Evidence of meeting #21 for Veterans Affairs in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was released.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Alice Aiken  Director, Canadian Institute for Military and Veteran Health Research
  • David Pedlar  Director, Policy and Research, Department of Veterans Affairs
  • Charlotte Bastien  Regional Director General, Quebec Region, Department of Veterans Affairs
  • Stéphane Lemieux  Team Manager, Client Services, Department of Veterans Affairs

3:35 p.m.

Conservative

The Chair Greg Kerr

Okay, folks, we're at the appointed hour.

I'd like to welcome our witnesses today: from the Canadian Institute for Military and Veteran Health Research, Dr. Alice Aiken is here with us today, and Susan Marlin, chair of the interim board of directors. From the Department of Veterans Affairs we have Charlotte Bastien--good to see you--and Dr. David Pedlar, director, policy and research. Good to have you here.

You know the study we're on, of course, and we're continuing along with the study of front-line health and well-being of veterans. We've had quite a few witnesses and some visits, and we're moving along quite well, so we look forward to today.

What happens is that we allow ten minutes for each. So we will start, and then the witnesses will answer questions from the members of committee.

So having said welcome, I guess we're starting then with you, Dr. Aiken. Welcome.

3:35 p.m.

Dr. Alice Aiken Director, Canadian Institute for Military and Veteran Health Research

Thank you very much.

Good afternoon, ladies and gentlemen of the Standing Committee on Veterans Affairs, and thank you very much for the opportunity to present to you today.

I am Dr. Alice Aiken, the scientific director of the Canadian Institute for Military and Veteran Health Research. I'm a university professor in rehabilitation therapy, and I am a proud veteran, having served in the Royal Canadian Navy for 14 years.

With me today is Susan Marlin, the chair of our interim board of directors and the associate vice-principal of research at Queen's University.

This institute and what it represents is near and dear to my heart, and I'm very excited to be able to inform you about CIMVHR and the role it plays in advancing research that will benefit veterans, military personnel, and their families.

In November 2010, Queen's University and the Royal Military College of Canada established the Canadian Institute for Military and Veteran Health Research, with the full support of Veterans Affairs Canada and the Department of National Defence. Until then, Canada was alone among our major military allies in not having such an institute. This academic institute, which extends from east to west across Canada, comprises 21 universities and over 150 researchers, and is still growing. We've joined together to respond to government priorities for research on the unique health and social consequences that impact military personnel, veterans, and their families—those who have sacrificed so much for our country.

With over 700,000 veterans in Canada and more than 100,000 serving personnel, we have a significant population with unique risks, exposures and experiences that demands new standards of protection, prevention and care for ill and injured military personnel, veterans, and their families.

As of now, more people have served in Afghanistan than served in Korea. We have the largest number of injuries since the Korean War, and these injuries are more complex. Parliament has been advised that one in five of those who served in Afghanistan and our other recent missions will suffer from mental health issues, and we have no idea if the scope of the problem is in fact this limited.

The Canadian Institute for Military and Veteran Health Research is an innovative organization that engages existing academic research resources and facilitates the development of new research, research capacity, and effective knowledge exchange. This institute serves as a base for all Canadian stakeholders interested in military and veteran health research, and provides a channel between the academic community, government organizations, and similar international organizations.

CIMVHR's mission is to optimize the health and well-being of Canadian military personnel, veterans, and their families by harnessing and mobilizing the national capacity for high-impact research, knowledge creation, and knowledge exchange. The institute's research focuses on outcomes that translate into programs, policies, and practices that can rapidly impact the lives of the beneficiaries. CIMVHR is focused on ensuring that Canada's best researchers are engaged in research that is fully coordinated with national and international agencies to ensure that they complement, not duplicate, existing research activities.

The Canadian government has provided our military going into battle with the best training and equipment in the world. We must ensure, when these soldiers return to their new battlefield—a personal battlefield that's marked by physical and mental injuries, and social challenges in reintegrating into family and civilian life—that we provide them with the same level of support. This support must be based on the best evidence possible resulting from research by the best and brightest Canada has to offer.

CIMVHR's vision is that the health and well-being of Canadian military personnel, veterans, and their families will be maximized through world-class research, resulting in evidence-informed practices and policies.

In order to see this vision through, CIMVHR has focused on building support and partnerships with individuals and organizations: professional associations like the Canadian Medical Association; foundations like the True Patriot Love Foundation and the Rick Hansen Institute, research institutes such as the Centre for Addiction and Mental Health, the Royal Canadian Legion, and the Congress of Social Sciences and Humanities, to name a few.

In fact, your own minister, the Honourable Steven Blaney, has said:

With the return of troops from Afghanistan,...it'is more important than ever to have a network of academics and researchers who can provide insight and intelligence into the long-term effects of military service, especially in the areas of mental health, complex health needs and families. With the extensive network of American research institutes, the Australian Centre for Military and Veterans' Health, and the recently created Canadian Institute for Military and Veteran Health Research, our nations will share findings and look for further opportunities to collaborate.

CIMVHR is creating ways to collaborate through our annual military and veteran health research forum. Last year's forum was hosted in Kingston, Ontario, from November 14 to 16. This major event had an audience of over 450 stakeholders, researchers, military and civilian personnel, members of industry, eminent keynote speakers, and national and international representatives. The highly interactive forum featured 12 keynote speakers, including two from the United States, one from the United Kingdom, and your minister. It had 31 scientific posters and 110 quality research presentations focusing on significant aspects of mental health, operational and environmental health protection, physical and mental rehabilitation, combat casualty care, health policies and programs, and transition from military to civilian life.

Our soldiers are returning from a difficult ten-year combat mission and they are already preparing for future deployments. Our country has a social covenant with these Canadian sons and daughters, husbands and wives, mothers and fathers, who we send into harm's way in defence of the freedom and quality of life we all enjoy.

The academic community is mobilized, our partners are committed, and Canadian pride in our veterans is strong. Just as our soldiers have served side by side in troubled spots around the globe, let us work together in a new coalition to help them as they come home to their own personal battlefield.

Merci.

3:40 p.m.

Conservative

The Chair Greg Kerr

Thank you, Dr. Aiken.

We'll now go to Dr. Pedlar.

3:40 p.m.

Dr. David Pedlar Director, Policy and Research, Department of Veterans Affairs

Thank you, ladies and gentlemen of Parliament. Thank you for the invitation today.

My name is Dr. David Pedlar. I'm the research director at Veterans Affairs Canada. I work in Charlottetown. My colleague Charlotte Bastien joins me today.

The work of your committee on the health and well-being of veterans is very important, and various colleagues at Veterans Affairs have been here to talk to you about it. In fact, last December my colleague Janice Burke introduced you to the life-after-service studies. These are studies that are providing critical information to the department as we continue to integrate our research findings into our programs and services.

I welcome this opportunity to give you more detail about these studies. As you might recall, the life-after-service studies research program was a partnership of Veterans Affairs Canada, the Canadian Forces, the Department of National Defence, and Statistics Canada. It was for understanding the transition from military service to civilian life and the short-term and long-term health effects of military service on the later life courses of veterans.

We're excited about what we're learning from these studies, partly because in the past our evidence on this subject was related only to VAC clients—that's about 11% of the post-Korean War CF veteran population in Canada. Up until now, we've had very little empirical data on the veterans who weren't receiving benefits from Veterans Affairs. That's the majority of veterans in Canada. These studies have changed that. The studies include both veterans receiving benefits from the department and those who are not, and we can make comparisons with the Canadian population.

We use a population health approach. This allows us to understand what may cause disease and what keeps a population healthy. It also allows us to answer critical questions about life after military service and about whether transition needs are being met.

I'm proud to say that this work puts VAC at the forefront of research on transition. It's a unique piece of work, which is generating real interest in the academic community but also among our international veterans affairs partners.

We're seeing more interest in this area, and we are taking all work, nationally and internationally, into consideration, including the work of people such as my colleague Dr. Alice Aitken. As you know, the department has already put in place improvements, through the Enhanced New Veterans Charter Act, to enhance the financial supports in place for our most seriously disabled veterans. Within VAC we make sure that the work has a practical application in the benefits and services we provide veterans and their families.

Now let's talk about what we've learned. There were three studies released in 2011. The first one looked at income before and after service, because we know that income is critically important to health and to security. The second was a population health survey of living Canadian Forces regular personnel who were released over a ten-year period, from 1998 to 2007. We looked at health, disability, and a range of determinants of health, such as income, employment, and social support, among others. The third was a mortality study; it looked at causes of death among current CF members and former personnel.

Let me share with you some of the findings from the study. First, let me tell you about some of the positive findings. First of all, 65% of that group who transitioned felt that they had an easy adjustment to civilian life. Second, as a whole, released Canadian Forces members were less likely to experience low income compared to other Canadians. In fact, they were about 50% less likely than other Canadians to have fallen below the Statistics Canada low-income measure. Less than 2% experienced persistent low income, which is low income that has continued.

Almost 90% worked after release, and the majority were satisfied with their work. Veterans were no more likely to experience unemployment. The unemployment rate was about 8% at the time of the survey, which was comparable to the general population.

On the question of death, male veterans had a 23% lower overall risk of death from all causes combined compared to the general Canadian population.

Finally, veterans were more likely than other Canadians to have a regular medical doctor and health care coverage.

I'll now go on to some of the findings that point to a challenges in this population and to some of the actions we're taking. While the findings I just mentioned report an overall lower risk of premature death, there was an important exception to this finding. That pattern was for suicide. Male veterans had a 46% higher rate of death from suicide. That is in the release population. With respect to these findings, we have been taking concrete research actions but also program actions in the area of suicide prevention.

Of course, there are issues of disability that do not result in death. For example, the rates of musculoskeletal disorders, which would be things like arthritis and back problems, pain, chronic pain, anxiety disorders, and disability are higher in the survey population than the Canadian population. Arthritis is reported at almost twice the rate of the general population, as are back problems.

Many of these conditions were concentrated in an important group of veterans who had what I would describe as very complex states of health. I have come to call this pattern the triple threat. That is veterans who suffer from musculoskeletal disorders--arthritis and back problems--mental health conditions, and chronic pain. That accounted for 16% of veterans in the survey. So we are focusing on these health issues in the analyses that we're doing so we can support the development of health care programs to support this group even better.

We also learned there are veterans out there who may need our help but may not be coming to us. For example, 17% of veterans who are not VAC clients reported they had a difficult or very difficult adjustment to civilian life, and 13% who are not our clients reported they have a mental health condition. This speaks to issues with program reach and communications to veterans. To address this we are working closely with our colleagues in communications outreach and engagement and national defence to try to reach these at-risk groups and to improve our communication with veterans.

As we spend more time looking at the data and focusing on smaller groups we're finding some groups have a disproportionate share of challenges. For example, low income was more prevalent among those released at young ages, those who were released involuntarily, and those who were released at lower ranks.

Another dimension of income is how much the income declines after they leave. We found that female veterans at release experienced one of the greatest declines in income.

While the majority did report a good transition experience, a sizeable minority, about one in four, had a difficult or a very difficult transition experience. Those who were more likely to have had a difficult experience included those who were medically released; those who were separated, widowed, or divorced; and those who had 10 to 19 years of military experience. They were in the middle.

There are subsets of veterans with very complex health needs, and we need to ensure our programs provide the support they need. Our case management function will play a critical role in addressing these concerns.

So there is a spectrum of health in this population of released members. Many are doing well. However, there are also some who have challenges, and a significant minority have complex states of health. According to our estimate, about 16% have this triple risk, if you will.

We are very active on the research side. In addition to some of the actions I mentioned earlier, such as the work on suicide prevention, we are continuing to be very engaged with knowledge exchange and making sure that these findings get out to end-users in the Department of Veterans Affairs, the Department of National Defence, and the Canadian Forces.

We are conducting further analyses on many fronts, including mental health, physical health, the income data, and a better understanding of those veterans who are not receiving services from Veterans Affairs. In addition, we are using the findings to improve aspects of VAC's policies, programs, and services, including disability benefits, programs, health care, case management, and informing health professionals.

A note: in these studies we were not able to look at those veterans who are members of the primary reserves. This is an area of interest to Veterans Affairs, the Canadian Forces, and the Department of National Defence. There are suggestions that reservists may have a more difficult time transitioning, but I do not have enough information to share on that today. This is a challenge that we and our international partners are facing as well, as reserve members become more and more active in armed forces operations and activities.

Thank you very much for the opportunity to share some information on the life-after-service studies with you this afternoon.

3:50 p.m.

Conservative

The Chair Greg Kerr

Thank you, Dr. Pedlar.

We'll now move to the committee members for questions. We'll start with Mr. Stoffer for five minutes.

February 14th, 2012 / 3:50 p.m.

NDP

Peter Stoffer Sackville—Eastern Shore, NS

Thank you, Mr. Chairman.

Ladies and gentleman, thank you all very much for coming today; I greatly appreciate it.

Dr. Aiken, you talk about the military and their families. Do you deal with this research with RCMP members and their families as well?

3:50 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

We have endeavoured to engage the RCMP as well. We have engaged other police forces as we see the research spinning off to other first responders. Any of the research that would be combined with Veterans Affairs that has an RCMP component to it would also come under that if the researchers are working with Veterans Affairs and they have RCMP, but despite several attempts we have not been able to approach the RCMP directly. They haven't engaged yet, but we're still working on it.

3:50 p.m.

NDP

Peter Stoffer Sackville—Eastern Shore, NS

Thank you.

Dr. Pedlar, you indicated that 65% thought they had an easy adjustment to civilian life. Have you mined that down even further to determine their rank? What I'm finding is that if you're a general or a colonel and you have 30 to 35 years of service with a decent pension, you can adjust to civilian life a lot easier than a private or lieutenant in that regard. Someone who has been medically released has more challenges. Did your research actually mine it down by rank of the individual, to see how they did in civilian life?

3:50 p.m.

Director, Policy and Research, Department of Veterans Affairs

Dr. David Pedlar

In fact we have done some of that already. That's one of the major areas we're working in right now. You are basically right, not everyone experiences transition the same way. In fact, some people had a very difficult transition. Members who had involuntary release had a lot of difficulty with transition. This is an administrative category that covers a number of release types you might be aware of.

Another area is recruits and members who served for a shorter period of time. In the recruit group, it looks like some people leave and do well because they may have opportunities outside the armed forces. Some leave for other reasons and may run into difficulties after they leave.

Another group is those who serve from 10 to 19 years. People who leave earlier in their career may have opportunities. Those who leave later in their career may have superannuation in place. One group that can have trouble is those who are in the middle, at 10 to 19 years. Rank also plays a role in almost all of the dimensions we've looked at. A lower rank has lower income and other kinds of problems, whereas someone who is at a higher rank might find the transition experience easier.

3:50 p.m.

NDP

Peter Stoffer Sackville—Eastern Shore, NS

On the document we have from Ms. Charlotte Bastien, she indicates halfway down that for 2010–11 more than 3,700 releasing members participated in a transition interview. We roughly have about 5,000 leave the service every year due to medical or normal retirement or through attrition. That means approximately 1,300 people are not going through a transition interview. May I ask why?

I assumed that when everyone was ready to depart—either a 3(b) release or an honourable discharge—there would be a transition interview. Not only are some folks with post-traumatic stress disorder having challenges, but I've known guys with 35 years of military service who have got out and a year later they were kind of lost. They didn't know what to do with their lives any more, because of that comfort level they had within the structure of the military lifestyle. Can I ask why the rest are not going through this transition interview?

3:55 p.m.

Charlotte Bastien Regional Director General, Quebec Region, Department of Veterans Affairs

First of all, it's voluntary. For the medical releases, we see everybody. For the voluntary releases, if people do not want to do an interview, we cannot force them. In that group there are the reservists, who are very hard to reach. It’s also hard to get them to sit down to do a transition interview. So part of that group would be the reservists.

3:55 p.m.

NDP

Peter Stoffer Sackville—Eastern Shore, NS

My last question before the good chair cuts me off is that you had indicated that the funding for this comes from the Department of National Defence, the Department of Veterans Affairs, and I assume some academic circles. You had also indicated the Royal Canadian Legion and the Military Families Fund. Is that correct?

3:55 p.m.

Director, Canadian Institute for Military and Veteran Health Research

Dr. Alice Aiken

We have liaised with several professional associations, as well as the Department of National Defence and Veterans Affairs. We haven't received direct funding from the government yet, but we have from some of the professional associations and the Royal Canadian Legion, etc.

3:55 p.m.

NDP

Peter Stoffer Sackville—Eastern Shore, NS

So you do get some funding from charitable organizations.

3:55 p.m.

Director, Canadian Institute for Military and Veteran Health Research