National Defence Committee on Nov. 1st, 2012

[Marie Josée Hull]

Yes.

[Jack Harris, NDP, St. John's East, NL]

If I said that I have an 18-year-old young fellow who seems to have some need for being able to relate better or whatever and came to you and asked you what you could do for him, could you just tell me what...?

[Marie Josée Hull]

We would start with an assessment to see what the needs are of the person. I'd go based on what the person's needs and what they want in therapy as well. In doing therapy like this, we would need to have a willing participant.

[Jack Harris, NDP, St. John's East, NL]

The assumption is, of course, that there's a sense that relating to horses might be a good start.

[Marie Josée Hull]

Yes. The way I'd do it is that I would do an in-office assessment of one to two hours. If it's judged that working with horses would be beneficial, then we'd prepare our treatment plan with some goals in mind of what we want this to look like in the end when we're finished. Then, after that, the sessions would be in a ring or a pasture.

[Jack Harris, NDP, St. John's East, NL]

How do you make that judgment? How would you make that judgment based on sitting down and doing your in-office assessment? What would you use to conclude that this was a beneficial or positive thing or that they were a prime candidate for this particular therapy?

[Marie Josée Hull]

First of all, there are some things we do have to look at. If a person has addiction issues, we wouldn't want to be doing this type of work with a person who's intoxicated. That would have to be put in place at the beginning: that if they have addictions issues, they would not use while doing therapy like this. Also, if there are any medications, we'd want to talk to their physician to see if there are any physical reasons why they wouldn't be able to do this type of therapy.

Anybody who wants to learn anger management, stress management, learn about themselves.... I have in my handout a list of therapeutic goals—I think it's on the third page—that you can achieve by doing this type of work. It's usually very effective. I find that after six to eight sessions we are getting somewhere, compared to office therapy, and people get to take home the learning they are doing in the ring with the horse. They can bring it home. I even give homework to do between sessions.

[Jack Harris, NDP, St. John's East, NL]

In your judgment, is this particularly suited to the PTSD types of psychological issues?

[Marie Josée Hull]

Yes, for a portion of the treatment of PTSD.

There are three phases I use to treat trauma. The first phase is the stabilization phase.

I believe that working with horses could be very useful for that phase; you bring a person to an arousal level that's lowered and you build their coping skills. You make sure that they are doing well in everyday life before going into the traumatic event, because you could really destabilize them a lot if you would just go into it when they're already pretty shaky. In that first phase, using the horses would be really useful.

There's the third phase of reintegration, once the trauma has been processed, once we have looked into the thoughts that keep a person feeling guilty, feeling shameful, feeling responsible, or feeling not good enough. Then we can start doing work with horses again and bring in their families or their children or their spouse and get their supports back up.

[The Chair, Conservative, James Bezan]

Thank you. Your time has expired.

Ms. Gallant, you have the floor.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

First of all, Mrs. Vandergragt, you work with families and with children who have emotional, psychological difficulties, including military families. Within some of these military families, one of the parents can be a soldier or is a soldier who does suffer from PTSD. Could you describe your observations of how this affects the family?

[Alison Vandergragt]

Keep in mind that when we're talking about equine assisted psychotherapy, these sessions take place with a mental health professional present who has partnered with us for programming through an agency. This is always done with another agency. Approximately 35% of the clients we've seen in this past year, and 50% of the clients from a pilot project that we did a year ago with the Phoenix Centre, involved military families.

Usually the children are coming in with some behavioural issues that we're looking to address. I'm very pro-family. We can make some little changes in the child, helped by the use of the horses in the program, but when the child goes back into the home, it's very hard for them to start integrating some of the new skills they've learned, such as the new coping skills and, the new communication and relationship things they've learned in the session. So we quite often get the family involved.

For the most part, the military families were very game to come to programming with their children, but some of the activities are high energy and there's a lot going on. What we've found is that we're supposed to be there for the child and helping with some issues, but we're seeing something else. There's something else in that arena that we're not addressing, and we call that the elephant in the arena: that elephant is the mental health issues that the parent is facing on his or her own—obviously stress-related.

So we're putting on band-aids and we're getting little fixes here, but there's this big elephant that we're not even allowed to talk about or discuss: why the parent is so stressed and the factors for this family's disintegrating. We can put on these little band-aids and give little tips on how to work together as a family, but really, there's an issue here that is not being addressed, and that is a concern for someone like me. We could be doing much better in these programs if we were actually able to address the PTSD.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Ms. Hull, you explained to us how you get paid through Blue Cross when you're dealing with the military. As there is not yet sufficient evidence so far to support the inclusion of equine therapy in the spectrum of care, based on any of the five criteria, have you investigated whether there are university studies going on or looked to partner with another organization to gather the data required?

[Marie Josée Hull]

No, I haven't looked into that. It might be really interesting, especially if I could get some of the soldiers in Petawawa on that. I think they could benefit. It would be of interest, but I haven't looked into it, no.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Colonel McLeod, what is the process for hiring civilian mental health workers, specifically psychiatrists? Does your staff interview them or is an intermediary contracted to contract the professionals?

[Col Scott McLeod]

There are two options. All of the psychiatrist positions that we have are public service positions. In that process, our senior psychiatrist would be engaged in reviewing the person's application. That's our primary method of trying to fill our psychiatry spots—through the public service.

If that does not work, we can go through a third-party contracting service with Calian. That's the service we use today. They're responsible for hiring the individual to fill that clinical spot until we're able to fill the public service position.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

On what basis would the intermediary or the contractor be paid? Not the psychiatrist, not the provider, but Calian, for example...? Is there a salary for the professional and would Calian get a percentage of that? How does that work?

[Col Scott McLeod]

To be honest, I couldn't get into the details of that specific arrangement. I'd probably have to refer that to our director of health service delivery, who manages the contract specifically.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So you don't know whether or not another company is getting a cut of their salary?

[Col Scott McLeod]

I couldn't tell you, to be honest with you. That is purely under another directorate's responsibility.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So the only time that you would use a third party to recruit the professional would be when the public service could not find the person for the position?

[Col Scott McLeod]

If there's no clinician interested in taking the public service position, then the third-party contracting is a backup, It's an available option for us. If a psychiatrist does not want to take a public service position and if we have no applicants for the position, but that same psychiatrist is interested in coming in through contracted services, that's our backup option to ensure that we have a care provider there to look after the members.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So to be hired directly by the military, the public servant has to be a public servant already.

[Col Scott McLeod]

No, they can apply. You could be a new graduate out of medical school, having just completed your residency and passed your exams, and you could say that you wanted to be hired as a public servant. You could go through that application process. There's an interview process, you get hired, and you are now a public servant being paid at the rate of public service psychiatry. If we don't have an applicant for the position and we need to have a psychiatrist working in the position, that's where the third-party contracted services help us fill those spots.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

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