National Defence Committee on March 13th, 2008

[John Cannis, Liberal, Scarborough Centre, ON]

Thank you, Mr. Chairman.

Guests, welcome.

The questions that have been asked have been primarily around the expertise, the service, etc. You've given valuable information, for which we all thank you. But throughout the responses, the word “budget” has been mentioned, in terms of budget 2007, and I'd like to take it in a different direction.

You mentioned in your presentation the provincial clinics, the services, the jurisdictional responsibilities--I'm just generalizing now--and you said “We finance clinics”, if I may quote you.

How does that work? Other presenters have come before our committee, including some just the other day, in terms of funding difficulties they've had as a result of the Senate committee report--as I believe, Mr. Chairman, was referred to yesterday--and funding being brought forward. You're funded by DND or Veterans Affairs. Could you please tell us how Veterans Affairs and DND tie together? And are there any obstacles that veterans run into because of jurisdictional responsibilities and the referrals that have to be made?

You also talked about how, when you don't have expertise, you “contract out”, as you put it. Where is that? Obviously we've been told by witnesses in the past that in the Canadian Forces, our military persons have a different health program, per se. It's not like I'm covered, for instance, under the Ontario hospital medical association.

Could you somehow join the dots for us there, in the short time we have left, and give us an overview on the services, the finances, the budgeting, and so on?

[Raymond Lalonde]

The funding of services to veterans who are entitled to receive services because of their mental health conditions is done through our health program. It is on an entitlement basis. If you're entitled to it as a veteran, we will reimburse you for the services you got from a private service provider.

The majority of our clients get services from those 900 service providers across the country. It's just a matter of entitlement. If you have a mental health condition, you're entitled to ten sessions a year. After that, we need to have it pre-authorized for us to reimburse for the other sessions. As we pre-authorize, we will look at whether the treatment is appropriate and working well, etc.

As for the clinics, we fund the clinics out of our health program at Veterans Affairs, so we finance the full clinic. What we're working on--

[John Cannis, Liberal, Scarborough Centre, ON]

It's the budget allocated through Veterans Affairs then.

[Raymond Lalonde]

Yes. Every year we sit down with the clinic and look at their requirements, and we approve every year the full budget for the operation of the clinic.

The issue for us at this point is that we need more clinics. We were really pleased to see, in budget 2007, that we have the opportunity to double the complement of clinics to cover the whole country.

[John Cannis, Liberal, Scarborough Centre, ON]

How much was it, Mr. Lalonde?

[Raymond Lalonde]

It was $9 million for five new clinics, and support to Veterans Affairs--

[John Cannis, Liberal, Scarborough Centre, ON]

So $9 million for the clinics. Was that the overall budget?

[Raymond Lalonde]

No, it was only for the OSI clinics.

[John Cannis, Liberal, Scarborough Centre, ON]

But was that allocated for the different services?

[Raymond Lalonde]

For Veterans Affairs?

[John Cannis, Liberal, Scarborough Centre, ON]

Yes.

[Raymond Lalonde]

Oh, it was much more than that. I don't have the exact number, but it was in the $30 million range at that time.

[John Cannis, Liberal, Scarborough Centre, ON]

Okay.

[Raymond Lalonde]

I don't know if that answers your question.

[John Cannis, Liberal, Scarborough Centre, ON]

I have one more.

You referred to jurisdictional responsibilities. If you have a veteran who needs a specific type of service and they live in Ontario or in Quebec or in P.E.I., are there any obstacles in getting them that service? Really, the bottom line is getting them the service they need. Have there ever been any obstacles? If so, how do we overcome that?

[Raymond Lalonde]

I don't think the provincial jurisdiction is an issue. The provinces offer general public health service to all of the veterans, including our veterans who have mental health conditions. This is done. If they need to go to emergency, they will be taken in. There's really no problem.

So they're covered all across the country in the same way.

[John Cannis, Liberal, Scarborough Centre, ON]

Thank you, Mr. Chairman.

[The Chair, Conservative, Rick Casson]

Thanks, Mr. Cannis.

We're over to the government, with Mr. Lunney.

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

Thank you.

Picking up where we were a moment or two ago, to bounce back, you mentioned in your remarks that there about 900 service providers across the country—I think that was in response to Mr. Rota's comments earlier—and that of course they need to be registered at the service provider, and so on.

I notice that in your remarks you mentioned the psychiatrist, psychologist, sociologist, group therapy, family therapy, detox, but I think I also heard you mention, Madame Gravel, natural caregivers. If I refer to slide 13, “Comprehensive Continuum of Mental Health Services and Policies”, I see that it mentions a “holistic approach...addressing all determinants of health”, and so on. Who did you have in mind when you were talking about natural service providers, and what is meant by a holistic approach?

[Doug Clorey]

Perhaps I can start with the holistic approach. I'd draw your attention to slide 14, which has our mental health framework. It's a very complicated slide, or it looks complicated.

By holistic, what we mean is that when our front line staff are dealing with an individual with a mental health condition, they ought to look at those five areas of interest, not just the health services environment but the personal factors. Very often they are ill, they are in pain, they may have diseases or disabilities other than their mental health conditions. We need to look at their social environment, at supporting their family, at connections with peers. You've already been briefed on the operational stress injury social support network.

The economic environment is part of this as well—do they have money to live on, do they have employment?—and also the physical environment, their actual home conditions and home environment.

When we say holistic, that's what we mean by it.

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

Okay, thank you.

Madame Gravel, would you care to comment? I think it was you who mentioned natural—

[Rachel Corneille Gravel]

The caregivers are really the family, the person who provides care at home—

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

The personal support network, you're saying, then.

[Rachel Corneille Gravel]

Right.

Oh, no; I talked about the peer support, which is different.

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

No, I'm aware of that.

In budget 2008, you're probably aware that we're putting $110 million into some four or five studies across the country related to homelessness and mental health issues and their relation to drug addiction. There's quite a connection between drug addiction—as you've mentioned here, alcoholism and so on—and mental health issues.

Looking at the centre for expertise and best practices, we know that in trying to manage depression, which I think you heard is not what you're seeing primarily as a presenting complaint, but rather PTSD—but often there's a relation, and these parallel or co-existing diagnoses get lumped in—SSRIs as a drug approach are falling under quite a bit of scrutiny these days as hardly better than a placebo.

In terms of non-drug treatments at Ste-Anne, we've heard a bit about a non-drug approach called EMDR. Is that something that's being made available? “Eye movement desensitization and reprocessing” is, I believe, what the acronym stands for. Is it offered at Ste-Anne's and other centres?