Good afternoon, ladies and gentlemen of the Standing Committee on Veterans Affairs, and thank you very much for the opportunity to present to you today.
I am Dr. Alice Aiken, the scientific director of the Canadian Institute for Military and Veteran Health Research. I'm a university professor in rehabilitation therapy, and I am a proud veteran, having served in the Royal Canadian Navy for 14 years.
With me today is Susan Marlin, the chair of our interim board of directors and the associate vice-principal of research at Queen's University.
This institute and what it represents is near and dear to my heart, and I'm very excited to be able to inform you about CIMVHR and the role it plays in advancing research that will benefit veterans, military personnel, and their families.
In November 2010, Queen's University and the Royal Military College of Canada established the Canadian Institute for Military and Veteran Health Research, with the full support of Veterans Affairs Canada and the Department of National Defence. Until then, Canada was alone among our major military allies in not having such an institute. This academic institute, which extends from east to west across Canada, comprises 21 universities and over 150 researchers, and is still growing. We've joined together to respond to government priorities for research on the unique health and social consequences that impact military personnel, veterans, and their families—those who have sacrificed so much for our country.
[Translation]
With over 700,000 veterans in Canada and more than 100,000 serving personnel, we have a significant population with unique risks, exposures and experiences that demands new standards of protection, prevention and care for ill and injured military personnel, veterans, and their families.
[English]
As of now, more people have served in Afghanistan than served in Korea. We have the largest number of injuries since the Korean War, and these injuries are more complex. Parliament has been advised that one in five of those who served in Afghanistan and our other recent missions will suffer from mental health issues, and we have no idea if the scope of the problem is in fact this limited.
The Canadian Institute for Military and Veteran Health Research is an innovative organization that engages existing academic research resources and facilitates the development of new research, research capacity, and effective knowledge exchange. This institute serves as a base for all Canadian stakeholders interested in military and veteran health research, and provides a channel between the academic community, government organizations, and similar international organizations.
CIMVHR's mission is to optimize the health and well-being of Canadian military personnel, veterans, and their families by harnessing and mobilizing the national capacity for high-impact research, knowledge creation, and knowledge exchange. The institute's research focuses on outcomes that translate into programs, policies, and practices that can rapidly impact the lives of the beneficiaries. CIMVHR is focused on ensuring that Canada's best researchers are engaged in research that is fully coordinated with national and international agencies to ensure that they complement, not duplicate, existing research activities.
The Canadian government has provided our military going into battle with the best training and equipment in the world. We must ensure, when these soldiers return to their new battlefield—a personal battlefield that's marked by physical and mental injuries, and social challenges in reintegrating into family and civilian life—that we provide them with the same level of support. This support must be based on the best evidence possible resulting from research by the best and brightest Canada has to offer.
CIMVHR's vision is that the health and well-being of Canadian military personnel, veterans, and their families will be maximized through world-class research, resulting in evidence-informed practices and policies.
In order to see this vision through, CIMVHR has focused on building support and partnerships with individuals and organizations: professional associations like the Canadian Medical Association; foundations like the True Patriot Love Foundation and the Rick Hansen Institute, research institutes such as the Centre for Addiction and Mental Health, the Royal Canadian Legion, and the Congress of Social Sciences and Humanities, to name a few.
In fact, your own minister, the Honourable Steven Blaney, has said:
With the return of troops from Afghanistan,...it'is more important than ever to have a network of academics and researchers who can provide insight and intelligence into the long-term effects of military service, especially in the areas of mental health, complex health needs and families. With the extensive network of American research institutes, the Australian Centre for Military and Veterans' Health, and the recently created Canadian Institute for Military and Veteran Health Research, our nations will share findings and look for further opportunities to collaborate.
CIMVHR is creating ways to collaborate through our annual military and veteran health research forum. Last year's forum was hosted in Kingston, Ontario, from November 14 to 16. This major event had an audience of over 450 stakeholders, researchers, military and civilian personnel, members of industry, eminent keynote speakers, and national and international representatives. The highly interactive forum featured 12 keynote speakers, including two from the United States, one from the United Kingdom, and your minister. It had 31 scientific posters and 110 quality research presentations focusing on significant aspects of mental health, operational and environmental health protection, physical and mental rehabilitation, combat casualty care, health policies and programs, and transition from military to civilian life.
Our soldiers are returning from a difficult ten-year combat mission and they are already preparing for future deployments. Our country has a social covenant with these Canadian sons and daughters, husbands and wives, mothers and fathers, who we send into harm's way in defence of the freedom and quality of life we all enjoy.
The academic community is mobilized, our partners are committed, and Canadian pride in our veterans is strong. Just as our soldiers have served side by side in troubled spots around the globe, let us work together in a new coalition to help them as they come home to their own personal battlefield.
Merci.
:
Thank you, ladies and gentlemen of Parliament. Thank you for the invitation today.
My name is Dr. David Pedlar. I'm the research director at Veterans Affairs Canada. I work in Charlottetown. My colleague Charlotte Bastien joins me today.
The work of your committee on the health and well-being of veterans is very important, and various colleagues at Veterans Affairs have been here to talk to you about it. In fact, last December my colleague Janice Burke introduced you to the life-after-service studies. These are studies that are providing critical information to the department as we continue to integrate our research findings into our programs and services.
I welcome this opportunity to give you more detail about these studies. As you might recall, the life-after-service studies research program was a partnership of Veterans Affairs Canada, the Canadian Forces, the Department of National Defence, and Statistics Canada. It was for understanding the transition from military service to civilian life and the short-term and long-term health effects of military service on the later life courses of veterans.
We're excited about what we're learning from these studies, partly because in the past our evidence on this subject was related only to VAC clients—that's about 11% of the post-Korean War CF veteran population in Canada. Up until now, we've had very little empirical data on the veterans who weren't receiving benefits from Veterans Affairs. That's the majority of veterans in Canada. These studies have changed that. The studies include both veterans receiving benefits from the department and those who are not, and we can make comparisons with the Canadian population.
We use a population health approach. This allows us to understand what may cause disease and what keeps a population healthy. It also allows us to answer critical questions about life after military service and about whether transition needs are being met.
I'm proud to say that this work puts VAC at the forefront of research on transition. It's a unique piece of work, which is generating real interest in the academic community but also among our international veterans affairs partners.
We're seeing more interest in this area, and we are taking all work, nationally and internationally, into consideration, including the work of people such as my colleague Dr. Alice Aitken. As you know, the department has already put in place improvements, through the Enhanced New Veterans Charter Act, to enhance the financial supports in place for our most seriously disabled veterans. Within VAC we make sure that the work has a practical application in the benefits and services we provide veterans and their families.
Now let's talk about what we've learned. There were three studies released in 2011. The first one looked at income before and after service, because we know that income is critically important to health and to security. The second was a population health survey of living Canadian Forces regular personnel who were released over a ten-year period, from 1998 to 2007. We looked at health, disability, and a range of determinants of health, such as income, employment, and social support, among others. The third was a mortality study; it looked at causes of death among current CF members and former personnel.
Let me share with you some of the findings from the study. First, let me tell you about some of the positive findings. First of all, 65% of that group who transitioned felt that they had an easy adjustment to civilian life. Second, as a whole, released Canadian Forces members were less likely to experience low income compared to other Canadians. In fact, they were about 50% less likely than other Canadians to have fallen below the Statistics Canada low-income measure. Less than 2% experienced persistent low income, which is low income that has continued.
Almost 90% worked after release, and the majority were satisfied with their work. Veterans were no more likely to experience unemployment. The unemployment rate was about 8% at the time of the survey, which was comparable to the general population.
On the question of death, male veterans had a 23% lower overall risk of death from all causes combined compared to the general Canadian population.
Finally, veterans were more likely than other Canadians to have a regular medical doctor and health care coverage.
I'll now go on to some of the findings that point to a challenges in this population and to some of the actions we're taking. While the findings I just mentioned report an overall lower risk of premature death, there was an important exception to this finding. That pattern was for suicide. Male veterans had a 46% higher rate of death from suicide. That is in the release population. With respect to these findings, we have been taking concrete research actions but also program actions in the area of suicide prevention.
Of course, there are issues of disability that do not result in death. For example, the rates of musculoskeletal disorders, which would be things like arthritis and back problems, pain, chronic pain, anxiety disorders, and disability are higher in the survey population than the Canadian population. Arthritis is reported at almost twice the rate of the general population, as are back problems.
Many of these conditions were concentrated in an important group of veterans who had what I would describe as very complex states of health. I have come to call this pattern the triple threat. That is veterans who suffer from musculoskeletal disorders--arthritis and back problems--mental health conditions, and chronic pain. That accounted for 16% of veterans in the survey. So we are focusing on these health issues in the analyses that we're doing so we can support the development of health care programs to support this group even better.
We also learned there are veterans out there who may need our help but may not be coming to us. For example, 17% of veterans who are not VAC clients reported they had a difficult or very difficult adjustment to civilian life, and 13% who are not our clients reported they have a mental health condition. This speaks to issues with program reach and communications to veterans. To address this we are working closely with our colleagues in communications outreach and engagement and national defence to try to reach these at-risk groups and to improve our communication with veterans.
As we spend more time looking at the data and focusing on smaller groups we're finding some groups have a disproportionate share of challenges. For example, low income was more prevalent among those released at young ages, those who were released involuntarily, and those who were released at lower ranks.
Another dimension of income is how much the income declines after they leave. We found that female veterans at release experienced one of the greatest declines in income.
While the majority did report a good transition experience, a sizeable minority, about one in four, had a difficult or a very difficult transition experience. Those who were more likely to have had a difficult experience included those who were medically released; those who were separated, widowed, or divorced; and those who had 10 to 19 years of military experience. They were in the middle.
There are subsets of veterans with very complex health needs, and we need to ensure our programs provide the support they need. Our case management function will play a critical role in addressing these concerns.
So there is a spectrum of health in this population of released members. Many are doing well. However, there are also some who have challenges, and a significant minority have complex states of health. According to our estimate, about 16% have this triple risk, if you will.
We are very active on the research side. In addition to some of the actions I mentioned earlier, such as the work on suicide prevention, we are continuing to be very engaged with knowledge exchange and making sure that these findings get out to end-users in the Department of Veterans Affairs, the Department of National Defence, and the Canadian Forces.
We are conducting further analyses on many fronts, including mental health, physical health, the income data, and a better understanding of those veterans who are not receiving services from Veterans Affairs. In addition, we are using the findings to improve aspects of VAC's policies, programs, and services, including disability benefits, programs, health care, case management, and informing health professionals.
A note: in these studies we were not able to look at those veterans who are members of the primary reserves. This is an area of interest to Veterans Affairs, the Canadian Forces, and the Department of National Defence. There are suggestions that reservists may have a more difficult time transitioning, but I do not have enough information to share on that today. This is a challenge that we and our international partners are facing as well, as reserve members become more and more active in armed forces operations and activities.
Thank you very much for the opportunity to share some information on the life-after-service studies with you this afternoon.
:
Mr. Chair, good afternoon and thank you for the opportunity today to be a part of the panel discussion on veterans' transition and rehabilitation services.
With the introduction of the New Veterans Charter in 2006, Veterans Affairs Canada has enhanced our support to Canadian Forces members, veterans and their families and continues to work closely with our colleagues at the Department of National Defence to provide an integrated approach to transition.
VAC's presence in the 24 integrated personnel support centres across Canada provides opportunities for early intervention, thereby strengthening the care and support to ill and injured military personnel and their families.
VAC is currently participating with DND in site visits and reviews of the IPSCs. Action steps are being developed to support recommendations resulting from these visits.
VAC services at each IPSC focus on recovery, rehabilitation and reintegration, including transition interviews and case management; information about and assistance with applying for benefits and services from Veterans Affairs Canada; and coordination of services and benefits from Veterans Affairs and others available within the community.
Transition interviews are available to every releasing Canadian Forces member and their family. Last year alone, more than 3,700 releasing members participated in a transition interview. This interview is an essential starting point, as the transition needs of the entire family are discussed and information is provided on the programs and services available to meet these needs.
As the committee heard from Right Management last Thursday, VAC offers career transition services to eligible members that release without a disability which will help them find suitable civilian employment.
Similarly, CanVet described the vocational services and assistance they provide under VAC's rehabilitation program which assists CF veterans and their families to successfully transition to civilian life through comprehensive services that restore ability to function at home, in the community and at work. It offers medical, psychosocial and vocational services for veterans with a career-ending illness or injury or health problem that resulted primarily from service.
Participants who completed the rehabilitation program and responded to our re-establishment survey have a better mental and physical health status and are less at risk for depression; have a stronger sense of belonging to their local community; are more involved in the day-to-day activities of their families; are more likely to feel recognized for their military service; feel better prepared to find and keep civilian employment; are more knowledgeable about job finding activities; and were successful in securing employment—79% are employed within the civilian workforce.
As Dr. Pedlar noted earlier, income is an important, if not the most important determinant of health. The positive employment indicators noted above support this key determinant of health.
While these results are positive, VAC continues to work closely with DND and their other partners to improve our services and support to CF members, veterans and their families.
Stéphane, who is the client services team manager at the integrated personnel support centre at Valcartier, will explain the services and benefits that we provide.
:
Mr. Chair and committee members, I am a client services team manager. I am from the Quebec district office, and I'm deployed to the Valcartier Garrison. I'm fairly new to Veterans Affairs Canada. I joined up on September 21, 2010, but before that I had the pleasure and the honour to command troops for about 23 years with the Royal 22nd Regiment.
One of the first things that struck me when I came into my new responsibilities was the amount of information I should have known. I should have known that information from VAC because I was commanding troops and I would have been in a better position to advise my soldiers. I also should have known that information when I was told that my career was going to be over, because I would have been in a better position to understand the programs and the benefits that were lying in front of me to help me make an efficient transition between military life and civilian life.
This is the scope of my presentation: I'm going to talk about why things changed in 2006. I will go through the programs that are available and the changes that have been made, mainly last fall, to illustrate how these things work. I will go through two case scenarios that will show you how the tools work to help our veterans make the transition between military and civilian life. Then, at the end, we will obviously take questions.
[Translation]
When I meet former colleagues, I'm often asked why we replaced a system that seemed to work well with the new charter. The reality and our perception of it are often very different.
A number of studies in the early 2000s showed that injured military members had significant difficulty reintegrating effectively into civilian life. The inability to have their knowledge and skills recognized on the labour market was often a problem for these military members when they had to start a second career as civilians. A failure often led to problems with depression, poverty and problems within the family, such as crises within the family unit. Disability pensions were often insufficient to enable veterans to continue to support their family.
Experts contend that starting a new career, occupying a new job, which carries with it a number of challenges, is key to an effective transition to civilian life. The only gateway to Veterans Affairs programs was eligibility for a disability pension. To gain access to more services, members had to show that they were much more ill.
[English]
If we look at the services that were available before 2006, first, we had the disability pension. The amount was based on the percentage of how much the illness or disease related to the service had an impact on your life. The monthly amount was tax-free and could be paid throughout your life.
Second, we had health care, which was broken down into three main categories. First was the veterans independence program, the VIP. It helped our veterans stay the longest time possible in their houses with dignity. Then you had long-term care for problems related to a service disability, plus the treatments--benefits for any health issues that were recognized as being related to the service. If you hurt your knee, it was recognized. And when you got out of the military anything that needed to be done to your knee was covered by Veterans Affairs Canada.
Finally, we had case management.
In order to better serve our military people leaving the forces to make the transition into the civilian world, the new charter came out in 2006. Let's look at the programs there.
[Translation]
We have the career transition service. Regardless of the reasons for the release, the soldier has access to transition services within two years of release. The program helps military members reorganize and find a job. The program provides workshops on how to write a résumé, on interview techniques and on searching for a job effectively. For soldiers who are released and who are leaving the Canadian Forces, one of the biggest challenges is finding a new job and, particularly, new interests. In fact, throughout their time serving in the Canadian Forces, they didn't need to ask themselves those kinds of questions.
Then, there's the rehabilitation program, which is without a shadow of a doubt the spearhead of the new charter. The rehabilitation program has three pillars: a medical component that touches on physical and psychological aspects; a psychosocial component to help military personnel find ways to interact in their environment; and a career transition component aimed at helping military personnel find a job that is suited to their physical or mental limitations. The objective of the last component is to enable military personnel to find gainful employment with new challenges, enabling them to become productive Canadian citizens.
Military personnel released for medical reasons are automatically eligible for the rehabilitation program within 120 days of their release. This is also the case for personnel who, regardless of the reason for release from the Canadian Forces, have physical problems or are having difficulty reintegrating into civilian life for reasons related to their military service. We will look at some examples to illustrate this at the end of the presentation.
We also have the disability award, which works in the same way as the disability pension I spoke about earlier. But it's a lump sum given in one payment.
In addition, the new charter provides access to the public service health care plan. Previously, military personnel who had less then 10 years of service did not have access to this plan. Now, a member eligible for the rehabilitation program can have access to the public service health care plan. This is a substantial benefit, especially for members who have a family and children.
The new charter also allows for a vast number of financial benefits.
First, there is the earnings loss benefit, which consists of payment of 75% of the military member's pay upon release for members eligible for the rehabilitation program. For military personnel unable to return to work, this benefit would continue to be paid until age 65.
Second, to compensate for the drop in a member's level of employability due to service-related injuries, a member could be eligible for the permanent impairment allowance, which is a monthly taxable benefit, that operates at three levels and may vary between $500 and $1,600.
Third, when the earnings loss benefit ends, meaning, once the individual has completed the rehabilitation program, the Canadian Forces income support benefit takes over. It helps the member financially until he or she can find a job and enter the job market.
Lastly, there's the supplementary retirement benefit, which is designed to compensate for the lower pension contributions made because the individual was unable to work. The earnings loss benefit, which ends at age 65, is replaced by the supplementary retirement benefit which, with the other plans that provide benefits at age 65, acts as financial leverage.
In addition, the new charter provides services to families. The Department of National Defence recognizes the importance of the families that support our military personnel. The Department of Veterans Affairs feels the same way. The career transition component of the rehabilitation program can be used by the spouse if our client is unable to begin a career transition. Also, our case managers can provide services to families to help children and spouses cope better with the new reality of the released military member.
Lastly, we've maintained case management services, the death benefit, which is a disability award, and, obviously, all the health care that was available under the former system before the new charter came into force.
[English]
Five years ago, when the new charter came out, it was well understood that along the line we probably had to go back to the books and review some of the programs to make sure we would better serve our veterans. Bill was approved and some major changes to some of the programs came into effect last fall in order to have the charter better serve our veterans.
First of all, we discovered that payment of a lump sum of the disability award in one cheque was not appropriate to everybody. So now veterans can elect to have payment of their disability award broken down into different payments. We also discovered that the earning loss benefit of 75% was not suitable for everybody. Let's take an example of a young soldier being injured in Afghanistan. When we took 75% of his salary, it was too low. So we came up with a $40,000 a year minimum earning loss benefit for some people with the lower rank. For somebody who had been released in the 1990s, the salaries were a lot different from what they are now.
We also improved access to the permanent impaired allowance to make sure more veterans would be eligible for this program. For somebody who gets to the higher level—the $1,600 a month, as I said earlier—there's a $1,000 a month increase on top of the last level of the permanent impaired allowance to make sure the veterans can properly look after their families.
Also not related to Bill C-55, there were a lot of changes in the service delivery to improve, to be streamlined, to be faster, to be quicker, and to be closer to the clientele. The delegation authority has been lowered to district office to make sure people who look after the veterans have the authority to put services in place. We lowered down the time for a disability award from 24 weeks to 16 weeks. New personnel came on to places where they were needed. So we're looking at other initiatives to better serve our clientele.
[Translation]
Now, let's take a look at how the new charter works as compared with the old one.
The case scenario you have there is that of a married corporal who has been released for medical reasons after four years of service. So he is not entitled to a Canadian Forces pension. The corporal in this scenario has a disability assessment of 80%. He was receiving a monthly salary of $4,410, which comes to $3,300 after taxes.
Under the old system, prior to 2006, the member would receive a pension of about $2,400 a month, tax-free for life. His SISIP benefit corresponds to 75% of his salary, but it would be significantly reduced because he collects a pension. Therefore, he would receive an additional $910 per month. In total, this injured member with a medical release would receive $3,300 per month, after taxes, until the age of 65.
Now, let's look at how the new charter helps injured veterans. I will cover the biggest differences. Using the same scenario and the same figures, we will see how the services available under the new charter are there to help our corporal.
First off, even though he had not completed 10 years of service, he would be eligible for the Public Service Health Care Plan if he accessed the rehabilitation program, which, in all probability, he would.
The disability award would be a lump sum of $220,000. For our purposes, his permanent impairment allowance was assessed at the second level, giving him $1,070 per month before taxes. The fact that he receives a disability award has no bearing on his permanent impairment allowance—which is equivalent to 75% of his salary and would be about $3,300 before taxes.
If we add up all the amounts that our corporal receives, we are talking $3,600 per month, after taxes, in addition to a lump sum of $220,000, as well as rehabilitation and family support services.
[English]
If we look at the second example, it's probably where you see a bigger difference in how the new charter is helping our veterans. We're looking at a corporal who left the forces voluntarily in 2008, after eight years of service. He was not entitled to any pension because he didn't complete his ten years of service, plus he's looking for a voluntary release. However, during his service he was injured in an automobile accident and it was service-related. Now he works as an electrician, after getting out of the forces, and he has a salary of close to $4,600 a month, which is $3,600 clear after taxes.
In the old system, if we assessed his disability at 20% he would receive close to $700 a month clear of taxes for the rest of his life. That would be it for services under VAC.
If we take the same example and look at how the new charter is helping our veterans, we'll see how the tools work. It's the same planning figures. However, his 20% disability brings him a $52,000 disability award, clear of income taxes.
He enrolled because he has a disability that is service-related. Even though he had a voluntary release from the forces, because of his injuries he has a problem transitioning to civilian life and keeping his employment. If he enrolls in the rehabilitation program, he would receive 75% of the salary he was receiving when he left the forces.
On top of this, he will be able to go through vocational rehabilitation to make sure he finds new employment that respects his physical limitation. At the end of his training he can go back to a good job, earning a good salary, and having new challenges.
That concludes the presentation showing how the changes to the new Veterans Charter are helping our veterans every day.
Thank you very much.