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.