Ill and
injured soldiers must be a higher priority for government
Liberals
believe that full support of ill and injured Canadian Armed Forced (CAF)
members and their families is a sacred obligation earned by their service to
the country. We wish to express appreciation to the witnesses who shared their
views and ideas, to procedural services who ensured smooth operation of the
committee throughout our deliberations, and particularly to our Library of
Parliament analysts for their hard work and dedication to the Standing
Committee on National Defence’s study on Caring For Canada’s Ill and Injured
Military Personnel.
Much of the
text is a thoughtful exploration of the testimony heard by this committee;
unfortunately, the recommendations of the report are not reflective of the
urgency and very real concerns expressed by many witnesses who appeared before
committee. While we appreciate the attention paid to issues such as the stigma
of mental health issues and the need for transition support, the prevailing
theme of “continue to support” or “continue to recognize” implies action on the
part of the government that simply has not occurred. We are deeply concerned
that the criticism levelled by many witnesses and the concerns expressed are
not given more weight in the recommendations.
Furthermore,
the minimal consideration given to this report in committee does a disservice
to the over two years of meetings and deliberations. It is a disservice to the
many witnesses who appeared and submitted input over the more than two years
this study was undertaken, to the advocates who attended committee day after
day, and to the men and women of the Canadian Armed Forces who look to
Parliament to ensure their needs are met. Particularly given the length and
scope of testimony, the time provided to deliberate on this report was
completely unacceptable.
Lack of
Concrete Recommendations
An overarching
issue running throughout the report’s recommendations is a lack of specificity.
Conceptually the Liberal Party supports the ideas behind many of these
recommendations, but we have concerns that the level of direction being
provided to the government is inadequate when concrete actions and benchmarks
are not identified.
By our count, 12 recommendations are built on the same
“continue to…” or “maintain….“ model. If the testimony heard at committee and
elsewhere from ill and injured CAF members and their families are any
indication, the government is not doing nearly enough. To merely encourage the
government to continue along this path of inaction is an insult to those
raising concerns about the quality of care they receive, and yet another
example of the government turning a blind eye to those in need of care and
compassion.
Similarly,
there are several recommendations that merely “encourage” the Government of
Canada or DND and the CAF to take action. To take just a few examples:
Recommendation 16 states that “The Committee recommends the Government of
Canada encourage the completion of all outstanding boards of inquiry into
military suicides.” Recommendation 10 asks the Government of Canada to
“encourage the Canadian Armed Forces to implement a policy that strongly
discourages military superiors from asking subordinates details of a medical
issue, unless the immediate health and safety of the member or his unit members
are at risk.” In cases such as these, the Committee needs to do more than
encourage, it needs to demand action.
In addition to
these overarching concerns, we have specific concerns about the tenor - or
absence - of recommendations, some of which are enumerated below.
Mental
Health Services inadequate for post-Afghanistan casualties
The Liberal
Party has deep concerns about the mental health services available to CAF
members. According to the government’s response to an order paper question in
December 2013, over half of all CAF bases did not have a single psychiatrist on
staff, and a full forty percent had neither a psychiatrist nor psychologist on
staff. This fact alone should raise serious questions about the level of mental
health care available to CAF personnel based in Canada.
Despite
persistent questioning, we found it difficult to ascertain exactly where these
gaps were being filled when provided with aggregate figures. Furthermore, even
the department’s own officials were unable to identify specific remaining gaps
to be filled. When we asked the Assistant Deputy Minister, Human Resources -
Civilian at the Department of National Defence how many of the recent hires
made were psychologists and psychiatrists, and how many of the remaining gap
are psychologists and psychiatrists, she responded that she “[didn’t] have a
number for psychiatrists.”
Even under
direct questioning in a parliamentary committee, we were unable to get the most
basic information about staffing levels in crucial mental health professions.
In our view, this issue calls for greater transparency. To that end, we
recommend the following:
That the Department of
National Defence and the Canadian Armed Forces make publicly available
quarterly reports about the number of psychiatrists, psychologists, medical
doctors and nurse practitioners available at each CAF base/location, as well as
the ratio of patients to provider for each.
While deployed
overseas, we have similar concerns about the care available to CAF members. A
particular area of concern is the lack of uniformed clinical psychologists in
the CAF. While CAF members can access psychologists in Canada - at least on
bases where they are available - those psychologists are civilians and cannot
be deployed overseas. Instead, we are forced to rely on our allies for
psychological services in theatre. This presents challenges not only on a
cultural level, but on a linguistic level as well, with the burden falling
disproportionately on francophone CAF members. The potential for disparities in
care to emerge based on language is troubling, and deserves further
investigation.
The need for
uniformed clinical psychologists was not an area of concern that the CAF was
forthcoming about in committee; it took an Access to Information request to
discover this was an issue that the CAF itself was concerned about. When asked,
directly, BGen Jean-Robert Bernier stated that “until now, we haven't found a
need for it because the only reason we would have them in uniform is for
deployed operations” while a briefing note from the CAF’s own Director of
Mental Health stated that “...there is strong indication that the addition of a
uniformed clinical psychology capability would greatly enhance the mental
health care of CAF members…” BGen Bernier later stated that an evaluation of
the need for uniformed clinical psychologists would be “out by the end of
April.” To our knowledge, this report has not yet been made available to
members of the committee, or to the Canadian public as of June 2014.
“Universality
of Service” increases severity of PTSD
The Liberal
Party of Canada believes that the universality of service must be re-examined
and either amended or scrapped. Universality of service is the principle that that
every CAF member must be fit for deployment. If not, he or she may not remain
in the CAF but must be transitioned out of the military.
Furthermore,
the fear of being forced to leave the CAF is cited as a key reason many injured
members fail to request help.
The existing
application of universality of service regulations pushes people out of uniform
before they are ready - ignoring their continued desire and ability to serve -
and should thus be re-examined and improved.
While we are
heartened to see the issue of universality of service raised in the report’s
recommendations, recommendation 27 does not go nearly far enough.
In 2009, the
Committee issued the following recommendation, “encourag[ing] the Minister of
National Defence and the Canadian Forces to continue to strive for the
compassionate application of existing regulations regarding universality of
service...” and recommended continued employment of recovering soldiers.
Clearly, encouragement from the Committee is not enough.
Sexual
assault in the Canadian Armed Forces cannot be tolerated
The Liberal
Party is dismayed by the absence of transparency and apparent lack of
commitment to reducing sexual assault in the military.
The report
does not contain a single reference to sexual assault. In the opinion of the
Liberal Party of Canada this is a glaring omission. The link between sexual
assault either in the theatre or at home and PTSD is well established,
particularly for female service members.
In our view,
it is necessary to address prevention and treatment not only of combat-based
PTSD in the CAF, but to address other causes of service-related PTSD such as
sexual assault. To that end, the Liberal Party of Canada recommends the
following:
That the Department of
National Defence and the Canadian Armed Forces conduct a formal evaluation of
sexual assault prevention programs with a view preventing sexual assault and
the resulting to adverse mental health effects.
The Liberal Party of
Canada recommends:
That the Department of
National Defence and the Canadian Armed Forces conduct a formal evaluation of
the response process and support services available to CAF members affected by
sexual assault and ensure that these support services are integrated within the
existing mental health care framework with an emphasis on PTSD.
he Liberal
Party of Canada additionally recommends:
That National Defence and CAF annually post a public
report of incidences of sexual assault and measures implemented to reduce
and/or eliminate this abhorrent problem.
Inadequate Support
for the Caregivers
The Liberal
Party believes that added resources and support must provide for families, and especially spouses, who shoulder the lion’s
share of the burden of caring for ill and injured service members. In the words
of MGen David Millar: “families are the lifeline for our members. Our spouses
are the lifeline. They are here today.”
By our count,
only three out of 32 recommendations even make reference to military families,
and none of them make reference to the need to address the concerns of military
families
Testifying
before committee on June 3rd, 2013, Ms. Heather Allison - the mother of a
service member suffering as a result of her service in Afghanistan - said the
following:
“I am just new at this;
my daughter has just returned. She's been back a year. In that short time,
we've dealt with two ODs. The most recent was in March. We got a call. Actually
a friend, another army buddy, called. The base didn't even call me, which I
find really strange, since I am the next of kin. She's a single parent. But yet
I don't get a call.
This is a problem I'm
having. As parents, it doesn't appear we have any rights. I know they're older,
but they're still our children. I'm sure your mom’s all want to know where you
are, if you're driving on the highway, if you're safe. Well, we're no different
as soldiers' parents.”
Even as next
of kin, she was notified by a friend, rather than the CAF, of her daughter’s
overdose. A greater effort needs to be made to incorporate family members -
with the consent of the CAF member - into the treatment of ill and injured CAF
personnel. This needs to occur not only when the CAF member is in distress, but
throughout the CAF member’s treatment.
In our view,
the recommendations of the report do not reflect the importance of family
member support in the treatment process, nor do they provide the necessary
recommendations to support family members.
Dedicated
transparent government action required
Liberals
believe that improvement in conditions for ill and injured members is a high
priority for all Canadians. Throughout the Committee process, Liberals raised
concerns about the absence of action by this government on many of the 36
recommendations the Standing Committee on National Defence’s 2009 report on ill
and injured soldiers, especially those suffering with PTSD.
In many cases,
the recommendations provided in that report were far more concrete, measurable,
and indeed more actively addressed the practical concerns of ill and injured
CAF members and their families, than the recommendations contained in the 2014 report.
For example, the following is recommendation 23 from the 2009 report[1]:
“The Department of
National Defence should immediately provide enhanced transportation resources
(such as modern multi-passenger vans or highway cruiser buses and drivers) to
isolated military bases to ensure that military personnel and family members
have adequate transportation for access to out-of-town health care services and
medical appointments.”
This is a
clear, tangible recommendation that would have a very real impact on quality of
life for injured service members and their families, and yet to our knowledge
it has not been implemented across the country.
Indeed, in his
testimony before the Committee, Cpl Glen Kirkland expressed his frustration at
the both the distance from his base (CFB Shilo) and the burden the commute
placed on him, saying:
“It was Deer Lodge in
Winnipeg, which sounds like it's great, but it's a two-and-a-half-hour drive,
and the whole way, driving there and back… I don't really understand why the
main mental health clinic is two and a half hours away from the closest combat
arms base.”
The Committee heard
this testimony on June 5th, 2013. Had the earlier recommendations from this
committee been monitored and implemented, this might have been one less
obstacle to care facing CAF members like Cpl Kirkland.
This is but
one example of a larger pattern. We have seen no evidence that the government
has made any effort to follow up by analysing and reporting on the progress or
non-progress on the Committee’s 2009 recommendations. To that end we recommend
the following:
That the Standing
Committee on National Defence request annual progress reports based on these
recommendations and from those of the committee’s previous report on PTSD from
Department of National Defence and the Canadian Armed Forces, and that they be
submitted to the committee for review.
In our view
this would provide at least a minimum level of accountability for following
through on committee recommendations, and would help prevent yet another report
on this important topic from gathering dust on the shelves of DND Headquarters.
Canadians
expect better
Canadians and
the Liberal Party believe that Canada can and must improve prevention, care,
and support for ill and injured soldiers.
In our view,
this report -- like the system designed to support ill and injured CAF
personnel more broadly reflects the ideas and dedication of many people who aim
to contribute to improvement and solutions. However, it falls short of its
potential and is plagued by a lack of transparency, and a lack of
accountability. If the CAF and DND are not forthcoming with the number of
mental health professionals available to CAF members, how can access be ensured?
Without external monitoring and follow-up, what assurances do we have that
these recommendations will be implemented? The existing report framework - and
the existing CAF health care system - gives few assurances.
This is an
important study, but fundamentally an unfinished one rushed to conclusion at
the expense of discussion and a thoughtful process and improving the
Committee’s Report. Many of the recommendations found in the preceding pages of
the main report tackle important issues; unfortunately, too many are a call to
complacency and not a call to action.
The Liberals
are strongly of the view that the men and women who willingly put their lives
on the line for Canada deserve better.
Respectfully submitted,
Joyce Murray, M.P. Vancouver Quadra