Canada's Original Think Tank

Third reading of Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder

Third reading of Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder

Third reading of Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder

Hon. Mobina S.B. Jaffer: 

Honourable senators, I rise today to speak on Bill C-211, An Act respecting a federal framework on post-traumatic stress disorder.

I would like to acknowledge the hard work done by Mr. Doherty, the author of the bill. I would like to thank Senator Housakos, the sponsor of this bill, and Senator Bernard for her work as its critic.

I would like to begin by stating that I support the spirit of this bill. Post-traumatic stress disorder or PTSD is a prevalent issue that affects seven or eight out of every 100 Canadians at some point in their lives.

For Canadians in the most stressful of work environments, like Canadian Armed Forces members, Royal Canadian Mounted Police members and first responders, among many others, the risk of developing PTSD is amplified. Each day these people put on their uniforms to protect, serve and heal Canadians, knowing that they will experience tragedies every day. While we as Canadians applaud these people for the heroic work that they do, they are just as at risk of developing PTSD as we are. To truly drive home just how much these heroes can struggle with mental health issues, I would like to share a story with you.

Natalie Harris had been a paramedic for 13 years. She had a reputation as one of the most caring and committed people in the area and was known for her ability to form connections with her patients as she held their hand and comforted them on their way to the hospital. When Natalie was assigned to handle a double murder case in 2012, the experience had a permanent impact on her. The things that she saw while working on that case would stay with her for many years, in the form of PTSD.

However, Natalie was unaware of her condition. She thought that she was fine and in fact did not want to admit that anything was wrong. She loved her job and knew that she would have to leave if she had a mental health condition. And so she kept on working in her strenuous job without any kind of support. Eventually, Natalie would find that this would prove too much for her, and she suffered a serious drug overdose, and she struggled to cope with her symptoms of PTSD. Thankfully, Natalie survived her overdose. However, many others like her do not. According to the Tema Conter Memorial Trust, a total of 68 first responders took their own lives in 2016 because of PTSD.

Stories and statistics like these are why Bill C-211 was drafted. The bill’s purpose is to create a national framework that can prevent stories like Natalie’s from ever happening again. By bringing together ministers, provincial and territorial representatives and stakeholders from across Canada, Bill C-211 starts an important conversation on what a national approach to prevent PTSD should look like.

It lets us develop consistent terminology, diagnosis and care to ensure that every Canadian will have access to evidence-based assessments and a far better treatment outcome. There is no doubt that this is an admirable goal. Countless Canadians are suffering from PTSD and deserve a strong framework that can help them improve their mental health. However, as we move forward with this bill, we need to ensure that this bill is as inclusive as possible in its approach to dealing with PTSD.

This is something that the author of the bill himself has called for. When Todd Doherty came before the Standing Senate Committee on National Security and Defence, he told us that he wanted to create a framework for PTSD that would reach out to the widest possible range of Canadians. His intent is for Bill C-211 to be as inclusive as possible.

Unfortunately, certain interpretations of Bill C-211 could prevent this from being the case. When this bill came before the Standing Senate Committee on National Security and Defence, several senators raised issues that could easily exclude several groups from a national framework on PTSD. Each of these issues was raised in the committee’s report, and I would like to touch on some of them today.

To be clear, I do not believe that any of these issues requires an amendment. Bill C-211 allows for flexibility since it does not actually create the framework. It only encourages ministers, officials and stakeholders to start a discussion on how this framework should look. However, I do believe that we should urge the conference on post-traumatic stress disorder to keep these issues in consideration, since they will ultimately be responsible for creating the final framework.

First, it is worth noting that Bill C-211’s preamble suggests that the framework should focus only on cases of PTSD that were developed because of occupational requirements. In other words, if someone experiences PTSD for other reasons, they could be excluded from the national framework. This simply makes no sense. Countless cases of PTSD emerge because of causes unrelated to a person’s responsibilities, particularly sexual misconduct and harassment.

To put this into perspective, 90 per cent of individuals who experience a sexual assault will exhibit symptoms that could eventually cause mental illness, and particularly PTSD. In organizations like the Canadian Armed Forces and the RCMP, this is a particularly serious issue. We already know that both organizations are currently struggling with sexual misconduct that wreaks havoc on countless victims across Canada. To not count these cases would be to ignore one of the major causes of PTSD that affects the people who serve and protect Canada every day.

Second, we must ensure that our nurses will be accounted for in the national framework for PTSD. Nurses take on some of the most difficult and strenuous medical work, including working in emergency rooms, trauma units, palliative care, operating rooms and psychiatric wards. They are on the front lines of Canada’s battle against the opioid epidemic and are often the first people to take over from paramedics when they bring patients over in critical condition.

Unfortunately, there is a very real chance that nurses could be excluded from a national framework on post-traumatic stress disorder. Currently, the bill’s preamble focuses only on a very limited number of fields. Right now, Bill C-211 only lists first responders, firefighters, military personnel, corrections officers and members of the RCMP. Honourable senators, other groups also need to be added to this framework.

The work nurses do is just as difficult and heroic as the work undertaken by our military, police, corrections officers and first responders, and as a result, they also experience post-traumatic stress disorder just as often. According to the Manitoba Nurses Union, one in four nurses experience PTSD symptoms. These nurses are also incredibly vulnerable to PTSD caused by workplace harassment and sexual misconduct, since 61 per cent of all nurses reported harassment, abuse and assault on the job over the course of 2017.

Excluding people from high-stress fields like nursing from Bill C-211 would be a serious mistake, but it is one that can be solved without an amendment. As I mentioned before, the bill’s preamble lists a range of occupations, but only lists them as groups that are “particularly” vulnerable to PTSD.

In other words, the preamble leaves room for an interpretation that can account for all groups that are at risk, including nurses. If we follow this interpretation, then we can truly have the inclusive bill that the bill’s author, Mr. Todd Doherty, intended.

Finally, I would like to touch on the term that this bill has focused on in particular, post-traumatic stress disorder.

It is unsurprising that PTSD was chosen as the main focus for Bill C-211. Of the mental health conditions that people in high-stress jobs experience, PTSD is by far the most common. However, it is important to note that it is far from being the only one. Workers in high-stress jobs experience occupation-linked depression, anxiety disorders, adjustment disorder and a full range of substance disorders. To simply focus on PTSD would be to leave out a significant number of Canadians who seriously need support.

With that said, it is possible to account for these people within the confines of Bill C-211 without presenting an amendment. Part of the mandate given to the conference on post-traumatic stress disorder is to create a list of consistent terminology that can be used for the federal framework.

I strongly urge the conference to consider the use of the term “operational stress injury,” or OSI. This term has a range of undeniable benefits that have helped psychologists and our military over the 17 years that we have used it. This term emphasizes that a full range of clinical diagnoses can be associated with trauma experienced while working.

Further, calling these terms “injuries” gives them the same legitimacy as physical injuries and plays a real role in reducing the stigma surrounding mental health.

Finally, the term has been widely adopted across our military and psychological associations across Canada, meaning that we can draw on a wide range of experience with this term.

Simply put, using this term can only strengthen our national framework on PTSD and our understanding of the full spectrum of conditions associated with stressful workplaces.

Honourable senators, I would like to stress once more that I’m not calling for Bill C-211 to be amended. While I believe that it is important for the bill to be as inclusive as possible, I do not think that its problems require an amendment to be solved. It is important to remember that this bill does not create a federal framework on its own.

There will be more work done to include groups such as nurses.

Instead, much of the responsibility will rest in the hands of the conference on post-traumatic stress disorder that this bill creates. By raising these issues before the conference instead of amending Bill C-211, we can ensure that Canadians can enjoy a truly inclusive federal framework on PTSD without delaying it any further.

Honourable senators, I first of all, want to thank Mr. Todd Doherty and Senator Housakos for bringing this bill to this place, but I would be remiss if I did not today acknowledge our colleague Senator Roméo Dallaire. Senator Dallaire taught us many things. I still work with Senator Dallaire in Uganda, and when I speak of PTSD, I often think of the suffering he regularly suffers. He was a cherished member of our Senate and many nights I worked with him, this man suffered severely from PTSD. There are many more Canadians like that and we have to stand up for them. Thank you very much.