Evidence of meeting #19 for National Defence in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was care.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Jean-Robert Bernier  Surgeon General, Commander Canadian Forces Health Services Group, Department of National Defence
Jacqueline Rigg  Director General, Civilian Human Resources Management Operations, Assistant Deputy Minister, Human Resources - Civilian, Department of National Defence

12:15 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

Thank you, Mr. Chair.

I want to pick up on what Mr. Bezan was saying.

You said that at Valcartier, the wait time had been reduced by several months. What precisely is the wait time now?

12:15 p.m.

BGen Jean-Robert Bernier

It's 28 days. That is what the Canadian Psychiatric Association recommended. Ideally, no community in Canada would have to wait longer than that.

12:15 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

So, the wait time was reduced from several months to 28 days.

12:15 p.m.

BGen Jean-Robert Bernier

On average, that is correct. However, the wait time varies depending on the circumstances. For example, a female psychiatrist might go on maternity leave and her team is made up of only three people.

12:15 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

That is the association's recommended wait time, but what is the wait time you are aiming for, for the armed forces?

12:15 p.m.

BGen Jean-Robert Bernier

Everyone should have immediate access to medical care and psychosocial care. Some cases require a more comprehensive assessment by a specialist such as a psychiatrist or a psychologist. For those cases, we aim for a 28-day wait time.

12:15 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

Is special training provided? We agree that

mental health is growing—I mean, our knowledge is.

As far as cooperation between the armed forces and the civilian system are concerned, you mentioned a number of times that there is a clear shortage of specialists in the civilian system. Do psychiatrists with specific knowledge and experience doing research and development in the area of post-traumatic stress disorder provide training to the social workers who assess the people they meet before this 28-day wait time lapses?

12:15 p.m.

BGen Jean-Robert Bernier

Together with the doctor, an assessment is made to determine what type of care people need immediately. The more complex cases will need a more comprehensive assessment. In Canada and in most countries around the world, general practitioners provide the bulk of the mental health care for cases that are not complicated. Accordingly, most of our patients who need drugs will have already gotten them before a psychiatrist or a psychologist begins a specialized assessment. This is recognized as the best practices based on—

12:15 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

There is no doubt that there have been advances in research and development. Earlier, you shared your opinion by talking about the difference between post-traumatic stress disorder from a peacekeeping mission and post-traumatic stress disorder from Afghanistan. I do not necessarily agree with you, but I am no expert.

Many soldiers who took part in missions such as the one in Bosnia are now veterans. Would it be a good idea to have them take part in the study, which would in turn provide more samples and help in making new discoveries? In light of that study, you might realize that we should have given these soldiers, who are now veterans, specific drugs or treatment, or provided them with certain support. Is there any interest in looking to the past, and acknowledging our mistakes and that we should proceed in a different way? It is good to help our current soldiers, but let's not forget those who have been veterans for a number of years now and all those who will become veterans. Your study is important in that sense.

12:20 p.m.

BGen Jean-Robert Bernier

In fact, last week we met with researchers from McGill University who are looking for serving and retired members of the military in order to conduct a study that will evaluate certain new technologies.

12:20 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

Is there an interest in the treatments?

12:20 p.m.

BGen Jean-Robert Bernier

The Canadian Armed Forces health services cannot provide the treatments directly. That is a problem. In our country, we have socialized medicine and health care is a provincial jurisdiction. With the exception of its 10 mental health clinics, Veterans Affairs does not provide health care directly. Our group is integrated and Veterans Affairs...

12:20 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

Nevertheless, the knowledge required to properly assess cases of post-traumatic stress disorder and provide services and treatment accordingly is not found in the provinces. We all agree that the problem of PTSD really is an area of expertise of the Canadian Armed Forces. I know that there is co-operation, but to what extent does that solve the problem?

12:20 p.m.

BGen Jean-Robert Bernier

Knowledge is shared across the country. Our group is plugged into all clinical community services so that it forwards new information emerging from our research. Veterans Affairs Canada is doing the same thing.

12:20 p.m.

NDP

Jean-François Larose NDP Repentigny, QC

According to the reports, veterans and regular and reserve force members say that services offered to families are inadequate. The wait times that you are working hard to reduce for members of the armed forces are not diminishing in the civilian system. According to the reports, it seems that the problem is being handed over to the civilian health system. At the same time, the armed forces recognize that civilian health care is not adequate for post-traumatic stress. You are the experts on that subject.

Does the government intend to change provincial participation in this area?

12:20 p.m.

BGen Jean-Robert Bernier

That goes beyond my mandate, which is limited to the health care provided to members of the Canadian Forces.

Veterans Affairs Canada would be able to answer that question.

Regardless, we help them as much as possible—

12:20 p.m.

NDP

The Vice-Chair NDP Jack Harris

Thank you, General.

Your time is up, Mr. Larose.

We now have Madam Gallant. Or is it Mr. Bezan?

12:20 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake, MB

I'll go first. We'll have time for another round anyway, so I'll take five minutes and Madam Gallant will go in the third round.

12:20 p.m.

NDP

The Vice-Chair NDP Jack Harris

Mr. Bezan.

April 8th, 2014 / 12:20 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake, MB

I want to come back again to the issue concerning the number of medical health professionals.

You mentioned, General, that we're going through a review. Colonel Blais mentioned it when he appeared here on April 1. The ombudsman's report also raised the question of staffing. There were 40,000 troops deployed who have returned home from Afghanistan, and we aren't sure when some OSIs are going to present themselves over the next number of years.

Can you give us some indication? I know you're still in the review, but when do you plan to reach a conclusion about what the right numbers are and what the mix is? And where do you already see that there could be some need for improvement?

12:20 p.m.

BGen Jean-Robert Bernier

Thank you, sir.

As I mentioned earlier, by early 2015 we expect to receive the results of the Statistics Canada mental health survey and the health and lifestyle information survey, which will give us better global data to help guide the optimum distribution and requirement.

We already have some good data. The operational stress injury cumulative incidence study permits us to project out, over about a decade, what we can expect for Afghanistan-specific related operational stress injuries. But we need more than that. We're trying to now update what we did in 2002 and 2003 for the global Canadian Forces requirement. As I mentioned, Afghanistan-related operational stress injuries constitute a minority of our global mental health problems.

We have adjusted incrementally over the years. It has crept up from 447 to 452, based on our evaluation of the success of the road to mental readiness program and various other evaluations, including the operational stress injury cumulative incidence study, but these have been piecemeal evaluations and tweaks based on limited data. Now we have spent the last year, before producing this strategy, to look at all the available data. We are now just waiting for these two missing pieces, these comprehensive studies, to give us everything we need to get the best possible determination of the distribution in the future and the number, the volume of care.

We're already at double, on average, what the civilian population has per capita and we have the highest ratio per capita of mental health clinicians within NATO. But is that enough, or is it too much, or will technology permit us to change things because things have changed?

12:25 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake, MB

Thank you.

One thing we heard from members when we were meeting with them is that, if they're at the JPSU and have made the decision to transition out or are at the cusp of making that decision, they have a lot of anxiety over their life after the military. We heard from a lot of them that they would like to stay involved in DND.

Ms. Rigg, could you talk to the fact that there is a desire among so many veterans and people who are currently serving members of the CAF to be still involved with DND? What types of opportunities would they have in coming back as civilian employees within DND? What policies does DND have concerning hiring veterans?

12:25 p.m.

BGen Jean-Robert Bernier

It's not my area, but I know that releasing veterans are eligible to transfer to elements of DND that permit them to stay up to age 65 in the cadet instructor cadre and with the Canadian Rangers; there are limited positions there. There's legislation that was passed recently giving priority for public service hiring.

12:25 p.m.

Director General, Civilian Human Resources Management Operations, Assistant Deputy Minister, Human Resources - Civilian, Department of National Defence

Jacqueline Rigg

Let me add that we have several programs in place on the civilian side to support and to look after ex-military folks who want to still stay working within the Department of National Defence.

On the civilian side, we have available to them the employee assistance program or EAP. We have a return to work program that is very useful. They have a worker who works with them to figure out how to get them back into the workplace. We also have a policy called duty to accommodate; we therefore have that in place. If there are any accommodation requirements, we have a duty to meet those, and we provide support that way. There are also leave provisions, provisions that are negotiated through our collective bargaining.

Those are several of the main ones that we have. But absolutely we encourage and support our ex-military in the civilian workforce.

12:25 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake, MB

Are there any barriers for ill and injured who are transitioned out? What barriers are there to actually being integrated within a DND context?