National Defence Committee on Feb. 25th, 2014

[The Chair, Conservative, Peter Kent]

Thank you all for attending this meeting of the Standing Committee on National Defence as we continue our study of the care of ill and injured Canadian Forces members.

Appearing before the committee today are two witnesses, Colonel Russell Mann, the director of military family services, and Colonel Blais, the director of casualty support management and the joint personnel support unit. Gentlemen, thank you very much for your response to a rather late invitation. We appreciate your appearance today.

Perhaps we could begin, please, with opening statements of 10 minutes each. Colonel Mann, would you begin, please.

[Colonel Russell Mann, Director, Military Family Services, Department of National Defence]

Good morning, Mr. Chair and members of the committee.

Good morning, ladies and gentlemen.

I want to begin by thanking you for your invitation to appear again today and to bring additional insight about services for military families.

In particular, I want to thank you for your interest in regard to military families in the work you do as members of the House of Commons Standing Committee on National Defence.

As the Director of Military Family Services, a division of the larger Canadian Forces Morale and Welfare Services which falls under Chief Military Personnel, I am responsible for ensuring that the Canadian military family community is well supported and that military families specifically are able to lead positive, nurturing family lives comparable to other Canadian families.

On November 5, 2013, the Department of National Defence and the Canadian Armed Forces' Ombudsman released a report entitled On the Home front: Assessing the Well-Being of Canada's Military Families in the New Millennium. The report noted that three aspects of the military life style—recurring geographic relocations, relentless separation and elevated levels of risk—make military families appreciably different from other Canadian families.

Today, 80% of military families live off base, as opposed to that same number living on base several years ago. This brings a host of new realities for families as they attempt to integrate themselves into new communities every few years, from posting to posting. Where families might have once relied on a close-knit community on base, they now rely on their civilian communities far more.

The mobility inherent to the military lifestyle also prevents many Canadian military families from accessing primary health care resources and related support services. l'm happy to tell you that as a result of two years of behind-the-scenes work with provincial-territorial governments, we were successful in having them waive the 90-day wait period for provincial health insurance for military families.

Further, military families are also largely made up of dual income earners, which has a significant impact for families when relocating. Employment continuity, career progression, credential transferability between provinces, and income stability are issues that arise for military spouses and their families.

However, what is omnipresent for us at this time is also the fact that we have military personnel currently facing physical and mental health stresses and injuries following operations, including the past mission in Afghanistan. While mental illness indirectly affects all Canadians at sometime through a family member, friend or colleague, the stresses inherent within the military lifestyle can in many cases weigh particularly heavily on military families.

With spouses, parent, children and other family members who are often the ones to experience, first hand, signs of the mental illness in their loved ones, we need to make sure that the families standing with them are resilient and strong and that the Military Family Services Program is responsive and agile in meeting their needs.

That said, however, only when we consider families as the first and most important partners in the work we do can we truly achieve success in supporting families. The Department of National Defence and the Canadian armed forces are deeply committed to supporting families. Through military family services, the Department of National Defence and the Canadian armed forces provide support and resources to families either in person, at military family resource centres, by phone through the family information line, and online at www.familyforce.ca.

One of the most significant milestones achieved this year by the military family services team was the expansion of the family information line service to 24 hours a day, 7 days a week, in order to always serve military families. Building on a legacy that was founded in 1992, known as the mission information line, the family information line's expansion of confidential, bilingual services 24/7, by trained counsellors, is already making a real difference for families who can now access services any time day or night.

Questions range from how to find information about policies and procedures, which services are available in the communities they live in, to how to resolve a family crisis, to name a few examples.

The Canadian Forces member assistance program is also available 24 hours a day for members and their families, with referral to a counsellor within 24 hours.

Support to families following the illness, injury, or death of a Canadian armed forces member has evolved over the past several years, and the difficult experiences of families have influenced our approach in reaching out to families of the ill, injured, and fallen. The Canadian armed forces acknowledges that families' needs may continue to grow over time and that no two families will experience their recovery or grief in the same way.

In 2011 we put in place family liaison officers who are trained social workers, and embedded them into each integrated personnel support centre to be an integral part of the caregiving team. Family liaison officers are employed by military family resource centres and remain an important way of offering mental health support to families who need it. A total of 33 family liaison officers provide counselling and support to families, to assist them in dealing with a range of issues including their loved one's operational stress injury, transition difficulties, anxiety, and depression. From April 1, 2012, to March 31, 2013, some 1,680 families were served by family liaison officers. This approach is absolutely essential and integrated into the integrated personnel support centres' approach.

Along with access to family liaison officers, families can also access a multitude of resources and programs at their local military family resource centres, in their communities, their base chaplains, the family information line, the Canadian Forces member assistance program, and the public service health care plan. Ensuring consistency of services for families, regardless of where they might be posted, is of critical importance to us. In fact, we are currently holding the fourth annual training session this week for all family liaison officers, mental health providers, and other caring professionals, to enhance the availability and quality of mental health services at military family resource centres in direct support of military families.

At military family services, our commitment is to increase our communications efforts to ensure that families are well informed of the services available to them so they never have to wonder where they should go to get the support they need. At military family services, we have expanded our communications approach from relying solely on military family resource centres as our primary means of communicating directly with families, to more recently communicating with them through social media, advertising, and partnering with publications like Canadian Military Family Magazine.

The Canadian Armed Forces remain committed to ensuring that our men and women in uniform and their families receive the care, services and support they need, because they should fully benefit from the same lifestyle options as other Canadian families. Research has proven that supporting military families insures an operationally-ready force, which is to the benefit of all Canadian citizens.

Honourable members of the committee, ladies and gentlemen, I could go on for much longer, but I realize that my time is up. I would be pleased to respond to any questions or comments you may have for me at this point. Once again, I want to thank you for the time you have allocated to me today, and I look forward to seeing the outcomes of the study.

[The Chair, Conservative, Peter Kent]

Thank you very much, Colonel Mann.

Colonel Blais, please.

[Colonel Gerry Blais, Director, Casualty Support Management and Joint Personnel Support Unit, Department of National Defence]

Thank you.

Mr. Chairman and members of the committee, l am very pleased to have the opportunity to appear before you once again to respond to questions pertaining to the care of ill and injured Canadian armed forces personnel and the various forms of transition assistance provided to military personnel. The joint personnel support unit is dedicated to providing standardized, high quality, consistent personal and administrative support to ill and injured Canadian armed forces members, former members, their families, and families of the deceased, with the assistance of partner organizations. The support provided encompasses all areas other than medical care, which is the purview of the Canadian Forces health services. The director of casualty support management is responsible for the development, promulgation, and continuous improvement of programs and policies delivered by the joint personnel support unit.

When a Canadian armed forces member is seriously injured or suffers an illness to the extent that they will be away from their normal duties for a considerable period of time, they typically go through three phases: recovery, rehabilitation, and reintegration.

Recovery is the period of treatment and convalescence during which patients transition from initial onset of illness or injury to the point where they are stable and ready to receive longer-term medical care and optimize their functional capacity in many aspects of their life, vocational, social, and mobility.

Rehabilitation is an active process designed to optimize functional outcomes following injury or illness in order to regain maximum self-efficiency. Rehabilitation can take various forms such as physical, mental and vocational.

Reintegration is the transition to either progressively returning the ill or injured Canadian forces members to a normal work schedule and workload in the Regular Force or Primary Reserves, transition to the Cadet Organization or Rangers, or preparing for a civilian career and life.

There can be significant overlap between the three faces as ill or injured members move from acute recovery to longer-term clinical, physical, mental and vocational rehabilitative support, and often simultaneously prepare to reintegrate. The medical care provided to Canadian Armed Forces personnel is outstanding, timely and comprehensive. The provision of non-medical care and support is extremely complex. The three Rs are anchored to the principle of universality of service. The minimum operational standards associated with this principle include the requirements to be physically fit, employable without significant limitations, and deployable for operational duties.

The term transition does not strictly apply to release from the Canadian armed forces. The primary goal of the armed forces is to return as many ill and injured serving personnel as possible to full duties. In fact, since the stand-up of the joint personnel support unit in 2009, 1,291 personnel posted to the unit successfully completed a return to work program and as a result returned to full military duties. This return can occur in the individual's own occupation or, depending on the extent of their recovery, in a new occupation. In those cases in which it is determined that employment limitations are such that the person cannot meet the parameters of universality of service, they will transition out of the Canadian armed forces and into the care of Veterans Affairs Canada.

As soon as a medical officer determines that the ill or injured person can begin to reintegrate, a return to work plan is developed by the return to work coordinator in conjunction with the individual and their commanding officer. The plan is blessed by the medical officer, and the individual then begins employment. The intensity and complexity of their assigned tasks increases as the member's condition continues to improve.

The ultimate aim is to return the person to full duties. This step is vital, as the individual gains therapeutic, psychological, and social benefits from the return and may actually fully recover more quickly. There are currently more than 900 members of the joint personnel support unit participating in a return to work program.

In addition to the return to work program, there are numerous programs and services available to assist in meeting the needs of our ill and injured, including home modification, vehicle modification, peer support for those suffering from operational stress injuries and for their families, disability compensation for members of the reserve force, and a number of other programs.

For those who are unable to continue to serve in the Canadian Armed Forces, there are a number of programs in place to assist them in returning to gainful employment in the public service or the private sector. Among those are Priority Hiring in the Public Service, Vocational Rehabilitation and Training through the Service Income Security Insurance Plan which includes income support, the Canadian Armed Forces Transition Assistance Program which links those leaving for medical reasons to private sector employers, and programs offered by Veterans Affairs Canada. The private sector has embraced the armed forces and the list of initiatives in which we are jointly involved is impressive including the Military Employment Transition Program which will offer 10,000 jobs to those leaving the armed forces in the next 10 years, a week-long university level course for those looking to launch their own businesses, reduced franchise fees with numerous franchisers, agreements with trade unions, and others.

The stand-up of the joint personnel support unit and its 24 integrated personnel support centres, in which Veterans Affairs Canada is co-located, has greatly facilitated the completion of a seamless transition. Staff from both departments begin to work hand-in-hand on the transition six months prior to the member's departure. For those who will be leaving with complex transition needs, an integrated transition plan is prepared. The preparation of this comprehensive plan includes the serving member along with a wide array of service providers. The plan ensures that needs in the areas of medical care, education, post-release employment, and Veterans Affairs support are addressed.

Once the process is completed, the individual signs the plan to indicate his agreement or indicates why he feels that the plan may not be suitable. There have been very limited instances in which this has been the case. However, when it does occur, a review is conducted, and every attempt within the art of the possible is made to address the member's concerns. Based on the recommendations contained in the integrated transition plan, an individual may be retained for from six months to three years in order to ensure a successful transition.

l am extremely proud of the outstanding dedication demonstrated by the military and civilian staff of the joint personnel support unit. Without fail, their goal is to ensure the well-being of the ill and injured. The numerous letters, emails, and telephone calls of appreciation, as well as a client satisfaction rate in excess of 90% expressed through surveys by those leaving the unit to return to military duty or to civilian life, clearly demonstrate that the unit is achieving its goals.

Our systems may not be perfect and we will continue to strive to improve them with input from injured and ill personnel. The care of the ill and injured, including their successful transition remains one of my, and the Canadian Armed Forces', highest priorities and we continue to examine opportunities to improve and to work in collaboration with public agencies and the private sector to assist those who ultimately leave the Canadian Forces.

Thank you, Mr. Chair.

[The Chair, Conservative, Peter Kent]

Thank you you very much, Colonel Blais.

We'll now proceed to the opening round of questioning. Each questioner has seven minutes.

Mr. Norlock, please.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much, Mr. Chair, and through you to the witnesses, thank you for appearing today.

My first questions will be to Colonel Blais.

As most of us here know—however, I believe that most Canadians don't know—the JPSU system was only created some six years ago by this government.

What was the situation like for the ill and injured soldiers prior to the creation of the JPSUs in 2008? What programs were available prior to 2008?

[Col Gerry Blais]

Prior to 2008, services were delivered at each base, but I would say mainly on an ad hoc basis. Each base commander assigned the resources that he had available to him, and the programs that we had were much more limited than they are today. As we saw more and more serious casualties come back from Afghanistan, it became clear that a more consolidated approach had to be taken.

That is when the joint personnel support unit was launched. Since that time, a number of programs have been created: such things as the ability to reimburse people to modify their homes or modify their vehicles; the creation of the joint personnel support unit, whereby now all of the services are available in a one-stop shop concept such that the individual can walk into one unit and see either, as Colonel Mann mentioned, the family liaison officer or see Veterans Affairs Canada or the financial counsellor. All these services are now available. As the person arrives at the reception desk, the clerk there listens to their issues and points them in the right direction to get the services they need.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

The second question is, what would you describe as the ultimate aim when members are posted to the JPSU, and what do we ultimately want to see for CF members when they are posted at the JPSU?

[Col Gerry Blais]

Our first goal is to return people to full duties. As an employer, we have spent a great deal of time, effort, and money in training personnel, and when we have people who are fully qualified we want to retain them. I would say we are averaging at the moment an approximately 25% to 30% return to full duties from those who begin a return to work program.

For those who unfortunately don't meet universality of service and cannot be retained, our goal at that point is to allow them to effect as smooth a transition as possible and, for those who either want to pursue their education or another career, to guide them down that path and assist them in securing that employment or the position in an academic institution.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

The next question is about the ombudsman report. We know that there has been commentary, especially in the media but from others, that there's an understaffing with regard to JPSUs and that this has led to poor services for the ill and injured CF members. The chief of military personnel commenced an internal review in August of 2013 as a result of some of these complaints, particularly the complaint from the ombudsman report with regard to training and support.

Can you tell us what the outcome was or what has come to pass as a result of this and what we may or will expect coming out of this review?

[Col Gerry Blais]

I certainly can.

There are three separate reviews, if you will, of the JPSU that are ongoing.

The first is the ombudsman's. In the late spring, I believe, he is scheduled to release a second report looking at how things have changed.

The chief of personnel has asked the chief of review services for the Department of National Defence to examine the JPSU and the network of services that surrounds it to ensure that we are delivering the services as efficiently as possible and to determine whether there are changes that need to occur.

Third, I am appearing before the program review board of the department at the end of March; there we will again discuss the resources assigned to the joint personnel support unit.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

I suspect that's it, is it, Mr. Chair?

[The Chair, Conservative, Peter Kent]

That is it. Thank you very much.

Mr. Harris, please.

[Jack Harris, NDP, St. John's East, NL]

Thank you, Mr. Chair.

Thank you both, gentlemen, for appearing before us.

We know that much has changed in the past number of years. Things are better than they were; let's accept that. Obviously it's overdue in some cases and a necessary improvement.

We had the ombudsman before us last March, and he talked about a study that was done in 2002 by Statistics Canada. He suggested that this Stats Canada study in 2002 pegged the ideal number of mental health care providers at 447. Now, we never got to that number. That was in 2002, before the knowledge of what was going to happen in Afghanistan, with respect particularly to mental health, OSI, and PTSD. That study was supposed to be done again in 2012. I'm wondering whether you can tell us what the outcome of that review was, by comparison.

What I'm getting at is that the goal was set in 2005. They set the exact number at 447, but we've never actually gotten there in terms of mental health professionals and we have a worse outcome for Canadian soldiers in Afghanistan and elsewhere.

Where are we now?

[Col Gerry Blais]

As I stated in my opening remarks, I am responsible for all of the care to the ill and injured other than medical care. That question would be best raised with the surgeon general. But we can take it under advisement and have the surgeon general prepare a response for you.

[Jack Harris, NDP, St. John's East, NL]

Please do. Thank you.

The second question is related to family services and the family covenant that the forces has issued. It contains very noble words. I'll read part of it. It says:

We honour the inherent resilience of families and we pay tribute to the sacrifices of families made in support of Canada. We pledge to work in partnership with the families and the communities in which they live. We commit to enhancing military life.

As I say, these are great words. There's a question of, as I think the ombudsman put it, the meat on the bone. There needs to be detail.

I'm only struck by this because we visited Petawawa recently, and one couple struck me as being very sincere and concerned about their own future. He was suffering from PTSD, but the spouse complained that it took four years for her to get counselling to even help to understand what her husband was going through so that she could help him. She said they almost lost their marriage, that she didn't understand what was happening, that she was in need of this service, that she had asked for it a number of times, but that it took four years.

I'm not trying to set this up as though everybody is like that, but how could this possibly be, in a situation in which it is recognized that these operational stress injuries could best be treated through families? How can it be? Can either of you help me understand how that could be?

[Col Russell Mann]

I think I can speak to that, sir.

First, I think it's important to understand that there is no silver bullet when it comes to mental health. Also, we're dealing with two systems of care here: the federal spectrum of care, which treats the member, and the provincial spectrum of care, which supports our families.

It may or may not be known to the honourable members that families do not go to bases for health care. Families are not able to go to bases for their mental health needs. They rely on the provinces to provide care, just as they provide care for other Canadians. That's an important difference from some of our allies, perhaps, but those are the cards dealt to our families in navigating the military lifestyle. One of the things that we have done is actively engage with the health and mental health communities to try to help them understand that, because oftentimes the caregivers in communities are not appreciative of the fact that our families can't simply go to a base to get care.

We also responded with internal programming. It was our surgeon general who led the charge on the road to mental readiness program, which helps families deal with mental stresses before, during, and after deployment. Although that's a very new and innovative product that may not have been an option at the time that the particular family you cite, sir, would have been seeking the help, it is there today. I'm happy to report that we have a working group in this calendar year that is engaged in developing unique family elements of the road to mental readiness program to build on the initial launch that was led by the director of mental health.

In addition, we put $27 million every year directly into family resource centres, which can help people access—

[Jack Harris, NDP, St. John's East, NL]

Yes, I'm sorry. If I may, I only have seven minutes here, Colonel, and I want to quote Greg Lubimiv, the executive director of the Phoenix Centre, which provides mental health services, including at Petawawa. He says the majority of treatment for PTSD should happen at the family level, not as secondary to individual care. He says that It's at the family level that the situation starts to break down, and he goes on to talk about that. This is in a news article in The Globe and Mail.

Given that, how can we say, “Oh well, it's not our fault, the Constitution stops us from helping families”? Is that the situation? Is it because health care is a provincial matter that we can't provide services to families of soldiers who have PTSD?

[Col Russell Mann]

I would have to make it clear that I don't make any such statement that—

[Jack Harris, NDP, St. John's East, NL]

You said that's the situation, that families are dealt with—

[Col Russell Mann]

The legislative framework says that health care and mental health for families of all walks are by provinces.

[Jack Harris, NDP, St. John's East, NL]

You can't help them.

[Col Russell Mann]

We—

[Jack Harris, NDP, St. John's East, NL]

You can't help them. Is that—

[Col Russell Mann]

I have put out there that we have programming that is there to help them and there to help them get connected. That's where the $27 million comes in. That forms a network of family resource centres. That's where our family information line comes in. That's—