Veterans Affairs Committee on April 29th, 2009

[Phil McColeman, Conservative, Brant, ON]

So it can happen at any time. If you wouldn't mind, I'd like to understand more: what are the major symptoms you see in these folks?

[Doug Clorey]

As for what we see, I'm not a clinician, so--

[Phil McColeman, Conservative, Brant, ON]

No, that's fine.

[Doug Clorey]

--that said, we see a reliving of the experience. When they start exhibiting symptoms of PTSD, these individuals start reliving what they've experienced, very often with great anxiety.

They start to look at separating themselves in safe places. Very often, you will find individuals with PTSD who cannot live in a home, in a traditional kind of setting. They have nightmares, sleep disturbances so that they can't sleep, paranoia, and very often depression. It tends to be a combination of a variety of symptoms that could in their own right be considered mental health conditions.

That is the complexity around PTSD, because it's kind of an amalgamation of a whole series of mental health conditions all rolled into one.

[The Chair, Conservative, David Sweet]

Thank you, Mr. McColeman.

Thank you, Mr. Clorey.

Now we'll go on to the Liberal Party, with Mr. Andrews, for five minutes.

[Scott Andrews, Liberal, Avalon, NL]

Thank you, Mr. Chair.

Thank you for coming in today.

I'd just like to get into the new Veterans Charter a little bit, get your understanding, and pick your brain a little on moving forward and where we go. Tilly just asked the question; it's been three years now and it's working well. How often would you suggest that you make changes to the charter?

[Darragh Mogan]

It may be less a matter of frequency, although if you look at the original Veterans Charter between 1946 and 1953, I think there were three separate periods when that was amended and changed. By the time of the Korean War, there was a statute passed called the Veterans Benefit Act, which added to the World War II Veterans Charter.

To answer your question, though, we try to focus on the wellness and the successful transition to civilian life, with the benefits and services that are there, and allow experience, plus a formal evaluation that we're now undergoing for the new Veterans Charter, to identify gaps. We've already identified some gaps in family support. We're doing this with a large advisory group called the New Veterans Charter Advisory Group, which we just met with today.

On the degree of economic support while someone's on rehabilitation, the question may be, for instance, is it adequate to ask a family of four to survive on 75% of a private's salary for two years while a private is going through rehabilitation? It's better than what was there pre-charter, but it may not be a reasonable thing to ask someone to do. In other words, you may be setting individuals up for failure by not providing an adequate amount of income support while they're going through rehabilitation.

The other area, then, in addition to family services, is the mental health area. We've made extensive progress within existing authority, but I think it's pretty imperative to look at gaps in that area.

As to timing, when we have the information that's there and when the government of the day is satisfied that it's ready to move and has the resources, that's when the movement will be there. We want to build, as I think anybody would want to build, a fairly strong consensus among modern veterans that we've identified where the gaps are. The foundation of the new Veterans Charter is solid, but we've identified where the key gaps are and we can fill them in a timely fashion.

[Scott Andrews, Liberal, Avalon, NL]

Did you say you have a group right now within the department reviewing the charter?

[Darragh Mogan]

We have a group right now called the New Veterans Charter Advisory Group, which is made up of veterans organizations, experts in the area of disability management, and psychological care. It is providing guidance of a professional nature to the government on the experience of the new Veterans Charter and changes that may be needed.

That's certainly not the only area where we're going to draw evidence, but it's one of the key ones where you get a mixture of veterans advocacy groups with a lot of experience and a mixture of academics and health professionals.

[Scott Andrews, Liberal, Avalon, NL]

Do they have a timeframe for their reporting?

[Darragh Mogan]

They'll be reporting some time this year on their deliberations. That will be a public report, and I'm sure your committee will be interested in talking to members of that group, and they're more than willing to be here, I think.

[Scott Andrews, Liberal, Avalon, NL]

Is that the only group you have reviewing it right now?

[Darragh Mogan]

We have a formal evaluation done by our evaluation directorate, which steps outside the current frame and looks at the overall outcomes and effectiveness of the program. It also tries to answer the question that was already asked about whether it is the right trade-off between a disability pension and disability award in terms of investing in wellness? That's a broad two-year evaluation. It was a commitment when there was all-party agreement on this, that this would occur within the first two or three years.

[Scott Andrews, Liberal, Avalon, NL]

And what is the timeframe on that?

[Darragh Mogan]

The first stage of that will be finished this year. It's a two-year one, so it will be done in about 18 months to two years.

[Scott Andrews, Liberal, Avalon, NL]

Will that be a public document?

[Darragh Mogan]

It is a document for your use here and for the public.

[Scott Andrews, Liberal, Avalon, NL]

I'm just getting to slide 35, where you've looked at some ways to amend. I don't know if you want to elaborate on any of these in particular, but I'm curious about the needs-based policy review. Are you identifying something there now that is not needs-based? What's the thinking behind reviewing that?

[Darragh Mogan]

I think when we look at pre-charter, it will give you a bit better context for considering that. We had run programs—for example, the disability pension program was an entitlement-based program. In other words, if you had the disability you got this much money; it didn't matter whether you needed it; you just got it; it was a compensatory program. That was the only program we had, so our policy framework for helping somebody was all entitlement-based. What would happen—it wasn't the intention it would happen—over time is the only way you could get more money or more support was to show that you were more ill. If you were more ill you could certainly get that, but you didn't want a system in place that encouraged that. So we had a number of policies that were entitlement-based rather than wellness and needs-based.

So what we are attempting to do is revise as many policies as we can, especially those focused on the modern veteran, to make sure we're responding to the need and not creating a financial dependency that inadvertently encourages illness. That was the policy foundation of the new Veterans Charter. It's not by any means a way of saying there are going to be benefits denied to individuals. In fact, some benefits will be offered to individuals who have greater need, which we haven't been able to do up until now.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Mogan.

Thank you, Mr. Andrews. You're well over the five minutes there, but I think by your questions you've identified a pool of witnesses who we'll want to call before the committee during our own review of the charter that's scheduled.

To the Conservative Party, Mr. Lobb, for five minutes please.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Good afternoon, and thank you for coming.

I would like to say that in the riding I represent, Huron—Bruce, there is a large number of troops who are current members of the forces, and it's reassuring to know about the veterans programs that are there, the new charter that's there, to take care of them in time of need and time of transition. So I know they'll be well served in the future.

Under the rehabilitation, what I found very interesting was on slide 10. I really like the idea of the case managers not only working with the client but working with the families and the extended families. I just wondered if you could broaden that out a little bit and give us an idea of where that idea came from and the kinds of successes we're seeing with that. I can imagine that is a very successful strategy.

[Brenda MacCormack]

Rehabilitation, by its very nature, is about working with an individual and their family, and certainly recognizing that the family needs to be part and parcel of any kind of rehabilitation moving forward.

Case management provides that kind of stabilizing influence, that one point of contact, where the case manager can work with their client, work with external community resources, work with professionals involved in the care of the veteran and the family, and help them navigate through the system, advocate for them in times when that is necessary, help them establish goals, and help them determine what kinds of intervention need to be in place to get them help. That personal relationship with the case manager is paramount.

In terms of working with the family, it's certainly recognized that when we have some of the complex veterans health needs we see before us, families--children and spouses--will be impacted because of the very nature, in particular, of the mental health types of impacts.

To achieve that comprehensive, integrated kind of approach that the rehabilitation program provides, case management is the means by which we do that.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Again, it is impressive, the numerous references in your report on mental health, dealing with that straight on, and dealing with any addiction issues that may lie therein.

On the rehabilitation front, many of us are from rural Canada. I represent a rural riding. Could you give me a sense of how that care works for people in rural communities and how that outreach works and develops?

[Brenda MacCormack]

In terms of the actual service provision, we certainly have capacity across the country to engage service providers, whether they're providing medical care or psychological counselling. I think you've had a good appreciation from Mr. Clorey around the importance of the infrastructure he's helping to build so we have the mental health capacity to work with these clients, whether it's counselling, family counselling, social work.

There is a capacity through the provider network across the country. As well, we have a national contract with a vocational rehabilitation provider who has access to clients, provides services all across the country, and if necessary will travel to assess clients and provide them the services they need.

[Darragh Mogan]

I'll add that it would be misleading to suggest we're going to have as many services available in Tobermory as we have in London. I think you know that.

What we do have are itinerant counsellors who are trained case managers. We do have the national contract Brenda referred to, and we do have a network of voluntary and professional suppliers in the area. We will not ignore someone who is a reservist or someone who lives in Tobermory who's having a struggle with transition. We will not ignore them. We may not be able to supply the service independently to them, as we could in London or Chatham or places of that nature, but they will not be ignored and they will not be asked to leave their environment in order to get service.