NDDN Committee Report

Dissenting Opinion of the Official Opposition to the House of Commons Standing Committee on National Defence Report on Caring for Canada’s Ill and Injured Military Personnel

When I was in the hospital in Afghanistan, I spoke to my father on the phone. My dad said, “Don't worry, Canada will take care of you. You stepped up like we always have and you did your part, and Canada will do its part. It's only fair. Everything will work out.” My dad was wrong.I am broken and can't be a productive, useful soldier. I wanted to be a cop someday, like my dad, but again, I'm too damaged and now I don't meet their standards. The bottom line is that we all stood up and offered to make the ultimate sacrifice for our country.

Corporal Glen Kirkland, June 5, 2013

Introduction

1. While we agree with many elements of the committee’s majority report, we, the Official Opposition committee members, wish to express significant concern that several issues in the majority report have not been accorded appropriate seriousness given the gravity of the subject at hand. In addition, there are a number of issues that do not appear in the report, or are only briefly mentioned, that we believe should be given a higher priority and emphasis when considering the care of Canada’s ill and injured military personnel. In general, we remain uncomfortable with the overly positive tone that runs throughout the text of the report. As illustrated in much of the testimony we heard during this study, the Department of National Defence (DND) has often been reactive to complaints rather than proactive in its treatment of Canada’s ill and injured military personnel – particularly when it comes to services for those psychologically damaged, and their families -  and we therefore feel consistent praise for their efforts is unwarranted. Moreover, several majority report recommendations are akin to those from the committee’s 2009 report, “Doing Well and Doing Better: Health Services Provided to Canadian Forces Personnel with an Emphasis on Post-Traumatic Stress Disorder,” suggesting that this report has not been given the necessary attention by the Government of Canada. Finally, we wish to express serious concern that the majority report was adopted in just one committee meeting lasting little more than an hour, an extraordinary decision that we find particularly worrying after a two-year-long study on this critical issue affecting thousands of Canadians. Our experience has been that rigurous committee discussion and debate has strengthened recommendations contained in reports from committees.

Recruitment and Pre-Deployment

2. Throughout this two-year study, Operational Stress Injuries (OSI), including Post-Traumatic Stress Disorder (PTSD), were consistently raised in testimony as some of the most serious health problems facing Canadian Armed Forces (CAF) personnel. Although statistics on this issue are sorely insufficient, one study reports that over an eight-year period following their first deployment in Afghanistan, approximately 20 percent of Canadian service personnel were diagnosed with a mental health disorder attributable to their service there.[1] This study was conducted both prior to and following the increased tempo of operations in Afghanistan, and therefore does not represent the full impact of the mission there, including increased psychological injuries due to the passage of time. With the end of our mission in Afghanistan, Canada must prioritize the treatment of PTSD within the military community. An important facet of future treatment begins with robust screening for mental resiliency in the recruitment and pre-deployment stages. Dr. Harvey Moldofsky, Professor Emeritus with the Department of Psychiatry, Faculty of Medicine at the University of Toronto, told the committee that he submitted a grant application to the Government of Canada to study predictors and symptoms of PTSD during the early stages of Canada’s mission in Afghanistan. Unfortunately, Dr. Moldofsky never heard back from the Government.[2] Although anecdotal, Dr. Moldofsky’s experience suggests that OSIs have not been accorded necessary attention and investigation. We therefore recommend that Canada significantly augment its research efforts into PTSD and OSIs to ensure that mental health screenings at the recruitment stage are as rigorous as possible, and that treatment for those suffering are as effective as possible.

In-Theatre

3. The committee heard compelling positive testimony about the successes of tactical combat casualty care, and the Role 3 hospital, in saving lives on the battlefield in Afghanistan. We join in applauding these efforts, but are also concerned that there did not appear to be the same level of emphasis on in-theatre care for psychological injuries in Afghanistan. During that mission, deployed mental health teams consisted of a social worker, a mental health nurse and a psychiatrist. Brigadier-General Jean-Robert Bernier informed the committee that psychologists were not deployed because the CAF only employs civilian psychologists, and “only deploy military personnel abroad”.[3] Military personnel needing psychological care in-theatre were treated by American psychologists. This reliance on our allies is problematic, particularly for cultural and language issues. Clearly, as the testimony from veterans and their families demonstrates, the consequences of psychological injures can be as serious and debilitating as physical ones. This leads us to recommend that Canada expand its deployable mental health care teams, including psychologists in uniform, to treat mental trauma in-theatre, and ensure that these mental health services are offered in both official languages. These teams should operate under status comparable to physical trauma teams.
4. We were very concerned to hear the testimony of Bombardier Geoffry Logue, who was repatriated to Canada after being diagnosed with severe PTSD in Afghanistan. Bombardier Logue recounted his repatriation experience:

I was repatriated to Canada on a civilian flight. I had no decompression time. My decompression was at the Boston Pizza in Portage la Prairie, Manitoba. I was presented a leave pass and told that I had the next two months off. I didn't have any support. I didn't have anyone to go to.[4]

Bombardier Logue’s story is shocking. As several military officials pointed out to the committee, when and how psychologically injured military personnel return from deployment is critical to their future wellbeing. We therefore strongly recommend that Canada investigate Bombardier Logue’s repatriation experience, and implement the appropriate procedures to ensure that it is not repeated.

Diagnosis and Treatment

5. We are concerned by DND’s difficulty in hiring and maintaining sufficient numbers of clinical psychologists, social workers, mental health nurses, and psychiatrists, especially for francophone CAF personnel. In 2013, then CAF/DND Ombudsman Pierre Daigle testified that DND had never reached its goal of hiring 447 mental health staff – a goal recommended in 2002 – but was instead 22 percent short.[5] This is particularly concerning given that this goal was recommended before the vast majority of the 40,000 Canadian service personnel that served in Afghanistan were deployed there, and before many of the mental health effects of the mission began to surface. Moreover, this staff shortage only began to be corrected in the spring of 2014. Although BGen Bernier stated that DND is “committed to hiring social workers, mental health nurses, and psychiatrists to the extent possible”,[6] these efforts need to be successful in order to ensure that all serving members, both Anglophones and Francophones, have access to necessary mental health care. We recommend that DND put in place the conditions needed to achieve the objective set in 2002 of hiring 447 mental health staff. We also recommend that DND immediately determine whether this objective needs to be increased in light of new needs following the return of 40,000 Canadian troops who served in Afghanistan.
6. The committee heard worrisome testimony about misdiagnoses, especially of military personnel suffering from psychological injuries. Two instances in particular stand out for us in which military personnel suffering from PTSD were treated for alcoholism. Mr. Gregory Woolvett told the committee that his son, who served in Afghanistan, was diagnosed with catastrophic PTSD in 2010, but was initially treated for alcoholism. “When it comes to this specific injury—post-traumatic stress disorder—it's misdiagnosed and characterized as something different,” he testified.[7] The treatment his son received was therefore highly unsuitable. The committee was also contacted by a veteran, Murray Wilkinson, who wrote of suffering a similar experience when he was enrolled in a 12-step alcoholism treatment program by the CAF, but was in fact suffering from PTSD. We recommend that mental health professionals working within CAF/DND receive more robust training regarding the signs and symptoms of PTSD so that appropriate treatments are administered.
7. Insufficient financial coverage for medications and prosthetics was also raised as a serious concern before the committee. For example, Cpl. Glen Kirkland sustained severe injuries while serving in Afghanistan when a rocket explosion hit the Light Armoured Vehicle he was traveling in, killing three fellow soldiers. As a result of the explosion, Cpl. Kirkland lost 75 percent of his hearing, and sustained a brain injury that caused his body to stop producing insulin. When he was prescribed insulin to keep him alive, coverage was denied due to the cost. Moreover, when Cpl. Kirkland was prescribed hearing aids with amplifiers, and as a result needed special eyewear to accommodate the aids, he recounted that the base medical officer said he had to choose: “I was told that when I leave my house I would have to make a decision about whether I would need to see more or hear more that day.”[8] While this may not be the policy of the military, we find Cpl. Kirkland’s treatment shocking. The committee was contacted by other military personnel who experienced, and are still experiencing, similar difficulties in obtaining appropriate medication and prosthetics for their injuries. Based on this evidence, we recommend that Canada ensure that appropriate funding is allocated to cover the costs of prescription medications and prosthetics to treat injuries and illnesses sustained by military personnel.
8. The committee heard from occupational therapists (OTs) about the various health care services – for both physical and mental health – that they could provide to military personnel and their families. In fact, this profession emerged during World War One in order to assist soldiers transitioning back to civilian life. Currently, there are only two OTs working with DND across Canada.[9] Elizabeth Steggles of the Canadian Association of Occupational Therapists (CAOT) informed the committee that these OTs have had significant success with, for example, the return to work program. In step with a recommendation from CAOT, we recommend that a total of eight OTs be hired by DND to assist military personnel and their families struggling with mental and physical injuries.
9. Similarly, the Canadian Chiropractic Association presented useful evidence about chiropractic services offered to United States military personnel, and the effectiveness of such treatments in keeping people at work.[10] We therefore recommend that consideration be given to the CCA’s proposed musculoskeletal strategy.
10. Colonel Gerry Blais assured the committee that all of the programs offered by the CAF’s Joint Personnel Support Units (JPSU) “are for everyone”.[11]  However, Col. Blais’s statement that “[w]e treat all our injured and sick members in the same way” [12] does not reflect the specific psychological and social aspects of women service members experiencing PTSD and other mental health issues, and particularly those who have suffered military sexual trauma. Reintegration programs and mental health services should take into account the higher rates of sexual assault women service members suffer while deployed in Canada and abroad.[13] Moreover, as Heather Allison, mother of a single-parent female medic, highlighted in her testimony, since women are often the primary caregiver in families, DND should provide specific reintegration programs that help women service members with children during their post-deployment phase.
11. We applaud the volunteer peer-to-peer support services provided at the JPSUs alongside that of public service employees. It is important and imperative, however, that all efforts be made to provide these services in both official languages, regardless of the location of the military base/installation. This needs to apply to both volunteers and employed service staff. The fact that the level of bilingualism of public servants (and one would assume volunteers as well), as Col  Blais said, “…depends on the position and the region”[14] should not preclude CAF personnel from getting access to necessary services.  CAF personnel of both official language communities serve across Canada and need to be able to access care in their preferred language.

Reservists

12. We feel this study did not adequately explore the health care issues facing reservists. In Afghanistan, reservists augmented regular force troops significantly, often comprising 20 percent or more of a total deployment. In light of the testimony we heard on this topic, particularly from Ombudsman Daigle, we recommend that access to health care services, including mental health services, for CAF reservists be expanded in terms of both geography (i.e. remote locations) and duration (post-deployment). Not all reservists live near a military base or near a major urban centre, but this should not hinder their access to appropriate care and treatment. Deployed reservists should have access to health care services for an amount of time equal to that of regular force members. As Ombudsman Daigle stated, “…when they return to the unit to which they belong, after being on an operation, they are in a more isolated situation. They are no longer supported or overseen as they were in the unit where they were deployed. In those cases, there are many of them who do not have access to these services.’’[15] Moreover, based on the testimony of the Ombudsman, we recommend that Canada promulgate permanent policies and regulations that clearly identify reservists’ medical entitlements, and that these entitlements be better communicated not only to reservists themselves, but also to medical personnel treating reservists, so as to prevent confusion.

Military Families

13. The deployment of military personnel has tremendous effects not only on those serving, but also on their families. Gregory Woolvett, father of a medic deployed to Afghanistan, told the committee that “the soldier went to war, but the family went with him.”[16] Family members of military personnel informed us of concerns about their lack of preparation, consultation and involvement when their loved one is ill or injured while serving. Heather Allison, whose daughter served in Afghanistan, recounted how her inquiries about PTSD were rebuffed by counsellors at a Military Family Resource Centre (MFRC), who told her: “We're not going to talk about that. We'll have that discussion a couple of weeks before your soldier comes home.’”[17] As the majority report acknowledges, it is clear that commanding officers and MFRCs are not consistent in reaching out to military families about the support and resources available to them. We recommend that commanding officers and/or staff from MFRCs reach out to military families as soon as possible – each and every time their military loved ones deploy – to connect them with the military community and the resources available to them.
14. Spouses of military members expressed concerns about the lack of consultation and involvement accorded to them during the treatment process of their loved ones in uniform. During the committee’s visit to Canadian Forces Base Petawawa in December 2013, one military spouse recounted that it took her four years to receive counselling to assist her in dealing with her spouse’s PTSD. Another military spouse contacted the committee to express concerns that:

Spouses worry about their partner's return from missions. They want to support them. But they may have no idea what to look for or how to assist. Generalized and vague answers in reintegration seminars create more confusion, not less…The spouses provide care daily, and deserve to be provided with the tools to enhance, rather than hinder, that treatment.[18]

The conclusion we reach is that there is an express need for the spouses of military members to be intimately involved in the treatment process, with education, training and counseling offered to them by CAF/DND, all with the aim of caring for the military member. Canada should undertake this training and support for spouses immediately. This will also strengthen the wellbeing of the family unit, a particular concern given that a recent survey by the Defence Research and Development Canada (DRDC) found that one-fifth of military spouses reported that they thought about ending their relationship with their partner during their partner’s deployment.[19]

15. In its 2009 report “Doing Well and Doing Better,” the committee recommended that the federal government work with provincial and territorial governments to enhance relationships between local community health services and CAF health services. With 80 percent of military members and their families now living off military bases, the increasing dependence on provincial/territorial health care services is a growing challenge. Based on evidence presented before the committee, it was not clear that this challenge is being appropriately addressed by DND/CAF. We therefore recommend that Canada redouble its efforts to enhance relationships between CAF health services and local community health and social services in order to improve timely and appropriate access for CAF personnel, including reservists, and their families. We further recommend that Canada initiate cooperative programs to offer incentives to qualified professional health care workers to provide their services to CAF personnel, including reservists, and their families, in locations where there is a shortage of such services.

Transition

16. While the committee was conducting this study, troubling reports surfaced of military personnel being medically discharged just before they reached 10 years of service, and would therefore not be entitled to a full military pension. Cpl. Kirkland was among those speaking out on this issue.[20] The committee heard mixed results regarding the return to work rates of ill and injured CAF personnel. For example, Major General David Millar stated that as of March 2014, the return to work program had a success rate of only 23 percent. These troubling statistics lead us to strongly endorse Recommendation 1 from the House of Commons Standing Committee on Veterans Affairs June 2014 Report, “The New Veterans Charter: Moving Forward”, which precludes medical release of CAF members unless all criteria set forth in Recommendation 1 are met, and includes the recommendation that a committee be struck to ensure uniformity of criteria, services and benefits for CAF members and veterans.[21]
17. In tandem with the previous recommendation, we urge Canada not only to consider examining the Universality of Service requirement, as outlined in Recommendation 27 of the majority report, but to undertake an examination of this principle in a modern context as soon as possible. In his 2012 Report, Fortitude Under Fatigue, Ombudsman Daigle made the same recommendation. As he told the committee, the rigidity of this principle may be preventing military personnel from coming forward to seek care, particularly with psychological injuries. He argued that in today’s context, there are likely ways of “doing it differently without affecting the operational effectiveness”.[22]  
18. We are concerned that Recommendation 31 of the majority report with respect to  the responsibility of the Government of Canada to our ill and injured CAF personnel. While the efforts of third-party organizations and charities are of great assistance, these should not be relied upon to replace governmental efforts to provide support and services to CAF personnel. Non-governmental organizations that help with soldier-to-civilian transitions are beneficial to military personnel looking to make career transitions, but it remains the responsibility of DND/CAF to provide the proper support to all service members, and in both official languages.

Sacrifice Medal

19. The Sacrifice Medal recognizes sacrifices made by CAF members and those who work with them who have been wounded or killed under honourable circumstances as a direct result of a hostile action or action intended for a hostile force. BGen Bernier told committee that “the fact that we award the Sacrifice Medal to people who wish to receive it, who have suffered an operationally related operational stress injury, send a very clear message”.[23]Unfortunately, the application of the criteria has, for example, excluded those suffering from PTSD as a result of treating or assisting soldiers severely injured in battle. We recommend that Canada review the criteria and policies regarding the Sacrifice Medal so that deserving CAF personnel receive it.

Boards of Inquiry

20. For months, we have expressed concerns about the 70 outstanding military Boards of Inquiry (BOIs) into the suicides of military personnel – some of which have been outstanding for five years. We were dismayed by MGen Millar’s simplified characterization of BOIs as “an administrative process to assign attributability for the purposes of Veterans Affairs benefits”.[24] In fact, according to Defence Administrative Order and Directive (DAOD) 7002-1, a BOI is convened if, among other reasons, a CAF member is suspected to have wilfully caused their own death, and in order to investigate the circumstances and possibly make recommendations so that future incidents can be avoided.[25]  Done in a timely manner, BOIs could possibly assist in preventing future soldier suicides by highlighting issues or triggers that might partly lead to such tragic events among current and former CAF members. We therefore recommend that Canada ensure that all outstanding BOIs into military suicides be completed as soon as possible.
21. We are equally concerned by the tracking of suicides of current and recently released military personnel. MGen Millar told the committee that while regular male force, women and reserve force suicides are all tracked, only regular male force statistics are publicly reported.[26] Moreover, veteran suicides are not tracked, despite the fact that the percentage of deaths attributable to suicides is 45 percent higher among veterans than among current CAF personnel. In order to better comprehend and prevent future suicides among current and recently released CAF personnel, we recommend that each of these groups be tracked by the CAF, and that these statistics be publicly released on an annual basis.

Research and Innovation

22. In order to measure the extent of physical and psychological injuries currently affecting members of the CAF, it is imperative that Canadians have access to reliable, up-to-date data. Unfortunately, for OSIs, committee members had to rely heavily on data from a 2002 Statistics Canada survey, before Canada’s significant engagement in the Afghanistan conflict. A more recent Statistics Canada study has yet to be released.[27] We find this extremely disappointing. Ombudsman Daigle told the committee: “Without reliable data, it is very difficult to understand the extent and seriousness of the problem, and design and implement effective national programs to help those suffering from an operational stress injury.”[28] We recommend that Canada undertake the recommendation of former Ombudsman Daigle to create a national database that would accurately reflect the number of Canadian Forces personnel, including reservists, who are affected by operational stress injuries. This was Mr. Daigle’s first recommendation as Ombudsman, and should finally be implemented.
23. Arm’s length research in military and veteran health is taking place at universities across Canada. Such research serves an important role in filling current gaps in knowledge about this pressing issue. Dr. Alice Aiken is Director of the Canadian Institute for Military and Veteran Health Research (CIMVHR), an independent institute made up of 25 Canadian universities that undertake research into the needs of Canadian military personnel, veterans, and military families. According to Dr. Aiken, “In terms of funding and sustainability, the short answer is that we're not.”[29] We understand that CAF/DND does contract research through CIMVHR. However, we recommend that Canada contribute to a significant and independent research fund that would allow the CIMVHR, through its partner institutions, to undertake self-directed research into the health issues affecting CAF personnel, veterans, and their families.