National Defence Committee on March 13th, 2008

[Rachel Corneille Gravel]

—a lunch for dysphagics—

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

—with mashed carrots in the shape of carrots.

[Rachel Corneille Gravel]

That project was commercialized not very long ago.

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

Has that generated profits for you?

[Rachel Corneille Gravel]

Not for us, no, not at all. We granted the designer a licence.

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

That's very good.

I'm going to talk a little more about administration. You told us about a memorandum of understanding, about a joint network of clinics. Is that MOU accessible? Can you send it to the Clerk of the Committee so that we can examine it?

[Raymond Lalonde]

With your permission, I'll answer because I am responsible for that MOU at the Department of Veterans Affairs.

The memorandum of understanding signed between the Department of National Defence, the RCMP and Veterans Affairs Canada provides for the framework under which we will establish a network of clinics for the purpose of providing a set of similar services in all clinics across the country accessible to veterans, military members and members of the RCMP. That network is currently being developed. The Department of Veterans Affairs is to open new clinics. We are to open four more to ensure that we have national coverage. We are establishing the financial and administrative operating rules, for quality performance indicators and financial standards. That will enable us to ensure that the three clienteles have access to all clinics in Canada: the on in Sainte-Anne-de-Bellevue, those under our responsibility and that we've negotiated with the provinces, and those of National Defence.

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

I have another question on standardized services. If I understand correctly, the National Centre for Operational Stress Injuries establishes, for example, the type of treatment that will be provided fo all OSIs. Incidentally, are the letters “SC” in the acronym “OTSSC” there to identify those that are directly under military responsibility?

[Rachel Corneille Gravel]

That's correct.

[Raymond Lalonde]

The OTSSCs are those of the military.

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

All right. You're telling us that there is coordination and an MOU with all these people.

[Raymond Lalonde]

There is an MOU establishing that we are going to work together to develop and harmonize... It's not yet complete. In some cases, veterans have access to the Defence clinic, and it's different in other cases. For example, there's a clinic in Winnipeg, and we have an agreement with Deer Lodge Hospital, which accepts a lot of military members from the Shilo base. It's already working; we're developing the mechanism, because there aren't enough clinics in the country, and we're working out the details of the services that will be offered.

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

Can we talk about standardized services? Are there the same services in Montreal and on the west coast, in Esquimalt, for example?

[Raymond Lalonde]

When you talk about mental health services, the mandate of the operational stress injury treatment clinics is first to conduct assessments. We use the best practices, those that are recognized by researchers, in the clinics of both the Department of National Defence and the Department of Veterans Affairs. There may be different terms and conditions for military members, but they are nevertheless quite similar. For treatment approaches, clinicians sat down together. The health professionals sat down with those of the Department of National Defence and those of the Department of Veterans Affairs to establish what the best practices should be. Once that's done, health professionals use their professional judgment to use, from among the recognized best practices, those they consider most suited to the client or patient they are treating.

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

How do you go about putting that together, since health is a provincial jurisdiction? Of course, you retain some responsibility for the soldiers, veterans and so on, but does the MOU establish a standard that must be met by British Columbia in Quebec, or are the MOUs instead segmented by province?

[Raymond Lalonde]

Even though I direct the National Centre for Operational Stress Injuries of the Department of Veterans Affairs, we have established agreements with the provinces and we're working on a collaborative basis. We don't have all the knowledge, all the experience or expertise in this area, since it's new and evolving. We're working with all the managers and professionals of the clinics to establish the best practices.

Consequently, this year, we worked to establish jointly what should be the best assessment tool or evaluation form, the one that should be used in all the clinics. We work a lot on a collaborative basis and by consensus instead of imposing standards, because this is a field where we need everyone's contribution. It's often said that we aren't the expertise centre since the expertise centre is the entire network of clinics working together.

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

Does that include the budget agreement as well? The Deer Lodge Hospital reports to the Government of Manitoba.

[Raymond Lalonde]

Yes, but we finance the clinics 100%. According to the agreement we've reached with the institutions, they use our model. This is a highly specialized, level-three interdisciplinary model that includes the best practices, case management, and so on. So we ask that certain criteria be met. In consideration of that, we fund the clinic's operation entirely.

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

My next question is for Mr. Clorey.

Mr. Clorey, you have the title of Mental Health Policy Director. Does that mean that you establish the entire mental health program of the Department of Veterans Affairs? In other words, are you the brains of the entire system that is then implemented in the OSIs? How do you work?

[Doug Clorey]

As Raymond has said already, everything we do around mental health is done in collaboration. So I would certainly not assume responsibility for all of this, or even my team. The department has organized itself with a group of people who bring expertise from all areas of the department to actually develop these policies. But you are correct, in that out of the directorate for mental health policy will flow the policies and business processes for how we will serve clients with mental health conditions.

[Rachel Corneille Gravel]

I'd like to add something. He handles strategy, and so ensures that all the pieces fit together well. However, it's really the expertise centre of Ste. Anne's Hospital—with the help of the clinicians and the interaction with the clinicians of the other clinics—that is responsible for developing and influencing policy. In a way, it sends that to Doug's box.

[The Chair, Conservative, Rick Casson]

Thank you.

Ms. Black.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you very much.

Thank you for coming to the committee. We had people here on Tuesday who were part of this and were peer support counsellors. I found it very interesting to hear about it from their perspective as well.

You say that your facility, Ste. Anne's, is the national centre. I guess this follows up on Mr. Bachand's question on how that spreads out across the country. When I look at your slide I see there's something listed for Esquimalt, but that's all I see for British Columbia, which is my province.

At one time there were veterans hospitals in B.C. as well, but there aren't any more. How do veterans in British Columbia access the same level of service you're talking about in your facility in Montreal?

[Raymond Lalonde]

All veterans have access to their services through the provincial health systems. There's also a series of private providers and private programs.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Are they funded by Veterans Affairs or the province?