:
I call this meeting to order. Welcome to meeting number 26 of the House of Commons Standing Committee on Veterans Affairs.
Today’s meeting is taking place in a hybrid format. Pursuant to Standing Order 108(2) and the motion adopted by the committee on October 27, 2020, the committee is commencing its study on service dogs for veterans.
Welcome to the witnesses who have taken the time to join us today. I'll introduce all the witnesses and then allow the opener to provide opening comments.
We are waiting for Dr. Alexandra Heber, chief of psychiatry, health professionals division. We are joined by Crystal Garrett-Baird, director general of policy and research; and Nathan Svenson, director of research.
Ms. Garrett-Baird, I believe you are going to be providing the five-minute opening remarks. The floor is yours.
:
Good afternoon, Mr. Chair and members of the committee.
[Translation]
I'm pleased to be with you today.
[English]
I will begin by acknowledging that the land I am speaking with you from is the traditional and unceded territory of the Abegweit Mi’kmaq First Nation.
I welcome the opportunity to speak with you today about mental health service dogs. I will be providing an overview of developments to date, both in Canada and elsewhere in the world, with respect to the use of service dogs to assist veterans with mental health issues.
It has been over 100 years since the Canadian National Institute for the Blind was founded in 1918, in large part because of the number of visually impaired soldiers returning from the First World War and the many Canadians who experienced sight loss due to the Halifax Explosion. We are forever grateful for those early advocates who recognized the need for enhanced supports for the visually impaired and stepped into action.
In the years since its inception, the Canadian National Institute for the Blind has provided guide dogs to the visually impaired, giving handlers welcome support.
As an additional support to those veterans who receive a guide dog, the Government of Canada, through Veterans Affairs Canada’s treatment benefits program, reimburses the costs associated with the care and maintenance of guide dogs, up to an annual maximum of $1,500, plus associated travel expenses, including those related to orientation and training with a dog. Other service dogs, such as mental health, hearing and mobility, are not covered.
[Translation]
In recent years, there has been an increasing interest in using service dogs to assist veterans with mental health conditions.
[English]
Mental health service dogs, or service dogs, are extensively trained to respond precisely to specific disabilities of their owners, including individuals with mental health diagnoses such as post-traumatic stress disorder. Service dogs are trained to detect and intervene when their handler is anxious, contribute to a feeling of safety for their handler, and promote a sense of relaxation and socialization.
In 2015, Veterans Affairs Canada funded a pilot study to evaluate the safety and effectiveness of using service dogs to assist veterans with post-traumatic stress disorder, as research was limited in this area. The project was contracted through the Canadian Institute for Military and Veteran Health Research and conducted by a research team at Université Laval.
Veteran participants in the pilot study were followed over the course of an 18-month period to examine the effects a service dog might have on psychiatric symptoms, daily social functioning and quality of life for veterans with post-traumatic stress disorder. The study was completed in 2018.
[Translation]
While the pilot study was small, the findings helped to inform policy decisions related to service dogs. Based on the phase one findings from this study, budget 2018 introduced a tax credit for psychiatric service dogs.
[English]
Specifically, the Canada Revenue Agency expanded the medical expense tax credit to recognize mental health service dogs. Expansion included mental health service dogs where the dog is provided by a person or organization whose main purpose is to provide this special training, and the dogs are specially trained to perform specific tasks to assist an individual in coping with a severe impairment. This measure directly benefits veterans who rely on mental health service dogs.
While there have been some advancements in this area, one of the main challenges with determining the effectiveness of using mental health service dogs is that there are no national standards regulating the industry. Authority for accessibility issues is an area of provincial jurisdiction. In Canada, different provinces are at different levels of maturity with their adoption of service dog standards.
In 2015, Veterans Affairs Canada contracted the Canadian General Standards Board to set a national standard to ensure consistency in the training and quality of the service dogs being used to assist veterans with mental health issues. While sponsoring this type of work is not typical for the department, Veterans Affairs Canada was aware that there was growing interest in service dogs in the veteran community and wanted to advance the issue in support of these veterans.
In April 2018, the Canadian General Standards Board notified committee members that it had withdrawn its intent to produce a national standard for service dogs as there was no consensus among the committee members that the standard could be achieved for the intended positive impact. The initiative to develop a standard was discontinued.
Veterans Affairs Canada continues to move forward and work with stakeholders. In 2019, Wounded Warriors Canada received funding through the veteran and family well-being fund for a project to expand its post-traumatic stress disorder service dog program.
[Translation]
Another interesting area is research. Veterans Affairs Canada continues to monitor studies related to service dogs currently being conducted by our allies.
[English]
The Australian Department of Veterans' Affairs is conducting a four-year study, which began in 2019, to examine the impact of service dogs for veterans with post-traumatic stress disorder.
The United States, however, may well be the most advanced in research and service dog benefits. Currently, the United States Department of Veterans Affairs’ service dog veterinary health benefit provides service dogs to veterans for issues relating to hearing, vision and mobility.
As well, the United States Department of Veterans Affairs recently released the findings of a five-year study on the impact of service dogs for veterans with post-traumatic stress disorder. The study included 153 veterans diagnosed with post-traumatic stress disorder wherein some were paired with service dogs and others were paired with emotional support dogs. Over 18 months, it was found that veterans with service dogs reported greater improvements in post-traumatic stress disorder symptoms, suicidality and anger reactions. The United States Department of Veterans Affairs has not yet advised of any changes in their current program, and whether or not they will add service dogs to their suite of benefits. Any future change in policy direction by the United States Department of Veterans Affairs is being closely monitored.
Finally, and in closing, the research and activity in this area are evolving. Veterans Affairs Canada is committed to staying connected with our allies, researchers, stakeholders and veterans and their families on service dogs.
Thank you for your time today.
I'll start by noting that the Canadian General Standards Board made a concerted effort to establish a consensus on this issue. They struck a technical committee with more than 15 members, including representatives from veteran groups, guide dog associations, government regulators and trainers themselves.
Early in the process, based on stakeholder input, the focus of the standard broadened from psychiatric service dogs to all service dogs. That might have made it more difficult to come to an agreement.
In 2017, the first draft of that standard was posted for public comment. The standard covered requirements for handlers, determination of disability, detailed information on training and care for dogs, acceptable breeds and acceptable sources of dogs. They gathered more than 600 pages of feedback at that time.
The fact that consensus couldn't be reached came from a number of different partners and stakeholders, particularly in the industry. That revolved around the length of time that was required for training, the age at which dogs started training and the use of shock collars. There was a wide variety of disagreement. That's really what caused the process to stop.
I'll stop there and ask if there are follow-up questions.
This study was launched in 2015 in collaboration with the Canadian Institute for Military and Veteran Health Research. It was led by Université Laval. The purpose of the study, as was mentioned, was to investigate the potential effectiveness of psychiatric service dogs for veterans, specifically those suffering from PTSD. It was a pilot study. It was not a large group. There were 18 veterans with PTSD who completed the 18-month study. There were 31 veterans who started the study, but only 18 kept their dog for the entire duration of the study and continued to report their results.
At the end of the day, they reported fewer nightmares, improved sleep quality, and a reduction in PTSD symptoms and depressive symptoms. Some reported an overall improvement in quality of life. There was an increase in social integration in the community as well. The one observation that was taken that didn't show a measurable improvement was a decrease in dependence on caregivers. That's another aspect that is being measured now in a separate study in Australia. That's ongoing. It's to see if they can separately measure dependence on caregivers in a more robust way.
The small nature of the study and the collection of schools in Canada that were used made the findings fairly limited in their use. There were seven schools in the study. In terms of some of the challenges they encountered, first of all, there was no consensus among the schools about which breeds of dogs to train and where the sources of dogs should come from. Most of them in our study were donations or animal rescues. There was a strong variation in the duration of the training, from hundreds of hours to thousands of hours. Even the tasks that were trained were quite different from school to school. Some schools put a bigger emphasis on each unique veteran's needs. Some put more training into the dogs themselves before pairing, and then very little afterwards. For others it was the opposite.
It's important to note that there's a lot of variation, too, in the placement and the environment in which the dogs are placed. From patient to patient, there's a difference in community dwelling, their social relationships, the other treatments and medications they're taking, their personal interest in activities and also their having another pet. All of those things made it difficult to make broad generalizations from the limited findings of this study.
:
Thank you very much, Crystal.
Let me add a couple of things. First of all, it is true that having a psychiatric service dog does not in any way have the evidence behind it to call this a treatment or a therapy, in fact. We consider it more as what we might call an adjunctive treatment or a complementary treatment to the evidence-based treatments for PTSD, major depression or whatever condition the dog is helping the veteran with. I think that's the first important point.
The second point I want to make, though, is that this issue is complex. It is not a benign issue. Let me tell you one anecdote that happened. When I was still in uniform back in 2014, I was given the service dog file, and I started contacting the service dog organizations in Canada to find out what they were doing and to talk to them a little bit about their programs.
One of the workers I spoke to told me a story. They had trained a service dog for a veteran or a serving member. A person had taken that service dog home, and they usually do follow-ups for a while to see how the person is doing. When they went to the person's home, they found that the service dog had not been fed and that the person was very incapacitated. I wonder if it was a major depression. The person was not able to get out of bed. They weren't taking care of themselves very well, and they weren't able to care for this dog. I asked, “What did you do?” She said, “We took the dog back.” Of course, my next question was, “What happened to that person who was left there in the home?” That, I don't know; she wasn't able to tell me that.
I think it just illustrates that this is not a simple issue. Having a dog also means that the person has to be in a stage of recovery where they can also take care of a dog, take care of that responsibility. I think there are a number of well-being issues that sometimes veterans have that may compromise their ability to do this. It's not a benign procedure to give somebody a dog. I think there are a lot of issues to be considered here.
Thank you, everyone, for being here and providing your testimony today.
It's a lot to take in. I heard one of the witnesses saying that doing the right thing for the veterans has to be a priority, and I absolutely agree with that.
I have to say that the lack of national standards has provided this opportunity for things to keep falling apart. What we see are multiple areas and different ways of training across the country, so there is no consistency. We see veterans trying to get the supports they need and not necessarily getting appropriately trained dogs. We also see that they often cannot take them into public places because they're not considered real support dogs. We know they can't get them on a plane.
I've dealt with this personally in my riding. A veteran who had a service dog could not find a home because there were no homes that would allow him to bring his dog because it wasn't certified as a service dog. This meant that he was “choosing” to be homeless because he could not function without having the support dog with him every step of the way.
When I listen to this, I respect that this is a complicated matter. I understand that most things are complicated, but the problem is that there are no national standards, which means that nobody is held to account and veterans don't get what they desperately need.
I have so many questions, but the first thing is with regard to the Canadian General Standards Board. What I think I heard was that they had a plan to make a study, but they didn't have a consensus. I would like to hear a bit more about what the top concerns were, maybe even just the top three concerns. I understand that they broadened the study, so it became more complex.
I'm just wondering, and I'm sure you won't have an opinion about this, does it make sense to stay within the single lane, to at least get that first level done before we start moving on to the next thing?
Can anyone answer that? I'm sorry, but I don't know whom to direct it to. I'll let you tell me.
:
I can start, and then I'll turn it over to Nathan for further comment around the specifics.
As you noted, and as I noted in my remarks, Veterans Affairs Canada previously had a contract with the Canadian General Standards Board to establish a set of national standards and provide assurance that the service dogs being provided to veterans are properly trained and meet standardized behaviour requirements.
However, as noted, in April 2018, the board notified members of the technical committee that it had withdrawn its intent to produce a national standard for service dogs in Canada because there was no consensus among the committee members that the standard could be achieved. As a result, the initiative to develop a national standard was discontinued.
Meanwhile, we continue to be an active player, with research and funding in areas like Wounded Warriors Canada. I'll ask—
:
Okay, let's talk about that.
We're looking for national standards. If VAC is going to work with Wounded Warriors Canada on their service dog program, could we not look at how to support them in setting and supporting some sort of national standards that we could give to another board to review?
It just feels like it's getting more and more confusing. I heard what Dr. Heber said earlier, and I absolutely understand. However, with no national standards, when a veteran gets a dog, there is no process for the normal check-ins. This is the gap.
What I hear is, “Oh, we have a tax credit.” Well, that's fantastic. Who is actually taking it? Could you guys give us the numbers? How many people have actually accessed that tax credit? The other number I would love to see is how many people tried to access that but couldn't, and what the reasons were. Do we have any information on that?
I guess there are two questions. First, since they're already receiving support from VAC, could Wounded Warriors Canada be a venue to start setting some of those national standards, even preliminary ones, for us to push up the line and see how it goes? That's one question.
Second, do we know how many people actually got the tax credit? I talked earlier about a veteran who had a service dog and was homeless. He did not have thousands and thousands of dollars to put forward to get a dog. He lost his dog not too long ago. Who is accessing the tax credit? How many people have been denied? Could we get those numbers?
Those are my two questions. I hope they were clear.
As I sit here, I'm getting more and more frustrated. Every day, I get a phone call or a message from a veteran who is struggling. Every day, I get a phone call or a message from a family member who has lost a loved one. I've seen first-hand the impacts that service dogs can have on our veterans and our first responders, and I find it absolutely mind-boggling that those who have been tasked to look after the veterans who have served our country come before this committee and point fingers—it's the provinces or....
Ms. Heber, your testimony about a veteran whom one of your colleagues found in obvious distress, and you couldn't find out how that veteran was.... This is unbelievable. It's been four years. We have countries that are doing yeoman service and that we can learn from. We have Wounded Warriors Canada, which is developing its own standards, and yet.... It is so frustrating. Now we're seeing first-hand why, when our veterans are dealing with VAC, they get this cold response back. It's absolutely shocking for me. Seriously, we have to be better. It's just unbelievable. Surely we have enough well-educated people.
Ms. Heber, you have a ton of degrees and diplomas and certificates behind you, and I'm sure all of our witnesses are from learned educational facilities. Surely we can come up with standards or agree to some standards so that we can supply our veterans with the much-needed support. Wouldn't you all agree, whether it is a prescribed treatment that you approve of, or maybe a security blanket....? I'm not sure, but the feeling I got was that that's what was being implied. If it saves veterans from taking their life, shouldn't we be doing everything in our power to find a way to supply that? Shouldn't we be doing everything in our power to make sure that our veterans aren't ending up on the street, homeless, that they have all the supports they need? I'm staggered at your testimony today.
Ms. Garrett-Baird, how long have you been with VAC?
:
Right. That's an excellent question.
Really, it comes down to a comparison of the impact of service dogs—psychiatric service dogs, in this case—versus emotional support dogs. The therapy dogs can be present during treatment, but they're not something that the veteran would have with him at all times. It comes down to those two categories, service dogs and emotional support dogs.
That was the main focus of the United States Veterans Affairs study. They paired 88 veterans with a service dog, and 65 veterans with an emotional support dog. That's the number of people who completed the study. It was a two-year study. What they found was that emotional support dogs showed similar impacts when compared to service dogs when measuring sleep quality, depression levels and mental aspects of the quality of life. However, they found specifically that psychiatric service dogs had a much greater impact in terms of improvement in PTSD symptoms and anger reaction, and to some extent in suicidality, compared to those with emotional support dogs.
Those are the findings of the study that were just released in the past couple of months.
:
Thank you for the question.
As we went through the work on service dogs, we looked at what the different provinces are doing and their levels of maturity. As I mentioned, we have British Columbia with a very advanced legislative framework, which is not necessarily the case in other situations.
Given the inquiries we were receiving about service dogs for veterans, that is the reason why, in 2015, we contracted with the Canadian General Standards Board to establish that national set of standards so that there would be consistency in the training and the quality of the service dogs being used to assist veterans with mental health issues. It was largely because we were aware and saw the growing interest in service dogs in the veteran community and wanted to advance the issue in support of those veterans. Unfortunately, as noted, the board notified committee members in April 2018 that it withdrew its intent to produce a standard, because there was no consensus and the standard would not be able to be achieved with a positive impact, so it was discontinued.
However, we continued forward with the research, and then through the veteran and family well-being fund in 2019 we funded Wounded Warriors Canada to expand their post-traumatic stress disorder service dog program. They really are doing amazing work in this area, both in developing prescriber guidelines and criteria—
We really need to solve this problem for our veterans. Basically, I think our issue is that there wasn't consensus on that board and in the group who were working on it, so they discontinued. What were the circumstances that brought us to that point? That's the whole purpose of this standards board. They deal with all kinds of complicated issues. What was it?
Quite honestly, from my understanding, there were conflicts of interest there because of the roads that a number of those organizations had already gone down. As you said, they could not come to an agreement around the fact that there's a huge difference between an obedience dog and a service dog.
I really think it is important that we find the people with the credibility and the research—and we have them in Canada—to take another crack at this and do what needs to be done. People who do not have money in the game or have not received funding directly from the government to fund service dogs can bring about the standards that we know we can have in Canada for them.
I would encourage you to look at that. We'll certainly be looking at that as a committee. A lack of consensus there was not because of the complexity of the issue; it was because of conflicts of interest, I believe, within that group. That's so key when you're trying to set standards. You need to move out and have people who are not part of that dynamic so extensively that they can't look at it objectively.
I don't know if that's something you would say was part of that dynamic or not, or whether you're prepared to go there.