NDDN Committee Report

Hon Peter Kent
Chair
Standing Committee on National Defence
House of Commons
Ottawa, Ontario
K1A 0A6

Dear Mr. Kent:

Pursuant to Standing Order 109 of the House of Commons, I am pleased to present the official Government Response to the Standing Committee’s Report on “Caring for Canada’s Ill and Injured Military Personnel” tabled in the House of Commons on 12 June 2014.

We thank you for your report and its recognition that members of the Canadian Armed Forces have access to the best care available in Canada. From enrolment to release and transition to civilian life, military personnel are managed by a comprehensive set of personnel strategies that guide individual career management and professional development, provide access to one of the finest health care systems in Canada, and deliver a morale and welfare system that caters to individual and family support and quality of life.

Each of these strategies consists of a number of subordinate strategies affecting specific areas. A prime example is the overarching Surgeon General’s Health Strategy with its subordinate strategies guiding our approach to mental health, suicide prevention and the overall spectrum of care provided to Canadian Armed Forces personnel. These strategies are delivered through a comprehensive network of public and non-public facilities, including 38 primary care clinics and detachments, 26 mental health clinics, seven Operational Trauma Stress Support Centres, 32 Military Family Resource Centres, and 24 Integrated Personnel Support Centers. Together, these facilities deliver a wide variety of programs to military personnel and their families that cater to the specific needs arising from the demands placed on them as a result of service to Canada.

Among these programs are those specifically designed to manage the recovery, rehabilitation and reintegration of injured military personnel. These programs ensure that injured personnel are afforded the time needed to recover from injuries or illness and to return, if possible, to full duty. For those personnel injured to the extent that they cannot remain in the military, there are programs that prepare them, mentally, physically and vocationally, and their families for transition to civilian life.

We are pleased to report that we have recently launched initiatives that address a number of the Committee’s recommendations, and we will continue our efforts to improve the care we offer our military personnel and their families in such areas as mental health and working with Veterans Affairs Canada, enhanced support in the transition to civilian life. Our response is structured along three main themes: prevent, treat and support our ill and injured; research and innovation; and, support to our military families.

Prevent, Treat and Support our Ill and Injured

The Committee’s report recommends that the Government conduct mental health screenings for military personnel at all stages of their career – including before, during and after operational deployments – as well as provide them with the training and tools they need to self-assess for potential mental health issues. To this end, National Defence has undertaken a number of reviews of the physical and mental health of Canadian Armed Forces personnel. It is clear that the vast majority of serving members are doing well, but there is a minority that requires high-quality ongoing physical and mental health care. We remain committed to continue our efforts to improve upon the system we have established to care for our men and women in uniform.

As such, we will sustain our efforts to treat and support our personnel who are suffering from illnesses and injuries and work to prevent them from happening in the first place. This is a top priority for National Defence and a key focus of attention from enrolment to transition to civilian life. Early in a member’s career, health questionnaires are administered that include a mental health section. We are considering ways to compare these with the member’s long term mental health outcomes to determine if there are any early markers for Operational Stress Injuries. These efforts may help us develop better tools and training, thereby improving treatment. We will ensure that these efforts remain in line with existing privacy laws and the Canadian Charter of Rights and Freedoms.

In addition, we recognize that the first line of prevention and treatment of Operational Stress Injuries is the Canadian Armed Forces members themselves. Research shows that depression and anxiety associated with the rigours of military life are more prevalent than Operational Stress Injuries. To this end, we will continue working to ensure all Canadian Armed Forces members receive the necessary preparation and training to self-assess for potential mental health issues. We will also continue to enhance each Canadian Armed Forces member’s ability to perform self-screening regularly, in addition to mandatory medical screening, but particularly through each stage of the deployment process and during the transition to civilian life.

The Committee’s report also recommends that the Government and military leaders work to de-stigmatize mental health issues within the Canadian Armed Forces and recognize the importance of peer-to-peer support in recovering from Operational Stress Injuries. Operational Stress Injuries can be an invisible injury that isolates people from their peers, family and friends. We know that peer support is a fundamental component of treatment, but that stigma surrounding mental health is often a concern. To address this situation, we will maintain our outreach and communication efforts, like the ‘Be the Difference’ campaign, to reduce this stigma and raise awareness that mental health issues can be successfully treated. In July 2014, we also started releasing online videos that feature stories from individuals across the ranks and services about their experiences recovering from mental health illnesses in an effort to reduce the stigma and show that anyone can be affected, and that help is available. In addition to these peer-based initiatives, the Chief of the Defence Staff issues guidance to Commanding Officers containing his direction in a variety of areas, including mental health. The CDS’s recent guidance amplified existing policy that discourages military superiors from asking subordinates about their medical conditions unless there is an immediate risk to the member or their unit.

We will also continue to research and reach out to our personnel to understand why some Canadian Armed Forces members fail to seek treatment for mental health issues, and educate them about the benefits of mental health treatment. This research will help break down the remaining barriers to treatment, improve the Road to Mental Readiness program, and enhance the mental health screenings for Operational Stress Injuries surrounding deployments.

The Canadian Armed Forces are also in the final stages of hiring an additional 54 mental health care professionals to increase clinical capacity, enhance help to members transitioning to civilian life, facilitate research efforts with universities across the country to better understand the complexities of mental illness, and increase awareness of mental health by working with partners. In addition, the recently published Surgeon General’s Mental Health Strategy presents a solid plan for continually improving the current system and ensuring that the Canadian Armed Forces remain a mental health leader in Canada. The seven strategic priorities outlined in that strategy identify a need to invest in specific aspects of the program and in the competencies of the clinical care providers who deliver it – not just in the care delivered to those who are ill.

In addition to mental health issues, our Canadian Armed Forces personnel will always face the threat of physical illness and injury. The Committee’s report recommends the Government develop a comprehensive strategy for musculoskeletal injuries. Our recent missions, including Afghanistan, demonstrated that musculoskeletal injuries in particular are very difficult to treat and have lengthy recovery periods. However, recent research showed that close to 60% of the musculoskeletal injuries suffered by Canadian Armed Forces personnel occur during mandated sports or physical fitness activities. As such, we will continue to improve our musculoskeletal injury prevention strategies, as well as seek ways to reduce the number injuries that occur during sports and physical training. We are also examining whether earlier interventions by alternative health care professionals to treat musculoskeletal injuries are a workable and worthwhile approach.

Beyond these initiatives, we recognize that the broader Canadian community has a role to play in helping to support and treat our ill and injured personnel. In particular, the Committee’s report recommends that the Government continue working with non-governmental organizations (NGOs) and provincial community health services to meet the needs of our military personnel. To this end, we will continue to support the work of NGOs and non-profit organizations like Canada Company and The Prince’s Operation Entrepreneur, amongst others, and to foster relationships with new organizations. These groups provide our ill and injured members with valuable opportunities, support, and learning experiences, and help make the transition to civilian life easier. We will also continue to work with Veterans Affairs Canada to optimize the Government’s implementation of the New Veterans’ Charter, and to make the transition to civilian life smoother through mechanisms to improve cooperation at critical times in a member’s career.

Finally, the Committee’s report recommends that the Government consider re-examining the Universality of Service requirement for military personnel. As part of our commitment to the ongoing evaluation of existing employment policies, we established an internal working group to assess the Universality of Service policy, as well as its application, this past summer. This working group is examining how the policy can be best applied to retain individuals who are willing and able to serve, while also ensuring the necessary availability of all Canadian Armed Forces personnel to perform their lawful military service. Once this work is complete, the working group will provide recommendations to the Chief of Military Personnel. In a similar vein, we will examine the eligibility criteria for medically released personnel under the Canadian Forces Superannuation Act and its regulations.

Research and Innovation

The Committee’s report emphasizes the need for National Defence to work with civilian and military health partners inside and outside of Canada to improve treatment options for our military personnel. In particular, the Committee recommends that we continue researching topics ranging from pre-susceptibility and treatment outcomes for mental illness, to new diagnostic and imaging technologies, to better understanding and increasing survivability from blast injuries, brain injuries and other traumatic physical injuries. To this end, National Defence and the Canadian Armed Forces remain committed to continually improving the care and support offered to men and women in uniform. The trauma and violence witnessed and experienced by our troops in Afghanistan have refocused the Department’s attention on the mental injuries of war, high-tempo operations, and the day-to-day rigours of military life. As our understanding of these challenges grows, so has our appreciation that the impacts affect the wider Canadian Armed Forces population and their families. Through the Surgeon General Health Research Program and its many supporting partners, National Defence is investigating the best ways to enhance clinical care, promote education and awareness, better understand operational stress injuries, and evaluate the programs in place to care for ill and injured personnel.

To increase our understanding of these issues, we will continue to prioritize research efforts to improve our prevention and treatment strategies. Learning from our experience in Afghanistan, we are supporting research aimed at improving survival rates from blast and traumatic physical injuries, including how to prevent death by exsanguination. The Canadian Armed Forces Health Services Group is already doing extensive research to this end in collaboration with Defence Research Development Canada (DRDC) and other partners, including looking at using new technologies and methods to improve treatments for burn and blast injuries. We have also established a Blast Injury Scientific Advisory Panel, which works with prominent civilian experts to oversee and prioritize research.

We are also continuing our efforts to adapt existing technologies to the needs of the Canadian Armed Forces. DRDC is doing exciting work to improve the diagnostic tools available to medical staff, including adapting civilian ultrasound devices to the requirements of field use. To this end, we already have one prototype ready to test, and another will be delivered this fall. We may have an opportunity to test these devices in a joint exercise with the US Army Combat Casualty Care Directorate to make sure they are robust enough to use on deployed operations.

A number of our ill and injured Canadian Armed Forces members have also suffered traumatic brain injuries. To improve their well-being, we are prioritizing research to better understand

traumatic brain injuries and possible links to Operational Stress Injuries. We have initiated research to look at how neuro-imaging and biomarkers can contribute to our understanding of operational stress injuries. This work may give us important treatment insights, but this research is in its earliest phase and it will take time before meaningful results are achieved.

Working with our Allies is a key enabler of our research agenda. As such, we will continually review best practices and new technologies from other countries. The Canadian Forces Surgeon General works closely with the international medical community through several bilateral and multilateral engagements with our North Atlantic Treaty Organization Allies and other key partners. Furthermore, we are currently working with the United States National Centre for Medical Intelligence to assess the applicability of its studies and programs in a Canadian context.

We can also learn from our civilian counterparts, and we are fortunate to have strong and extensive relationships with civilian hospitals, universities and rehabilitation centres, among others. For example, the Canadian Institute of Military and Veterans Health Research (CIMVHR) helps coordinate research from 30 Canadian universities that have agreed to work together to address the health needs of military personnel, veterans and their families. Moving forward, we will continue to work alongside Veterans Affairs Canada to engage civilian stakeholders, exchange best practices and leverage new technologies. As part of these efforts, we will keep embedding Canadian Armed Forces clinicians within civilian institutions to facilitate these exchanges and leverage the skill sets of civilian hospitals.

The efforts listed above exemplify our commitment to supporting research to find better treatments, promote faster recovery, and achieve better outcomes for our ill and injured Canadian Armed Forces members. Our efforts are not limited to research and studies – we are also taking tangible steps to improve the lives of our ill and injured members. By using technologies available today – telemental health and virtual reality treatments for post-traumatic stress disorder – we can expand and improve the care being delivered across Canada.

Support Military Families

Supporting our military families is a key component of caring for our ill and injured Canadian Armed Forces personnel. Our military families make tremendous sacrifices, whether in the form of frequent trans-Canada moves, interrupted careers and education, and separation from family and friends. In addition, our families endure considerable stress and worry each time their loved one is deployed. However, we also know that the care and social support from family and friends is critical to a member’s recovery from an illness or injury. Since 2008, the Canadian Forces Family Covenant has captured our military’s commitment to its families and it continues to serve as a foundation to enhance military family services. The Department of National Defence and the Canadian Armed Forces will continue working with the families of our men and women in uniform to alleviate some of their burdens as described in the Department of National Defence and Canadian Forces Ombudsman’s 2013 Special Report.

The nature of military life poses an enduring challenge to the well being of our families. Every move means finding new schools, new homes, new friends, and new health care providers. We will persist in our efforts to improve coordination with provincial health services to help our families quickly find health care in their area. For example, we successfully worked with the New Brunswick College of Physicians to provide family physicians at Canadian Forces Base – Gagetown. In addition, we have reached an agreement with all provinces to provide military families with immediate access to health care without serving the normal 3 month qualifying residency period.

The Committee’s report emphasizes the importance of educating military families on the topic of mental illness, as well as ensuring that Military Family Resource Centres and other support networks remain available to the families of military personnel permanently affected by physical or mental illness or injury. Prior to and during a deployment, we will provide military families with more focused and practical communication programs and mental health outreach strategies. To this end, we are pleased to report that the Road to Mental Readiness program will deliver an enhanced program to our military families starting this fall. This education, which includes the You’re Not Alone awareness program, will help reduce stigma and better inform both our members and their families about the benefits of mental health treatment. We will also continue to provide the spouses of our ill and injured members with education and employment support by leveraging services available through the Military

Family Services Program, including access to Military Family Resource Centres and the Family Information Line, as well as a dedicated web portal on the familyforce.ca site. Moving forward, we will continue exploring options to ensure military families maintain access to these or similar programs following their loved ones’ release from the Canadian Armed Forces.

Eventually, our members will transition to civilian life, and your report recommends that the Government and the military continue assisting them and their spouses as they manage this transition. This is a stressful time for the members and their families, especially if there is a risk of unemployment. Our Military Employment Transition portal will help to alleviate some of this stress by providing an online service to connect Canadian Armed Forces personnel with civilian employers. Another example is Op Entrepreneur, one of the Prince of Wales’ charities, which provides releasing military personnel with support and assistance to set up small businesses.

We are also having ongoing discussions with the Veterans Transition Network about the effectiveness of their programs and the possibility of doing a trial. We are also investigating whether the Veterans Transition Network, Couples Overcoming PTSD Everyday (COPE) and other similar programs provide coping skills to the families of military members transitioning to civilian life.

Finally, we recognize the importance of investigating suicides and other tragic deaths promptly and thoroughly. To this end, in February 2014, the Chief of the Defence Staff created a team to clear the backlog of Boards of Inquiry into military suicides. This led to the process being streamlined, including making the Chief of Review Services responsible for the Board of Inquiry process as of 1 June 2014. We have now cleared the backlog of outstanding Boards of Inquiry into military suicides.

Informed by the Committee’s report, we will continue to improve our support for our ill and injured Canadian Armed Forces members. I am confident that the new and continuing initiatives outlined above will address your recommendations, and will lead to tangible improvements to the care and treatment that we offer our members and their families. I would like to thank you and the other Members of the Committee for your report and your continued commitment and service to Canadians.

Yours sincerely,

 

Hon. Rob Nicholson PC, MP