National Defence Committee on Feb. 23rd, 2017

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

As of April 2014, 434 of the established 455 mental health professional spots had been filled in the Canadian Armed Forces, or about 95%. Has that number reached 100% yet, or has it gone down from the 95%?

[BGen Hugh MacKay]

The percentage of positions filled fluctuates. It is nearly impossible to reach 100% and sustain 100%, just because of the natural turnover of staff, which goes on in every organization. Right now I believe we're sitting at about an 8% vacancy rate, of which about 7% are clinical care providers.

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

I know that locally, in Petawawa, a couple of months ago we were at the point where we had no psychiatrists available to treat the soldiers there. Has that situation improved?

[BGen Hugh MacKay]

I'll ask Colonel Downes.

[Colonel Andrew Downes, Director, Mental Health, Department of National Defence]

Perhaps I can just chime in on that. I'm not sure exactly of the circumstance you're speaking about, because we do have a full-time military psychiatrist there and she's still there now. There are also civilian psychiatrists who work in the clinic. I'm not sure if there was perhaps a gap while people were on leave or something like that, but there has not been a time when there were no psychiatrists in Petawawa.

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

What number of people in JPSUs are being treated for OSIs now? I'd like a percentage, not an exact number, because you wouldn't have that. It changes from day to day.

[BGen Hugh MacKay]

I don't know if I have a percentage.

[Col Andrew Downes]

JPSUs, as I think you know, are not part of the health care system. These are organizations that exist to support members when they're ill or injured. We don't necessarily have visibility on who's posted there and what the specific diagnoses are. We continue to provide them with care, regardless of the reason that brings them to the JPSU.

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

Across the forces, what number of psychiatrists and psychologists are available to the Canadian Forces members?

[Col Andrew Downes]

I don't have the exact number in my mind, but we have more psychiatrists per capita in the Canadian Forces in our clinics than there are in the civilian sector.

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

From the political level, what could we be doing to lower the rate of suicides in the Canadian Armed Forces?

[BGen Hugh MacKay]

I'm not sure it's my place to advise you, from a political level, as to what you can or cannot do.

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

Okay.

One of the recommendations the military ombudsman made was that:

...the Canadian Armed Forces retain medically releasing members until such time as all benefits and services from the Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan have been confirmed and are put in place.

Part of that would be to allow the findings of the clinicians. When they determine that somebody has to medically release and that the injury was as a consequence of service duty, he's recommending that this adjudication apply for their back pensions, their medical pensions. Right now, upon release, they have to apply to Veterans Affairs for the different benefits, so there's a gap.

In essence, they've been evaluated by a military doctor, but then upon their release or upon their trying to apply for veterans benefits, they have to go through another system and prove to a Veterans Affairs doctor that this injury was indeed as a consequence of service.

Do you see any reason that we couldn't use the evaluations of the military clinicians for the purposes of the pension adjudication?

[BGen Hugh MacKay]

It is not exactly as you have presented it, in that physicians in the military evaluate employment limitations. They don't make a decision as to whether or not it's going to result in somebody being released. It's the DMCA that makes that decision. Our physicians don't actually make a decision with respect to attributability to service at the present time. We diagnose, and we advise on employment limitations at the present time.

[The Chair, Liberal, Stephen Fuhr]

That's your time, Ms. Gallant.

Mr. Garrison, you have the floor.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thanks very much, Mr. Chair.

Thanks to our witnesses for being here today.

I'm going to start by saying something I know I've said before. I think the Canadian military is ahead of a lot of other sectors in our society in tackling some of the difficult questions, whether it's sexual misconduct or suicide, so I want to give credit to the Canadian Forces for doing that.

That said, then you get held to a higher standard. When others don't address these problems, they can throw up their hands and say they don't really know the nature of the problems. Now I'm about to hold you to the higher standard you established for yourself.

I want to go back to the question of health professionals. It seems, over the last couple of years, that the record on filling the vacancies has improved. If so, if that's true, can you tell me why that's so?

[BGen Hugh MacKay]

I think we went through a tremendous effort probably three years ago to try to create staff pools to fill the types of positions that we needed to fill. We had the approval authority for hiring delegated down, actually, to the individual who preceded Andrew in the position of director of mental health. We still need to have our contracted third party service provider provide us with some of the health care providers. We, quite frankly, have had very long discussions with that contractor to encourage the contractor to find innovative ways to find us the health care providers we need to fill those positions if we can't fill them with public servants.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

That's what I was hoping you would say. That was my understanding, that there was a really concerted effort that had begun. For a long time there were a lot of underfilled positions, and from my understanding in talking to people in the mental health positions, there were people who were doing jobs that were beyond their formal qualifications. That's not to say they were doing a bad job, but I wonder whether that problem still exists.

[BGen Hugh MacKay]

I'm not aware that it ever happened.

[Col Andrew Downes]

I'm not aware of anybody who has been working beyond their scope of practice. If there have been cases where that has been identified, the leadership in the clinic would take care of that.

We have a very well-trained workforce. As we've discussed, within our clinics the staffing levels are good. Obviously we'd love to have 100% staffing, but that just is not a realistic thing in any organization, because as soon as you hire one person, somebody somewhere else leaves.

We demand a high standard and a high level of training and experience for the people working in our clinics.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I'll stand corrected on the question of the underfilled positions.

In terms of retention, I know that if you go back three or four years, there was a huge problem with retention of mental health professionals. There was a bit of turnover, which I think exacerbated the problems of filling vacancies. How are we doing on retention at this point?

[BGen Hugh MacKay]

With respect to our civilian workforce, I think we're doing not too badly with retention. We still have challenges with filling civilian psychologist positions and having them stay with us.

From a military uniform perspective, we have challenges with our uniformed physician cadre, in that attraction and retention have become an issue for us. We are working hard to look at ways that we might be able to improve both the attraction and, more importantly, the retention, because once we get them trained up and experienced, we want to keep them.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I'm asking all these questions leading up to one of the concerns I've heard locally, which is that for people with mental health problems, the relationship with the mental health professional is very important. In terms of stability and even in attracting people into treatment, you need that stability of personnel. I know the military has a challenge with that because of the rotation of service and deployments and all those kinds of things. What's being done to make sure there can be that consistency of treatment for those who need it?

[BGen Hugh MacKay]

One of the important initiatives we launched a couple of years ago was the actual creation of the electronic mental health notes. Up until just two years ago, notes were not necessarily available in the electronic health record. Now we know that if somebody goes from one location to another or is deployed for some reason, the caregivers who are there are able to access what has gone on before with the care of that individual. There may not be that same clinician in front of the individual, but they will at least know what has gone on before with his or her treatment.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I'm glad to hear that. From my understanding, that's a significant improvement.

My other question is, are you facing particular regional challenges in filling these jobs? I'm from British Columbia, and I know sometimes we've been told that it's harder to fill the positions there, where costs of living are higher and where there are more opportunities for people with the same skills.