Thank you, Madam Chair.
Good morning, Madam Chair, committee members, and guests. It's with great pride that I come before you today, and sadly, with great emotion concerning my topic and our force, the Royal Canadian Mounted Police.
I'm a proud member of the RCMP, serving in my 37th year. My service has been in the provinces of Nova Scotia and Prince Edward Island. Like most RCMP members, I began my career in front-line policing at the detachment level. I have done numerous duties in the force, including criminal intelligence, outlaw biker gangs, extensive drug work in many various aspects, including undercover. I spent about ten years on an emergency response team, which resulted in multiple deployments in two capacities, primarily as a marksman or sniper and as an assaulter. These exposures have led to some life-impacting experiences and injuries.
My appearance here today originates from my current duties as a staff relations representative, a labour relations representative who acts on behalf of over 900 members in my division, which is the province of Nova Scotia, but also thousands nationally in my capacity as chair of the SRR, our national occupational health and safety program. This is a responsibility I have held for many years. I've been elected to this position by my peers in caucus and elected divisionally by regular and civilian members of the force to terms now exceeding 14 years.
In the time we have this morning, I want to bring to your attention a critical situation that exists in the RCMP and has reached a crisis. I will try to remain focused on the occupational stress injury component broadly and not just on post-traumatic stress.
Many of you have likely seen the recent SRR publication. Many of you have it in front of you this morning. I would hope you can find some time to give that document a view. The edition has little fluff and lots of facts. The testimonials were sought to emphasize the difficulties encountered by numerous members throughout the country. There were many offers of input, and some were extremely emotional. We chose to concentrate on those individual situations impacted through the circle of care.
Some of you already know that members of the RCMP are excluded from the Canada Health Act, along with new immigrants to Canada and federal inmates. Because of this exclusion, I am not entitled to receive health care in my own province without the approval of my employer. That authority comes under subsection 83(1) of the Royal Canadian Mounted Police Act and regulations.
The publication provided to you today has also been given wide distribution, including to the Senate and the House of Commons. Features within are impacting articles from affected serving and retired members, treating professionals, families, and others. There were many who wanted to contribute their experiences, but we could not accommodate the demand.
Some of the real thoughts expressed by regular and civilian members when they have been impacted by operational stress injuries include the following:
--It would harm my career, job promotions, advancement.
--Members in my unit have less confidence in me.
--Unit leadership might treat me differently.
--Leaders blame the member for the problem that he or she has become ill, because from a leadership point of view, we're now down a body with no replacements.
--Members are seen as weak—the “suck it up” type of attitude.
--It will be too embarrassing for my family.
--I do not trust the RCMP.
--I do not trust RCMP health services.
-- I will get better on my own.
We recently had a serving member of the force sustain major injuries during an international deployment. I received phone calls from various members who were concerned about the medical and support services needed by this severely injured member. My first contact was with one of the presenters here today, Superintendent Rich Boughen. After I discussed this matter with Rich, he immediately went to the member's house and he facilitated some of those needs that the member and the family had.
Many of our support programs that were designed to assist first responders in the field are suffering from a lack of resources and funding. We need help externally to deal with these situations we confront. We need your help to put these medical needs concerning the health of our members in their rightful place—as a true, real priority.
Some members are dealing with medical situations by paying for their own appointments and medications, so that no one will know they're having personal difficulties. In situations such as this, if a regular member goes to pension and makes a Veterans Affairs' claim application upon retirement, there is no medical information contained in the member's personnel medical file to justify the claim. So then the process has to start from a position of pension in which to justify that application.
These are outcomes encountered when members feel that they must keep their condition secret.
Recently, an RCMP veteran who had been retired for six years read some of the SRR work concerning OSIs. During this pension period, he dealt with many personal issues and realized he needed support, so he reached out for help. That help was provided. He was taken to a local VAC office, and he is now in treatment.
We have RCMP members who are self-medicating through drugs and alcohol. This is a short-term fix for a monster that returns even angrier. The RCMP has a growing underground of sick members who do not want to come forward.
We deal with any number of contract professionals who know little or nothing about the policing profession or the lifestyle that we live. They have no introduction to our world. In fact, in my home division right now, we have a contract doctor who is working, I believe, seven days a month. If you happen to get hurt or have a file for review during those seven days, what do you do? Those are the realities we're faced with in my organization through the inability to have the resources to provide the service.
For years, SRRs have been promoting the need to have designated physicians who are educated and knowledgeable about police work. We have a member employee assistance program, MEAP, as a core program that is respected by serving employees for its many successes. But it has been continually crippled by vacancies.
Members often do not go to RCMP health services for referrals, especially for psychological conditions, because they are concerned about their personal and professional situations.
We have had and continue to have members who are not followed in their transfer from one division to another, who ultimately fall through the medical administrative cracks. I would suggest that, more than often, members are not followed up when they come out of northern or isolated posts. This is because of a lack of health care professionals who have an understanding of our world, police work.
Our concern is not for those who are off duty sick as much as it is for the large numbers we have who are working sick, those members who come to work every day until they crash. Our organization cannot tell you how bad the psychological situation is within our organization. We maintain few or no statistics. We are forced to depend on numbers provided by Veterans Affairs Canada. As recently as last night, the closest I can get to those is for last spring, almost a year ago. Remember that VAC only has those numbers after the damage is done.
Our health care program defers to VAC to make decisions on injuries that were sustained during employment, which is another test of our inability to deal with these issues ourselves and then make application to Veterans Affairs.
The RCMP has no in-home care available to our severely injured serving and retired members. Imagine a person being hurt and unable to remain in their own home. Our members serve throughout Canada and the world and show the Canadian flag in more jurisdictions than any other government service. But historically our injured members have been denied the benefits of the veterans independence program. Our battleground is primarily domestic, but we serve abroad as well, in many other countries. Our force has paid a heavy price in supporting our nation, as have our brothers and sisters in the Canadian Forces, who have made the same sacrifices. We are asking for nothing more than to be looked after medically.
First and foremost, we need your help as a health committee. We need A-base funding of our health services requirements so that the money is protected and cannot be extracted for other purposes.
The RCMP needs the resources—trained resources—and funding to provide health care programs that meet the needs of our front line members. These resources must be identified in an organizational chart that does not change frequently. At present, we have the money for 20 positions; we have 40, minus some vacancies, in a workplace that needs every bit of 60 positions. This is a circular response to our situation that you have to know about.
We need a committed, strong MEAP program, fully focused on the mental and physical health of the RCMP. Members trust other members, and this is what allows us to access what we know now. This inherent trust in our members maintaining the MEAP program—knowing who we are, knowing what we do and how we function as a police force—makes this program not only unique but trustworthy from within. In essence, you speak to someone you know who understands what you do, rather than a stranger on the end of a 1-800 number.
It is critical that every employee of the RCMP be given immediate training in OSI.
I've taken enough time this morning. I realize that your time and my presence here today is at a premium. It is one that I will carry through the remainder of my service, and I thank you for the opportunity to come in front of you today.
Thank you. Good morning, Madam Chair and members of the committee. Thank you for inviting the RCMP to appear before you today.
I would like to introduce Superintendent Rich Boughen, acting director general, occupational health and safety, who is with me to answer questions on occupational health and safety. I would also like to acknowledge the presence of Staff Sergeant Murray Brown, who was invited directly by the committee to speak on behalf of the staff relations representative program.
The RCMP is the largest police force in Canada. We employ a workforce of extremely diversified occupations. The bulk of this workforce is composed of police officers who diligently carry out traditional police functions. We also employ a wide variety of specialized officers and civilian members, as well as public servants, auxiliary constables, volunteers, and contractors from all trades and professions, who in all total over 28,000 employees. The RCMP is present in large centres, small communities, northern and isolated posts, and peacekeeping missions across the world.
There is no such thing as routine work for a police officer. By nature of their work, RCMP members can be placed in operational situations that can result in physical, emotional and psychological injury and/or illness. They are regularly exposed to traumatic events, tragedies, atrocities, natural disasters and deep human suffering. Operational stress injuries not diagnosed can have a significant impact on the functioning and enjoyment of life within the family, work and social domains without the member or their families understanding the reasons for behavioural changes.
RCMP members are excluded from the Canada Health Act. Health care to our members is provided under the authority of the RCMP Act. Under this authority, the RCMP, through its operating budget, provides all health care benefits for its regular members to maintain and, if necessary, ensure a timely return to good health and fitness for duty.
The occupational health and safety branch establishes policies and programs aimed at promoting a healthy and safe work environment, and collaborates with a network of designated providers and other federal health care partners. The national branch supports regional and divisional occupational health offices by establishing national medical and psychological health standards, which are carried out by the divisional offices.
Preventative measures are in place to monitor the health of regular members throughout their career. Divisional physicians evaluate physical and mental wellbeing during a mandatory Periodic Health Assessment. This assessment must take place every one to three years dependent on specialized duty.
Members have access to comprehensive health care through entitlements and benefits. Health care is provided by medical and psychological professionals in the community and chosen by the member, although the RCMP does provide immunization. We strive to meet the health care needs of our members and those of their families and, when necessary, we will transport and may even relocate a member to ensure access to treatment resources.
The federal health care partnership aims to achieve economies of scale while enhancing the provision of care as well as to provide strategic issues leadership. The RCMP is unique among its partners in the FHP, as we do not provide direct health care or treatment to our members and as such we do not encounter the same types of pressures in the recruiting and retention of health professionals.
We are pleased with the leadership that the FHP has provided in Privacy, Enterprise Architecture Plan for the development of the Electronic Health Record, Health Services use of Data and Health Claims Processing. We also believe that the departments could further capitalize on the potential economies of scale by the provision of a knowledge base in support of partners in all areas of health care and health care management.
In closing, it's important to note that as our organization matures and changes, so do the needs of our employees. The RCMP is evolving to keep pace. As of April 1, I will be commencing the new position of director general, workplace development and wellness. The creation by our organization of this new role at the assistant commissioner level underscores the importance of wellness at the RCMP. We also continue to be intelligence-led and have engaged experts in the field to shepherd us as we move forward. We will utilize the latest research and best practices to keep our people healthy, fit for duty, fit for life.
I have provided a photo of my husband, whose suicide was a direct result of the failure within the health service of the RCMP. My husband responded to a move to the north, and at no time during this time was he interviewed psychologically prior to leaving. He responded to an interview. He came home with a transfer paper, and at that time he had been transferred on three separate occasions in his career of 18-plus years, so he knew what a transfer paper was.
He indicated to me that he thought he had been transferred, and I said, “Well, that's not possible, because we both would have had to go through a number of psychological interviews.” I have had friends go to the north as well, since I am an RN. I said, “Make sure that you give me lots of notice, because I too am busy in my work.”
He proceeded to go to the interview and discuss a position that was possibly available. At no time was he interviewed, but he was promoted to go to the north. I was not given a psychological interview at all. As a spouse, I was given a piece of paper and sent home to review it and send it on.
We proceeded to the north. At that time the conditions were unbelievable in the place where we went. Support was minimal in a number of factors. He reached out and said, “I can't do this any more. I don't know what is wrong with me. I don't know what is wrong with me.”
He contacted his division supervisor. We then went to K Division headquarters in Edmonton. We met with psychological professionals and force physicians. The psychological physician was not within the force; she was an outsourced member. During the interview, I was with my husband at all times. I made sure of that. Even if I wasn't invited, I made myself invited.
Paul responded to a question that is mandatory. He was asked if he had any issues with self-harm or harm to others, and his response to the question of suicide was yes. Her response was, “You have a few issues we have to talk about.” He was asked where his family was. He said it was down east in Ottawa and Nova Scotia. She said, “Fine, I'll refer you to Ottawa.”
We went on to Ottawa. It took some time for the appointment to actually get made to go forward. We then went in. The doctor indicated within an hour and a half over a two-day period that nothing was wrong with my husband, but indeed he was going about this blindly. He had not been given my husband's work file, and I said, “Dr. So-and-so, I am a nurse. How can you be evaluating us with no file?”
His response was that it was never given to him. He said this was common. He said, “I go to the north on a monthly basis for a period of five days a month.” He works for three days a week. He is not a member, nor does he know anything about being a member.
Within a two-day period, my husband was told that there was nothing wrong with him. He was told, “You are normal.” He walked out and said, “Dear, I'm normal.”
We were posted to Ottawa. We bought a home, and while signing the papers for the home, we received a call to come and pick up his side arm. Within three days he took his life. We were told that he was normal, that nothing was wrong.
Throughout his career, as you see.... You may not be able to tell from his photo, but my husband was six feet three inches and 265 pounds. He was a gentle giant. He never asked for help until then, and the resources were not there. The people we met were not trained to recognize what was wrong with him. He didn't know what was wrong with him.
When we sat with the Ottawa psychologist, Paul opened up completely. “Okay, just a sec,” he said, “we'll start.” Paul had no issues in opening up and reiterating what was going on, but not necessarily what was wrong with him. To be told by one psychologist that you have a few issues, and to answer “yes” to suicide....
I'm not a member, but I am a member's wife. At no point in time did the psychologist take me aside, for the sake of 15 minutes, and say, “Mrs. Smith, I have grave concern” or “I have concern. These are the things I want you to watch for.” I'm not sure why she didn't, but when the response to a mental health issue and burnout is “yes” to suicide, I don't think it leaves much of a question of diagnosis.
As a nurse, I think we can all identify with someone breaking an arm. We have tools to identify that. We bring you into emergency. We do an assessment. We take photos and X-rays. We determine that the arm is broken, that the bone is fractured. We put on a cast. We assess you. You come back in four to six weeks, and we do another assessment. We have tools to assess for mental health issues as well, and for burnout.
Members, my husband is not the only one. There are many members. As Mr. Brown said, they self-medicate through abuse of drugs and alcohol and through many other ways as well.
Paul didn't choose to do that, obviously. I think his feeling was to suck it up, and that was the feeling that was given to him through the actions and the treatment within the health issues. That was what he was given to deal with this issue. He had none. It was, “Turn around and go out the door. You're fine. Go back to work.” He was told, as I sat in the office, that he was fit for duty. This was from a psychologist who works on contract for three days a week.
I ask you to consider what these men have to say, realizing that first-line personnel--RCMP, firefighters, EMTs, persons of that sort--are all high-stress individuals in high-stress jobs, and not everyone deals with their issues in the same way.
My husband paid the ultimate price. When he asked for help, it wasn't there. It was not provided. I am not quite sure why, in the total sense, but he did everything he could do.
Good morning ladies and gentlemen and thank you for the opportunity to address the committee.
I will begin by providing you a brief summary from the Canadian Forces perspective of issues surrounding health personnel and collaborative care that I understand are of interest to the committee.
The Canadian Forces are very much really a separate health care jurisdiction in Canada. While the most tertiary and high-level care within Canada is obtained through civilian jurisdictions, the CF has its own deployed tertiary care and its own training establishment, dental service, public and occupational health agency, pharmaceutical supply system, and research organization, as well as other services. It also maintains nationally unique capabilities necessary to support military operations. Except in very specific authorized circumstances, the military health service is only mandated and resourced to provide care to CF members, but pursues every opportunity to enhance the provision of provincial or territorial care to the families of CF members.
The Canadian Forces Health Services experienced severe personnel shortages in the 1990s that seriously affected our ability to support military operations. To address this and other gaps, the Rx2000 project was initiated in January 2000. One of its many components was an Attraction and Retention Initiative to address health personnel gaps.
Our attraction and retention model and strategy had been expected to close some of these gaps, particularly for physicians, which was the first group we targeted. As of January, our total effective strength for uniformed medical officers has been met, and our intake requirement is satisfied up to 2017. These successes are mainly due to competitive recruiting incentives, compensation scales, continuing medical education opportunities, and employment opportunities in other work environments.
The successful physician model has been applied to other distressed professions with varying success.
Pharmacists remain a challenge due to shortages in the civilian sector, where salaries are high and the CF is not competitive. Forecasts indicate that most of our distressed occupations will achieve their Preferred Manning Levels within five years if our funding model remains at its current level.
Given the investment required to recruit health care professionals, we try very hard to retain them once they are enrolled. We use a number of incentives, such as professional development programs, maintenance-of-competency programs, incentive allowances, professional advancement opportunities, and so on.
The importance of recruiting and retaining enough health professionals is only expected to increase as the implementation of the Canada First defence strategy progresses. Since it takes many years to educate and train health professionals, their attraction and retention must remain the subject of constant effort and vigilance.
The CFHS also employs many civilian health professionals. Our ability to recruit and retain them is constrained by disparities between market forces and public service employment incentives.
This has resulted in some staffing gaps and has necessitated a reliance on expensive contracted services. We therefore support efforts to enhance Public Service recruitment and retention.
With the exclusion of the CF members from the Canada Health Act, very much like the RCMP, civilian health care providers and provincial and territorial health authorities may also charge out-of-province, and sometimes non-Canadian, resident rates for health care services to CF members, ranging from approximately 130% to 200% of provincial rates. We would therefore support initiatives to standardize and minimize such cost differentials.
With respect to collaborative health care, the primary care renewal initiative was designed to provide high-quality patient-focused care through collaborative practice, strong continuity of care, and a standardized approach across CF health services, while remaining adaptable to ever-changing CF operational needs.
At the core of our model, our care delivery unit is composed of several types of clinicians supported by a variety of support and population health staff. They work closely together through means such as case conferences to deliver optimal evidence-based care based on best practices and are supported by a variety of mental health centres and clinical and population health specialists. Our lessons learned in all aspects of health care are available to any interested departments. We collaborate closely with many departments, such as Veterans Affairs Canada for the transition of care to CF members leaving the armed forces, VAC and the RCMP for the provision of mental health services, the Public Health Agency of Canada for national public health threats, provincial and territorial authorities for the provision of tertiary care, and many health institutions for health research and clinical training.
We're committed to assisting the federal health care partnership and departments interested in our CF health information system, which is very popular for our clinicians. It would permit controlled electronic access to patient records and link health facilities across Canada and locations outside Canada, such as in Europe and in Afghanistan.
Thank you again for your interest in the health of CF members and for the opportunity to appear before you today. I'd be pleased to answer any questions.
Thank you, Madam Chair.
Honourable members, as the chair has pointed out, my name is Janet Bax, and I'm the executive director of the Federal Healthcare Partnership Secretariat. Accompanying me today is Hillary Flett, who's the manager of the federal health care partnership's office of health human resources.
We are very pleased to be with you today to report on the activities of our office since it was created in 2008. We are going to make most of our presentation in English, but we will be pleased to answer your questions in French.
I will begin the presentation. Ms. Flett will follow and will describe the office's achievements and the challenges we are facing. You have the brief in front of you. We do not intend to go through it page by page. We are simply going to give an overview to allow for as many questions as possible.
First, Madam Chair, I'll offer a brief word on the partnership. We are a horizontal initiative of seven partners, including Citizenship and Immigration Canada, Correctional Service of Canada, Health Canada, National Defence, the Public Health Agency of Canada, Veterans Affairs Canada, and the Royal Canadian Mounted Police. We represent over one million clients and an annual expenditure on health services and products of over $2.7 billion.
Established in 1994, the partnership has a mandate to work collectively to obtain economies of scale, as Monsieur Tousignant said, while enhancing health care provisions, and to identify areas of health care that would be susceptible to joint collaboration.
In 2006 partners were facing a serious issue with respect to hiring and retaining positions in the Government of Canada and asked the partnership to work collectively on this issue. The result was a study on recruitment and retention of federal positions, which was published in March 2007, three years ago. I believe, Madam Chair, that the committee has seen and read this report.
The commodore has spoken to you about measures that were and are being undertaken by the Canadian Forces. As Commodore Jung points out, however, many of these measures are not available to the public service, particularly with the introduction of the Expenditure Restraint Act. We are still living in a period of economic restraint. We and our partners are realistic about our ability to propose increases in remuneration in present circumstances.
However, our study also demonstrated there is much that could be done to improve the working environment for physicians and health workers. Madam Flett will take you through those initiatives, and then we would be pleased to answer any questions you might have.
I will now hand things over to Madam Flett.
Madam Chair, as Madam Bax has indicated, the severity of the shortages was documented in the 2007 federal health care partnership study on the recruitment and retention of federal physicians and further revealed in a PCIS, a physician classification information survey, in 2008, which indicated that National Defence had a vacancy rate of 25% of their nursing positions, the correctional services had a vacancy rate of 35% in their psychology positions, and National Defence was, among its indeterminate public servants' positions, grappling with a 90% vacancy rate.
The FHP partner organizations have endeavoured to mitigate these shortages; however, these strategies, including third-party contracts, have led to a significant financial and administrative burden to the departments. As mentioned, the health human resource committee was stood up in July 2006 to develop clear and actionable recommendations that would address the federal physician shortage.
The committee tabled its report in March 2007, highlighting six recommendations: to increase compensation package and salary levels, to be competitive with provinces, territories, and the private sector; to develop an attraction program to attract medical graduates; to establish a partnership network; to focus on the overall change in government culture; to increase liability coverage; and to encourage continuing education.
Over the past three years, the federal health care partnership has moved forward on all six recommendations, including the standing up of a functional community office, the Office of Health Human Resources, in October 2008. The purpose of the office is to undertake horizontal initiatives on behalf of partner organizations and other implicated federal entities, including Transport Canada, Human Resources and Skills Development Canada, and the Public Service Commission.
As its logic model indicates, the long-term objective of the federal health care partnership's Office of Health Human Resources is that the federal government be able to employ the optimal health care provider mix and number.
The OHHR has three key strategies. These are to develop activities to address health service occupational classification and compensation issues, demonstrate the federal government as an employer of choice, and facilitate communities of practice. The benefits of a collaborative approach include alignment with the Privy Council Office direction and with key documents, including the sixteenth annual report to the Prime Minister on the Public Service of Canada and the third report of the Prime Minister's Advisory Committee on the Public Service, which speaks of the importance of facilitating collaborative recruitment, supporting functional community models, and strengthening the public service brand.
In addition, the community approach realizes economies of scale by collaborating on career marketing, learning and development, and enabling infrastructure.
The federal health care partnership office of OHHR is looking forward to continued collaboration with its federal partners and central agencies in addressing the federal health human resource challenges.
Thank you, Madam Chair.
The collaborative care model obviously is very in vogue today, and you hear about the PCR, primary care reform, basically everywhere you go in the health care sector.
The collaboration in the military is nothing new. It's been in existence for much longer than it existed in the civilian system. When I entered the military practice in 1985 I was actually quite surprised at how much collaboration was already in place and how much leveraging of services was already in practice. We were using nurse practitioners before the term was known. We were using pharmacists much more than giving drugs in the civilian sector. We were using physios much more robustly. That collaboration diminished during the nineties during the budget cuts, when we were closing a lot of bases and our services.
When we came back to rejuvenation in the year 2000 through the Rx2000 program, we really re-entrenched the collaborative model through what we call PCR, the primary care reform initiative. This is primary care but it's not limited to primary care. What we're talking about is continuative care whereby you have.... It's a form of capitation where members are rostered to a care delivery unit. In that unit there are physicians, military and civilian. There are nurse practitioners, physician assistants. There are medical technicians. With that core, they look after a group of people. Then we have as primary care providers physiotherapists, where a member can simply access.... If you have an ankle injury over a sports weekend, you don't have to go see a doctor to get a referral. You just go see the physiotherapist and have them look at it. If there are issues that he or she wants looked at, then they refer them back.
If you have some issues about certain self-medication, for example, again you don't have to go see a doctor. You can just go down to our pharmacy. We're one-stop shopping. They can do all of that. If you have some family issues, you can go see a social worker for family issues directly.
That is the core to which then we have secondary and tertiary care. In all of our bases, there are mental health components. Some of the larger bases have a much larger centre, where the core of the primary care is part of the mental health care team so that the communication between the primary care and the mental health is smooth. The mental health itself is not stovepiped. That is a team of psychologists, psychiatrists, mental health nurses, and social workers and pastoral counsellors who work together to look at that patient. If it's a complex one we have case conferences, and that involves not just mental health but there's the primary care team that goes into it.
That kind of stuff actually does play havoc a little bit with so-called efficiency. It takes a lot of people to look after holistically. I don't really want to get down to efficiency in that regard, but rather it is a very effective way to holistically look after the patient who's in the middle and you have the whole team.
I commented earlier about being envious of the military situation. I realize that they pick up and leave and need to be self-contained. I don't think it would ever be practical for us to do that. I think, though, that we have some similar good things happening in our organization. We are here collectively, working for an outcome. I hope that this is witnessed by your committee today. I'm not standing here as a labour person trying to attack the force. I love it dearly.
I would like to start with the budget. We don't have one. We've never had a health care budget allotted at the Royal Canadian Mounted Police. What we do is this: If it cost x million dollars last year, that's where we start you this year. What I'm asking is that money be locked in so that no one can come during the fiscal year, based on some other pressure, and extract money that's for the membership. That would be one humongous change.
In relation to the concept of holistic care, I thought we would move a little bit that way with a quarterback, if I may, which is case management. I don't know if we've advanced much as an organization, even within the case management realm. In a recent situation, a member was back to work on a return-to-work program. The person is working one or two hours a day so is no longer a priority with case management. That's tragic. That's what I refer to in my notes as an administrative gap. It's these transitions. Paulette has touched on it tremendously.
When Paul, who I knew during the years before he left Nova Scotia, came through, he fell through some tremendous gaps.
We had an attempted suicide in my division. My health services office didn't even know that the person was in our division. The person had transferred in.
We do a very poor job. I don't mean to be mean or critical. On isolated and remote posts, those men and women should be followed up maybe at six months or a year. Then we can wean them off the corporate eye, so to speak. At least the membership would know that the system has followed them during those experiences. Paulette touched on that when she answered Mr. Stoffer's question.
If we were more attentive, instead of saying that you're one over.... If I sprain my ankle, I can go to a physiotherapist. In my organization, I can go so many times, but if I don't have another injury, I'd better go to a doctor to get a referral. It doesn't have to be so complicated, and in our organization it is. Everything needs permission. We're paying as much now for permission as we are for the service.
Are there possible efficiencies? There are.
I look forward to working with Alain in his new position—with all due respect to the rank—but in all fairness to Alain, he's just been put in that position. Again, this is not a criticism. It's an observation. Now, instead of being able to go directly to the chief human resources officer, I have a stopgap. I will see how well this stopgap works out. Alain and I talked about it this morning. I can't go as high now, directly, but I can go to Alain. We'll see how that position works out. I am optimistic. I'm optimistic because he found the interest and the time to come here today, because he wasn't originally in the program.
I really believe—and I said so to both gentlemen this morning—that we have the occasion to have a fresh start.
I hope, Madam Chair, that this gives you some context.
I thank particularly Ms. Smith for really painting a picture of what this is like, and how really helpless you feel when somebody's designated fit to serve and you know that's not true.
I would like to explore how we can do a much better job in terms of wraparound care, first by identifying people at risk and then by providing some sort of continuous support. I don't think somebody who's there three days per week--and if you see a different person each time--is the way we sort this out. In most jobs people have to say “I'm okay, Jack” and get on with it. As a family doctor, you know when somebody is not himself or herself. You actually do need somebody with a continuity of care.
Maybe we should also be exploring how even in Nunavut people are able to do mental health visits electronically. To be able to see the same person each time, even with Skype, would be using the technology that we used in other parts of the services for this most important thing, our health human resources.
Even though, Ms. Smith, you had difficulty in terms of the clinical psychologist, I have to say that after the problem with Colonel Williams at Trenton a great number of my friends commented that we don't as yet have clinical psychologists in uniform in the military. Although you have operational psychologists, without clinical psychologists, who use the kinds of tools Ms. Smith described that we use for broken bones.... There are tools you can use to find out these things. I guess we're the only force without clinical psychologists but we also seem to be unlike the U.S. Air Force. We don't seem to do a pre-psychological assessment of our pilots.
I want to know how we can help. Another piece for which a number of us have been fighting for a very long time is that people are moved all over the country, particularly in the armed forces, and the soldiers receive care but their families do not. In my experience as a family doctor, if I'm not having the wife or the kids tattle on whoever's having trouble, I might not know what's going on.
What would it take, Dr. Jung, for us to be able to provide services of the highest possible quality for the military and their families?
From being a wife and observing my husband--we were married for five and a half years, and obviously I'm not a member--their training makes them so stoic. I think they feel--and I'll use the term Mr. Brown used earlier in his speech--that they must suck it up; that speaking beyond the uniform shows weakness, and that you are maybe not able to handle a situation.
It becomes a little harder when you are six foot three and 265 pounds, versus maybe of smaller stature. As well, your superiors, your staff sergeant, your immediate supervisors, and staff in your detachment maybe go to you a bit more because you are a larger person and you tend to handle things well, versus other members. You seldom complain, because that's not your nature. I'll add that my husband was from a military family. His father was a colonel, so he knew all about what military meant and what the uniform meant. He was very proud to be a member. I know I've never said that, but he really was. Even at the end he still was.
I feel that it's almost in them as members. It's in the training and in what they're presented with on a daily basis. It's just the way the force is. You are to be strong and show strength, because you are protecting everyone else. We're forgetting that the people behind the uniforms are fathers and sons, that they have children and feelings.
They may see a child of 18 months being administered CPR and later dying, and rush the parent through at 150 kilometres per hour on a Sunday evening. But no treatment is given to them; no follow-up. They may pick up a young girl of 19 years of age who was brutally murdered, and put her in a body bag, and for over two years work with a major crime unit when it's not their position to do that--and never receive follow-up. They need help, and we need you to help them. The members are crying in their own way, telling people they need help, and I think the only way to do that is through funding.
They need to feel at ease when they're speaking to their superiors. They need to have conferences where they're told what they may be exposed to, and what they may encounter over their careers. It should be brought down to the ground level when they're training and they should be told, “Guys and girls, this is it. This is the job and what it entails. You will see things that normal people, on an everyday level, will not see. But we will follow through and we will take care of you, as we should. This is what we have in place for you. When you feel something different or wonder why you're not sleeping or eating, feel free to come to us and speak of that. Get it off your chest.” That's all it takes. It's prevention.
Thank you, Madam Chair.
I too would like to thank our presenters here this morning and apologize for missing your presentations. I will definitely be checking Hansard, as will my colleague, to make sure that I don't miss anything.
I just want to say this to Ms. Smith. I certainly hear your voice and feel your pain. I lost a very dear and close friend who was a member of the police force and was not getting the attention that he needed. He was dealing with undercover units in a very nasty world, and there needs to be something there.
I also have a husband and a son who are emergency responders in the fire service. I understand some of the tension that families go through and some of the assistance they need, as well, to deal with the issues that our loved ones deal with as a matter of routine, almost.
So I'm certainly glad and thankful that you were able to come here and give your testimony today.
I want to ask a couple of questions to the Department of Veterans Affairs, to Ms. Bax and Ms. Flett, please.
I understand you are part of the federal health care partnership movement, and I think that's great. I want to hear a bit more about it, and I hope I'm not asking for things to be repeated that I missed.
I think the face of Veterans Affairs is changing greatly and changing rapidly. I am speaking of the demographics and what we had traditionally been accustomed to with veterans, and now, with today's world, what we are faced with with the veterans in the demographic area.
I'd like you to address some of the challenges that presents, if you could, please. Are we looking at different shortages, different types of shortages for specific specialties, or are things remaining much the same?
I appreciate the questions of my colleague. I think it's important to understand some of the process and steps that people take.
Just by way of introduction, I spent eight years as a registered nurse living and working in isolated and remote first nations communities across Canada, at the very least northwestern Ontario, Manitoba, Saskatchewan, British Columbia, and across the Arctic. I have a rich understanding of the experiences one goes through in taking an assignment in those communities. I have to say, Mrs. Smith, that I have very close friends who are members, and I share some of your concerns, particularly with the culture of stoicism that you referred to and the fine line between bravery and an ability to come forward with some of the things that you see. In nursing, not unlike the RCMP, we have come into a variety of different things. Of course, there's always a nexus between our personal and professional issues and the counter-transference between those two.
Having said that, my questions may be focused more with Mr. Tousignant around the wellness program. I just want to very briefly talk about what nurses have experienced in the north and how they've come to respond. It seems to me, based on what Mrs. Smith is talking about, there may be some structural defects in how emergencies or traumatic scenarios are dealt with that prevent officers from coming forward. If I can shed a little bit of light on our own experience, it's actually mandatory that we participate in debriefing programs or sessions by phone, or if the situation necessitates it, with a counsellor. Obviously there's a grade on which they're evaluated, but it can be highly subjective and highly individualized based on what the person has seen and how they respond to that.
Furthermore, there are other scenarios that require a mandatory group debriefing, the entire unit in this case. The entire nursing station staff converge on the basis of what transpired. It deals not just with the incident itself but with how the group interacted, things they feel they could have done better. Inevitably, that scenario rises again there or in some other station, and most of us get moved on over the course of our career. I think one of the cornerstones there is that it's built right into our operation.
Another cornerstone would be confidentiality: the real ability of the member, or in this case of the nurse, to be able to go in confidence and actually make disclosures because these kinds of things can sometimes trigger or manifest issues that you have in your other life. As I said, I talked about a nexus between them and prevalences of the use of alcohol—certainly maybe not when you're in the community but binge drinking when you've left the community—or social adjustment disorders with your family or large groups when you get out.
At risk of rambling on here, I'm just wondering whether you've contemplated some of those features in this wellness program, or foundationally speaking, some of these around it. I believe that they are the most important pieces that actually have us come through. I'm not terribly comfortable in a group therapy session, although I have been in one, but for the benefit of my colleagues, I thought of at least one case of a shooting where a murder was the outcome that it was productive for us as a group dynamic, more so than individually. I'll stop there and maybe you could just talk about it.