave the armed forces, like to receive support from peers, from people who served in the forces.

    Can you talk about this relationship with peers?

    How can this help prevent suicide among veterans?

     Both Ben and I have done a lot of work on this. We look very strongly upon the need for that lived experience and that lived expertise because of the nature of service and then the shared understanding of values, expected behaviours, shared experiences and all those sorts of things as well.

    When we talk about community, that's part of what we're talking about. An individual should be able to go to, effectively, a mini community in whatever part of an organization or wherever they are geographically, and it's then up to different organizations and services to help that person fit into that particular community.

    Novel ways in which it can be done include things like adaptive sports. Canada hosted the games this year. I was the archery coach for our Australian team from 2017 to 2022. Things like adaptive sports are a massive way of getting people into an adjacent community that also tends to attract a lot of veterans. Those are things outside government and various things people might think of, but they actually work really well.

     We have a very strong veteran sector. Recent studies showed that there are about 4,000 different charities attempting to address veterans' needs. Obviously, only a small percentage of those are core organizations.

    I mentioned the idea of serving after service. One thing that has been really interesting about the study we're doing on veteran suicidality in Australia is that we have a partner in the U.S. We're not getting the same comparative from the U.S., because the guns used in the U.S. are high-fatality. In Australia, we have a high survivor rate. That's what we're doing; we're talking to those men and women and working out not just what took them to the brink but also what brought them back. Serving after service is a key piece, as well as engagement in the veteran sector.

    It's a key piece in the postvention space as well. This is what we talk about when we talk about education and various other things too.

     Thanks very much to both of you. I know it's late at night in Australia.

    On behalf of our committee, thank you very much for taking the time to share your expertise and your experience with us. Again, thank you for your service, both of you, to your country.

     On this note, I will be suspending to allow our other witnesses to come.

     Again, thank you very much.

     We will resume for our second panel.

     I want to say thanks to our witnesses who are here in person and by video conference.

    We have, as an individual, Mrs. Amanda Hatcher.

    Here in person, we have retired corporal Mark Meincke. He's the host of Operation Tango Romeo, a trauma recovery podcast for military, veterans, first responders and their families.

    We also have, from the Chronic Pain Centre of Excellence for Canadian Veterans, Dr. Ramesh Zacharias, president and chief executive officer; and Mr. Cameron Kowalski, retired sergeant, director of operations.

     I'm going to allow Mrs. Hatcher to start, for five minutes, and then each of you will have the chance to speak.

     Mrs. Hatcher, go ahead.

     Thank you. Good morning.

    Let me start off by introducing myself. I am Amanda Hatcher, the widow of Master Corporal Shawn Hatcher, who lost his battle to suicide on October 4, 2015. Shawn served 18 years with the Canadian Armed Forces, and during those years, he did two tours in Afghanistan. In 2010, Shawn started to experience suicidal ideation that was observed by a close friend and member. The information was passed on to the social worker of his posting at the time, and the next day she made a phone call to Shawn asking him if he was suicidal. At that time, Shawn stated no, for fear of repercussions on his job, so the option was to post him out—case closed.

    In February 2014, while we were posted to Gander, Newfoundland, Shawn attempted suicide and spent 10 days in the intensive care unit of the local hospital. Upon discharge, there was no follow-up from the hospital psychiatrist, but he was told to go home and live normal. What exactly is living normal when a member is dealing with mental health issues? However, I made a call to the employee assistance program, where I was able to get both Shawn and myself in for a total of six sessions. These were six hours in which we were informed that the program was not equipped to handle suicidal members, the first of many failures within the system.

    Shawn suffered depression, anxiety and undiagnosed, at that time, PTSD. Not only was Shawn battling his demons, but as his wife, I was going through the battle behind closed doors. Shawn was monitored by the base physician at the time only for depression, and the physician would turn to me for suggestions, as my background was in nursing. While I was his wife, more pressure was added as I would monitor him with his medications, his mental illness, and whatever was necessary to get through the day, all the while wondering if he would attempt suicide again, as the risk was there.

    At no time during the suicide attempt of 2014 was Shawn referred or did he receive mental health treatments from Veterans Affairs, nor did it go on the screening for Cold Lake, another failure.

    Fast-forward to Cold Lake, Alberta. On October 3, 2015, Shawn attempted suicide for the second time. We had just arrived in Cold Lake on August 31. He was transferred from the Cold Lake hospital to the Royal Alexandra in Edmonton, where he passed on October 4, with myself and our daughter back in Cold Lake.

    In January 2016, I attended the board of inquiry into Shawn's death every day for six to eight weeks. Upon the completion of the BOI into Shawn's death, changes in Ottawa would be made within the CAF to benefit or help a member dealing with mental health or to help prevent further suicide. As far as I am aware, I'm not sure if any of these changes were made, as there is no follow-up with the family members of the deceased member. I do want to mention the support I received from the 417 Squadron and the Cold Lake base.

    I believe suicide in the Canadian Armed Forces today still very much carries a huge stigma, a taboo. I believe it is the stigma of suicide that needs to be openly discussed. More needs to be done for the mental health of the members who are active and upon release from the Canadian Armed Forces. These men and women served their country with their lives and deserve the treatment they need to function in everyday society. As we all know, some of them never return to Canadian soil the same as they left.

    Ten years have passed since Shawn's death, and while the survivor's guilt has eased, the heartache of his death and grief remain. Who knows, if he had received the treatment he deserved, he might be here today, I like to think. Now, as a widow—I don't think one ever fully gets used to that term—I prevail on the services of operational stress injury social support, OSISS, but I am unable to utilize treatment or therapy through Veterans Affairs as I am not entitled, with my husband being deceased. Any therapy services that I have used in the past have all been on my own. Changes need to be made within the mental health system for the benefit of all members—active or released—families and widows.

    September 10 is recognized as World Suicide Prevention Day, but when you lose a loved one from suicide and mental health issues, every day is a reminder of how much more work needs to be done for the health and well-being of the Canadian Armed Forces, our veterans, the families and the general society to move forward.

    Thank you.

     Thank you very much, Mrs. Hatcher.

    On behalf of our committee, I want to say thank you for your service. Thank you for your courage. Our sincere condolences on your loss.

    We will now invite Mr. Meincke, retired corporal, to take five minutes, please.

     Thank you very much.

    For me, the frustrating part about being here today is that I have solutions. I am completely confident that if I had a magic wand and could implement what I need to implement, we could drastically reduce veteran suicide. We could cut it in half today. I have the knowledge. What I don't have is the authority. You have the authority, here in this room today. All you have to do is listen with an open mind and an open heart. I'll do my best to make a case for this.

    My name is Mark Meincke. I first reached out to VAC, Veterans Affairs Canada—I'm sorry for the acronyms—for help in 2017. I suffered for 23 years without help or diagnosis. In 2019, I started my trauma recovery podcast in an attempt to help as many veterans and first responders as possible. My mission was really simple: Save lives and relieve pain by making help for PTS injuries easily accessible. I would hope that VAC has the exact same mission.

    Being in the system had me quickly realizing that there must be a better way to recover from a PTS injury. I'm now in my seventh year of researching healing modalities from around the world. My show is listened to in 98 countries. I've been working to find out what works and what doesn't. The good news is that I have found numerous healing modalities with significant efficacy. The bad news is that none of the most effective therapies are available directly through Veterans Affairs Canada.

    My podcast showcases a comprehensive list of healing modalities. As far as I know, there's no similar list that can be found on the VAC website. I invite Veterans Affairs Canada to share my show on their site, use it for reference or simply call me: Pick up the phone. Let me help them to be aware of the effective resources that are available right now.

    Numerous Conservative members of Parliament have joined me on my show to discuss veterans issues, and some of them even consult me on these issues. Unfortunately, I have not yet had a response from the numerous invitations that I've put out to other members of other parties, which is odd, because I'm not partisan. I don't care what party anybody is with. My door remains open to members of Parliament from all parties. If they would like my help in reforming Veterans Affairs, just ask. I'm here. I only care about helping the veteran community. That's all.

    A PTSI, a post-traumatic stress injury, is not a weakness, nor is it a choice, and nobody is immune to being injured by it. Whether the injury is a PTSI, traumatic brain injury, CTE or concussion, make it simple: It's brain damage. That's the bottom line. It's all brain damage. The symptoms of any of these injuries are nearly identical, which is a problem for diagnosis, because the symptoms are just about the same in all of them, including mefloquine poisoning, and can be completely debilitating.

    I lost my first marriage. My business collapsed. I went bankrupt and my house was foreclosed on, all because of undiagnosed and untreated post-traumatic stress injury. Living with intrusive, relentless suicidal thoughts is exhausting, and being jolted out of my sleep by hyperintense nightmares two to three times a night, devastating. The help offered by Veterans Affairs did not improve my condition. Instead, it made it so much worse.

    When the thoughts of suicide became more dominating, I told my OSI-assigned therapist—that's the operational stress injury clinic and that's what we're provided—that I was concerned. I was worried that I was getting closer to the proverbial cliff, and I was concerned that it wouldn't take much for me to be pushed off that cliff. I told her. I told her that I had a plan and that if I were to end my life, it would be by opening my wrists—nice way to go. Her advice to me was to hide the knife that I imagined I would use and that if I hadn't done it yet, I probably wouldn't.

    This is an example of sanctuary trauma. The one person I was turning to for help, the person I was vulnerable with, the person I had the courage to tell where I was at and what was happening to me, that one person did not catch me when I was falling. She failed the trust test, and I never returned to that clinic.

    Three months after that conversation, I attempted suicide, and it was nothing short of a miracle that I survived it.

    After feeling betrayed by the OSI clinic, I took responsibility for my own healing. As a result, I've made a great deal of progress, I'm glad to say. Both the American Veterans Affairs and the Canadian OSI clinics—and this is something you probably don't know, so please write this down—claim that their success rate is 12% to 16%, and this is published by the American VA. To be clear, this means that only 16% of Canadian veterans who seek help through Veterans Affairs actually get it, which means that 84% to 88% of veterans who are seeking help do not receive it.

    Now, here's a very short list that hopefully you'll ask me questions about. Stellate ganglion block is very tough to access, but it is legal in Canada. That's huge. Psychedelics have been talked about in this room. There are both legal and illegal psychedelics. The legal ones are ketamine—it's a great place to start—and ibogaine, which is now legal in Texas and is starting to spread across the States; it's a game-changer. Please ask me about these modalities and more.

    Thank you, Chair.

    Thank you very much, Mr. Meincke.

    I would now like to offer the floor to Dr. Zacharias for five minutes.

     Madam Chair and committee members, my name is Dr. Ramesh Zacharias. I'm the president, CEO and medical director of the Chronic Pain Centre of Excellence for Canadian Veterans, CPCoE. We're an independent, not-for-profit organization funded by Veterans Affairs Canada.

    Let me start by thanking you for giving us the distinct privilege to testify before this committee on this incredibly important issue facing our veterans today. Along with my work at the CPCoE, I have a specialized clinical practice treating veterans and civilians suffering from chronic pain.

    Joining me today is retired sergeant Cam Kowalski, a 34-year RCMP veteran.

    Cam, go ahead.

     Thank you, Ramesh.

    Good morning, Madam Chair and committee members.

     I'm speaking today as the director of operations of the Chronic Pain Centre of Excellence for Canadian Veterans. I've spent more than half of my lifetime serving as a police officer throughout the country. I had a truly blessed career, but one which was enveloped with tragedy, trauma and stress. It left an indelible mark on me as a human being.

    This topic strikes deeply into my personal and professional life. I've lost countless comrades and close friends to suicides, many of which could have been prevented. Following my retirement, a twist of fate through a kind Veterans Affairs case manager brought me to the Chronic Pain Centre of Excellence, where I assumed the role of director of operations.

    What I have learned in my time at the CPCoE is that there is a deep connection between suicidality and chronic pain. What is important is not just the stories you've heard—although they have, no doubt, been profound—but also the research being done, which provides optimism for those struggling in isolation. In my darkest days, I was only looking for a glimmer of hope. It took years to come, but there by the grace of God it did. The research we do at the CPCoE is essential to bringing education and knowledge to veterans and their families on suicidality related to chronic pain.

    Now I'll turn it back to Ramesh.

     Today, I would like to highlight the strong evidence linking chronic pain management with a consequential increase in suicide risk.

    From 2012 to 2019, I served as a coroner in the Province of Ontario. During my tenure, I was the investigating coroner in approximately 700 cases. Several of those were suicides, ranging in age from 12 to 88. The motto of the office of the chief coroner in Ontario is “We speak for the dead to help the living”. We need to give a voice to those who are silent today.

    Suicide is a complex public health issue. The processes underlying suicide risk are still not well understood. It also continues to be difficult to reliably predict suicide behaviours. However, much is known about the risk and the protective factors for suicide and suicidality, meaning that any organization with a duty of care must do everything in its power to recognize and mitigate the risks that its members may be exposed to.

    An abstract from The Journal of Pain in November 2023 states, “Living with chronic pain has been identified as a significant risk factor for suicide. Qualitative and cross-sectional studies have reported an association between mental defeat and suicidal thoughts and behaviour in patients with chronic pain.”

    Recent data indicates that male veterans are about 1.4 times more likely, and sadly female veterans are about twice as likely, to die by suicide compared to the general population. Chronic pain and physical ill health significantly increase suicide risk. Timely, evidence-based interdisciplinary pain management can assist in reducing that risk.

    I recently presented at an open forum with three veterans, including Sergeant Kowalski and two CAF veterans. The two CAF veterans, who suffered from service-related disabling chronic pain and PTSD, shared their stories of how they had seriously contemplated suicide before engaging in an interdisciplinary pain management program. There is strong evidence in the literature that treating chronic pain can and will reduce the suicide risk in Canadian male and female veterans. We need to keep hope alive. It is time for all of us to speak for the dead to help the living.

    Thank you. We are now happy to answer any questions.

     Thank you very much and, again, thank you for your service.

    We will start our rounds with six minutes for Mr. Richards.

     First of all, thank you to all of you for being here. Thank you to our veterans for their service to our country. In particular, thanks to Mark and Amanda for your courage in sharing your personal stories with us to help make sure that others don't have to go through what you've gone through. Also, to our other witnesses, thank you for what you do to help serve our veteran community.

    I am going to start with you, Mark. You mentioned that your podcast focused on trauma recovery, which you've been doing for a number of years now. The question I have for you is this: What would you say is the biggest barrier to trauma recovery among veterans in Canada?

     It's probably stigma. It's a lot better today than it was five years ago, but it's stigma and access. Veterans Affairs Canada has some decent programs and benefits, but try to get to them: It is a gauntlet. This is why I consider it predatory. It's horrible on purpose. One of the symptoms of a post-traumatic stress injury.... I'm hoping we can somehow legally change the name of PTSD to PTSI. It's actually a big deal. It is a neurological injury. You can see it in a brain scan.

    Veterans Affairs Canada makes you jump through flaming hoops of fire and dance on a meat grinder before you get the programs. The benefits I received and the five years it took me to get them.... Holy smokes. Most people, because they hear the stories, don't even try. They're instantly overwhelmed. That's a very, very common symptom. Emotional regulation is the overall issue with a stress injury. Your neurology is fried. You're on 10 all the time. You've had too many “fight or flights”, so the throttle gets stuck on full. If you have a problem, you're always on “kill it” mode. That's no way to live.

    When you're already at eight or nine out of 10 for anxiety, and then you have 47 steps and 500 questions to answer, you just say no before you even start. That's why we use service officers. Without the service officers, Blake, I wouldn't have benefits. Almost nobody would have benefits without the service officers.

    I hear that kind of story way too often. It's either a service officer or a fellow veteran who happens to tell them how to find some way to navigate through the system from their own terrible experiences.

    I know that you were in the room during the previous panel. In the Australian example, they mentioned the fact that they have some of those services available, the mental health services and other things, on a non-liability basis. Basically, they were saying that they're not requiring that there be all these hoops jumped through to prove that it's related to service. They're just there to help the veteran.

     If we were to adopt a model like that, would that make a big difference?

     Any bureaucratic barriers you can get rid of will save lives. Just to get into My VAC Account—

    Sorry, I'd like to move to a different topic. I have only two minutes before I get cut off here.

    Mark Meincke: Sure.

    Blake Richards: I think you gave us a pretty good indication there.

     I know that you've talked to veterans. In fact, I know that you were also one of the ones who helped Christine Gauthier, one of the veterans acknowledged as having been offered medical assistance in dying. She had it pushed on her.

     Yes.

     I know that you've spoken to others. I've heard it on your show. How many veterans are you aware of who've had MAID pushed on them by Veterans Affairs, and how many caseworkers are involved in that?

    Thank you so much for asking that.

     Last week or the week before, the honourable Mr. Casey made a statement in reply to the veterans that there was only one caseworker. He was quite adamant about it. Hopefully, I can offer some information that shows that can't possibly be true.

     David Baltzer is the most recent one who came forward on my show. He was offered it on December 23, 2019. His veteran service officer was male. When I was here the first time, that veteran service officer—I can give you their first name, if I'm allowed to do that—was female. At the bare minimum here, we have two different veteran service officers.

    Now, here is my logic about how there were five veteran service officers whom little old me, with no resources, was able to find. Okay, so—

    I'm sorry. You used the term “service officer”. Are you talking about a case manager or a caseworker?

     God only knows; they can call themselves whatever they want. I'm using it as a generic term.

    Okay. I just wanted to clarify that.

     David Baltzer is the most recent. Veteran number one never used his name, but he sued the government, won the lawsuit and signed an NDA. The lawyers talked to me directly and said he received a life-changing amount of money. His service officer was female and she was in B.C.

    On one of my episodes, I called Veterans Affairs Canada. I recorded the call and published it. Anybody can listen to it. All the same questions that were asked of Minister MacAulay at the time, I asked this veteran service officer. The answers at this committee were completely different.

     Thank you very much.

    I'm so sorry, but I have to interrupt you. We have five minutes. There'll be more questions for you from that side of the House, I'm sure.

    Thank you very much, Mr. Meincke.

    I thought we had six minutes.

     Yes, it was six. Sorry, my clock said six.

     Do I have a moment?

    I apologize, but I'm going to allow the other member of Parliament to address our witnesses.

    Thank you very much.

    Okay, thank you.

     Mr. Clark, you have six minutes.

     Thank you very much, Madam Chair.

    Thank you to all of our witnesses for being here today, for your service and for your stories, and to those of you who continue to advocate on behalf of veterans, thank you.

    Dr. Zacharias and Mr. Kowalski, I wanted to ask you a few questions, if I could, around the issue of chronic pain, which I think, as you correctly identified in your opening statements, is a significant risk factor in relation to suicide. Is there any way to know what the prevalence of chronic pain is among veterans coming out of CAF and the RCMP? Is there any data on that to know how many veterans are actually suffering from what we would define as chronic pain?

    Yes. There was the life after service study that VAC published in 2016 and then subsequently in 2019. So that people are aware, in the general population in Canada and, frankly, throughout most of the developed world, 20% of civilians have chronic pain. Of male veterans in Canada, 40% have chronic pain—twice the general population—and sadly, female veterans are at 50%. When a young woman signs up with the Canadian military, there's a 50% chance she will be released with chronic pain and all the other comorbidities with mental health, sleep disorders and depression.

    We have reasonably good data, and the situation is similar in the U.S. and in Australia as well. There's a much higher incidence among veterans.

     Mr. Kowalski, did you want to make a point on that?

     Thank you.

    It would be similar for the RCMP and the CAF, because basically we train similarly. We have injuries that are related to our training and equipment, etc., that lead to chronic pain—it led to my chronic pain—so the numbers would be the same or possibly even higher.

    If you're comfortable doing so, Mr. Kowalski, could you explain to us how, in your personal experience, your chronic pain has contributed to any issues you may have experienced since you left the RCMP?

     Yes. My service was particularly long, at 34 years. I can relate my chronic pain to a bunch of different factors, but mainly it was the equipment and the wear and tear of daily operational requirements of wearing 16 to 18 pounds of equipment—your use-of-force options, etc.—around my waist and the vest I wore for protection, which added one or two more pounds. You're standing, sitting, marching and doing all of these sorts of things, but you're also arresting people who don't want to be arrested. The wear and tear is daily, but you have to remember that you also wear the equipment 12 hours a day, four days a week for 30-plus years. Everything weighs you down.

     In my particular case, I have osteoarthritis in my neck, in my back, in both knees and in my feet. I have to have my hip replaced. These are all related to injuries I've suffered from my particular chosen vocation, and that doesn't even include the mental health struggles that I had as a result of what I did, what I saw and who I interacted with.

    Thank you for sharing that.

    Dr. Zacharias, you touched on this in your opening statement. Based on what you said earlier, obviously chronic pain is a significant problem with a huge percentage of male and female veterans experiencing it, but if it is treated effectively, there could be a significant reduction in suicide risk.

     Is there a way to quantify that reduction in risk, and how do you assess successful treatment?

     The clinic I work in celebrated its 50th anniversary two years ago. Over the last 30 years, it's been collecting data on both civilians and veterans who come through our program. We have published data and presented it at international conferences.

     What's interesting is that civilians do well, and veterans do better. The reason is that it's part of their DNA that got them into trouble, and it's their DNA that gets them out of trouble. They're very committed, if you tell them that this is what they have to do.

     One of the CAF veterans I presented with was one of my patients. When I first saw him in 2017, he couldn't walk for six minutes. Today, he has bicycled 120,000 kilometres and he takes vacations with his kids that he never dreamed he could take. It's been a long journey. Does he have times when he slips? He still does, but he would tell you—and he has testified to this before an audience—that he was very close to committing suicide, and this was the hope he got.

     When you can't sleep and you're having trouble with PTSD and pain, there's not a lot of hope in your life. Sadly, too many of them take that course.

     Do I have any time? No. Okay.

    Thank you.

     Thank you very much, Mr. Clark.

    To our witnesses, Madame Gaudreau will speak in French, so make sure you have your interpretation set to English.

    Ms. Gaudreau, you have the floor for six minutes.

    Thank you, Madam Chair.

    Yikes! I look back on certain things as a member of Parliament. As members of Parliament, we go through many experiences.

    I encourage all the members to listen to what the witnesses have to say in order to better understand their life experiences. Seriously, it's worth it.

    I wore a military uniform for several hours, not even a full day. Even though I'm a fairly fit person, I realized how suffocating and heavy the uniform can be.

    When I look at your build, Mr. Kowalski, I have the following question.

    What about women? Is the equipment adapted to their size?

    I personally found the uniform quite heavy.

     There's a complicated answer to that question, but recently, yes. This is across the board. This applies to not only the RCMP members, but the CAF members as well. The training was not designed for female members. It was put into place for male members. The equipment was designed for male members. I'm not suggesting that it dates back to 1873 and the “March West” for the RCMP, but it dates way back.

     They adapted all of the equipment that was required to perform duties with the CAF and the RCMP to fit the female body. You can understand that there would be challenges and problems as a result of ill-fitting equipment that—

    Sorry, but I must interrupt you. You're saying that the equipment provided to all women military members who went to Afghanistan or to other places wasn't adapted. Once again, the reality facing women was overlooked. I trust that the situation has indeed changed.

    That said, what is being done about chronic pain?

    You just said that poorly fitted equipment exacerbates their pain and, at some point, they can no longer tolerate it.

    Isn't that the situation, Dr. Zacharias?

     Thank you. I will answer the question in English.

    I recall a female veteran, from just outside Ottawa, whom I treated about five years ago. She was probably five-foot-one. She was an outstanding scuba diver and did training for CAF. She decided, during her service, that she wanted to be a rescue person. She was sent to North Bay, where she was given equipment, and the tanks were hitting the back of her calf throughout her service, so she ended up having chronic pain complications in both lower legs, because those tanks and the vest were designed for men, not for a five-foot female.

    Could it have been avoided? Probably. Are they doing a better job today? I don't know—I saw her five years ago—but that was clearly equipment that was faulty for her. It was not adjusted for height. There's been evidence about shoulder injuries, with female veterans, because of the height of what they have to work with on the aircraft.

     I think people are more sensitive today, but so much more needs to be done. These are people who sacrificed for us. The least we can do is give them equipment. Frankly, we have a moral obligation to treat them when they have suffered.

    Thank you.

    As members of Parliament, we're extremely sensitive people. We want to do everything possible to change things. Ask any member of the House. We all want the best for our constituents.

    The issue is a lack of clear political will. You contribute to the decisions, but you need to shake things up and ask yourself whether it really matters. The final decision comes from so high up in the hierarchy that, when we look at the percentage of people who manage to receive care, we're relieved to see that we may have succeeded in helping 16% of the people. We say that we'll help the others on an ad hoc basis, by giving them money and assistance to ease our conscience. Many must have trouble sleeping. This must change.

    Since I have only a few seconds left, I would like to turn to Ms. Hatcher.

     Ms. Hatcher, I fully understand your feelings about being abandoned after you became a widow.

    You were abandoned after your spouse died by suicide.

    Is that right?

     I want to reiterate that I had great support from the 417 Squadron in Cold Lake, and the whole base. I stayed there with my daughter until July 2016, and then we were given the last move with the military. It was after that that I did prevail on some services when I moved here to Greenwood. To be honest, it was like, “Now that you're a widow, you're no longer part of the military,” though I received my late husband's pension—Canada pension—at the time.

    I started the process of seeing a social worker, and she and I, after a lot of hours and tears, opened up a VAC inquiry into my late husband's death, because I knew it was service-related. I won that case, thankfully. It wasn't about the money. It was to honour him, because he served his country. As a widow, it's so hard and difficult, because it's still with you that you are a part of the military, yet you're not a part of the military. To be honest, even this year—forgive me for saying this—I just didn't attend a Remembrance Day ceremony, because it's so hard. It's so devastating, especially even sometimes hearing the bugle play. It brings you back to that moment.

    It's been a challenge when dealing with Veterans Affairs as, of course, being a widow, I don't have case managers or a service rep. I do still deal with OSISS, from Edmonton, for personal reasons. The lady I deal with at OSISS, I have to commend; she has been excellent. She has been a great support. However, still, as a widow, you are.... I don't want to say “forgotten”, because I still have so many friends who are in the Canadian Armed Forces and ones who have now released. I still consider those a part of our family. Yes, becoming a widow, it appears like we are forgotten and we are told to just move on with our life, basically.

    Thank you, Madam Chair.

    I just added my two and a half minutes of speaking time, with all due respect to my colleagues.

    That's all.

    Thank you, Ms. Gaudreau.

     Mr. Richards, you have the floor for five minutes, please.

     Thank you.

     I actually wanted to pick up where Madame Gaudreau just left off, Amanda, if I may.

     I'm still not sure I'm clear. Following the death of your husband, what help did Veterans Affairs offer you?

     At the time, I was not dealing with Veterans Affairs first, when Shawn passed away. As I said, I started the process with a social worker in 2016, and I won my case in 2017.

     Honestly, there has not been a great deal of support as a widow through Veterans Affairs. There's no mental health when you lose someone through suicide. It's a lasting impact. I always say that I spent 18 years in nursing and six years as a paramedic EMA, and nothing in those two occupations prepared me for the death of my husband by suicide.

     Even now, it's a challenge. As a widow, when you call the 1-800 number at Veterans Affairs, you may get someone who's really good, and then at other times—and I don't want to be rude in saying this—you may not. It's basic information, and they're not equipped to handle widows and the situations that we are going through as widows. As widows, we don't have case managers.

     That's what I was just going to ask you.

     Wouldn't it make more sense for you to have someone dedicated to deal with, so that you wouldn't have to take the chance that you might not get the right person who understands what you're going through, or that you might have to retell the story of what you've dealt with over and over again?

     It would definitely make more sense, but unfortunately that's not the way it happens. I could call Veterans Affairs today and speak to a lady. Tomorrow, I could call Veterans Affairs and speak to a gentleman. What the lady tells me today versus what the gentleman might tell me tomorrow would be two different stories. You get off the phone, and you're more confused than when you called the first time, because it's not the same information given to you. It may be the same question you're asking, but you're getting two or three different responses, so it's more confusing.

     I guess it would be fair to say that you would identify with what Mr. Meincke described in his comments about all the hoops that he had to jump through. Ultimately, it sounds like there are programs that exist, but getting to them is almost impossible.

     Would that be your experience as well?

     Definitely. I can definitely understand what he is saying. When Shawn was alive, he dealt with Veterans Affairs for a shoulder injury. I can recall times when he would call Veterans Affairs for something quite minor compared to mental health, and he was jumping through hoops. I've definitely felt as a widow when I've called Veterans Affairs that, many times, there are many hoops and no satisfaction.

     Okay.

     I have a question that would be both for you and for Mark.

     What recommendations would you make in terms of how Veterans Affairs should improve that experience—in your case, Amanda, as a widow, and in your case, Mark, as a veteran? How could Veterans Affairs improve that experience so that you're not having to jump through all those hoops?

     Whoever would like to go first is fine.

     Thank you. I'll go first.

    Personally speaking, as a widow, there are no policies with Veterans Affairs for widows, as far as I know. They're not equipped to handle us. That could be a major change in the system. I understand that when a veteran calls, they're a veteran, and they were a military member, but my veteran is now deceased.

     When you call, getting 10 or 12 different people every time you call contributes to the frustration. As soon as we, as widows, are prevailing upon Veterans Affairs services, maybe it would be a good thing to assign us a case manager, and maybe even in our home province.

     I was told that I had a service worker in Halifax—I don't think it was called “case manager”—and, no disrespect, it was a gentleman. I was told that we were supposed to receive four phone calls a year, basically like a check-in. I did not even know that I had this gentleman assigned to me. I was told this by another gentleman, and then I was told, “Well, he's off on mental health leave, so now you have a lady.” I did receive an email from this lady saying, “No, no, I don't have you.”

    It's the confusion. It's the unknown. Do better. If I can say that I was told I had this lady, and now she's telling me that she doesn't have me and to call the 1-800 number if I need anything.... I first used the 1-800 number, the mental health line, when my husband passed away. It was in the nighttime and I was told, “Unless you're suicidal.... We only take suicidal clients at night, and I don't have time to talk to you, only 15 minutes.” I won't tell you some other things I've been told, because it's just too hard, but there are things like that.

    Assigning us a caseworker is the most important aspect that you could do for a widow.

    Thank you.

    Thank you very much, Mrs. Hatcher.

    Mr. Meincke, you have 30 seconds to answer Mr. Richards' question, please.

     It's a tough question. Everybody I know who has been in the system goes through caseworkers or service officers—or whatever you're going to call them—like crazy. I think I went through five in two years.

     I don't know what the national average is for employee retention, but I'm pretty sure that Veterans Affairs is below that national average. I think that's where you have to start. Find out why it's such a toxic work environment that nobody wants to work there for more than three months. Figure that out. Get some HR professionals or something. Figure out why they hate working there and what training is required to get them to do their jobs better and to empower them to be able to deal with us better.

     We're not easy to deal with when we're hot. We're a lot. We're a handful. For them to not take that personally requires training. All the hoops are what makes us hot in the first place. Figure that out, and the proper training, and figure out why in the world it's such a horrible workplace that causes staff turnover.

    Thank you very much, Mr. Meincke.

    Mr. Casey, you have five minutes, please.

     Thank you, Madam Chair.

    I'd like to start with the witnesses from the Chronic Pain Centre of Excellence.

    I want to ask you a question about the present state of treatment and research in chronic pain and then talk a bit about what's on the horizon. Could you address what is the current state of research with respect to chronic pain and what are the most effective treatments or strategies today?

     I can start with that, Mr. Casey.

    It's a very topical question. I'm going to speak generally in relation to chronic pain and suicidality, and also speak about what we know and what we are doing currently at the Chronic Pain Centre of Excellence.

    We recently conducted our priority-setting process through the James Lind Alliance, which basically identifies what we're going to be studying for the next three to five years. It's an important milestone in our organization's history, after we've just celebrated our five-year anniversary of inception.

    The 2025 veteran-led priority-setting process utilized our advisory council for veterans. There are 15 of them. They represent what we do, and they identify what is to be studied each year. This year, we rank the priorities as gold, silver and bronze. Our gold-level stream of research this year is going to be specifically on the correlation between chronic pain and suicidality. Within that context, the outcomes or the objectives are to explore the relationships between chronic pain and suicidality in veterans, to understand the impacts on families and caregivers, to evaluate interventions at clinical system and policy levels and then, finally, to inform suicide prevention and policy strategies.

    Therefore, it is high on the level of research that we're going to be conducting over the next three to five years. However, again, with research, it takes time to answer the questions that are being researched.

    That's speaking to the topic itself on suicidality. I'll have Dr. Zacharias answer the part about the chronic pain research that is on the generalities.

     Thank you.

    Thank you very much for your question.

    I think what we have tried to do is look at the life after service studies program and talk to veterans. When we were awarded the centre of excellence, I decided to go from coast to coast. I started in Victoria and ultimately ended up in Newfoundland. COVID was in the middle of it, so it was in two phases. I met with veterans and their families. I told them that I was the custodian of their centre and asked them what they wanted me to do. They were pretty clear. God bless them. There's one thing about working with veterans. I've treated probably a thousand veterans since I went to McMaster, and they will tell you exactly what they're thinking. God bless them, I love looking after them. There are no filters. They tell you exactly what's going on.

    We decided to empower them to direct us, and we created the advisory council for veterans. I think our chair, Hélène Le Scelleur, testified here last month. They, along with their family members now, tell us what is a priority for them, so this is a priority process that's evidence-based. It came out of the U.K., and that's what we implement.

    We looked at the ACVA report that came out in June 2024. We have decided to take some of those items and fund the research around it. Most veterans get care in the public system, not from DND and CAF. They get some care from VAC. We're trying to raise the bar for civilian women, along with female veterans, to make their health issues a priority.

    We will be listing the 20 projects that we're going to fund over the next three to five years. So far, we have funded over 60 projects involving almost every university but certainly every province. We have one criterion: We will not fund you unless you have a veteran co-PI. Then you get evidence from the people you're trying to serve, as opposed to you telling them what they need.

    It has been an incredible journey for us. I learn from the veteran advisory council. They completely decide what we're going to do in the next five years, and they decided for the last five.

    Thank you so much for your question.

     Thank you for your answer.

    Thank you very much, Mr. Casey.

    This will end our round of questions.

    Mrs. Hatcher, Mr. Meincke, Dr. Zacharias and Mr. Kowalski, thank you very much to all of you for taking the time to come and share your stories. I want to say, on behalf of this committee, thank you for your service to our country.

    Is it the will of the committee to adjourn the meeting?

    Voices: Agreed.

    The Chair: The meeting is adjourned.