:
Thank you very much, Mr. Chair and committee members.
As the chair indicated, my name is Janice Burke and I am the director of mental health for the Department of Veterans Affairs. With me to also respond to questions is Raymond Lalonde, director of the National Centre for Operational Stress Injuries, and Dr. Tina Pranger, who is our national mental health officer for the Department of Veterans Affairs.
We are very pleased to be here today to talk to you and provide you with information on what the Department of Veterans Affairs is doing in the area of mental health and how we're responding to the needs of veterans and their families who have been exposed to trauma or operational stress injuries in the military, and how we are supporting them in their re-establishment and transition to civilian life and to their communities.
The presentation deck in your package has more details, certainly, than what I will cover, but we hope it provides you with information to assist you with your study regarding combat stress and its impact and effects on the mental health of veterans and their families.
Operational stress injury, for folks who may be new to the committee and may not be aware, is a term used by National Defence, Veterans Affairs, and the RCMP. It's defined as a persistent psychological difficulty resulting from operational stress in duties performed while serving in the Canadian Forces or in the RCMP. I need to point out that it is not a medical diagnosis; it's just a term to describe a broad range of medical diagnoses such as anxiety, depression, and post-traumatic stress disorder.
Response to operational and combat stress has been described also in different diagnostic terms over the years, from the American Civil War to World War I and World War II. It's been stated as things like soldier's heart, battle fatigue, shell shock, and psycho-neurosis. So the name has evolved to being recognized, in 1980, as post-traumatic stress disorder in the diagnostic and statistical mental disorders.
The type of trauma that can result in a significant stress reaction can range from threat of death or threat of serious injury, to the viewing or handling of bodies and the witnessing of human degradation. Reactions to such stress, I must point out, are normal, and with early intervention, education, counselling, and treatment, we believe that the impact of trauma on veterans and their families can be reduced significantly.
The development of severe post-traumatic stress disorder and other mental health conditions we believe can also be prevented, or at least the symptoms reduced significantly.
An operational stress injury without proper and early intervention and treatment can lead to things like, and not in all cases, absenteeism from work, unemployment, family relationship problems, alcohol and drug use, social isolation, involvement with the criminal justice system, homelessness, and risk of suicide.
As in the case of the general Canadian population, stigma remains a major impediment to achieving early intervention and preventing mental illness or preventing the severe impacts of post-traumatic stress disorder.
I have to point out that there has been considerable work by the Department of National Defence around reducing stigma and educating about operational stress injuries through the education that's provided by their speakers bureau network and other anti-stigma campaigns they've had under way.
The establishment of the VAC/DND operational stress injury and social support program, which is also known as OSISS, and the joint network of over 15 operational stress injury clinics has allowed us to ensure early referral, diagnosis, assessment, treatment, and psycho-social education. And this has helped, we believe, to reduce stigma, achieve early intervention, and improve treatment outcomes.
Pre- and post-deployment education and screening of Canadian Forces members and appropriate timely referral to counselling and other services are also making a difference. For example, we know that approximately 53% of our VAC clients who have service in Afghanistan and who have a service-related disability are currently still serving in the military. So we have 1,504 clients with Afghanistan service who have a disability benefit relating to a psychiatric condition, and of those, 797 are still serving.
To support veterans with mental health conditions and their families in their journey to recovery and to ensure their successful transition and re-establishment to civilian life, Veterans Affairs has put in place several important measures. I'm not going to go into the details. We may cover it throughout the session, but you'll see that they're listed in your deck in slides 17 to 21. Also listed in the deck, from slides 22 to 23, are initiatives that are in process of being implemented but are not yet completed.
These initiatives, I have to point out, are built around the Department of Veterans Affairs mental health strategy framework. Our framework focuses on ensuring that a continuum of programs and services are in place to fully meet the needs of veterans and their families. These areas include economic, social, health, and physical environment supports. These supports can be provided either through Department of Veterans Affairs programs or through community, provincial, and non-government organizations.
Our strategy, therefore, also includes enhancing awareness of the needs of veterans and their families in the communities where they live; building sufficient capacity in our programs and in provincial and community programs to effectively treat veterans and their families; and ensuring that there are no gaps.
Partnerships in the area of mental health are therefore extremely important to veterans and their families, and to the Department of Veterans Affairs. You will see from the deck that we are putting an unprecedented focus on not only strengthening current partnerships with National Defence and veterans organizations, such as the Royal Canadian Legion, but also on nurturing new partnerships that will improve programming, services, and supports to veterans and their families in the communities where they live.
It is important to emphasize, as well, that while all of the initiatives listed in the deck contribute to improving transitioning and the re-establishment to civilian life for our veterans and their families, the implementation of the new Veterans Charter--with its focus on recovery, wellness, and independence--has been, and will continue to be, of paramount importance to the recovery of veterans with mental health conditions and their families.
The new Veterans Charter is also enabling Veterans Affairs staff to provide more holistic case management to veterans and their families who are struggling with their mental health, and to treat all barriers including medical, psycho-social, and vocational that are affecting their re-establishment. The new Veterans Charter does not limit supports to the medical treatment of a veteran's pensioned condition, as was the case prior to the implementation.
I would like to acknowledge and emphasize the importance of family in the veteran's recovery process, and highlight that military trauma has significant impact not only on the veteran but also on his or her family. In recognition of this, Veterans Affairs has improved supports to families, beginning with the implementation of the new Veterans Charter. Families are now part of the veteran's rehabilitation and case management plan, and they receive treatment, counselling, and support if needed from the operational stress injury clinics.
The clinics have recently developed, in partnership with community organizations, two unique psycho-education programs for children affected by operational stress injury. The first is a ten-week program for children ages eight to twelve who live with a parent affected by an OSI, and the second is a six-session program for youth ages twelve to sixteen.
With the new Veterans Charter, the veteran's spouse can receive vocational assistance if the veteran, because of his or her mental health condition, is not able to participate in rehabilitation or employment due to his or her disability or death. Income support for the family is also guaranteed if the disability is such that the veteran cannot be gainfully and suitably employed.
In addition, more resources have been added to our OSISS program--and that's the peer support program I mentioned earlier--to provide more peer support to families and to strengthen our volunteer network.
I'm not sure if you're aware, but we have a volunteer network of peer support people across the country who volunteer their time to provide support to families, to peers, and also to those who are in the bereavement process.
Veterans Affairs is also forging partnerships with national, provincial, community, and non-government organizations to raise the awareness of veterans with mental health conditions and their families, and to improve access, coordination, and delivery of required supports in the communities where they live.
As a final remark, I want to mention that suicide prevention is a priority for Veterans Affairs. I know your committee has a special concern in this regard. We recognize, as you do, that one of the most devastating and tragic consequences of serious mental, physical, social, and emotional problems occurs when someone takes his or her own life.
Although we do not know the rate of suicide in the veteran population or in our VAC client population--the rate of suicide we hope will be obtained through data, through work with Statistics Canada and National Defence, and we’ll have that in early 2011--we do know that even one death by suicide is too many.
Veterans Affairs also provided training to all staff in the area of suicide prevention in 2009. That’s all front-line staff. We have suicide protocols in place for use by all staff who work with veterans and their families.
In addition, in 2010 we undertook a review of our approaches to suicide prevention, and as a result we are now implementing several recommendations to strengthen suicide prevention within Veterans Affairs Canada.
We actually have Dr. Tina Pranger here with us today. She is the author, with folks from our research directorate, of those two reports and the recommendations. If there is interest, even at a later time, we would be pleased to go through that in detail with you.
This concludes my opening remarks. Thank you for the opportunity to appear before you. We look forward to responding to any questions you may have.
:
Thank you, Mr. Chairman.
Thank you folks for coming today.
On page 25 you put as your second bullet point that the suicide rate is lower than that of the general population. I ask this in a very respectful manner: Why did you put that in there? Why did you say that?
I had a brief of this and I showed it to a family going through these problems, and they were very pissed off, to be honest with you. It almost makes it look like, “Oh, it's okay”. You said that one suicide is too many, so I highly recommend that you take that out of there; it's not fair to compare the military service with the general population.
Second, a lot of veterans I've been dealing with lately are complaining about the fact that they're not getting help regarding their teeth problems--because as you know, they're grinding their teeth--and their sleep apnea problems. Both of these concerns are very serious for people who have PTSD. They have to go back to DVA, get another assessment, and it literally takes months and months before they get adjudicated once again on these claims.
Is there is a way DVA can balance all of the concerns of post-traumatic stress disorder and the symptoms arising from it together, so that if a person has PTSD and claims they have sleep apnea, they should automatically have the programs available to help them immediately, without having to be re-assessed once again?
My last point is that I noticed that a lot of this is based on our modern-day veterans from Afghanistan and Bosnia. But I'm going to give you the case of Stanley Eisen, from Nova Scotia. He was an 86- or 87-year-old World War II veteran. He claimed he had post-traumatic stress disorder from his World War II experience, and his claim was flatly denied. He died shortly afterwards.
I know many World War II and Korean War veterans who, because of the news from our military in Afghanistan, every time we lose one of our soldiers, relive that moment. They're suffering just as much. But I don't see the department reaching out to World War II and Korean War veterans and those who served from say 1953 to 1994. A lot of those individuals are suffering as well, and I don't see a reach-out to them looking for assistance.
I just put that out as a comment to you. I do thank you for coming.
:
As I said earlier, most of the clinics are provincial ones that Veterans Affairs funds. We have established protocols with the clinics to ensure that the types of services across the country are similar, even though they're delivered by different health authorities.
On the initial contact, the clinic receives a referral from the district office with details on the veteran's needs. The first thing the clinic does is contact the client to set up an appointment. Initial screening is done over the phone to see if there is any urgency or if any issues should be addressed right away. Once the clinic takes responsibility, they ensure that those who are in danger are referred or taken care of immediately.
So the initial activity in the clinic is the screening interview. It's normally done by a nurse, who gathers all the information she needs to present to the clinical team, because all the clinics we have are specialized clinics. They work in an interdisciplinary team of psychologists, psychiatrists, social workers, and nurses. They work together and say, “We have a new client who needs to be assessed. We don't know what the diagnosis is, so we need to do it.”
Depending on the initial interview, it may involve the psychiatrist and the psychologist. We invite the family members as part of the assessment plan, because we know that the impact of PTSD is not only on a veteran or the member, it's on the family. So we invite the spouse to accompany the veteran to the assessment so we have a global understanding of the family situation, not only the patient situation.
A standardized test is run. It's the PTSD anxiety scale. Different scales are used to try to understand the condition. A diagnosis is made by the interdisciplinary team—let's say it's PTSD. Then the treatment can start.
For treatment, there are different modalities depending on the condition. We use prolonged exposure therapy, for example. It's a type of treatment where the therapist ensures that the patient relives the trauma. It makes them speak about the trauma and write about it so it comes back. After that session the therapist is able to put things in perspective to make the difference between the situation then and the situation today. Over time, with exposure therapy, the feelings associated with their trauma will diminish.
There are different modalities of treatment that can be used. We use Telehealth as part of our treatment modalities. After an initial assessment at the clinic, treatment can be provided in the home community through Telehealth services. It's a new type of treatment modality we've started using. More than 85 of our clients have already received treatment through Telehealth facilities in their own communities.
They go to the local hospital or any centre that has Telehealth equipment. They might receive therapy from a psychiatrist. The psychiatrist will renew the medication or see how the medication is going. There is group therapy. There is couples therapy and group therapy, like anger management. At the conference two weeks ago we shared with the participants a new anger management protocol for group therapy that was shared with all the participants of the international traumatic stress society conference.
So there's either one-to-one, couples, or group therapy. In some cases we involve the children in group activities. And there's Telehealth. We use drugs and therapy. Those are the basic things you can expect from the clinic.
:
Thank you, Mr. Chairman.
I notice on page 19 that there are no clinics shown on your map in Saskatchewan, Newfoundland and Labrador, and northern Ontario. The territories are understandable, I guess. I was wondering why that would be.
Also, you talk about Brad here, which is not his real name. On the back it says that “VAC will be there to provide support, when needed, for as long as it is needed.”
I have a gentleman who had to leave Halifax because he couldn't afford to live in his home any more. He was seeking psychiatric assistance through DVA. Because he now lives in Truro--he doesn't drive a car, because he can't--DVA won't assist him in getting to his psychiatrist in Halifax. They say that he has to pay for that himself. I'm just wondering whether you are aware of this. What can I do to pursue that? I've spoken to the regional director, and they've said no, it's for that area. They don't supply transportation from an area like Truro into Halifax, which is about 50 miles, which is not much.
I just bring that up as a case.
Also, Mr. Lobb talked about and you talked about those forms. Can you send us a copy of all the forms they have to fill out so that we can have a look at them? I know that some of them are quite cumbersome.
One thing that is very therapeutic for veterans is massage therapy. In Halifax, some therapists charge $70 to $75 per session, but DVA's limit is only $58. I've seen the forms these massage therapists have to fill out. It takes a long time to fill out that form to get the $58, even though they charge $70 or $75. They were told that they cannot claim the additional difference. If their rate is $70 an hour, and DVA only pays $58, they cannot get the extra $12 from the client. They're told that. I'm just wondering if that is indeed correct.
Second, if they're not downtown but they're in an outside area and their rates are a little higher, why wouldn't DVA meet the rate of what a massage therapist charges, if that's the going rate in that particular area? Is it just a blanket rate they receive?