Veterans Affairs Committee on April 14th, 2016

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

Very quickly then, can you possibly answer this question. What's the most pressing issue: opening these service delivery offices, or mental health clinics?

[Michel Doiron]

They're both pressing issues, to be honest.

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

And we realize they both are valuable, but what is the most pressing issue?

[Michel Doiron]

To me, right now it's opening the offices, and I can explain why. I'll try to do it very quickly.

If we don't have somebody to do that first assessment, a case manager on the ground or a VSA to identify and promote that, to actually be able to refer them, there's a step missing in the process. But it does not preclude.... I don't want to sound as if mental health is not important, because absolutely, the mental health component is very important; it's hard to really rank them. But they need somebody to do that initial assessment before they send anyone to our professionals, because it's on a referral basis.

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

Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. How long do I have?

[The Chair, Liberal, Neil Ellis]

Five minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

This is a little complicated. I'll try to put a preamble on this to put it in perspective. There are military personnel who are discharged for disciplinary reasons, but the discipline is substance-related. Military personnel are discharged because they're found driving a tank drunk on the base and crash into a building, something like that. They're just simply discharged, dishonourably, despite the fact that the substance abuse may be secondary to unrecognized PTSD.

So the question is whether someone who is discharged in that kind of situation—not on medical leave, but just simply discharged as a matter of discipline—can access these Veterans Affairs services.

[Dr. Cyd Courchesne]

Yes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

That is much simpler. That answer, I think, made my day. Thank you.

[The Chair, Liberal, Neil Ellis]

We just gained some time.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Excellent. It's the simplest answer to the most complicated question I've ever asked.

I have another question I was wondering about, and I made reference to this in a previous meeting with another group. We've made some reference to this. We have a lot of vets who have injuries that are diagnosed well after the fact, where it could be the sore knee but there's no medical file from when the person was there. It's the same for the person who saw horrendous things and never actually submitted a request for care when he saw his friends being blown up, but later, when he presents, you find out that, yes, he has this serious mental health issue because this, this, and that was happening.

Is there a feedback mechanism to the Department of National Defence where you can say that you are seeing these patients who have this going on, and that you believe you may be able to mitigate this if you take this into account when they're in active service?

[Dr. Cyd Courchesne]

We work very closely with our partners in health services. We sit on the same committees. We do research together. I work with them. I left the military, but I didn't leave the building where I worked. To their great despair, I still hang around. I walk into the director of mental health's office whenever anything crosses my desk that I think they should know about. We talk to each other on a daily basis. They know that.

To your point, what I would like to point out is that—and this is what our research has shown us, the life after service study—people come to us at different times. Some people come to us strictly, directly from the military. The military hands them over to us. We know they're going to be released. We take them on into our OSI clinics. Some people come to us years after they left because they hear about this, and they say, “I think I have a problem and I think it's related to my deployment”, and they come back to us. They come to us over their lifetime, when they leave. We have 25% who come immediately after service; and 75% over 40 years.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

How much time do I have?

[The Chair, Liberal, Neil Ellis]

You have one minute.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

There's something that just occurred to me in response to the previous question, for which, again, there was a much simpler answer than I expected. Let's say we have someone with a disciplinary discharge, which will have quite a lot of implications for a lot of the benefits they might receive. If you're looking after these patients who present later, and find out that the root of their behaviour that caused the disciplinary discharge was in fact an unrecognized mental health issue, is there a mechanism to feed that back and to change their status, change the ruling of their disciplinary process?

[Dr. Cyd Courchesne]

I'll answer that because in my previous life, we had cases like that.

It used to be that we could. Someone was released. They decided to take a voluntary release rather than wait around for a medical decision, and we found out that it would have been better for benefits and all that, so we used to change it retroactively. Several years ago the lawyers said that was illegal, and I don't know where that is now. I would say that you would have to go back to the CF and to legal people in the chief of military personnel's branch to find out if they can still do that.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

As a medical professional, would you agree that it would be a good thing to change it back to that system?

[Dr. Cyd Courchesne]

It's an administrative, legal thing. I don't think my medical expertise in there has anything to do with that.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay. Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall, for four minutes.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

I'm beginning to get a grasp of this. OSI clinics are your third line. The veteran has gone through a first and a second line before they get to them. Am I to understand that these are the more serious cases?

[Dr. Cyd Courchesne]

No. They don't have to go one, two, three. It's just that in medical terms, it's not considered first-line treatment.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Okay, so they've been diagnosed, and referred to you by whom?