:
I now declare this 48th meeting of the Standing Committee on Public Accounts in order.
Colleagues, before we move to the orders of the day, perhaps I could ask your indulgence for approval for a short business meeting afterwards. We have some scheduling that I need to run by you for approval. So, with your agreement, at the conclusion of our questions I'd like to move into a business meeting. It shouldn't take too long. I guess we're in agreement. I don't see anybody violently opposed so I assume we're good on that.
Therefore, we'll now turn our attention to the matter at hand. Welcome to all of our guests. We're here to study chapter 3, “Mental Health Services for Veterans”, of the fall 2014 report of the Auditor General of Canada. The Auditor General couldn't be here but his capable and renowned assistant auditor general, Mr. Berthelette, is here.
Sir, we will begin with your opening remarks. You now have the floor.
:
Thank you, Mr. Chair, for this opportunity to discuss chapter 3, “Mental Health Services for Veterans”. Joining me at the table is Dawn Campbell, the director who is responsible for the audit.
As of March 31, 2014, about 15,000 veterans were eligible to receive mental health support from Veterans Affairs Canada through the disability benefits program. An additional 1,000 veterans in the department's rehabilitation program self-identified as having a mental health condition. The proportion of the department's disability benefits clients with mental health conditions has increased from less than 2% in 2002 to almost 12% in 2014.
[Translation]
Our objective was to determine whether Veterans Affairs Canada had facilitated timely access to services and benefits for veterans with mental illness. We focused on the timeliness of eligibility decisions made by Veterans Affairs Canada. We did not assess the appropriateness of the decisions made or the quality of care received.
For eligible veterans, the department pays for various mental health services not covered by provincial health plans. These services can include specialized psychological care, residential treatment, and some prescribed medications.
[English]
We found that Veterans Affairs Canada has put in place important mental health supports. These included operational stress injury clinics, a 24-7 telephone service, and the operational stress injury social support program. However, in many cases the department was not doing enough to facilitate veterans' timely access to mental health services and benefits.
The rehabilitation program provides access to mental health care support for those veterans who are having difficulty transitioning to civilian life. Eligibility requirements are less stringent than those for the disability benefits program, but treatment and benefits end once a veteran completes the program. We found that Veterans Affairs Canada was meeting its service standards for providing timely access to mental health services through the rehabilitation program.
The disability benefits program provides lifelong access to benefits and requires that veterans provide evidence that they have a permanent mental health condition that was caused or aggravated by military service. We found that from the veterans' perspective about 20% had to wait more than eight months from the first point of contact for the department to confirm their eligibility to access the specialized mental health services paid for by the department.
[Translation]
Veterans Affairs Canada needs to do more to overcome the barriers that slow down the decision as to whether veterans are eligible for support provided through the Disability Benefits Program. These barriers are a complex application process, delays in obtaining medical and service records from National Defence and the Canadian Armed Forces, and long wait times for getting access to mental health care professionals in government-funded operational stress injury clinics.
[English]
We noted that 65% of veterans—843 of 1,297—who challenged denial of eligibility decisions for disability benefits were successful. While the department knows that most successful challenges rely on new information or testimony, it has not analyzed how the process could be improved to obtain this information prior to rendering decisions upon first application.
[Translation]
In this audit, we also looked at what Veterans Affairs Canada is doing to increase awareness among various stakeholder groups of the supports it makes available to veterans. We found that the department delivered a variety of outreach activities that target its existing clients and soldiers being released from military service.
However, it could have done more to reach other groups who can encourage veterans to seek help, in particular family doctors and families of veterans.
Veterans Affairs Canada agreed with our recommendations. An action plan was posted on the department's website. Its implementation deadlines range from December 2014 to March 2016.
[English]
Mr. Chair, this concludes my opening remarks. We would be pleased to answer any questions the committee may have.
Thank you.
Good afternoon. I am Michel Doiron, Assistant Deputy Minister of Service Delivery for Veterans Affairs Canada. I have been in this position for just over a year, and this is my first appearance before this committee. Thank you.
[English]
Joining me today is our director general of health services, Dr. Cyd Courchesne. Dr. Courchesne leads, nationally and virtually overseas, a VAC team of health professionals at Veterans Affairs Canada. She and her team provide expert advice, guidance, and direction to me and to VAC senior management. She is also responsible for a national operational stress injury network within VAC.
Mr. Chair, as you are aware, mental illness indirectly affects all Canadians, sometimes through a family member, friend, or colleague. The Canadian Mental Health Association says that 20% of Canadians will personally experience a mental health illness in their lifetime. Mental illness affects people of all ages, education, income levels, and cultures. Our veterans, as well as our men and women in uniform, are not immune to mental illness.
[Translation]
In the fall report, the Auditor General looked at how Veterans Affairs was managing access to mental health services for veterans. The audit aIso examined: joint initiatives, the transfer of military records by National Defence and the Canadian Armed Forces, and information on reviews and appeals by the Veterans Review and Appeal Board.
The audit focused on three lines of enquiry: facilitating access to mental health services, providing mental health outreach, and managing the Mental Health Strategy.
[English]
The Auditor General raised key points, and we are thankful for his valuable insight and important observations. Having that independent assessment is absolutely essential in helping the department move in the right direction to improve our delivery model and place support where our veterans, men and women in uniform, and their families need it most. To that effect, my department has put into place the mental health services for veterans action plan, and I believe you have been given a copy of that action plan.
The action plan focuses on five priority activity areas: providing timely access to psychological and psychiatric assessment and treatment; reducing barriers to timely access to disability benefits; identifying trends to overturn decisions; ensuring that outreach activities are comprehensive; and measuring the effectiveness of the mental health strategy.
The plan identifies commitment under each of these five areas, and numerous advances and improvements have already been made. To name a few, the number of psychological counselling sessions that veterans, their families, and caregivers are allowed access to has increased up to 20 sessions per issue from eight sessions, and that was effective December 1.
Along with the Mental Health Commission of Canada, a mental health first aid program has been established for veterans and their families, providing them with the tools needed to be better equipped to recognize and deal with mental health issues.
In terms of investment to our operational stress injury clinic network, OSI clinics in satellite locations provide critical assessments, diagnostics, and treatment services to those dealing with operational stress injuries such as post-traumatic stress disorder. This investment will help us accelerate access to mental health services for our veterans and will include a new clinic in Halifax in 2015.
[Translation]
We already streamlined our disability benefit application package last October, but we are also streamlining the process. This includes the adjudication of benefits for post-traumatic stress disorder using a new evidence-informed decision model, which results in faster decisions.
[English]
Close work with our colleagues from the Canadian Armed Forces to improve timeliness of access to disability benefits and reduce the seam and transition support between serving and civilian life.... This is managed through our Veterans Affairs Canada-CAF steering committee, and through our approximately 100 VAC employees co-located with the CAF at integrated personnel support centres on or near bases or wings across Canada.
We will communicate with the Veterans Review and Appeal Board to better understand why disability benefit claims are overturned by identifying trends. This information will be used to improve policies in the decision-making process.
A pilot four-year military family resource centre will allow medically releasing veterans and their families access to support and services at seven military family resource centre sites across Canada. This will help us identify future needs and the best approach in the future.
Lastly, our operational stress injury social support program will be strengthened with 15 more peer-support coordinators—and there will be more—focused on direct outreach to veterans.
Those are the highlights of our mental health action plan. I assure you that we are fully committed to further improving the system so that veterans and their families receive the care and support they need now and in the future.
Thank you again for the opportunity, Mr. Chair. Dr. Courchesne and I look forward to questions.
:
Mr. Chairman and members of the committee, as Surgeon General, I thank you for the opportunity to speak to you about the measures being taken by the Canadian Armed Forces to address the two recommendations made by the Auditor General in chapter 3 of his 2014 report, entitled
Mental Health Services to Veterans.
These recommendations relate to timely access to psychiatry and psychology assessments at specialized Operational Trauma and Stress Support Centres, or OTSSCs, and the accelerated transfer of medical records to Veterans Affairs Canada.
[English]
Also with me today is the Canadian Forces director of mental health, Colonel Andrew Downes, MD.
Access to mental health care is impacted by the demand for care, available clinician resources, and the efficiency of practices. We don't want to limit or control the demand for care but on the contrary do everything we can to encourage those who need care to come forward. We must therefore focus on maximizing clinician resources and the efficiency of our practices in striving to minimize wait times. In doing so we must be careful to avoid compromising other aspects of care such as its quality, basis of evidence, and collaborative approach.
To measure access to mental health care the Canadian Forces health services group applies the widely accepted metric of the third next available appointment. This is considered a more sensitive reflection of true appointment availability than the first or the second next available appointments because those metrics are more affected and skewed by cancellations and other unexpected events. The third available appointment, however, does not necessarily reflect the patient's actual experience. It can often overestimate true wait times since referrals scheduled for the first and second available appointments are seen sooner, particularly when there are cancellations.
[Translation]
The third next available appointment metric also only applies to routine referrals. Cases that are clinically deemed to be urgent are seen much sooner, and virtually all patients awaiting OTSSC assessment are under the mental health care of a primary care physician, and in some cases, a psychologist or psychiatrist from a clinic's General Mental Health Section.
OTSSCs provide monthly reports on the average wait time between receipt of a routine referral and the third next available appointment for an initial diagnostic psychiatry or psychology assessment. Our benchmark target is no more than 28 calendar days. Although few civilian health facilities achieve this target, we pursue it in accordance with the recommendations of the Canadian Psychiatric Association and the national Wait Times Alliance.
[English]
In 2014, four of the seven OTSSCs provided an annual average third next available appointment within that benchmark. The other three experienced longer wait times, averaging 49 days among them, primarily due to staff absences for such things as extended sick leave and parental leave.
By January 2015—this year—only one centre exceeded the benchmark and then by only two days.
In 2014 the Canadian Armed Forces was authorized to hire an additional 54 mental health staff. Of these, 21 were for clinics with operational and trauma stress support centres. As of mid-January 2015, 94% of our 455 authorized mental health positions were filled and efforts continue to fill the remaining vacancies. This is a dynamic challenge affected by normal staff turnover, heavy competition with the civilian sector for mental health professionals, and difficulty recruiting personnel to certain non-urban locations.
We're in the process of installing high definition secure video teleconferencing systems in our mental health clinics to help balance short-term increased demands for care in one location, with staff capacity available in other locations. This will also reduce travel requirements for our patients in outlying locations and improve their continuity of care when they're posted to a new location.
[Translation]
To improve efficiency and quality of care, we have hired a mental health quality and patient safety officer to review business practices in the clinics and help establish additional performance measurement metrics.
We will also soon implement the electronic mental health record and a digital outcome measurement system called CROMIS. This system, which is also used by mental health clinicians contracted by Veterans Affairs Canada, will allow for early identification of people not responding well to treatment, thereby prompting the clinician to adjust the treatment.
[English]
With respect to the transfer of medical records to Veterans Affairs Canada, Canadian Forces health services group has been working jointly with VAC for a year on a project to accelerate the file transfer process. In particular, VAC and DND have created a 14-person records disclosure team with the sole focus of expediting files between the two departments, and they have established a full-time VAC adviser within that records disclosure team to provide timely and expert advice on VAC requirements.
A second team has been established to address the backlog of outstanding files due for transfer to VAC. Through their joint efforts, the backlog has been reduced by almost 50% and the overall process has become increasingly effective and efficient. We monitor the process daily and are constantly striving to pursue innovative business practices to provide the best possible service to both our serving and retired personnel.
Thank you for your attention, and I'll be happy to answer any questions you may have.
My questions will be directed to the Auditor General's department, and I'll specifically focus on sections 3.25 to 3.29 in the report, about eligibility decisions under the disability benefits program not being timely. I really want to dig into that a little bit and make sure I understand the numbers.
It's my understanding that there are basically two streams, in terms of these. There's the veteran's perspective, so there's a process leading up to the application; and then there's the perspective of the department, which is once the application is received, then that's a stream as well.
I want to focus on the application being received. There's a standard that says the target rate is 80%. In your opinion, is that a reasonable target rate, to process 80% of the applications within a 16-week time period?
:
Absolutely, and I'll get to the other stream later on.
Within those 733 people, or really the 144 who fell outside of the standard, if we were to go to section 3.29 of the report, some analysis was done and it basically said that you tracked 47 veterans who were on the waiting list, per se, and that:
We found evidence that 17 of these veterans received mental health care while waiting for an eligibility decision.
We can sort of extrapolate from that and there is knowledge that there are another 19 veterans who you really didn't know whether they were receiving mental health treatment within DND.
Even in the worst-case scenario, 36% of those people waiting for treatment were actually receiving some form of mental health care along the way. I just want to clear this perception. Be it 733 who were waiting, or be it 1,000 who were waiting, at least 37% of those, according to your statement in section 3.29, were receiving some form of mental health treatment while they were waiting to determine their eligibility.
:
Perhaps I could make two points in response to that observation.
I think the first point is that for approximately 60% of the veterans implicated in this statistic, Veterans Affairs didn't know if they were or were not receiving services.
The other point is that getting services to individuals who have acknowledged that they need mental health services is and should be a priority of the department. As I said, when we look at whether it's the standard of 16 weeks or if we look at the number who have actually received a decision within 16 weeks, the point we should not forget is that veterans are looking for the service and Veterans Affairs needs to set up a process that allows veterans to access the services as quickly as possible.
In our view, and from what we have seen, that wasn't the case because, as we note in exhibit 3.5, to get to the 80% mark—and that is at page 10—it took 32 weeks from the perspective of the veteran who is looking for services.
:
Thank you very much, Mr. Chair.
I appreciate the comments. Thank you all for coming, by the way.
To my friend across the way whose comments were about provincial wait times, it seems to me that the dilemma in the provincial health care system is that one might go to a GP for mental health care, not necessarily to a psychologist or a psychiatrist, so no one knows how long you really wait to see a psychiatrist if your GP treats you, because quite often that's what happens.
For minor mental health awareness you go to somewhere like the Canadian Mental Health Association, around which I have a lot of personal knowledge because my wife worked for them for 25 years. Quite often there are different agencies in different places so you're not actually waiting, you're actually just going....
Mr. Berthelette, in questioning you were trying to talk about the wait times and the standards. If I understood you correctly, it's really the department that set a standard of 80%, which is really what they believe is fair or is a reasonable standard to try to maintain. Is that what you're telling us?
:
No. We have a network of anywhere from 4,000 to 6,000 external mental health providers. When a psychiatrist or a psychologist is not available, nobody is not getting mental health care. Everybody from day one, if it's an urgent requirement, sees a psychiatrist or psychologist the same day. But they are all under primary care, and up to 85% of all mental health care in Canada is provided by primary care physicians. So they're all seeing and having access to addiction counsellors, mental health nurses, primary care physicians, in addition to sometimes general mental health psychiatrists and psychologists.
So the fact that there's some delay before getting a detailed assessment by a subspecialized operational and trauma stress support centre doesn't mean that they're not getting good mental health care. In many cases, the OTSSC specialists simply confirm the treatment plan that's already been put in place by the primary care people. All of those patients are constantly being triaged and reassessed, so if at any time their condition changes and requires more urgent, subspecialized assessment, then they get it, the same day if necessary.
The other thing is that those numbers, the 445, is double what we had before. We were ready even before Afghanistan began, and we've modified those numbers over time. It's the highest per capita ratio in NATO and close to double the per capita in any jurisdiction in Canada. Just a few years ago, we were spending roughly about six times per capita more on the mental health care of our troops than any other jurisdiction.
It goes without saying that mental health disorders are a major problem. Since 2004, 168 members of the military have committed suicide. In addition, of the 2,620 veterans who have died, 696 committed suicide. Therefore, 27% of former members of the military who died committed suicide. It would seem that mental health problems are five times more deadly than the Taliban.
We should be asking ourselves a number of questions, particularly concerning section 3.7 of the report, which states that members of the military often fear declaring an illness because it might threaten their career.
The Canadian armed forces recently adopted a series of positions that seem to harm those who make these requests, particularly veterans who fought in Afghanistan.
Is it possible to avoid penalizing people who wish to access mental health services in the Canadian armed forces, by simply letting them go, for example, a few months prior to their retirement? Do you have control over this type of situation?
:
My next question is for Mr. Doiron.
In sections 3.10 and 3.2, the report deals with delays of favourable decisions with respect to applications for disability benefits. In 20% of cases, individuals must wait more than a year, which is a major delay. For the remaining 80% of cases, who receive their disability benefits within a one year time frame, there may be a wait of 11 months, which is an enormous delay.
Could this situation contribute to crime, self-harm, or spousal violence? Among the individuals who have applied for this disability benefit, how many are now homeless?
:
Sure. I just wanted to see if that is something...because the government, obviously, has spent a fair bit of time to make sure it's a complete list. We have a copy of it here today.
Changing gears, I'd like to talk to some of the other officials from DND, as well as from Veterans Affairs.
We recently conducted a study on transnational crime. One of the unique aspects of the report that came out of that was the impact the Privacy Act can sometimes have on process.
Sometimes, there are things within the government's ability to control. Sometimes there are limitations on government put in place by the Privacy Act for very good reasons, but which may cause, you know, unintended consequences. Mr. Hayes has raised the point that, sometimes, we could look at simplifying some of the forms that Veterans Affairs uses to get these applications done sooner.
Could you please speak to the Privacy Act, and whether or not that could sometimes provide a challenge in getting files and histories from DND, and what kinds of constraints that puts on your ability to process these files quickly?
:
Thank you for the question.
I'm not sure that I would quantify the Privacy Act as a detriment to the service. I'd be careful saying that because it's there for a reason as you've highlighted, sir. But we have seen that in the exchange of information between DND and VAC, we have to comply with the Privacy Act. When we do, it does create additional challenges to getting the information, especially when reviewing the personal file of a veteran where there's some good recent, third party information. We have to comply.
The Privacy Act says you can only share for the reason that you've taken the information. Therefore, we do need releases and we do need permission to share that information. It therefore adds, I don't want to say a delay, but it does add a step in the process where my partners at CAF have to redact a file prior to providing it to Veterans Affairs to process a disability claim, or anything else that we may do with the file.
We work with it. We comply with the Privacy Act. We feel very strongly that it's important, but it does sometimes cause us some additional steps in the process.
:
Just that the protection of the confidentiality of the health information of our troops is critical, vital ground for us.
If our troops, especially those with sensitive conditions like mental health conditions have the slightest concern that we are not strictly protecting their confidentiality, and completely complying with all elements of the Privacy Act strictly, then we run the risk of those people suffering from mental health conditions, who are already vulnerable, not presenting for care and their conditions getting worse and worse until, in some cases, they'll commit suicide.
Strict compliance with the Privacy Act is absolutely critical for us. But it does pose some delay because we necessarily have to have the consent and we necessarily have to do the severances for any third party information. Often with psycho-social or mental health issues there are third parties involved in the notes, in the files, that have to be extracted before they can be legally and ethically transferred to another authority that serves a different government purpose, in the interest of the individual.
Thanks, everyone, for appearing before us.
Mr. Doiron, I'm going to speak directly to you.
It's nice for certain members to bring forward the successes, or partial successes or efforts on behalf of VAC, but I have to highlight the failures, sir, just so you know.
We've had $1.13 billion in cuts retracted from Veterans Affairs that must have put some pressure on Veterans Affairs Canada in providing the services it needs. We closed nine Veterans Affairs offices, and there's been a huge impact and a huge response by the Canadian public, particularly veterans. We know from the Auditor General's report that over 15,000 applied for those benefits and we know that 24% were denied, and of that about a third appealed.
I think about how difficult it is for somebody to come out from under the cloud or the shadow of mental illness and come forward and actually seek help. Of those who appealed, 65% were successful. I think about the ones who gave up, who didn't appeal. Not just as an MP but as a person, I automatically think, my God, there must be a culture of denial at the veterans appeal board, at any level there, and not a culture of “give these people the benefit of the doubt”, those who were prepared to and do put their lives on the line and who suffer the ultimate liability.
I'm concerned, Mr. Doiron, that we are not responding.
Last year we presented a report—and was on the committee—to the then Minister of Veterans Affairs who accepted everything but virtually did nothing.
My first question is this. You said 50% of the 168 who died by suicide were not self-identified. Can you tell me if any of the 50% who were not in treatment were any of the ones who were denied treatment but had applied? Before you answer you could give some thought to this, Mr. Doiron. It says the Auditor General recommended VAC “work with the Veterans Review and Appeal Board to identify whether reasons for successful reviews...indicate a need to modify the application process.”
I'd like to hear from you about that and I want to know what's happening now, not what you will do, because we've been hearing a lot of “wills” but not a “now”.
You can go first, Brigadier General.
We have taken a lot of steps to improve, following and at the same as the Auditor General was in with us reviewing it.
As an example, we have simplified the application process for mental health but also for all our application processes for disability. We went from an 18-page form—and I know 18 pages is incredible. I've only been here a year and I'm reviewing all forms, and our forms are complex. We're down to 11, and you say that's not much better but the form itself is four pages and it includes a quality of life. The other part of the package is information. That was implemented in October. It has been done. We're now doing a secondary review to see if we can simplify that even further.
On mental health, we've implemented an accelerated, evidence-based process for PTSD or for mental health. Now, when we speak of mental health, 72% of our cases are PTSD. But it's not only PTSD. We have various cases.
We've had about 250-odd applications to date under this new model. It is done at a lower level closer to the veteran. It is much quicker. It is an accelerated process so we get that answer quicker to the veterans so we can get them into care much faster.
Welcome to our witnesses today. Thank you for joining us.
I'd like to shift the focus a little bit to information flow and talk about some of the causes of the delays that are inherent in the process. I'll start with Mr. Berthelette, and then, Mr. Doiron, perhaps you could offer a few thoughts of your own.
Mr. Berthelette, you identified in the audit report delays in the disability program. I wonder if you would be able to confirm whether the primary cause of that delay is the transfer of records from National Defence and CAF to Archives Canada and Veterans Affairs. It is my understanding that this process could take up to nine weeks. I understand privacy and the Privacy Act, etc., but I wonder if you could talk about some of those delays and how they impact the process.
Mr. Berthelette, in looking through your chapter that the Auditor General's responsible for, I found the conclusion. This clearly wasn't a snapshot of 10 years ago. This is more recent in a sense. It took a period of time, for sure. You looked at a large period of time but it also includes very recent data.
One of the recommendations is what has given us CROMIS, quite frankly. Prior to that, according to the Auditor General's report, you had a mechanism for looking at things but not measuring them. So you didn't actually measure outcomes, you just had outcomes. We now see...which is a good thing. It will now measure outcomes.
We're now going to see them next year, I believe, Dr. Courchesne. Is that what we're looking at, the first quarter of next year when we actually get those metrics of that kind of measurement?
In 3.68, Mr. Berthelette, your conclusion—let me just read it—says:
We concluded that Veterans Affairs Canada is facilitating timely access for veterans to the Rehabilitation Program.
Kudos, Mr. Doiron. We should point that out.
But unfortunately that's the smallest component of your overall program. It runs to about a total of 18%. Therefore, 82% is in the other part of that statement, which says:
Access to the Disability Benefits Program, through which the majority of veterans receive long-term mental health support, is not timely.
That's a bit of a failing grade, unfortunately
But I want to turn specifically, Mr. Berthelette, to the issue of folks who actually went into the appeal process. My colleague has already pointed out the fact that a number of folks decided not to, for whatever reason. Either they were fed up with the system or they just felt, “Well, perhaps I don't need the services so I'm not going to bother.” We don't know. I don't think the department knows. I don't think you probably track those. I see Mr. Doiron saying no. I'm not asking you to track them, by the way. If folks don't do things, they don't do things.
What's interesting in this is the length of time that a denied veteran ended up having to wait to get service unless, of course, they went and got private service. Now, they may have done that. I'm not suggesting that may not have happened. In some cases they may have gone into the public system and said, “I need some help,” or they went and paid for it, or did whatever. They may have done that.
But the dilemma here is that the Auditor General's report talked about the fact that the wait times exceeded your benchmark, and for those who were successful, the length of time it took at the outside was up to seven years. That appeal was successful. That is a catastrophic amount of time to wait to be told, “You're successful.” How does that happen, Mr. Doiron? How does it happen that we end up with a system that takes seven years potentially for a veteran to actually get through the appeals process to get what turns out to be a “yes”?
:
Sir, listen, I don't get very much time. I appreciate multiple levels of appeal. Whoever this particular case was, it was ultimately a yes, that you should provide the service. What I'm saying to you, sir, is that even though there are multiple levels of appeal, and you pay for this and you pay for that and it's all wonderful, the bottom line is that whoever that serving member was didn't get service. Basically, if they had gotten the benchmark of your 16 weeks, which really is 32...but it was seven years. Let's do the math: seven times 52. It's a lot of weeks. It's way past your benchmark.
How is it that a system that eventually says “yes” would have taken seven years to get to a yes? What was systematically missing in your system? Because ultimately, it's about medical information. That's what we're looking at, mental conditions and a mental health issue that is actually and literally an illness.
We're looking at how you prove you have an illness and how you prove that you actually got it when you were serving, right? There are two components. I used to do WSIB cases. There are two components in all of this. First, did you get hurt at work? That's where you are serving. That's your workplace. Second, do you actually have that particular illness? That's what you have to prove to get service.
It took seven years, sir, for this serving member who's a veteran in this country to get a yes. How did the system fail—in my view—that veteran? Have we seen the weaknesses in it to make sure that it doesn't happen again?
:
In this case, we have reviewed to make sure that type of weakness does not occur, but you are right, sir, there are two areas. Usually it's not the illness. The doctors tell us what the illness is. That's pretty clear. The big challenge we have is service relationship. We have to remember in Veterans Affairs legislation, to open that door, it has to be linked to your service. There are exceptions, but typically it is that service.
Often, for a veteran to prove this, especially in an area where files were not really completed, or people did not report injuries.... We know that our older veterans did not necessarily report that they injured a knee or whatever it may be. The files are incomplete. We have to follow legislation that stipulates, as you know. If there was no documentation and the individual cannot provide documentation at one of the levels of appeal, then you go into a long period of time.
At some point, documentation was provided, but seven years...I agree, it's a long time.
:
I'm going to be a little bit more categoric. I think the services are there.
We link disability benefits to mental health services, and I think we have to be very careful when we do that. The disability benefit—the 16 weeks, the 32 weeks—for sure, it opens the doors to many services for a veteran.
That said, there is a lot of other support available to a veteran. We have the crisis line, which will give them 20 sessions with a psychologist. You can call 24-7. You will get to meet a psychologist. There are peer networks, such as OSISS, where a veteran can talk to a fellow veteran who has been where this individual man or woman has been. The services are there.
First and foremost, we can't forget that we have national health care in Canada. Any one of these...and actually, we're not a 24-7 operation at Veterans Affairs, so when we have a crisis at two in the morning, my counsellors—I do have people on phones—call 911. Any veteran that is in a crisis, the national safety net is there to take care of them.
Now, if you talk purely about Veterans Affairs programming, the one about the 20 sessions is with us. OSISS is with us. We use the services of our colleagues in the CAF for veterans. They are available to help veterans also. They have full-time psychologists, psychiatrists, and things like that.
The review looked at the disability process. It is 16 weeks, and 32 weeks from the view of veteran. We agreed with the OAG on that. I think we have to be careful, because there are services—not that everybody would take those services, as there's still the stigma. I'm not going to...but the reality is that there are services available to a veteran.
:
I'd just like to know.... We got two contradictory answers to Mr. Aspin's question. Mr. Berthelette said there are services that aren't there, and Mr. Doiron says there are services that are there, but I'm not going to pursue that line of questioning.
You'll recall the earlier question I asked about the faults with the Veterans Review and Appeal Board and how long it takes, etc. I would have thought that you would have, in addition, sought the opinion of veterans themselves. I know you're waiting for this question, Mr. Doiron, because you know there was a survey done in 2010, and we had a drop in satisfaction from 80% to 68% for those who served in Afghanistan.
Now we're not even seeking the opinions of veterans. In fact, not only are we not seeking them, but there are a lot of stakeholder veterans who want to express their opinion and are no longer considered stakeholders by this minister, because, in my opinion, respectfully, sir, he doesn't want to hear from everybody. He typically prefers to hear from people who—
:
Thank you very much, Mr. Chair.
Mr. Doiron, I want to reassure you again, as the chair has said, that you need not apologize for refusing to answer an inappropriate question requiring you to divulge information about a constituent. In fact, the member who asked that question should be apologizing to you.
I also want to address what I believe is a mischaracterization by Mr. Valeriote when he says that there have been two contradictory views offered to us about services: one saying that there are services there, and another saying that there are services that are not there.
Mr. Berthelette, I don't believe you have said that there are services that are not there. In fact, I believe that your report, particularly in paragraph 3.19, says exactly the opposite and reviews the mental health services that are available for veterans. Am I correct in that?
:
That's perfectly fine and accurate. I'm certain that if Mr. Valeriote thinks about it for a few minutes he'll see fit to retract his mischaracterization.
I'd like to go back to where Mr. Giguère left off with Mr. Doiron some time ago, and that's the point that in fact veterans shouldn't have to wait a year to receive mental health supports. I just want to be clear, because as I understand it, we have operational stress injury clinics, we have case management services, we have the 24-7 line, we have the operational stress injury social support program, we have the rehabilitation program, we have in fact mental health supports provided by the service income support insurance plan.
With all of those opportunities out there, Mr. Doiron, is there any reason why a veteran would have to wait a year if he or she asked for mental health supports?
:
That's what I thought. Thank you.
To go back to where you and I left off when I ran out of time, Mr. Doiron, I think I heard you tell me that the rehabilitation program is capable, if needed, of providing necessary mental health supports for veterans through a wait period that might be as long as eight months or a year. Then Mr. Berthelette said, well, the purpose of the rehabilitation program is to reintegrate people into the workforce.
I want to ask you this directly, based on what Mr. Berthelette said. Does the fact that the purpose of the rehabilitation program is to reintegrate veterans into the workforce mean that somehow the mental health supports that the rehabilitation program provides are substandard or will not be adequate to meet the needs of veterans if they happen to be waiting for a disability eligibility decision?
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I have to share my time.
It's an ongoing process, fair enough. I just wanted to make sure that I was looking at it correctly.
My last comment, Mr. Chair, is to the Brigadier-General.
I reread your opening statement, and we had this conversation—I don't have time to go through it again—about the numbers. According to what you told us today, 94% of 455 authorized mental health positions are filled as of mid-January. Last year you had a problem because some folks went on parental leave and some folks were on long-term sick leave, but by January you were okay because they'd probably finished their parental and they'd probably come back to work. The fact is that you're short 6%, about 27 full-time spots, give our take.
I hate doing half a person because I'm not sure what that looks like. I know we do FTEs but I always have a problem with what looks like half a person. I know human resource folks do them differently. But if we have some more folks going on parental leave, we may be back to a place where it says that the OTSSCs experienced longer wait times, in fact up to 49 days, based on the fact that they didn't have enough folks.
So, this is what you've told us, in the sense that these are your numbers. If we can't find the full complement, and some folks go off on parental leave—and heaven knows, we certainly want families to have children—it seems to me, we're back where we were last year. It seems unfortunate.
Mr. Giguère.
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In that case, let's talk about the conclusion of the report. In section 3.64, it says that your department is more interested in the quantity of services and the speed with which they are provided than by their quality and the impacts on the lives of veterans. The report even states that it cannot be determined whether your strategy has borne fruit or whether the mental health needs of veterans are being met.
This problem was already raised in the 2012 report on the transition from military to civilian life. At that time, you said that you would accept all recommendations. However, despite this, three years later, nothing has changed. The same problems that existed in 2012 are reappearing in 2015. They are exactly the same. The only thing that you have done is to decide to calculate the 16 weeks from the moment the file is considered complete rather than the moment the application is submitted.
You have played with the numbers. In fact, you had promised that it would be 16 weeks from the moment when the file was submitted. You promised that in 2012. In 2015, the delay is now 32 weeks and you are giving yourselves six weeks to send a response.
There is a problem in your department. Are you able to correct this problem by yourselves? Do you need the Treasury Board or the Privy Council to give you the resources to correct your problems?
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We can correct some of the problems ourselves. I have been in this position for a short time. We have been working on this for the last year.
Don't forget that the waiting period was 24 months just a few years ago. I'm not saying that things are good right now, but they were much worse before. Now, the waiting time is 16 weeks from the moment when we receive the documents. The Auditor General mentioned 32 weeks, and we accepted his assessment. We have had a lot of discussions on this issue because there are a lot of factors at play. But if, at the end of the day, someone calls me and tells me that it's 32 weeks, I accept that.
How should we address this situation? The forms need to be simplified. We have done so, and we will continue to do so because the forms are still too complex. We are working on it, and we have initiatives to achieve our goal.
First I'd like to go on record as respectfully disagreeing with Mr. Valeriote's position in terms of our unanimous report “The New Veterans Charter: Moving Forward” and his opinion that the government has done virtually nothing. I will go on record as disagreeing with that completely.
Second, I'd again go back to Mr. Valeriote's comments with respect to the Veterans Review and Appeal Board and the appeal process. I just want him to know that prior to his being part of the Standing Committee on Veterans Affairs, we actually undertook a very comprehensive study on the Veterans Review and Appeal Board. Veterans Affairs witnesses were there, and we indeed sought the opinions of several veterans.
I do encourage you to read that report, and I will go on record as maybe forewarning you that we may be having a look at where you are with respect to the recommendations from that report of our Standing Committee on Veterans Affairs.
That said, I want to step back to Mr. Berthelette for one second.
From the veterans' perspective, you mentioned in your chart 3.4 that there's an up to 16-week period. Within that, you've also stated that there are certain factors that Veterans Affairs can control and there are factors that are outside of their control within that 16-week period. I would like to have an understanding of that. Which is most responsible for that 16-week period—factors within the control of Veterans Affairs or factors outside the control of Veterans Affairs?
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The OAG is correct. There are a multitude of reasons—and I wouldn't want to speculate on all of them—but the points that were raised were correct. Sometimes it's just a matter of organizing themselves. There's a multitude of things. Why would it take so long to send it to us? Our responsibility, once we get it, is to get it out as fast as we can. I don't want to speculate on all the reasons.
But you're correct. We are modifying our forms. The forms are very complex. Our programs are complex. When I arrived at Veterans Affairs, I was very surprised at the complexity of the programs and eligibility for the programs. If I, after 25 years in the public service, have a hard time sometimes figuring out the eligibility, then some of our veterans...so we have to simplify that.
Our deputy minister and our new have been very clear that they want us to be more veteran-centric. We're working very hard on that to show that care, that compassion, and that respect for the veteran not only in our forms but also in the services we are offering. So we are looking at the forms.
We are also doing some things that may resolve some of the issues with the appeals process. We're actually calling the veteran now with regard to disability. Before saying “no”, we tell the veteran that, based on what we have in front of us, the answer is going to be “no”, and we ask them if they can provide us with anything that may bring us to a “yes”, to allow us to give the benefit of the doubt to the veteran within the confines of the act .
We've seen an increase in our approval rates since we started doing that. Around the time the OAG was coming in, probably in July, I implemented that. Since then, our first-level approval rate went from 71% to 79%. We touched 80% in one month, but I'll say 79%. So we're taking steps to be more client- or veteran-centric in the way we are doing our business. It's not an easy business. There are a lot of avenues for the veterans and navigating this is difficult. That's why we want to reinstall or reimplement—I hate saying the personal touch because then people expect that every veteran will have somebody, but at least help for individuals to complete a form and help for individuals to get the services.
At the end of the day, employees at Veterans Affairs care a lot for the veterans. They are totally committed. They have hard jobs. I know some of you have been to our offices. Our offices deal with veterans on a day in, day out basis, as do our mental health clinics, and that's not an easy job. They care for the veterans. We want to move that care to make sure it shows up in the forms, in the calls, and in other places, and that's what we're really working on.
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We look forward to seeing you again.
Again, thank you all very much for being here today. We appreciate it.
Colleagues, this part of the meeting is going to be suspended for a moment while we clear the room, do a little bit of a tech change, and go into a business meeting. So with that, I will adjourn the public part of the meeting, suspend, and we'll reconvene in camera to do business.
Thank you all.
[Proceedings continue in camera]