National Defence Committee on Nov. 21st, 2013

[The Chair, Conservative, Peter Kent]

Good morning, colleagues. We are continuing today with the standing committee's study on the care of ill and injured Canadian Armed Forces members.

We have three groups before us this morning. They are the Canadian Association for Disabled Skiing, represented by Clay Dawdy, the director of Calabogie Adaptive Snowsports, National Capital Division; and Bob Gilmour, operations director with Calabogie Adaptive Snowsports.

We have the Canadian Mental Health Association, represented by Mark Ferdinand, the national director of public policy.

The third group before us this morning is the Canadian Association of Occupational Therapists, Elizabeth Steggles, professional affairs executive, and Nicolas McCarthy, communications officer.

We will begin with 10-minute presentations from each of the groups in the order I just referenced, and then we'll go around the table with our questions for the witnesses.

Mr. Dawdy, you have 10 minutes.

[Clay Dawdy, Director, Calabogie Adaptive Snowsports, National Capital Division, Canadian Association for Disabled Skiing]

Thank you very much.

Everybody should have a copy of our presentation in front of them, hopefully, and bear with me, because it's 15 pages. We'll skim through some of it and we'll concentrate on the important areas.

If you take a look at the Canadian Association for Disabled Skiing, you'll see that we put on winter sports clinics for injured soldiers and veterans, including their spouses. I'd like to talk about the background. We'll talk about who we are nationally and locally, how we got involved, what we are doing, the issues, and our recommendations.

If you go to the third slide, which talks to the background, we have approximately 3,000 members across Canada. We were established in 1976. We are a volunteer and charitable organization. We have snowboard and ski programs in all provinces, excluding Prince Edward Island. Locally, we have five programs, starting at Edelweiss. We have a visually impaired program at Camp Fortune, and about 10 years ago we migrated from the Gatineaus over to Ontario and started programs in Pakenham and Calabogie.

Our mission is to enrich the lives of persons living with disability through adaptive skiing and snowboarding. Notice we didn't say teach them how to ski. In other words, we're looking to enrich their lives, and I think it's important for this committee to understand that.

How did we get involved? It's on the next page. A number of our instructors have been going down to the U.S.A. Disabled Veterans Winter Sports Clinic in Colorado. They're in their 28th year. My friend Mr. Gilmour has been going down for 24 years. Unfortunately, I've only gone down for three or four years.

A number of instructors from Canada took a look at that, a model that was going on down there, putting 400 injured soldiers and veterans through such things as skiing, snowboarding, biathlon, cross-country skiing, scuba diving, wall climbing, and self-defence clinics, and learning what they can do with their new bodies and developing peer and mentor relationships. We said, “Let's see if we can migrate this program to Canada for our boys and women.” And we've done it. It's the sixth year for the program in Mount Washington, in British Columbia; for Calabogie Peaks it's our fourth year, and then there are a couple of others as well.

The next page shows a picture of 2012, with Walter Natynczyk, the Chief of the Defence Staff.

If you go to the next page, we'll get to the winter sports clinic overview. We've worked with 125 Canadian Forces members over the past years as a Canadian association. I think it's important to note that learning to ski and snowboard is not our main objective; it's rather that clinics have a physical and mental therapeutic value, allowing our injured soldiers and veterans to learn what they can do with their new bodies, resulting in higher self-esteem and developing peer and mentor relationships. That's really what we're trying to do here.

We also allow for the individual sharing of personal and family impacts related to trauma injuries. Last year this became very apparent, with one of the soldiers describing the impacts on his personal life. It's very personal, and yet I think we all agree that it becomes part of the healing process when you can verbalize those emotions and the things that happened to you.

I'd like to talk about what we do at Calabogie, and this is the same with all of our winter sports clinics right across the board. Our priorities are safety, fun, and learning how to ski. Safety is first, and if you ain't having fun, you ain't going to learn, okay? It's as simple as that.

We want to ensure success, so we take baby steps, if you will. We don't take people to the top of the mountain and say, “Here you go”, as many of us might have learned how to ski way back when, when our friends abandoned us at the top of the mountain. We'll start at the bottom of the mountain, on the learning slopes, ensuring success all the way. We don't want to have failure and then go back. It's very important and critical in this process.

We do more than just skiing. We have the participants doing social events. We introduced sledge hockey, adaptive swimming, and other events, just to keep the cycle going, and we had a lot of fun doing it. I'll tell you that sledge hockey, with the national development coaches for Canada's sledge hockey team, was a huge success last year, and this year we're introducing biathlon.

Several spouses accompany the soldiers, and we may want to talk to how they can become part of the therapeutic process as well.

The next page takes a look at a number of our injured skiers. You'll see three-track skiers and, although it might not be readily noticeable, below-knee amputees, above-knee amputees.

I would like to note that the picture on the bottom left is a fellow in a sit ski. It's an amazing story, because when he first came to us he was about four months post injury; he lost both legs above the knee, and quite honestly, he was very depressed. He thought his world as he knew it had ended. We put him in a sit ski, and we had a pretty rough year with him the first year. He had a lot of falls, but he mastered it somewhat. He left that year and we wondered if he would be back. Son of a gun, he came back, and the next year we developed the skill sets and really worked with him and balanced his equipment and so forth, and he became very good that year. The following year, last year, we put him in a custom sit ski, and this guy is now just ripping down the hill and ripping down all the hills across Canada. He's has a new raison d'être in his life.

That's what we're trying to do here. That's just one story of many.

We're getting positive feedback from all attendees, including their spouses.

We've introduced a new prosthesis in Canada called the Bartlett tendon universal knee, which allows above-the-knee or single-leg amputees to ski with two skis, instead of three-tracking down a hill. Amazing. Not only can they ski with two skis, but they can use the same prosthesis on bicycles and for doing scuba diving and so forth. Amazing things happen when you can migrate some of the technologies from the United States, and that's what Bob brings back quite a bit.

Some accomplishments listed are an improved outlook on life, especially for soldiers with OSI, and there are lot of soldiers there. There's the personal sharing of stress and issues. Finally, there are proven fundraising capabilities by our volunteers. This year we are on target to raise over $75,000 just for our winter sports clinic at Calabogie.

Here's a participant letter of appreciation. I think in this letter the only thing I wanted to note was a line where Jim Hapgood, a retired warrant officer in Newfoundland with OSI, says, “Living, as I do, in a small military community it is easy to feel alone at times in what I'm going through. This week has shown me that I'm never alone.”

Those are the peer and mentor relationships we're talking about.

Finally, we get to the important part, and that's the issues as we see them. First is planning. We need promotion and support from the military to canvass for participants. Our ratio of attendees to potential participants is extremely low. We've been told in this catchment area there should be 450 soldiers with OSI or disability injuries.

Timing, funding.... Volunteers and instructors, of course, we can get here. We've got a fairly good bunch in that regard.

Finally, it's a great opportunity for positive media relations. We think Calabogie is an ideal location—and we're going to blow our horn here a little bit—because it's got lodging, indoor pools, exercise rooms, and everything is located at the base of the hill. Your soldiers aren't travelling for an hour to get to their location. It's all right there for them, including all the social activities and the biathlon activities.

We recommend that we continue to hold an annual winter sports clinic in the east and in the west. We recommend maximizing military participation. I'd like to talk about that. We'd like to address potential roadblocks preventing access to potential participants. In other words, how do we get at the participants? And WSC, our winter sports clinic, should become a DND-approved event so that soldiers can attend while on duty. I think that's important, versus taking holidays.

Finally, in addressing planning issues, I think reviewing spousal support is a big one. The other one is that it seems we abandon our veterans after they're discharged from the service.

We think maybe there's a better model here, one where we can start serving our veterans as well.

All that being equal, that is the vision and growth: to continue to expand—the fourth year at Calabogie, the sixth year at Mount Washington—and to continue to grow this program.

[The Chair, Conservative, Peter Kent]

Mr. Dawdy, thank you very much for your presentation.

We'll move now to the Canadian Mental Health Association.

Mark Ferdinand, you have the floor.

[Mark Ferdinand, National Director, Public Policy, Canadian Mental Health Association]

Good morning, Mr. Chair.

Good morning, everyone.

On behalf of our Chief Executive Officer, Peter Coleridge, it is my great pleasure to be here today representing the Canadian Mental Health Association.

The CMHA was founded in 1918. We were then known as the Canadian National Committee for Mental Hygiene. Our main goal at the time was to provide care and treatment for people suffering from mental disorders across Canada.

For the purposes of your study, I think it's important to note that one of the first relationships CMHA had in Canada was with the Department of Soldiers' Civil Re-establishment. Our goal was to help the department—the predecessor to Veterans Affairs Canada—help Canadian soldiers returning from the First World War, who suffered from a range of different neuropsychiatric disorders, including post-traumatic stress disorder, or, as it was called then, shell shock.

Today we're proud to continue this collaboration, notably with Veterans Affairs Canada. Last year we signed a memorandum of understanding with Veterans Affairs Canada to do a number of things that we hope will help provide better supports and services for veterans in the communities we operate in.

The Canadian Mental Health Association is a community-based organization. We're located in 120 offices across Canada. We serve thousands of communities. We see roughly half a million people every single year.

We accomplish much of what we do through volunteers. We have about 10,000 volunteers and employees across the country. We provide what I would call community-based supports, services, and programs, which run the gamut from prevention programs to mental health promotion programs, interventions, and a number of other services and programs. I'd be happy to talk to you about them during the question and answer period.

We believe that any service that's provided, whether to Canadians or to certainly military personnel in the Canadian Armed Forces, must be proactive. It must be relative to the unique needs that exist within the community at the time. It must also be integrated as best as possible with health and social services. We believe that doing this will help us achieve the outcomes we're all looking for—for Canadians and for our armed forces.

In this regard, the CMHA is very encouraged by what we have seen in the Surgeon General's mental health strategy. We feel that not only does it offer supports and services for soldiers and their families—I'll talk a bit about support for families a little later—but they've also organized the services in a very deliberate and programmatic way. I think that is extremely important for this committee to know.

We believe, in fact, that many features that exist within the Surgeon General's mental health strategy can serve as a model for what ultimately we would like to see across Canada, which is a comprehensive, universally accessible mental health program for all of Canadian society.

I don't have to tell this committee about the human costs related to combat. It's very clear. I'm sure you equally are aware of the burden associated with neuropsychiatric disorders and mental illness. I won't go into any detail on that.

What we've recognized, in the work the Canadian Forces has done for soldiers over the last two decades, is that we've seen and participated in, in different ways, the co-development and the co-design of really what is a very comprehensive program for soldiers. In this regard, we remain very buoyed by what we see in the strategy.

Now, we don't have any special knowledge with regard to how the Surgeon General's mental health strategy is being implemented on the front line. However, what we do see, based on the strategies and the priorities that have been established, is an evidence-based approach to addressing a person as a whole person. We see an approach that is multi-disciplinary, an approach that is fairly comprehensive, and we see a service that is focused not only on interventions but also on health promotion, prevention, and a number of different supports.

As well, and it's important to underline this, we see research and evaluation. We remain impressed by the way in which the strategy has been developed, because it does provide for ongoing research as well as evaluation.

From our perspective, in Canada we are facing a chronic underfunding of community mental health services. This has existed not only in Canada but across the world. However, we do see rays of light and hope as they relate to the role the federal government has been playing in not only bringing attention to mental health issues but also to conducting research that we know is going to make a difference in people's lives.

For example, about five years ago, one of our former CEOs, Taylor Alexander, served with DND and the Veterans Affairs mental health advisory committee. We understand that the RCMP was also involved in that work. Ultimately, we believe that this type of highly collaborative approach to supporting the design, the development, the validation, and the implementation of the mental health strategy is crucial in order to ensure that we are serving our armed forces in the most appropriate way. We strongly recommend to this committee that this type of collaboration between different parts of the community, including the medical community, continue.

In recent years, we've also seen the federal government invest around $11 million to hire mental health personnel within the Canadian Forces. We also recognize that this is the right thing to do in Canada. We have, unfortunately, chronic underfunding and non-availability of human resource planning and mental health human resources, or people who have the appropriate training in order to provide the type of safe care or trauma-informed care that is needed to intervene appropriately with people who may be suffering from a serious mental illness or a serious mental health problem. In that regard, we think that investing in both human resources as well as training is extremely important to ensure that people receive the type of appropriate care they need to prevent the onset of more serious complications associated with their mental illness or disorder, as well as to intervene in an appropriate way at the earliest time.

We would encourage the federal government to continue playing a leadership role in providing adequate training and resources to all providers.

We believe that, similar to services under medicare for physical health, Canadians and those under the jurisdiction of the federal government should have a guaranteed right to mental health services that are universal, comprehensive, accessible, affordable, and publicly administered.

We believe that particular populations' direct health care is the responsibility of public agencies, such as the armed forces, veterans and justice services, and should be guaranteed in the same way as services that we all now enjoy and receive under medicare. Services should be proactive and relative to the unique needs of a population.

We believe this is extremely well-reflected in the Surgeon General's mental health strategy, and we still remain impressed today, after years of consultation and review, that the level of integration and interdisciplinary approach to mental health problems and the mainstreaming of mental health promotion across all levels of the Canadian Forces is being accomplished. This includes, of course, surveys, research, development and publication of operational guidance for commanding officers, periodic studies, as well as comparative research with the United States and the general population. All of these facets that we see within that strategy are what we would call a true program of care that is focused on reaching better health outcomes.

As you consider your work in your study, we would ask you to make sure that you adopt or at least consider a “no wrong door” approach to receiving care. In looking through the mental health strategy that the Surgeon General published, we note there may be a tendency to look at the medical community and primary care exclusively. We would think that there's a role, certainly, for community mental health services to support the work the Canadian Forces is doing very well. There are a number of family supports that are provided within the community, and, quite frankly, we think there is something lacking in terms of community mental health within the strategy at this point.

After the next presentation, I will be pleased to answer your questions. Thank you.

[The Chair, Conservative, Peter Kent]

Thank you, Mr. Ferdinand.

Now we'll hear from the Canadian Association of Occupational Therapists. Ms. Steggles, you have the floor.

[Elizabeth Steggles, Professional Affairs Executive, Canadian Association of Occupational Therapists]

Thank you.

Good morning, members of the standing committee. It's my pleasure to represent the Canadian Association of Occupational Therapists, along with my colleague Nick McCarthy. Thank you for the invitation to share information about the role of occupational therapy in supporting transitions of Canadian Armed Forces and veterans personnel.

I have to thank Mr. Dawdy for a perfect example of engagement in occupation. Engagement in meaningful occupation is a determinant of health.

Occupational therapists, or OTs, as we're often called, believe that occupation not only refers to paid employment, which of course is an important component, but also encompasses everything that we need, want, or are expected to do in life. Occupation encompasses meaningful everyday activities, including simple things such as walking the dog, gardening, preparing a meal, doing the laundry, and playing games. Occupations are part of life. They describe who we are and how we feel about ourselves. Occupations bring meaning to life.

To give you a little history about occupational therapy, it came into being in 1915 in order to assist soldiers who were returning from World War I in their transition to civilian life. OTs have worked with military personnel and veterans for almost a century. It was recognized that injured soldiers benefited from engagement in meaningful occupation. Ward occupation aides, as OTs were then called, worked with injured soldiers therapeutically to restore function and assist their transition to civilian life.

Today, OTs work with military personnel and veterans who have been impacted by physical and mental health issues, which may be aggravated by exposure to chemicals, diseases, and extraordinary environments. Increasingly, injuries are adversely affected by a rising tide of chronic conditions such as obesity, diabetes, and substance abuse.

OTs are highly trained, regulated professionals who work with individuals and organizations to determine and address goals that lead to productive and satisfying lives with minimal dependence on family and society at large. Dependence may be physical, emotional, or financial.

I’d like to give you an example of occupational therapy intervention. I was talking recently to an OT who was working with an Afghanistan veteran and his family. This man had always been the go-to guy, the guy that everyone relied on. As a result of PTSD, he became reclusive, unable to leave his bedroom, and detached from his wife and children.

Having discussed the issues independently with husband and wife, the OT encouraged the man and wife to explain their fears and frustrations to each other. The wife explained that she felt overwhelmed by the burden of caring for the whole family. The man explained that he was fearful of situations that would cause flashbacks and intrusive thoughts, that staying in bed was safe, but that he felt guilt and fear of failure.

The couple agreed that the husband would try to get up, washed, and dressed each day. It was a start. Today, the couple, with assistance from the OT, are setting new practical goals each day. There are relapses, but the husband has now taken on most of the household chores and has started to drive his children to sports activities. The wife is working. Life isn’t perfect, but it improves every day. This is just one example.

It's known that periods of transition may be stressful for military personnel and may affect both mental and physical health status. In fact I heard a statistic just last night that 90% of people who have mental health issues also have physical issues, so we're not talking about one or the other.

Transitions occur before and after missions, with changing rank and jobs, as well as during each posting. Anyone who is deployed on a combat, peacekeeping, or humanitarian assistance mission faces a life-changing event, and the transition home may be difficult for some.

At the end of a career in the Canadian Armed Forces, there is also the transition from military to civilian life. This period can be more difficult for those who are released from the armed forces because of a physical or mental health injury or illness.

OTs work with clients, which includes the families, to identify personal goals, conduct capacity assessments, and develop targeted and measurable outcomes that take into account the whole environment—physical, social, and institutional.

In other words, the OT does not just focus on one aspect of the person without considering the whole context. A physician may prescribe a medication or a physiotherapist may fix a muscle; OTs work with individual clients, taking the whole package into account.

This is why OTs are often the catalyst that pulls together the parts. They see a person’s real life in the home setting and not in the office. To go back to my example, the OT told me that she was the only professional who saw this man in his home. She saw him unshaven and unwashed. He said, “I'm sorry, I don’t really look too good”, and she said: “No, you don’t. Let’s talk about it.”

I have deliberately focused on providing you with an example of a veteran with a mental health issue, because the public is not generally aware of this area of OT practice. But I would like to provide another example from my own clinical experience.

I worked with a young man who had sustained a spinal cord injury that had left him paralyzed from the neck down. He is not a member of the Canadian Forces, but he could well have been. My OT colleagues provided him with a motorized wheelchair that enabled independent mobility, and they worked with architects and contractors to design and build an accessible home that met his individual needs. I worked with the rehabilitation technologist to provide him with voice-activated electronic equipment so that he could independently operate a computer and all that this implies—it's a powerful tool—or control his TV and other audiovisual technology, use the telephone, answer the door, and change his position in bed. The last time I heard from him, he said, “The doctors and nurses saved my life, but you gave me a life worth living.”

I understand that there are some areas of growing concern for military personnel and veterans. Canadian Forces and Veterans Affairs Canada will be addressing the health needs of 30,000 Canadian Forces members and veterans who have served in the Afghanistan mission. Soldiers are getting lost in the system, finding it difficult to access services and benefits in a timely manner because of complex eligibility criteria, lack of clear program and benefits information, the amount of paperwork needed to access programs and benefits, and the length of time it takes to access programs and benefits. And we know there are discrepancies across the country.

National Defence is looking to evolve from a program-centric model to a family-centric comprehensive and holistic health and wellness model for active forces members, veterans, their families, and communities. National Defence is considering an alternative service delivery initiative to supplement the delivery of core health services.

CAOT proposes the Canadian Armed Forces and veterans wellness action plan. We propose working in collaboration with the Department of National Defence and Veterans Affairs Canada to develop a strategy that will facilitate access to timely and effective occupational therapy services in order to manage and assist the transitions within and after military life.

We also propose the development of a Canadian Forces-centric model in order to help build capacity among Canadian occupational therapists to support the understanding of and education for caring for our military forces.

The goal of CAOT is to work with the Department of National Defence and Veterans Affairs Canada to support access to meaningful and effective interventions that will successfully allow transitions within and after military life. There are many opportunities to advance this goal through cost-effective physical and mental health interventions. CAOT also believes that it is important to stress that timely action is required. The result will be improved overall health and well-being, which can be measured through increased success in transitions to active deployments and to civilian and family life, improved productivity, and labour market engagement.

Thank you.

[The Chair, Conservative, Peter Kent]

Thank you, Ms. Steggles.

We'll now begin our first round of questioning.

Ms. Gallant.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

I have ten questions and we have seven minutes, so if we can, let us time our answers accordingly.

The first is to the Canadian adaptive skiing people.

Who pays for the cost of the room, board, equipment, and trainers, and what costs are incurred by the military?

[Clay Dawdy]

Go ahead, Bob.

[Bob Gilmour, Operations Director, Calabogie Adaptive Snowsports, National Capital Division, Canadian Association for Disabled Skiing]

As an organization, we do our own private fundraising, as I think Clay has indicated. We have a budget of $75,000 this year, and basically that money is used to house and feed all our volunteers, who actually donate a week of their vacation to come up and be part of this whole thing.

Also, part of all the other expenses concerned, for all the Canadian soldiers who are coming this year, and for both the soldier and the spouse...everything is covered for them too. There are no expenses for them. They just have to get there, and everything is looked after for them.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

What number of Canadian soldiers were in your sports clinic last year?

[Bob Gilmour]

We were able to find eight soldiers who could take part.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

How do you find the soldiers who may benefit from the activity?

[Bob Gilmour]

That's one of the reasons we're here, to inform you. We have everything: we have all the volunteers; it's at no cost to the Canadian government, no cost to the participants. Basically all we need to do is find a way to get to these soldiers and help them. That's where we are right now.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So as of 2012 or 2013, are we at a lower participation rate than in previous years?

[Bob Gilmour]

Starting off, in our first year we were able to gather six participants, and it went up to 10 or 11 in the second and third year. This year, because of the fundraising that we've done through public organizations that have supported us, we're looking to get at least 20 soldiers and their families this year. I showed you the advertising in the white envelope. But it almost seems that we'll have to go to the Ottawa Citizen and put in an ad to say: this is available, if you're out there; whether you're a veteran or whether you're active, we are basically here to help you.

We want to build this thing slowly. I think we mentioned that in the U.S. they have 400. Well, they started with a very small number too.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Do you work with the JPSU to find which soldiers may benefit from this type of activity?

[Clay Dawdy]

We worked with the Soldier On organization in the first two years. Last year and this year, Soldier On said they would concentrate their limited resources on sports clinics in British Columbia, including Whistler.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Okay, so you're having a hard time finding the soldiers who would benefit from this. Would you compare the cooperation that you receive from the U.S. military and the Canadian military?

[Bob Gilmour]

Not at all.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

I'm asking you to compare.

[Clay Dawdy]

It's an interesting question.

Right now we have 15 disabled American veterans coming fully funded to our winter sports clinic as part of our international esprit de corps, including one of their national Olympic biathlon coaches. So far we have found two new injured soldiers who will be coming to our sports clinic this year, and we plan to go on a major advertising campaign within the next two to three weeks.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Have there been any adaptations to the buildings at Calabogie to improve the access for the amputees?

[Clay Dawdy]

There have been major renovations. We now have two new wheelchair ramps to allow for access and egress, a separate meeting facility, a new equipment room. Our main facility is 1,700 square feet. We have automatic door openers, disabled access washrooms. Chris Werhane, the safety supervisor for the DAV—the U.S.A. disabled veterans association—went to 15 ski resorts last year. Out of the 15, he said that Calabogie Peaks was the best-adapted facility that he has been to.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Very good.

You mentioned that soldiers must use vacation time. Now, besides the fact that some soldiers are given one day's notice prior to the commencement of their vacation, what other timing problems does this pose? You have a definitive week for your clinic.