Veterans Affairs Committee on Sept. 29th, 2016

[The Chair, Liberal, Neil Ellis]

I call the meeting to order.

Good afternoon, everybody.

Pursuant to Standing Order 108(2), a motion adopted on February 25, the committee resumes its study on service delivery to veterans.

The last part of the meeting will be on committee business.

I'd like to welcome the witnesses today.

First we have, from Maison La Vigile, Nancy Dussault, director of nursing, and Denis Simard, director general. From the Veterans Transition Network we have retired Sergeant Doug Allen, program coordinator, Atlantic, and Oliver Thorne, national operations director.

We'll follow the same order. We'll give each witness group 10 minutes and then we'll start with questions.

We'll start with La Vigile.

Thanks, and go ahead.

[Jacques Denis Simard, Director General, Réseau d'accueil des agents et agentes de la paix (Maison La Vigile)]

Mr. Chair, members of the committee, good afternoon.

My name is Jacques Denis Simard. I am the director general of Maison La Vigile, and I am the founding president. We obtained our letters patent in 1999.

Between 1999 to 2012, we worked with other therapy centres in the Quebec City area. Since 2012, we have had our own therapy centre with our experts and workshops for those in uniform.

During my career, for eight months, between June 1970 and February 1971, I was a member of the Royal 22nd Regiment in Quebec City.

Afterwards, I worked for the Sûreté du Québec for 33 years, from 1972 to 2005.

In 1988, I was discharged from my police duties to work as a responder for the Sûreté du Québec's peer-administered employee assistance program in Eastern Quebec. During that time, I recognized the urgency of having a therapy centre to help our men and women in uniform specifically because of the many distress calls and cases that we had to handle.

I will now give the floor to Ms. Dussault, after which I will tell you about the services provided by Maison La Vigile.

[Nancy Dussault, Director, Nursing, Réseau d'accueil des agents et agentes de la paix (Maison La Vigile)]

Good afternoon, Mr. Chair.

Good afternoon, everyone.

My name is Nancy Dussault and I am the director of nursing at the Maison La Vigile.

I have been a nurse for 23 years now. I have worked in various settings: hospitals, rehabilitation and geriatrics. For the past 15 years, I have been working in mental health.

From 2002 to 2014, I was the coordinator of the first responders service team for the CONSTRUIRE en santé program of the Commission de la Construction Du Québec. This program is available to 250,000 insured. A phone line is available 24 hours a day. It is an emergency service for people with psychological, dependency, violence and physical health problems.

I went through a career change in May 2014, and I arrived at Maison La Vigile. I am the director of nursing and my main role is to assess the clients. I supervise the alcohol withdrawal process and the physical and mental health of the people at the Maison La Vigile.

In addition to my training as a nurse, I also have training in psychodynamic psychotherapy and I am now finishing a certificate in psychology.

I also attended many crisis response training sessions for suicidal behaviours, personality disorders, post-traumatic stress disorder and depressive disorders. In a nutshell, that's my career path.

I will now give the floor to Jacques Denis Simard to tell you about our services.

[Jacques Denis Simard]

The Maison La Vigile has four divisions. The first is the therapy centre, which has six distinct therapeutic services. I will come back to it later. The second is PAPV, the assistance program. The third is training. And the fourth component is research and development.

The star in the logo represents those who watch over others in society. It also symbolizes the lucky star of those protecting the public. It is also La Vigile's mission to protect those who come to meet us. The heart in the logo symbolizes the humanity of those people, the staff and the clients. The double bar is a roof, symbolizing the Maison, a place of comfort for those in uniform. You will also see in the logo three unidentified individuals, suggesting that all those in uniform have access to La Vigile therapy centre.

La Vigile therapy centre is in Quebec City. We can accommodate 16 people at a time for stays ranging from one week to one month. We are a not-for-profit agency that assists past and present uniformed front-line workers. We also provide a 24-hour help line to our clients and their families.

We are well known in the entire province of Quebec. Our clients include police officers, military personnel, veterans, firefighters, peace officers, health professionals—nurses, psychologists, social workers, doctors, pharmacists, and so on—family members, spouses and children over 18 years of age, persons retired from uniformed positions, and other members of the public as needed.

We provide two 30-day programs, the addiction program and the depression program. All our programs entail psychoeducational workshops and a cognitive behavioural approach, the approach recommended by health professionals, particularly for past and present uniformed members.

The addiction program provides an opportunity to follow an alcohol and drug withdrawal program under medical supervision. It is available 24 hours a day. We also provide one-on-one meetings with a worker twice a week, and more than 20 group sessions and weekly workshops on various addiction-related topics.

The depression program seeks to improve self-awareness and understanding of depression and its impacts, to develop coping strategies and to improve interpersonal relationships. It also includes the teaching of calming techniques and a personal development component with eight one-on-one meetings.

The short workshop on post-traumatic stress disorder, or PTSD, is part of the psychoeducational workshops. We focus on general facts about PTSD, core beliefs, symptom management strategies, managing emotions, cognitive distortions and various calming techniques. Our goal is to help program participants understand why they have certain ailments or certain negative thoughts and reactions. According to Kessler, 80% of people with PTSD also have another psychological condition.

Anxiety management focuses on signs of anxiety, cognitive distortions, coping strategies, automatic thoughts, risk factors for stress, self-medication risks, control strategies and calming techniques.

We also have an eight-day anger management program. The basic principle is that anger in and of itself is fine as an emotion, but that someone who channels it in a different way may end up in a bad situation. We look at anger and how it can be productive, the consequences of poor anger management, triggers, perceptions and reality, as well as the stages of emotional management.

Respite services are available to individuals who come to us and need some downtime for various reasons.

The length varies. It can take from two days to four and a half months. I will not elaborate, since I want to have time to finish my presentation.

The second division is the assistance program, PAPV. We have service contracts with Sûreté du Québec, the MRC des Collines-de-l'Outaouais and the CSN Fédération de la santé et des services sociaux to serve their clients with an external assistance program. All those employees have free access to the Maison La Vigile and external consultation, with no interview limit.

Our third division is training. We are experts in training those in uniform. We provide sentinel training and training on stress-related interventions in particular.

We provide sentinel training to police officers in the City of Lévis and the people of the MRC des Collines-de-l'Outaouais. We are also preparing training for the dispatchers of the City of Montreal Police Service.

We also provided in-house training to the firefighters of Lévis, Kingsey Falls and Danville, as well as the Radio-Canada cameramen and journalists. We also provided training on stress to the members of the Quebec City Police Service.

The fourth division is research and development. We give students from Laval University and CEGEPs an opportunity to do internships with us in psychoeducation, social services, as well as delinquency and addiction intervention techniques.

La Vigile is also organizing an international conference, in partnership with the École nationale de police du Québec. The conference will take place in 2018 and focus on health and public security issues.

That is the end of my presentation. Ms. Dussault will continue.

[Nancy Dussault]

I will provide you with some figures on the admissions of clients to our programs. From 2013 to 2015, 36% of requests had to do with an addiction issue, 32%, depression, 19%, respite, 8%, PTSD, 4%, anger management, and 1%, anxiety management.

It is important to understand that someone in one program, such as the addiction program, can also have a depression and PTSD diagnosis, as well as an anger and anxiety management issue. Furthermore, 58% of residents have suicidal thoughts.

The requests of Veterans Affairs Canada clients come mainly from the department's case managers, the operational stress injury clinic, the OSISS program—for the operational stress injury social support—or directly from veterans who call us. In that last case, the veterans are redirected to Veterans Affairs Canada to talk to a case manager who will then connect them with us for their application. Generally, the confirmation of the stay at La Vigile from Veterans Affairs Canada case managers takes less than 48 hours.

The main reason for admission of military personnel and veterans is addiction, meaning the alcohol and drug withdrawal program, which requires 24-hour medical supervision and participation in psychoeducational workshops.

La Vigile is the only specialized centre for those in uniform in Quebec that provides a 24-hour medical service for alcohol withdrawal. It is important to understand that alcohol withdrawal comes with risks, especially during the first 48 hours after stopping consumption. There are risks of convulsions, delirium and even death. The presence of medical staff is a must for the first 48 hours.

The respite service is also very much in demand for managing post-traumatic stress symptoms, anxiety, depression and suicidal thoughts, for developing a healthy lifestyle and dealing with home and workplace stress.

I will now talk about the criteria for excluding patients from our programs.

The nurse must complete an assessment...

[The Chair, Liberal, Neil Ellis]

Excuse me. We're down to 30 seconds. We'll have to wrap up quickly.

[Nancy Dussault]

...over the phone. The exclusion criteria are: high-risk alcohol withdrawal, where 20 or more drinks are consumed a day; imminent risk of suicidal, homicidal or violent threats; severe psychological instability, such as psychosis; aggressive behaviour during assessment or refusal to follow the centre's rules.

In terms of the percentages of use of our services, from 2013 to 2015, military personnel accounted for 22% of our clientele, veterans, 19%, other uniformed positions, 42%, and civilians, 17%.

So far, for 2016, military personnel have accounted for 12% of our clientele, veterans, 29%, other uniformed positions, 47%, and civilians, 12%.

Ninety-four per cent of our customers report that they are satisfied with the services received at La Vigile and that they achieved their treatment objectives.

This concludes our presentation.

We are ready to answer any questions you may have.

[The Chair, Liberal, Neil Ellis]

Great. Thank you very much.

Next is the Veterans Transition Network, for 10 minutes.

[Oliver Thorne, Director, National Operations, Veterans Transition Network]

Thank you very much.

Hello, everyone. My name is Oliver Thorne. I am the national operations director for the Veterans Transition Network, which is a registered Canadian charity and service provider to Veterans Affairs Canada.

Our mission as an organization is the delivery of our 10-day veterans transition programs across Canada. Our mission is to make those programs as accessible as possible to any veteran across Canada who may request them.

Essentially our program, as I said, is a 10-day group-based program with the mission of helping Canadian Forces service members and veterans to identify and overcome barriers to transition back into civilian life.

We break up those 10 days into three phases, or what we call three workshops, and each workshop has a particular focus. In the first place we're looking at building a cohesive group of those veterans so they can do this work together, so trust-building is very important in the initial stages.

We're then looking to teach communications skills, which we're encouraging the participants to use throughout the program, the idea being that by the time the program comes to an end, these skills will be second nature to them.

The whole basis is teaching skills and competencies that can be used in the transition back into civilian life, so phase one—the focus of the communications skills—is very much around reconnecting with family members and loved ones, perhaps after returning from service overseas or in that transition period on leaving the military.

Of those three workshops, there is a two- to three-week break in between each one. That's specifically designed so the participants are taking these skills back to their lives at home in between the program days and rehearsing those skills, and then returning to the group, reporting on what's working and what's not, and picking up new competencies along the way.

As the members return to the second phase of the program, the next four-day block, we are working on trauma education, psychoeducation, and providing any skills that we can to help them manage symptoms they may have of operational stress injuries or post-traumatic stress.

As we near the end of that phase, they would then return to their day-to-day life again to practise those skills and return for the final two days of the program on phase three. At this stage we're looking at long-term planning for life after the program, connecting them to continuing resources, such as one-on-one counselling or perhaps a career transition they may be looking at, and helping them make long-term plans for life after the program.

As a little bit of background about our program, it was developed first in 1997 at the University of British Columbia by Doctors Marvin Westwood, David Kuhl, and Tim Black. Over the next 15 years or so, it was researched and developed at UBC with funding from the Royal Canadian Legion in British Columbia.

In 2012 the Veterans Transition Network was incorporated as a not-for-profit, and is now a Canadian charity with the mission of taking that program across Canada and making it accessible to veterans. In the same year, Veterans Affairs reviewed our research and reviewed our program and accepted us as a service provider. We've been seeing Veterans Affairs clients now every year since, and we're up to roughly 50 clients who have now taken our program through Veterans Affairs funding.

For about two-thirds of the clients we see, we raise funds from the community in order to put them through the program, because they have either not accessed Veterans Affairs funding or the funding they do have with Veterans Affairs does not cover their attendance on the program.

Again, with our mission as an organization to make this program accessible, a large part of our day-to-day activities is raising the funds to put those members through who would not otherwise be able to access the program.

Since 2012 we've expanded from one province into six. By the end of the year we'll be in seven provinces. We're working to train both psychologists and clinical counsellors across Canada, as well as regional staff, such as retired Sergeant Doug Allen here, who is our man in Atlantic Canada.

We are working to create programs in both French and English, so we're currently training bilingual clinicians local to Quebec, and we anticipate that by the end of next year we will have delivered our first program in French. Really, that is the bulk of our mission, which is to make sure that we make this program as accessible as possible to Canadian veterans.

I'll hand it over to my colleague Doug to talk a little bit about his work, both as a coordinator and now in training with us as one of the clinicians who helps to deliver our program.

[Doug Allen, Program Coordinator, Atlantic, Veterans Transition Network]

Thanks.

My name is Doug Allen. I'm a retired infantry soldier, and now I have a master's degree in social work. My relationship with the Veterans Transition Network is that I graduated from the program myself. Like many veterans, I decided to make sure I was advocating for everybody else, and I wanted to make sure this program was good to go for my troops. What I found was that I needed more help than I thought, and I got it from the veterans transition program. Since then, I joined the team as a coordinator for Atlantic. I have been the para, and now I'm also a clinician in the program.

One of the differences with the veterans transition program is that it uses camaraderie, the same thing that soldiers need to do their job when they go into combat or tough situations. The veterans transition program re-creates that camaraderie, which they need in order to identify their triggers and their stuck points in life. They utilize that camaraderie to get themselves out of that. That's what the veterans transition program does.

When Oliver was talking about it, he broke it down into three phases. It's one of the most important components of the veterans transition program, because it enables us to get out of that safety bubble that was created by the program itself. We leave the safety bubble and we go back into what's essentially the unknown, civilian life. That is what scared us, because we're not used to it, and that's usually where our troubles occur. It's not while we are on a mission; it's when we're at home.

Using the space in between the phases, we're able to go back to where we feel unsafe and use the skills we learned where we did feel safe, which was within the veterans transition program. With how we developed the program, we're able to see what works and what doesn't. We know we're coming back into that bubble in the next phase, and we're able to say what worked. Then we're able to tailor what has to happen the next time. Instead of it not working and having no answer, individuals are still part of the program when they come back in. We can work with them on that so we can fine-tune it for success in the next phase. That is one of the key components to the success of the veterans transition program.

[The Chair, Liberal, Neil Ellis]

Great. Thank you.

We'll start off with questions from Mr. Clarke for six minutes. When we get down to about 30 seconds, I'll motion to wrap up the questioning or answers.

Go ahead, Mr. Clarke.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Thank you, Mr. Chair.

Thank you all for being here with us today.

To the Veterans Transition Network, I visited your installation in Vancouver when I was there last May.

I am very pleased that representatives from the Maison de la Vigile came to meet with the committee. I live near the Maison de la Vigile in Quebec City and I can say that you are doing a great job. Thank you very much.

We may have to interrupt you sometimes because we have a number of questions for you. Do not be taken aback by that.

Inevitably, you work with veterans very often. In fact, you work with them every day and I imagine that many of them express their discontent, rightly or wrongly, with case managers and with the way the Department of Veterans Affairs operates.

What do you think of the administrative process and the organizational practices of Veterans Affairs Canada? What is your relationship with case managers? How do you see the department’s way of operating? Are the administrative processes followed properly? Are there things that need to be replaced?

[Nancy Dussault]

Mr. Chair, if I may, I will answer the question.

In terms of the administrative process before the Maison La Vigile receives a call from a case manager, we unfortunately cannot say because we don’t really know what is happening up there. However, our relations are excellent from the time we receive a call from a case manager. As I explained, the admission process is often initiated in less than 48 hours and the veteran's date of admission is set. Our relations with all the managers are excellent.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

You say that veterans talk to you. I am not blaming the department but, very often, veterans complain to the committee that their relationships with the department are quite horrible. Those are usually complicated cases.

What are the comments you most often hear from veterans about the problems they are experiencing, about the documents they have to complete and, in some cases, about the transition steps they need to take?

[Nancy Dussault]

Most of our veterans, our clients, have post-traumatic stress disorder, one of the symptoms of which is anger. We have heard some comments about veterans. It is important to understand that people diagnosed with depression are often going to be haunted by the past whereas people with anxiety will be haunted by the future. Our role is to bring people back into the present. We don’t really dwell too much on comments they may make.

We also see that, for some veterans, returning to civilian life is difficult. Simply getting things done, like going to an appointment for a blood test or to see a doctor, can be very difficult and cause a lot of anxiety. For some, simply picking up the telephone and making a call disorients them. They often need the help of a professional in our organization just in order for them to do that. So you can imagine that, for a veteran who has to call Veterans Affairs Canada, starting all those steps and filling in all those documents for various procedures can be a major source of anxiety.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Are you and your colleagues prepared to help veterans to fill in forms or do paperwork?

[Nancy Dussault]

At La Vigile, our role is to develop people’s independence. So we are there for them, but we do not do the work for them. For example, if they have appointments, we can do part of what needs to be done, but the goal is really to develop their independence and not to act for them.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Along those lines, do you believe that it would be a good idea for the department to fill in forms for veterans or, conversely, do you believe that it is good to leave that task to them, even those with sometimes complex mental health issues?

[Nancy Dussault]

The role of a support worker is to develop independence. If we adhere to that principle, I would say that it is better for them to do it themselves, but some veterans are not capable of doing so. So, perhaps for some clients, it is necessary to help them, but for others, the goal is to develop their independence.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Your document points out that veterans’ family members do not necessarily have easy access to the department’s case managers. This committee has, on several occasions, come across that problem of family members’ lack of access to case managers. Does that complaint come up often?

[Nancy Dussault]

We have heard those comments from some veterans. Some would have liked their family members to have access to La Vigile’s services too. We have also heard that on occasion.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Speaking of La Vigile’s services, at what point do you feel that they really should be available on a broad scale? Clearly, there is a need. Is the department having discussions with you about possibly expanding your services?

[Jacques Denis Simard]

There are no plans along those lines yet. We are ready to do it. In fact, two policewomen from the city of York, Ontario, have shown a lot of interest in starting a “Vigile 2” in that province for everyone in uniform. We are ready to expand our services.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Thank you.

[Nancy Dussault]

I can perhaps add that, when a veteran is diagnosed with post-traumatic stress disorder, depression or alcohol problems, the consequences are felt by the entire family. So it becomes difficult for the wife, the children and so on. In fact, the family needs help as well.