Standing Committee on Public Safety and National Security Thursday, March 10, 2016 Chair

Standing Committee on Public Safety and National Security Thursday, March 10, 2016 Chair
Standing Committee on Public Safety and
National Security
SECU
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NUMBER 007
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1st SESSION
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EVIDENCE
Thursday, March 10, 2016
Chair
Mr. Robert Oliphant
42nd PARLIAMENT
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Standing Committee on Public Safety and National Security
Thursday, March 10, 2016
● (1110)
[English]
The Chair (Mr. Robert Oliphant (Don Valley West, Lib.)): I
call the meeting to order.
Thank you to our witnesses for waiting.
This is our first meeting on our study looking at PTSD and OSI.
We are going to be studying the issue over the next several weeks,
starting with some foundational witnesses.
Just so you know, you are foundational witnesses. From your
testimony today and the questioning, we'll be developing our study
over the next several weeks and moving ultimately with a report to
Parliament with recommendations for government actions. That's the
context of what we're doing.
We welcome Jitender Sareen, professor of psychiatry, from the
University of Manitoba, as well as Dr. Shlik, the clinical director at
the Royal Ottawa. I'm going to suggest that we begin with Jitender
Sareen.
You have 10 minutes to present. Then we'll have a second
presentation of 10 minutes. Then the committee with ask questions,
and they can direct them to either of you as we go.
The floor is yours. We'll let you know at just around 10 minutes,
so if you're running out of time, you might....
Dr. Jitender Sareen (Professor of Psychiatry, University of
Manitoba, As an Individual): Thank you very much for inviting
me. It's a pleasure to be here. I really appreciate the opportunity to
speak to this important issue for us.
To give the committee a context of who I am, I'm a psychiatrist at
the University of Manitoba, and I've worked here for 16 years. I've
worked at the Winnipeg operational stress injuries clinic for about
seven years, and I've also done work with our team in post-traumatic
stress epidemiology research as well as military mental health
research and suicide prevention work. Currently I chair the research
committee and I'm a board member for the Canadian Psychiatric
Association.
Today I'll summarize what we know about operational stress
injuries and my suggestions for future work in helping public safety
officers in Canada.
An operational stress injury, as defined by Veterans Affairs
Canada, “is any persistent psychological difficulty resulting from
operational duties performed while serving in the Canadian Armed
Forces or as a member of the Royal Canadian Mounted Police.” It is
used to describe a broad range of problems which include diagnosed
psychiatric conditions, like post-traumatic stress disorder but also
other conditions.
Operational stress injuries are associated with substantial
morbidity, mortality, health care utilization, and financial cost to
our society. They not only affect the member but also the member's
family, and it's important that we address these issues carefully.
Here I'd like to underscore that most people exposed to traumatic
events are actually resilient. Almost all of us have struggled with
trauma and have faced traumatic events, but the vast majority of
people do recover. Post-traumatic stress is the signature condition,
but other difficulties like anxiety, depression, alcohol problems, and
physical health conditions can also result from traumatic events.
It is also important to note that there is a dose-response
relationship between the number and severity of traumatic events,
for example, seeing dead bodies and being physically assaulted. If
there's an increased number of events at work there is a doseresponse relationship with mental health difficulties. However, it is
really important to understand that mental health problems are a
combination of biological risk and protective factors, psychological
risk and protective factors, and socio-cultural factors.
Biological factors that are known to increase the risk of
operational stress injuries include being female, having a family
history of mental health problems, which increases the genetic risk,
as well as physical health problems, very commonly, traumatic brain
injury.
Psychological factors that are known to be associated with mental
health difficulties include an impulsive, aggressive personality style
and a highly perfectionist and self-critical cognitive style.
Socio-cultural factors are also very important, including the
experience of adverse childhood events, poor social supports, family
violence, racism, and poverty and financial stress.
From the international literature, there are six main approaches
that are important in the prevention and treatment of work-related
mental health problems and post-traumatic stress.
First, prevention strategies include selecting people who are
resilient and have little history of severe mental health difficulties.
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Second, workplaces that provide systematic training, an organized
work environment, and supportive colleagues and managers reduce
the risk of mental health difficulties.
Third, the military has developed resilience training programs for
personnel and families to help them learn skills in managing stress
before they're deployed as well as after they're deployed. At this time
we're not aware of evidence-based national resilience training
programs that are being implemented among public safety personnel.
We're working on developing a mindfulness-based cognitive
behaviour therapy course to help people learn coping skills when
they enter a stressful job.
● (1115)
Fourth, there is strong evidence that cognitive behaviour therapy
and prolonged exposure therapy—another psychological treatment
—are useful in treating people who have acute stress disorder and
post-traumatic stress disorder. These treatments are delivered by
trained mental health providers. Due to the limited number of
providers and large number of people who could benefit from this
type of intervention, the latest research is testing innovative
strategies for providing cognitive behaviour therapy through
Internet-based platforms, telephone-based strategies, as well as large
classroom platforms.
It is also important to note that medications are important in
treating people who are suffering with post-traumatic stress and
other mental health conditions. Antidepressants, like paroxetine and
sertraline, have been approved for the treatment of anxiety and
depression.
Medications that specifically target insomnia, which is often a
major concern of people who come to us for care, are very important.
Prazosin is a high blood pressure medication that has been shown to
be quite effective in helping people with nightmares, sleep
difficulties, and PTSD symptoms. Trazodone, another antidepressant, and zopiclone, which is a hypnotic, can also be used.
Benzodiazepines are generally not recommended for posttraumatic stress disorder. However, they can be used carefully
among people with severe anxiety. Atypical antipsychotics have also
been shown to be effective in people with severe anxiety and
depression.
Here it is important for me to clarify that none of the practice
guidelines support the use of medical marijuana for PTSD. Although
this is a common question from clients, the evidence weighs in the
favour that marijuana use can actually worsen PTSD symptoms. I
think it is important for us to carefully study the impact of marijuana
and medical marijuana in PTSD, not just in short-term outcomes but
long-term outcomes, especially around functioning.
Here are some specific recommendations for policy.
Although there is increased awareness of operational stress
injuries in public safety officers, we do not have good Canadian
information on the prevalence, prevention, and treatment of these
conditions in our unique Canadian environment. Much of what we
know comes from the U.S. and other countries.
However, we can learn from our Canadian military and veteran
partners that have systematically addressed mental health problems
March 10, 2016
and suicide over the last 15 years. Although a lot of work can be
done in this area, the military has placed significant strategic
initiatives that have been very successful in improving the lives of
military and veterans.
The military has invested in getting accurate estimates of mental
health problems among their populations by conducting state-of-theart epidemiologic surveys that are nationally representative. They
have also implemented post-deployment screening tools to identify
and treat people quickly.
Veteran Affairs Canada has funded a national network of
operational stress injury clinics that include interdisciplinary teams
to help people recover from operational stress injuries. They've also
worked with Queen's University to develop the Canadian Institute
for Military and Veteran Health Research, which encourages
unbiased, arm's-length research with university partners. Over 35
institutes across Canada are involved with this Canadian institute.
Similar to the approach taken by the military, I suggest that we
need to do three things. First, we need to invest in a national mental
health survey of public safety personnel. Second, we need to create
an arm's-length institute that engages academics, policy-makers, and
key stakeholders to advance the knowledge in this area. Third, we
need to develop clinics that are funded in partnership with federal,
provincial, and workers' compensation boards to help people have
quick access to appropriate treatments.
To give a bit more detail around this, there is a need for a national
mental health survey, because the rates of mental health problems in
this group range from between 10% to 40%. Some argue that
because of the selection, people who are public safety officers might
have lower rates of mental health difficulties, where others argue that
because of the high-stress environment, there are actually higher
rates than in the general population. We actually don't know.
● (1120)
A national institute—
The Chair: I'm just going to ask you to wind up a little bit if you
can.
Thank you. I'll give you another minute or so.
Dr. Jitender Sareen: I have two last comments.
The national institute would guide a national action plan for
research; create a national online resource for clients, families, and
providers who have evidence-based information; and have standards
of minimal intervention.
Thank you so much for the attention. I look forward to your
questions.
The Chair: Thank you very much.
Mr. Shlik.
March 10, 2016
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Dr. Jakov Shlik (Clinical Director, Operational Stress Injury
Clinic, Royal Ottawa Health Care Group): Mr. Chair, esteemed
members of the committee, Professor Sareen, I'm speaking to you
from the Royal and just using the opportunity to acknowledge that
we are very privileged to contribute to work on this important topic
here at the Royal. The Royal, as you may know, is an academic
health science centre and it has been contributing to the leading edge
of research on a variety of topics, amongst them depression and
suicide.
The Royal has some experience in work with first responder
services. For example, we have provided extensive mental health
training to nurses within the correctional services. I work at the
operational stress injury clinic here at the Royal, and at some other
clinical programs at the Royal. I am a psychiatrist and clinical
director of the OSI clinic. I have a few notes about the OSI clinics,
which Professor Sareen also mentioned in his introduction, which,
by the way, was an excellent overview.
The Royal has operated the OSI clinic since 2008, so this is part of
the network funded by Veterans Affairs. We provide specialist care
and support to the members, and mostly veterans, of the Canadian
Armed Forces and also to the current and past members of the Royal
Canadian Mounted Police who are experiencing mental health
problems, as well as their respective families. I will speak to my
experience as a clinician providing services to this particular
population. To the issues of public safety officers and first
responders we can easily apply some of our experience to that
population as well, although, as it was mentioned before, particular
aspects of their mental health issues, operational work stress
problems, definitely need a further, more detailed survey and study.
We have some experience with paramedic services. Our department of psychiatry has been engaging in a round table around the
issues that paramedic services, first responders, are struggling with,
and they, in their grassroots-level initiative, have been collecting
some data on the impact, on the consequences, on the services
required, and this type of work needs to be done in a more
coordinated and integrated way.
As was mentioned before, operational stress injuries in public
safety officers and first responder types of workers, may be in some
ways similar to those experienced by federal police and armed forces
personnel and veterans, but there are certain specifics and certain
cultures and subcultures that need specific attention. For example,
the issues that corrections workers deal with in their day-to-day life
and those of paramedics overlap somewhat, but also have many
specific differences. This may lead to a certain fragmentation of the
system of care and approach. We, on the site, have been witnessing
certain developments that may lead to a variety of approaches, a lack
of coordination, and the resources, as a result, are not used properly
and not accessed in a way that leads to impact.
One obvious aspect, especially from our work with the federal
police, which is really important to emphasize, is the importance of
promoting a positive culture and perception around the work-related
stress and operational stress injuries. To give some examples,
Professor Sareen mentioned work done by the Department of
National Defence. We found that for one of the programs, which is
named road to mental readiness, R2MR, this approach has been
adopted now as far as we know by the RCMP as well. The process of
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training and implementation has been done in various units and this
program takes into account the continuum of mental health
difficulties in operational work and also provides certain ways to
access help and also how to help themselves.
● (1125)
This type of program may be easily adopted by the first responder
services, and as was mentioned before, the models of care and
expertise of the existing hubs of research and care should perhaps be
taken into account, and correspondingly, a data-driven integrated
strategy would be very helpful to have with all the input of
stakeholders on national and provincial levels.
Perhaps I will stop now.
I will be happy to answer any questions and comments. Thank
you very much for your attention. It's definitely a privilege to
contribute to this important work.
The Chair: Thank you very much, Dr. Shlik.
We turn to the questions, and we have seven-minute rounds with
four questioners.
Ms. Damoff, you'll begin, please; thank you.
Ms. Pam Damoff (Oakville North—Burlington, Lib.): Thank
you very much and since I am the first one to ask questions, I would
like to comment on the fact that a parliamentary committee is
studying this issue. I think it's a huge step forward and I can't say
how thrilled I am that we're doing this and we're going to get it out
there.
One of the things that you mentioned, Dr. Sareen, was the
definition of operational stress injuries. You mentioned it was
defined by Veterans Affairs Canada. I know from reading some
information it's not recognized by the American Psychiatric
Association. Is it recognized in Canada?
Before you answer that, one of the issues I've come across is
different terminology. There are operational stress injuries, there's
operational—my mind's gone blank—occupational.... What is the
difference and what is the recognized terminology within your
organization?
Dr. Jitender Sareen: That's an excellent question.
Operational stress injuries is the term that has been defined by the
Canadian Forces and Veterans Affairs. I think the important piece is
that it shows that post-traumatic stress is not the only disorder that
can happen related to combat stress or trauma. It is a signature
condition but generalized anxiety disorder, panic disorder, and other
conditions can also be linked.
The other thing that's important for you to know is that there's a
move in psychiatry away from dichotomous “does the person meet
the full criteria for a condition or not?” Lots of people who come
with some threshold PTSD symptoms are resilient. They have lots of
supports but they're struggling with nightmares or having difficulty
with irritability, and it's linked to their service. The Canadian
Psychiatric Association agrees with this terminology.
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The other question is occupational stress versus operational stress,
I think that is a bit of semantics because there's a whole literature on
occupational health, and I think the aim is to try to link the mental
health difficulties to the occupation. I'll try to make some comments
around this at another opportunity. The most emotional difficulties
are an interplay between the stressor and pre- and post-vulnerability.
When I'm sitting with a person it's hard to try to figure out if it's
exactly related to their work or not, and we've done work showing
that it's a combination. Adverse health experiences—family stress,
financial stress—impact on and worsen symptoms as well as a
person's recovery.
● (1130)
Ms. Pam Damoff: One of the other things you talked about were
clinics where partnerships between federal, provincial, and the
WSIB, for example, provide quick access. There's a stigma attached
to this. Even providing the quick access, people may not want to go
to it because they're afraid other people they work with in corrections
or in policing or firefighting will look at them differently. How can
we go about removing the stigma? I like what you were saying about
not putting terminology on it, but do you have any comments on
that?
Dr. Jitender Sareen: That's an excellent question.
What we're trying to move toward is giving people lots of
different options as far as care is concerned. There's a lot of work
now being done on Internet-based cognitive behavioural therapy, so
people can have access to evidence-based psychological treatment
on their own. That might help people with mild to moderate
conditions.
There's some very nice literature showing that Internet-based CBT
actually has similar effectiveness to face to face. That's one piece.
We need to think about a range of different options.
Yes, there is stigma in the clinics. You could argue that people
who develop cancer, and are going to the cancer care building, are
going to have to deal with some of that stigma. What we find is that
people often suffer alone and feel they are the only ones dealing with
this. As you know, suicide is an outcome of people feeling alone and
not feeling there's anybody there for them. We have used a lot of
classroom and group-based work. People learn from each other and
often recover faster because they challenge some of those concerns.
I think this is where there has to be some support within the
leadership for destigmatizing mental health issues. You can get
burned and have a physical injury that everyone can see. PTSD is a
silent injury, but it's probably just as severe.
Ms. Pam Damoff: I only have a few seconds left. I've asked this
of a few other people before.
Do you know of any research being done on the cost of these
mental health issues, the cost to the RCMP or corrections? Do you
know of any work that's been done on that?
Dr. Jitender Sareen: We don't have good estimates in Canada
about the costs to the system, but what we know from other countries
is that they cost the system a lot, huge amounts of disability
payments.
If you look at disability claims, the most common reason for
disability claims is depression. This is where the fractionation and
March 10, 2016
the fragmentation of the system is. People often suffer, they are off
on disability, they don't have timely access to psychological
treatment and medical treatment, they fear going back to work
because they might have difficulties performing, and then they are
on disability and can't get back to work.
● (1135)
The Chair: Thank you, Dr. Sareen.
Go ahead, Mr. O'Toole.
Hon. Erin O'Toole (Durham, CPC): Thank you, Mr. Chair.
Thanks to both of you gentlemen. I found it very illuminating,
dealing with some of the issues I've been working on as a passionate
advocate before I became a parliamentarian. Your work is
appreciated. I've also had the opportunity to go to the Royal on a
few occasions, so thank you for your work.
I think most of my questions are going to be for Dr. Sareen, based
on your testimony here today.
Your comments on medical marijuana struck me because, as you
may know, I was veterans affairs minister, and I tried to have a clear
discussion on the use of medical marijuana, which as you know,
veterans affairs approves when prescribed by a physician.
There's a real divide between use for some symptom relief—
which is known for chronic pain or a variety of other things—and
some suggestion by advocates and some commercial companies that
it is a cure or recognized treatment for PTSD.
That concerned me, so I went out clearly on that because people
who are striving for assistance should not be preyed upon by the
growing commercial practice. I still get notes from some of the
online folks suggesting there's clinical support, and then I look at the
article and it's not clinical support at all. Can you talk about that for a
moment?
Dr. Jitender Sareen: Absolutely. There was a systematic review
done last year on the use of medical marijuana in medical conditions
in The Journal of the American Medical Association. What it
showed was that in certain non-psychiatric conditions there might be
some benefit, but in psychiatric conditions the data is not strong
enough to say that medical marijuana is a long-term useful treatment.
I think that, as you were saying, there is a divide between what the
public perception is and industry. I made that comment specifically
because I think it is important for this committee to appreciate that
there is a lot of wish.... Every single week I get questions about
prescribing medical marijuana. I don't do it. The reason is that we
know and have known for a number of years that marijuana use is
associated with worse outcomes in PTSD. Especially in young
adults, in whom there's a developing brain, there is a risk of
psychosis that has been shown repeatedly.
March 10, 2016
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I think there is a major divide between the medical knowledge...
and I think it calls for important research that is unbiased and that
looks not only at short-term but also at long-term outcomes. If you
think about alcohol, it helps with anxiety, but we also know that
alcohol problems can happen, long term. I don't disagree that it may
have short-term benefit, but we're trying to help people, long term,
return to their best level of functioning and get back to helping their
family.
Hon. Erin O'Toole: Thank you.
I appreciate your raising it, because I think it's important,
particularly for the cohort you talk about, the young person who is
trying to transition to a new career and who is looking for symptom
relief, that we not hold this out as some solution when it can be more
a detriment. I appreciate that.
I also appreciate, because we are starting to look at this, and my
colleague Todd Doherty is here, who has been long advocating for a
national strategy on operational stress.... Your three recommendations were very helpful. I'm going to explore number two for a
moment, on the national institute.
In many ways, the previous government, working with universities, Veterans Affairs, DND, CIMHVR, and Dr. Aiken at
Queen's, and their network of I think as many as 25 or 26
universities now.... Is that institute, in some ways, or do you think it
could be....? Does it need a broader mandate? Can it be that national
institute you're talking about?
● (1140)
Dr. Jitender Sareen: I think it probably requires a separate
institute or a partnership.
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Dr. Jitender Sareen: I think it's the future. I think that trying to
get people to have access—and we use large classrooms where we
give people self-help tools they can utilize at home—is the future of
care.
Hon. Erin O'Toole: Thank you.
The Chair: Monsieur Dubé.
[Translation]
Mr. Matthew Dubé (Beloeil—Chambly, NDP): Thank you,
Mr. Chair.
Thank you, gentlemen, for being here today.
In the context of this study and related issues, the situation facing
corrections officers is being somewhat overlooked. An officer once
told me that the people who perform those duties sometimes feel like
forgotten police officers, in the sense that most people have no idea
that officers on the front lines have to deal with extremely difficult
situations.
We have learned that, in recent years, the number of accidents in
that work environment has been on the rise, especially in 2014.
These are often called accidents, as though these incidents were
happening in a factory, but in fact, these accidents are often
associated with violence and very troubling situations.
I would like you to comment on the resources that may or may not
be available. I actually think this is a major problem. Of course, I
mean no disrespect to the RCMP, the Canadian Forces, police forces,
and firefighters, but I note that we are talking about them a lot, even
though there is often a tendency to forget these officers.
I want to highlight the importance of the institute. First, everybody
has a bias, including me, drug companies, and police. One piece is to
try to bring people together to really look at the science and try to
understand the truth—does this work or does it not?
Based on your expertise, can you tell us how it might be possible
to learn more about the problems these people face, and therefore
provide them with the resources they need?
The other important reason there's a need for an institute is that we
know from research that usually a research discovery sits on a
bookshelf for 30 years before it comes into clinical practice. These
kinds of institutes really drive the relationship among policy-makers,
stakeholders, and academics. We academics like to sit in an office
and write papers. This gets us out to understand what the questions
are: what are the firefighters and the national firefighters association
dealing with at this time, and can we work together on addressing
these questions in a timely manner?
Dr. Jitender Sareen: I'll give the opportunity to respond first to
Dr. Shlik.
Hon. Erin O'Toole: Can I jump in? I want to get one more
question in, and I'm conscious of my time.
You talked a little bit, under the national institute section of your
recommendation, about the online resources. One thing we
developed while I was minister—and I was very happy to see the
new minister roll it out—was online tools for caregivers particularly,
or for people working with somebody struggling with OSIs in the
home. Have you had the chance to look at or contribute to what
Veterans Affairs produced, and what are your thoughts on these tools
going forward?
The Chair: Be very quick, please.
[English]
Dr. Jakov Shlik: Thank you.
I appreciate very much, Mr. Chair, the fact that this question was
raised. We have had some experience with people who we've worked
with in the corrections system through our clinic for veterans,
because some of the veterans went on to work in the corrections
system. This experience is very cursory. It doesn't give us a big
picture, but it does give us some reflection.
For us, it was striking how difficult this work can be, and how
little support and how little ability to cope people might sometimes
experience. It's not that the support systems do not exist, but perhaps
they are just not accessed, not developed, or not supported.
We've heard—again, as was mentioned before, it's hard to find
really reliable data—that the rate of diagnosis of post-traumatic
stress disorder specifically in correction services is striking, and
possibly startlingly high, and it calls for action. Some work can be
done on more training, at least in practical experience with mental
health nurses.
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In correction services, that was provided by the Royal and it
seemed to be well received. That is suggested as probably one of the
stepping stones in the system. I think the workers in correction
services should be empowered by the same tools and systems,
including peer support and access to care, with a variety of
technologies and options, as any other operational employee would
be.
● (1145)
Mr. Matthew Dubé: Before you answer, Mr. Sareen, I just want
to elaborate on that. You've mentioned a lack of data. Is the lack of
data representative of a lack of tools? Does the fact that we don't
have the answers to those questions demonstrate that there is more
work to be done to better understand that specific work environment
and what tools we can put in place?
Dr. Jitender Sareen: Yes, I think it's both that and the fact that
there hasn't been a survey done. Mental health surveys, if they are
done well, are expensive. But we have worked with Stats Canada,
and the military and Veterans Affairs have invested in getting
accurate information, because you can't guide policy if you don't
have an accurate number. If we have x percentage of cancer, then
you know how much to spend on cancer.
We don't have information about this. What are the accurate
estimates? Are we dealing with 10% PTSD, or 30%, or are we
dealing with 50%, whether that's in nurses or in security officers? I
completely agree with you. I've treated and seen in my practice
people who have struggled with PTSD, because it is a very high-risk
environment. You're holding people down and you're being
assaulted, and that physical assault has been shown to be a specific
risk factor for post-traumatic stress disorder.
Mr. Matthew Dubé: I appreciate that.
The work that happens when we're talking about data, and when
you look at the purview of Veterans Affairs, I don't believe it covers
necessarily correctional officers. I might be wrong about that, but do
we have more work to do to get data that's more in tune with their
specific workplace and the issues there?
Dr. Jitender Sareen: Absolutely.
That is exactly what I'm recommending. We need evidence-based
policy, and you can't start with programming without a good
estimate of.... You know if you look at cancer registries, first you
need to get accurate information about how common it is and what's
happening before you can invest in it. At the same time you still have
to invest in getting people treatment. I think we're about 15 years
behind the military and veterans around public safety officers and
what we do in Canada.
[Translation]
Mr. Matthew Dubé: Okay.
Fifteen years is quite a significant gap. I appreciate your
comments on this issue.
Regarding my first question, I mentioned situations that are
described as workplace accidents.
For police officers and soldiers, there is a degree of physicality
associated with the work they do. When we hear about accidents
related to their work, we have a pretty clear idea of what that entails.
March 10, 2016
I think I read in a recent report that two-thirds of those kinds of
accidents involved violence.
In your opinion, should we be using more appropriate language
when talking about these issues?
● (1150)
[English]
Dr. Jitender Sareen: Yes, I'm just trying to understand the
question.
Is the question, should we change the terms of workplace safety?
Mr. Matthew Dubé: When we say workplace accidents, and twothirds of those involve violence, are we doing a disservice in making
it sound like it's something that might...giving a different perception
of the public that impedes our job to get the proper treatment for
PTSD and such.
Dr. Jitender Sareen: Yes.
I agree with you. I think it is important to note though that the
majority of people who are hurt are resilient. Saying that if
somebody gets injured that means they have PTSD, I just don't want
that to be the outcome.
You're absolutely right that the more times a person is injured
there's a higher risk of getting post-traumatic stress, but I wouldn't
equate it.
[Translation]
The Chair: Thank you.
Mr. Mendicino, go ahead.
[English]
Mr. Marco Mendicino (Eglinton—Lawrence, Lib.): I'd like to
thank both of the witnesses for appearing today, and I have been
listening attentively also.
I also want to thank Mr. O'Toole for his work on the file in the
previous administration. I'll echo Ms. Damoff's comments. I think
this is an important topic worth taking up at this committee at this
time.
I have a number of questions for Dr. Shlik.
I'd like to take you to your written submission. Do you have that
before, sir? If you could go to point 4, key learnings based on our
clinical experience....
Dr. Jakov Shlik: Yes.
Mr. Marco Mendicino: What I see in this section are what appear
to be the elements of a strategy or a way forward. Some of the
elements or the key ingredients of this strategy include a move
toward developing policies.
The first point talks about policies to develop a positive culture
and perception in the workplace. Is that a fair characterization?
Dr. Jakov Shlik: Yes, it's a fair characterization. It's an assortment
of impressions and suggestions as you mentioned, indeed.
March 10, 2016
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7
Mr. Marco Mendicino: A little further down you address
resources, and you talk about access to care. There is a bullet point
that says, “Access to care: specialized assessments and effective
evidence-based and research-informed therapies”.
● (1155)
We need resources to ensure those who suffer from OSI or PTSD
have the requisite access. Am I right about that?
Dr. Jakov Shlik: That's correct.
Mr. Marco Mendicino: Further down you have a component that
deals with education and training on traumatic stress. Yes?
Dr. Jakov Shlik: Yes.
Mr. Marco Mendicino: Then there's technology. This is about
leveraging innovation and the developments we have in technology
to ensure that those who suffer from OSI and PTSD are able to get
the best treatment possible. Yes?
Dr. Jakov Shlik: Yes, indeed, technologies can be critical to the
empowerment of individuals. They can help people become more
capable of dealing with their situations and be open to seeking help
when they realize that this is the time. We need to help people to
make that differentiation.
Mr. Marco Mendicino: Obviously, ideally we would be detecting
these symptoms at the very earliest of stages so that we could
prevent the onset and development of OSI to its latter or worst
stages. Is that a fair statement as well?
Dr. Jakov Shlik: Yes. We as clinicians know that when an
individual comes to seek help, in our minds we often think to
ourselves that unfortunately it's a bit late. People do not seek help for
a variety of reasons.
Mr. Marco Mendicino: Very succinctly, could you help us stitch
together these elements in a coherent strategy? How do you see these
pieces fitting together?
Mr. Marco Mendicino: I'll tell you the reason I asked the
question. For those of us who are learning about this subject for the
first time in a serious way, I think you can imagine that it can be a
rather overwhelming subject to tackle. Just by sheer volume, and
disparate views on how to address this important health issue, I have
found in the early stages that is there not a lot of uniformity. What I
am going to try to extrapolate, as we move our way through this
study and through our witnesses, are some of the common themes,
which I hope we'll weave into a committee report.
To go back to my original analogy, I see the ingredients here.
They are bullet-pointed out, and we can take them out and look at
them in isolation. But do you have a vision that pulls all of these
elements together for a strategy that works for your institution and
that could be applied potentially as a model across the board for first
responders?
Dr. Jakov Shlik: I really appreciate how you put this question,
because it's critical to have a big picture but not to miss important
components.
I might not be able to provide a very quick strategical review here
at this time, but I see it as a continuum. It's a continuum that starts
with the culture in the workplace: supports, openness, and the
presence of certain tools and settings. Peer support, for example, is
extremely helpful and in great need of empowerment. Peer support
has been supportive, always useful, but sometimes it's destructing;
that's maybe a separate topic.
From there it is access to care, using the opportunities provided by
self-help, by self-education, by group education, and by manager
education. Then there's the proximity of services in the community, a
network of community providers. Not far from that is the specialized
mental health services clinic.
In that continuum, specialized clinics, somewhat analogue to the
OSI clinics perhaps, all—
Mr. Marco Mendicino: Sorry, can I pause you right there?
Dr. Jakov Shlik: Yes, of course.
Perhaps not today—it doesn't seem we'll have the time, given
what's left—but if both of you could turn your minds to this question
when you leave here, I think we'll be able to build on it as we make
our way through the course of this study.
Dr. Jitender Sareen: I think that's a great idea.
One thing I want the committee to be aware of is the model of
stepped care that's talked about.
If somebody is struggling with emotional difficulties, they get
their care and support in the primary care clinic. If they're still
struggling, they move to specialized care.
I really want to underscore what you were describing. That early
intervention in the first year of the onset of these conditions is really
an important timely piece. We have shown in Manitoba that, with
people who have their first diagnosis of a mental health problem, the
first year is the time of highest risk for suicide. So I really support
what you're saying, that we really need a systematic approach and
screening and development of services. I think the challenge is that
you have provincial, national, and workplace issues. It's really
important to try to interact with those three.
The Chair: Thank you very much.
We have time for one more questioner.
Mr. Doherty, you have five minutes.
Mr. Todd Doherty (Cariboo—Prince George, CPC): Thank
you, Mr. Chair.
I want to thank our guests, as well as my colleagues across the
floor.
As my colleague Mr. O'Toole has mentioned, I'm deeply
passionate about this. This is something I'm very familiar with and
I have spent a long time working with those who have been inflicted
with PTSD. I have had a lot of colleagues, over the years, who have
been dealing with this.
I'm going to direct a few questions, but I'm going to do a
shameless self-promotion, if I can, because my passion and my
belief in this area and why it's so critical—and I applaud this
government for taking this on—is that this discussion is long
overdue. That is why I tabled Bill C-211 calling for a national
strategy and the development of a national framework dealing with
PTSD in first responders and veterans.
8
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Specifically for the areas of concern that we've been talking about
here and some of the intricacies in dealing with what our guests are
talking about, there has to be a national strategy that deals with and
then can build on the standards and consistencies among all of the
levels of first responders or the classification. This means the
terminology, the best practices, ultimately the care and education,
looking at pre- and post-vulnerability, dealing with the very real
stigma attached to PTSD, so that our first responders or veterans
have the ability to come forward and have a voice, and that we've
armed their colleagues and families with the tools to be able to deal
with and recognize the concerns and the challenges as we move
forward, and the warning signs, so that we don't lose another person.
I do have a question for Dr. Sareen.
In your testimony before the Senate Subcommittee on Veterans
Affairs, you referred to a concept called “the rule of thirds” and you
indicated that a third of OSI patients can be expected to have a full
recovery, a third will have a moderate recovery that leaves some
remaining symptoms but it enables a patient to function well, and
another third will continue to struggle over a long period of time
I have to challenge you on this. I'm not quite sure we can erase the
traumatic incident from people, which they've experienced. I agree
on recovery. I think we can provide resources and the ability to cope
and to lead a productive life, but I'm not quite sure that we can fully
recover, as with any other mental health issue.
Dr. Sareen, can you provide a little bit more insight as to how you
came to that recommendation that there can be full recovery on that?
I'm interested in your comments.
● (1200)
Dr. Jitender Sareen: It's a very good point.
I'll tell you where I learned that first. I learned from my first
supervisor when I was a resident about the prognosis of emotional
difficulties. In the DSM, the Canadian Psychiatric Association and
the American Psychiatric Association, the idea that someone who....
I agree with you that you never erase the traumatic event, but people
can recover and have amelioration of their symptoms and get back to
the highest level of functioning. They still have a—
Mr. Todd Doherty: Let me interject for one second.
In my opinion, it is comments like those, unfortunately, from
academics and our medical profession— again, we are all learning as
we move forward with this to fully understand the scope of it—that
then lead to those who are suffering.... They may go back to work,
because as somebody has said there is a full expectation that they can
recover, but then another traumatic event comes up, or a flash, and
they are again having to go off.... It puts the burden of proof back
onto the person who is suffering to demonstrate that he or she is not
fully recovered.
Would you agree with that?
Dr. Jitender Sareen: It's a controversial issue. On the one side,
you could say that a person who's ever had some PTSD will never be
able to go back to work, and that's also a challenge.
I completely agree with you that we don't want to put people at
risk of trying to show that they are ill or anything like that, but I
guess it is a challenging issue. I can understand your perspective.
March 10, 2016
● (1205)
Mr. Todd Doherty: I have just one final comment. This is to Dr....
Do I have time?
The Chair: Well, yes; you have 20 seconds.
Mr. Todd Doherty: The comment is about not having a national
resilience program or a program that is national. I think we have a
great tool at our hands, the road to mental readiness program that the
military and the Royal have been implementing. I think it deals at the
earliest point of induction into either the military or RCMP or first
responders. I think it is a great model that we can move forward
with.
The one other thing I would probably recommend is that we also
include 911 or emergency call dispatchers in this area.
The Chair: Thank you, Mr. Doherty. You'll have more chance, for
sure.
Mr. Todd Doherty: I know. I know.
The Chair: I want to thank our witnesses for your truly expert
testimony today.
We're just going to take a few minutes as we change the regime
and get our next panel ready. Thank you very much.
● (1205)
(Pause)
● (1205)
The Chair: Let's reconvene.
I want to thank our witnesses. We have, via video conference,
Tom Stamatakis, the president of the Canadian Police Association.
It's nice to see you again—twice in one week.
From the Mental Health Commission of Canada we have Louise
Bradley and from Mood Disorders Society, Phil Upshall.
I'm going to suggest that we begin with the Canadian Police
Association for a 10-minute presentation and then go to our guests
here, only because it always gives us a chance, if the video
conference somehow fails us, to get you back in if we need you. If
we begin with you, it gives us a little extra chance.
Thank you for your attendance today.
March 10, 2016
SECU-07
● (1210)
Mr. Tom Stamatakis (President, Canadian Police Association):
Good morning, Mr. Chair and members of the committee. Thank you
for the kind invitation to appear before you today as you begin a very
important study into the effects of operational stress injuries and
post-traumatic stress disorder upon public safety officers and first
responders.
With so many new faces around the committee table, I want to
begin my remarks today with a brief introduction of the Canadian
Police Association, though I am very happy to say that I had the
opportunity to meet with many of you during our annual legislative
conference in Ottawa. I'd like to thank you for taking the time to
meet with our delegates last week.
The CPA represents more than 60,000 civilian and sworn frontline police personnel across Canada. Membership includes police
personnel serving in 160 police services across Canada, from those
in Canada's smallest towns and villages to those working in our
largest municipal and provincial police services and members of the
RCMP, railway police, and first nations police personnel.
I should also note that I'm a police officer in the city of Vancouver.
I'm seconded from the Vancouver Police Department to the
Vancouver Police Union as its president. I'm also the president of
the British Columbia Police Association, which is an association of
all the municipal police unions in the province of British Columbia,
and I am the president of the Canadian Police Association.
I am seconded to these positions while I'm elected in the capacity
as president. If I were no longer in that capacity, I would return to my
policing career in Vancouver.
Introductions aside, though, the CPA is quite encouraged that your
committee has made this important issue one of the first topics you
have chosen to study in this new Parliament. As I mentioned, our
organization recently concluded our annual legislative conference, at
which almost 200 delegates from policing agencies across Canada
came to Ottawa to meet with members of Parliament on the need to
push the new government to fulfill its platform commitment to
establish a national strategy with respect to first responders who are
suffering from post-traumatic stress disorder. We're very encouraged
by the responses we received from MPs representing all political
parties. It can sometimes be an overused cliché, but in this case,
protecting those who protect others is truly a non-partisan issue.
Part of the difficulty in this discussion, though, is that there is no
single cause for operational stress injuries or PTSD in the first
responder community. For some it's a question of a single traumatic
event, which is often followed by intense analysis by supervisors,
media, and the general public, all with the benefit of hindsight and
time, while for others it is built up over years of exposure to some of
the worst circumstances. It's almost impossible to predict and
extremely difficult to prevent. We also must not forget the role that
organizational policy and practices play in this issue.
There's absolutely no question about the urgent need for action.
Since April 2014, 77 first responders have taken their own lives.
Obviously, not all of these suicides are a direct result of PTSD, but
apart from the elevated risk of suicide, almost every officer I know
has direct experience and knows a friend, a colleague, a partner who
9
has suffered from what we now recognize as PTSD or operational
stress injury.
To illustrate, the Vancouver Police Union recently completed a
survey of my own home service in which we reached out to
members through their private email addresses to get a better idea of
how widespread PTSD might be. In tallying the responses, it became
evident that more than 30% of our members meet the criteria to be
clinically diagnosed with PTSD.
Surveys conducted in other major police services across Canada
by the Canadian Police Association have shown similar results.
These results offer a glimpse into the scope of how serious this
problem is.
While suicide is obviously the most severe of the consequences
that can be suffered, it's far from the only one. Our recent conference
heard testimonials from service police personnel regarding their own
personal experiences dealing with provincial workplace insurance
boards when filing claims for benefits for those suffering from a
disease whose symptoms aren't always easily visible. This is why
our members have been actively advocating for presumptive
legislation to reverse the burden of proof for those who have been
diagnosed.
I am pleased to say that a number of provinces have already taken
very positive steps in this regard, including Ontario, which is the
latest to move in this direction.
Of course, not all the solutions come directly from government,
and I will certainly acknowledge that we have work to do ourselves
as police leaders, both on the front lines and particularly at the
executive level. “End the stigma” is a familiar refrain that recognizes
that we all need to work harder to understand the difficulties faced
by those who are suffering. It will come as no surprise that in a world
like policing, there has been for a long time a culture that encourages
our members to tough it out and work through problems while still
pulling your weight as part of your policing team, whether on patrol
or as part of a specialized unit within the service.
Everyone from partners to supervisors must work harder within
the policing structure to understand the signs and to reach out with a
helping hand and the necessary assistance when one of our
colleagues needs it the most.
I should also note that police associations across Canada have
made tremendous progress in recent years in addressing the issue.
Employee assistance programs, peer counselling, and psychological
health and safety standards are all innovations that have been pushed
by front-line representatives.
10
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● (1215)
Despite all of that, there is still a tremendous lack of research into
the issue itself, particularly with respect to first responders, and I
believe that is one major area where the federal government can play
a significant role. While a number of organizations have taken steps
to begin to better understand PTSD, there is a lack of focus in this
area that could be addressed with federal leadership. As president of
the CPA, I'm approached regularly by researchers and groups that
want to be more involved. However, without proper coordination,
there is a serious concern that any new resources might not be used
in the most effective or efficient way possible.
Underlying all of this is one very important point. While any
action plan needs to engage professionals across a number of
disciplines, from academic researchers to psychiatrists, this must be
a process for and by first responders. I firmly believe that for any
new project to have the necessary credibility among those who need
it the most, it must be driven by those with a serious understanding
of the particular culture and environment that is unique to the first
responder community, and I hope the committee can help us
reinforce this important point. I know the time here today is limited,
so while I could continue for some time, I've always found the
greatest benefit in appearing before a committee is the opportunity to
answer your questions.
I'll conclude here and I'll reiterate my thanks for the invitation here
today and for the work you're all doing taking on this study. I know I
speak on behalf of my front-line colleagues when I say that we
appreciate your efforts and I look forward to seeing some action on
this front.
March 10, 2016
It's important to note that the mental health concerns of public
safety officers are not limited to PTSD. They include a range of
problems, from depression and somatic and psychosomatic complaints to chronic fatigue and difficulties with alcohol and other
substances. We know the suicide rate is approximately 30% higher
than comparison groups, while marital problems are twice as
prevalent.
Thankfully, the collaborative work spearheaded by organizations
like the commission is lending a voice to this quiet crisis. Our efforts
are centred on empowering first responders by exchanging knowledge, sharing best practices, and leading cutting-edge research.
Among our seminal work is the adaption of the road to mental
readiness program, referred to as R2MR, which is a program that
was originally developed by the Department of National Defence
and designed to foster stigma reduction and mental health promotion
in the Canadian Forces. The Mental Health Commission has taken
this excellent blueprint and modified it to reflect the needs of police
officers, firefighters, paramedics, and other first responders.
Participants are familiarized with a mental health continuum model
and provided with a simple, colour-coded self-assessment tool with
clear indicators of good, declining, and poor mental health. R2MR
also focuses on teaching a set of cognitive behavioural techniques
that help manage stress and build resiliency.
Thank you.
The Chair: Thank you very much.
Now we're going to turn to our other witnesses. You have 10
minutes together. I don't know how you're going to split that time.
Thank you.
Ms. Louise Bradley (President and Chief Executive Officer,
Mental Health Commission of Canada): Thank you very much.
I'm absolutely delighted to be here today to talk about operational
stress injury and post-traumatic stress disorder.
I'm Louise Bradley of the Mental Health Commission of Canada,
and I'm joined by Phil Upshall from the Mood Disorders Society of
Canada. Together, our organizations are poised to act quickly in a
critical area, thanks to internal knowledge, and strong and existing
stakeholder partnerships in Canada and worldwide.
Canadian first responders and public safety officers bear the
weight of tremendously responsible jobs. These unsung heroes are
quick to act in times of crisis, courageously putting their personal
safety at risk in an effort to help others. In a relatively short time, the
true toll exacted by this work has become the focus of an
impassioned national dialogue. The safety risk faced by first
responders goes well beyond their physical well-being. That's why
it's heartening to see the federal government showing leadership and
taking an active role in confronting the reality of occupational stress
injuries like post-traumatic stress disorder.
Currently, more than 500 police, firefighter, and paramedic
organizations across the country are partnering with the Mental
Health Commission to deliver this training. Within the federal
government, our partners include the RCMP, which has agreed to
deliver training to its 30,000 employees. The recognized need for
R2MR is overwhelming. Meeting the demand is among our
significant challenges.
It's certainly an area where the allocation of more resources would
have a significant impact. To date, the Mental Health Commission
has also conducted two train-the-trainer courses with Correctional
Services Canada—one in English, one in French. They are rolling
out R2MR to corrections personnel as we speak. We're also doing
work at the provincial level, both in corrections and with other first
responder groups.
I'd like to touch just briefly on our efforts to support the training of
Ontario's 30,000 regular and volunteer firefighters, which began in
February of this year. We are particularly honoured that the R2MR
has received the endorsement of the Canadian Association of Fire
Chiefs.
March 10, 2016
SECU-07
Our work with first responders also extends to the provision of
mental health first aid. Offered in over 20 countries around the
world, mental health first aid consistently offers key results for those
who participate in the course, namely an increased awareness of the
science and symptoms of mental health problems and decreasing
stigmatizing attitudes. The importance of this training also extends to
the promotion of good mental health and prevention of mental illness
among first responders themselves. In 2013, more than 40 fire
departments, 30 paramedic organizations, and 80 police organizations, as well as the Department of National Defence, delivered
mental health first aid training.
We're also working to adapt mental health first aid for use by
veterans and their families.
● (1220)
As president and CEO of the Mental Health Commission of
Canada, I feel very fortunate to be at the helm of this organization at
a time when so many positive initiatives are being undertaken.
However, I'm even more hopeful about the positive outcomes that
may result as mental health becomes an integral part of workplace
safety training, for which the commission has given a great deal of
time, effort, and research.
Now, more than ever, we're in a position to equip our first
responders with life-saving tools and training. As far as I can see, it
is a societal obligation. Ultimately, to neglect the mental health of
our first responders is to put the welfare of our communities at risk,
and that's a risk we cannot take.
I'd now like to turn the rest of the remarks over to Phil Upshall,
who's going to tell you about a proposal that will help ensure first
responders seek help, and that it's met with informed and supported
care.
Thank you.
Mr. Phil Upshall (National Executive Director, Mood Disorders Society of Canada): Thank you, Louise.
Thank you for the opportunity, Mr. Chair and members, to be with
you today.
My name is Phil Upshall. I'm the national executive director of the
Mood Disorders Society of Canada.
Before I start into my quick remarks, I'd like to point out the fact
that Syd Gravel is sitting here with us today. Syd is the co-chair of
the Mood Disorders Society of Canada's peer and trauma support
team. Syd has lived and continues to live with PTSD and its impact,
as a former police officer in Ottawa. He's well informed on both the
national stage and the provincial stage, particularly in Ontario as it
looks at it's WSIB issues. Syd and his co-chair lead our peer support
and trauma team, which is the largest peer support team in Canada,
and probably in North America, directed specifically at first
responders and people who have significant issues with PTSD. If
you want to talk to him later on, you're more than welcome to. He's
really a great guy.
The Mood Disorders Society of Canada is a national consumerled, patient-led, and caregiver-led organization. All of our team,
including me, have lived with mental illness, at one stage or another.
My associate national executive director, Dave Gallson, lives with
11
PTSD, having lost his legs in a terrible accident. It took him a year to
recover physically from losing his legs, and it's taken him many
years to recover from the PTSD associated with it.
My senior research person and project manager, a fellow by the
name of Richard Chenier, is a former RCMP officer whose colleague
was shot to death while he was writing up a report. He lived with that
trauma for 29 years before he got the proper help.
Now I'm going to have to really go quickly.
As we outlined to the finance committee a few weeks ago, 85% of
first responders and veterans dealing with mental illnesses, including
PTSD, go to their primary health care provider. Regardless of all the
other opportunities out there for help, if someone is going to go for
help with PTSD, most go to their family physicians. Sadly, many of
them, over half in many instances, leave without adequate care.
I'm not going to remind you of PTSD's significance today.
Because of the expert advice you've been given, I won't get into what
PTSD is. But from our perspective, PTSD is an issue that does not
need to come to fruition, if you like, if early diagnosis is available
and if help in the community in which that person lives is available.
Mood Disorders Canada learned about this problem when people
phoned us and asked, “Where can we get help? There's no help for
us.” We would refer them to the armed forces, Veterans Affairs, or
their own police department, and they would always come back
saying there was no help.
The first thing we did was ask, “How come?” We held a meeting.
It was called Out of Sight, Not Out of Mind. At that meeting, it
became very clear that we needed to attack the problem in a very
significant way. As an organization with limited financial resources,
we chose to focus on one thing, and that was family physicians and
health care providers. They are the door. They're the gatekeepers.
They're the first ones who see people living with mental illnesses.
They are not taught appropriately in their medical training with
regard to mental illnesses generally, and certainly not with regard to
PTSD.
We have a very good working relationship with the College of
Family Physicians of Canada and the shared care community,
including all primary care providers. We've talked to them about
working to engage them in the business of learning about PTSD, and
they're all on board.
● (1225)
The Chair: I'm afraid I'm going to have to cut you off, please
wind up.
Mr. Phil Upshall: Thanks very much for the opportunity. I'm
happy to respond to any questions.
The Chair: That's perfect.
Mr. Spengemann for a seven-minute round.
Mr. Sven Spengemann (Mississauga—Lakeshore, Lib.): Thank
you, Mr. Chairman.
12
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Ms. Bradley, Mr. Stamatakis, Mr. Upshall, thank you so much for
joining us today. I think I speak for all members of the committee
when I say we're extremely grateful to have this opportunity to
conduct this study, and we are grateful for the opportunity to hear
your insights this afternoon.
For the benefit of Canadians who may be listening or reading the
transcript later, and for the benefit of the committee, I wonder if we
could start by taking a closer look at the human costs of what we call
OSI, PTSD, the mental stressors we're talking about. What exactly is
it? How do the individuals react who are exposed to these
circumstances? How do their families react? How destructive a
force is it? With examples, if you can, could you illuminate this issue
for us and paint a picture of what we're talking about?
Mr. Phil Upshall: How about the fact I got a call yesterday that a
first responder had killed himself? That's a pretty big impact.
How about a family that's broken apart with six kids? The person
involved with PTSD is totally unable to cope with life, after asking
for three or four years for help. The family breaks apart. There's no
income, no disability payments. Those are just two of hundreds of
thousands of issues in terms of the cost. I leave it to the others to
comment as well, but it's very significant and it's a totally avoidable
cost.
Ms. Louise Bradley: I can provide a personal example as well.
My niece is a police officer, 24 years of age. She called me after
her first call-out in the middle of the night to an abandoned car and
she said to me that the woman had died by suicide. She told me the
woman's face looked like a Halloween mask and she had to stay with
that person for about an hour before help arrived. She went on a few
weeks later to have other similar situations. She's 24 years old and I
think it's safe to say that's pretty traumatic. The expectation was that
she go back to work the next day. Had she broken her leg in the line
of duty, it would have been different.
Fortunately, I am head of the Mental Health Commission. Not
everybody has such an aunt. I pushed her to get help and she's doing
well, but it's an ongoing process because these situations are very
real on a daily basis, and I'm sure our police officers have many
examples.
● (1230)
Mr. Sven Spengemann: Thank you for that.
Mr. Stamatakis, would you have anything to add to that?
Mr. Tom Stamatakis: Sure. I have a colleague who killed himself
on New Year's Eve, December 31, 2014. He was working a project
targeting a number of high-level criminals. He was away from home
working an excessive amount of overtime for an extended period of
time, away from his two young children and his spouse over the
Christmas vacation when they were expecting him to be home.
There's a lot more to this story but ultimately it appears to have
culminated in this police officer becoming so overwhelmed by his
circumstances—he also suffered a head injury during that time that
was misdiagnosed—that he went to his hotel room on New Year's
Eve 2014 and killed himself with his own service pistol.
I'm still supporting his spouse who's now left with no husband and
no father to her two children. She has received no benefits. She's
now lost the primary provider in the home, and is still now, over a
March 10, 2016
year later, waiting for a response from the local workers'
compensation board. I don't want to come across as being critical
of the board because they are, of course, investigating and doing all
those things, but there's a clear example of something that has
resulted in the loss of a life. It's left two children without a father, a
wife without a husband, and a lot of questions and uncertainty
around their future.
That's just one example. We had four suicides in the police
community early this year. I can give you many more examples, and
that's just on the personal side. There's an impact organizationally
when you have people suffering from operational stress injury or
PTSD. The absences from work, the suffering, the issues with their
performance that manifest themselves in disciplinary processes, and
how that consumes an individual and the individual's family and an
organization, and how inefficient that is, it's just a travesty.
That's why this is so important and why we have to get so ahead
of it so that we understand it, so that we can diagnose it early, so that
we can prevent it, and treat it, and provide people with support so
they can stay productive, not just in their personal lives but also
professionally.
Mr. Sven Spengemann: Thank you for that.
These are only four stories. Suffice it to say that there's a
tremendous economic cost. I won't ask about that.
What I wanted to seek your help on is some clarification of
concepts—again for the benefit of the Canadian public—and
separation of what we're talking about here and what else might
be going on in the workplace. You've already alluded to it, but one of
the terms that floats around a lot is “burnout”. It's a common
Canadian term. You can have burnout in investment banking, but
you won't get PTSD. Could you talk about the stressors that exist in
the workplace outside of the actual events that would trigger OSI or
PTSD, and how they might serve as an accelerant and how we need
to focus on those as well as the actual symptoms that we're looking
at here?
Ms. Louise Bradley: I have—
Oh, sorry, go ahead.
Mr. Sven Spengemann: Mr. Stamatakis, go ahead.
Mr. Tom Stamatakis: There was work done by Professor Linda
Duxbury a few years ago. She's at Carleton University. She found—
and this is a huge contributor I think, particularly in the police
community—that most police officers were working an excessive
number of hours on a weekly basis. Let's say roughly that we work
about a 40-hour work week, as everybody else does. But she found
through her research, which is a national research project, that police
officers were regularly putting in between 10 and 20 additional hours
on top of the 40 that they normally work. So when you talk about
burnout, there's not a police agency or a police officer across this
country who won't tell you that on a weekly basis they're having to
put in additional time.
March 10, 2016
SECU-07
Sometimes that's because they're appearing in court to help
prosecute the cases in which they've arrested people, so victims can
be supported and the accused can be convicted of the serious crimes
they were committing. There are special events. There are always
additional demands on police officers, in addition to the regular
hours of work they typically do.
That's just one example that leads to this burnout, this constant
demand.
● (1235)
The Chair: Thank you.
Go ahead, Mr. O'Toole.
Hon. Erin O'Toole: Thank you, Mr. Chair.
I'm going to be dividing my time with my colleague Mr. Doherty.
13
We've done a terrible job, and that's where I think this committee
can play a significant role by creating some broad framework around
what we need to do nationally to make sure we track these issues
more carefully and understand the scope of the problem.
Mr. Todd Doherty: Mr. Stamatakis, I just want to say thank you
to our guests as well.
In developing my bill, Bill C-211, I am deeply familiar with some
of the concerns that are being experienced, but one of the things that
I failed to do adequately, and the question has been raised.... How
would you define the term “first responder”?
Mr. Tom Stamatakis: Typically what people look to are the frontline police officers who are wearing the uniform and responding to
calls for service and ambulance paramedics wearing uniforms and
who are responding. It's the same for firefighters.
I want to welcome and thank all the witnesses for your frank
testimony, personal in some cases, and your advocacy. I've had the
pleasure of working directly with many of you in the last few years.
Particularly, I think one of the real achievements of the Conservative
government was the Mental Health Commission of Canada, and I
applaud this new government if it's going to build upon that. I hope
to see some of you at the Sam Sharpe mental health breakfast on
May 5, which Roméo Dallaire and I host on the Hill each year.
We have a number of people who work in policing, in particular,
because that's my area of familiarity. We have 911 operators, so
communications operators who take the calls from the public, and
these are sometimes pretty traumatic calls. We have analysts that
work side by side with our police investigators, who are looking
often at some pretty horrendous evidence and dealing with
horrendous images and scenes.
● (1240)
Thank you for your work and the training program that, Mr.
Upshall, your organization's been critical in creating for family
physicians, because as you said, that's a first point of contact for
veterans and first responders, and we need to empower them with
knowledge.
There's all manner of other police personnel or personnel in the
other partners in the first responder community who also need to be
included in this discussion.
My question will really be for Mr. Stamatakis. I had the honour of
addressing your group. I talked about PTSD and OSIs and the need
for the federal government to share, and the road to mental readiness
program is being shared and built upon. Dr. Sareen, who was just
before you, talked about the dosage issue and that a single event, as
you said, or prolonged exposure can lead to OSIs. How do you track
that sort of prolonged exposure at the police level? Is it being
monitored now, so that there can be a health check for your
members?
Mr. Tom Stamatakis: No. That's the short answer. We've done a
terrible job of tracking, and I think that's tied a little bit into this
notion of stigma and an unwillingness in our culture, in particular, to
acknowledge the scope of the problem and the fact that it is an issue
that must be tracked. We're just starting now to try to track that as
best we can. I think programs like the road to mental readiness are a
step in the right direction.
We in policing also have done a terrible job, in my view, of
building the capacity that you need to build in order to allow
programs like R2MR to be successful, so that, when police officers
and first responders are educated and able to self-identify that they're
in one of these stressful situations for whatever reason, there's the
capacity then to manage that without adding to the whole stigma
issue. If I declare that I'm suffering and I need some time away, I
need to be in a position where my colleagues aren't going to be left
short-handed and upset because they've just lost someone and now
they have to work twice as hard because there's a vacancy in that
work unit.
Mr. Todd Doherty: Really quickly, I'm glad you brought it up in
terms of the compensation act, and having survivors, the friends and
family members who are left behind.... We really need to build a
real-world solution by engaging those who are putting their boots on
the ground, those who are putting their lives in danger every day, and
those who are tasked to take charge and look after those who are
putting their lives in danger.
How do you see that moving forward in terms of developing that
national framework so that we can develop a framework that is most
effective, so that it's not just for now but for the long term?
Mr. Tom Stamatakis: One of the things I see is that we need to
first of all come up with some common understanding of what we're
talking about.
Let's define terms like “occupational stress injury” or “PTSD”
clearly. Let's all talk the same talk. You can talk to different groups
or advocates in this area that have different definitions around
common terms.
Then let's get to some common discussion about what we think
those appropriate tools are or what we think those appropriate
treatments or supports are for people who are suffering, so there's
some consistency around that across the country. I think again that's
where this body can play a significant role.
There's been lots of talk about presumptive legislation provincially, which I know doesn't fall within the jurisdiction of the federal
government, but the most important piece from my perspective is
what happens after. Just getting the diagnosis and the acceptance of
the claim is one part of the problem, but it's what happens after.
14
SECU-07
In the example I gave you about the spouse whose husband killed
himself, she herself was diagnosed with PTSD because of the
circumstances around the death of her husband, and she's still paying
out of pocket to get the counselling service that is helping her
manage her own diagnosis. This is over a year later, and there's no
mechanism for providing people with access to that counselling. In
her case she's getting lots of support, but the common theme is where
people don't have the financial capacity to manage that on their own.
They go without.
The Chair: Thank you.
March 10, 2016
Ms. Louise Bradley: Do you mean R2MR specifically?
Mr. Matthew Dubé: Yes, but the pilot project with Corrections
Canada that was kicked off in August....
Ms. Louise Bradley: It's still at the very beginning. Some
correctional centres are doing some training for train-the-trainers, but
I couldn't say that it's widespread.
Mr. Matthew Dubé: It's still early, fair enough.
Mr. Dubé.
[Translation]
[Translation]
Mr. Matthew Dubé: Thank you, Mr. Chair.
I want to thank the witnesses for being here with us today.
Ms. Bradley, you mentioned the support program, the pilot
project.
Ms. Louise Bradley: I'm sorry, but I don't speak French.
[English]
Mr. Matthew Dubé: While the clerk shows you where the
translation earpiece is, I'll continue in English.
You talked about the pilot projects that are being organized with
Corrections Canada in the Pacific region and in Quebec. That's under
way now, I believe. Can you perhaps give an update on how that's
going and where things are at?
Ms. Louise Bradley: We're seeing a large uptake right across the
country, so we're very pleased about that in terms of R2MR and
mental health first aid.
Another component relates to several of the other questions that
were asked along with yours, which is that the commission has the
“National Standard of Canada for Psychological Health and Safety
in the Workplace”. We are seeing some areas in health care and first
responders looking at this, because regardless of whether the
workplace is in an office or out on the streets or wherever it may be,
it applies equally. This can look at and address the stigma that is
associated with the thought that it's a career-limiting move to admit
that you're experiencing difficulties. It also allows people to take
steps to make sure that things like this are prevented. It could involve
everything from peer support groups to accommodating people. We
know how to accommodate somebody in a physical setting if they
have a physical injury, but psychological ones, not so much.
It's costing Canada over $51 billion a year in lost productivity, so
we are promoting the psychological safety standard in the
workplace. We are seeing more of them take this up, so that allows
for a much broader and in-depth approach to prevention and being
able to respond quickly to a situation than just the two tools—which
are extremely effective, by the way—R2MR and mental health first
aid.
● (1245)
Mr. Matthew Dubé: I know that you guys are only partners, but
do you know where that specific pilot project is right now? I
appreciate the overarching theme, but is that going well? Is it going
to be adopted at large?
I will continue in French.
In your road map—it was in 2012, if I'm not mistaken—you
talked about the importance of better collaboration with the
provinces on mental health services. Although the issues we are
focusing on here today have more to do with what the federal
government can do, would you still say that services need to be
better integrated in order to really be able to provide as many
services as possible to those who need them?
[English]
Ms. Louise Bradley: Yes, I do think that more work can and
should be done in that regard. After all, the provinces are largely
responsible for providing health care.
I think the good news is that with a mental health strategy for
Canada where all these items are identified, several of the provinces
have now developed individual provincial mental health strategies
that overlap with the national one. That's a good thing, but I think
that is dependent. Not all provinces are dealing with it and doing as
well as others, so there isn't all that much consistency.
I think that working with the provinces and territories is absolutely
critical. The issues that are occurring, for example, in the Northwest
Territories are going to be quite different from those in Toronto. Yes,
the outcomes are very frequently the same, but the issues are
different and therefore have to be dealt with differently, which is why
we've done adaptations specific to mental health first aid for northern
peoples, first nations, and seniors.
[Translation]
Mr. Matthew Dubé: That's an interesting point.
When we think about the federal government's role in terms of
public safety for indigenous people, one has to wonder how an
approach that is more tailor-made for first nations could be
developed. This could include mental health services and various
actions by the RCMP, for instance, as well as other similar situations.
March 10, 2016
SECU-07
[English]
Ms. Louise Bradley: I will answer this question to the best of my
ability with a great deal of caution because I'm not an indigenous
person. Therefore, I think that the solutions that you would need in
an indigenous setting are going to be quite different. We need to be
culturally aware and sensitive, and certainly the approaches need to
take that into perspective. I don't think there is just one approach that
would work there. In fact, I would suggest that there are probably
quite different approaches from what I've heard from my indigenous
colleagues. That's something that they caution us about on a regular
basis.
The Chair: Merci.
Mr. Di Iorio.
[Translation]
Mr. Nicola Di Iorio (Saint-Léonard—Saint-Michel, Lib.):
Thank you, Mr. Chair.
Good afternoon and welcome, ladies and gentlemen.
I want to echo my colleagues' expressions of thanks and
welcoming, although I won't repeat everything, considering our
time constraints.
Ms. Bradley, the doctors who appeared before you indicated that
some people were at higher risk, were more vulnerable, and more
likely to have reactions that are harmful to their health.
Could you comment on the work, research, considerations, and
steps your organizations has taken to identify those individuals?
● (1250)
[English]
15
Mr. Stamatakis, as you know, this committee is a federal
parliamentary committee, but the situation we are talking about also
exists within organizations that fall under provincial jurisdiction. It
also exists in the U.S., in Latin American countries, in European
countries, and elsewhere around the world.
Has your organization taken any steps to identify best practices,
especially when it comes to prevention and treatment, in jurisdictions outside of Canada and in the provinces?
[English]
Mr. Tom Stamatakis: There's nothing specific. We are just
starting to survey our own organizations in Canada. We have a
network of affiliations internationally where this is now something
that we've added to the agenda to start having a discussion about, to
discuss best practices and similarities.
I think you touched on the key point, and where I think there is a
role for the federal government to play. It is around research
identifying what's happening in the different provinces and creating
some kind of a broad overarching framework that everybody can
look at to find consistent information, particularly when it comes to
research about how to build resiliency.
What should we be looking at when we're recruiting brand new
police officers, for example, to ensure that they have the tools or the
capacity to manage the situations that we put them in? How do we
recruit more diversity into our organizations? We want to have more
women in policing. We want to have our police organizations reflect
the diversity in our communities. How do we build the capacity to
manage different values and religious beliefs? How do we manage
women who come into policing but then want to have families, so
that we remove the stigma that Ms. Bradley was talking about?
Ms. Louise Bradley: There are definitely people that are at higher
risk because of the work that they are doing and the situations that
they find themselves in. Some are definitely more vulnerable. Youth
—
These are the things that we have to have a conversation about and
create some consensus around, so that we can consistently respond
across the country in each of the provinces.
[Translation]
[Translation]
Mr. Nicola Di Iorio: Let me interrupt you, since we are running
out of time.
Mr. Nicola Di Iorio: In response to a question from my colleague,
Mr. Spengemman, you used the expression “totally avoidable cost”.
What you are telling the committee, then, is that concrete action
could be taken and that certain projects could become a reality.
Can you tell us about any work or research that has been done in
that regard? We can share personal opinions, but more importantly, I
want to know if your organization has taken a science-based
approach to this.
I would like you to elaborate on this. You mentioned it, but did not
have the opportunity to discuss it in further detail.
[English]
● (1255)
Ms. Louise Bradley: The commission has not done any specific
research on PTSD other than with the road to mental readiness
training. We've certainly done a great deal of research in the area of
stigma. Of anything that we talk about in this regard, that has a major
impact. It's huge in that people simply will not go to get care. We are
conducting research right now into how well various areas are
adopting the psychological safety standard. These are all very
important areas, but we have not done any specific research in those
two.
[English]
[Translation]
Mr. Nicola Di Iorio: Thank you, Ms. Bradley.
Mr. Tom Stamatakis: In my opinion, and I think you've heard a
lot about this from Ms. Bradley as well—and I agree with her—we
have programs like the road to mental readiness that are being
adopted. She referred to the psychological standards in the
workplace, which organizations are very slow to adopt. If we build,
adopt, and create policies and practices that recognize these features
in our workplace and then build the capacity to manage them better,
then I think the costs can be avoided. We can avoid the long
absences. We can avoid the dysfunction in the workplace and the
dysfunction in the home.
16
SECU-07
For example, on the road to mental readiness program, we're now
for the first time educating our members around why they're feeling
the way they're feeling and giving them some options around what
they can do about it.
What's missing so far, though, is that if I identify that I'm in crisis
and I need some assistance, we haven't yet built the capacity
organizationally for me to be able to get quick access to that support
so that I can stay at work and so that I can stay productive, and not
think I have to take advantage of sick benefits, and not start to rely
on medications or alcohol or other substances to manage my feelings
or the stress that I'm going through. That's what I was alluding to.
March 10, 2016
talk about it, my own experience has a much more significant
impact.
We're seeing in a couple of police conferences that we have cohosted that when police officers and other first responders are able to
talk about their own experiences it really makes a big difference in
terms of others feeling free to be able to talk about it. That's one of
the biggest things.
Until we have work environments and cultural settings that will
allow us to talk about depression in the same way as I would talk
about having the flu, we're simply not going to get past it.
[Translation]
The Chair: I think we have to end there. It goes by quickly.
All of these pieces that we're talking about here today are working
together. They can't be looked at in separate little pieces. Things are
coming together quite nicely, but there's a great deal left to be done
structurally.
Monsieur Rayes.
● (1300)
Mr. Nicola Di Iorio: Thank you.
[English]
[Translation]
Mr. Alain Rayes (Richmond—Arthabaska, CPC): Thank you,
Mr. Chair.
I would like to thank the witnesses for being with us today and
helping us in our work.
Before I was a member of Parliament and a mayor, I was a school
principal and teacher. On a number of occasions, I saw people who
were suffering from depression, burnout, or anxiety. I saw how they
felt ashamed and weak. They were afraid of being judged by their
peers, and they didn't understand what was happening to them.
We are talking about training, awareness, and research tools, but
there is a need for cultural change within organizations, in the
institutional environment. Some tools have been put in place, and it
has been a difficult process. From what I understand, the Canadian
Police Association is just getting started. You haven't started talking
about this at the international level to find out what other countries
are doing.
We see police officers, firefighters, and members of the military as
strong people who are immune to weakness. I imagine that there
must be work to do, even when it comes to the corporate culture.
Have you taken your research further and involved the managers
of these sectors and the police stations to see what could be done?
My question is for all three witnesses.
Mr. Phil Upshall: There's no doubt that corporate cultures have to
change from the ground up, but when you start changing corporate
cultures and you start asking people to be prepared to talk about their
stories and discuss these issues, a lot of it boils down to the fact that
maybe we need to get them some help.
Try going to get help. There is none. In many instances you can
talk all you like about research and everything else that's going on at
our levels but on the ground across Canada, people can't get help.
There are no waiting lists for people with mental illnesses, whether
they're first responders or not. Why aren't there? Because there's no
help. People go to see their doctors.
We have an instance going on today where a person's gone six
months trying to get in to see a psychiatrist. They can't get in.
They're willing to talk about it. They're out there and self-help
groups are doing all that neat stuff. They're listening to people who
say they should get help but when you knock on your doctor's door,
you find out that the help is not there. Our solution is to get the
doctors and health care providers involved. They're the gatekeepers
to help change the corporate culture.
[Translation]
Mr. Alain Rayes: Thank you, Mr. Upshall.
I would like to hear from the president of the Canadian Police
Association, Mr. Stamatakis.
[English]
Ms. Louise Bradley: Thank you.
Yes, the points you raise are excellent points and they're extremely
accurate. Again, I harken back to the research that we've done on
stigma and the workplace.
We're finding that getting past the stigma is really the biggest
challenge. It really is. We have discovered at the commission
through our research that contact-based education is what makes a
difference, so I as a nurse can tell you the signs and symptoms of
post-traumatic stress disorder or depression, but to actually be able to
Of course, I hear the stories about doctors, but within the
organization, if the culture prevents these people from speaking out,
they may not even get to the point where they are seen by a
professional.
I imagine that in police forces, the fact that this is being studied
must be a very sensitive subject.
[English]
The Chair: Be very quick, please. We're over time.
March 10, 2016
SECU-07
Mr. Tom Stamatakis: Specific to your question, I alluded earlier
to some surveying we're doing directly with our members. We're
identifying some pretty startling outcomes particularly around
PTSD, where we're including some diagnostic skills on the survey
tools we're using. On average about 30% of our members in major
police departments are suffering from PTSD or diagnostic for PTSD.
There are similar rates of people suffering from depression, anxiety.
We have very few people in the normal range for depression and
anxiety. That's our first step. We're trying to create a baseline in
terms of what's happening in our organizations across the country.
To your point around the cultural or the organizational piece, we're
trying to introduce a different approach to some of the organizational
structures that contribute to operational stress or PTSD. which I
eluded to as well. Another finding we're getting from our surveys is
that a lot of the stress also comes from organizational practices.
We're introducing new methodologies around how we promote
people, how we deal with issues around tenure where people are
going into assignments and are becoming embedded in their
communities, because they engage with their community quite
extensively. Then they're being told they have to go to a different
assignment, so they lose these relationships and that has a huge
impact on them.
We're starting to make some proposals around looking differently
at how we promote people. Let's look differently at how we deal
with people, how we assign them, so we can take away some of the
pressures and stigmas that go along with it. That's just one example.
The Chair: I'm afraid I have to stop you.
Thank you very much.
I want to thank all our witnesses. We've come to the end of our
meeting.
Committee, I want to mention two things before we break. First,
in the middle of that meeting I asked our analysts if they could
17
prepare a short note on some terminology on the object of our
attention—first responders and public safety officers—what is
included, and how we can find a short form without having to list
everybody every time. They're going to give us some advice on that,
based on some work we've done. We'll get that for our next meeting.
Second, I wanted to get a quick poll about the meeting on March
22, which is budget day. There has been some conversation lately
that some members want to be in lock-ups that day and others would
like us to continue with our study. I wanted to get a nodding or a
shaking about whether people would like to cancel that meeting and
be available for budget issues or whether they would like to continue
with this study that day.
Mr. O'Toole.
Hon. Erin O'Toole: Mr. Chair, the position of the Conservative
Party with respect to budget day, or as we're describing it “Black
Tuesday”, is that we would still want the committee to work that day.
● (1305)
The Chair: That's all right.
Monsieur Dubé.
[Translation]
Mr. Matthew Dubé: I agree with Mr. O'Toole.
I think there are enough resources so that members can do their
work on budget day and the meeting can still take place.
[English]
The Chair: I am going to suggest that we meet that day. If one of
the members wants to be away from committee, they can get a
substitute so they can engage, but we will meet on the 22nd.
The meeting is adjourned. Thank you.
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