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37th PARLIAMENT, 1st SESSION

Standing Committee on National Defence and Veterans Affairs

COMMITTEE EVIDENCE

CONTENTS

Thursday, February 7, 2002

1535

The Vice-Chair (Mr. David Price (Compton--Stanstead, PC))

Mr. André Marin (Ombudsman, Department of National Defence)

1540

1545

The Vice-Chair (Mr. David Price)

Lieutenant-General Roméo Dallaire (Retired; Individual Presentation)

1555

1600

The Vice-Chair (Mr. David Price)

Mr. Benoit

LGen Roméo Dallaire

1605

Mr. Benoit

LGen Roméo Dallaire

Mr. Benoit

LGen Roméo Dallaire

Mr. Benoit

1610

Mr. André Marin

Mr. Benoit

Mr. André Marin

The Vice-Chair (Mr. David Price)

Mr. Claude Bachand (Saint-Jean, BQ)

1615

Lgen Roméo Dallaire

Mr. Claude Bachand

LGen Roméo Dallaire

1620

The Vice-Chair (Mr. David Price)

Mr. Stan Dromisky (Thunder Bay--Atikokan)

LGen Roméo Dallaire

1625

Mr. Stan Dromisky

LGen Roméo Dallaire

1630

The Vice-Chair (Mr. David Price)

Mr. Peter Stoffer (Sackville--Musquodoboit Valley--Eastern Shore, NDP)

Mr. André Marin

Mr. Peter Stoffer

Mr. André Marin

Mr. Peter Stoffer

1635

Mr. André Marin

LGen Roméo Dallaire

The Vice-Chair (Mr. David Price)

Mr. Rob Anders (Calgary West, Canadian Alliance)

LGen Roméo Dallaire

1640

1645

Mr. Rob Anders

The Vice-Chair (Mr. David Price)

Mr. John O'Reilly (Haliburton--Victoria--Brock, Lib.)

LGen Roméo Dallaire

Mr. John O'Reilly

Mr. André Marin

1650

The Vice-Chair (Mr. David Price)

Mr. Bob Wood (Nipissing. Lib.)

LGen Roméo Dallaire

1655

Mr. Wood

LGen Roméo Dallaire

Mr. Wood

The Vice-Chair (Mr. David Price)

LGen Roméo Dallaire

The Vice-Chair (Mr. David Price)

Lieutenant-General Christian Couture (Assistant Deputy Minister, Human Resources-Military, Department of National Defence)

1705

1710

The Vice-Chair (Mr. David Price)

Mr. Claude Bachand

LGen Christian Couture

Mr. Claude Bachand

LGen Christian Couture

Mr. Claude Bachand

LGen Christian Couture

Mr. Claude Bachand

LGen Christian Couture

1715

Mr. Claude Bachand

Brigadier General Lise Mathieu (Director General, Health Services, Department of National Defence)

Mr. Claude Bachand

1720

The Vice-Chair (Mr. David Price)

Mr. Bob Wood

LGen Christian Couture

Mr. Bob Wood

LGen Christian Couture

Mr. Wood

LGen Christian Couture

Mr. Bob Wood

LGen Christian Couture

Mr. Bob Wood

BGen Lise Mathieu

LGen Christian Couture

1725

Mr. Wood

LGen Christian Couture

Mr. Wood

LGen Christian Couture

Mr. Bob Wood

LGen Christian Couture

The Vice-Chair (Mr. David Price)

Mr. Rob Anders

LGen Christian Couture

Mr. Rob Anders

LGen Christian Couture

Mr. Rob Anders

LGen Christian Couture

Mr. Rob Anders

LGen Christian Couture

1730

The Vice-Chair (Mr. David Price)

Mr. John O'Reilly

1735

LGen Christian Couture

1740

Mr. John O'Reilly

LGen Christian Couture

Mr. John O'Reilly

The Vice-Chair (Mr. David Price)

Mr. John O'Reilly

LGen Christian Couture

Mr. John O'Reilly

The Vice-Chair (Mr. David Price)

A voice

The Vice-Chair (Mr. David Price)

LGen Christian Couture

The Vice-Chair (Mr. David Price)

LGen Christian Couture

The Vice-Chair (Mr. David Price)

CANADA

Standing Committee on National Defence and Veterans Affairs

NUMBER 042

1st SESSION

37th PARLIAMENT

COMMITTEE EVIDENCE

Thursday, February 7, 2002

[Recorded by Electronic Apparatus]

¹ (1535)

[English]

The Vice-Chair (Mr. David Price (Compton--Stanstead, PC)): Good afternoon, ladies and gentlemen.

I'm sorry we're starting a little late. That's really not normal at all, but we did have votes in the House, and it took a little while for people to get here. As you'll notice, we're still missing a couple. They'll be along shortly, I'm sure.

[Translation]

Mr. Marin, it is a pleasure to see you and General Dallaire here.

We could start with about a ten minute presentation by each of you and then move on to questions.

Mr. André Marin (Ombudsman, Department of National Defence): Allow me to start by thanking you for having invited me to appear before the committee.

[English]

I continue to be impressed with the non-partisan, diligent, and true concern that this committee has demonstrated in improving the welfare of members of the Department of National Defence and the Canadian Forces.

Because time is brief, and because I know you will have read our special report on the systemic treatment of CF members with post-traumatic stress disorder, or PTSD, I will not present the report to you in detail today. Rather, I would like to briefly present to you on the Canadian Forces' management of stress issues, including post-traumatic stress disorder, since it formally became aware of the true significance of this matter in the Canadian Forces.

Over time, much ink has been spilled noting what needs to be done, yet through our investigation we came to the conclusion that for the eight years since the Canadian Forces first decided that action was required, the most that can be said is that baby steps have been taken.

The first indication of a formal pronouncement on PTSD in the Canadian Forces came with the issuance of the Canadian Forces administrative order, the CFAO, in March of 1994, which defined PTSD as “the chronic psychological distress that may develop in a minority of cases”. The order's content can clearly be described as clairvoyant in that it makes statements and gives direction to the chain of command in dealing with PTSD that echoes the recommendations in our special report released this week--a full eight years later.

Consider the following.

[Translation]

All high-risk groups should be given preventive education. Leaders at all levels must be aware that lack of proper management of CIS can threaten mission completion and contribute to appreciable human and financial costs.

Moreover, this leads to strained work relationships, lowered productivity, unnecessary absences, and early retirement by highly trained individuals.

[English]

The order continues:

Leaders must be familiar with potential CI (critical incident) events and be prepared to utilize appropriate CF human resources for preventive education....

The order continues by saying that factors identified in the order include group cohesion, realistic training, and specific education.

The order notes that confidentiality and mutual support are key ingredients in the critical incident process.

The order also refers to adjustment problems for returning personnel and post-deployment briefings. It requires that commanding officers ensure their personnel are prepared to cope with critical incidents through structured education and appropriate debriefings.

All the issues contained in this 1994 order are the subject matter of recommendations in the report we issued this week, eight years later. In fact, they dovetail and echo the earlier order.

Since March 1994, many more reports and commitments made to action by DND-CF have not been met with any more success in implementing change. In 1998, the McLellan report recommended training, for example, of Canadian Forces leaders on care of the injured, including those suffering from PTSD.

You will probably remember that this House of Commons committee in 1998, in a report entitled Moving Forward: A Strategic Plan for Quality of Life Improvements in the Canadian Forces, recommended that the McLellan recommendations

be implemented as quickly as possible and that other measures be taken to inculcate leaders on the importance of caring leadership.

In response to your committee, the Canadian Forces stated:

Leadership course content is in the process of being changed to ensure that proper training is given with respect to the care of injured personnel.

Although lesson plans have been developed, our investigation concluded that there has been little or no advance in the quality and quantity of training actually delivered to CF leadership about PTSD in 2002.

There are many more examples of noble statements and worthy undertakings throughout the organization in the time period leading up to today. Progress on implementing change has been sclerotic.

Training and education is key to changing attitudes. The lack of deliverables has allowed attitudes and prejudice against those who suffer from PTSD to continue to flourish. Despite the overwhelming public support we received since our report was published earlier this week, attitudes continue to question the validity of the syndrome.

Take the Kingston Whig-Standard, the day after the publication of the report, where a former senior Canadian Forces leader is quoted as saying:

“We never called it a syndrome.” ...“We called it being a whiner and told people like that to go deliver pizzas in downtown Kingston.” ... “They're not career soldiers.”

As changes occur at a snail's pace, soldiers and their families suffer. In the hours that followed the public release of our special report, we received a dozen fresh complaints from soldiers in dire straits, including a handwritten note sent to me, which I received a few hours ago through registered mail, from someone who said he was going to kill himself.

This can't be allowed to continue.

We have made 31 recommendations that address the issues of prevalence of PTSD, attitudes, education, deployment-related training, taking care of the caregiver, and systemic issues. While I acknowledge that there are some good initiatives under way, the efforts now deployed to deal with PTSD are uncoordinated and inefficient, and they are nowhere near where they should be to make a real difference.

For example, the peer support initiative by the Canadian Forces, which we fully support, resembles what most police forces have been doing since the early 1980s, but the Canadian Forces' version, as we speak, is staffed by only three counsellors and will not be fully implemented until 2004. What are people supposed to do until then?

In the meantime, we are deploying 750 soldiers in a combat operation. I'm asking for your backing of our recommendations, and in particular the recommendation for the creation of the position of PTSD coordinator, a position reporting to the Chief of the Defence Staff, which will be able to galvanize all the sectors in the military in moving this issue forward.

¹ (1540)

The issue of PTSD is not an issue for any one particular sector in the military. It affects the army, it affects the navy, it affects human resources, it affects the medical sector, and it affects training. We need to have a position that will be able to bring together all these sectors, be responsible and accountable, and speak from a level of authority and carry the weight of the CDS's office.

Now is not the time for more studies or to deal with these issues as a public relations problem. Now is not the time to lull ourselves into a false sense of security that all is well. Now is not the time to steady the course. Now is the time for action.

Thank you.

¹ (1545)

The Vice-Chair (Mr. David Price): Thank you.

General Dallaire, do you have a statement?

[Translation]

Lieutenant-General Roméo Dallaire (Retired; Individual Presentation): Mr. Chairman, ladies and gentlemen, this is the second opportunity I have had to appear before your committee to discuss post-traumatic stress and its effects on members of the Canadian Forces.

When I was a three-star general, assistant deputy minister of Human Resources, I appeared before you, in 1998, to define the situation, express concerns as to the future of the program and expose what we believed at the time.

It was a very stormy meeting during which the Chief of Defence Staff and I exchanged words. He continued the debate, as at that time, I was a few months from totally collapsing and becoming totally unable to effectively look after anything at all, and I took six months' sick leave.

It was a stormy meeting, because I had the impression that my colleagues at the time were trying to consider the problem as a health issue, and not part of normal operational requirements or operational difficulties at the time.

¹ (1555)

[English]

So losing my temper at that time was probably not as productive as it should have been. However, I believe when I look back at those moments and the state of mind I was in, it was a cri du coeur from someone who was injured, and remains so, someone who was trying to bring forth the fact that we were facing a large number of casualties from our operational units, and that those casualties were not mainstream casualties but sort of “off to the side” casualties. In fact the tone at the time was somewhat of the nature that they had a sickness, a disease. We even had to “quarantine” them in order not to infect the rest of the units. This term was used not more than three months ago by a battalion commander in the Canadian Forces.

The content of the report tabled this week is both timely and appropriate. I say it's timely because we seem to be moving into an era where the fact of, the presence of, these casualties and the methods of bringing about the unloading of the professional care...but also the changes within the spirit of the units. The atmosphere in the units, the culture regarding these casualties, has seemed to wane.

I would think it's inappropriate that the resolution of a very sophisticated and in-depth system of support for these casualties isn't already far more in place than it is. We cannot let our sense of urgency about getting it to that sophisticated level wane. Soldiers, sailors, and air personnel are not only still suffering from this, and becoming operationally ineffective, but their families, their units, and they themselves at times go to extremes to try to eliminate this pain. As such, they remain casualties, some of them at the risk of their own lives.

So I've been invited and I wish to speak on this PTSD situation. However, I do not wish to understate the fact that even in peace time--with the variety of the tasks, the nature of the reductions, and the impact of the demands on the Canadian Forces, both in the field and in garrison--we are sensing a higher level of stress and of trauma in the general atmosphere of the Canadian Forces, simply because we're literally moving them to a state of burnout and abuse. As such is the case, the policy review that I hope will be initiated must recognize that the number of bodies in the forces is a critical component of the forces, just as critical, if not more so, than the actual hardware, technology, and command and control garrison structures.

Now, ladies and gentlemen, I have three primary points to raise with you, if I may, in this opening address. The first is the fact that even recently, as we saw with people commenting on this report and describing the casualties of PTSD, we're still speaking of illness. We're still speaking of sickness. We're still speaking of a mental health problem. We have continued to understate the fact that those who become casualties of PTSD are physically affected in their brains with the attendant mental disequilibrium that is created. They are injured. They're not sick; they're injured.

And still today, when you look at a person who has come back from operations with a limb lost or a back blown out by a grenade or whatever, the method of handling that problem, of bringing solace to the family, of the new, more mature process of ensuring that the system is responsive, not only within DND, to help them through the complexities of all the paperwork and so on, but also with Veterans Affairs Canada, who have taken significant steps in this area.... We try to ensure that they don't fall between the cracks, the individual and the family, and that they are supported; they are even assisted to find jobs in industry.

No such scenario exists on PTSD casualties. We're still working on the recognition that these people are injured. As injured soldiers, sailors, and airpersons, they are to receive the same respect and support, not only from within the forces, but from without the forces. Whenever a person at a legion or whatever other organization comes in missing a limb, it's obvious, and people demonstrate enormous respect for the loss of capabilities that person has had to suffer through, and the trauma since then.

So the first thing in this whole exercise is PTSD casualties are injured personnel. They are not anything less than any other type of injured personnel. The impact of that injury is everlasting. What you hope to achieve over time is to build with therapists and support from friends a prosthesis that will prevent you from falling into these incredibly depressive situations that can lead and do lead to suicide, and should you be falling into that scenario, there is something there to pull you out--to get out of that spiral of death, to pull you out, and to let you at least live another day to ponder your future. They are casualties of physical and mental injuries. They are nothing less.

The second point, if I may, is the whole arena of peer support, a new initiative started by a young major who himself is a casualty, served with me in Rwanda, and is still getting support. And I hope he's getting as much as he needs, both professionally by therapeutic help and also by colleagues. I think this initiative has a lot of merit.

In the building of the prosthesis there are two instruments essential. One is professional therapeutic help. You can't get away from that. This is no witch doctor. This is no “With time, you'll get better”. With time it gets worse, unless you build that prosthesis. With time you see digitally clear every one of those traumatic scenarios, and they haunt you all the time. All you need is a smell, a noise, a comment to actually throw you off.

I was in Sierra Leone in December. I was crossing a street. There was a vendor there with a machete and coconuts. He was taking the bark off a coconut and it was white underneath. As I was crossing and seeing that, I stumbled. Then as I was attempting to continue to cross, I heard the sound of the machete going inside that coconut. I was paralysed. For five minutes--four minutes and some seconds--I was totally ineffective, and I was totally out of it. Thank God there were people around me to hold me up and to take me away.

The vulnerability is always there. You need that professional therapy as one component of prosthesis. Then you need bosom buddies, peers, friends, colleagues, who were colleagues before you fell to this injury, and hopefully will remain colleagues.

You need more than family. Often your family cannot understand and you don't have the patience to explain all the nitty-gritty. What you need is someone who's lived it, who can sit there and listen--rarely counsel, but just listen. Not laugh, not run away, but cry and feel the emotion.

Thank God after the Second World War we had the legion. Many Saturdays I saw my father sitting around a small Arborite table with a few buddies as he gave me 5¢ to get chips and a Coke to play on the pool table. There was always one of them crying, or they would all be bursting in enormous laughter. There was a lot of beer. That was the therapy of that era. It produced a lot of people who became drunks, but some of them were able to survive that and live reasonable lives with their families.

That peer dimension is not only on an individual basis, but it's on the basis of the milieu, the unit, the job place. Those dimensions are still lacking. We're still pushing those people aside because we now face a scenario, as with the end of the Second World War, where we have armed forces made up of veterans and non-veterans. Some of the veterans have come through marvelously, or have never been through a trauma experience. They join the non-veterans in saying, “I am never going to get sick like them. I'm not going to turn into one of them.” That sort of pretentiousness creates a scenario that shuns those who are injured and pushes them back into their depression.

Colleagues who could potentially become reasonable soldiers in order to continue to serve in a reasonable fashion are often destroyed by the leadership and their peers. I say they're destroyed because some of them go to the extent of killing themselves, for there is nothing left. Family can't understand. Therapy is wherever it is at that time, and peers, that loyalty for years, have disappeared.

That whole dimension is still embryonic in the Canadian Forces. You still have battalion commanders who are quite prepared to get rid of those people as fast as they can because they need operationally fit troops. They have a demanding job and they don't have enough troops, so they have to stay focused. Well, in doing that, they're guaranteeing that those casualties will remain casualties and get worse.

The last point I wish to raise--I'm over my time, but please forgive me--is families. Ladies and gentlemen, what's out there for the families is next to nothing. The family support centres have been structured and are there in support, and they have taken on a lot of duties of the rear parties. I am not negating that. However, there is not the sophistication there to handle families of soldiers who come back with this injury, nor is there clinical help for the members of those families in order to handle the stresses and traumas they live with. They're going through those missions with us because of the media. At 6 o'clock at night, my family still doesn't talk at the table, listening to the CBC news. They're always clicking to find out what reporter is going to report us killed, shot, or whatever.

The families are still getting nothing, technically, to help them get therapeutic, clinical support. I've had two in my family who I've paid for out of my own pocket, because the systems in the provinces, the insurance, don't cover enough. There's nothing for those who are out in VAC and those who are still serving. The system has not recognized a complete responsibility to the close family.

º (1600)

My family was injured because I was injured in operations. This is not a responsibility of the provinces. If my family were not supportive of me, no matter how much therapy I got, I would never go back to the forces. They'd never let me back in the forces, or I'd lose my family and my therapy would be minimized by that absence of those holistic perspectives on ourselves.

And lastly, in that sense we talk about bringing troops back for 12 months or 24 months in order to permit them to be rejuvenated for potential next missions. Ask what we specifically do to rejuvenate those soldiers during that 12 or 24 months. Ask specifically what programs those families and those individuals are going through in order to lower the stress levels of these new-generation operations so they can live recognizing that there's been an effect, that it's been hard, but they're ready for the next one, this instead of keeping them up there, sending them off again, and having the whole family crash. That is not on the books. That is crucial to the future operational capability of the forces because those casualties, as many as you send over, remain vulnerable to falling victim to that injury and putting others at risk.

Thank you for your patience.

The Vice-Chair (Mr. David Price): Thank you very much, General, and thank you, Mr. Marin, for two very good presentations.

We're going to be a little short of time, but I'll start off with Mr. Benoit. I imagine you have some questions.

Mr. Leon Benoit (Lakeland, Canadian Alliance): Thank you very much, Mr. Chair.

It's good to have you both here.

General Dallaire, I heard you quoted on the radio or television in just the last couple of days saying that you're still not confident that many of the commanding officers accept the legitimacy of this disease. Could you comment on that?

LGen Roméo Dallaire: Mr. Benoit, I've just been giving you an emotional--I hope--expression that first, it's not a disease, it's an injury. And second, yes, the pressures on commanding officers, on subordinate commanders, and on NCOs to get as much as they can out of those troops to fill the demanding task this government gives them--which I agree totally with--is such that they are less receptive to those who might have problems and who are still hiding or camouflaging them.

Remember, sir, that the most recent casualty of the 12 officers who joined me in Rwanda at the start of the war when the Belgians left, of which 9 out of 12 have totally crashed as I have done, was only two months ago--seven years later. There is simply no room for it. Moving them off to the MPHL and other systems seems to be a methodology of trying to put that in a corner as they continue the operation, but there is no fundamental recognition in the forces yet that a PTSD casualty is an injured colleague you don't shun but someone you hold within the bosom of the unit.

º (1605)

Mr. Leon Benoit: Now, is it that it's not recognized as an injury? Is it that the commanding officers are over-tasked because of our heavy commitments in the military? Is it for some other reason, or all of the above?

LGen Roméo Dallaire: Thank you for all of those, plus the fact that even on civvy street, people who are injured or who have mental health problems are also shunned, are also kept in the bag. They're not mainstream injuries or diseases like cancer, so that of course is found within the forces. We come from civilian society. We have mothers and fathers too. We've gone through that. And the culture of having people 100% operationally effective does not leave much room for those who are deficient or damaged goods, so there is still this terrible stigma on people who cannot sustain the demands of the job because of something that is between the ears versus a leg or a back problem.

Can you imagine that someone recently said that the PTSD scenario of today is similar to our back problems in the seventies and eighties, where we had a lot of malingering? That's what was said. We had a lot of back problems because we were out of shape and we weren't doing things right. To equate the two today is a blatant demonstration of....

Mr. Leon Benoit: Even looking at it beyond the personal and what's good for the military to the economics, Mr. Marin pointed that out in his presentation of the report, saying that we should absolutely treat these injuries and treat them quickly so you can get the soldiers back in performing their duties, because if you have quick treatment, you're far more likely to be successful. It certainly isn't the cost if you're looking at the economics in a complete way.

LGen Roméo Dallaire: Since I started in this in 1997, there has never been, at the senior leadership level, any restriction from three stars and deciders on funds and attitude. Because of the time it takes and the methodologies involved in bringing these programs to fruition, we find ourselves still on a learning curve, with whatever programs that are already there being overwhelmed with work.

Let's say you have two out of ten who are injured because of PTSD. If you're able to move them to a level where they can still be operationally functional but maybe not be in a line unit, you save hundreds upon hundreds of thousands of dollars on training and experience. If you lose them, you lose that depth of experience to handle these complex new missions. So it is an operational problem that has to be resolved.

Mr. Leon Benoit: Mr. Marin, looking at how you could be better able to ensure appropriate action is taken on this report, the Office of the Ombudsman requires that you report to the minister, not to Parliament.

Many countries have in the military an inspector general, who has a lot of power to look at what's going right in the military and what isn't, and to say, this is what you should do to fix things. There's some authority.

Under some inspectors general, you have an ombudsman's office, which deals with the concerns of the military. If we had an inspector general in place, I would suggest that it would be far more likely that this would be followed through on, that parts of it wouldn't be swept under the rug, and that we'd have far better action on it. It's something that Canadian Alliance called for in our Canada Strong and Free document of a couple of years ago.

Do you think we should have an office of inspector general in Canada?

º (1610)

Mr. André Marin: That's a broader question, and it's not appropriate for me to comment on that.

What I would say, Mr. Benoit, is that I'd be hard-pressed to think of what more an inspector general could have done than what we did in this particular case. We compiled a report of over 200 pages and interviewed 200 people. We have transcripts of interviews. We received cooperation from the Chief of Defence Staff down.

To answer the beginning of your question about how we can make sure the recommendations will be followed, Mr. Chair, we intend to adopt an approach whereby we will cooperate with the department in seeing to the implementation of these recommendations and in having a follow-up report in nine months.

We don't think there's anything in this report that is unyielding. A lot of things are worded in ways that allow the chain of command to inject some creativity into the implementation of the recommendations. So we intend to work with the chain of command to see that every one of those recommendations is implemented. We intend to have a follow-up report in nine months to bring the minister and ultimately the public up to speed as to what's happening.

Mr. Leon Benoit: But in the end you have no authority to enforce action on this.

Mr. André Marin: No, we don't.

Mr. Chair, if I may have one brief minute to add to an answer previously given by General Dallaire, one of the things we've noticed in the organization is that there's a disconnect between orders and directions from the top and what is actually implemented. General Dallaire referred to the problem of how to bring programs to fruition. I call it a disconnect. They're presented with a document that on the face of it is full of good intentions, just like the 1994 document that I referred to in my opening statement. Eight years later, where are all these programs? They're just not there.

If we had said in this report that 10% to 20% of people coming back from operations are suffering from tuberculosis, would we still be wondering about a particular recommendation or saying, this one's on my turf? Would we still be in a void? I would suggest to you that if the report pointed to an illness such as tuberculosis, there would have been massive commitments and we wouldn't be here today. I think it would be implemented and well on its way.

So to complement the views of General Dallaire, I would say that we need to be able to treat PTSD like a broken leg. It is having an eroding effect not only on the morale of the Canadian Forces, but on personnel retention issues and financial issues, and it deserves recognition, and recognition now.

The Vice-Chair (Mr. David Price): Thank you.

Mr. Bachand.

[Translation]

Mr. Claude Bachand (Saint-Jean, BQ): Thank you, Mr. Chairman. Allow me to start by welcoming Mr. Marin and telling him that I read the report, and that I find it very complete, but above all very courageous. To his credit, he also now officially and publicly recognizes that this injury exists. It has always existed. It has often been called other things, but this report is such that it is now in the public opinion. I think that people are now aware of that.

It is too bad that we do not have much time, as I have a question for you, Mr. Marin. I'm going to save it for the second round. If we do not have a second round of questions, I will get back to you.

Above all, I have a question for General Dallaire whom I would also like to welcome as one of the great commanders of the former Collège militaire royal de Saint-Jean. I remember meeting him there, for the first time. I want to tell you, General, that the people of Saint-Jean have not forgotten you. People remember the time you spent there. They always had great admiration for your leadership and above all your straight talk, which you have demonstrated once again today.

I too am a member of a legion, and I witnessed scenes like the one you mentioned. However, you see many different scenes in the legion. People are very proud, for example, of lifting up their pant leg and showing one of their war wounds, a scar, a missing leg, a missing body part, but when the time comes to talk about the true psychological problem, for example, a lot of emotions spill over and that is very touching.

I think that we, having not experienced the same type of stress, sometimes have a bit of trouble understanding that these people can cry like children. It is true that it is important for them to have friends around them who understand. It is true that that is absolutely necessary, in my opinion.

We can easily say that we sympathize with them and recognize the fact that they witnessed terrible scenes during the Second World War, but I think that it is the type of injury where if you have not experienced it personally or if you did not go into the theatre of operations yourself and see these things, it is not very credible to tell someone that you sympathize with him.

There's a problem with that, as far as I know. That is what I want to ask you. In my opinion, there is a problem with institutional culture, not at the political level. That is the question I would have put to Mr. Marin. In the military, the institutional culture of the Canadian Armed Forces and all armed forces involves trying to develop supermen and superwomen, both physically and psychologically. It is as if they were renouncing the training and education they received in the army to say... The army will say that it has failed with those people. That is what the armed forces will say. And that is where the problem lies.

I wonder to what extent, even with political will, we can change that structure. I wore a uniform myself, in training in Valcartier, a few months ago. I too wanted to be strong. I wanted to face anyone. If I had seen a reliable person who was on the verge of tears, I would have wondered what was wrong and I would have said that he was not where he should be.

It seems to me that when someone puts on a uniform and has a busy military life, we have trouble acknowledging that the system has failed. Is there an answer to that? First of all, is my analysis accurate?

º (1615)

Lgen Roméo Dallaire You hit the nail on the head. It is quite natural for you to have trouble understanding.

The example that I occasionally give people to try and help them get a feel for these traumatic experiences is as follows: think about a three-year old child you know, a niece or a nephew. Think about this three-year old child and imagine not only his head smashed open, but also his arm chopped into little pieces, like salami. Think about that child. Imagine that and you will get a sense for how these traumatic events leave you beside yourself.

Some time ago, the Canadian Forces asked me to participate in a project with Gérald Mathieu and his team on changing culture. It was an attempt to see what we can do so that people remain full of motivation, so that they can face the fact that they will perhaps die and so that we can recognize at the same time that those who are injured must be kept in the environment, that we must help them build their prostheses and respect them.

I received an offer to work with them, and that is what I am going to do more specifically on Monday when the first meeting is held. Our mandate is to see just how we can instill in non-veterans and veterans who have experienced these atrocities, this sensitivity with respect to those who have been injured and who suffer specifically from this almost hypocritical injury.

Mr. Claude Bachand: So you agree with me that in terms of institutional culture in the Canadian Armed Forces, there is still a lot of work to do. The reaction, not only by high-ranking military officers, but also people who are working with this person in the field, the reaction of fellow CF members who see the victim of post-traumatic stress, is not the same as if the person had cut his finger in the line of duty.

LGen Roméo Dallaire: When I retired, people who met me often said that when I was suffering from this disease, they did not really know how to talk to me or deal with me. So at the end of the day, they left me on my own. There were times where that suited me, but there were other times when I would have appreciated some help.

But the Canadian Forces have nevertheless made some major progress. I am sure that Christian Couture will talk about this. We see when this type of injury occurs and when we remove the person, even temporarily, to help him, and if it is clear that he is at a total loss... I had the case of a lieutenant-colonel who had to be evacuated within 24 hours, because he went mad, and became dangerous; he was shooting his gun in my headquarters.

So there are varying degrees. But today, we are much aware of the problem. There are many more response systems in place. The question is now this: have we really met the objective of insuring that each person injured in this way, whose injury is much more difficult to identify, receives treatment equivalent to those received by someone who is shot or hit by shrapnel and who might end up with gangrene in his arm if he is not treated?

º (1620)

[English]

The Vice-Chair (Mr. David Price): Merci beaucoup.

Mr. Dromisky, you're on.

Mr. Stan Dromisky (Thunder Bay--Atikokan): Thank you very much.

I have to commend the general. I have to tell you that your emotional presentation has hit a spot in me and other members of my family. We've watched you on television and we've read articles. All I can say is it has taken a tremendous amount of courage on your part to step forward, because you're a high-ranking officer, and make the declarations you have made. It takes far more courage, from my perspective, to do the kind of thing you have been doing ever since you retired, than to face an enemy with a machine gun, cannon, bombs or anything.

I'm so pleased and proud of you that you have not hidden yourself and run away from this problem. You are, in a sense, making the Canadian public extremely sensitive and aware. From it all there will be some positive outcomes in the future, but above all, there are unknown thousands who are suffering also. We don't know how many because the records aren't being kept, I've been told, and that has to change, there's no doubt about it. But those are the people who collectively can work with you to make the general public--and especially politicians--more supportive in bringing about positive action.

At the same time, I'm going to take you back in time. I was on a special committee studying the relationship between the active forces and the reserve forces, when Mr. Collenette was Minister of National Defence. I found some very disturbing things about relationships and people in general who were in the military. To this day, I always have to listen to what a military superior officer tells me with a question in my mind: Is that his perception, based on custom and tradition over many years?

I look at you and say to myself, you've been in the service for a long time, so what was happening with the soldiers who suffered in the years when you were in command? Were there any cases you were aware of? Did anything happen to people who could have been classified as having a mental illness or personality disorders--traumatic experiences that threw them over the end--and nothing was done? Are they signs of weakness? Are they still perceived by the superior officers as signs of weakness? I think you gave me answers to some of those kinds of questions, but I'd like to hear more from you.

LGen Roméo Dallaire: I won't negate that even at the senior levels some questioned the validity of PTSD versus trauma or outright mental health problems. That differentiation, and of course the therapy, costs, pensions, and all that, tend to make people now think twice about whether it is PTSD or some other mental deficiency that doesn't respond to that. Hopefully, it's not as bad as PTSD; however, you can't downgrade that effect.

I was deputy commander of the army. I came back from a year in Rwanda, of which four months were in the war. I was on the job as deputy commander of the army three weeks later. That was the thinking at the time: get him back to work fast and with time he'll forget it.

I had a driver who was a corporal. He had been in Sarajevo as the unit photographer in the Vandoos battalion that was there. He worked with me for two years and I never picked up how much he was suffering. In fact, near the end of the second year he even asked me for permission to go on another mission. I said, “No, I don't think you should go”. Ultimately, my job was changed around and my successor let him go. That chap is a drug addict and an alcoholic. He is in the forces and has now had nearly four years of therapy. He is still injured to the extent that you would call him a basket case. He was in a formed unit at that time, a solid unit, and he still became a casualty in those operations.

We were simply learning that we were not doing Cyprus stuff any more, and it wasn't as easily identifiable as cold war stuff, which ultimately became peacetime soldiering, but was still operationally demanding. We were into something different, and lo and behold, we were taking casualties.

I commanded the brigade in 1992, when we started sending the first troops into Bosnia. In fact, my battalion was the first one to go into Bosnia. We had a casualty come back, killed, chopped in two by an RPG round--an anti-tank missile. He was treated nearly the same way as someone coming back from Cyprus who had gotten drunk, had an accident in a scuba club or something, and was being brought back home. We didn't capture the extent that this was someone who had been killed in operations, and if we were taking casualties like that we had to change how we helped them and their families.

We treated the family very shoddily. It was no more than if somebody had been in Germany and had had a motorcycle accident. He was brought back and buried between the grandmother and some jerk who killed himself because he was drunk at the wheel. We gave the normal little funds and cross, and the family was essentially left there, by the government, by the people of Canada, and by us. We said to them, “Yes, your son gave his life to the mission and it's important and we thank you very much”. It doesn't hold water if we can't even explain why it's so significant to go on these missions, which I totally believe in, and give them the recognition.

Since then there has been all kinds of stuff. They're even now talking about a national cemetery. I don't agree with where it will be, but that's another story. The whole process has now recognized that we're in an era where the country is at peace but the troops are at war. They're coming back with war injuries, and we have to handle them as troops coming back from war, as veterans, and make them feel that same sense of appartenance for having done their duty. Their families have to feel that the sacrifice was worthy of being made, because we're pushing our values, human rights, and so on. We haven't achieved that yet.

º (1625)

Mr. Stan Dromisky: I just want to ask one little question pertaining to this.

Is it possible that some component of the training program from the very beginning could help prepare our armed services personnel for some of these traumatic experiences they might have to deal with in the years to come?

LGen Roméo Dallaire: Yes, sir. I think the missions are going to continue to be complex, just like the one going on in Afghanistan. It's a different nature, and so you can expect, of course, casualties of a variety of sorts.

I think there's been a lot of work in preparing, in identifying, with movies and such, to try to see who will be affected. I think there's consciousness in the units to remain cohesive, so that the individual doesn't feel isolated. I think a lot is like that. But just like using a flak-jacket to prevent shrapnel or bullets killing you, you have no more guarantee, ultimately, of not being killed or injured with that protection than you have of not being injured because of PTSD. It is an injury. It's not something you teach. It's something you prepare for, just like you prepare for any other casualty you're going to have.

But you have to acknowledge that you will get those casualties. And you have to handle them with the same dignity and sense of urgency as the one who lost a leg.

º (1630)

The Vice-Chair (Mr. David Price): Thank you.

Our time is up for these particular witnesses. I would ask you if you would like to stay for a little while. I do have a speaker's list here, and I'd like to go around and give everybody a chance, if you don't mind staying for maybe another 20 or 25 minutes.

A voice: No problem.

The Vice-Chair (Mr. David Price): Okay. Next we'll go to Mr. Stoffer.

Mr. Peter Stoffer (Sackville--Musquodoboit Valley--Eastern Shore, NDP): Thank you Mr. Chairman. My apologies to both of you for being late. When you're only 13 members of a political party, you have to be in two committees at the same time.

First of all, Mr. Marin, I want to say how pleased I am with this report. I have the Shearwater military air base and the Shearwater military resource centre in my riding, and they are extremely pleased. This is what the women and the men--the spouses, more or less, of the military troops--have been saying for a long, long time. And now they see their words in print. I must say, this report has given them a bit of a light to shine toward. I must congratulate you and everyone else who had a hand in this.

I wanted to ask a question. On page 109, you say a soldier said this, and on page 99, a CO of a large base said that. You also say a very senior battalion officer said this. In the whole report, you don't mention anyone's name except for Corporal McEachern and a few others.

Through it all, this whole report, I got the feeling that ostracism still is alive and ripe in the military, that if anybody speaks out, it's either a sign of weakness or you're being a tattle-tale, whatever. In this whole report, you say this person said this, but you don't say who they are. You don't say their name. I want to know, is it because they didn't want to be identified, or is it because if they were identified, they could be ostracized and then punished through the military?

Mr. André Marin: For complainants who turn to our office on anything, fear of reprisal is incredible. They call up and they want to know whether there are any military people in the office, if the lines are bugged, if someone has access to the call, or if we're going to let people know they've called our office. That's usually a huge barrier to building a relationship with complainants on any topic. So we have to deal with that in every case.

In this case, dealing with post-traumatic stress syndrome, it's particularly pervasive. People don't want to be associated with it, because they are seen as being weak soldiers. There's an enormous amount of stigma that attaches to people who come forward and are identified as suffering from PTSD. For that reason, to protect those people and to make them feel more comfortable to come forward, we have made most of the quotes anonymous.

Mr. Peter Stoffer: My other question, sir, is do you believe there's funding available right now, within the military, to meet the needs of those soldiers who may come back from Afghanistan suffering from PTSD? We know some of them will be. Are the resources available now to meet those needs that are anticipated when they come back home?

Mr. André Marin: Probably Lieutenant General Couture would be a better person to respond to that question. We haven't investigated that, but I can say that the issue of funds is not a barrier to adopting the recommendations in the report.

Mr. Peter Stoffer: Okay. I have another question, sir.

In regard to looking for a voice out there that may be of assistance, I was thinking, when I went through the report, about the availability of the legions and the army and navy veterans' associations, the 450,000 people who are a part of those associations. As you know, many of them went through World War II and the Korean conflict, and they've seen some outrageous things as well. A lot of them went through some pretty serious traumatic experiences.

Has it ever occurred to either you or the military to look at that branch of service for assistance in dealing with the PTSD that our current military are suffering?

º (1635)

Mr. André Marin: I think that's worthy of exploring.

What we found during our examination of the issue is that the stigma that's here today didn't come about last year or ten years ago. The stigma that exists here has always existed. Some people were executed during wars. That's something we have to deal with.

We do find, from time to time, some supporting people and we try to get them involved. As I said, education applies probably even more to former members because there's a tremendous amount of misconception as to what it is. So for that reason, we approach that issue with a lot of caution.

LGen Roméo Dallaire: The legion handles about 15% to 20% of the cases that go to Veterans Affairs Canada, as it is.

Secondly, retired Admiral Murray, who's the deputy minister of Veterans Affairs Canada has a committee of which I'm a part. I represent the Canadian Forces members. I was delegated by the Chief of the Defence Staff to that committee.

In that capacity, the committee has been doing an incredible job of reforming Veterans Affairs Canada to handle this. Within that you have all the associations, even the peacekeepers' associations.

The head of the Second World War associations, Cliff Chadderton, said that what the troops are going through now he considers worse, in most cases, than what they went through in the Second World War, because of the nature of the beast, the cruelty. So they're very supportive of this new generation of veterans.

Within the bureaucracy of government it is very difficult to make the bureaucrats understand that these are new-generation veterans and they are not simply people who have been injured à la Cyprus or à la Germany. That new role is different from defending the country. Cracking that mould, creating this new social contract between the government and the people of Canada and the soldiers for this new role of conflict resolution, of pursuing our human rights and our values overseas.... That social contract has not been written, and that's why the government has so much problem explaining casualties and why we're sending people to these missions. And the troops and the commanders at all levels have problems explaining casualties to their troops, and we certainly have problems explaining casualties to their families.

Imagine all the reservists who are literally time bombs throughout every town of this country, what support they're getting and what scenarios they could come forward with in regard to help and support, and the risk they are living in with those injuries within their communities.

The Vice-Chair (Mr. David Price): Your time is up, Peter.

Mr. Anders.

Mr. Rob Anders (Calgary West, Canadian Alliance): I imagine in some of the circumstances where soldiers have been sent, they are being asked to do what I call “peacemaking” rather than peacekeeping. Because of the rules of engagement, you have to watch things go on that nobody would want to watch go on and you would rather intervene to stop it from going on. I realize that doesn't represent all of the cases of this particular injury, but I would imagine it's a factor and a good chunk. I imagine you'd have some experiences with that.

So I'm wondering if you may be able to comment to the committee on whether or not soldiers should be sent in to those peacemaking situations whereby they're asked to watch two sides slaughtering each other without being able to actually intervene.

LGen Roméo Dallaire: It is my belief that the use of forces in this new generation of conflict is critical to helping not only maintain a certain stability between belligerents, but also to help stabilize belligerents in their quest for gaining a modicum of room for the moderates to be able to take over from the extremists. It's the extremists on both sides that create the bulk of the problems, and many of the moderates not having enough security from their own people. With forces being there, the moderates can then work with a much safer sense in trying to bring all of this together without always fearing that some extremist on one side or another is going to blow them away.

Now, peacekeeping, peacemaking, peace enhancing, I believe that all this kind of stuff is terminology that is not of the era. Nor do I believe we're at war right now, as a proper term, classic war. We are in conflict. We are in missions of conflict resolution. We're in missions where the answer doesn't come by one battle or two and people go home and you count the number of enemy you killed, and then you're the winner. You're into long-term multi-disciplinary work, of which the military and security is only one component.

So if you're in Sierra Leone, you're there for 20 to 40 years, helping at different levels to help that country gain an ability to achieve a certain steady state and then carry on. If you're going into Afghanistan, well, if everybody pulls out in two years except some humanitarians, you're not helping the situation; you're just stabilizing it for a re-enactment of whatever is going to happen.

You're going into conflict because of the depth and the complexities of these missions, of which you're getting complex mandates. And any general who tells you that we're not going in unless we have a clear exit, an end strategy, and a clear mandate, tell them they're in the wrong era. They're not going to be simple. The question is, do we have the tools, do we have the action verbs, do we understand the problem?

I'll give you one final example. We spent 50 years in NATO understanding action verbs. That's what we are in: attack, defend, withdraw, pursuit. And everybody knew what that meant. We're now in an era, since the nineties, where you have as action verbs “to create an atmosphere of security”. Now, what does that mean? Does that mean I defend the nation if somebody, while I'm demobilizing him, attacks the country? Does that mean I simply watch them as they do their thing, and hopefully they're following the rules? What does that mean? Where is the doctrine of that? Where are the new methods of solving that with the political, humanitarian, and the nation building? We're still doing it ad hoc. Sometimes we do well, sometimes we do terrible, but we're still doing it ad hoc. That whole new generation of doctrine is not there.

And lastly, the impacts. Right now the biggest complexity the military faces are the ethical and moral decisions they face. It's not simple; it's not somebody with another uniform shooting at you.

I'll give you one example. A corporal running a section of 10 men comes to a village and is stopped at a barrier. It's not a very complicated barrier, but there are about 15 to 20 militia men there with rifles and machetes. As he looks beyond the barrier, in the village there are about 200 or 300 people milling around. And as he looks closer, in the middle of that there is a girl, 14 or 15, with a child on her back--as they do--with a machete, who is about to kill another girl with a child on her back. What does the corporal do? Does he shoot in the crowd to disperse them, and then fight his way through the barrier to save that girl and create God knows how many casualties? Does he shoot the girl with the machete and possibly kill her child in order to avoid that girl being killed? Or does he simply walk away, saying “I can't do anything, it's not in our mandate, we're not allowed to do that”?

Crimes against humanity are not even in their mandates any more, when you look at chapter six. Only in chapter seven missions do you see crimes against humanity demanding a response, which is not always done, because we don't maximize our rules of engagement; we always minimize them because we want to cover our butt because we're still subject to the Canadian laws and military law and so on.

º (1640)

So what did the corporal do? Well, the corporal negotiated and negotiated and negotiated, and by the time he finished negotiating, he didn't make it through the barrier and that girl and her child were killed. Come back with that question in your mind--you as the corporal.

And what about those soldiers under your command? How do they handle the moral and ethical problems they're facing? They're 19, 18, 20, 21. These are not philosophers. These are kids of this nation with our values, high as they are, trying to figure out what to do on these complex missions.

º (1645)

Mr. Rob Anders: Thank you.

The Vice-Chair (Mr. David Price): I have two more people on the list. Mr. Bachand has graciously given up his time so Mr. O'Reilly and Mr. Wood can have a question.

Mr. O'Reilly.

Mr. John O'Reilly (Haliburton--Victoria--Brock, Lib.): I'll be very brief. I know you don't like the parliamentary secretary asking questions.

General Dallaire and Mr. Marin and I have had conversations in the past, and I thank you for coming.

You've taken a giant step. This committee is looking for the next step. It is always something we have to look at. How do you overcome? You've done a great job, for which, as you know, I commend you. But the identification, coming forward and seeking counsel, the fear of labelling, and the availability of caregivers to look after people would seem to me to be systemic problems. In General Dallaire's case, the problem was his commanding officer refusing his request for reinforcements so that he could protect people. You have to go back to why this happened.

As General Dallaire knows, I was a fireman. We've talked about how it affects you and how you have flashbacks of certain things; I gave up the fire department because of it. And I still have flashbacks. They don't go away after 20 years. But I drink a lot of beer, and it seems to work.

LGen Roméo Dallaire: I take two.

Mr. John O'Reilly: You recommended that.

I can always talk about my problems when I've had a beer. Up to then I have a problem with it.

But how do you overcome...? Is it increasing the role of the chaplaincy branch? Is it the role of the Canadian Forces college to increase the type of training going on? Keep in mind I'm looking at the systemic cause. We know post-traumatic stress happens. We know why it happens. We know how it happens. But how do we deal with it? How do we deal with it in our senior ranks? How do we deal with it, as I said, in our chaplaincy branch and in our colleges, and at the Royal Military College, RMC, for all the people coming up?

This is where I come back to the systemic problem. What do you identify as the systemic problem, how do we deal with it, and what does this committee recommend from it? Those are my short questions.

Mr. André Marin: We have recommended several ways to tackle that in the report. One is the training curriculum--right from the recruit school, continuing education, the Royal Military College. And actual delivery needs to be built into the system--not just a program, but that it's actually happening. Training on PTSD is not happening right now, in terms of sensitizing people as to what it is, how it happens, how to respond to these situations as a leader, as a member of the chain of command.

In terms of treating it, the military have set up five clinics across Canada to deal with PTSD--operational trauma and stress. Those five clinics are all located on bases. It is the virtually unanimous view--and I could probably say unanimous view--of people seeking treatment that by going to get treatment at one of those clinics on the base, you are putting a label on yourself of being a weak soldier. It is counter-productive.

One of our recommendations is to try locating one of those clinics off the base to see whether it reduces this kind of stigma. Locating a clinic off a base would in our view allow the rest of the institution to catch up through training and so on. We don't see locating a clinic off-base as a permanent solution. We see it as a solution that we must at least try out until the rest of the organization's attitude catches up with the times.

We've also exchanged that idea with most caregivers, and most caregivers agree, as well, that it would be worthwhile to try it off a base. Those who disagree with the approach of putting an OTSSC, one of those clinics, off the base take the position that you may be adding to the stigma, because you're telling people they have to go outside the Canadian Forces family to get treatment.

Right now getting treatment on a base is not an option because you're considered a weak soldier. We're not saying throw them all off the bases, but at least give it a try. Try one off-base and see whether it works. To us, that is one of the key recommendations in order to get treatment to members.

Education is key in changing the attitude. So is peer support, rehabilitating soldiers. It seems right now, as far as we can tell, that in virtually 99% of cases when you have PTSD, you're taken out of the Canadian Forces. What we are advocating is an approach that would want to recycle, rehabilitate the soldier, instead of throwing the soldier out. This is because of the initial investment and because of the human factor. Once you have approached the situation from that end, then you'll be able to keep those people, turn them back into productive soldiers, and eventually the attitude will change. I don't think you can change it overnight, but those are the ways you can.

º (1650)

The Vice-Chair (Mr. David Price): I'm sorry, Mr. O'Reilly. We're just short on time. I really hate to cut you off, but....

Mr. Bob Wood (Nipissing. Lib.): Maybe I'll ask it to you, just to take up what Mr. Marin was just saying.

In your opinion, and you were talking about acceptance of the injury, and Mr. Marin is quoted as saying he wants to take them off the base, wouldn't it be more appropriate to keep them on the base and tackle the problem of acceptance of the injury, sir, than to move it off? This is what has to happen, isn't it? Don't we have to tackle the problem of acceptance of the injury, and would it not be more appropriate if we did it on the base?

LGen Roméo Dallaire: We are in a transitory phase. That is to say, the culture shifts have not happened to the extent required, and the capabilities within the forces of handling all this are not there. In this transition phase, as we achieve a steady state, we hope ultimately for that capability, which will be a mixture, in my opinion, of military and civilian because you can't do it all internally. In fact, you don't want to do it all internally. You want therapies to be there locally. If you have a reservist, you want a therapist there who knows what's going on, who has been briefed. Maybe you give them opportunities for the therapist, and they can be handled there instead of going all the way to Valcartier to get it.

The way we're still doing it...imagine you're on the bus from Kingston to Ottawa to come to the clinic here, and the bus is full of people who have colds, maybe cancer, God knows what. You're sitting there, you have nothing overtly or demonstrably wrong, and your buddy asks, “Why are you going to Ottawa?” “Oh, I'm going to the clinic”, you reply. He says, “Oh yeah, geez, I didn't know you were affected that way.” Then on the way back the question is, “Well, how was your treatment? How did you do? How did the psychiatrist talk to you?” Now, the mere fact of being with their peers in this is crushing. They should be handled separately in order not to have that stigma as we're still working our way through solving it.

I believe that multi-disciplinary solutions are required. That is, from padre to whatever other instrument is handling the family and individual, they have to build a capability of working together, not as prima donnas, not with one dominating the other, but with a multi-skilled solution that includes civilians, that is, civilian staff, civilian skills, and civilian knowledge you can adapt to the military problem, including civilians who will give care to the members and their families. Multi-skilled people and multi-disciplinary solutions are, I believe, the answer, and I believe the project Gérald Mathieu has going right now is moving down that road of bringing all these elements together.

Therapists have a responsibility to pull the injured people out of the closet. The idea of waiting until they volunteer or crash and land on the therapist's doorstep to try to make their way invites catastrophe and is irresponsible. There must be a way the therapist can get into those units in those milieux, start identifying and pulling those people out, and do that in concert with the leadership.

That brings you to the fundamental point of cultural attitudes. How do you change an attitude? It doesn't take one briefing, or a CANFORGEN, or a glossy. It takes actual human beings talking to other human beings, being credible in what they're saying, and convincing them of the necessity for change. It has to be done continuously because there are always new people in the forces.

When do we achieve the timeframe when we think the general attitude has changed in recognition of this injury and that all we have to do is keep topping it up? Well, I would contend that if you're going to change attitudes and culture in this regard in that milieu, you're talking about two or three years of very professional, structured instruments with people, as Grenier is doing with his peer organization, orienting them to be able to talk to the troops and know what the hell they're talking about.

Remember the little example I gave earlier on. You tell that to any of those corporals who are going over right now, and tell them they may face something like that. They don't remain immune, particularly if you ask them, what answer can you give? Put those questions to them before they leave, and then have the leaders give them the answer. Not much of that's going on.

That's pretty complicated, and many leaders are finding it complicated, just as I found it complicated. But you can't keep ad hoc-ing it, and you can't leave it on the shoulders of some poor corporal to have to take those decisions purely on his own emotional strength, values, and ethics.

º (1655)

The leadership has to give him reference points to help convince him that he's doing everything possible and that the loss has to be accepted and you have to work with it. We're not that sophisticated yet, but the problems are very sophisticated.

I say we need two to three years of deliberate, in-your-face discussions on what this means, this new generation conflict, from the private to.... I would say that maybe three stars need a bit of a reminder. The injury of new-generation conflict is PTSD, by far, versus bullets and mines and shrapnel. Well then, let's make that a significant point, because the Canadian Forces are going to keep going into that stuff. I would be the first one to continue to push it, but you're not allowed to let them continue in that fashion, where it falls on the shoulders of corporals who may not have all the ability or the sense that they're being supported in some of these complex decisions they're making.

Mr. Bob Wood: So you're saying it would be better off the base?

LGen Roméo Dallaire: No, I'm saying you mix it.

Mr. Bob Wood: Okay. Thank you.

The Vice-Chair (Mr. David Price): Thank you very much, General and Monsieur Marin. As usual, you've been very helpful to us to get the information you did have to put out. You always present it very well, too. So we thank you.

We're going to take a two-minute break.

LGen Roméo Dallaire: May I thank Monsieur Marin? Also, if I may, I particularly want to thank General Joe Sharpe, who Monsieur Marin had chosen to do this, and his enormous credibility in the forces. He put it together for us. Magnificent.

The Vice-Chair (Mr. David Price): Thank you.

» (1700)

» (1703)

[Translation]

The Vice-Chair (Mr. David Price): We are back. I want to welcome Lieutenant-General Couture and Brigadier-General Mathieu. We will ask you to start with brief opening remarks and then we will have questions for you.

Lieutenant-General Christian Couture (Assistant Deputy Minister, Human Resources-Military, Department of National Defence): Mr. Chairman, given how late it is, I will make some rather brief comments in order to leave more time for questions.

The Chair: Thank you.

LGen Christian Couture: Mr. Chairman, members of the committee, I want to thank you for having invited General Mathieu and me to talk to you this afternoon about injuries linked to operational stress,

[English]

of which PTSD is the most well-known.

The problems associated with PTSD are not new. In past conflicts, PTSD was more commonly known as combat stress, battle fatigue, or shell-shock. Often the symptoms were misunderstood for cowardice and other weaknesses. But Canada has been at peace for a long time, and it is only in the past few years that our awareness of PTSD has resurfaced.

We need to remember that between 1953 and 1992, PTSD wasn't really an issue for the force because we were mostly engaged in a cold war operation, with little or no intense peacekeeping or combat operation. Since the early 1990s, however, CF personnel have been engaged in numerous operations, many under intense and hazardous conditions.

It's also important to remember that operational stress injuries are not limited to just combat operations. They can occur in a variety of circumstances. Included in this is the example of the Swiss Air crash disaster, where many military personnel who were involved in the recovery of the human remains and debris were greatly traumatized.

The more we have discovered about this problem, the more concerned we have become and the more we have done to both prevent it and to treat it.

As you are aware, over the past few years we have concentrated our efforts on quality of life improvements for our personnel. We have been undertaking a serious reform of our health care system

[Translation]

an in-depth reform, I must admit.

[English]

And we have launched several new mental health care initiatives, including a particular focus on the treatment of PTSD. We are committed to ensuring that those who suffer, whether it's from a physical or a mental injury, and particularly in the case of PTSD, get the right kind of treatment they need from qualified professionals in this field, be they military or civilian.

With respect to PTSD, we continue to dedicate significant resources to the prevention and treatment of PTSD and operational stress injuries, all of which are accessible to both regular and reserve force members. I will describe some of the initiatives we've undertaken over the last couple of years.

In 1999 we established five operational trauma and stress support centres, and in 1998 we set up the Canadian Forces members assistance program, which is a voluntary and confidential service to help members and their families with personal concerns of any kind.

The operational stress injuries social support project, also known as OTSSC, was created in May 2001, and in fact that's the project that was referred to by the previous speaker, headed by Major Grenier.

The mandate is to create a national peer support network for injured members, veterans, and their families. The first peer coordinator course is scheduled to start February 18 and will run until March 1 in Mississauga, Ontario, to be precise. Immediately after, the participants will then set up support centres in Edmonton, Winnipeg, Petawawa, and Halifax.

We chose four sites to pilot this project before we can expand it across the force. We need to learn how this will work, and I'm convinced that this will work and I'm expecting a great deal of success from it.

They also exist to validate the development of education packages and pre-deployment training modules, in partnership with health care professionals and the environment in the chain of command. They've also been tasked with taking a leading role to develop the methodology required to effect an institutional cultural change pertaining to the stigma around operational stress injuries.

Since April 1999, with Veterans Affairs Canada, we have opened a centre for the support of injured and retired members and their families.

Monsieur le président, the health and welfare of our troops are of the utmost importance to us. We are serious about this, and we will continue to implement programs and activities to deal with it.

When Mr. Marin tabled his report, the first thing this told us was that we are definitely on the right track but we still have a way to go, and we recognize that. We welcome the recommendation of the ombudsman, and in this regard, many have already something implemented or something in the making. For the remainder, if we can fast-track initiatives into place we will do it.

Part of the process of improving our capacity to respond to PTSD is in educating our members that operational stress injuries such as PTSD, although they're not visible, are injuries as much as any physical ones.

We need to continue to educate our members, and leaders particularly, that PTSD is real and treatable. Obviously, the report will assist us in doing so. In fact, we have conducted extensive pre-deployment training to ensure that our soldiers deploying to Afghanistan have the professional and peer support they need to deal with operational stress injuries such as PTSD.

With respect to PTSD, when caught, early chances of successful treatment increase.

» (1705)

Like a physical injury, the impact of PTSD on a service member can range from successful treatment and return to active duty to a long-term disability, which may leave the member with employment limitations or even make them unfit for duty. Unfortunately--and this is very unfortunate--in some cases this disability may leave the members unfit for service, and thus we have a responsibility to support their transition back to civilian life, with the support of both DND and the Department of Veterans Affairs.

Mr. Chairman, some people may have the impression that we discovered PTSD with the tabling of Mr. Marin's report and the content within. Well, let me assure you that we did not discover PTSD through this report. We have become increasingly aware over the last few years that PTSD is out there, and we have been investigating its causes and the manner by which we can treat it.

Nonetheless, we welcome the report and its recommendations. We are fully committed to take the necessary steps to look after our service members. Helping men and women suffering from operational stress injuries such as PTSD is a very demanding task. We recognize the need to continue improving the services in place for our soldiers. This report, of course, will help us very much to continue the progress we've made over the last three years.

I said three minutes and I took four, so I will stop here, Mr. Chairman, and I will answer any questions you may have.

» (1710)

The Vice-Chair (Mr. David Price): Thank you very much, General. That gets us started for sure.

Unfortunately, we have lost some members of the opposition. Strange how things turn about, but the new official opposition is the Bloc again.

Monsieur Bachand.

[Translation]

Mr. Claude Bachand: Thank you, Mr. Chairman.

Allow me to start by welcoming Lieutenant-General Couture, who is from the Royal 22ndRegiment.

LGen Christian Couture: [Editor's Note: Inaudible]

Mr. Claude Bachand: Likewise, Sir. I am always proud when a Quebecker or a French Canadian, as my colleagues might say, one of ours, rises right to the top. I am from the 22nd Regiment myself, from section 2 of 2nd Battalion, Group 3.

What comes after a section?

LGen Christian Couture : A platoon: company A, platoon 3.

Mr. Claude Bachand: Exactly. You know it better than I do. Did you look it up?

LGen Christian Couture: No, but I commanded the 2nd battalion.

Mr. Claude Bachand: I also want to welcome General Mathieu, who is a role model, because out of 70 generals, I think that there are only two women. I think that is important. She is a pioneer.

A lot of women talk to me about women who are generals in the Armed Forces. There are not many, so I think that you have a great responsibility as a woman as well. I would like to tell you that there are many women who admire you, because I hear about you regularly.

LGen Christian Couture: There's no doubt in my mind. All my colleagues at my level and even at lower levels are convinced that injuries resulting from operational stress are very real. They are very definitely genuine, there is no doubt in my mind about that, and people are sure of this.

The culture to which you refer is obviously passed on at all levels, even at the recruit level. Yes, we train strong individuals with mental and physical stamina, and some of them, who have already been on operations or who have simply done some exercises that are similar to a real operation, have had to show a great deal of strength and stamina. We are not necessarily talking about the strength required to lift very heavy weights, we're talking about mental and physical stamina. The English word “stamina” is perhaps more appropriate here.

In all the training that our leaders and members of the Canadian Armed Forces get at all levels, any reference to physical injury and its treatment always refers to visible, physical injuries, which are easy to see and analyze. An invisible injury is a concept that is extremely difficult to understand. Until you have experienced it, you can be given all sorts of explanations about what it is, and you will say“yes, right”. However, proper preparation, training and education will teach all the aspects of such an injury: its causes, symptoms, after-effects, the reactions it causes and the impact it can have. However, and particularly, this training could teach people that injuries of this type are very real and that unfortunately they cause certain consequences, just as physical injuries do.

When an injury of this type is treated and cured, or at least controlled—there may be a prosthesis available, to use the word used by General Dallaire a little earlier—and when the individual can function, it is up to us, whatever our rank, to ensure that people with such injuries receive proper treatment, that they are recognized for what they are and are brought back to their units as quickly as possible, if this can be done. That is why we have made a commitment with all the services that are part of my organization, including the medical services.

Unfortunately, this is not always possible. In such cases, we have to recognize this, and our responsibility, again, as military leaders, is to ensure that these people go back to civilian life in a proper, responsible and dignified way, with the assistance of the Department of Veterans Affairs.

» (1715)

Mr. Claude Bachand: I now have a question for General Mathieu.

I think I've read some reports recently that all acknowledged that there is a lack of doctors within the Canadian Armed Forces, and that it was difficult to hire them. I believe I also read in the ombudsman's report that there was a lack of therapists to treat post-traumatic stress syndrome. This shortage may be somewhat similar to rotations that are too frequent: these people are overworked. Without being a therapist myself, I imagine that it must be hard as well to listen to horror stories all day long.

Could you start by giving us an overview of the medical care available within the Canadian Armed Forces and tell us whether or not it is true that there is a shortage of doctors, more particularly as regards post-traumatic stress syndrome? Are there enough therapists available at the moment to help people who go to the therapy centres? Is there any specific recruitment plan in place, if you confirm that there is a shortage?

Brigadier General Lise Mathieu (Director General, Health Services, Department of National Defence): At the moment, there is a shortage of about 300 people in the staff providing services. We are short 50 doctors, nurses, social workers, medical assistants and other assistants. In addition, 3% of the staff, or about 60 people, are on long-term sick leave because of the heavy workload. There are about 30 others who are on what we call the SPHL, who are therefore in the process of returning to civilian life for the same reasons.

So care provider burn-out is definitely a reality: it is a major problem. It is also a difficult problem, in that the shortage of health care providers we are experiencing also happens in the Canadian community as a whole.

What I am saying is that I hire all the health care staff I can. Some health care providers are not available, but others are working elsewhere, and we are not managing to attract them to the forces, even though we are trying to do so. There's absolutely nothing stopping me from hiring all those individuals who would be prepared to come and work with us.

Mr. Claude Bachand: Will there be a second round?

» (1720)

The Vice-Chair (Mr. David Price): We will try.

Mr. Wood.

[English]

Mr. Bob Wood: I'll take up what Mr. Bachand was just talking about.

Mr. Marin was quoted as saying, Generals, that we lack a third of the necessary staff to help our soldiers returning from overseas missions.

To carry on from what Mr. Bachand said, how many people do we need? Do you know how many people we need--a ballpark figure--to help out people coming from various missions? You're about to set up four or five pilot projects, are you not?

LGen Christian Couture: The pilot project we're talking about is--

Mr. Bob Wood: PTSD.

LGen Christian Couture: --the OTSSC, the operational stress support network, and it's non-medical. It's a peer support group. It is in sync with the health care provider but it's outside health care. It does not involve psychiatrists, but they do have social workers and psychologists assisting them. If we don't have the people in uniform, we hire them from civvy street, if we can. In fact, we do have some civilian social workers and psychologists working for us.

One of the problems we face, as was mentioned by General Mathieu, is that in the civilian community there's a general shortage of those people. We know, as does everyone, that we do have a shortage of medical officers and some medical specialists. We're doing everything possible to find, attract, and recruit them. But to provide stable and continuous care in our garrison clinic--

Mr. Bob Wood: We're dealing with this report.

LGen Christian Couture: --including the PTSD, through a third-party contractor, we can hire civilian practitioners in the speciality we're looking for. Is this successful in every place? I'll ask General Mathieu to answer that portion. But what we don't have in uniform and we need, we go and buy the service from the civilian community.

Mr. Bob Wood: How much money are we talking about here? Is money a problem helping these people? Do we have the funds available to help these people on a professional basis?

LGen Christian Couture: I mentioned in my notes that we are renewing and rebuilding our health care system. As you know, health care is very expensive. I just finished my budget for the next fiscal year. For the medical resources we need I have almost everything I asked for. This includes the delivery of general health care and the money General Mathieu and her crew need to address some of the issues that are a consequence of the mental health issues.

Resources from a financial point of view at this moment are not a problem, because the department is committed to providing the necessary resources we need to attack this problem, this fléau--that's the only word that comes to mind. But sometimes even money cannot help, because we cannot find people with the proper qualifications.

Mr. Bob Wood: General Mathieu, do you want to add anything to that?

BGen Lise Mathieu: I would just echo what General Couture has said. I have no difficulty getting the resources I need to take care of people. What I have difficulty doing is buying the services outside, because there are shortages. But from my perspective, the dollars are not an issue.

LGen Christian Couture: In fact, from 1999 to 2002 we have doubled the budget for health care. That just gives you an idea of how serious we are in addressing the health care issues--the injuries, the casualties, the illnesses our people may have.

» (1725)

Mr. Bob Wood: Do you have any idea how much this would cost? Or is it too early to tell?

LGen Christian Couture: I don't think cost is an issue here.

Mr. Bob Wood: Good, I'm glad to hear that.

LGen Christian Couture: From my perspective, cost is not an issue here. As I said earlier, with respect to many of the recommendations, we already have something. We've thought of it or we have something in the making, and now we need to examine how effective it is or how effective it will be and make the necessary changes we need. So I don't think money is at stake for this injury.

Mr. Bob Wood: I should know this, but does this include reservists?

LGen Christian Couture: Yes, sir. The reserves have full access to this, particularly in the case of PTSD.

The Vice-Chair (Mr. David Price): Mr. Anders, five minutes.

Mr. Rob Anders: Are there soldiers in Afghanistan right now who suffer from PTSD? What I mean by that is we sent over a contingent from Edmonton with the third battalion, PPCLI, and it was estimated in Edmonton there were 750 soldiers--I believe that was the number I heard--

LGen Christian Couture: Were they going to Afghanistan?

Mr. Rob Anders: Yes. The 750 I'm referring to, though.... In Edmonton, we had a number of soldiers who were suffering from PTSD previous to the Afghanistan deployment. Because of our resource issues--I'll be polite, in terms of what I call it--were there people who probably have PTSD who were sent over to Afghanistan--in other words, they had PTSD or symptoms of it before they were sent?

LGen Christian Couture: We do have a screening process before we select people to go into operation, and I have every level of confidence that the screening process, when done appropriately, would have detected these cases.

Now, can I put my hand on the bible and swear that there's nobody that ever had any symptoms of PTSD, or does not carry any...? No, I cannot do that. But I have every level of confidence that those who may have had those injuries have been screened out for the mission.

But at that point, the troops who have been deployed or are deploying to Afghanistan have proper training, which I believe is sufficient pre-deployment training to help them recognize the symptoms and cope with what they could encounter. In addition to that, they are deployed with the necessary professional and peer support. Peer support is very important in a case like this--I can speak from experience--and they do have sufficient support of that nature. I'm very confident they are okay.

In addition to that, they have access to the coalition medical chain, medical support, which includes psychiatrists, psychologists, and so on. If at one point in time there is a reason to believe that's not enough, then we can adjust. But they are leaving the country, they are deploying into Afghanistan, with appropriate support with regard to this injury.

Mr. Rob Anders: Okay. I appreciate that.

I also note that on page 124 of your report, it says that spouses are frequently not consulted and that--

LGen Christian Couture: I'm sorry, sir.

Mr. Rob Anders: Well, I'm quoting from the report here, where it says on page 124, under item 747, that spouses are not frequently consulted, and it goes into problems you've had with your pre-deployment screening process.

So I understand what you're saying, but I also note that your report says it's not extensive and it's not done in all circumstances. It's kind of haphazard. It's done in some places and not in others. Fair enough. Okay.

The next question I'd like to ask is how long are we allowing for recuperation?

Mr. Dallaire was talking about 12 months or two years, in terms of recuperation time. He raised a question about what was being done for people to recuperate. And rest, basically, wasn't the only thing; they need more than that, in terms of recuperation, especially with regard to this. However, my understanding is they're not getting 12 months or 24 months to recuperate, so I'd like to find out what our recuperation situation is.

LGen Christian Couture: First of all, let me make a comment about the screening process. I don't think that I or anyone in my position ever said the screening process we have is a perfect tool. This tool is being perfected every time we use it. Whenever we do this kind of screening, there's always an examination afterwards as to how effective it is. If something happens in the theatre, the first question that will be asked is, what kind of screening did those persons go through? So we examine that on a constant basis.

In his report Mr. Marin talks about a standardized screening process and an improvement of the screening process, and I don't dispute that.

For those who have been injured with PTSD, how long does it take to recuperate? I don't know that. But for those who are coming back without any injury--and thank God they have no injuries--based on my personal experience, I assess a minimum of 12 months to recuperate.

Our policy right now is that nobody should be redeployed outside the country within 24 months of having returned, and only the chain of command can provide a waiver. We can go down to a year. If it's less than a year, then a waiver has to be signed. The person needs to be screened properly, because we understand there is a cumulative effect of multiple deployments, although we don't understand it all. It's something we are studying right now, and we hope we will find some answers to our questions.

We also have as a policy that within the first 60 days of people coming back from an operation they will not be sent anywhere. They will remain on the base or close to the base and close to home, taking some time off and being back with their family and trying to reintegrate into the Canadian way of life.

In addition to that, we are also introducing a post-return screening process, which includes a detailed questionnaire. It involves an interview administered by a social worker, a psychologist or psychiatrist, a qualified person, who will interview not only the member but also the family members within three to four months of coming back. Everyone is going to go through that process.

In doing this, what we hope to achieve is that if somebody has some symptoms but does not recognize them or we discover that somebody needs treatment, we will be able to provide that treatment. I firmly believe that if we can get them early enough, the chance for a complete recovery is on our side.

We have a ship coming back to Canada in about four or five days. In three months' time, which is some time in May, we will start that process.

We have never done that before. Before, we gave a questionnaire to the individual asking them if they had something during their tour. If the answer was no, then that was it. If the answer was yes, then a medical officer would see the individual and we would take it from there.

I have been deployed outside the country four times, and I have prepared, I would say, about a dozen contingents to go overseas. When soldiers are coming back, they have only one thing in mind: leave me alone and let me go home. Don't bother me with these kinds of questions and these kinds of tests. I want to go home. That worries us a little bit.

So we need that kind of questionnaire anyway, at least before they come back, but we need to revisit them later on. The indications are that a few months afterwards is a good time to look at them. We look at them also for other physical diseases they may have had, but this interview in particular will serve the purpose I just mentioned.

» (1730)

The Vice-Chair (Mr. David Price): Thank you.

Mr. O'Reilly.

Mr. John O'Reilly: Thank you very much, Mr. Chairman.

And thank you very much for attending. It's a pleasure to deal with experts.

I just want to lead you through something. I feel the off-base clinics are one method in this report that we should look at. Sending people to Afghanistan and to Kandahar is different from sending them to Kosovo and Bosnia and Macedonia and on peacekeeping efforts. This is a different type of stress. I have been in Kosovo and in Bosnia and it's certainly stressful. But I don't think it's anything like being shot at everyday or cleaning out tunnels where there are people who want to kill you. I think we're going to produce more of the cases you would see in a war situation rather than in peacekeeping.

The problem I see in our general population is that general medicine is changing. Family doctors now don't want to have a general practice. They don't want to deal with people who have emphysema and won't stop smoking, who are overweight and have high blood pressure. They get tired of walking into the office everyday, having 40 people there and knowing that they're not necessarily going to take their advice. Particularly the younger doctors now are insistent that you follow their instructions or go to a clinic.

I see the changing face of medicine as a problem. So when I see the off-base clinic as a recommendation, I think this solves a couple of problems, one being that you would deal with a 24/7 type of clinic or an emergency care situation that is popping up all over the country. They have the support staff. Even now, young doctors coming out of medical school don't know how to do an IV because there are IV teams or nurse practitioners who do the shots for flu and allergies. It used to be that when family doctors came out of the institution they were ready to take out an appendix and do all kinds of things. Now they're in a different situation. They end up gravitating to clinics; it gives them the team they need.

Noted somewhere in the report are comments indicating that social work colleagues do not have the skills specific to the treatment of PTSD. I look at this and ask what your resistance would be to off-base clinics that would provide the confidentiality and professionalism you need, if in fact you lack the ability to recruit professionals. It isn't only a military problem. All kinds of small towns in rural Canada have no doctor. People retire into my area, which is a vast rural area, and they keep their doctors in Toronto and Hamilton. They drive back there because they have trouble getting people.

Most doctors in rural Canada aren't taking on people and people end up going to clinics. Quite frankly, the clinics are becoming very professional, very general purpose, where anything can be done. They have a great base in psychiatry. I just wonder what your take on this is.

» (1735)

LGen Christian Couture: You used the word “resisted”. Who said I resisted?

» (1740)

Mr. John O'Reilly: Well, I asked if you did.

LGen Christian Couture: I didn't resist. I said this is a very interesting recommendation and it needs to be looked at very carefully and analyzed. An OTSSC type of clinic is a very highly specialized clinic. I don't think we would find the specialists we're talking about in every downtown clinic. We would have to create it with the proper specialists, both military and civilian, I suppose. That is not the issue, because this is doable.

What we need to look at is having a holistic approach. We talk about the stigma, we talk about the recognition, we talk about the people, the leadership, we talk about the education, and so on. This recommendation is a pilot. We need to determine where we should pilot and what we should pilot. How do we measure the relative success compared to others? And so on.

I never said I resisted it. If people think I'm resisting it, well, I guess maybe I was using the wrong words. I'm not thinking either that I'm going to jump and do it right away, because I want to know exactly what I'm getting into. I don't want to use my soldiers as guinea pigs. I don't want to waste resources either. So I have to learn and I have to study very carefully what I'm getting into.

In fact, I'm not afraid of going outside the base. The OTSSC project, the four pilot projects, will be starting as of March 1 in Edmonton, Winnipeg, Petawawa, and Halifax. It's Halifax or Victoria, because we need the people. They will be downtown. This OTSSC project is something we do in sync with Veterans Affairs Canada. In places we will be using their office space, or if we cannot, we are in discussion in some places with the legion to use the legion hall.

So I'm not afraid of going off base. If people think I don't want to go off base because I'm wearing the uniform and I want everything in-house and so on, that's totally wrong. I need to find out exactly what I'm getting into.

Mr. John O'Reilly: Mr. Chairman, I don't think I suggested that there was anything--

The Vice-Chair (Mr. David Price): You are quite a bit over time.

Mr. John O'Reilly: I know, but I think we're onto something here.

Some hon. members: Oh, oh!

Mr. John O'Reilly: I'll give you some of my time.

The Vice-Chair (Mr. David Price): You have 10 seconds.

Mr. John O'Reilly: The actual off-base clinics are not just what I was referring to as general medicine, but they also refer to psychiatric clinics that are available in some rural locations two days a week. So it's only to get a referral--

LGen Christian Couture: Oh, I see your point. Mr. O'Reilly, we do that all the time. I'm sorry I misunderstood you. I thought you were saying that I was against going off base, which is wrong. That's my fault.

Mr. Chairman, I apologize for having taken his time, but let me tell you one thing. We said a while ago that we are short of some specialists. Sometimes they exist downtown, so we refer patients there all the time. If that's what you were referring to, yes, we do that all the time.

Mr. John O'Reilly: Okay, that was my bottom line. Thank you.

[Translation]

The Vice-Chair (Mr. David Price): Thank you very much, General Couture and General Mathieu.

We have taken a little longer than planned. I hope that will not be too expensive in overtime.

A voice: Mr. Chairman, I am paid 24 hours a day, seven days a week.

[English]

I am on duty.

[Translation]

The Vice-Chair (Mr. David Price): I do not think this is the last time we will see you here, because this is a matter that is of increasing concern to us.

LGen Christian Couture: Certainly, Sir. In addition, there's the report tabled by Mr. Marin. We do not intend to simply look at it once and then set it aside. In fact, I have informed my staff that we must maintain contact with the ombudsman. We will do so, because there will sometimes be something on which we want some sort of clarification. We want to know exactly what was said.

The Vice-Chair (Mr. David Price): You and Mr. Marin spoke about the quality-of-life report, which must be tabled in Parliament every year.

LGen Christian Couture: We are in the process of writing it. I saw the draft version last week.

The Vice-Chair (Mr. David Price): Thank you very much.

The meeting is adjourned.