National Defence Committee on May 1st, 2013

[The Chair, Conservative, James Bezan]

Thank you very much.

Ms. Moore, your time has expired.

Mr. Strahl, it's your turn.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you, Mr. Chair, and thank you to the witnesses for your testimony and your questions and answers so far.

Colonel Heber, am I saying that right?

[LCol Alexandra Heber]

Heber. Not so fancy.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Heber, that's good.

We've heard from some previous witnesses about clinicians who work in the military system, then get frustrated and move the other way. I was interested to hear in your testimony that you started in the public system and chose to move into the military system. Can you talk a bit about the professionals—I'm sure you've seen it go the other way. For yourself, how was your experience different from that which we've heard is maybe more prevalent in the clinician field when dealing with the military?

[LCol Alexandra Heber]

Thank you for that question.

I actually don't think it's more prevalent that people get frustrated and leave. When I think about the teams I know well across the country, Edmonton has had a very stable group of clinicians. As for my team and the team in Halifax, you can't get these people out of the clinic. They love it.

I think, though, it takes a certain kind of person who wants to have a certain kind of practice, especially if we're talking about psychologists and psychiatrists, because I think social workers and mental health nurses work in teams naturally. I was a nurse before, and maybe that's why I was attracted to that kind of work.

If you are very independent or you need to have all the control over your practice and you don't want somebody else going into your scheduler and booking in the assessments, then our mental health clinics are not for you. But I will tell you that for a while I told my psychiatrists and psychologists that as a way of learning from each other they were going to see patients together. They didn't like that, but then after a while they loved it so much I could hardly pry them apart anymore to see people separately.

Really I think the benefits for these people are that they get to work in wonderful teams. They get to really share the load of the patients. They learn from each other. It's not the same kind of piecework or fee-for-service type work. They can do other things and still get paid. A psychiatrist can be making a phone call to a patient. A psychiatrist can be seeing a family member, and they're going to get paid for whatever they do.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

I appreciate that perspective. It certainly gives us a new one here.

I wanted to ask you about pre-deployment checkups and post-deployment reviews. My question is more on the pre-deployment side—an ounce of prevention is worth a pound of cure. Has the military discovered any preparation that they can give a soldier who's about to deploy that girds them against OSIs? Has that work been done? What have we found to be effective in that regard?

[LCol Alexandra Heber]

It's a really good question.

There is not a lot of really solid evidence yet. However, we do have some, and we've based our programs on them. We know that no matter how terrible the situation is going to be, it seems that the more prepared people are ahead of time, the less traumatized they are. Surprise in and of itself produces trauma. Our whole road to mental readiness program that we devised, which I think you've heard about before, really comes out of that body of research.

So we prepare people just in the same way that we prepare them to go out with their company and fight. I'm thinking about Afghanistan. We also prepare them mentally by teaching them some techniques they can use when they find themselves feeling overwhelmed or getting very anxious as well as some things that will help them to calm themselves and calm their bodies down.

[The Chair, Conservative, James Bezan]

Thank you. Your time has just expired.

Monsieur Larose, vous avez la parole.

[Jean-François Larose, NDP, Repentigny, QC]

Merci beaucoup, monsieur le président.

I have three quick questions, and then I'll bring it to a point.

Lieutenant-Colonel Heber, have there been any cuts to any of your programs since you've been there?

[LCol Alexandra Heber]

No, there haven't been cuts.

[Jean-François Larose, NDP, Repentigny, QC]

Have there been any evaluations? We have a lot of statistics and data concerning the effect this is having on the military. Are there any evaluations on the performance of your centres and the performance of the programs that are offered? Is there a necessity for more data on that?

[LCol Alexandra Heber]

Just yesterday we had a meeting at our headquarters to look at revitalizing the treatment standardization committee—which had run for a number of years, and then I think everybody just got so busy that it fell by the wayside—and it's exactly to look at this.

Over the last several years we've done a lot to develop pre- and post-deployment screenings, and looking at that and evaluating them. Major Sedge did his piece of research in Gagetown, looking at people developing PTSD and the course of that over time. The other thing we've done is a lot of educating and training of our staff in evidence-based treatments for such things as PTSD. Now we're looking at what we need to start putting in place to evaluate.

There certainly are tools. We have a tool that we've used in Ottawa for the last two to three years. You give a kind of quick checklist to the member every time he or she comes in and you look at symptoms, at how they're doing in their interpersonal life, how they feel about themselves in their role. It's very well researched. We've been using it in Ottawa in an unofficial way, but I think this is the tool we're going to go forward with. It's a great tool, because you can then look over time at whether people are actually getting better, and at what is reducing.

[Jean-François Larose, NDP, Repentigny, QC]

That would be my next question.

We mentioned in a conversation that, compared with the civilian life—and that was my point at the last committee meeting—the military on these issues is highly advanced.

Do you feel that everything as it is right now is adequate, or are there quite a few points that would need to be bettered?

[LCol Alexandra Heber]

We can always improve, and this is one example for us, to start looking at outcome measures in a much more standardized way. I think this is going to be our next step.

We know that we help people and we can see that their symptoms decrease, but to be able to capture that objectively would be very helpful.

[Jean-François Larose, NDP, Repentigny, QC]

I wonder whether you can help me in an assessment. I'm looking at all the witnesses the committee has had so far....

I want to thank everyone from the military who has been here so far. I think your commitment and your energy are absolutely wonderful. I've never seen so many people in the clinical environment taking so much to heart their helping of our military. It's absolutely amazing.

The problem I see—and I wonder whether you see the same thing—and the feeling we get is that there will be cuts. Finally we're getting somewhere, but at this point the cuts are coming in.

Then, we're also referring a lot to civilian life. We're getting reports that there are military personnel who can't get access to these programs, that they're just not sufficient and that we need to do more. They end up having to go into civilian life, and while there is a collaboration with the civilian system, it is not up to par with the studies you're doing.

So where are we going with all of this? It's very confusing and we need to clarify this.

[LCol Alexandra Heber]

Huguette may want to add something to this.

Since the time when we closed our military hospitals, which was in the early or mid-nineties, we have been dependent upon and working with the civilian system in different ways.

For example—you're absolutely right—we assess, diagnose, and set up a treatment plan for every single member who comes with a mental health problem in our catchment area. But we cannot provide the therapy for all those people within our clinic. So we have a system, mostly of psychologists in the community in Ottawa, to whom we refer people. But every 10 sessions, that member comes back in, meets with one of my social workers, who does one of these instruments, these checklists, to see whether they are actually progressing, and talks to them about what is happening in the therapy and whether they have set goals.

The last thing we want is for that person to go out to see an external provider and see that person for years and years while we have no idea what is going on. So we don't let that happen. We meet with our providers twice a year. We have them come in.

[The Chair, Conservative, James Bezan]

Thank you. That time has expired.

We have time for one more round.

Mr. Chisu.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much, Mr. Chair.

Thank you very much to our witnesses for your testimony, and thank you for the work you are doing for our men and women in uniform.

I have a question for Ms. Gélinas.

I understand that the health services civilian-military cooperation program works closely with federal, provincial, and territorial health authorities and with professional licensing bodies. Can you explain exactly how you work with these different levels and types of health care providers? What do the Canadian Forces gain from the various partnerships that your program works to make?

I am looking also at the aspect of training. You mentioned in your testimony that you are in agreements to keep the Canadian Forces workers up to date at a certain level, such as that which the licensing bodies are probably requiring.

[Huguette Gélinas]

Thank you for your very interesting question.

Our group is responsible for a program that I mentioned earlier, the Maintenance of Clinical Readiness Program. My team works in close harmony and synergy with them. My team's role is to promote opportunities within civilian hospitals or with ambulance services, for example, so that our clinical personnel maintain their readiness and keep their skills up to date.

It takes different shapes, depending on the profession. For example, our specialists work full-time in hospitals, in highly specialized centres like McGill and Sunnybrook in Toronto. They work full-time to be at the top of their game. The only exceptions are when they need to take predeployment training or be deployed. That is how it works for our specialists.

Doctors and nursing staff are in demand. They go primarily to hospitals, where they work in various departments, generally speaking in the emergency room, to deal with trauma and anesthesiology. This program works very well. Our collaboration is excellent. It is a win-win situation. We provide assistance, and the experience our personnel receives is incomparable. It is very enriching for them to receive that. We offer our personnel these opportunities to keep their skills up.

My team has put in place memoranda of understanding. The collaboration is two-way, not just one way. We prepare the arrangements for activities like these and negotiate favourable conditions. Sometimes that means negotiating certain aspects with provincial departments of health.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

I have another question. Do you have your 35 people licensed—psychiatrists or others? I ask because licensure is a provincial responsibility.

[LCol Alexandra Heber]

Yes, absolutely. We only employ registered health professionals. It's the same with the external providers I talked about using. We also only use external providers who have a college, basically, that registers them.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Okay.

And you, Madame Gélinas...?

[Huguette Gélinas]

Moreover, this skills maintenance program enable these professionals to keep their licences.

[Corneliu Chisu, Conservative, Pickering—Scarborough East, ON]

Thank you very much.

Do I have time for a very short question?

[The Chair, Conservative, James Bezan]

You have less than 10 seconds, so we'll cut it off there.