National Defence Committee on March 13th, 2008

[Raymond Lalonde]

Of course the priority is decided by the clinic staff upon their analysis of the condition of the client, so it's not first arriving, first in. The wait time that we're trying to achieve within the clinics is to have 80% of the initial interviews with the patient or client within 15 working days. We have a phone contact, so it will be faster if we're told by the referring organization that this client really is in need.

The way we deal with the issue of capacity is that the 2007 budget allowed us to open five new clinics, so it's going to double our capacity across the country. In each of the clinics, if there's a need, we will increase the capacity of the clinic by funding the province with new resources.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

We can open those five new clinics, but do you have enough service providers to man those five new clinics? How difficult is that?

[Raymond Lalonde]

Do you mean the staff for the clinics?

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Yes.

[Raymond Lalonde]

They will be hired by the provinces. So far it has been going well. It's not that easy, but so far we're getting the resources in those clinics as needed.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

I know you can't give me a finite answer to this, but in terms of ramping up the increase across the board, a lot of that is probably due to awareness, much better awareness, and some obviously is due to increased activity.

Can you give me a feeling for how much is simply awareness, versus increased activity?

[Doug Clorey]

One of the issues we deal with, particularly with Afghanistan, is that it can take up to two years before a member is released, essentially before they become our client. We know that's going to cause some issues in the not too distant future, because more and more are going to reach that two-year period and be released. The extent of that we're estimating. We don't have fixed numbers, because we don't have the release numbers. However, we do know that we're just seeing the tip of the iceberg, I would say, in terms of the clients who will come to us as a result of service in Afghanistan.

I think that's probably as much as I can say on that question.

[The Chair, Conservative, Rick Casson]

That's it, Laurie, sorry. We're out of time.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you.

[The Chair, Conservative, Rick Casson]

Mr. Bouchard, and then Mr. McGuire.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chairman.

Thank you for coming to testify before the committee.

One can readily see an upward trend in the tables on pages 4 and 5. However, sometimes statistics also say something else. Can we say that there was a need and that it developed, or that people were embarrassed at first and then expressed the wish to be treated? Is that the main cause of the increase? Otherwise, is it a real upward trend?

Furthermore, are these all people who are treated at outpatient clinics? Are there any hospitalization cases? Do they spend a morning, a day or two at an outpatient clinic? How have these figures been distributed?

[Raymond Lalonde]

It's extremely hard to attribute the increase to any one factor in particular. The knowledge we have of post-traumatic stress disorder has increased thanks to General Dallaire. The support of peer counsellors and information have encouraged more veterans to seek services. But there is also an increase in needs related to the types of missions facing the Canadian Forces. So it's very difficult to know what's what.

Clients may go to an outpatient clinic to get an assessment, which may take one, two or three hours. That isn't a full day or a half-day; in general, this involves shorter periods. Clients go to an outpatient clinic to meet a counsellor, either in an individual session or with their spouse, to take part in various therapeutic techniques in a group consisting of eight to 10 veterans.

The veterans who are in crisis, who need to be hospitalized, have access to all the beds and all the public emergency services across Canada. So we're responding to this needs segment. We also have internal programs, which are offered by private providers whom we reimburse for costs incurred. For example, with regard to the post-traumatic stress disorder program and substance abuse, we'll reimburse providers who care for our clients internally for two months. In the Quebec City region, we refer clients to CASA. We also have some stabilization beds at Ste. Anne's Hospital. We hope to start up a new hospital program to increase capacity.

[Doug Clorey]

I might add that I think you're correct in saying PTSD in general has received a greater acceptability in terms of coming forward. We're seeing members of the Canadian Forces and war service veterans, for that matter, and Korean War veterans coming forward with PTSD symptoms and receiving the treatment they should receive.

What's interesting is if you look at the previous slide, PTSD is reported as being the fourth most common within the Canadian Forces, yet we are seeing that two-thirds of our clients with psychiatric conditions have PTSD. Again, it's speaking to the tip of the iceberg. I don't think we've seen the depression, which is number one. Alcohol dependency we're seeing mostly in comorbidities, and we haven't seen the social phobia yet. I don't think society and the military are yet at the point where it's as acceptable to come forward with these other conditions as it is to come forward with PTSD. That's another factor that plays into this equation.

[The Chair, Conservative, Rick Casson]

Thank you for that, Doug.

I just want clarification before we go to Mr. McGuire. These two graphs you have on page 4 and page 5 indicate that they're cumulative. Does that mean the 1,760 on page 4 in the second column is included in the 5,872 in the last column?

[Doug Clorey]

Yes.

[The Chair, Conservative, Rick Casson]

It looks to me that if there were 1,760 in 2002 and it went up by....

It's not going up more per year; you're getting about the same number of people, but you're just adding them on.

[Doug Clorey]

That's an interesting observation, because in general--

[The Chair, Conservative, Rick Casson]

Mr. McGuire's going to ask this question. He'll have to use his five minutes for something else. I apologize.

[Doug Clorey]

In general, over this five- or six-year period we've seen about 1,600 new clients with psychiatric conditions. That's essentially the bottom line. It's a little less earlier, and a little more later. What's interesting--and you don't see it in your chart, as this data was hot off the presses as of this morning--is that as of the end of February, it appears we will have a total of 779 for this fiscal year, which is a significant drop from what we've seen over the last five to six years.

I'm not sure what that means yet. We'd like to think people are recovering and have less need to come forward. But there's clearly a drop in the numbers in 2007-08.

[The Chair, Conservative, Rick Casson]

Thank you very much.

I will now turn it over to Mr. McGuire to ask the same question.

[An hon. member]

Give him just two minutes.

[Joe McGuire, Liberal, Egmont, PE]

You can understand why the numbers for the Canadian Forces have been growing for the past five years, but in the case of the RCMP, the veterans of the Second World War and the Korean War, and maybe the Suez peacekeepers, is it because you're finally treating these people that you're getting these numbers? Is word spreading, particularly among the veterans?

They were suffering these conditions for decades, and all of a sudden they're coming into the picture as statistics. They are near the end of their days. Whether they had pensions before they were diagnosed with mental illness I don't know, but it seems totally unfair that these people spent fifty years being untreated, and now all of a sudden they're coming out of the woodwork.

As well, to what would you attribute the clearly dramatic increases in the RCMP numbers?

[Doug Clorey]

On your first question, I think the observation is very valid. I'd just make a couple of points.

There was a recent research initiative in Australia that came out with some really interesting statistics around Korean veterans. They found that there was indeed a very significant increase in the number of Korean veterans coming forward with mental health conditions about fifty years after the conflict. These were individuals who had returned from Korea, had married, had successful business careers and successful family life, and apparently no issues, but they reached a point in their life, perhaps when they started to reflect back on their life, and suddenly PTSD started to appear in fairly significant numbers. That's one point.

The second point is what we're seeing in our OSI clinics as well, which we thought would be primarily the Canadian Forces veterans. We are seeing a fairly significant number of war service veterans, and Korea veterans as well, coming forward with very complex mental health conditions, very late in life. That's a reality that we are living at this point.

I'm not sure, Raymond, if you want to add anything to that.

[Raymond Lalonde]

Some have been living with it all their lives and kept it to themselves. But some, as they grew older and retired, started to have nightmares again at 70 or 80 years of age. They were okay, but it came back. As you probably know, there are a lot of war vets who had never, in all their life, talked about what happened.

[Joe McGuire, Liberal, Egmont, PE]

So a lot of these people weren't on pension before they started getting treated for mental illness. They lived completely normal lives.