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Results: 1 - 11 of 11
Alain Beaudet
View Alain Beaudet Profile
Alain Beaudet
2011-03-02 16:31
Thank you, Mr. Chair.
I would first like to thank the Standing Committee on Veterans Affairs for this opportunity to discuss the issue of combat stress and its consequences on the mental health of veterans and their families.
As in all matters of health, research is critical for achieving the quality of health and health care that we wish for Canada's military veterans. In the preamble to the act that established CIHR in 2000, Parliament recognized that investment in health and the health care system is part of the Canadian vision of being a caring society.
The act went on to establish CIHR's objective: to excel according to internationally accepted standards of scientific excellence in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system.
I have believed since I became president of CIHR in 2008 that this vision means little if it does not include a responsibility for the health of those federal employees who put themselves in harm's way in defence of our country and in fulfillment of national security objectives.
Reducing the burdens of mental illness is one of the five research priorities in CIHR's latest five-year strategic plan. In order to address this priority, CIHR is relying on one of its 13 institutes, the Institute of Neurosciences, Mental Health and Addiction. The institute's mission is to promote and support research in order to improve mental health by developing new strategies for prevention, screening, diagnosis, treatment and service delivery. We often forget that Canada has excelled in this area of research. It is in fact ahead of the pack compared to the rest of OECD countries in terms of quantity, quality and the impact of its scientific publications in this field of research.
CIHR investments in mental health research have totalled more than $234.4 million since 2006—$65.2 million in 2009-10 alone. As to post-traumatic stress disorder, CIHR has invested $7.6 million in research since 2006, including $1.7 million in 2009-10. However, this figure can be deceptive, since operational stress injuries can include PTSD as well as a variety of other disorders ranging from depression to hormonal imbalance, for which CIHR is also providing research funding.
For example, new brain imaging techniques have been put to use in looking at the effects of post-traumatic stress disorder on the brain. Neuroendocrinology studies, which look at the relationships between the brain and the endocrine system, have demonstrated significantly lower levels of the stress hormone cortisol in individuals with PTSD. Finally, it is likely that genetics and epigenetics will be key in helping us better understand the factors underlying the susceptibility of certain individuals to post-traumatic stress reaction.
I would now like to turn to some of CIHR's efforts to advance research into the issues affecting military veterans and their families, as well as research in operational stress injuries. You will appreciate that while I am not a research expert on this subject matter, I am pleased to speak to CIHR's efforts to accelerate research in this area.
As the other witnesses mentioned, the mandate of a number of departments is to promote research on the health of soldiers and veterans. These departments have formed specific partnerships with CIHR in this area. The Department of Veterans Affairs and the Department of National Defence have joined us in funding various research initiatives. I think we should build on these first successes to expand and strengthen our framework for action, increase consistency and maximize impact.
To this end, CIHR has started discussions with the office of the surgeon general of the Department of National Defence in order to identify areas of possible cooperation as part of their research initiative on the health of soldiers and veterans.
More recently, I met with the associate deputy minister of Veterans Affairs Canada, and we agreed to get our staff members together as soon as possible in order to set joint research priorities on the health of soldiers and veterans, and to develop a long-term cooperation plan.
Although there is a significant body of American research on combat stress and its effects, the military culture and community in Canada are different, and so are the types of operations in which Canadian troops participate. It is therefore important that we develop a research program of our own to fit the Canadian context.
A particularly noteworthy development for Canadian research has arisen from the November 2010 Canadian military and veteran health research forum in Kingston, which is the creation of the Canadian Military and Veteran Health Research Network, a network dedicated to building a better understanding of the health and well-being of military personnel, veterans, and their families.
Together, CIHR and the network announced in the fall of 2010 a request for applications for knowledge synthesis grants to summarize existing research in this area and determine gaps within the knowledge base.
This call for applications recognizes that military personnel and veterans have unique experiences in the service of their country, which can impact their physical, mental, and social health in a manner not experienced by the rest of the population. It also recognizes the increased need for research on the health and well-being of military personnel, veterans, and their families. We anticipate announcing the results of this competition later this month and subsequently using the data to identify research priority areas.
One of Canada's leading researchers in veterans' health is Dr. Jitender Sareen. He receives funding from CIHR and he testified before you in November.
Dr. Sareen is leading a CIHR-funded team on the study of trauma and post-traumatic stress disorder among soldiers involved in peacekeeping operations. He is also examining soldiers' need to access mental health care and the obstacles they have to overcome in order to obtain care; one obstacle is the fear of stigma in the workplace. The findings of his research have helped the Canadian Forces to create programs for those who need treatment and also to develop strategies to improve the mental health of military personnel.
Also, at the University of Manitoba, Dr. Darren Campbell is using functional magnetic resonance imaging in conjunction with psychotherapy to look at the emotional responses of military personnel with post-traumatic stress syndrome.
Similarly, Dr. Alain Brunet at McGill has led a Montreal-based research team on mental health disorders, including PTSD and related problems resulting from traumatic events in high-risk workplaces, and has been funded to examine treatment available to military veterans with operational stress injuries.
Dr. Gordon Asmundson of the University of Regina led a multidisciplinary team of researchers from Regina and UBC who examined whether exposure therapy—where patients are exposed to prolonged and repeated images of trauma until the images no longer cause anxiety—may be more effective than other methods for treating the disorder. Dr. Asmundson and his team have also looked at delivery of treatment over the Internet.
In 2009-10, Dr. David Pedlar, the Director of Research at Veterans Affairs Canada and a professor at the University of Prince Edward Island, along with a team of experts, received CIHR funding to study the reintegration into the workplace of veterans with mental health conditions.
CIHR-funded researchers are also doing important neural investigation into the brain activity of individuals with post-traumatic stress disorder writ large. For example, Dr. Ruth Lanius is the director of the post-traumatic stress disorder research unit at the University of Western Ontario. Her research focus has been the neurobiology of post-traumatic stress disorder and treatment-outcome research examining various pharmacological and psychotherapeutic methods, including in patients with post-traumatic stress disorder or major depression following motor vehicle crashes.
I could cite other examples of funded research dating back to CIHR's inception to demonstrate our history of funding those with research interests in issues specific to military veterans. I would like, however, to conclude by looking forward and acknowledging that more research is needed.
Canada is approaching the completion of one of its longest and most intense military missions in recent history. The care of these young men and women who served our country in Afghanistan makes even more pressing the need to thoroughly understand the physical and mental demands of military operations. We need to better understand through research what sorts of unmet mental health needs there are for veterans so that we can meet them with outreach and treatment.
We need to recognize that Canadian health research in this area is growing but needs to move beyond its infancy. The old military saying that “no one should be left behind” should guide us in ensuring that we understand and are ready to help veterans with health issues when they have completed their service.
Your work in this study will help us to understand where the gaps are and to set directions for future health research, and I would like to thank the committee for its work. I am pleased to take your questions.
View Peter Stoffer Profile
We know that other countries are doing research similar to this. Are there any cross-references between researchers here and researchers in the United States, Europe, and Australia? If so, it could constitute a cost saving.
Moreover, you don't want to keep spending money reinventing the wheel. And you want to develop best practices. We've heard that a soldier is a soldier is a soldier. Regardless of the uniform, their experiences may be equal. Is there any linkage from your organization to assist researchers in coordinating these efforts?
View Siobhan Coady Profile
Lib. (NL)
Thank you very much.
I certainly appreciate you being here today. I have a great deal of respect for the Canadian Institutes of Health Research. I hope you continue to do great work.
I have a couple of questions.
I was in biotechnology. I had a company that looked at how genes affect human health and disease; that's why I'm so familiar with CIHR. Here's one of my questions, though. You talked earlier about a lot of the research that you were doing. I'm wondering how that research is being translated? Do you know of programs that have been developed and where we are in the cycle of the research?
Because it's great to do the research, and I applaud you for it and I think it's important, but how is that being translated to help today?
View Wayne Marston Profile
Thank you very much, Madam Chair.
I'm going to take this to a personal level for a second. In 1974 I was a signal maintainer for the railway, and I had four people killed on one crossing over 11 months. Over a period of years I had mental strain as a result of that; PTSD, I guess, is the word for it.
Then in the 1980s I was involved in a car accident. I pulled a guy out of a burning truck. When I first went to the side of that vehicle, I looked in. Your mind will try to protect you: oh, no, he's already dead, don't worry. I paused for maybe 20 seconds. I had nightmares for five years after that because I even considered leaving him, when in fact we got him out.
Using a lay term, I'd call the result of all that “mental anguish”. When you take that kind of thinking and you apply it to our veterans who are coming back from Afghanistan--I understand there are about 3,000 young men and women coming back from there with various injuries--what's the correlation between the mental anguish potentially causing it or a combination of physical and mental anguish leading to this kind of outcome? Is there evidence that this could be happening? And is there evidence that just the mental side alone might lead to something like this as opposed to physical head trauma?
Jon Stoessl
View Jon Stoessl Profile
Jon Stoessl
2010-11-16 9:09
Thank you very much, Madam Chair.
Good morning, and thank you for the opportunity to be here.
I would like to start by outlining my interest in the problem of Parkinson's. I'm a clinical neurologist. I've devoted my entire career to Parkinson's disease. I'm also a researcher in Parkinson's and now do pretty much clinically oriented research, although in the past I did more preclinical research.
I'm the former chair of the Parkinson's Society scientific advisory board. In my current administrative role I'm responsible for academic and clinical deliverables for neurology in an urban centre, but I spend a great deal of time thinking about the challenges of delivering care to largely disenfranchised communities that face these enormous geographic problems Joyce has already alluded to.
I'm sure this committee is well aware that brain diseases represent 28% of disability-adjusted life years worldwide. This is for non-communicable disorders. This compares with 22% for cardiovascular diseases and only 11% for cancer. Brain diseases are extremely expensive, both financially and in terms of social consequences, yet they have largely been ignored.
Brain diseases include psychiatric disorders. I understand that the focus of this committee is neurological disorders, but I would just like to remind the members that there are enormous co-morbidities. Most chronic neurological disorders have psychiatric co-morbidities, and the converse is also true. The mechanisms underlying these conditions are likely to be very similar, and in some cases identical.
I'd also like to emphasize that, in my view, clinical and research activities are not divisible. Excellence in one has to inform the other. For many of us, the clinic is in fact our laboratory.
On the research that's being conducted in neurological disorders, Michael has already indicated that Canada has an extraordinarily distinguished history of research in Parkinson's disease dating back to the fifties and sixties. That record of excellence has been sustained, despite the fact that we're a relatively small country, in terms of our economy, with limited resources. I'm happy to outline some examples, but I'll leave that for questions from those who might be interested.
It's also worth remembering that research in one neurodegenerative disorder is likely to inform advances in all the other neurodegenerative disorders, because we're really looking at the mechanisms that contribute to the selective death of isolated groups of nerve cells. Once we understand the mechanisms that are true for one, there are likely to be lessons that can be learned about the others.
In fact, the cross-talk is probably more extensive than that. As Michael was talking, I jotted myself a note that probably the greatest single advance in the last few weeks in terms of understanding Parkinson's is an example of a master regulator gene. That knowledge can be immediately applied because there are drugs that can be used to test the hypothesis in patients. But those are drugs that were developed for diabetes, not for neurological diseases.
The other point that Michael also raised is that while there is a great history of successful researchers, research nowadays will only very rarely succeed using the old model of the single investigator who's in their lab and is brilliant. What we really need are teams of people from multiple disciplines who work together and who actually cross disciplines, but we have very few models right now to support that kind of activity.
CIHR used to have a team grant program, but that has largely been eviscerated. There are only small emerging teams left, or ones with specific goals, so that capacity has been lost. The networks of centres of excellence is another model. Those are difficult to get. I'm currently in the middle of three NCE letters of intent that are going forward in the next week because of Parkinson's involvement, and I'm aware of others. But these are very difficult to get with very limited funding. So they're really not doing what we need.
Additionally, I think a huge problem in Canada, compared to the U.S., is that we do not have good mechanisms for supporting clinician scientists. It's difficult to convince people to do this. We don't have a good track record of training them or of recruiting them. MD Ph.D. programs, such as the one Dr. Schlossmacher just mentioned, are obviously one important mechanism for doing this.
Finally, if I can just talk briefly about the clinical challenges, I understand that health care delivery is a provincial mandate, but I also understand that the federal government plays a critical role in establishing the expectations and setting the standards for delivery of care across the country. I'm sure I won't be the first person to suggest to this committee that our health care system does a superb job of managing acute and critical illness, with care available for all who need it. That's why we love Canada. I, too, am an immigrant, by the way, and am very grateful for the opportunities this country has offered me. But I'm sure you all know that we fall very short in terms of providing care for those who have chronic diseases.
Parkinson's, I want to emphasize, affects not only the individuals who formally carry the diagnosis but all those around them. It affects their ability to work, to be parents, to interact with others, and it affects their sense of dignity. The disease and its treatment may be associated with cognitive and behavioural complications that can be absolutely devastating for the members of their families.
These are complex disorders that are best managed by a multidisciplinary and interdisciplinary approach, but getting funding for the delivery of multidisciplinary care is an enormous challenge, despite the fact that these approaches can save money.
I actually just asked my own hospital to pull out data from 20 to 25 years ago as compared to the present. The number of admissions, or hospital days, where the most responsible diagnosis was Parkinson's, declined from nearly 5,000 between 1984 to 1986 to just over 1,300 between 2006 to 2008.
That's a reduction of 73% in hospital days, despite the fact that the number of people in my province with PD has doubled in that time, and that the more recent figures include hospital and forced hospital admissions for surgical treatment of Parkinson's. But this is only possible if infrastructure can be provided to allow for outstanding ambulatory care, and we fall dangerously short in that matter.
I will close and thank you very much for the opportunity to be here and for your attention.
View Shelly Glover Profile
Thank you, Mr. Chair.
I want to welcome you, as well, and wish you a merry Christmas.
I was very interested to hear what you had to say about the waste of time and money on the policing side. I'm glad to hear someone acknowledge that, because I spent a number of years policing, much like my colleagues on this side of the House. I'll tell you that situation you described, where two police offers sit—as I was sitting—for between five and ten hours, sometimes longer, in a hospital, only to have the patient, who is clearly exhibiting some kind of mental illness, be released because the criterion that has to be met by the psychiatrist is simply whether they are a danger immediately to themselves or others--that is very disappointing. And I feel we fail these people at that point. I strongly believe that's where the prevention Mr. Kania talks about comes in. That's one aspect of prevention that needs to be inserted at that point. We will have to work strongly with the provinces to encourage them to see about perhaps alleviating some of that wasteful time and money.
I also enjoyed what you said in your dissertation at the beginning, when you talked about developing a program similar to what you have for health care professionals. I note that you've passed out some pamphlets that refer to those all-important projects and programs that the Mental Health Commission is endeavouring to offer. I would like you to explain how you suggest we mirror these in the Correctional Service.
I understand when you talk about the anti-stigma program. Your Opening Minds program is very clear in your pamphlet, so I understand education. I don't quite get how we do the research demonstration project, the one you have for the health care professionals and the one that is being financed by the Government of Canada, where we're taking homeless people and putting them into housing and studying whether or not that has a positive impact on their receiving further relations or further treatment, as opposed to the placebo group who will not be receiving housing, and they're going to watch and see how they transition into treatment. How do you suggest we do that within a correctional facility? How do we research and do a demonstration project, as you're suggesting, within a secure facility?
I'm not sure how we do that, and I'd love to hear your suggestions on how it gets done.
Glenn Thompson
View Glenn Thompson Profile
Glenn Thompson
2009-12-10 12:19
To go back to the intermediate facility idea, for instance, the correctional services have many people at the moment who go from RTCs back to the general population. Take a group of 300 people who are going to that population, divert 150 of them randomly to the intermediate facility, and find out which one works better for those two groups. That would be a research-type way to do it.
View Shelly Glover Profile
My only concern is that you don't have a population of 300 in one facility who are necessarily at that point in their recovery or treatment. That might involve having to pull people from all across the country to put them in this research demonstration project. That would be problematic, I believe, because they would want access to family and other supports they already have there. That's where I'm at a bit of a loss as to how we get this done while also taking into consideration their needs for support.
Glenn Thompson
View Glenn Thompson Profile
Glenn Thompson
2009-12-10 12:20
I would bet that if the commissioner of corrections were here, he could find you 300 people in half an hour in the general population who would very well use an intermediate facility, plus people coming out of the RTC. I think people from both directions could use these kinds of facilities.
The Correctional Service of Canada has a lot of people who have mid-level mental illness, for sure. I don't think finding the number of people would be the problem; I think the difficulty is in the complexity of that kind of research. With the homelessness research we have going on, people who know about research—and I don't pretend to—tell us it's the biggest operational research on homelessness that's ever been done in the world. It's a very commendable project.
It's very expensive as well. These things are not something one can do without a significant piece of funding. That program, over five years, costs $110 million. I was deputy minister of housing in Ontario, and I know how much housing costs. Dividing $110 million by five doesn't give you a lot of housing dollars if you're putting people in rent geared to income accommodation. It costs a lot to live in our housing situations these days. Housing plus treatment is an expensive process.
Housing plus treatment plus research would be an expensive process, but it would very worth doing. It might very well alleviate a lot of the difficulties in the general correctional institutions federally that are caused by, if you can put it that way, people with a serious mental illness--people who are making the lives of correctional workers and their fellow inmates unbearable because they don't know what to do with them and they're very complex cases to deal with.
I think it would be doable to have that kind of research project. We have a lot of people who know a lot about research, and we can help the Correctional Service with that. We are running about 25 research projects now, plus these ones on homelessness.
Neil Cohen
View Neil Cohen Profile
Neil Cohen
2009-12-04 8:02
First of all, let me begin by thanking the committee for the opportunity to be here today. I want to begin by telling you a bit about our organization, and then you'll understand the nature of my presentation. I must say I'm somewhat embarrassed that I didn't have time to prepare a brief, but I do have speaking notes that I'll use for my own benefit. I would be quite embarrassed to share them with you because they are rather sketchy.
The Community Unemployed Help Centre is a Winnipeg-based non-profit organization that was established in 1980 to assist unemployed workers with matters on what was then unemployment and is now employment insurance. Essentially, we provide information, advice, and representation to unemployed workers. In particular, we represent workers who have been denied EI benefits for various reasons. We do test case litigation and public education around EI.
When I looked at the responsibility of this committee in terms of its study on federal contributions to reducing poverty and putting that in the context of a seven-minute presentation, I decided to focus on what I know best. So I will talk only about EI and leave it to my other learned friends to talk about whatever they choose to talk about.
Because we've been operating since 1980, our organization certainly has considerable expertise in the area of EI. We have watched, tracked, monitored, and followed, criticized, and applauded--on occasion--changes to the unemployment insurance program in Canada. If I switch back and forth between the two terms, it's that some of us still prefer the term “UI”, so I hope you'll understand.
I want to talk about our clients. We've been fortunate in Canada, until the past year, that unemployment was relatively low throughout the 1990s, so our client base shifts to some extent. When we've gone through periods of high unemployment in the past, particularly a period about 10 or 15 years ago, our clients represented the broad cross-section of workers from blue collar, to white collar, to people in poverty, to those who were in management positions, as a result of restructuring and layoffs and so on. But now, with relatively low unemployment in Manitoba, our client base is largely represented by people in poverty, particularly aboriginal people, new and recent immigrants, and marginal workers who have irregular labour force attachments.
We've seen the UI policy throughout the 1980s and 1990s, and there's been a general theme. With some exceptions, I will acknowledge, throughout that period of time, beginning with Bill C-21 in 1989, the general trend has been to require workers to work longer to qualify for benefits, benefit duration periods have been shortened, and penalties have been increased for workers who are fired or quit or made false or misleading statements.
The impact on low-income people of the reform of EI was that low-income people to a large extent now fail to qualify, and those who do qualify find their benefits run out much sooner. The benefit rate is lower as well. Many years ago, some people might remember, the benefit rate was actually 66 2/3% of average weekly insurable earnings over the past 20 weeks. Now the benefit rate is 55%, and because of the way the benefits are calculated, they don't take into consideration the worker's best weeks of work, but rather, the earnings in the last 26 weeks. I'm sure some of you will know the formula. It has the effect of reducing benefits below 55% for many workers, and that remains a concern. Particularly now, with the economic situation where many workers have their hours cut before they become unemployed, it has the effect of reducing their benefits even further.
At the Community Unemployed Help Centre we have taken on some important landmark cases over the years. In particular, I will draw your attention to the case of Kelly Lesiuq, a woman working part-time. Because she was working part-time she failed to accumulate enough hours to qualify. This represents one of the fundamental flaws of the program. This program is very much biased towards workers who have a long-term attachment to the labour force and have more regular patterns of work. It really has the effect of differentiating between men and women, because women are disproportionately represented in part-time work. That was, in short, the basis of the Lesiuq case.
We currently have a case where one of our clients, a woman, is a person with Down's syndrome. The case is currently before the courts. They're moving its way through the courts. Again, because of her mental or physical disability, she is unable to accumulate sufficient hours of work. This is a heroic woman with Down's syndrome--I'm trying to provide you with some real stories--who is doing the best she can to work and she is working part-time. Because of her disability, it is impossible for her to accumulate sufficient hours to qualify for benefits.
There has been a growing body of evidence accumulated, beginning in the 1930s but certainly over the last 30 years, that talks about the impact of unemployment. There was a recent report done by the Ontario Institute for Health & Work that, again, reaffirms some of the work that's been done in the past. It's easy to dismiss unemployment as being a temporary condition from which people will recover, but many people don't. The impact of unemployment has a devastating impact on one's mental and physical well-being.
Let me very briefly commend Parliament, certainly, on some of the recent measures that have been passed and introduced, particularly the extension of the duration of benefits, although it must be noted that it's a temporary measure. We certainly support those measures and we certainly support legislation to increase the EI benefit to change the way in which benefit rates are calculated. Both measures will assist those living in poverty or who have different labour force attachments. We'd also call for changes in the way the qualifying period is currently structured to go only to 52 weeks, because it fails to recognize women, in particular, who may have been removed from the labour force for a period of time. We would welcome a study and a commitment on the part of this committee or Parliament to look at workers who have irregular attachments in the labour force.
In closing, it's important. CUHC sees every day, and again, from our personal experience, we see every day the impact of unemployment on people's mental and physical well-being. We see this every day in the faces of our clients, particularly those who live in poverty, who fail to qualify or who see their benefits run out. We would call for easing of entrance requirements and also for restructuring the program in a way that is responsive to workers who have unstable or irregular labour force attachment patterns.
Thank you.
View Garry Breitkreuz Profile
Thank you very much. I appreciate that outline of your research on the correctional mental health and substance use services.
Our next witness is Mr. Frank Sirotich, from the Canadian Mental Health Association. Go ahead, sir.
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