National Defence Committee on March 20th, 2013

[The Chair, Conservative, James Bezan]

Time has expired. Just to be fair, we'll continue.

Monsieur Larose, s'il vous plaît.

[Jean-François Larose, NDP, Repentigny, QC]

Thank you, Mr. Chair.

Mr. Daigle, like you, I am a little skeptical when I hear the Canadian Forces being compared to other armed forces. On that point, it could be argued that some of them have access to no care at all, and by comparison, everything is fine here and there is no need to improve anything. As well, I think you said a standard had been adopted by the Canadian Forces, but it was not even followed, given that there was a shortage of personnel.

I would like to come back to Ms. Moore's comment, which I found interesting, about the possibility of improving access to care for reserve units located in remote areas.

Do you have any recommendations on that subject?

[Pierre Daigle]

The "Reserved Care" report that we submitted in November dealt with care services for reservists. Ordinarily, when we submit a report like that, we follow up afterward. We can certainly take a look at what you have raised.

In that report, we did note that reservists did not have access to the same care as regular soldiers. We noted that it was difficult for them to access care because when they went to a military base, they were told that being a Class A reservist rather than a full-time soldier meant that they had to see their family doctor, that this care was under provincial jurisdiction, and so on. We contended that this was not acceptable and that they had to be treated. That is why the Surgeon General has issued a temporary directive. We recommended that these people make sure that it was now incorporated into the Queen's Regulations and Orders and that the doctors everywhere in Canada were really told what their duties were.

I have met doctors on a base who did not know what their responsibilities were to an injured reservist who approached them. We want to stress the fact that this information has to be communicated to the entire medical chain and to reservists, in all units, so they know they are entitled to this care.

We sent a copy of the "Reserved Care" report to all units of reservists in the country so they know what they are entitled to, among other things. In that report, we also noted the enormous gulf between what regular soldiers are offered and what reservists are offered if they lose a limb. The document in question was the Accidental Dismemberment Insurance Plan.

Two weeks after our report was released, the Minister announced that reservists would be receiving the same compensation as regular soldiers for the loss of a limb. The Treasury Board of Canada has put that policy into effect. That has been solved.

Concerning what you are saying, we are going to do follow-up. We also hope that our recommendation will strengthen the directives and that all these people will then be aware of the care they are entitled to, so they are able to access it.

[Jean-François Larose, NDP, Repentigny, QC]

When I was a reservist, in 1994-1995, we understood that we had to go and consult a civilian doctor. I am glad to see there will be follow-up.

[Pierre Daigle]

We have started a study of the care provided to reservists for PTSD because we realized that reservists have brought about a 20% increase in the number of soldiers on operations. When they are on operations with members of the Regular Forces, they are employed under a Class C contract. They receive the same benefits as their colleagues, but when they return to Canada, if they are finished, they return to their unit and they are then in a Class A employment category. If PTSD emerges two years later, they will be civilians somewhere in the landscape, and they will be suffering. All that has to be analyzed.

[Jean-François Larose, NDP, Repentigny, QC]

Thank you.

[The Chair, Conservative, James Bezan]

Okay.

Mr. Strahl.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you very much, Mr. Chair.

Thank you to the witnesses.

When we were discussing the mental health system for our men and women in the Canadian Forces, the commentary was that this was kind of a Cadillac system, that the members of the Canadian Forces have the best access in the country to mental health services.

I was formerly on the health committee, and we talked about electronic health records and how the Canadian Forces have a significant advantage. They're able to do what the provinces and territories can't do, in that they know that where these people move, their health records will follow them.

If we have acknowledged it's a good mental health system and a good way to track the medical care or the electronic health records of our men and women in uniform, I'm questioning why we can't extrapolate the data as to who's receiving mental health services. You said there's no formalized system in place, but isn't the data already there, and why can't we get to it?

[Pierre Daigle]

When we did that report we tried for balance, and I think we have a balanced report. We have had no challenge to the veracity of what we're saying. We do mention what's better now. The forces have done better things over the years. There's more capability. There's the leadership commitment to mental health. There's are reduced barriers, and so on.

What's not good enough—we don't say “negative” and “positive”—is the number of mental health care providers, the database that's linked to a performance measurement of effectiveness, and so on. We did find that there were good things. Obviously the medical files are more portable now—you can move them around the country—which is better.

What was created, and you will hear this from the mental health community, is what they call the Canadian Forces health information system. That was created in 2012. Now, there's some limitation to that system. It does provide basic information, a resource utilization for the location of patient, appointment type, and so on, but it was not built into the system to put in the mental health care provider notes. The mental health caregiver's notes cannot be input into the system and so forth.

When we talked to some medical health specialists, they told us that in order for the CFHIS, Canadian Forces health information system—the automated system—to provide all this information into the system, they figured that at best it would take until 2014-15 to be able to do that.

We keep after them. We keep saying, “You need to have a better database. It is twinned to your performance measurement. At the end of the day, a lot of money, effort and energy is placed here. You need to make sure you have a system that tells you if you're efficient or not.”

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

I certainly appreciate, even in your notes today, how you've talked about the positives, the minister's commitment to additional funds for more mental health practitioners, as well as the shortcomings in the metrics and all the rest of it.

We've heard some challenges from previous witnesses on this. Ms. Gallant certainly has a wealth of knowledge as to the challenges they've had at Petawawa. There's the contractor they've used, and there are different rates of pay for practitioners.

As someone who's been in this and has heard the frustrations of families who are trying to get this care, in your opinion, what is the best way to attract, hire, and retain those health care professionals that we need? As you've said, there is a gap. How should the Canadian Forces best do that?

[Pierre Daigle]

Definitely, as I said before, one needs to look at the internal mechanism of our system in place to manage this. When you have a base wing surgeon or a doctor on a base somewhere and they need people, and because of the local community they can hire people, they have to revert to a very bureaucratic-heavy system in Ottawa. It takes so much time. There are so many barriers. There's a myriad of freezes on hiring. They are losing those capabilities that are ready to come on board.

The money is one thing. There are public service doctors who are paid less than a contractor coming in. The Canadian Forces medical system is now hiring a lot through Calian, which is a contracting organization. If you want to attract someone, you'd better pay them as much or more than others, otherwise they'll go elsewhere.

Obviously, a recruiting campaign, more aggressive, more innovative contact.... I know there's some initiative to get in touch with medical associations and so on. This is definitely all there.

All of what we're talking about here is definitely related to the military members and so on, but the impact on family is very important. I've seen initiatives on bases where the base surgeon at the end of the day—because medical doctors are forbidden to provide care to civilians; therefore, they're forbidden by law to provide care to family—takes his uniform off, and at 6:00 p.m. he has an office provided by the base commander and he's looking after families. Instead of doing his time in a hospital downtown, which all doctors need to do to maintain their skills and so on, he's doing it by giving support to the families. There are a lot of initiatives that I've heard of from people on the base that can be helpful.

Also, you're right: it's competing with a resource pool that is in great demand, absolutely.

[The Chair, Conservative, James Bezan]

Thank you, Mr. Strahl, your time has expired.

The time with you, Mr. Daigle, has also expired. We've had an hour with you, and we appreciate your coming in and helping us with our study. In the interests of time, we're going to suspend, allow the end of the table to clear, and invite our next witnesses.

Again, on behalf of the committee, we thank you for your report and also for sharing your insight. It was great.

[Pierre Daigle]

Thank you very much. Your work is important, and I appreciate your interest.

[The Chair, Conservative, James Bezan]

The meeting is suspended.

[The Chair, Conservative, James Bezan]

I'll call this meeting back to order. We are going to continue with our study.

Joining us for the second hour is the True Patriot Love Foundation. We have Bronwen Evans, who is the managing director, and Mariane St. Maurice, who is the manager of disbursements and community outreach. Welcome both of you to the committee.

You have already received the text of their presentation in both French and English. They have also brought a long and glossy form, which is on the back table. You can get it in either French or English as well. There aren't enough copies to have them in both official languages, but there are definitely enough to cover off the anglophone and francophone members of the committee.

Ms. Evans, if you would kick us off with your presentation, and if you could keep it under 10 minutes between the two of you, we'd appreciate it.

[Bronwen Evans, Managing Director, True Patriot Love Foundation]

Thank you very much for having us here today. We appreciate being invited.

The True Patriot Love Foundation, or TPL, was founded in 2009 to bridge the divide between the military and civilian worlds. It was through a presentation that the founding board members heard from General Rick Hillier, who was at the time raising money for the Military Families Fund, that we first put together a dinner in Toronto to raise funds to support military families.

We disburse those funds to charities across Canada to deliver programs that support members of the Canadian Forces. We are like the United Way for military charities, which is probably a good way to think of us. We don’t run programs per se, but we raise funds and provide supports to charities across the country.

So far we have raised $14 million to support military families over the last four years, $3 million of which has been disbursed to the Military Families Fund. We also provide funding to all the MFRCs around the country, Soldier On, Outward Bound, the Veterans Transition Program, a whole host of programs that are out there.

We have three principle areas of funding. The first is family health and support. That includes a wide range of things, everything from emergency child care.... Oftentimes that’s child care, so a member of the CF or a spouse can attend doctor's appointments, that sort of thing.

We have come across many requirements around needs for funding for children with special needs. When a family, for example, moves from Alberta to Ontario and they have a child with autism, in Alberta, where there aren't waiting lists for therapies for autism, they would have had the services that they require. But when they move to Ontario, where the waiting lists for publicly funded services are years long, oftentimes these families are having to remortgage their homes to pay for the therapies in the interim, so we step in and provide funding in situations like that.

Another area for us is mental health and well-being, obviously helping to deal with issues around post-traumatic stress disorder and operational stress injuries. We also include under that umbrella mental health supports for the entire family, because when a soldier is affected, the family is often affected.

We're also seeing situations with children and youth. Even simply dealing with the day-to-day challenges of being part of the Canadian Forces, in terms of moving from base to base, causes some challenges in the mental health and well-being area for the children and youth.

The third area we focus on is physical health and rehabilitation. It's important to state here that our role isn't to supplement government funding. We step in and fund where government isn't able. Here is a good example. When you think about rehabilitation, it may be a soldier who, say, has lost a leg in Afghanistan, comes back to Canada, and wants to be able to drive again. The government will pay to retrofit the soldier's existing vehicle. However, if it's a small vehicle and, say, they can't fit a ramp or a wheelchair in the back of that vehicle, we will provide funding for a more appropriate vehicle, and then the government will pay to retrofit that one.

One of the areas we thought it was important to talk about was that of mental health. We held a multinational symposium with the White House in Washington last fall, which various members of Parliament and representatives from the Canadian Forces attended. One of the things that was a common theme among the participating countries—Canada, the U.K. and the U.S.—was that serving members, when they're dealing with mental health issues, need to be able to access services that fall outside of the CF. It's very difficult for them to put up their hand and say to their employer, “I'm having issues”, and to seek help through their employer. An important area of focus for us is to provide those alternative services through the various charities that exist out there.

One of the charities that we have been supporting and which was recently given some support from Veterans Affairs Canada is the Veterans Transition Program. They have data that shows that only 37% of impacted veterans will seek services from Veterans Affairs Canada because of that whole sort of stigma associated around that.

We also look at and fund non-traditional types of mental health supports because there is a stigma around mental health. If you think about the culture of the military, people are often reluctant to come forward and ask for help.

One program we have provided substantial funds to is Outward Bound Canada. It doesn't put itself out there as a charity offering therapy. It's an adventure-based type of initiative. We've had testimonial after testimonial from individuals who have gone through the program: “It was the best thing I could have done for myself.” “It was an opportunity to talk to my peers about some of the challenges they're facing.” “I realized I wasn't alone.” “It opened up a whole new network for me that I never had before.”

Now they're seeking help for mental health issues, addictions, family counselling, or whatever it may be to help them get back on their feet.

I'll turn it over to Mariane to talk about a couple of other areas.

[Mariane St-Maurice, Manager, Disbursements and Community Outreach, True Patriot Love Foundation]

Thank you.

Thank you for having us here today.

There are two more areas that I'd like to talk about. The first is about making sure there are services and programs available to members of the CF and their families wherever they are and whenever they need them.

Of course, after people come back from deployment, they and their families keep moving around the country. Symptoms of PTSD, for example, can take years to manifest themselves. We need to make sure that whenever the symptoms come up, or whenever family members need access to services that will help them or provide care for the family members, they have access to them, whether they're in Shilo, Goose Bay, or London. We've seen these needs met in a few ways.

For example, a new association, Military Minds, was recently incorporated. They grew out of a need that they identified through an online forum. They basically provide a network of connections. Family members, members of the CF, and veterans go on this website and ask or manifest their needs, talk about what they need, and say what area they're in. Military Minds works to connect them with services and programs in their area to make sure that whenever they need things, wherever they are, they have access to those programs for support.

The military family resource centres, or MFRCs, across the country are also a great source of support for the members of the CF, veterans, and families. Whether it's support around deployment, like Shilo, which is facing one last deployment, or whether it's post-deployment, like Valcartier, where there's a big need for that, they have support for the children and for the spouses.

More and more we find that it's the parents of the new recruits who need the support as well. There are a lot of new recruits and young reservists who are still in university and whose parents don't really know what's going on with the military, and don't really know about the military community. There's a growing need for support for those parents, to keep them informed and also to keep them informed on how to identify symptoms of mental illness. When their kids, those young reservists, come back and are at home, the parents oftentimes are the first people to see those symptoms. If they are aware of ways to deal with that, and if the resources are available for their children, they can access those services as early as possible.

The last thing we'd like to mention is that care for ill and injured members is not limited to basic health care. A lot more goes into that. There are lots of different components of health. That includes relationships, education, housing, and that sort of thing. It's important to provide support for the families and to make sure that the parents, as Bronwen was saying, can have access to emergency child care so that they can access health services for themselves.

There's also a lot of spousal support needed for families. Spouses need support networks when they move to new communities. If they're francophone and they move to an anglophone community, then.... In Winnipeg, for instance, their MFRC has about 30% of their members listed as francophone. They organize four different types of activities for people to have that network of support where they feel comfortable when they move into that community.

Bronwen was talking about retrofitting vehicles and homes. It's a way of making the injured soldiers feel comfortable, and feel like they can still contribute to family life. Just being able to drive their children to school, not having to rely on their spouse for everything, it's a way for them to feel helpful again, to feel they can contribute to their community and to their family.

The last area is lots of family and community support. We can see family retreats across the country, where people will host military families for a weekend. It's just a time to step back from the daily challenges of military life. Spouses can take some time by themselves, either for workshops on parenting or just some time alone, and their kids can go and meet other youth of the same age to talk about the challenges they're facing. The younger kids can be taken care of while the parents go away and spend some time alone.

A lot of MFRCs also have a lot of community-building initiatives and programs that are very helpful to families and make sure those relationships and that sense of community are strong and are taken care of for those members. The physical health is taken care of, but the mental health is also taken care of.

[The Chair, Conservative, James Bezan]

Thank you very much.

We're going to go to our questioning. Again, just as in the first hour, we're going to stick with a five-minute Q and A. If you could keep your answers as concise as possible, we'd appreciate that.

Mr. Harris, you have the floor.

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

Thank you, Chair.

To the witnesses, thank you for your presentation. You indicated that you have managed to raise $14 million since 2009.

Ms. St-Maurice, I believe you're the person in charge of disbursements. You talked about a lot of needs that military families and forces members have, and we have certainly heard these issues.

It's not clear to me. Ms. Evans, you indicated that you disburse money to other charities, but you talked a lot of individual needs. If I wanted to go to Outward Bound, would I send my personal application to you, and ask if I can be one of the 80 people? I went to Outward Bound 20 years ago, and it's a wonderful organization, and I can see how it would be helpful. Would I apply to you? If I need daycare for my children, or autism support or whatever, would I apply to you?

[Bronwen Evans]

No. The charities, such as Outward Bound, would apply to us, or the individual MFRC would. This year we're running three different rounds of applications to address the three areas I mentioned.

We've reached out to the various military charities around the country to indicate the areas we will fund, and they will send in their applications to us. We don't assess any individual needs at all. We leave that up to the charity that delivers the program to do that.

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

How does a guy who needs a bigger car than he has get access to your funding? Does he have to get a military family resource centre to make an application for him or her?

[Bronwen Evans]

Yes. I believe the funding we provided for retrofitting of vehicles or purchasing vehicles has come through the Military Families Fund. What they do—

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

You gave them $3 million, I read from your website. You gave them money, and they make the decisions.

[Bronwen Evans]

We didn't hand over a cheque for $3 million. No. What happens is they evaluate what they think the needs are, and they will submit a proposal to us. One of the recent things that has come up has been tutoring for children and youth. They will say, “This is a big need. We've identified, say, 100 families on various bases that could really benefit from this. Here's the amount we're requesting; here is the number of families it's going to help”. Then they report back to us after the money has been spent on how that money was used.

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

Why would you do that? You're collecting money, and I know you are obviously very successful at it. The ability to collect $14 million is testament to the amount of public support and community support that is out there for our military families.

Why wouldn't you just give it to the Military Families Fund and tell them to decide what to do with it? Of your $14 million you collected, do you give it all out, or do you disburse it out over time? Do you have a policy to, say, collect $4 million this year and give out $4 million? How do you work that?