Veterans Affairs Committee on April 14th, 2016

[Colin Fraser, Liberal, West Nova, NS]

With regard to the operational stress injury clinics themselves, I assume those deal with a variety of different mental health issues. Mental health can be manifested in many ways, including in addictions. I am just wondering how well-equipped these clinics are to deal with addiction issues and if those can be properly addressed on an outpatient basis.

[Dr. David Ross]

This is an excellent question.

Two years ago we reviewed our competencies using the CCSA competency list. We did a survey across the country and took a look at where we were at.

We guarantee that each one of our teams has outpatient level 2 competencies, which means that they can screen and assess. They can determine the severity of the problem. If the persons have enough control over their addiction problem that they can complete the rest of their treatment—say, for major depression, PTSD, or whatever—then it is treated concurrently and in an integrated fashion, because that is the best practice.

If, however, the persons' condition has advanced to the point where they have completely lost control over the behaviour, then we do what is called “stepped care”. We will refer them to a designated facility with level 3 or 4 competencies, with the assurance that we will take them seamlessly as soon as they come back. We work in collaboration with them so that, as their discharge approaches, we start harmonizing the care plans. That is the best practice, and that is how we operate.

[Colin Fraser, Liberal, West Nova, NS]

With regard to the clinics themselves, is there much outreach? Obviously, there are centres across the country, but there are places that aren't serviced close by. Is there outreach to those folks, and how is travel arranged for people to come to the clinics?

[Dr. David Ross]

As a matter of fact, we do as much outreach as we can. We take people by referral.

One of the things we have been trying to do is to bring the services to them as much as possible. Take British Columbia as an example. You know, this is Canada. We have cities along the bottom and a great open expanse. Some of the people who need us the most are not in those cities.

We use Telehealth; we fly people out to points of service where we can deliver services; we do everything we can. As a matter of fact, B.C. was one of the very innovative places where they used a new technology so that they could FedEx a secure Telehealth terminal directly to the person's home. All they had to do was plug it in, and they could do secure sessions that way. This is not a replacement for face-to-face, but if the alternative is driving 300 miles, it's a nice option. It is a serious priority for us.

[Colin Fraser, Liberal, West Nova, NS]

I have one final question.

With regard to family physicians, are they aware of your services, and do you reach out to them to ensure that they know you are there to help the veterans if they need it?

[Dr. Cyd Courchesne]

You go.

[Dr. David Ross]

We are aware of the importance of family physicians. The reality is that family physicians do a lot of Canada's front-line mental health care, de jure or de facto. These people are vital in the care linkage.

We go and identify their communities of practice. We speak to them. What we try to provide, wherever possible, is just-in-time support, because whether or not they take a veteran may depend on whether they know they can pick up the phone and say, “I have this guy, and this is happening. What do I do?” If they know they can speak to us, that can make the difference as to whether they accept them or they say, “You know what, I have 2,000 files. I don't think I can handle any more stress right now.”

That is one area we would like to do more in, and we have been looking at options for that. We have prepared some proposals.

[Colin Fraser, Liberal, West Nova, NS]

Thank you very much.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Kitchen, go ahead.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Dr. Ross, for your presentation. It helped to fill in some things, especially knowing where these clinics are.

Now, my understanding is that the funding of these clinics is provincial. Am I correct?

[Dr. Cyd Courchesne]

No, we fund them totally.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You fund them.

I notice that you have them in a lot of provinces; you don't have one in Saskatchewan. We have some great medical facilities and a teaching hospital, etc. Are there plans for that to happen?

[Michel Doiron]

We're looking at it. I was aware that there was nothing in Saskatchewan, and as you know, we're opening a new office in Saskatoon, and we're going to look at all the services and how we can improve those services.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You realize that Saskatchewan is a huge mass, and the reality is that Saskatoon is in the bottom third of the province. We have a lot of veterans there who are looking for services, and if they have a distance to go, it's very difficult for them. Telehealth is a wonderful thing, but when the technology isn't there.... They don't have the technology; they can't access it. They live in remote areas. They're prepared to go, but they need to know, and they need to be somewhere local.

So thank you for that. I appreciate it.

I'd like to follow up on Ms. Romanado's thought. You talked about there being a quality assurance program. My question to that is, who's supervising the supervisors?

[Michel Doiron]

We have an internal audit shop. I call it A and E, and I'm trying to remember what A and E stands for.

[Dr. Cyd Courchesne]

It's audit and evaluation.

[Michel Doiron]

Thank you, ma'am. Audit and evaluation come in and do function audits. I've asked them to come in. I've asked them to audit our case management, do a tiger team, go out and see, and the same with our VSAs, veteran service agents. They also do work within to make sure that we are complying with the rules and following what we're supposed to be following.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Is this an internal organization or an external one?

[Michel Doiron]

No, this is an internal organization that reports directly to the deputy minister.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Is there any particular reason that it's internal versus external?

[Michel Doiron]

External is the OAG. Every department has an internal audit—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay, but to do your audit as we're talking about, on whether we're getting the services provided, if you're going to do quality assurance and know whether these individuals are doing their jobs, then are we asking someone external to verify whether that's being done, versus the people they work for?

[Michel Doiron]

In the case here, A and E would come in and do it, and the OAG, when they come in and do an audit, as they did in 2014, will either say yea or nay, right? You're doing it or you're not.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Do I have time for one more question?

[The Chair, Liberal, Neil Ellis]

You have two minutes.