My name is Robin Geneau, and I'm a licensed psychologist. Joyce Belliveau is a colleague of mine. We've been doing this work together for a long time.
I've been treating combat PTSD for about 10 years now. I have a lot of specialized training for that. I've taken specialized training in cognitive behavioural therapy. I've also taken a lot of specialized training in EMDR. It's one of the treatment approaches I use quite frequently.
I'm going to repeat what Joyce said about what happened to the program in Gagetown. We had been working for several years with this OTSSC satellite clinic in Gagetown, which was shut down. When the clinic was shut down, the treatment for OSI fell under the mental health clinic.
Everything this panel has heard about the OTSSCs does not apply to Gagetown. There is no OTSSC in Gagetown. The standards and qualifications that the OTSSC staff have are not applicable in Gagetown. A Gagetown social work program took over mental health, and they have been running it since March 2005.
As Joyce said, prior to the satellite clinic shutting down, we had a wonderful working relationship with the OTSSC. We all did training together--Gagetown staff, Halifax staff, the private practitioners. We had free clinic case conferences. We were very successful in treating members with combat PTSD and getting them back to work--back into their careers. Things were going very well.
When the satellite clinic shut down, and that was in March 2005, the program started to deteriorate then. But the next spring--that would have been about April 2006--there was new management at the mental health clinic in Gagetown. That new management was blatantly hostile to civilian therapists. We got the impression that their intention was to do all the treatment themselves and that they didn't want to hear from us or talk to us or have any involvement with us any more.
As a result of that change in attitude, there started to be problems with our clients. To give you some examples, clients were being cut off in the middle of treatment for no clinical justification. I ended up seeing clients--serving soldiers--for free: one soldier for three months, a couple of soldiers for a couple of sessions, and I did a group session. All of those were done at no charge because of difficulties with authorization processes at Base Gagetown.
The one client who was cut off from treatment had to do with what Dr. Belliveau spoke to. We would always receive referrals for treatment of PTSD, but this new model the mental health clinic had was that you would treat a client by issue. This particular client had been referred to me for tour-related trauma. We were dealing with issues to do with his workplace, and it was related to Afghanistan. Basically the clinic decided that I had changed topics and they were no longer going to support his treatment. He was the one I ended up seeing for free for about three months.
They changed the rules about all different kinds of things, about how reports were to be submitted. Basically communication really shut down. Because I advocated for my clients, I was punished by having my name taken off the provider list for the psychosocial team. I expect to be punished further for being here today, and I'm prepared to deal with that if that's the case. But certainly any attempts we've made to address client issues with the clinic have been very unsuccessful.
There are other issues with this new mental health system in Gagetown. I had sent a request for one client to see the psychiatrist and it was denied. I was told that the client was already seeing the psychiatrist, which wasn't true. The client was not seeing the psychiatrist and he needed to, and they seemed to be unable to identify that the psychiatrist was not seeing him. It took increased networking on my part to get him an appointment with the psychiatrist.
I requested that a client of mine see the case manager because he was concerned about his medical release, and it was denied.
In a letter he sent me, the clinic manager told me there's no such thing as an OSI or an OSI program. He said that OSI was an old medical term that is no longer used; it's an inappropriate term, and it is not to be used by external service providers.
The other thing that was happening as things were falling apart was that nobody was checking on cases. There was supposed to be a BF system under which clients would be checked every several months to see the progress of their treatment. That just completely stopped. It went by the wayside.
I requested case conferences and was told no. I was denied case conferences to deal with treatment issues. I requested clinical reports on the clients I was treating, and I didn't receive them. I asked about the mental health clinic's standards of care. This committee has heard about evidence-based practice, and as a psychologist, I engage in evidence-based practice, so I attempted to get the clinic to clarify what their standards of care were. I didn't receive any response to that at all. To my knowledge, there are no standards being used in the clinic at all for PTSD treatment.
This past February I received a referral in the mail. It just showed up in the mail, and when I called the client that day to come in for an appointment, he told me he'd been waiting for me to call him since December. He was on sick leave, at home, waiting for me to call, and the only delay was for that referral to come to me in the mail. It took two months for them to send the referral so that I could make an appointment. I could have easily started the treatment in December.
In addition, I want to talk a little bit about the spouses, because I treat spouses as well. I think this committee has already heard a little bit about the experience of spouses when a member is ill with PTSD. It's very frustrating for the spouses. I've gone to the OSISS support group to give presentations to the spouses, and I've heard horrendous horror stories about how the members are not getting treatment. Supposedly they were to be treated in-house, but they're actually seeing mental health nurses or bachelor-level social workers, and they're not actually receiving treatment.
What ends up happening in that system, in which they have non-mental health professionals seeing the clients, and not doing treatment, is that the client just ends up getting screened and screened and screened and never actually gets any treatment. That's what the spouses are complaining about. That's what their experience has been, that the serving members aren't getting treatment.
After these problems had developed, Dr. Belliveau and I decided we would contact the ombudsman. We had attempted for over a year to resolve issues with the mental health clinic and were met with nothing but hostility, so we contacted the ombudsman, and we felt quite desperate about that at the time. One of the things we were concerned about, which Dr. Belliveau mentioned, was the over-prescription of benzodiazepines, which are not even supposed to be prescribed for PTSD. There were all these other issues of clients not getting therapy or having treatment cut off.
So when we complained to the ombudsman, their response was that our complaint was not within their mandate and that they hadn't heard of any problems in Gagetown. They forwarded our complaint to the Surgeon General in August 2007, and we never received a response to that particular complaint.
Another issue is the medical release. When soldiers are released with PTSD, ideally they are in treatment at the time they are being medically released. I saw in the evidence for this committee that this committee was told that the forces would follow the treatment through the release process until the member was set up with service providers in the community. That's not happening. People are just being released, and they're told to find their own doctor, find their own therapist, find their own psychiatrist. There's no transitioning being done there at all.
So they're struggling once they are released, and they're usually in the midst of treatment. Our clients have been fortunate, because we've been able to help connect them to a psychiatrist in the community who they could see, and we have connections now with the OSI clinic, but the base mental health clinic is doing nothing to prepare the soldiers for release.
I had a soldier who was released in February, and the only contact the base mental health clinic made was when the Blue Cross lady called me and left a message that as of such and such a date, I was not to bill them because the client was no longer theirs. That was the sole contact that was made with regard to the follow-up care.
There is a mental health team at the mental health clinic that has some highly qualified people on it, but they don't seem to be making any of the decisions. The decisions that we're still having difficulty with are not coming from the team; they're coming from non-clinicians. We're not allowed to have any access whatsoever to the mental health team. We don't even know who the case manager is for individual clients, and we haven't been allowed to know that since March 2005.
We did have a meeting with SAV in January. They came to do their visit in Gagetown. They knew we had concerns, so they came and met with us. That was a very satisfactory meeting. They seemed to understand our concerns. We felt they had listened, but nothing has changed since. I had a soldier cut off from treatment again last week. I had recommended that he have six sessions of follow-up over the next year, because he's in maintenance and I felt that would be sufficient, and it was denied. The person who decided to deny it felt that he didn't need the follow-up sessions. The soldier was not told that the treatment was denied, so it was left to be my responsibility to tell him that--and he has submitted a complaint about it, as far as I know. So despite our going to the ombudsman and talking to the SAV and trying to deal with the clinic, the same problems are continuing.
PTSD needs to be treated early, and ineffective treatment makes it worse. In the end, this is our ultimate concern. The mental health clinic on the base has a lot of people seeing the clients, but they are not doing treatment. I can't convey to you enough how frustrating and discouraging it is to be a soldier and to meet with this person and that person, to tell the same story over and over again, but not get treatment. One of my recent clients who was referred to me for treatment had seen seven mental health people in Gagetown before he came to me, and he was just frustrated from having to repeat his story over and over again.
This idea that PTSD can be treated in six or seven sessions, maximum 20, is just astounding to me. I've been treating primarily complex PTSD cases. You can't put a limit on it because you really don't know how long the treatment is going to take. I'm very concerned that the CF would think of putting some kind of arbitrary maximum limit on treatment, rather than go with the clinical recommendations of the people who are doing the treatment.
The other thing is that the treatment needs to be done by specially trained clinicians. It can't be done by mental health nurses. It can't be done by counsellors. It has to be done by people who have advanced graduate training and actual training in PTSD treatment. The base mental health clinic has very few people who have the qualifications and training to do that kind of treatment.
We've complained about these things over and over again to the mental health clinic. They seem to believe that they're not accountable to anyone and they don't have to answer to our complaints or concerns. So I hope by participating in this process something can be done to help develop a more effective program there. In particular, they need some clinical leadership, because there isn't any clinical leadership there by anyone who has the expertise in PTSD.
That's it. I'm finished.