Finance Committee on May 17th, 2017

[The Chair, Liberal, Wayne Easter]

We'll come to order. We're pleased to have witnesses here this afternoon for our further discussions on Bill C-44, an act to implement certain provisions of the budget tabled in Parliament.

As the witnesses know, the bells are ringing. We think that we have time to hear everybody's presentation. We will go to vote and then come back and spend a half an hour, or thereabouts, on questions for witnesses.

The first witnesses are from the Equitas Society. We have Mr. Bedard, who is the representative, and Mr. Campbell.

The floor is yours.

[Mark Campbell, Representative, Equitas Society]

Good afternoon, Mr. Chair, and distinguished members of the committee. Thank you very much for having us here. We sincerely appreciate the opportunity to testify on behalf of the Equitas Society.

My name is Major (retired) Mark Campbell. I am one of the six representative plaintiffs in the Equitas class action lawsuit; and my compatriot here, Corporal (retired) Aaron Bedard, is another one of the six plaintiffs.

We'd first like to express our gratitude for what was included in budget 2017, which, of course, was an education benefit—yet to be defined, but an education benefit nonetheless—and a family caregiver recognition benefit. Both of these new benefits are long overdue, and we are certainly grateful to all the authorities associated with the adoption of those initiatives within budget 2017. The devil, of course, is in the details, and we don't know the details yet as regards the education benefit and the qualifying criteria, which we often find become exclusionary in their actual application on the ground. That remains to be seen. Our concern lies primarily with the financial compensation package and financial parity between the former Pension Act and the current new Veterans Charter.

As you may or may not know, the Equitas Society was in fact formed as the fundraising arm of the class action lawsuit, which seeks, above all other things, parity with the former Pension Act for those who fall under the new Veterans Charter as of April 1, 2006. I'm a perfect case in point. Had I been injured on my first tour of duty in 2002, I would be under the former Pension Act. As it is, I was injured in 2008 and on my second tour of duty in Afghanistan, and as a result my injuries are covered under the new Veterans Charter. A direct result of that is a 46% reduction in my family's expected financial compensation over my lifetime. That is a significant amount of money—yes, 46%. The concern here is that although budget 2017 makes allusions to a reinstatement of the pension for life for Canada's veterans, the can was kicked down the street yet again. We have seen deferred yet again any details regarding the pension for life, implementation timelines, and details of the implementation—indeed what it would entail, in essence.

Our concern, of course, is this ongoing disparity between the former Pension Act and the new Veterans Charter, and the financial implications thereof, not just for the veteran himself but for the larger family unit as well, which may as well be included in the definition of veteran because they're there every step of the way along the journey with the veteran. Moreover, we have yet to see some family benefits restored from the Pension Act. We've yet to see any importing of some of the benefits available under the Pension Act into the new Veterans Charter, as has been recommended by the minister's policy advisory group.

Our concern is what appears to be a dragging of the feet, if you will, in consolidating the financial benefits for veterans into something that's easily understood. The benefits package right now continues to become more complicated as opposed to more simplified. At the end of the day, it comes down to, yes, the dollar amounts, and the money in veteran families' pockets in order to have a moderate standard of living, and to be able to do the things that other Canadian families, in many cases, take for granted, such as raise children, send them to school and help them launch into their own young adulthoods.

I'm going to leave my comments at that.

One other thing I will say, as I hand the mike over to my compatriot here, is that Equitas is interested in parity in all aspects of veterans' care and compensation—and that would extend to access to mental health and mental health facilities.

At that point, I'll turn it over to my cohort.

[Aaron Bedard, Representative, Equitas Society]

Thank you, Mark.

Am I good for a few minutes?

[The Chair, Liberal, Wayne Easter]

Yes, Mr. Bedard, go ahead..

[Aaron Bedard]

Again, there's a lot of programming for veterans in this budget, and that's always a good thing for veterans.

The issue I'm having, though, is with the $20 million towards the centre of excellence. I'm the one who helped advocate for its inclusion in the original veteran's platform for the election, and that money was costed specifically for the building of a physical place to treat veterans with PTSD. Now here it is a year and a half later, and I'm part of the mental health advisory group that has been briefing the minister, working very hard to make sure it ends up being that way.

In this budget, the centre of excellence appears to be a bag of money going towards research. We have tons of research happening. For the last six years, CIMVHR has had a gathering of 500 to 800 doctors, and they all like to talk research.

Veterans need a physical place to get treatment. When we do get sent for treatment, it's usually after the person has ruined their life to a great degree. Everything is a mess, or everything is about to fall off the edge, and they send us to 12-step programs at addiction centres. There are places where you can end up trying to seek treatment within a group that includes criminals, organized crime gang members, and drug dealers. It is not a healthy environment.

I was at one of these briefly in 2013 with the RCMP. While I was there, Ron Francis, an RCMP member, got into trouble for smoking pot in the red serge. Those of us with PTSD would see that as a sign. He's raising a flag, he needs help, because he's not in his right mind if he's doing that. He was there while I was there, and he lasted about a week. As an RCMP member, he was not comfortable talking around gang members and drug dealers. He left, and six months later, he took his life.

I received a letter recently from two other RCMP members, who within these last few months had to go to one of the Woods facilities. It was the same thing. They're in there, and one of the people with them was a high-level member of organized crime. There were several other criminal-type people who made it feel like a prison environment. There are issues of hierarchy and ego, and who's done the most.

That is not the kind of treatment we need. That's why I pushed Harjit Sajjan and Andrew Leslie, in 2015, to please include within their electoral platform an in-patient care facility, where we could bring veterans at the beginning, rather than waiting until they're addicted, abusing alcohol excessively, or having out-of-control anger.

Do we wait until their lives are falling apart and then send them to care? That's the wrong way to do it. We should be catching them at the beginning.

I'll stop there. I am part of the mental health advisory group to the minister, and Mark Campbell is part of the policy advisory group working to try to make the pension happen.

I'd be happy to answer questions, if you have any. Thank you.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Mr. Bedard.

With the Mental Health Commission of Canada, we have Mr. Rodrigue, the vice-president of organizational performance and public affairs.

Michel.

[Michel Rodrigue, Vice-President, Organizational Performance and Public Affairs, Mental Health Commission of Canada]

Thank you.

Thank you for inviting the Mental Health Commission of Canada to speak with you today on the budget implementation act. We are, after all, your commission, and it's always a pleasure to act as your trusted adviser on matters relating to mental health and wellness of Canadians.

Since the creation of the Mental Health Commission of Canada over 10 years ago, funding from the Government of Canada has helped us decrease the stigma of mental illness and improve Canadians’ mental health.

We're now celebrating the fifth anniversary of the mental health strategy for Canada. Five years ago, the funding and mandate provided by parliamentarians like yourselves enabled us to release the mental health strategy for Canada. The document is used by all provinces and territories to better direct mental health services and make real progress in delivering these resources.

Indeed, we recently released an updated analysis of government mental health spending called “Strengthening the Case for Investing in Canada's Mental Health System”, which clearly demonstrates that making investments early in mental health ends up saving governments money in the long run, as well as leading to better outcomes for Canadians living with mental illness and their families.

In keeping with that increased record of investments in mental health, we were particularly pleased to be renewed by the Government of Canada this past April. This renewal will allow us to realize our mission: mental health and wellness for all.

In that context we viewed as very exciting the investments in mental health as part of the new health accord and in the legislation currently before this committee. These historic investments are really desperately needed and cannot come soon enough. However, this money will only be effective if it is spent in the right area, spent responsibly, and reported on in a manner that allows governments to capitalize on the cascading effects of investments that are proven effective, timely, and accurate. Above all, shared data will be critical in this respect.

I would like to share with the committee some of the work that the Mental Health Commission has done previously on developing indicators to guide governments in making the very kind of investments currently under consideration.

In 2015, we released “Informing the Future: Mental Health Indicators for Canada”, comprising 55 indicators that together paint a picture of the mental health of children, youth, adults, and seniors. The objective was to create a pan-Canadian set of mental health and illness indicators. This looked at mental health in different settings and reported on aspects of services and supports used by people living with mental health problems and illnesses. It also identified gaps in services, allowing stakeholders to gauge progress and strengthen efforts to address the recommendations in the mental health strategy for Canada.

As part of our new mandate, we intend to build on our pan-Canadian indicators project. It is our hope that this work will help inform the efforts of provinces and territories as they look to deliver the results with these new federal investments. Maintaining a national perspective, while respecting provincial and territorial differences, will be critical for success.

We particularly hope that governments will explore opportunities beyond their traditional large health sector players, given that it's been demonstrated that community-based models of care are some of the most effective methods of delivering mental health supports. These include programming, such as the commission's mental health first aid courses that, just like physical first aid, train individuals to deliver aid to those experiencing a mental health crisis before more professional assistance can be delivered.

The advantages of community support are clear, particularly when delivering services in a culturally appropriate and sensitive manner. The advantages for isolated communities and indigenous peoples are also easily seen when equipping community members to provide mental health support.

To conclude my brief remarks, I would like to reiterate the Mental Health Commission's high hopes for the mental health spending committed in the budget, and when time permits, we'd be happy to take questions.

[The Chair, Liberal, Wayne Easter]

Thank you very much.

We turning now to the Mood Disorders Society of Canada, Mr. Gallson, associate national executive director.

[Dave Gallson, Associate National Executive Director, Mood Disorders Society of Canada]

Thank you, Mr. Chair and honourable members, for the opportunity for the Mood Disorders Society of Canada to take part in this important meeting and to provide our comments to the committee.

Since 2001, MDSC has worked to help people with mental illness improve their quality of life. We work with the public, private, and voluntary sectors; those providing front-line primary care; educators; and people living with mental illness, their families, and caregivers. MDSC has engaged, on an ongoing basis, in major national projects, working closely with national, provincial, and regional partners.

As part of a national organization representing people with mental health issues, today I would like to be their voice at this table. To best reflect their views, I would like to provide you with key findings from two of our national mental health care surveys that consolidated their input.

In 2011 MDSC conducted a pan-Canadian mental health survey that received 3,125 responses. It is important to note that over 500 individuals took the added time to write out specific comments on the survey questions. The results told us that while there have been improvements in mental health care systems, many improvements are desperately still needed.

Of particular concern to the Mood Disorders Society of Canada was that 35% of the respondents indicated having to wait more than 12 months for a diagnosis. Comments cited the shortage of professionals available to diagnose and treat individuals with mental health issues. Fifty-two per cent of the respondents reported visiting a hospital emergency room because of their mental illness; 50% of those respondents indicated that they were moderately to extremely dissatisfied with the care they received in the emergency departments. Eighty-two per cent of respondents indicated that they were able to access the medications they needed to treat their mental illness; however, some of the respondents indicated that this meant going into debt, rationing drugs, and staying in stressful situations to take advantage of benefit programs.

We followed this up with a second survey in 2015, which received over 2,200 responses. Four years later we learned that of the top two priorities suggested for government action, 91% of respondents indicated that increasing access to mental health care professionals was their top priority, and 88% reported the need to focus on increasing community mental health services. When asked directly, 38% of respondents indicated that the time between initially seeking help and diagnosis exceeded 12 months. In the four years from 2011 to 2015, we actually got worse.

The majority of individuals have been dealing with mental illness for more than 10 years, either first-hand or through the provision of care for somebody experiencing mental illness.

We realize that the federal government cannot dictate to the provinces how to deliver health care services; however, we note that the negotiations for the health accord with the provinces, and the federal government's demands of the provinces to significantly increase expenditures on mental health care were very successful. A more unified approach to knowledge sharing and best practices replications are key to improving program availability and lowering development and delivery costs, and this should interest everybody.

The federal government is directly responsible for the health care of millions of Canadians—the RCMP, our armed forces, veterans, indigenous peoples, correctional workers, and the large federal workforce. The government can lead in health care transformation by supporting innovative foundational mental health programs that take new approaches, that address core issues identified by patients and caregivers themselves, and that support recovery and promote wellness, programs such as Project Trauma Support, located in Perth, Ontario, a week-long, concentrated program for military and first responders who have had their lives ravaged by PTSD. Project Trauma Support incorporates equine therapy, rope training, group psychotherapy, and peer support. The program allows participants to process their experiences and authentic emotions and to improve the lives of their families and peers in the process. The success that this program is having in changing and saving people's lives is incredible.

While professional help is very necessary, it's not always available at 8 p.m. or midnight when the person needs someone to talk to. With peer support programs, people have a network of peers who understand what they're going through because they've experienced the same things. Peer support programs also form a crucially important referral resource for community health care providers. There is not enough support for peer support programs across Canadian communities, leaving gaps in supports nationwide. Peer support programs have been scientifically evaluated and shown to be highly effective.

In 2013 MDSC signed a five-year contribution agreement with the Government of Canada, with project partners, the Mental Health Commission of Canada—

[The Chair, Liberal, Wayne Easter]

Dave, I am going to have to cut you off there, regardless of how much you have left, even if it's only a minute. We're down to less than three minutes until the vote, and if we don't get to the vote, we'll be in trouble.

We will suspend, and then let you finish immediately after the vote.

The meeting is suspended.

[The Chair, Liberal, Wayne Easter]

We'll reconvene. My apologies for the interruption, folks, but we voted twice and therefore won't have to skip out again 20 minutes from now.

We'll finish up with the Mood Disorders Society of Canada, and Mr. Gallson.

[Dave Gallson]

Thank you very much, Mr. Chair.

While professional help is very necessary, it's not always available at 8 p.m. or midnight. I talked about peer support and the importance of supporting that across Canada.

In 2013, Mood Disorders Society of Canada signed a five-year contribution agreement with the Government of Canada, and with project partners the Mental Health Commission of Canada and the University of Ottawa Institute of Mental Health Research. Together, we helped develop the Canadian Depression Research and Intervention Network, CDRIN. CDRIN now has seven depression research hubs across the country, involving 53 research institutions and organizations working together on depression, suicide, and PTSD. We now have four major research projects moving forward.

We also have a hub focused solely on indigenous wellness issues. All its researchers are of indigenous heritage, and are located in all provinces across the country. This is an example of the federal government leading innovation to address mental illness.

I'd like to thank the federal government for its support in our Transitions to Communities program, a partnership between Mood Disorders Society of Canada, the opportunities fund of Employment and Social Development Canada, and Veterans Affairs Canada. Our goal is to assist nearly 450 veterans in three cities over three years who are experiencing obstacles. The program provides direct supports to veterans, with a focus on employability skills, mental well-being, and peer support. This is another innovative program that incorporates mental health knowledge and wellness maintenance into the daily lives of participants.

In conclusion, the budget under discussion has significant positive support for mental health, wellness, and illness programs and initiatives. We commend them to you and urge you to support the budget's implementations.

I thank you for your time.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Mr. Gallson.

We'll go with five-minute rounds. Mr. Ouellette, you're first up.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Can we go to seven minutes? I think we have time. We have almost an hour and 45 minutes—

[The Chair, Liberal, Wayne Easter]

Okay, for this and the other panel, we'll go with seven minutes. That's the way you want to go.

Seven minutes, Mr. Ouellette.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Thank you.

I'm just reviewing the mental health services and what the government is providing. Obviously, we did the major agreement with the provinces, and it's a proposal over 10 years.

This is a question for Michel and Dave. Are you satisfied with the reporting mechanisms to ensure that these services are actually being offered and in a way that is appropriate?

[Michel Rodrigue]

I'll start, and let Dave wrap up.

I'm not sure it's about being satisfied. It's about being able to accurately reflect what the investments are creating in terms of faster access to services when and where people need them. In order to do that, we need to acknowledge that, as part of the accord, each province and territory will invest these new federal investments to support their own strategies that they've developed. A lot of them are inspired by the national strategy, but there are nuances and differences, so they are likely to track different components. In our work, we firmly believe that it's possible to have a meaningful set of national indicators against which each jurisdiction is able to measure themselves. That should be our goal.

In terms of where investment should occur, which I think was the other part of your question, certainly what we've learned is that you can't go wrong investing in youth and children. Those investments certainly bring returns and change their quality of life forever, but there are also major needs across the spectrum in terms of at-risk populations and different age groups.

[Dave Gallson]

That's really an appropriate question and I thank you for asking it.

There are a couple of things I have to add to Michel's comments. Number one, the indicators are based a lot of times on billing codes, which differ from province to province. Doctors bill in different codes across different provinces. There are some really successful programs that have been implemented in certain provinces. Take B.C., for instance. Physicians have new billing codes to provide additional services and follow-ups for people who are working through mental health issues. They are able to bill the provincial government to make extra phone calls and to have extra meetings with the patients and stuff. That has seen some really good outcomes.

The provinces and the federal government need to work together on the outcome indicators across Canada to make sure they're appropriate and even across the country.

Another thing that I would like to add is that people with mental health issues, and their families and caregivers, need to be involved in all aspects of health care delivery. People with mental illness want to be part of their wellness plan. They want to be as involved as any other medical professional, because they have the vested interest in it. So, I strongly encourage, in whatever way, shape, or form, that the people with lived experience of mental illness, or families and caregivers, be engaged and included in decision-making processes, but also in the research and recording structure.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Thank you very much.

Now I have a couple of questions for Monsieur Bedard and Mr. Campbell. It was a very interesting presentation. I'm pleased to hear you were happy with some of the new programs that are being implemented. I was really interested in the comment by Mr. Campbell.

You said that as there are more benefit packages, they become more and more complicated to administer, and I suspect there's increased cost. as well. Could you address that for a few moments?

[Mark Campbell]

Certainly. With the new Veterans Charter, if I were using an analogy, we could call it an old, rotten, leaky tire. From our perspective, what happens is that the government continually applies Band-Aids, patches, to that leaky tire. It's still leaking. It's still a rotten tire. It's going to have to be replaced, but we keep putting these Band-Aids on top. Every time we apply another solution or another benefit to the mix, without consolidating those financial benefits, we create a more complex mix that the veteran himself ends up having to navigate, sometimes with the assistance of a case manager, sometimes without.

I guess our point is that we always welcome new benefits. You'd be a fool to say “no” to a new benefit, provided it meets the target audience's need. But at the end of the day, if those new benefits aren't consolidated with other benefits into a simpler approach, we're going to risk confusing veterans even more. I can tell you that the confusion out there is already rife.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

I have a question for Monsieur Bedard. It's related to the cost of mental health centres, the centres of excellence. I suspect what happens is that when we have individuals who have arrived at a certain point in their life, with perhaps PTSD or other mental health issues, and they were a veteran, we place them in a 12-step program. There are various mixes of people within those programs. They're placed within those programs in centres because perhaps there are not enough veterans at the time who might need those services.

Is the current way we're offering these services appropriate for veterans? Maybe we should be using military facilities, hospitals in Edmonton, Winnipeg, Quebec City, and Montreal, for instance. Are there places that offer some of these services that might have a more concentrated group and population where something beneficial might happen?

[Aaron Bedard]

The issue right now is that they're not sending people into these programs until they're a mess. They're at their bottom, at their end, when they come to ask for help. They're saying, get me off the street. That's usually at a point when they're thinking about suicide, and very often they'll still have to wait months before they get to the program, right when they're at the end of their rope. What we're pushing for here is programming that will catch them at the earliest phase of developing issues with PTSD, rather than waiting until the end, because right now we get them into one-hour sessions maybe once or twice a week. That's like taking your car to the mechanic on a Monday and saying, “I need to drive to work every single day. I need it quickly”, and they come back at you saying, “We'll fix it, but we'll just work on it one hour a week.” It's going to go on forever. We need something foundational at square one. We don't want to see guys wait until they're at the end of their rope.

I have a story here that I just dug up. It's about two RCMP fellows who went to a program out of Toronto and were in it with organized crime members. They were completely uncomfortable about speaking. They were there for 10 weeks and they tried reaching out to the people through the chain, and the RCMP. They were told, “Just go through the program. Just do the check in the box and then you will get something on a form, and then you'll be able to come back to work. Just go through it. Just do it.” That's not good.

[The Chair, Liberal, Wayne Easter]

We'll have to cut it there, folks.

Mr. Liepert.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Thank you, Mr. Chair, and thank you, witnesses.

Mr. Rodrigue and Mr. Gallson, I don't want to be inconsiderate, but we had an entire panel here last week for two hours on mental health, so we've asked a lot of questions on mental health. I have limited time. I may get to you two fellows, but I want to get a better understanding of our situation with veterans.

Before I start, I think it should be noted to Mr. Campbell and Mr. Bedard that this committee, before commencing these hearings, asked the chair to write to the chairs of five separate committees like this one in Parliament to study parts of the bill that were more relevant to those particular committees. One was Veterans Affairs. Unfortunately, the committee or the chair or whoever chose not to take our invitation up. I think that's unfortunate, because having just the few minutes that we're going to have will probably not get us the information we need.

I want to get a better understanding of two things. One is the treatment that you talk about. Secondly I want a better understanding of the pension situation.

It seems to me that this has been continually churning out there for far too many years. The Minister of Veterans Affairs, I think is trying hard, but he keeps hanging his hat, when we ask questions about things, on the fact that they've opened x number of veterans' intake centres across the country.

I guess, Mr. Bedard, sometimes it comes down to either/or situations. In your view, would the government have been better off to do what you asked for rather than re-open these intake centres across the country?

[Aaron Bedard]

They were all promises for their mandate. They had a very large mandate, specifically concerning in-patient care; that was very specific. I had no interest in opening physical places in epicentres across the country, because very often these fellows who develop PTSD and multiple injuries prefer to go out to remote regions, to very small towns. I was more consumed with the idea of having and had been pushing for a few years leading up to that election to have free-roaming case managers who can work out of their homes and be up in regions where they would be able to get at people. We have a vast country and don't all live right next to the city.