National Defence Committee on March 13th, 2008

[The Chair, Conservative, Rick Casson]

I call the meeting to order.

We waited a few minutes because we know that one of our colleagues, on crutches, is a little slower on his feet than normal.

I'll give a little update to the committee before we get into hearing the witnesses today. We were successful in getting the funding back for our trip to Afghanistan. I understand it was just approved in the House.

Let's get down to business. We're here to continue our hearings on the health of our Canadian Forces members, with the emphasis on post-traumatic stress disorder. Today we have some expert witnesses, and we're anxious to hear from them.

I'll explain that we can't go overtime today. The bells will ring at 5:30 for a vote, and then at 5:45, I believe, for another vote.

Go ahead.

[John Cannis, Liberal, Scarborough Centre, ON]

Congratulations, first of all, for getting the money. Thank you very much.

Are we going to allot some time to discuss dates, etc., at a future meeting?

[The Chair, Conservative, Rick Casson]

Yes. The first meeting back, on April 1, will be a subcommittee meeting on future business. We'll be able to deal with that then.

[John Cannis, Liberal, Scarborough Centre, ON]

Thank you. I appreciate it.

[The Chair, Conservative, Rick Casson]

I've asked the clerk to start us off that way in April.

Today we welcome, from Veterans Affairs, Doug Clorey, director, mental health policy directorate; Rachel Corneille Gravel, executive director, Ste. Anne's Hospital; and Raymond Lalonde, director, National Centre for Operational Stress Injuries.

I understand that each of you has a short presentation to start. Then we'll get into questions.

Whoever wants to start, the floor is yours.

[Rachel Corneille Gravel, Executive Director, Ste. Anne's Hospital, Veterans Affairs Canada]

Good afternoon. My name is Rachel Corneille Gravel. I am Executive Director of Ste. Anne's Hospital. I want to tell you that we are very pleased to be here today and to be able to answer your questions. We are not clinical specialists, but we will nevertheless try to give you a good idea of the work we do and of what we can do for our clientele.

I'm accompanied by Mr. Doug Clorey, who will take the floor after me. As Mr. Casson mentioned, he is Director of the Mental Health Policy Directorate. He is also responsible for the Veterans Affairs Canada Mental Health Strategy. Mr. Raymond Lalonde is Director of the National Centre for Operational Stress Injuries at Ste. Anne's Hospital.

I'm going to talk a little about Ste. Anne's Hospital, which was founded in 1917. It is the last hospital administered by Veterans Affairs Canada, the last hospital under federal jurisdiction. It is a long-term care centre specializing in geriatrics and psychogeriatrics. It currently houses nearly 415 veterans of World War II and the Korean War. Obviously, we no longer have any patients from World War I.

The hospital also specializes in mental health. The first Veterans Affairs Canada clinic for operational stress injuries was established at Ste. Anne's Hospital in 2001. An enormous amount of work has been done since then. As part of the modernization of programs and services offered to clients through Veterans Affairs Canada, Ste. Anne's Hospital was assigned a national clinical leadership role in 2005 for all matters pertaining to operational stress injuries, OSIs.

Today, the National Centre for Operational Stress Injuries at Ste. Anne's Hospital has three sectors.

The OSI clinic employs psychologists, psychiatrists, social workers and nurses. It offers specialized outpatient services to more than 300 new-generation veterans. There's also the clinical expertise sector, the main role of which is to develop and promote best practices across the country and to provide consulting services, particularly through our other OSI clinics. Lastly, the network coordination and development sector, which is more administrative in nature, is responsible for developing and coordinating clinical mental health services across the country to ensure that all clients, regardless of where they live, can receive the clinical services they need.

Veterans Affairs Canada has a very specific mandate to provide care and services to individuals who have served in the Canadian forces and are now veterans, whereas National Defence is responsible for active military members. Although our mandates are different, our purpose is to develop, coordinate and harmonize care and services in areas of common interest, such as mental health.

For that purpose, Veterans Affairs Canada, the Department of National Defence and the Royal Canadian Mounted Police signed a memorandum of understanding a few years ago. That MOU defines a framework for putting a joint network of clinics in place. Veterans Affairs currently has six clinics, and will soon have 10. The Department of National Defence also has its own clinics. I believe there are five of them. This synergistic and partnership effort is seen in a very good light; it represents a commitment by two departments to assist this clientele.

That was a very brief introduction to tell you who we are and what we do. I now turn the floor over to Mr. Doug Clorey, who will tell you about his area of expertise.

[Doug Clorey, Director, Mental Health Policy Directorate, Veterans Affairs Canada]

Thank you, Rachel.

As Rachel and the chair have mentioned, my name is Doug Clorey. I am the department's director of mental health policy. In that capacity I have the overall responsibility for overseeing the implementation of the department's mental health strategy. There are some details on this strategy in your deck, and perhaps we can refer to some of the slides at some point during our discussion.

The strategy essentially consists of four elements. The first one is to ensure that the mental health services required by still-serving members of the Canadian Forces and by veterans are there. It covers the whole gamut from health promotion to assessment, treatment, rehabilitation, and ongoing care.

The second element of the strategy is to build capacity. Building capacity is about ensuring that when we are not satisfied the resources are available, we take steps to initiate those resources, particularly in the local communities where the veterans are located.

We think we also have a role in terms of leading in this area, so there's a leadership component to our strategy.

Finally, we recognize that none of us can do this particular work on our own, so partnerships are key to being able to achieve.

Those are the four elements of the strategy. We can talk more about that as time unfolds this afternoon.

I also have overall responsibility with my team to develop the business processes and the policies associated with the delivery of mental health services to veterans and other clients within the department. This is all to say that I am ready, willing, and hopefully able to speak with you this afternoon on the mental health strategy of the department, on the mental health framework that constitutes how we go about delivering services to our clients, and also a little bit on the lessons we've learned over the last number of years.

Finally, I want to recognize the work of this committee as I suppose part of the work we do in partnership. We really look forward to what will come out of this committee in terms of recommendations, because we would like to think we're all working towards the mental health and well-being of veterans and those who have served our country.

Thank you.

[The Chair, Conservative, Rick Casson]

Thank you for those comments. We appreciate that.

We will start the seven-minute round with Mr. Coderre.

[Denis Coderre, Liberal, Bourassa, QC]

Mr. Lalonde would like to respond.

[The Chair, Conservative, Rick Casson]

I apologize, sir; take all the time you need. We'll keep Mr. Coderre on hold. It's not an easy thing to do, but we'll try.

[Denis Coderre, Liberal, Bourassa, QC]

Take your time.

[Raymond Lalonde, Director, National Centre for Operational Stress Injuries, Veterans Affairs Canada]

Thank you very much.

As Ms. Gravel said, the National Centre for OSIs, which I direct, is part of Sainte-Anne Hospital. We have a three-part mandate: to provide clinical services at the hospital for OSIs, to provide OSI expertise to the department and on an outpatient basis, and to develop access to services across the country.

One of the major characteristics of this last component is the establishment of a network of clinics. The Department of Veterans Affairs offers no direct service to its clientele, except at Ste. Anne's Hospital. The services covered by Veterans Affairs are offered through provincial health services and private service providers, the cost of which is reimbursed by the department.

We also have networks of private service providers across the country that offer specialized programs, such as comorbidity programs for PTSD and substance abuse. As regards the OSI clinics, apart from that in Sainte-Anne, we've entered into agreements with institutions under provincial jurisdiction. Under those agreements, we provide the provincial institutions with funding so that they can establish clinics for our veteran clientele. However, those clinics are also accessible to members of the Canadian Forces and the RCMP.

So the department's only OSI clinic is located at Ste. Anne's Hospital. Our other clinics were established under agreements reached with the provincial institutions. I think that's an important difference, having regard to the fact that the Canadian Forces are responsible for their own clinics, which are operated by their personnel.

I wanted to be sure to clarify that point.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Coderre.

[Denis Coderre, Liberal, Bourassa, QC]

I'd like us to go off the beaten path. Hearing talk about leadership, partnership and offer of service, I got the impression—and I mean this quite respectfully—that I was reliving the years when I was studying for my MBA. It was all well and good, but I would like us to go a little off the beaten path. I know you aren't clinical specialists, but we're trying to get a clear understanding of the environment in which a person who most of the time feels alone and has to go through trying times is confined. In addition, it wasn't so long ago that anything called mental health wasn't taken seriously. No doubt you've often preached in the wilderness.

When someone is in need, how do things happen, in concrete terms? Do you offer services, and so on? Do you work with other organizations? Another organization offers support through peers. It tries to reach those who have experienced the same problems, to oversee them, and so on. I know that you're doing quite outstanding work at Ste. Anne's Hospital, but it's a tough and difficult job, and it has to be linked up with other clinics. How is that done? How are you going to go after people, or how do people come to you when they are in need?

[Rachel Corneille Gravel]

I'll start, and Raymond or Doug can add their comments.

People in need can be referred to Ste. Anne's Hospital, for example, in various ways. That can be through the Montreal district office. Normally, eligibility is one of the set of rules. These people are referred by the veterans assistance system so that they can receive care and services, for example, at Ste. Anne's Hospital. That can also very well be done through peer support. We also work very closely with a group called the Operational Stress Injury Social Support Program. It's a peer support group, people who have suffered from various mental health disorders and who establish strong ties with their companions in the armed forces. A person in need will be referred to us. The deadline for seeing that person is very short for us, among others, at the operational stress injury clinic. We have to ensure that there is an assessment and treatment plan. That person will be seen by the nurse, by the social worker and, if necessary, by the psychologist or psychiatrist, because, in many cases, a diagnosis has already been made. Obviously, we'll trigger a treatment plan. There are various types of treatment—group therapy, individual therapy—and a lot of work is also done with the families since the family is an integral part of the life of that person. That especially should not be forgotten in the treatment process. It is possible that we may refer them for detox treatment because we work in partnership with other groups, other institutions. The person has to be referred to the right place, depending on his or her situation.

Of course, someone living in an urban area, near an operational stress injury treatment clinic, has better access than someone living in a remote region. In general, I believe we respond to most of the needs of people across the country. We're obviously developing. We have contacts and we're trying to build a network. Some service providers can meet these people where they live. We're also developing a telemedicine system to put people in touch with remote specialists, in another way.

Perhaps Raymond wants to add something.

[Denis Coderre, Liberal, Bourassa, QC]

After speaking with certain soldiers privately—and we'll be hearing from others—it appears that one of the problems is that these people very often feel somewhat trapped in the system. The system may be beneficial and help them—when they've gotten to you, perhaps they'll be saved—but there's a confidentiality problem. They're afraid that things will be known. Obviously, that also depends on whether they have been relieved of their duties or not. We also have the feeling that there's a lot of bureaucracy, because people often give up at some point.

How are you experiencing that? You said you had worked with the organization that we met, which moreover is doing quite outstanding work. How do you ensure follow-up? How do you ensure that you can treat these people humanely and not as statistics or within too bureaucratic a framework? I say that respectfully, of course.

[Rachel Corneille Gravel]

The people we meet have been discharged from the Canadian Armed Forces. The Department of National Defence has taken charge of a part of their lives, with emotional consequences. When they are discharged from the armed forces, they become part of our clientele.

I think the approach is very humane. The work that is done very closely with the peer counsellors and health professionals consists in trying to restore their dignity and a sense of belonging to a community. One of the objectives moreover is to be able to do everything to help them find their place in society. The follow-up that we do includes clinical follow-up, for which the clinicians are responsible. However, we also do follow-up with these people and their family through surveys and individual meetings. We have a way of taking the pulse to see if they are satisfied. We have a whole quality control system for finding indicators that give us a faithful representation of a certain degree of success. This system is obviously evolving.

[Denis Coderre, Liberal, Bourassa, QC]

Are you finding that patients are younger and younger? There are World War II and Korean War patients at Sainte-Anne-de-Bellevue. Do the missions we are taking part in give you the sense that there are increasing numbers of people?

[Rachel Corneille Gravel]

Yes, the clientele is much younger. It's an out-patient, non-hospitalized clientele. We only admit the hospital veterans who have served overseas in a war. The really much younger clientele, between 30 and 50 years of age, is the one we see on an outpatient basis.

[The Chair, Conservative, Rick Casson]

Thank you very much.

Mr. Bachand.

[Claude Bachand, Bloc, Saint-Jean, QC]

Thank you, Mr. Chairman.

Welcome. My first question is for you, Ms. Corneille Gravel. Have you been Executive Director of Ste. Anne's Hospital for a long time?

[Rachel Corneille Gravel]

Yes, since 1996. I've worked at Ste. Anne's Hospital since 1974.

[Claude Bachand, Bloc, Saint-Jean, QC]

Your face is familiar. The members of the Standing Committee on Veterans Affairs visited the hospital a few years ago. We were very impressed.

[Rachel Corneille Gravel]

That's it.

[Claude Bachand, Bloc, Saint-Jean, QC]

I even remember having lunch—