CARING FOR CANADA’S ILL AND INJURED MILITARY PERSONNEL Report of the Standing Committee on National Defence Rick Norlock Chair JUNE 2014 41st PARLIAMENT, SECOND SESSION Published under the authority of the Speaker of the House of Commons SPEAKER’S PERMISSION Reproduction of the proceedings of the House of Commons and its Committees, in whole or in part and in any medium, is hereby permitted provided that the reproduction is accurate and is not presented as official. This permission does not extend to reproduction, distribution or use for commercial purpose of financial gain. Reproduction or use outside this permission or without authorization may be treated as copyright infringement in accordance with the Copyright Act. Authorization may be obtained on written application to the Office of the Speaker of the House of Commons. Reproduction in accordance with this permission does not constitute publication under the authority of the House of Commons. 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Also available on the Parliament of Canada Web Site at the following address: http://www.parl.gc.ca CARING FOR CANADA’S ILL AND INJURED MILITARY PERSONNEL Report of the Standing Committee on National Defence Rick Norlock Chair JUNE 2014 41st PARLIAMENT, SECOND SESSION 41st Parliament – Second Session STANDING COMMITTEE ON NATIONAL DEFENCE CHAIR Rick Norlock VICE-CHAIRS Jack Harris Joyce Murray MEMBERS James Bezan Jean-François Larose Corneliu Chisu Élaine Michaud Cheryl Gallant John Williamson Hon. Peter Kent OTHER MEMBERS OF PARLIAMENT WHO PARTICIPATED Harold Albrecht Kirsty Duncan Mike Allen Randy Hoback Alexandre Boulerice Daryl Kramp Tarik Brahmi Chungsen Leung Lois Brown Ted Opitz John Carmichael Joe Preston David Christopherson Lawrence Toet CLERKS OF THE COMMITTEE Evelyn Lukyniuk Leif-Erik Aune LIBRARY OF PARLIAMENT Parliamentary Information and Research Service Melissa Radford Martin Auger iii 41st Parliament – First Session STANDING COMMITTEE ON NATIONAL DEFENCE CHAIR James Bezan VICE-CHAIRS Jack Harris Hon. John McKay MEMBERS Chris Alexander Christine Moore Tarik Brahmi Rick Norlock Corneliu Chisu Ted Opitz Cheryl Gallant Mark Strahl Jean-François Larose OTHER MEMBERS OF PARLIAMENT WHO PARTICIPATED Malcolm Allen Mathew Kellway Stella Ambler Chungsen Leung Kelly Block Isabelle Morin Lois Brown Jamie Nicholls Robert Chisholm LaVar Payne David Christopherson François Pilon Joe Daniel Greg Rickford Earl Dreeshen Hon. Judy Sgro Rick Dykstra Jonathan Tremblay Dan Harris Bernard Trottier Randy Hoback Rodney Weston v 41st Parliament – First Session (cont’d) STANDING COMMITTEE ON NATIONAL DEFENCE CLERKS OF THE COMMITTEE Leif-Erik Aune Jean-François Lafleur LIBRARY OF PARLIAMENT Parliamentary Information and Research Service Wolfgang Koerner Melissa Radford vi THE STANDING COMMITTEE ON NATIONAL DEFENCE has the honour to present its FOURTH REPORT Pursuant to its mandate under Standing Order 108(2) the Committee has studied the Care of Ill and Injured Canadian Armed Forces Members and has agreed to report the following: vii TABLE OF CONTENTS CARING FOR CANADA’S ILL AND INJURED MILITARY PERSONNEL ...................... 1 Introduction ................................................................................................................ 1 Context ...................................................................................................................... 2 Stage 1: Recruitment ................................................................................................. 6 Mental Resilience and Readiness at Recruitment ................................................ 8 Stage 2: Pre-Deployment ........................................................................................... 9 Pre-Deployment Mental Resiliency and Readiness ............................................ 10 Preparing CAF Families ..................................................................................... 11 Stage 3: In-Theatre .................................................................................................. 13 Tactical Combat Casualty Care .......................................................................... 13 Care at the Role 3 Multinational Medical Unit ..................................................... 15 In-Theatre Operational Stress ............................................................................ 17 Research and Innovation .................................................................................... 19 Supporting CAF Families .................................................................................... 21 Stage 4: Recovery ................................................................................................... 24 Prevention and Diagnosis ................................................................................... 25 a. Confronting Stigma ................................................................................. 25 b. Diagnosing OSIs .................................................................................... 28 c. Suicide and Suicide Prevention .............................................................. 29 Access to Care and Treatment ........................................................................... 31 a. Rehabilitation and Recovery for Physical and Mental Injuries ................ 32 b. Shortage of Mental Health Staff ............................................................. 36 c. Care and Treatment for Reservists ......................................................... 38 Social Support Services ..................................................................................... 40 Research and Innovation .................................................................................... 45 Supporting CAF Families .................................................................................... 48 Stage 5: Transition ................................................................................................... 51 Final Thoughts ......................................................................................................... 55 LIST OF RECOMMENDATIONS .................................................................................. 59 APPENDIX A: LIST OF WITNESSES — 41ST PARLIAMENT – SECOND SESSION ... 65 ix APPENDIX B: LIST OF WITNESSES — 41ST PARLIAMENT – FIRST SESSION ........ 67 APPENDIX C: LIST OF BRIEFS — 41ST PARLIAMENT – SECOND SESSION ........... 71 APPENDIX D: LIST OF BRIEFS — 41ST PARLIAMENT – FIRST SESSION ................ 73 REQUEST FOR GOVERNMENT RESPONSE ............................................................. 75 DISSENTING OPINION OF THE NEW DEMOCRATIC PARTY ................................... 77 DISSENTING OPINION OF THE LIBERAL PARTY OF CANADA ................................ 87 x CARING FOR CANADA’S ILL AND INJURED MILITARY PERSONNEL The health and well-being of Canadian Forces members is the shared responsibility of leaders, health care providers and the members themselves. That includes a whole-of- government approach to ensure that those who serve their country and are called upon to serve with unlimited liability are provided with the care and support they and their families need in the unfortunate event that they become ill or injured. This is the social contract. Rear-Admiral Andrew Smith, Chief of Military Personnel, 22 November 2012 Introduction The House of Commons Standing Committee on National Defence (“the Committee”) has had a long-standing interest in the care of ill and injured Canadian Armed Forces (CAF) personnel. Our last report on the issue entitled Doing Well and Doing Better: Health Services Provided to Canadian Forces Personnel with an Emphasis on Post-Traumatic Stress Disorder was released in 2009. The report concluded that although the CAF health care system and social support programs were effective, there was room for improvement — particularly with respect to the care of CAF members suffering from operational stress injuries (OSI), including post-traumatic stress disorder (PTSD). In the report, the Committee made 36 recommendations to the Government of Canada. The care of ill and injured CAF personnel is still of interest to us, and we embarked on this study to examine improvements that have been made over the course of Canada’s mission in Afghanistan with respect to the treatment of physical and mental injuries, and the challenges that remain. Throughout our study, the Committee identified a number of recurring themes, including prevention, treatment and support services for ill and injured CAF members, research and innovation, and support for military families. The Committee firmly believes that in caring for its members, the Department of National Defence (DND) and the CAF must continue to improve on all of these aspects throughout