National Defence Committee on Nov. 21st, 2013

[Elizabeth Steggles]

Yes.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Is that what you are recommending?

[Elizabeth Steggles]

Yes.

I'm sorry; I really can't give you the numbers, except to say that the scope of practice of occupational therapy looks at anybody who has a physical or mental health condition, so it would be those numbers. It may be a very limited contact with those people or it may be something that goes on for several years.

I'm sorry that I really can't answer your specific question, but I can find out and get back to you with that.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Okay, thank you.

Mr. Ferdinand, you mentioned a number of times in your testimony that you do not have information and that prevents you from determining the real needs. I am sure you are aware that Statistics Canada conducts a survey called the Canadian Community Health Survey. It is modular in form, meaning that, for a certain period, every department can add a module about the particular aspect of health they deal with.

Could the Department of National Defence explore that possibility? It could add a module every six months, every year or every two years that would deal specifically with the mental health of military personnel. You would then also have access to more information, which would allow you to make better decisions and come up with better recommendations. What do you think about that?

[Mark Ferdinand]

Yes and no. The department already works with people from Statistics Canada. They take part in program evaluation and they conduct one-off projects for the department. So, as I understand it, there is already a relationship between the department and Statistics Canada.

That said—and the answer to this part of your question is yes—those surveys are not regular. Since they are not really regular, we cannot really determine trends over time. The surveys could take place every two or three years. It would depend a lot on the department's or the Canadian Forces' strategy.

If I were to make one recommendation, it would be to standardize the kind of survey a little. That would help us to determine the needs of the soldiers and their families. It would let us tie the forces in with community services more fully. It is difficult to plan without that data.

[Tarik Brahmi, NDP, Saint-Jean, QC]

Thank you, Mr. Ferdinand.

Mr. Dawdy, you mentioned a clinic approach whereby people go to participate in winter sports for a week.

Could the approach work all winter at military bases located near ski resorts? Have you thought of that?

[Clay Dawdy]

As we mentioned, we certainly think that CFB Valcartier is close to Mont Sainte-Anne, which is excellent. I'm not fully aware what the facilities are for adaptive skiing at Mont Sainte-Anne. I know that we have a program there.

There is certainly a possibility for more regionalization right across the country. What we really would like to do is introduce a host of adaptive sports that we could demonstrate to the newly injured soldiers and veterans to show that these are possibilities they can succeed at.

[The Chair, Conservative, Peter Kent]

Thank you very much.

Mr. Bezan, please.

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

Thank you, Mr. Chair.

I want to thank our witnesses for appearing today and for the great work you're doing with our military members as well as veterans, and indeed all Canadians, in providing the services you provide.

My first question is to Ms. Steggles.

You're talking about occupational therapy, and I think this is a critical profession. I witnessed it first-hand with my mother after she had a stroke and saw how important it was. Her recovery was really dependent upon the occupational therapy she received to be able to go back home and live independently and do the things she loves to do. I totally appreciate your profession and the services you provide.

Were you aware that the Canadian Forces Health Services Group has a physical rehabilitation program, with seven centres of excellence across the country that include at least one physical therapist and one occupational therapist?

[Elizabeth Steggles]

I know of those facilities across the country, but they do not each have an occupational therapist.

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

They don't, so far?

But they're also instructed to work with civilian providers as much as possible. So your membership is working with those centres, I would hope.

[Elizabeth Steggles]

Yes.

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

If they don't hire locally, then it is important that—

[Elizabeth Steggles]

Yes, but it goes back to the issue of their not necessarily understanding the specific needs of military personnel.

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

In the wellness action plan that you're recommending, you want to have more integration, with their either being directly hired within the health services directorate of the Canadian Forces or having more cross-training so that they can better serve the members at that level of health.

[Elizabeth Steggles]

Both, I would say, would fit in with the current model.

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

Okay.

My next question is for Mr. Ferdinand.

We have all been hearing a lot about mental health issues—PTSD, operational stress injuries—and we as a government have increased dollars to mental health by more than $50 million a year now. We have hired currently 378 mental health professionals within mental health services, and we're trying to hire more.

Is that enough? We always hear that we have a higher ratio than our allies of mental health workers to soldiers. Do you think we've gone far enough, or do we need to go farther?

[Mark Ferdinand]

Any good health program based on guidelines published by the World Health Organization would suggest that you need to start a population need first and then determine what types of resources you need in order to meet that population need.

I don't know immediately; I can't say whether these are enough. When you look at the general context, you have to take into consideration what types of operations are ending, who will be coming back to Canada, and what percentage we could predict, among those who are coming back to Canada, will possibly experience a mental health issue for which we'll need very specific types of services.

Good planning is based on an appreciation of all of those different variables, so it's difficult to say whether this is enough. We heard earlier that there are a number of soldiers returning from tours internationally. The Surgeon General's mental health strategy notes that there are people here in Canada already serving in different roles.

Is it enough? It's all based on population need. We don't have special knowledge as to what the forces are doing with regard to the implementation of their strategy, so it is difficult to say whether it is enough. What we can say is that we are pleased to see that there was that hiring, because we know there was a lack of mental health professionals to begin with several years ago when we collaborated on some of this work with Veterans Affairs, DND, and the RCMP.

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

Would you have any comparison, taking the Canadian Forces population and that of the provinces or of Canada in general? Do we have a higher ratio of mental health workers at the Canadian Armed Forces level than the civilian population has?

[Mark Ferdinand]

This may be simply my own personal conversations with Statistics Canada or someone else, but the reality is—and the mental health strategy actually points this out—there are wait times associated with mental health services for all of Canadians, and we know that from surveys that have been done by Ipsos-Reid with the Canadian Medical Association. We know what the wait times are.

Apparently, wait times and affordability are not issues the Canadian Forces necessarily deal with. But there are still some challenges with regard to the supports they may not be receiving in a timely manner because of geography.

I think we heard of some of those challenges. When you look at the number of centres that exist across this country for forces, they are not as numerous as one would like. There are great geographic distances for some people to travel in order to get the care they need.

[The Chair, Conservative, Peter Kent]

Mr. Harris.

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

Thank you, Chair.

Mr. Ferdinand, your original comments suggested that your organization was supportive of and generally pleased with the Surgeon General's mental health strategy. But did I get it right when you said you really had no knowledge of how good the implementation was, or how successful the implementation was? Did I get that right?

[Mark Ferdinand]

That's correct. We just have not read the evaluation reports that we know are planned for and that have been done, but we know they have been planned for and have been done. So I can only assume they're telling the forces something with regard to the types of services they need to have in place. But we just don't have special knowledge with regard to how these services are evaluated.

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

But you like the theory.

[Mark Ferdinand]

Well, the theory, as well as what we saw maybe 10 or so years ago when we were first involved and what we're seeing now.... There's a world of difference in terms of things being structured in a way that's more person-centred.