National Defence Committee on March 13th, 2008

[Raymond Lalonde]

No.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Do your statistics take into account those who receive outpatient treatment and who do not call on the Canadian Forces? I imagine your statistics don't take into account those who go to see their family doctor or who go to a civilian hospital to receive psychological treatment.

[Raymond Lalonde]

Are you referring to military members or veterans?

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

I'm referring to both.

[Raymond Lalonde]

Our mandate doesn't cover military members. We don't monitor them. We're concerned with veterans. These figures show those who file a claim for compensation for a disability that is recognized as related to their service. That concerns only those who come to see us and whose disability has been recognized. Some of those 10,000 individuals will subsequently receive the services of a psychologist or psychiatrist, or will receive medication. There are others who will simply receive the services of their family doctor, because their condition is less serious.

[The Chair, Conservative, Rick Casson]

Sorry, Steven.

[Steven Blaney, Conservative, Lévis—Bellechasse, QC]

Thank you very much. It's a whole world.

Thank you, Mr. Chairman.

[The Chair, Conservative, Rick Casson]

Thank you.

That finishes the opening round. We'll now get into a five-minute round, starting with Mr. Rota.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Thank you, Mr. Chair.

Thank you for being here today.

I'm going to just use one case study in particular. An individual was in my office. He's a young man. He came back from Afghanistan, and he was getting treated. He went to see a psychologist he was referred to. He's with Veterans Affairs now. He's no longer in the military. He sat down with a psychologist and the psychologist looked at him and said, “Well, I really don't know how to treat post-traumatic stress disorder, but we'll go through this together and we'll see what happens.” This leads me to chapter 4, page 3, of the Auditor General's report, when she reported that mental health work is being contracted out to civilian workers who don't have the experience or knowledge to treat injured individuals. That has to do with the military, with DND. I'm sure a lot of it spills over. I'm not sure exactly what the division is. That's one question.

The real question is how do you choose health care providers? What criteria do you use to assess their capabilities? When you have a psychologist or a psychiatrist or a mental health care provider, where do they get their training? Is it mainly through school? Do you look at what training they have afterwards? Is it a combination of all?

You may answer in French if you wish.

[Raymond Lalonde]

As I explained earlier, 900 service providers across the country meet our criteria. Clients are free to go and see the service provider of their choice, provided that provider meets our criteria. We then reimburse for treatment expenses. In one sense, that's very different from what is done in the Canadian Forces. In their case, contracts are established with service providers, and forces members are referred to them. In our case, it's a matter of free choice.

To be a service provider, you have to meet training and experience criteria. We don't have any contractual relationship with those suppliers. We can't impose practices. Our role is to ensure that clients are satisfied and to improve the training and supervision of those providers. Since we don't have any authority, the practice of those providers is the responsibility of their professional order, in the province where they are located. We're in the process of improving training for service providers. In addition, the OSI treatment clinics have a role to play in training.

Our role is also to improve our relations with service providers so that they can work with the specialists at the OSI treatment clinics. The objectives is to enable them to improve their practice. To do this, they can discuss the best approach to adopt with the professionals and experts. We also aim to further standardize reports and information that we want to receive when we are asked to approve a series of treatments.

Clients may consult the therapist of their choice, but they must seek pre-authorization from us where they exceed a certain number of treatments. In that respect, we're working to improve our policy and our instruments, particularly with a view to offering the right answers and asking the therapist the right questions and to ensuring that the treatment heads in the right direction.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

I don't understand. Individuals choose where they want to go, but I imagine that criteria have been set in the matter.

[Raymond Lalonde]

Yes, suppliers must meet our training and experience criteria in the area of the therapy.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

If someone wants to try something different, such as acupuncture, for example, or another unofficial treatment, does your system have some flexibility or is it rigid?

[Raymond Lalonde]

The treatments for which we provide reimbursement are those offered by health professionals.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

That's only one example. That's the first idea that came to my mind. If there's something new, a new treatment—

[Raymond Lalonde]

It must be studied and recognized in the research field. We don't accept just any treatment, especially where it isn't offered by health professionals. That's a really important criterion. And we've previously been asked to approve a treatment offered by people who weren't health professionals. In that kind of case, we don't give our approval, and we don't reimburse for treatment.

[Rachel Corneille Gravel]

Veterans can choose to go and see whomever they want. However, their treatments won't be reimbursed by Veterans Affairs Canada if they aren't part of the protocol that we apply.

That's an unfortunate situation for your client. We've never heard about that. This is the kind of situation that can occur, I imagine. It may involve people who are replacing others, but the fact remains that it's unacceptable. The fact that a client who was supposed to see a person experienced in the field of PTSD winds up with someone inexperienced in the area should immediately be brought to our attention. That is indeed unacceptable.

[The Chair, Conservative, Rick Casson]

Thank you.

Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you very much, Mr. Chair.

Thank you all for coming.

Your approach is interdisciplinary, and some of the people you treat are suffering from addiction as well as operational stress injuries. How do you go about approaching those kinds of situations? In the cases you deal with, is there a number of how many are suffering from both an addiction and a stress injury? Do you have an idea?

[Raymond Lalonde]

The numbers are quite high. Research says probably someone with PTSD will have 50% or more chance of having a substance abuse problem. The way we treat it, our clients have an OSI with the substance abuse problem. The issue is first the identification, because a lot of our clients will not admit they have substance abuse problems, so screening is very important. We're looking at training the Veterans Affairs staff on that, OSI clinics. This is one thing.

Then the engagement means that someone can have a problem but doesn't want to do anything about it. We have service providers, so we could refer clients and pay for sessions with service providers. We also have six providers across the country who offer in-patient service for up to two months' comorbid PTSD and substance-abuse programs. So we have them across the country, and they are very effective. They are working well.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Are you telling me that—on page 5—of the 6,500 people you are treating, 50% of those would have an addiction problem as well as a stress injury?

[Raymond Lalonde]

The 6,500 is the number of clients who have recognized conditions. It doesn't mean that we treat them all, because some may have a condition and may not come to us for services. The literature says that someone who has PTSD would have 50%—

[Laurie Hawn, Conservative, Edmonton Centre, AB]

So that's a reasonable assumption, okay.

The VAC clinics and DND clinics, are they all the same with respect to services provided and so on?

[Raymond Lalonde]

They are fairly similar. The context is quite different, but assessment, treatment, interdisciplinary approach, and group programs are similar, yes.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

In your deck here, you talk about capacity challenges, which you obviously have, just from the increasing numbers. How are you coping with that? You must be setting some priorities, prioritizing patients. How much difficulty are you having with that? Do you have a level of comfort that you're reaching the higher-priority folks appropriately?