Mr. Chair and committee members, my name is Brenda MacCormack and I'm the director of rehabilitations at Veterans Affairs Canada.
It's my pleasure to appear before you again today with my colleagues: Janice Burke, the director of mental health; and Jane Hicks, the director of operational direction and guidance.
You heard from other colleagues last week on the disability and income support programs. We are here today to talk about rehabilitation, career transition services, and mental health.
As you requested last week, Mr. Chair, we provided a presentation in advance, including four case scenarios. We gave the clerk hard copies for distribution today as well. I'll be referring to that presentation in my remarks, and we'll be happy to walk through those case scenarios in more detail if members wish.
We have been following your committee's study closely and have noted one important question that is arising: is there anything really new with the new Veterans Charter? So I'd like to start by responding to that question for you today, from the perspective of the rehabilitation program.
First, a veteran doesn't need to be receiving a disability benefit to be able to get rehabilitation services. This is new and critically important to making sure veterans and their families get services early, which I know you've heard before is essential to success. We don't have to wait for a disability award to be approved, which can sometimes be a lengthy process and can delay getting someone into rehabilitation services.
Secondly, we can now provide economic support while the client is in rehabilitation. We could not do that under the Pension Act. We could provide disability pensions, but in many cases there would certainly not be sufficient income to allow the person to undertake rehabilitation. As my colleagues emphasized last week, having an appropriate level of financial support at the time it's needed is critical to achieving successful rehabilitation outcomes.
Third, we now have the authority in legislation to help veterans who are not eligible for SISIP because they were not medically released from the military, or perhaps were medically released a number of years ago and are once again experiencing challenges. I know many of you are concerned about this group of veterans who were falling through the cracks before the new Veterans Charter. I want to be clear that these veterans could not before, and still cannot, receive services from SISIP because they were not medically released, or they may have been released quite some time ago and have emerging challenges.
VAC is now able to help them get back on their feet. An example of Ron, starting on page 17 of the presentation deck we've provided, shows how we might do that.
I know your committee has also heard about veterans who start showing signs of post-traumatic stress disorder ten years after leaving the military. The new Veterans Charter was designed to help these people as well, no matter when the disability manifests itself. In fact, one-third of our clients currently in the rehabilitation program have been out of the forces for at least eight years.
Fourth, we now have the authority in legislation to provide rehabilitation to spouses and survivors if the veteran is unable to participate. As you'll see in the Paul case scenario, starting on page 22 of the presentation deck, this is vital to helping restore the family's earnings capacity. You'll note that Paul's wife Kelly can now pursue a nursing degree and get the support she needs to be successful. Kelly and the children can access counselling in their own right--and I'll speak more about our mental health services in a moment. This example of Paul shows the shift to seeing the veteran as part of a family and a community, not an individual in isolation.
[Translation]
Now, we can take a more holistic approach to the treatment and support required for disabilities that hinder successful reintegration. Previously, under the Pension Act, we could provide health care services only in cases where veterans were receiving a disability pension.
On page 27 of the presentation, we have André's case scenario, which is based on the example that Mr. Vincent asked us to examine. André lost his right arm and three fingers on his left hand as a result of an IED. Of course, André will receive psychotherapy, occupational therapy and prosthetic care, among other services, but we can also support André by offering him driver training to help him overcome his anxiety, which resulted from his traumatic experience. If he experiences depression such that it becomes a barrier to him, that can also be taken into account to achieve the objectives set out in his rehabilitation plan.
We can go beyond treating just the amputations. Under the New Veterans Charter, our medical and psycho-social programming is much broader than our traditional treatment programs. It allows us to meet the specific needs of a younger population making the transition to civilian life.
[English]
The rehabilitation program recognizes that injured and ill CF members and veterans are committed to getting well. They want to engage in treatment, establish goals for themselves, and accept their own roles in their health and treatment. It's premised on a more holistic and integrated approach that focuses on the goal of independence and return to active engagement in family, work, and community.
Clients in the rehabilitation program receive individualized case management. What does this mean? It means that case managers sit down with the client and their family, assess needs, develop goals and intervention strategies in collaboration with health professionals, and help them transition to VAC services, benefits, and programs, as well as community resources.
The committee requested examples of our approval forms, which we have provided. I want to stress that we don't just give these forms to veterans and abandon them. The case manager can help the client and family every step of the way, advising them as required, including gathering evidence.
Mr. Oliphant commented earlier this week that CF members experience a significant cultural shift when they're released from the military. We recognize that as well. That's why case management begins prior to release from the military, in collaboration with CF case managers, to ease them through that transition and provide support as early as possible.
The 19 integrated personnel support centres set up across the country are playing a vital role in making sure that CF members and their families are aware of the full range of benefits and services available to them, and that they can get all the information and help from both DND and VAC in one place.
As you'll see on page nine of our presentation, 50% of clients entering our rehabilitation program have an identified mental health condition. So to support the new Veterans Charter we have also invested in mental health supports. We have a comprehensive mental health strategy based on four pillars: providing a continuum of services, building capacity across the country, showing leadership through research, and nurturing partnerships.
Our strategy is based on a whole-person approach that recognizes the impact of personal, physical, social, economic, and health circumstances on mental health. The objective is to promote wellbeing, symptom reduction, recovery, community integration, and enhanced quality of life.
Our network of ten operational stress injury clinics across the country and the operational stress injury support program, or OSISS, as it's better known, are key to reaching out to potential clients battling the stigma associated with mental health conditions, and helping people get support and treatment.
Serving members and veterans of both the CF and the RCMP and their families can receive services. Over 2,700 people have been helped by our OSI clinics, which is more than 20% of our total number of clients receiving disability benefits for mental health conditions.
The final topic I'd like to touch on today is VAC's career transition services. Whereas SISIP and our rehabilitation program are focused on those with health difficulties, the career transition services target those who are voluntarily leaving the forces, both regular and reserve. It offers practical advice and help in finding suitable civilian employment. There are three key services: job-search training workshops, individual career counselling, and job-finding assistance. This program can begin while the member is still in service. This is a new benefit under the new Veterans Charter.
In summary, we are now able to help a wide variety of clients in a wide variety of circumstances. So whether it's someone who has a minor injury but is unable to pursue his or her occupation, or someone who is releasing from the Canadian Forces after suffering a catastrophic injury, the new Veterans Charter can help, proportionate to the level of assistance each one of them needs.
Thank you for the opportunity to appear before you today. We look forward to responding to your questions.
Merci.
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Good morning, everyone.
My question will deal with three different things. I will put them to you, and then you can answer. I will be quick because I do not have much time.
On one hand, you have a good assessment table for evaluating the needs of veterans, but the process has some grey areas. As you know full well, certain cases are contested. Some cases are contentious. Take, for example, someone who, 10 years after leaving the Canadian Forces, notices some back pain. He may not necessarily have undergone a medical evaluation while he was in the Canadian Forces. As you know, cases like that are typical. After some ten years, the person comes back and says that their back pain stems from something they did while on a Canadian Navy ship. That kind of case is contentious.
I would like to know the percentage of those cases. We are aware of certain cases in which the person has been fighting a long time for a disability pension. Now, they have to go up against the entire system to get a disability pension. Those are specific cases. What can be done to settle those cases. How do you assess them?
On the other hand, I want to talk about the lump sum payment and financial advice. As you know, prior to 2006, there used to be the monthly pension payable for life. The new charter sets out lump sum payments and a disability pension of 75%, which is a different amount. I am not sure whether you can give me a ballpark figure, but let's take the example of a 25-year-old who receives a payment of $260,000 and invests it according to the financial advice he gets. You know that there have been some serious complaints: in some cases, 22- and 23-year-olds had spent all their money after two or three years. I have a 21-year-old son, and I do not think I would hand over a large chuck of money to him at his age—let us be clear.
In cases where young people seek financial advice, how do you assess those amounts? With an estimated amount of $260,000, which is the maximum, how do you determine the specific income until the age of 65, for example? Also, would the person not have received a larger amount before 2006, as opposed to the lump sump assessment? I would like to hear your thoughts on that.
Furthermore, last week, we heard from an individual who had suffered from post-traumatic stress. What struck me—and I used to do case work—was the lack of support for natural caregivers, such as his spouse, as well as the lack of information. Obviously, it requires a certain level of confidentiality, an agreement, because the case is ongoing. That being said, there can still be an agreement with the client to at least provide more support to the natural caregiver, in other words, the wife living with the person suffering from post-traumatic stress.
I was also struck by some of the things she said: she had not had much contact with the Department of Veterans Affairs regarding the situation, she had not received much information and she felt as if she had been left out in the cold. And she had discovered that her husband was a bit different because of his mental health problem.
I would like you to answer those three questions, please.
Welcome here today. I think you've given some very concise, very important information.
I want to start by saying I'd probably disagree with where Mr. Stoffer came from on a couple of things. I want to make it clear why. Ever since we started this review I've gone back to the department to try to dig into what's going on, what's happening, and so on. I've become more of a believer in the charter, with its flaws, with the changes needed. I think it's fair to say we had people in here as witnesses who had individual problems with government, with the department, or it may have been with the politicians themselves. It was people who just simply said “We want to get back before the charter”, and so on.
What I understand is the whole point is the change in direction the former government put in place, which we all endorse, and that is, go away simply from the money and look at the long-term benefits and treatment and support for the individual and the families. They've answered a lot of that, particularly on the mental health side, on some of these things that just would not have been addressed that are being addressed today. I just want to get on there. I think we have a job ahead of us, but I think it's fully on us to ask, “How do we strengthen the charter? How do we make it better?”
Having said that, I know there are some legitimate complaints, and you are or we are addressing some of them. I guess the point is we know that one of the complaints we've heard is that government has not reacted to some of the recommendations coming in. Again, that's not your job so much as it is the minister's and the government's to do it.
If the recommendations that have come through from the review committee were in place--the big 16 we're talking about--what difference would that make in the kind of service you could provide?
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Thank you, Mr. Chair, and I thank my colleagues for this opportunity.
I want to address my questions to Ms. Burke, to deal with the mental health aspect here. I think at the same time that the Veterans Affairs committee was looking at PTSD, we were doing a study at National Defence on quality of life focusing on PTSD, and there were a number of revealing things that came out of that. I was glad to hear you mention the families because a lot of the witnesses who came with us came with a family member for support, and there were all varying degrees of stress or trauma from quite mild to very severe.
Some of the things that came forward were that if you were in the regular force and you were close to where your unit was stationed, you had more opportunity for treatment. If you were reserves and you were far away from where your unit or any of your colleagues was, it became harder to get service. There is an urban-rural split, it seemed, just generally; you mentioned that in Canada alone, just the general population, getting help for mental health issues.
So I certainly hope that some of these issues have been addressed. Maybe you can address that, and the fact that PTSD sometimes is not apparent for quite a while, and then the addictions and the instability in the family and the inability to work and cope with people around you start to appear. So you may leave the forces and you may sign something to say you feel good, you're young, you're ten feet tall and bulletproof, nothing is going to bother you, and then months later you collapse.
So I'd like you to talk a bit about what has been put in place—maybe not so much with the Veterans Charter, but try to relate it to that if you can—for these types of folks.
Actually, as you indicated, on the impact on families in terms of people with mental illness, it's recognized that it doesn't just impact the individual, it's the whole family, and the whole family needs to be part of the solution and be part of the planning too. So I think it's recognized that that's an issue.
When you talk about the rural-urban split, about 33% of our clients with mental health conditions live in rural areas, and the remainder are obviously urban. So that is creating a challenge not only for our department. Other federal departments have clients in rural areas, and the same with the provinces and communities. So what we're doing is we're implementing tele-mental health, for an example. We have that in most of our clinics across the country. We have ten clinics. We also have now providers who have come on board with tele-mental health, and we've done a few pilots and we find that that's helping. Through the pilots, we found that the clients are actually benefiting from it. It's probably the health professionals who don't feel as comfortable utilizing that capability, but we are doing things like that.
I don't know if you know this about our OSI clinics, which I think is just fantastic: they do spend time in the communities going to different providers and putting on conferences to share the knowledge and transfer the knowledge around how to treat people who have PTSD and their families. So we're doing a lot of work in that area. We also have peer support people who do travel to the rural areas, obviously, and provide support to families, and to veterans as well, who have mental health conditions. So that's happening. And we do have the VAC assistance line, which they can call 24/7 if they're struggling, if they need some assistance. So that is available as well for the people in the rural areas.
But it is an issue, and it's interesting that you raise it, because we are starting a pilot in Newfoundland. We thought it was a good place to start because of its vast geography and the fact that a lot of their clients—more than the national average—live in rural areas. We're working with the province, with communities, and with other federal partners to see how we can better support people who live in rural areas. It will be interesting to see what comes out of that that would have applicability across the country. So we are certainly doing more around that.
Your second question was around mental health...? I should have taken notes and I didn't. I was too intrigued by your questions.
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Yes, it doesn't say it anywhere on here.
The other one here....
First of all, Mr. McColeman talked about the benefit of doubt clause being applied in some cases. Of all the VRAB decisions that come on my desk that I have seen on veterans I've worked on for the last 12 years, I have yet to see the benefit of doubt clause applied to any VRAB decision that I have ever worked on. Where it happens I don't know, because they constantly ask. You have to have new medical information in order to do this. But that's not necessarily Veterans Charter stuff. That's a bone I have to pick with them.
But here we talk about the complication of the forms. Now just picture this: you're in a LAV and six of your buddies are killed, two are severely injured, and you're injured. You have PTSD like we couldn't comprehend. You're now asked to fill out this form within 120 days, it says. We've heard testimony that sometimes the forms sit on a table for months. They just can't touch it. They don't want to go near it.
The first question is, why the 120-day limit?
Secondly, a lot of veterans say that every single member of Parliament uses them for photo ops--and that includes us, too--and say they're the greatest Canadians, and everything else. Yet on the bottom of this declaration, and I don't even have to do this for my mortgage or a line of credit or anything else that I get to do, it says, “I declare that the information provided here is, to the best of my knowledge, true and complete and knowing that it has the same force and effect as if made under oath.”
The veterans I've talked to who have to fill out a form of this nature ask why they are being treated with suspicion. This is how they think because of their mental state. They're heroes of Canada, yet when they fill out a form seeking assistance it's like it's made under oath. It's like they're under suspicion. This is part of the problem these forms have.
And by the way, I can fill out these forms, but if I had a severe disability, as my friend Rick Casson had to fill out.... It says to fill out section D, F, G, or D, E, G. A person under mental strain is going to have great difficulty doing that. Plus, you say attach this form, attach that form, do this, do that. A guy's got to go through hoops to fill out this document. This is not simplistic enough, and I'm being frank and honest.
For a person who is mentally stable, this is not a problem. This is just a process and you do it and on you go. But for someone suffering, and their family is suffering, this is not helpful, even if someone is on the phone walking you through it. So as a suggestion to you, is there any way these forms can be looked at to simplify them and to put the trust back into the veteran? The veteran is not applying for something they don't think they deserve. They're applying because they believe they deserve this.
So if you could comment on that, it would be greatly appreciated. These two forms over here are fairly straightforward, but these two over here for the lost benefits and for the rehabilitation program, I would definitely include families and children on that. And also, there should be a form here asking if this information can be released to your family. It doesn't say that. But I'll just leave that with you.
Thank you.
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I could probably start.
In terms of particularly clients who have mental health conditions, who are transitioning out of the military, I think it's fair to say that most of these folks would prefer to remain in the military. It's partly perhaps because of their illness as well, but there is a lack of trust, maybe, in the system, that the system can work for them. That's why we have our peer support coordinators working with them.
That's very powerful, because it's people who have been through similar experiences that they have. It's people who have struggled, but they sought help and they got treatment. They got the services through perhaps the new Veterans Charter or through the counselling through the clinics, and they got the support for their family.
They work with them. They listen, they assess, they try to refer, and that's the objective, to get people into the programs that can help.
We are finding that it is significant and it is helping these folks. But there's no question that we have to recognize that there is sometimes anger in terms of leaving the military, and there is distrust.
So we need to work with them. It's a complex process to transition people from military to civilian life, and it takes time.
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The programs as they're currently structured certainly go a long way to meeting those needs in terms of the focus on rehabilitation: giving people opportunities to live independently; the capacity we have to look at the person, their situation, their family situation, their community situation; and trying to respond in a more holistic way to achieve the best outcome possible.
I think we certainly have that properly constructed, and that will continue to evolve. We have built into the legislation the capacity to continue to evolve the rehabilitation program to be in line with best practice as we go forward. So as new evidence comes forward about the most appropriate kinds of interventions that achieve the best outcomes, then we're well positioned to respond to that.
In terms of the other complementary benefits--and we've had lots of discussion here today about the financial benefits and whether they are adequate--those issues are currently being looked at. Not only have we had multiple reports from committees, but we also are undertaking an internal evaluation of the new Veterans Charter, which is looking at how it's working and if it's going to be prepared to respond in the future.
So it's all those pieces, not just the new Veterans Charter, but the complementary pieces that need to go along with that, like enhancing case management so we have staff prepared to deal with these clients, making sure we have the appropriate mental health supports in place across the country.
We're on the bases. We're building relationships with the Canadian Forces at the local level, and that's where we're going to see lots of solutions for these clients, because our people are involved from the get-go. From the time they're injured, there's an opportunity to build the trust, do the transition planning, and carry on.