Finance Committee on Nov. 19th, 2012

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Mr. Chair.

Again, thank you to all the presenters for speaking on very diverse and important areas that we need to reflect on.

I'd like to start with Ms. Aiken. We've all been home for the Remembrance Day week, and I had conversations with reservists in the riding I represent. A number of them had done tours of duty in Afghanistan and some had struggled on their return.

I was talking to them about the care that was available. What stood out in my mind was some of them telling me that they needed choices. I look at your comment that only a few, a small percentage, work through Veterans Affairs to get the care they need. One of these gentlemen found support locally with his church and with his psychologist.

Could you talk more about how our veterans are seeking care, especially in the area of post-traumatic stress disorder?

[Dr. Alice Aiken]

It's a great question.

There are 700,000 veterans and only 72,000 are clients of Veteran Affairs Canada. They really are part of a health care system that doesn't understand them at all or their unique needs. We also know from the research that particularly mental health issues don't always show up right away when you return from a tour. Veterans Affairs Canada will tell us that it can take 5, 10, or even 50 years for a mental health problem to surface. At that time, people aren't always capable of going back to Veterans Affairs Canada and navigating the system in order to access benefits. They really are part of a system that doesn't understand their unique needs.

The research would also tell us that while there is some crossover—for example, post-traumatic stress disorder—really, military-related post-traumatic stress disorder is very different from trauma-related, where you are surprised by an attack or a traumatic event, whereas the military are running headlong into it. There are some subtle differences in the assessment and treatment of disorders like that.

I also heard you ask the CEO of the Canadian Psychological Association about access to other professionals. That's a huge issue in the Canadian system. If they are clients of Veterans Affairs Canada, they will have access to physiotherapy and psychology and all of those things provided, whereas if they are just in the public system, they may not. If they don't have health insurance, they don't have those things covered.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Would you say that when I am having these conversations I should be encouraging them to make those connections? What would you say to the thought they express, that “This is where I am comfortable seeking my care, even though it might not be as expert”? Not every community has the ability to provide that expert kind of service.

How do you provide outreach to your rural or smaller urban areas? How do they provide that expertise and outreach?

[Dr. Alice Aiken]

As I mentioned, what's really critical in some of the work I am doing with a great team of researchers is that we are trying to get that specific information into the hands of clinicians working on the front line in all communities across Canada. We are looking at the specific health needs of veterans, and we are working with the Canadian Medical Association to disseminate that to all Canadian primary care physicians. We really are trying to get it into the communities.

I would agree with you. I would think that people don't want to leave their hometown to seek care. If they get coverage by Veterans Affairs Canada, they often don't have to. It's a health insurance system, right? It's not specific practitioners.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

A quick question on your $50 million over five years. Is that strictly research dollars?

[Dr. Alice Aiken]

No. It would be for research and implementation of policies and programs—really working at the coal face to get cutting-edge research into the policies and practices that are happening.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

[The Chair, Conservative, James Rajotte]

Mr. Brison, please.

[Scott Brison, Liberal, Kings—Hants, NS]

Thank you all very much for joining us today.

Dr. Aiken, have you calculated the potential savings to Canadian governments at all levels of making this sort of investment? It stands to reason that if we conduct the kind of research you are speaking of, the social and economic benefits in the future ought to be quite significant in terms of a multiplier effect.

[Dr. Alice Aiken]

Yes. We haven't done the exact calculations, but really, when you look at the numbers—700,000 veterans—everybody has family members, parents, siblings, and children. We know there is trans-generational impact of military service. Ensuring people have the best health care they can have within our system is going to make them more productive members of society.

We already know that the majority of veterans who are released feel underemployed. While their tangible skills may be used, the intangible skills that you learn in the military of loyalty, teamwork, and resilience are not always harnessed and mobilized in the civilian workforce. Not to mention the families—resilience is a very strong characteristic within the families as well.

[Scott Brison, Liberal, Kings—Hants, NS]

Thank you very much.

In 2006, Sir Nicholas Stern's report identified the cost of not acting. It really made the point that there are going to be massive global costs associated with climate change. Should we be putting line items in budgets as governments, anticipating and preparing for those types of investments in the future? I visited a community in Newfoundland a couple of years ago where the mayor showed me a breakwater that was partially destroyed by more frequent and severe storms. The only road leading into the town was being threatened. At some point, that needs to be addressed. Should we be anticipating and budgeting for that pre-emptively?

[Dr. Gordon McBean]

Yes, certainly we should be making those investments in redeveloping our critical infrastructure. We have been reducing that infrastructure as a percentage of GDP over the last decade, and there is need for that kind of investment to reduce our impact.

My colleagues down the table, from the Retail Council and the restaurant association, for example, rely on the fact that their customers can actually get to the stores and restaurants. When a storm wipes out a bridge, or when it wiped out the Finch Avenue bridge road, as it did in 2005.... Incidentally, the rain storm that caused the wipeout of the Finch Avenue bridge road cost the insurance company $650 million, which meant they just applied it to the rest of us through premiums.

[Scott Brison, Liberal, Kings—Hants, NS]

Thank you very much.

Ms. Reynolds and Ms. Brisebois, on the issue of credit cards and the regulatory framework, has the voluntary code of conduct achieved all of the objectives, or should we be looking at other models, including potentially the Australian model or other models?

That leads to another question. Which countries have it right in terms of regulatory framework around credit charges to businesses?

[Diane Brisebois]

I'll go first.

The current voluntary code served an important purpose, which was to ensure that merchants could continue to accept Interac debit, which is a low-cost, flat-rate debit payment transaction. The code basically allowed a merchant to say yes to Visa credit but no to Visa debit, which is what Joyce referred to earlier as the “honour all cards” rule. As you know, there is a case before the tribunal, so it will be interesting to see if the tribunal agrees that the “honour all cards” rule should be eliminated.

To answer the second part of your question, we believe that the voluntary code is working now, but we are concerned that it may not be tough enough going forward, considering what Visa has decided to do.

[The Chair, Conservative, James Rajotte]

There are about 20 seconds, Ms. Reynolds. Did you want to comment on that?

[Joyce Reynolds]

I would agree. I don't think there is a perfect system out there. What's happening in Australia is that certainly the fees are lower, but the number of cards they are introducing and the difference in fees between the cards—they're finding more and more of these premium and super premium cards are coming on the market, so they haven't completely resolved the issue with legislation.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. Brison.

Ms. Gallant, please.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman, and all my questions will be through you.

My questions are going to be directed to Dr. Aiken. Would you please tell us the types of research projects that you are coordinating that relate specifically to PTSD?

[Dr. Alice Aiken]

There are several projects going on, everything from the hard science side looking at brain biomarkers of PTSD for diagnosis.... One of the big problems has been that it's difficult to diagnose between mild traumatic brain injury, which is very common in areas where things are exploding, and post-traumatic stress disorder, or a person may suffer from both, and if you don't administer the correct treatment.... If you misdiagnose, you might administer the wrong treatment.

We have a really outstanding pan-Canadian team that we've managed to assemble, and they are looking at what are the brain biomarkers of PTSD to make diagnosis better.

We also have groups of people looking at new treatment techniques, novel treatment techniques. We have one of the groups that works in one of the operational stress injury clinics funded by Veterans Affairs coming to our upcoming forum to present to a whole group of civilian psychologists, psychiatrists, and mental health workers. It's getting that information on current best practices treatment that they've studied, which they know is evidence-based, into the hands of front-line practitioners, so they can help the veterans. We're working really at both ends of the spectrum.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Do the universities actually use soldiers and veterans as subjects in their studies?

[Dr. Alice Aiken]

The answer is yes, some of them.

That hasn't been a smooth process to date, but it is now, with the advent of our organization. We are able to work really closely with the government. We have a college of peer reviewers, so if people put forward research to us, we kind of screen it first.

One of the issues is that we have quite a small military, so you can't keep testing them for everything. When we had a combat role in Afghanistan, some people went over and did studies and collected data, but you couldn't have everybody assessing the same rota every single time, because you get research fatigue or exhaustion. What some of them are doing is working with other populations initially and then bringing it to military populations once the methodology is well refined.

Veterans are a different story. For example, in the operational stress injury clinic there are a lot of veterans, so they really are able to work with patients on a real-time program, evaluate how it's working, and bring that back to other clinicians who might be working with these populations as well.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

What sorts of studies are you coordinating in the area of suicide prevention that are not necessarily related to PTSD?

[Dr. Alice Aiken]

Interestingly, if you look at the Canadian-specific literature, almost every study that talks about suicide does talk about PTSD. But you're exactly right, it isn't always related to PTSD. In fact, we know from our British colleagues that in Canada the number one mental health issue for people who have served in a combat role is depression, not post-traumatic stress disorder. The Americans tend to have more post-traumatic stress disorder and the Brits tend to evolve to binge drinking. I don't know if those are cultural differences or what.

There are a few studies looking at suicide. I think one of the issues is still getting the data harnessed in Canada. We have really good anecdotal data on suicide, but the large-scale studies are still not showing an increased rate in suicide in regular-force males. The studies show an increase in regular-force females over the general population for suicide and in the reserve force.

[The Chair, Conservative, James Rajotte]

You have 30 seconds.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

When you are looking at the stats, are you looking at only the suicides that actually follow through, or do you have access to the stats where there are suicide attempts?