National Defence Committee on Feb. 7th, 2008

[MGen Walter Semianiw]

They've all been adopted because people have been told to do them. I went through the last committee, where I made the comment...people said we're bureaucrats at the end of the day, but we're not, we're leaders at the end of the day. We provide direction and people agree.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

I am not sure who to address this to. We've seen the stories of families not getting adequate care. I saw in my home province of Ontario the conflict that went quite public around here at Petawawa for the children. Has that been cleared up or is it still a problem?

[MGen Walter Semianiw]

I'll kick off and then turn it over to General Jaeger, and she'll talk about the constructive framework.

Immediately on hearing that, the department provided moneys to the province, to a local care provider, to assist the case in Petawawa you're talking about, a couple of hundred thousand dollars to help them out.

As General Jaeger is now going to tell you, that, in part, becomes our challenge, because from a legislative regulatory framework, much of it falls outside of our purview. We both know that the family is the bedrock of operational effectiveness--and it's a point worth pursuing here. I come back and say there are instances throughout where we need to do better with families. We have done a lot of things with families. There are specific cases, and when we find out about them we get on. But the department provided money to the province in that case to help out. I know General Jaeger can explain that.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Comartin, I thought you were going to lead further with your questioning on the seminar they had and ask if we could be invited to be witnesses or observers at the next one. We didn't get quite that far.

[MGen Walter Semianiw]

No.

[The Chair, Conservative, Rick Casson]

The answer seems to be no!

We'll move over to the government side.

[Joe Comartin, NDP, Windsor—Tecumseh, ON]

Could we get General Jaeger to finish that answer on the treatment available for families?

[The Chair, Conservative, Rick Casson]

In the next round you'll have time.

Ms. Gallant.

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

Thank you.

Through you to the witness, Mr. Chairman, I noticed that the Canadian Forces have five operational trauma and stress support centres in Halifax, Valcartier, Ottawa, Edmonton, and Esquimalt. I think these are excellent steps forward for care, but how are we providing care to soldiers not based in these urban centres?

Many CF bases are in rural or suburban centres, not in the major metropolitan areas. In fact, I would think that a majority perhaps live outside those areas. It's not always practical for people with mental health issues to get treatment away from their families, especially if they've already spent six months on deployment.

Are we considering satellite operations in smaller areas or innovative solutions like travelling clinics or something else?

[BGen Hilary Jaeger]

Thanks for your question.

I know exactly where you're coming from. I was a senior medical officer in Petawawa from 1996 through 1999, so I know the Ottawa valley fairly well.

The OTSSCs are part of a specific program. You have to remember a couple of things about them: they were thought up in 1998 and implemented in 1999, i.e., before the current mission in Afghanistan. With the available resources we had, we could only have so many, and we had to look at providing services in both languages and in a way that provided the best footprint across the country. And that really meant having one clinic in Ontario.

When you look at the number of bases in Ontario, there is Petawawa, Ottawa, Kingston, Trenton, Borden, and Toronto. We thought actually that the best single place at the time was Ottawa. Now, with the pace of operations and the mission going on, of course, there's quite a lot of need coming out of the base up the road in Petawawa.

The concept was always that those were not the only places to get mental health care. Every base has a mental health service of varying size; it can be one social worker in a place like Gander, or it can be 10 or 12 people at a larger base.

Petawawa faces a double challenge. It's a big and very busy base, but it's in a part of the world—a beautiful part of the world, I know, as I love to go hunting and fishing—where not a whole lot of psychiatrists really want to live. I don't know why. Not a lot of clinical psychologists want to be there either.

When and if we finish the mental health initiative, there will in fact be more mental health providers in Petawawa than in some of the other OTSSCs, with the same mix of providers following the same methods.

But we are, I admit, having a serious challenge attracting mental health providers to work for us in Petawawa.

[MGen Walter Semianiw]

If I could expand on that, Mr. Chair, both General Jaeger and I realize that we need to get more people into Petawawa. We have heard that message loud and clear. We try not to attach to it, but clearly, we need to put an OTSSC-like thing in Petawawa as quickly as possible, and that's what we're working on right now—and in Gagetown.

If I could add—which may assist the committee—we have to remember that at the same time we put in the OTSSCs, these are part of a broader concept. That concept is connected to the Department of Veterans Affairs, because they have OSI clinics, and the two look pretty much the same across the country in different locations. So the Department of Veterans Affairs is putting an OSI clinic into Gagetown very shortly. To help meet or address the issue, the two departments are working together very closely. Don't quote me here, but I believe the department was given money in the last budget to add an additional ten OSI clinics, and one of them is going to be in Gagetown.

So you're right, especially for reservists. And that's an issue that did come up, Mr. Chair, at the lessons learned symposium. I agree it is one of those six areas. What do we do for reservists who are in Kitchener, but maybe not in Toronto and maybe not in Petawawa? Again, we don't have the time to go through this, but we know it's an issue.

We're moving ahead on a number of different fronts to ensure that men and women in uniform, regular or reserve, get the support they need. But we realize the challenge is when someone is not near a major base.

[BGen Hilary Jaeger]

Getting back to the short-term fix, we do recognize that it takes a long time to hire people. We've hired people in Ottawa whom we've told, you can only be hired if you agree to get on a bus and go to Petawawa a couple of times a week. Similarly, for Gagetown, the OTSSC folks in Halifax conduct routine outreach clinics into Gagetown.

We know we have some gaps, which we'd rather not have, and we try to move the resources around to fill them. That's a stop-gap measure.

[MGen Walter Semianiw]

But is it perfect? No. Is it better than it was? Yes. We know where we're going and what we have to do.

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

I'm glad to hear that.

With respect to staffing, in my riding of Renfrew-Nipissing-Pembroke, the riding where Petawawa is situated, we have upwards of 20,000 civilians who are now orphan patients; they don't have a family doctor. There's a shortage of doctors. It's the way the provincial government limits health care costs. By keeping the number of family physicians down, you keep down the number of referrals and the diagnostic testing; wait lines are therefore diminished. It works out for the government coffers, but not exactly in the best interests of the patients.

You mentioned that you were looking at various services. I notice that in the United States, in 2006, there was signed into law federally a sweeping bill that adds marriage and family therapists to their front-line health care workers.

What sorts of possibly non-traditional medical professionals are added to help cope with the stresses that might not necessarily require a psychiatrist but need preventive care along the way?

[BGen Hilary Jaeger]

We make heavy use of our social workers along those lines. The vast majority of our marital counselling is done by uniformed social workers. It's open to families and members, one with or without the other; that's not an issue.

I'm probably stepping on thin ice, but I'll say we exploit the ability of social workers to deal with families to the maximum. We push that envelope as far as we possibly can. I have no legal mandate, no legal authority, to treat civilians, outside of life- and limb-threatening situations, without ministerial authority, except with social workers.

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

Is each physician who treats Canadian Forces personnel required to hold a provincial medical licence?

[BGen Hilary Jaeger]

Yes, they are.

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

Okay. Now, despite the fact that the Canada Health Act stipulates that health care coverage for the Canadian Forces is a federal responsibility and that the Canada Health Act specifically excludes military personnel as insured persons, in Ontario the soldiers still have to pay the Ontario health tax premium, unlike the case in other provinces.

Is there any consideration given by the province to providing professionals or treatment facilities, over and above the extra the federal government already pays on the soldiers' behalf?

[BGen Hilary Jaeger]

It's an interesting question. I pay the health tax too. It varies widely across provinces, and of course it's not always the provinces themselves who provide the billing. It usually isn't. It's individual providers and the regional health authorities or the hospitals themselves.

But on average, we pay 30% above provincial health care rates for every service we purchase on the provincial system.

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

My last—

[The Chair, Conservative, Rick Casson]

I'm sorry, Cheryl, we're a little over.

That ends the first round. We'll get into the second round. They're five-minute spots. We start with the official opposition, then go to the government, the Bloc, the official opposition, the government, the official opposition, the government. That's how this round goes.

Mr. McGuire, do you want to start for five minutes?

[Joe McGuire, Liberal, Egmont, PE]

Thank you, Mr. Chair.

I'll follow up on that regular line of questioning. The whole country is short of doctors and health care givers. Do you have the same problem recruiting and training people in the military?

[BGen Hilary Jaeger]

We had a serious problem with general duty medical officers—family physicians—which hit its low point about 2002, when we were short more than one-third of those. We now believe we'll be back up to full complement in a year to a year and a half. We've done extremely well with recruiting, with a very focused attempt.

We've also done a pretty good job recruiting our specialist physicians as backup. The mission in Afghanistan has actually been a drawing card for us for that. Base people, trauma surgeons, and anaesthesiologists see this as really important, worthwhile work to do, and they want to be part of it. So that's helped our recruiting.

Pharmacists constitute a big hole for us now. But we're doing well on the uniform side.

It's really the public service, and a lot of my health care providers who stay in place are supposed to be public servants. At the moment, they're not; they're contractors, because public service pay scales, quite frankly, aren't sufficient to attract physicians at the moment. I pay a third-party contractor a lot of extra money to fill those holes.

[Joe McGuire, Liberal, Egmont, PE]

Do you use foreign-trained doctors who are available in the country but are not in our system? Are you tapping that resource?

[BGen Hilary Jaeger]

I have foreign-trained doctors, but only those who have gone through the established hoops to receive licences to practise in a province in Canada.