National Defence Committee on April 8th, 2014

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

I would like to come back to another aspect of how services are provided to our soldiers in French.

Last week, Colonel Gerry Blais, Director of Casualty Support Management of the Canadian Forces, appeared before our committee. I asked him if it was possible for all military bases to provide services in French, considering the needs, whether this involves volunteers or staff.

Is that the case or not? Is it possible for all military personnel to receive mental health services in French on every base in the country?

Although this is not linked to mental health, I have seen cases where people have been sent to certain bases to take a course that was supposed to be bilingual, but since most of the people on site were anglophone, the course was given entirely in English. Even when a service was supposed to be offered in French, that is not what actually happened. This really worries me.

I wonder if you could talk about the situation on all bases across the country.

[BGen Jean-Robert Bernier]

Some bases do not have a single psychiatrist. When it comes to health care, we always try to have enough clinicians, nurses, physicians, physician assistants and people with enough mental health literacy to act as interpreters, if necessary, or to provide part of the care in French.

In francophone units or certain francophone regions, of course, all services are provided in French.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Yes.

[BGen Jean-Robert Bernier]

In the rest of the country, especially in the western provinces like Alberta and British Columbia, we try to have enough people with the skills required. It depends on the proportion of francophones on the military base and in the military community. It is hard, considering the shortages that exist in many fields across the country.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

What do you mean by “enough people”? Does that mean one person per shift?

If I understood correctly, you are saying that someone does not need to provide the service entirely in French; they need only be able to translate the information to a unilingual anglophone professional. In your opinion, this constitutes providing service in French.

[BGen Jean-Robert Bernier]

If the resources are not available in the military community, we try to find them externally. For instance, in a city like Victoria, there is likely at least one psychiatrist or psychologist who is bilingual. So we will then be able to provide the necessary service, especially to those whose language skills may prevent them from receiving services completely in that language.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Beyond language skills, it is important to feel comfortable and be able to talk about health concerns, particularly mental health. Although I consider myself perfectly bilingual, when I go to my doctor, I speak to him in French. This is the same situation.

It doesn't sound to me like the service obligation is being met. I can imagine the additional delays that francophone soldiers are experiencing before they can access mental health services when they are posted outside of a francophone region.

Since I have other questions, I unfortunately have to change the subject. In any case, based on the information you are giving me, the situation regarding the services provided to our francophone soldiers seems extremely troubling.

[The Vice-Chair, NDP, Jack Harris]

You have a minute and 15 seconds.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

When a member of the Canadian Psychiatric Association appeared before our committee on April 17, 2013, he recommended that the Canadian Armed Forces carry out periodic screening for PTSD and common co-morbid conditions such as depression, addictions, and suicide, which would enhance early detection and facilitate treatment.

How often does the Canadian Forces carry out such period screening?

[BGen Jean-Robert Bernier]

Do you mean individual screening?

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Yes.

[BGen Jean-Robert Bernier]

A full assessment is done at the time of recruitment and then every five years until age 40, or thereabouts. We also do an assessment before every deployment and sometimes one during the deployment. Between three to six months after the deployment we do another comprehensive assessment. This goes on throughout the soldier's entire military career until the end of his service. One final assessment is done before the person is released from the armed forces.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

You mentioned earlier that taking care of the families was not part of your mandate. Nevertheless, do you do any outreach with the military families to find out whether they are satisfied with the services and determine their needs? How often is that done?

[BGen Jean-Robert Bernier]

That is beyond the purview of the Canadian Forces Health Services Group. Another organization with the Department of National Defence deals with family support and services.

Often, these centres offer the families on the base services from sociologists and other specialists. What is more, they have service networks in the community. Nonetheless, their clinical care is not subsidized by the Department of National Defence.

[Élaine Michaud, NDP, Portneuf—Jacques-Cartier, QC]

Thank you.

[The Vice-Chair, NDP, Jack Harris]

Thank you, General.

Mr. Bezan, for five minutes.

[James Bezan, Conservative, Selkirk—Interlake, MB]

Thank you, Mr. Chair.

I want to thank our witnesses for coming back and helping us wrap up our study on the care of the ill and injured, and helping us fill in some of the holes on the report that we're putting together.

Ms. Rigg, when you were here last time, we talked briefly about the shortfall in trying to meet that goal. Two numbers were floating around. One is 447 mental health professionals, another one is 452.

What were the challenges in trying to find those people? There seems to have been a bit of a wait in trying to meet that number and reaching that goal. Can you just fill us in why it's taken as long as it has?

[Jacqueline Rigg]

Absolutely, there have been some challenges in filling these positions. We'd identified a gap of 54 positions that needed to be filled and we've been working very hard to do that.

One of the first challenges is our limited labour market availability of these professionals in Canada. That's why it spread. DND falls into that same challenge of finding the right skilled professionals.

We also have a challenge because we are staffing these positions in remote locations or non-metropolitan areas. For example, staffing in Cold Lake, Alberta, in Shilo, Manitoba, are quite challenging for us to get folks who are willing to relocate to do that.

We're also competing with the private sector. Notwithstanding that we offer the top of the scale salary in our wage bands for these positions, it doesn't make us fully competitive with the private sector salary bands. To do this, we realize that we need some mitigating strategies to have this happen, so we are running specific processes in these remote areas to attract them.

We have partnered and worked with Treasury Board Secretariat and the Public Service Commission. We went to Treasury Board Secretariat, so that we can increase the amount of money that we can offer to external hires for relocation. That's often a barrier. Previously, we could only offer $5,000 to support external hires to the public service. We got it increased. Until March 31, 2015, we can offer up to $40,000. This we feel will help us in our remote locations, which has been a very big barrier.

With the Public Service Commission, you cannot make any hires unless you check all the priorities in the system. We've created an expedited process with them, basically telling them, “Because we have such a shortage in this area, just refer to us any priorities who have that skill set and we can automatically bring them on board”. Also, for the priority clearances that we require before making a letter of offer, we ask them, “Can you please give us a faster process to get this done because we can't wait?”

While we're waiting for some information as well, we moved to giving a lot of conditional letters of offer because you've got to get your official languages done, you've got to get your medical done. We figure that by providing a conditional letter of offer we're getting a bit more stickability to the person who may be getting another offer while we're trying to get those ducks lined up.

[James Bezan, Conservative, Selkirk—Interlake, MB]

Have you found that there's any particular occupation or profession that has been more challenging to fill than others within the mental health field?

[Jacqueline Rigg]

I think our hardest—and it's largely probably due to the wage band issue—are psychologists and psychiatrists. Those are the two hardest areas.

[James Bezan, Conservative, Selkirk—Interlake, MB]

General, now that we've been able to bump those numbers up, and I know it's been relatively recent, have you seen any reduction in wait times?

We heard from some of our witnesses that we've had here, as well as when we went out to Petawawa, that there were some complaints regarding the wait times especially to see the psychiatrists or psychologists. Have we started to see any reduction in wait times for our members?

[BGen Jean-Robert Bernier]

Yes, we have, but we weren't exclusively relying on the public service. Many of those positions were filled by Calian. We're pursuing other methods, like tele-mental health, which I mentioned, and process improvements.

For example, I've just come back from Quebec City. The base in Valcartier, where there was at one time a four- to six-month wait time that we identified through our regular monitoring about a year ago, is now down to one of the shortest wait times in Canada. I just want to congratulate them. We routinely look and conduct site assistance visits as well to look for process changes that could make things better.

But, yes, overall, there are now very few places where there's an exceedance of a 28-day wait time for initial treatment and assessment for specialized care, which is far faster than is generally available. There are still individual cases that we have to pursue individually when we hear of circumstances that don't sound right. Though, in many cases, when we hear about such cases and we look into it, it turns out that there was something else to explain why there was either not a requirement or they were getting the appropriate care that was not requiring or was unrelated to a perceived delay. Most of the delays that we have, we have data that shows that wait times are not a barrier for almost all of our patients, that the barrier is in other areas, and that most of time when there is a delay—

[The Vice-Chair, NDP, Jack Harris]

Thank you, General. Can you clew up?

[BGen Jean-Robert Bernier]

—it's because of the self-imposed delay in presentation.

[The Vice-Chair, NDP, Jack Harris]

Thank you, General.

Your time is up, Mr. Bezan.

Mr. Larose, you have five minutes.