I'll begin the opening remarks and turn to my colleague to complete them.
Thank you very much, Mr. Chair, for the opportunity to speak to you about this very important topic.
As noted, my name is Faith McIntyre, and I'm the Director General of Policy and Research.
Veteran homelessness is unacceptable in Canada, and one homeless veteran is one too many. A picture of homeless veterans is not easily available. According to Employment and Social Development Canada's coordinated point-in-time counts, which were carried out on a specific date in the early spring of 2016, in 31 different locations across the country, veterans accounted for nearly 5% of all homeless Canadians. An additional similar study regarding point in time was conducted in the spring of 2018, and we are still awaiting the results.
Veterans, similar to the general population, become homeless as a result of complex and interrelated issues, for example, health status, personal problems such as family breakdown or violence, employment instability, poverty, lack of affordable housing, and addiction. However, what sets veterans apart from the general homeless population is their transition from military life to a civilian culture and a civilian world.
We find that many veterans have experienced traumatic and dangerous situations as a result of their military service and often struggle with the after-effects of these experiences. As well, we find that homeless veterans tend to become homeless much later in their lives, quite a while after their release.
A 2013 Canadian Forces mental health survey identified that one in six regular Canadian Armed Forces members identified symptoms of at least one of the following mental health conditions in the past 12 months: depression, panic disorder, PTSD, general anxiety disorder, and alcohol abuse or dependence.
The Veterans Affairs Canada life after service studies identified that approximately one-quarter of veterans released from the military since 1998 have experienced a difficult transition.
As the federal department responsible for veterans' well-being, we have the lead to ensure a whole-of-government approach is taken to address veteran homelessness, and this is a top priority for us. The effort must be a collaborative one. It takes the whole community to support the well-being of veterans and their families. The key to making progress will be in continuing to forge strong partnerships with a variety of organizations that are equally as passionate and charged with this issue.
On June 7, 2018, Veterans Affairs Canada hosted a round table on homelessness in Ottawa, which included over 70 participants from 65 national and regional organizations. The participants were all identified as subject matter experts in the area of homelessness, particularly focusing on veterans. As a result of this round table, an interactive map has been developed and is live on our external website. It identifies resources across the country that can provide supports to homeless veterans.
We are working on Coming Home, Veterans Affairs Canada's strategy to prevent and end veteran homelessness. This strategy proposes a number of objectives that will ensure that Canada's homeless veterans receive the support they need to achieve housing stability and well-being, and assist in reducing the likelihood of veterans from ever being homeless.
Veterans Affairs Canada, along with the Canadian Armed Forces and other government and community partners, are working closely to ensure that finding homeless veterans becomes easier. Our proposed homelessness approach is broken down into four themes: lead and engage, by improving collaboration and leadership; find, by improving outreach and identification; assist, by improving mechanisms to assist homeless veterans; and prevent, through optimizing veteran well-being.
Several initiatives are already under way. For example, the return of the veteran's service card was recently announced. This will allow veterans to more easily be identified and to feel a greater sense of community.
In addition, we have developed a new homeless veteran poster, which will be distributed to over 2,000 areas within Canada.
We are also partnering on improving the military-to-civilian transition mechanism to ensure a successful transition to civilian life by bridging members releasing from the Canadian Armed Forces to the support they require.
In budget 2017, Veterans Affairs Canada established the veterans emergency fund, along with the veteran and family well-being fund.
The veterans emergency fund provides emergency financial support to veterans, their families and their survivors whose well-being is at risk due to an urgent and unexpected situation. More than 450 veterans have already benefited from this program.
As announced earlier this month, Veterans Affairs Canada has chosen 21 organizations out of 155 applicants to the veteran and family well-being fund, awarding a total of $3 million.
Of the 21 organizations selected for the fund, three have specifically identified their projects to assist homeless veterans.
The three organizations are Veterans Emergency Transition Services Canada, or VETS Canada, the Respect Campaign and the Old Brewery Mission. Other organizations among the 21 are indirectly involved but will still take positive steps to support homeless veterans.
We are excited to work with these great organizations to improve the state of veteran homelessness in Canada.
I will now ask my colleague Robert Tomljenovic, who has joined you by teleconference as indicated by the chair, to speak to you about what is being done in the area offices.
Good afternoon, Mr. Chairman and members of the committee. Again, I apologize for the technical difficulties this afternoon.
My name is Robert Tomljenovic and I'm the Area Director for the southwestern Ontario area at Veterans Affairs Canada. I am responsible for about 100 employees located in five area offices and service locations and three integrated personnel support centres, or IPSCs, serving over 12,120 veterans living in the area.
I would like to thank you for the invitation to appear before the committee. I'm happy to be here with Faith to provide more details about our work to prevent and address veteran homelessness on the ground.
As you know, homelessness can result from a magnitude of life situations that an individual may experience. Research indicates that veterans, like the general population, become homeless as a result of complex and interrelated issues such as health status, personal problems, employment instability, poverty, lack of affordable housing, addiction issues and others.
However, veterans are unique from the rest of the population in that their experience within the military may have significantly contributed to the factors that led them into homelessness. Some veterans have faced extreme situations such as combat, injuries, high levels of stress, and long absences from families, home and supports.
The goal for us, as the front-line team for Veterans Affairs, is to create an increased awareness with our community partners to help identify homeless veterans. To do so we have adopted a few strategies.
Our case managers and other VAC staff work with a number of community organizations to identify homeless veterans in the local areas via a number of outreach initiatives, such as reaching out to local shelters and first responders and engaging in community activities geared towards assisting the homeless population.
Veterans Affairs Canada has 38 office sites across the country, and our staff within each location is working with veterans who are homeless or at risk of becoming homeless, and with local homeless organizations and service providers.
We also work closely with the Canadian Armed Forces to improve the transition of members from military to civilian life. Early intervention is one of the most critical components of a successful transition process and can prevent difficulties that may result in homelessness.
As Faith mentioned, since April 1, 2018, we also have the veterans emergency fund which allows us to attend to immediate financial distress as quickly as possible at any time of the day—evenings, nights and weekends.
We have veterans service agents across the country available on call. These VSAs have been trained on how to apply the veterans emergency fund and they have access to subject matter experts to help them with any complex cases.
We understand the needs of veterans in Calgary can differ from those in Halifax. We must be flexible and nimble to adjust to the needs of the person and the community.
VAC is the catalyst to bring key partners and stakeholders together, such as VETS Canada, the Royal Canadian Legion, Soldiers Helping Soldiers, Veterans Helping Veterans, Aboriginal Veterans Autochtones, and other organizations focused on the issue.
Continued discussion and dialogue among all of our organizations is an essential part of the way forward to preventing and ending veteran homelessness.
Thank you again for the invitation to speak to you today.
Good afternoon, Mr. Chair, vice-chairs and members of the committee. I'm Dr. Cyd Courchesne, Director General of Health Professionals and Chief Medical Officer at Veterans Affairs Canada. I'm pleased to be here today with my colleague, Dr. Alexandra Heber, our chief psychiatrist.
We would like to thank you for the invitation to appear before the committee in regard to your study on the implications of veterans' mental health as it relates to medical cannabis through the medical cannabis program administered by Veterans Affairs Canada.
We will briefly touch on the reimbursement program for cannabis for medical purposes at Veterans Affairs Canada, the data on program uptake, the approvals process for reimbursement exceeding three grams per day and the most recent research data available to the department.
Veterans Affairs Canada's mandate is to provide exemplary, client-centred services and benefits that respond to the needs of veterans and their families, as well as its other clients, so as to recognize their service to Canada and keep the memory of their achievements and sacrifices alive for all Canadians.
Our goal is for veterans and their families to receive the care and support they need.
In 1999, legal access to possess dried marijuana for medical purposes was first approved. Since then, as a result of many court decisions, the way individuals access cannabis for medical purposes has changed significantly. Veterans Affairs Canada has provided coverage for the cost of cannabis for medical purposes since 2008.
Between 2008 and 2014, reimbursement was based on section 4 of the veterans health care regulations and in accordance with Health Canada's marijuana medical access regulations. The marijuana medical access regulations, implemented in 2001, provided limited access to marijuana for medical purposes for a number of conditions and circumstances as defined by Health Canada when authorized by specialists only.
In April 2014, Health Canada introduced the marijuana for medical purposes regulations, which removed limitations related to the authorization for specific conditions, and the requirement for authorization by a specialist was changed to a medical authorization.
It also provided individuals with a medical need to access quality-controlled dried marijuana produced under secure and sanitary conditions by licensed producers. In June 2015, licensed producers were permitted to produce and sell cannabis oil and fresh marijuana buds and leaves in addition to dried marijuana.
In August 2016, Health Canada's access to cannabis for medical purposes regulations were introduced, which set out provisions for individuals to grow a limited amount of cannabis for their own medical purposes, or to designate someone to produce it for them.
While cannabis for medical purposes is still not an approved therapeutic drug in Canada, the access to it continues to grow. With the advent of these new regulations, Veterans Affairs Canada subsequently experienced a significant increase in requests for cannabis for medical purposes reimbursement.
In its spring 2016 report, the Office of the Auditor General recommended that Veterans Affairs Canada improve the management of its drug benefits program to consider the health and well-being of veterans, as well as cost containment.
As a result, the department conducted an internal review, which involved consultation with medical professionals, subject matter experts, licensed providers and veteran beneficiaries. The result of this review led to the implementation of Veterans Affairs Canada's reimbursement policy for cannabis for medical purposes on November 22, 2016.
The 2016 policy allows eligible veterans to be reimbursed for a maximum of three grams per day of dried cannabis, or its equivalent in cannabis oil, and fresh cannabis at a fixed rate per gram.
The decision to reimburse for three grams per day is based on data obtained through consultations and research. Veterans Affairs Canada brought together a panel of Canadian medical experts, who recommended a very cautious approach to the use of cannabis for medical purposes, with some indicating one to two grams per day was a reasonable amount for the vast majority of cases.
Veterans Affairs Canada also reviewed current scientific evidence and consulted with veterans, stakeholders and licensed producers. The decision is also consistent with Health Canada data, which indicate that the average Canadian is authorized less than three grams per day.
The approval process to obtain a reimbursement from Veterans Affairs Canada for cannabis for medical purposes requires that veterans have an authorization from a medical practitioner, and that they be registered with a licensed producer from Health Canada's website. The documentation is received by Medavie Blue Cross, which sends it to Veterans Affairs Canada for a decision. Medavie Blue Cross sends the decision letter to the veteran on behalf of Veterans Affairs Canada.
To ensure greater rigour in the department's approach, a process for approving exceptional requests was put in place in November 2016, when the policy was introduced.
While reimbursement requests for up to three grams per day require a medical authorization document from a general practitioner, or a nurse practitioner in some provinces, requests for more than three grams per day may be approved only when supported by additional documentation from a medical specialist with expertise in the veteran's diagnosed condition. For example, if the veteran is eligible for treatment benefits associated with a mental health condition, the specialist's document would be provided by a psychiatrist. For pain due to cancer, an oncologist could provide the supporting document.
Each exceptional claim is reviewed on a case-by-case basis. The medical specialist's supporting document must include a rationale for the use of more than three grams per day, confirmation that there are no contraindications when using cannabis for medical purposes, and an indication that alternative treatments have been ineffective or contraindicated.
Similar to other treatment benefits reimbursed by Veterans Affairs Canada, the exceptional approvals process is a mechanism to help ensure the health and well-being of the veteran remains at the forefront of any decision.
Veterans Affairs Canada reimburses only for medical treatments authorized by the veteran's physician or health care practitioner. The department does not prescribe medical treatment.
VAC considers the veteran's own physician to be in the best position to identify and authorize the most appropriate treatment to address the patient's health condition.
In 2017-18, a total of 7,298 veterans were reimbursed for medical cannabis, at a cost of approximately $51 million. While the number of veterans seeking reimbursement continues to rise, the cost per veteran has decreased.
An analysis of expenditure data for the nine-month period between April 1 and December 31, 2017 revealed expenditures of $39 million. Had the 2016 reimbursement policy for cannabis for medical purposes not been in place, it is estimated that costs would have been $91 million for the same period, indicative of a potential cost savings of $52 million. This meets the Auditor General's recommendation to contain costs, while ensuring the health and well-being of veterans.
A comparison between December 2016 and December 2017 provides further evidence of the policy's impact. In December 2016, Veterans Affairs Canada reimbursed an average of 155 grams per eligible veteran, at an average cost of $11.28 per gram. In contrast, in December 2017, reimbursements declined to an average of 89 grams, at an average cost of $8.38 per gram.
On December 31, 2017, approximately one year after the reimbursement policy was implemented, of the 6,119 veterans with active medical authorizations from their health care professionals, only 734 veterans, or 12%, had exceptional approvals in place. This is in sharp contrast to the previous year.
On December 31, 2016, a total of 2,771 veterans, or 66% of all recipients, were authorized for more than three grams per day. This decline in the number of veterans requesting reimbursement for over three grams per day is also in line with Veterans Affairs Canada's focus on supporting the health and well-being of veterans and their families.
On August 31, 2018, a total of 8,175 veterans were being reimbursed for medical cannabis, for a total expenditure of $29.7 million.
On October 17, 2018, the Government of Canada’s new Cannabis Act and cannabis regulations came into effect, providing legal access to cannabis for Canadians. The act and regulations also control and regulate the production, distribution and sale of recreational cannabis and cannabis for medical purposes.
To coincide with the coming into force of the new act and regulations, Veterans Affairs Canada has updated its reimbursement policy, which simply reflects adjustments to the language under the new legal recreational cannabis regime. Veterans will experience no change in the current reimbursement process for cannabis for medical purposes. Under the revised policy, Veterans Affairs Canada will continue to reimburse for a maximum of three grams per day of dried cannabis, or its equivalent in fresh cannabis or cannabis oil. Veterans Affairs Canada will only reimburse eligible veterans for cannabis for medical purposes.
That concludes our opening statement, Mr. Chair.
We would be pleased to answer any questions you have.