Thank you for the invitation to speak on this important topic. I'm going to give you an overview of several projects we've done in this area to give you an idea of where it might be helpful for you to ask more questions.
You understand from the introduction that I am a researcher. My Ph.D. is in psychiatric nursing, so I come to this from the perspective of looking at people with various mental health challenges, and I have a keen interest in how people integrate into the community. It's not just about recovering from illness but about having people be part of society.
A few years ago, in finding the overrepresentation of people with mental illness in the homeless sector, I became concerned. Over the last almost two decades I've done quite a bit of work in looking at different subpopulations of homeless, and more than a decade in looking at this group of homeless veterans.
Briefly, because I have only a few minutes, I'm going to highlight in order some of the projects that you can ask me about.
Over a decade ago, with my colleague Susan Ray, I did the first study that actually looked at homeless veterans in Canada. Up to that point, we were completely relying on research from other countries, primarily the U.S. Over 90% of the research at that time, which is a lot different, comes from the U.S., and context really matters. We have a very different military system, a different health care system and a different housing system.
In the U.S., the main issue is around PTSD, which is why I asked Susan Ray to join me on that study, because her expertise was in PTSD. We interviewed over 50 veterans from across the country who were homeless. We wanted to find out their life stories. How did they become homeless? How did that intersect, if at all, with their service for the country? What did they think it would take them to get out of homelessness? That was essentially the basis of the study.
What did we find out? It was very interesting. Most of them believed that their military service was a highlight of their life, so it's very different from that American literature where it was basically a nightmare. They began to drink more heavily during the time of their service; they saw it as part of military culture. The adjustment to civilian life was not easy, but the alcohol also helped them cope with that transition. Ten to 20 years after leaving the military, there was a pattern of losing the job, losing the family, falling deeper into alcoholism—and sometimes other drug use—and eventually becoming homeless. It's a completely different trajectory compared to that of the U.S. literature, so that's very important to understand.
When we talked abut the solution—I'm being very brief here—they talked about how that was the best time of their life and how, because of that, they wanted to reconnect with that identity as a serving member. I think some of the representation we're hearing now is probably going to echo a lot of that. It's about including things like peer support but also about addressing the alcohol use and dealing with some of the issues around culture, such as structure. They often did not access traditional homeless services because they saw them as too unstructured. In fact, they would often be living in the rough rather than accessing services or going to shelters, because they did not like that unstructured nature.
The second study we took on was to take the recommendations that veterans themselves made, develop those into principles and test them out. Would these solutions actually work in practice? We had four sites: London, Toronto, Calgary and Victoria. This project was co-led with Jan Richardson, who is from the City of London and has an expertise in program development.
Again, the principles we were looking at were to address the substance use, particularly alcohol, and by doing so, to look at access to treatment, harm reduction strategies and housing first—housing first meaning that housing is a right. You don't need to be sober, for example, to get housing, or prove yourself to get housing. You become housed first and then you can deal with the other problems.
Reconnecting with military culture is the opposite of what you would do if the issue were PTSD. I'm not saying that PTSD is not an issue. At the Parkwood Institute, we also have our operational stress injury clinic, and that is the most common problem we see. What I'm saying is that it's not the issue underlying veterans' homelessness, just to make that important distinction. Mind you, even in our OSI clinic, substance abuse comes next on the list, but it's a far second.
Again, they wanted to reconnect with military culture and re-identify in that way, and it's about the peer support, but we'll come back to the peer support.
Again, it's about the structure and the self-respect. They needed something separate from the general homeless population. They needed a transition to being housed. It takes time. Again, part of the idea is that many of the people we talked to in both of these first two studies talked about being housed and then losing housing so many times that they almost gave up hope. Nobody likes to see a homeless veteran, so people are frequently housing them, but without adequate support.
In that second study, we saw that the average person, in the previous five years, had been housed six times at intake. Again, there are constantly groups that are going out and saying that they have to get these people off the street and putting them into housing, but then they lose it. They are at the point many times of saying that they almost don't even want to try because this is happening on such a regular basis. They say, “I'm being housed, but I'm not really being supported in the housing.”
Across all those sites, when we put in the service that the veterans themselves said they wanted, we served over 80 people and the really good news is that only one veteran over two years returned to homelessness.
I did bring you some materials in French and English, as directed. On that second project, we have an executive summary. I have one English and one French copy, and there is a website where anyone can download these things for free, as well as a practice manual for communities to set up a similar program in their own community and a peer support manual on how to develop that. It's different from how we traditionally think of peer support, in that it means understanding homeless culture as well as military culture. It means being a cultural broker. There's a full research study, which I'm only giving you very briefly, and as I say, in French and English. This is all available. I will give this to the clerk.
There were other main findings that came out as very important, because some of the sites.... There was a tendency to look at single sites and say, “Let's get a house for these guys.” That was the kind of solution that communities often looked at. The thing is, for one, they're not all guys. No women were served where they went to a single site solution. No families were served with a single site. That only happens if there are scattered sites and neighbourhood of choice. That's the Reader's Digest version of this. You can ask me more later.
On the third project, based on these good results, Jen Richardson and I were getting a lot of requests from communities to help them establish their own programs in their own communities. We partnered with the homelessness partnering strategy and the Canadian Legions. What we did with the Canadian Legions is find out where they were getting the most requests for the poppy fund from homeless veterans, go to those communities and then have workshops in those communities where people from both the veteran-serving community and the homeless-serving community could come together. We would go over the materials and talk about how we could set up something in each of these 10 communities across the country.
The interesting thing is that these were generally not the traditional what we call “HPS communities”, which tend to be larger urban centres. Similar to what we found before, these were mostly rural communities. It was not Winnipeg, but Flin Flon and The Pas. It was not Vancouver, but Surrey. It was not Halifax, but Sackville. That just gives you an idea of where we went.
This is really important, because a lot of these places don't have a VAC office. They aren't HPS communities. It's one of the challenges. We still have many communities that we were unable to get to. In our Victoria project—which we did here—they had a large number of homeless veterans coming from the Northwest Territories. It's the same thing.
One of the big issues we have to deal with is that where we traditionally set up most of our services both for homeless and for veterans is quite often not where they actually are. That was the really important thing, along with partnering with the Legions to find people, rather than through some of our traditional sources of data.
Our HIFIS data comes federally through HPS. That's data on shelters, on the HIFIS community, so they're missing all of these people who are in these small rural communities, who might be living in tents. We found some places where there would be five people camped out who were all veterans. They would even have a schedule up as to who was cooking meals on what day, but they were not being picked up by any of the traditional methods.
For that project, in every community we went to we found that the homeless sectors knew each other very well, and the veterans sectors knew each other very well, but they were completely different cultures and they did not know each other.
There are two final things, which I won't say as much about. We also did two systematic literature reviews to figure out what was going on. In this study we had nine people who were indigenous, and only three women who had served, so we wanted to do some literature review to find out “What about those populations?” These were questions that were constantly asked in those communities. Shockingly, in the entire world, there has been only one study on indigenous homeless veterans. This is an incredible gap in the literature. There's no Canadian study looking at the specific needs of women.
I'll just leave that, again, for future planning. That's my short spiel on a whole pile of studies.
Thank you, Mr. Chair and members of the committee.
On behalf of Wounded Warriors Canada, let me begin by thanking the House committee for its hard work in addressing the important issue of homelessness among Canadian Armed Forces veterans.
I know this committee has probably heard a lot of statistics and a lot of studies and comparisons of numbers and percentages of homelessness among our veterans in the general population. One thing I think we can all agree on is that even one homeless veteran is too many, especially since this is a population that was recruited, trained and screened to protect Canadian interests. Wounded Warriors Canada has a very simple mission: to honour and support Canada's ill and injured Canadian Armed Forces members, veterans, first responders and their families. To that end, we're endeavouring to be the benchmark charity delivering effective evidence-informed mental health programs in support of ill and injured veterans, first responders and their families.
As introduced, I'm privileged to serve as the national program director of Wounded Warriors Canada. Owing to the generosity of Canadians from coast to coast, we will invest over $3.2 million this year in leading-edge programming that's changing and saving lives. My brief comments and observations today are reflective of our 12 years of experience as a charity operating in the veterans space, with the last six years seeing Wounded Warriors Canada focus on mental health, with just a little bit of influence, maybe, coming from my quarter century as a chaplain in the Canadian Armed Forces and some of my observations there.
Successive governments and ministers have spoken about the critical need to institute policies and practices that would see the Department of National Defence and the Department of Veterans Affairs have what they keep calling a seamless transition from uniformed service to civilian life and beyond release. The critical need for this is particularly true in the cases of those who are medically released, as they are the most vulnerable and sometimes fall through cracks in the system. We have observed some progress in this area over the last number of years, and I think we would all agree that still more needs to be done. We don't doubt the earnestness or the strategic understanding of this necessity by strategic ministers; however, we must redouble the efforts to ensure that this objective is indeed implemented at the tactical and bureaucratic levels, where it often seems to get off track a bit.
Particularly, we note that those who are medically released are most often ill-prepared for transition because they planned on having long careers. Therefore, it's incumbent upon leadership to do all they can to ensure an orderly, informed transition to increase the chances of successful transition. Many facing medical release are suddenly met with the unexpected coupled with the sudden existential crisis concerning their meaning, their value and where they are as members of society. This is kind of reflecting what the last speaker said about the best years of your life and having that identity tied to being a member of the Canadian Forces and the pride that comes with that. Many facing medical release are suddenly met with that crisis and they have their identity completely taken away from them because they've tied it so much to being a Canadian Armed Forces member.
Of course, when they receive the news of that, they most often don't want to leave, so there's a delay and denial and then they start to plan for their eventual release from the Canadian Forces. Steps need to be taken to ensure that members and families understand and participate in the full release process and understand timelines, benefits and options. We need to make sure they actually understand the entire process that is going on.
Given that medical releases in particular or voluntary releases that have not been completely thought through may leave the member and his or her family with limited plans and support post-release, early engagement in the process, including assistance with sound financial literacy, would seem to be a wise and prudent provision as people transition into their period of release.
Many of the veterans who experience homelessness also have addiction problems and mental health problems. On the mental health end, we can say our experience as a charity in all these areas is that the earlier the intervention takes place, the more successful it is. Early on in Wounded Warriors Canada's experience, we believed that, since we were at the height of Afghanistan, those seeking the mental health services that Wounded Warriors Canada's programs offered would come from that population.
In the first number of years that we offered our mental health programs, we found that the veterans and their families who came to us were often 10 or 15 years removed from the incident from which their mental health injury occurred. That made that injury so much more entrenched and much more difficult to address, so the earlier the better.
Finally, there are lots and lots of various organizations that are seeking to address this across the country in various ways. There are studies and large groups from coast to coast, like VETS Canada, the Royal Canadian Legion with Leave the Streets Behind, Soldiers Helping Soldiers, and a patchwork of other provincial and non-governmental organizations right across the country.
Our advice to this entire space would be that these groups begin to learn lessons from one another and co-operate in best practices. One of the principles that Wounded Warriors Canada has in all of our programs is that it doesn't matter where the veteran or the first responder or their family lives in Canada; they're going to get the same level of service. We have to try to do that on the homeless front as well. It doesn't matter whether you're in Flin Flon or in Vancouver; you should be accorded the same thing.
It's a challenge, we know from programs we've done. We spent a lot of time working with Help for Heroes and learning some of the lessons that they have learned in the U.K. They have a great benefit to their programs. They have a really small country with a big population, so they can get everybody in one place. We have the opposite problem. We have a small population with a big country. So some of the bricks-and-mortar solutions need to be looked at, and we need to look at other ways of creating partnerships at the strategic and tactical levels that will avoid duplication and allow people to work together with best practices.
Mr. Chair, ladies and gentlemen, it's good to see you, and some of you again. Thanks for the work you are doing. Thanks for the invitation, actually. I think just being here with Phil and Cheryl has made my day. I'm going to take advantage of all of Cheryl's work and continue to leverage Phil's connections to help us improve how we....
Voices: Oh, oh!
LGen (Ret'd) Stuart Beare: That piece of business is now done.
I'm here representing the experiences of Soldiers Helping Soldiers as it relates to this phenomenon, not to speak entirely on behalf of all the experiences of those in it. For those who have not heard of or met Soldiers Helping Soldiers before, here is a very brief who we are and what we do. We are an organization of volunteers that aids in recognizing and connecting with veterans on the street. We identify them. We connect with them. I loved Cheryl's description of how that cultural and military reconnection is so important to so many. We connect with them on a personal level and then facilitate their connection and interconnectedness with those who can help them. It's very much that “walking beside” mission as opposed to “delivering the service” mission, and allowing those who are experts at delivering the services to be accessible to them so they can get the services they require. Fundamentally that's who we are and what we seek to do.
It's all volunteer work, including by serving members of the Canadian Forces who have permission to work with us as volunteers in uniform, helping to bring the uniform into that ecosystem. Veterans as well as citizens at large work within that diverse ecosystem that Phil and Cheryl described.
We have six years of experience in Ottawa. This year we will be expanding into Montreal and Vancouver, once we establish the conditions for an all-volunteer organization to find all the volunteers it needs.
We incorporated as a not-for-profit in late 2017. We are looking forward to working with other partners in this space.
What I'd like to offer, really, is just five observations, if you will, about the nature of homelessness and the dynamics that are the most useful and relevant to apply to finding and connecting with veterans and facilitating the connection of veterans to those who can help them.
The first one is that the numbers, the diversity and the geographies of homeless veterans are way larger and in way more places than we would have imagined. When I first heard the words “homeless veteran” six or eight years ago, I said, “There can't be that many.” I had to be educated as to how many more there were than I ever would have imagined, and how many more different places they are in than I would have imagined, and how different they are from their peers, if I can use that language, others who live through homelessness. Gender, age, diversity, geography—we need to continue to unpack those, and the work that Cheryl and others are doing to do that is incredible.
Second is that vets don't necessarily see themselves as veterans. The word itself can unintentionally limit someone's ability to self-identify and/or accept the help that may be due to them. The question or the language, if you will, that resonates with finding and connecting with them is less the language of the institution and bureaucracy, the “Are you a veteran?” than it is “Did you wear a uniform? Have you served?” The mental model within which we relate to each other is an important part of that as well.
Third, it takes a village. When prevention fails, the finding, connecting and recovery are not one thing; they're many things. It's not a person; it's many persons. It's not a relationship; it's many. It really is a potpourri. You can just imagine, if you walk through downtown Ottawa or your own hometowns and see all the folks involved in finding, serving the homeless, and trying to help them recover, that they are incredibly diverse. It does take that entire village, including all the functions they provide to help someone recover. Within that, case management is a significant challenge. I don't mean the case management of a person as it relates to a service provider. It's a question of how you design the journey for that individual through all those different service providers and walk with them on that journey. It does take a village.
The last point, if I may, is that it's a whole-of-community effort. It's creating platforms, and as Phil described, getting the community of those who care and those who are doing together to get to know each other better and to collaborate more naturally as opposed to compelling that collaboration. Inviting the collaboration and creating the opportunities for that collaboration is very powerful. I think you may have heard, if they haven't spoken to you already, of an initiative called the Respect Forum, which is actually in operation now. It is seeking to do that by bringing together at the community level all those who are engaged with veterans in distress—for mental health issues, homelessness and the like. Bringing community together is very much encouraged.
To conclude, a difference can be made and is being made, and clearly more can be made. It's gratifying for me to be involved. I see how gratifying it is for anyone who's involved at the street level and working with the individual veterans and their partners. It makes a difference not just in the veteran's life, but also in our own.
Thanks, all of you. I'm very familiar with your fantastic work. It's appreciated by all parliamentarians and all veterans and serving members.
General, it's great to see you retiring and still serving those who serve. Please give my best to Victoria Ryan, who started your charity. I went to RMC with her. At that time, her name was Victoria Cross, which I thought was the best military name ever.
Voices: Oh, oh!
Hon. Erin O'Toole: Her father was a chief, and when she got married, she lost that unique name—V.C. Give her my best.
The real challenge here, and I know you have a couple of former ministers in the room, and the gap or the seam that we've started dealing with—and this government has cross-appointed ministers—is the problem here with transition from the Canadian Armed Forces, from that homogenous group, culture and service provider, into health care, housing and a whole range of things, sometimes back in provinces that those members have not been in since they enrolled.
That, I think, means that partnerships have to be core to this, and partnerships not just with provinces, but with groups and providers that are uniquely suited to veterans.
Phil, I think you mentioned partnerships being key.
I'd like your thoughts here, because addiction is key as well. I hear constant complaints from veterans about Homewood in Guelph, in particular because it's not uniquely serving veterans and first responders. In fact, sometimes their first response is, “I'm surrounded by people who are lawbreakers, not peacemakers.” Do you know what I mean? They just do not fit in there.
What proposals do you have? I'd love to hear from you on the addiction piece. I think there should be a veteran-specific one regionally, or partnerships.
On the housing piece, I agree that the single-use site does not fit all needs. What partnerships here do you see, whether they're with the Legion or others? I think that has to be immediate, because housing comes up all the time, but how can we really tailor to quickly address the needs?
I'll just put that out generally.
I'll take a couple of quick angles.
It was ironic they had Sue Ray come in on PTSD, and it wasn't what we found. That's one of the reasons we went to 50, because we kept looking for it and thinking we had some kind of sampling error we weren't finding.
I started my career working in addictions and alcoholism. One of the best things about addiction and alcoholism is it often takes a decade of heavy drinking to get to the point of physical withdrawal from addiction. There's a huge trajectory, a huge opportunity for intervention and prevention.
One thing we suggested in the report that Sue Ray and I did when we found this is as people are being released, a lot of 10-item screeners can be done on substance use. There's a lot of assessment around looking for PTSD. I think we need to be assessing at the point of a person leaving the service because you have a really long intervention period to prevent a problem and to deal with it. I think we'll probably hear a lot more from the others around other specific transition supports.
Some addiction counselling does occur through our OSI clinics, and we did partner with them. That's often where people would receive service. But in a lot of our discussions in the focus groups that we had throughout, which were phenomenal, part of that disconnect of cultures...is that one of the best practices around addressing addiction is harm reduction because you go at your own pace. You aren't required to have sobriety. They felt internally as well within organizations, it was a real conflict with military culture, the idea that if you're given an order not to drink, you should just be able to stop drinking, end of story. I heard this over and over again. Although they wanted something specific for veterans, it was one of the reasons they felt there might be more conflict if it was totally run by those organizations. The idea of harm reduction strategies, which came up over and over again as the main way they needed to get out of addiction, ran so counterintuitively to military culture. You're given an order, you should just stop drinking.
I'll give you two brief examples, both involving vodka.
One of the veterans in one of the sites had been on the street for 20 years only drinking non-palatable alcohol. I don't know how the person was alive. When I first met him at one of the first focus groups, his goal was to only drink vodka. I asked why vodka after all this? He said it's expensive, it will limit how much he can drink, and that's his goal. A year later he'd only drunk vodka, now he was ready to quit.
In a different city we had another situation with vodka, which is ironic, but it illustrates what we're talking about with harm reduction. So for him, imagine 20 years on the street and to just tell him to give up alcohol. That would be ridiculous. Twenty years on the street with non-palatable alcohol, he can't just suddenly stop. The other example was—
We heard from Sergeant William Webb, who testified at our last committee meeting. He's from Vancouver Island. He's a veteran who has a family, and he talked about the challenges of finding support, especially for veterans for family members.
Sorry, I didn't even thank you for your service and the work you do, because you do great work, especially in our region. I appreciate that.
Captain Ralph, I certainly see a lot of your team, the Wounded Warriors, on Vancouver Island.
Your organizations are doing really important work.
Sergeant Webb cited that lack of support for families.
There's Cockrell House in Victoria. They are really making a difference. They're at 100% capacity. They need three of those facilities at least. None of them are designed for people with young children.
In terms of the number of spaces, I have two bases in my riding: the Nanoose naval base and CFB Comox. We have a large number of veterans retiring in our area. We've seen housing skyrocket 50% just in the last three years, so already we have a homeless problem. We have veterans who want to be located close to their comrades to be part of that military family.
Housing prices are huge, and there's no strategy around housing veterans. There's no federal component that in the national housing strategy really deals with it.
We've heard about a project here in Ottawa. Their challenge was that they could get one-third of the funding from the federal government, but they couldn't get the matching funds from the province and the municipality. They were pushing back, saying it is a federal responsibility, just like indigenous housing.
I want to get your feedback and thoughts on that, because we are seeing huge challenges, and not just urban ones. I'm really glad, Dr. Forchuk, that you talked about some of the rural challenges, because they're real.
In terms of funding, do you see the federal government creating more funding, and should it be dedicated funding just for veterans and housing?
General, I'll start with you.