Health Committee on April 10th, 2014

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Thank you, Madam Chair.

Ms. Cohen and Mr. Bland, I quite appreciated your presentations.

First, I'd like to hear your opinion on a very specific issue, post-traumatic stress disorder affecting members of our military and our veterans.

I attended a meeting of the Standing Committee on National Defence a few weeks ago. I was rather stunned to learn that no systematic or regular follow-up is done on the men and women in uniform we send into combat situations overseas. And what's happening as a result, unfortunately, are terrible tragedies, family tragedies.

In your view, what should the federal government do to improve how mental health care is handled when our men and women in uniform return from missions?

[Terence Young, Conservative, Oakville, ON]

Madam Chair, on a point of order. This is a very important and interesting topic, but it's not what we're studying. It has nothing to do with scope of practice.

[The Vice-Chair, NDP, Libby Davies]

Well, I think it is involved with what psychologists do in terms of how far afield they go, what kinds of constituencies or demographics they cover—

[Terence Young, Conservative, Oakville, ON]

That wasn't the question.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Yes, it was.

[The Vice-Chair, NDP, Libby Davies]

I don't see it is as out of order, so I'm going to allow the witness to respond.

[Dr. Karen Cohen]

Post-traumatic stress disorder certainly is a condition for which there are some very robust interventions. We have a section within our membership of 7,000 that specializes in traumatic stress, in terms of research as well as practice delivery.

One of the challenges, I think, within military populations, is access to that care and the way in which care is contracted out. There are no clinical psychologists in uniform, as far as I know. There are some who work on the personnel or industrial organizational side, but not on the clinical side.

There are robust treatments. I think maybe more attention needs to be paid to the mechanisms of accessing them.

Dr. Bland may have some other points of view on that topic, as well.

[Dr. Roger Bland]

Many of us have heard the comments made by Roméo Dallaire, for instance, who years and years after his traumatic episode is still having problems, and I don't think his problem is unusual. I do not know how long the military extend their services to people who are no longer in the military.

Another example would be Colonel Ethell , who is the Lieutenant-Governor of Alberta and who talks frequently about his post-traumatic stress experiences in Bosnia. This was many years ago, and he is still having trouble.

I think that the need for supportive services to continue, in some cases for many years afterwards, and for those supportive services to be extended not only to the individual who was in the military but to the family members who also become victims of this, is incredibly important. I can't—

[The Vice-Chair, NDP, Libby Davies]

Dr. Bland, we've now reached the seven minutes, so thank you. We'll perhaps pick it up later.

[Dr. Roger Bland]

Thank you.

[The Vice-Chair, NDP, Libby Davies]

Mr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you very much, Madam Chair. It's nice to see you in the chair. It's the first time since I've been here, I think.

Thank you very much to both of our witnesses for being with us this morning.

Dr. Bland, you were discussing collaborative models of care as opposed to multidisciplinary teams, and I think you drew a distinction there. You mentioned a study that had been done recently about examining the models.

Could you tell us what the name of that study was, or where was it published, or where we would access that?

[Dr. Roger Bland]

It was published as a supplement to the Canadian Journal of Psychiatry, in, I think it was 2008. We'll certainly be able to make copies available to you.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you very much. We would very much appreciate that.

Now, back to your collaborative models. Multi-providers, I think I heard you say, are based on personal context, mutual respect, understanding each other's competencies, evidence, and experience-based. I think those are very appropriate comments.

Can you describe the genesis or development of this type of model? How do you get these groups together, and is it contingent on the size of the population or the pool of resources you have to draw on, and so on? Could you please describe an example of that?

[Dr. Roger Bland]

The history is that this started as a collaboration between the College of Family Physicians and the Canadian Psychiatric Association, based on problems that the College of Family Physicians was getting from its members about its relations with psychiatry, difficulty in getting referrals and so on.

To give you a single example, I worked for about five years in the Northeast Community Health Centre, in Edmonton, on a part-time basis as the psychiatry consultant. This is a community mental health centre, which had family medicine, maternal care, public health, child care, and a couple of other things as well. All of these services work collaboratively. The mental health program was set up there to be a support to the other programs and not to assume an independent life of its own.

In my work there and the work of the staff, which included an addiction service as well, this mostly meant seeing patients the other services had seen and thought had a problem. It was seeing those patients with them, developing a treatment plan jointly, and assigning who was going to do what. We had some problem cases and we'd have a large case conference and assign responsibilities. It was not a case of saying this is my problem and I'm handing it over to you; it was a case of which of us was going to do what to help this patient with these defined problems.

Does that—

[James Lunney, Conservative, Nanaimo—Alberni, BC]

That's very helpful. Then you would get together as a team once a week. What was the funding model for that? How did they manage that aspect because that seems to be a barrier to some of these problems?

[Dr. Roger Bland]

The program as a whole was getting funding through the Capital Health Authority as it was in Alberta at that time.

I just billed fee-for-service on the fee schedule. I got no extra funding for this. The Alberta fee schedule is quite conducive, though, to spending time in case conferences and discussions with other professionals. That is not true in a lot of the other provinces.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

In building teams like this, is physical proximity an essential ingredient or is it relationship proximity? Can you build those relationships and then maintain them through online or through other e-forms of connecting?

[Dr. Roger Bland]

It tends to be difficult to build distance relationships. It can be done, but it takes a long time.

The person you're seeing on a regular basis down the corridor and can go and ask a question of, you tend to build a closer relationship with much more quickly.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Exactly. Then in building a team like that you might get people together in remote communities, bringing some resources in, spending a weekend together once every three months or something so you establish relationships, and then maintaining more of a collaborative distance relationship.

Might that work?

[Dr. Roger Bland]

That could, and I think there are some models like that. I think probably once every three months isn't frequent enough. You have forgotten who was there.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

That is a good point.

You mentioned that increasing the number of primary care providers improves access and outcomes for the patients. I think that's a very reasonable assessment. Did I quote you accurately on that?

[Dr. Roger Bland]

It's not quite what I said, but I would agree with it.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Could you repeat what you said so I could get it your way?

[Dr. Roger Bland]

I said that increasing the number of primary care providers tends to increase population health.