Good afternoon, Mr. Chair, vice-chairs, members of the committee, ladies and gentlemen. As mentioned, I am Michel Doiron, assistant deputy minister of service delivery at Veterans Affairs Canada. With me today is our chief medical officer and director general of health professionals, Dr. Cyd Courchesne. As you may recall, Dr. Courchesne oversees the VAC team of health professionals.
It is our pleasure to be here this afternoon to talk about mental health supports and transitional services for the CAF, RCMP, and family members. This is very timely given that last week members of the Veterans Affairs Canada team participated in the 2016 Military and Veteran Health Research Forum in Vancouver, British Columbia. I believe some of the members attended as well. The forum was co-hosted by the Canadian Institute for Military and Veteran Health Research, or CIMVHR; the University of British Columbia; and the University of Victoria.
The annual conference is a key event for sharing knowledge among our researchers. This year attendees explored a variety of research topics related to the health of military members, veterans, families, and first responders, with presentations by leading Canadian and international researchers and experts. Themes included mental, physical, and social well-being; advances in trauma care; health technologies; the transition to civilian life; occupational health care; care ethics; and gender differences in health.
As mentioned, I'm aware that some of the members did attend the forum. I encourage members to attend when possible, because it is a very good sharing of information.
Much has happened since my last appearance in April, and I was here with you on Tuesday.
As of November 2016, Veterans Affairs Canada has hired more than 300 new frontline employees to ensure veterans and their families have the support they need, when and where they need it.
We have also hired additional case managers—to better support and serve veterans and their families and help veterans navigate a successful transition to civilian life. With the new staffing levels, case managers will serve, on average, 25 individuals each.
We have successfully implemented the increase to the earnings loss benefit from 75% to 90% of a member's pre-release salary. The earnings loss benefit supports a veteran financially as he or she undergoes physical rehabilitation, vocational retraining, and counselling, giving them peace of mind financially as they work towards physical and mental well-being. The goal, of course, is to ensure that military personnel have the support in place for an optimal transition to civilian life and that veterans and their families know they have ongoing resources to help them overcome life challenges.
A large part of our focus is on mental well-being. Veterans Affairs Canada is committed to ensuring eligible veterans, retired Royal Canadian Mounted Police members, and their families have the mental health support they need, when and where they need it.
I am proud of the wide range of mental health services, supports, and information VAC provides to veterans and their families. The document you were provided with earlier, which was also shared with our stakeholders at the last stakeholders summit, lists VAC's mental health services, supports, and information.
In particular, Veterans Affairs funds a network of 11 operational stress injury, or OSI, clinics across the country, 10 outpatient and one in-patient as well as satellite clinic service sites closer to where the veteran lives. I think some of you have visited some of our OSI clinics. These clinics are complemented by the Canadian Armed Forces network of seven operational trauma and stress support centres that mainly serve still-serving military personnel. This network continues to grow. More OSI clinic service sites will open across the country.
Each OSI clinic has a team of psychiatrists, psychologists, social workers, mental health nurses, and other specialized clinicians who understand the experience and unique needs of veterans. To further improve accessibility, each OSI clinic provides services through telehealth, or distance health services, to support those living in remote areas.
Our clinics also are using specialized software, called the “client-reported outcome measuring information system”, or CROMIS, that has been developed and implemented within these clinics. This system is used to track veterans' mental health outcomes by ensuring timely access to psychological and psychiatric assessment and treatment. CROMIS speaks to how well a given veteran is actually responding to the treatment. It tracks and reports client-reported emotional distress and satisfaction with social and vocational function on a week-by-week, session-by-session basis. When used in accordance with published guidelines, it significantly improves clinicians’ ability to identify those at risk of deterioration and/or premature termination and also to significantly improve outcomes.
We also have a well-established national network of around 4,000 mental health professionals who deliver mental health services to veterans with post-traumatic stress disorder and other operational stress injuries.
Our Veterans Affairs Canada assistance service offers a 24-hour toll-free help line, short-term face-to-face mental health counselling and referral services, to military and RCMP Veterans, and their families.
The operational stress injury social support, or OSISS, program offers confidential peer support to CAF members, veterans, and their families impacted by an operational stress injury. The support is provided by trained peer support and family peer support coordinators who typically have first-hand experience with these injuries.
We have collaborated with a number of partners in developing a series of free online and mobile applications that can be used by veterans and their families. PTSD Coach Canada and OSI Connect are mobile apps that provide valuable information to CAF members, veterans, and their families impacted by an OSI. The operational stress injury resource for caregivers is a self-directed online tool for caregivers and families of CAF members and veterans living with an OSI. It provides self-care, problem-solving, and stress management techniques for managing the challenges of being a caregiver. “Veterans and Mental Health” is an online tutorial designed for anyone who is wanting to learn about service-related veteran mental health issues or who is supporting a loved one with a service-related mental illness.
Medically released veterans and their families have access to seven military family resource centres, or MFRCs, across the country, as well as the family helpline and familyforce.ca website as part of the veteran family program. This program is part of a four-year pilot to provide veterans and their families with access to the MFRC supports and programs, traditionally only available to still-serving members of the Canadian Armed Forces.
The Government of Canada has launched a Canadian veteran-specific version of the mental health first aid in partnership with the Mental Health Commission of Canada. This program provides mental health literacy training for veterans in the community.
The government is also providing funding for the Mood Disorders Society of Canada to provide skills development training and support services to unemployed veterans with mental health conditions, to assist them in establishing a new career.
A partnership between VAC and Saint Elizabeth Health Care has also recently been established to design, develop, and deliver, in the summer of 2017, an online caregiver training program to support informal caregivers of veterans with an OSI.
Naturally, we continue to collaborate with the Department of National Defence to create two new centres of excellence in veterans care, including one with specialization in mental health, post-traumatic stress, and related issues. We're also collaborating with our partners at DND to develop a joint suicide prevention strategy for Canadian Armed Forces and our veterans.
These mental health services and supports are examples of how VAC is delivering on the commitment of care, compassion, and respect for our men and women who have served their country, and their families.
Thank you again for the opportunity to address the committee. Dr. Courchesne and I look forward to your questions.
Merci. Thank you.
Thank you for the question, Mr. Chair.
First and foremost, under the various acts, Veterans Affairs is for the veteran. Most of our services, disability awards or pensions and things like that, are aimed at the veteran. That said, we strongly encourage family members to attend the OSI sessions, peer support, and various other programs. It's been proven that having the family involved in treating the illness usually works better.
The other thing we've learned is that often the member may say they're doing okay, but the family member may not be quite in agreement with the diagnosis of the member.
However, that being said, there is a full range of services that we provide to the family, without going through the veteran. As an example, the 1-800 phone number is 24/7. A family member, a child, or a veteran may call there and get help online immediately and/or, depending on the severity of the situation, be referred to a psychologist or a mental health care provider for up to 20 sessions. Veterans Affairs pays for this, regardless of whether it's service related or not service related, or whether the veteran is a client. A lot of the apps I just mentioned are available to family members.
As we're advancing in our program, we are looking at how to have better programs for families. We have the family caregiver program, but again that is through the members themselves to help the caregiving side.
Thank you, Mr. Chair, for the question.
It is true that our system is hard to navigate. There are a lot of policies, programs, and processes. There are a couple of things we are doing to address that.
The first thing we've undertaken is something called the service delivery review, which is looking at how we can simplify our processes and improve transition, because it is a mandate of the minister, as associate minister of National Defence, to eliminate that seam to the extent we can. However, more concretely, what we are doing, and we're piloting it right now, is looking at something we're calling “guided support”, but I like your term of “navigator”.
What we're realizing is that when a soldier gets ready to release, they don't know our programs. They may start talking to a military case manager and they may start talking to one of our case managers, but they don't know the programs. This guided support would be meeting with a Veterans Affairs employee during transition, and that employee would go through their entire file, what we think they're entitled to, and even trying to get the cases adjudicated before they're release from the armed forces.
It does not mean they would not come back five, 10, or 50 years later. We have people who show up 50 years after release, but at least if you're moving to a certain part of the country and you have special needs and maybe you'd have a hard time receiving the specialized medical help you need, you would know if you eligible for a disability or what type of employment opportunities there are. That's why we're calling it “guided support” or the “navigator”. It's to get them better suited for transition, because we know that 27% of the people transitioning have a hard time. Most of them transition well, but 27% do not.
The reason we're concentrating on this is that we've concentrated a lot on the medically releasing individuals. We've been doing a lot of work in transition in eliminating the seam for the medically releasing individuals. We just realized, because our researchers had done some work on it, that of that 27%, 60% are actually non-medically released people who are having a hard time. We've been concentrating on the medically releasing, and now we have to make sure we're taking care of the non-medically.
Most of them want to be released with their head high, no stigma, but then they realize when they get into the Canadian population, it's a little different.
I will talk about the transition to civilian life.
We work closely with Canadian Forces health professionals to facilitate the transition of members to civilian life. Whether the person has been with the Canadian Forces for two years or 35, when a member has a mental or physical health problem, we are contacted.
The Canadian Forces would of course like to allow the member to continue serving. Their first goal is to reintegrate or retrain that person, because training a soldier is expensive. Regardless of the person's occupation, it is a major investment. The Canadian Forces invest a great deal in their personnel.
Once it has been determined that the member cannot be reintegrated into their unit, we are contacted and we work closely with the member to provide guided support. We have to assist the member and support them throughout the process. This person's goal in life, their career, is to be a member of the Canadian Forces. As a result of psychological or physical injury in combat—there are different kinds of injuries—from one day to the next, the person can no longer be a member of the Canadian Forces. That is traumatic. Suddenly the person has a lot of forms to fill out and has to make some decisions. In addition, their mental health may be suffering. At that point, we work closely with the Canadian Forces to facilitate the member's transition to civilian life. The guided support is a way of working even more closely with that person.
The changes proposed by the committee in the last session have allowed us to intervene much earlier in the process. Thank you for that. Under the previous act, our responsibilities began the day that the member was no longer in uniform. We still work with the Canadian Forces, but as a result of the changes proposed by this committee, we can play a more effective role in this process.
My deputy minister always says not to say six months, but often we become involved from six months to a year before the person leaves the military, working with Canadian Forces health professionals. We work as a team to ensure a smooth transition.
Thank you for the question.
We use the information that's available. I want to be very clear that our researchers.... Dr. Pedlar may have appeared in front of you at one point. He was on a scholarship to work on mental health and health of veterans. His group leads a lot of research. We read what the other groups are doing and we talk to them.
I was in England three weeks ago talking to their veterans affairs organization. It was interesting, London was mentioned, even in England. No pun intended, I just realized what I said...London, Ontario. We do read what's going on. The other thing we have to make sure is that, often we say “research”, but it's not just having a dog, because some people out there may try to give you a dog that is not well trained.
Mr. Cousineau, as an example, has an excellent dog, very well trained, top-notch. I've met Medric, and his dog is top class. But you have to make sure that the tool—the dog, the horse, or the program—is going to help the veteran. We recognize dogs, but that dog must be well trained and trained for what it is supposed to do. It's not just somebody working somewhere who says, I can.... A lot of the work we're doing right now is certification. It's not necessarily studying the dog.
For some of the other stuff that people say helps, anecdotally they say it helps, but where's the evidence? Where are the clinical trial? Does it work for any case? What cases does it work for?
I look forward to your report on service delivery. I'm not sure when it will be tabled, but I do look forward to it. The last time ACVA tabled a report, there was stuff that we did use and it was very useful, so I'm looking forward to it.
For sure it is known, not just with suicide but in treating mental health in general, that the faster we can get them into treatment, the faster we can get them the care they need and the better it is for the individual. It's probably true for all illnesses. With any delays in approvals or getting them into treatment, there's an impact. That's why we're working so hard on the service delivery review that the department has been doing, but also on how to modernize our systems, get more stuff online—eliminating some of the bureaucracy is maybe the best word to use—to move it forward.
Understanding that we are governed by a multitude of acts and regulations that are laws, I can't just decide that I'm going to do X. There's a law that I have to comply with. That said, we are doing some work on that. The health care provisions are one we're starting to look into, and the financial benefit suite that we have. At the end of the day, where we're trying to go, and we've really undertaken this in the last little bit, is focusing on the veteran's well-being. You'll hear a lot about veteran-centricity, veteran-centric not program-centric, and not just making sure all the boxes in the system are.... What does the veteran need, when, and how? Let's get to it and let's get them trained.
Unfortunately, we're still heavy on the administration, and I don't mean staff when I say that, please. I mean the documentation and some of the stuff that we need to do, and sometimes it's to comply with acts. People like to say, that's what the act says. I am not a lawyer. I've been in the public service a long time, so I ask them to show me in the act where it says that. Often, over time, and this is my eighth department, people start adding requirements because of one bad apple somewhere throughout the years, and all of a sudden that becomes the policy.
Let's eliminate that policy, and our and deputy minister have really challenged the department to get rid of these areas, ensuring though that we don't break laws and we follow what we're supposed to. We have to or the OAG will come in and give recommendations, but let's take care of our veterans. The bottom line is care, compassion, and respect, and not just saying those words but getting them there.
In mental health, with 16 weeks, okay, I'm meeting my service standard but it's a long time to get your diagnosis and treatment. We know that and we're trying to do that much faster. For some other stuff, maybe it's acceptable.
Absolutely. We are piloting one right now in the Montreal office, and we'll see how it works. When they send documentation, they make a phone call to ask five days later if they have received their documentation. We're trying to facilitate, make readable, I guess, the letters we're sending out, to make sure that the veterans understand the content. We're trying to use a language that is understandable, not jargon.
We have to be careful, though. Right now our first application approval rate is 84%, so a lot of people are being approved for what they come in for, but 16% is still not being approved yet. We are working on that. We're looking at how we can make this.... In the adjudications, I have a team who now calls the veteran before sending the letter to say no. They will call and say that based on the information we have, it doesn't look favourable. Is there anything you can add to the file that may help us make a favourable decision?
There are some exceptions. We had somebody claim that we addicted them to cocaine when they were in Afghanistan, and we should pay. When we get a claim like that, we're not going to make the phone call. I apologize. We're going to deal with him in a different way, and this is an actual case. But they call and ask if the veteran is okay, and can something more be provided, because if the veteran doesn't provide anything more, then that's their file.
A lot of that is being done, but we are trying to put a much more human, personal touch, and that's the care, compassion, and respect.
Sometimes the answer is no. Let's be honest. It's not service related. There will always be those letters that say no, but let's do it in a way that is not traumatic for the veteran.
We're finalizing one that we're going to start implementing probably in January or February. It's the service delivery review, which is looking at the journey of a veteran in our process. We've done journey mapping, and some of that stuff, to see.... They've looked at 400 veterans, actual cases, and mapped what happened.
It's not always nice in the sense that the service was done, but there are a lot of touchpoints, a lot of letters sent, and a lot of medical exams needed. We're going to be looking to eliminate some of this, to make it simpler. That's the service delivery review. We're also looking at stuff to make our forms easier. It's very practical stuff.
The other review that the associate deputy minister is going to embark on in the very near future is what we're calling a functional review. I think the meeting was called for tomorrow but it may be next week now. As I mentioned earlier, we're noticing the policies. Often there are departmental policies that are not law or regulations, so it's about how we can remove these layers of policies that have morphed.
Veterans Affairs is a very old department. The deputy minister likes to call our legislation and our policies a quilt. I think that's a very good picture of our stuff. Governments add programs or change things, but there are all these rules and regulations that we have to follow. How can we remove the internal policies that have been put in place over time that are not in law and are not in regulations and simplify that?
There are 741 internal regulations and policies, and I stand to be corrected on the exact number. They're not legal. We're going to be embarking on figuring out which ones don't make sense and eliminating them to try to save time, process, and documentation, and advance this. This is ongoing.
We are serious about trying to simplify this. In my mind, I keep thinking about TurboTax, and it may be a plug for a company here. I use TurboTax to do my income tax. I would love to have TurboVAC. I'm very serious about it, because you can go on the web, assuming you're web literate, and if you're not, we'll take care of you, but it won't ask you to fill out 25 forms. It'll ask if you served, yes or no, and you can put out some stuff and our system would populate it.
We are not there, but I had a veteran talk to me the other day who said it was the first time he had a VAC form sent to him that was completed. We put all the information on the form, and he just had to confirm and send it back to us. We're going down that road.
First of all, we've hired over 300 new individuals based on budget 2015 and 2016. All these individuals are going through an intensive training program, which is all about care, compassion, and respect. They are going out into the offices across the country with the new philosophies. Come April 1, we're going to bring in our more experienced people and put them through, not quite the same training because they have the expertise, but to make sure they know the new concepts.
For the service delivery branch, for my branch, my directors general and my executives are all tasked to get out to a field office on a very regular basis. Our head office is in Charlottetown, as opposed to other departments, but if you're always in the ivory tower and you never make it to the front line, or to the train yard, you don't really know what's happening on that front line.
It caught me by surprise when a person in a certain position said he went with a deputy to an office, and it was the first time in x number of years he'd been to a field office. I was thinking to myself, how do you know what's going on?
I feel it every day.... I field the complaints—not just feel, but field—but it's important that everybody does. Our deputy—you've met him, he was here Tuesday—and the associate deputy minister go to offices, and the deputy probably hits an office every couple of weeks, a bit less now because of his operation. When he comes back, he goes to the senior management table and tells them what he heard and saw.
It's being brought into the entire organization, because care, compassion, and respect has to be believed and lived at all levels of the organization. The staff are living it. I live it every day. The doctor here lives it every day, but we have to ensure the entire department understands it.