National Defence Committee on April 28th, 2023

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Mr. Chair.

To continue on with that, I think the conversation was a bit more in terms of general medical practices. Maybe we could talk about the transition for mental health services.

When someone is going through specific trauma or circumstances dealing with mental health, the relationship with their care provider is often unique, and it takes a lot of trust. How is the transition group working in terms of that continuity of care? To just stop care, specifically for people with a higher traumatic issue that they're dealing with and so on.... How do they do that continuity of care?

Telehealth may be okay in some situations, but certainly not in others. You said you were dealing with that one on one, but specifically, how do you do it with mental health?

[LGen Lise Bourgon]

Thank you, Mr. Chair, and you can interrupt me any time you want. It's okay.

[Voices]

Oh, oh!

[LGen Lise Bourgon]

Those services are in place. OSISS is the operational stress injury group that provides that service.

I'll turn the floor over to Commodore Bouchard to provide a little more information on what this service does.

[Cmdre Daniel Bouchard]

Thank you very much, Ma'am, and Mr. Chair.

Yes, OSISS, the operational stress injury social support, is a partnership program that we do with Veterans Affairs Canada. It's a group of 70 managers/coordinators and 70 volunteers. They have lived experience. They are also on their own journeys in assisting our members through this difficult process. It's a one-on-one peer support group that provides these volunteers. It can be done virtually and in person. It can be done on the base. It can also be done at a civilian establishment off the base, which is sometimes required in order to have that further discussion.

On average, we'll support about 2,000 peers. That's divided by peers. It's also with their families. The families are invited to these support systems. Twenty per cent will be serving members: 11% are the members themselves, with 9% being their families. The other 80% are veterans: 55% are the veterans themselves, and 25% are the families who accompany them on these services. On average, we have 2,000 peer interactions to support these individuals throughout, and again, it's in partnership with Veterans Affairs Canada.

[MGen Marc Bilodeau]

I'd like to add, Mr. Chair, that we also have our network of operational stress injury clinics, which are clinics that are led and funded by Veterans Affairs all over the country and are specifically designed to take care of members who are releasing and who have mental health issues. We have a close partnership with those clinics through a memorandum of understanding that we have between our military clinics and those OSI Veterans Affairs clinics. That allows us to do a safe transition of care specifically for mental health issues for our members, on top of the peer support program that Commodore Bouchard spoke about.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

In terms of health care providers in the military, how do they balance the obligations and the principles they have to face with their medical licensing bodies versus their military directives? What barriers do health care providers face in terms of finding that balance?

[LGen Lise Bourgon]

Thank you, Mr. Chair.

On that one, I'll give the floor back to General Bilodeau.

[MGen Marc Bilodeau]

Thanks for the question.

It is a challenge that all of our health care providers are faced with, because obviously we're health care providers first and foremost. We need to be there for the patients who are in front of us and make sure that we're providing them with the right level of support from a diagnostic and treatment perspective and with follow-up, recovery and so on. We also have an obligation to the employer, basically, to make sure that how these members are employed is in accordance with their medical condition and the medical employment limitations that we're obliged to provide to the employer.

I would say that in most cases this is something that can be managed without too many challenges, because we always put our patients first. As providers, we have an obligation. Also, I have an obligation to the college that gave me my licence to treat my patient first, so the obligation to the employer usually comes second. It's not less important, but it's a second consideration after the first one. This way, we're ensuring that it's the care and the health of our patients that is considered before everything else. Secondly is the security of the armed forces and its mission.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

This has come about a lot, especially....

Justice Arbour spent a great deal of time in her review on the details of the impact of “duty to report” specifically for health care providers. At that time, there was a working group that was considering exemptions for provincially regulated health care providers to ensure there was that balance and that medical needs did outweigh the requirements of military service. She made it really clear in her report that the duty to report needed to be abolished outright.

Can one of you update the committee on that working group and the impacts around the duty to report in a medical environment and what's going on there?

[The Chair, Liberal, John McKay]

Again, it's an important question, but when you have one second left to answer it, it's probably not going to work.

Colleagues, we need some collegiality here. Otherwise, I'm going to end up cutting you off all morning.

With that, Ms. Kramp-Neuman, please don't let me cut you off.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Good morning.

Thank you, Mr. Chair, and thank you to all of our witnesses for being here today.

My first question is to General Bourgon.

Can you speak to the effects that the current PSAC strike is having on service delivery to our CAF members, particularly regarding the sexual misconduct response centre and grievance officers?

[LGen Lise Bourgon]

Mr. Chair, that's a very good question.

I am not tracking the impact for the SMSRC, the sexual misconduct support and resource centre, but I can certainly give the floor—if that's okay with you—to General Malcolm. He can talk about the impact that it has on our health services right now.

Scott.

[BGen Scott Malcolm]

Thank you for the opportunity to respond.

As it stands right now, we're tracking that our clinics across the country are still able to deliver the services to our patients. The absence of our public service employees is mitigated by uniformed members. We're able to carry on with the delivery of care.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Switching gears, can we speak to systems that are currently available to provide health care supports for spouses and children of CAF members? In concert with that, how do these supports adjust for the frequent mobility of military families due to being stationed in new locations regularly?

[LGen Lise Bourgon]

That's a really good question.

The mandate of the health care services for our members is that we provide support to families, spouses and children through using services provided by the Canadian Forces Morale and Welfare Services. They are provided with funds to liaise at the base level and provide mental health support and educational support for our children. Again, it is difficult to move every three or four years.

I think that Seamless Canada is a great working group. Hopefully everyone is tracking the work of all of the provinces and territories working with CAF and DND in looking at those three files. There's spousal employment, child care and health care so that we can smooth the way for our families when they're asked to move across provinces. Great work is being done. I think it was established in 2018. The next one will be in Gagetown in May.

It's really working hard on those three lines of effort. They are small steps, but it's a huge step at the end of the day for our CAF members.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Does that suggest, then, that the CAF has been working with provinces to ensure family doctors are more readily available to military spouses and families living on bases in rural and remote areas?

[LGen Lise Bourgon]

Yes, but it's not CAF, it's more the SMSRCs. They are liaising and coordinating at the local level and trying to work with the local communities with availability at the tactical level to try to facilitate our families in getting access.

It's more of a service that's being provided. We're not doing it from a uniform and a CAF perspective, but the service for coordination at the local level is being done, yes.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Do you think the concern about support in this area is undermining recruitment and retention overall?

[LGen Lise Bourgon]

Again, we are looking at everything to improve our recruitment. This is part of the things we need to continue working on with the provinces, the federal government and the territories. It's about how we can keep working and making the situation better. It's a problem across Canada. We're just a player in there.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

You have been cited as saying that we're presently 16,000 members short of authorized regular and reserve force strength of 101,500 personnel. That may be causing higher attrition rates.

To what extent could the lack of military support be impacting these attrition rates? In addition to that, could you speak to what types of health care professionals you're looking for in recruitment?

[LGen Lise Bourgon]

At this point, out of our 71,500, we are about 8,000 regular forces member short. Those are the stats.

Again, looking at recruiting Canadians, we have to change. Let's be honest: The last three years has hurt the reputation of the CAF a little bit. We need to regain that reputation. We need to connect with Canadians again. We need to change.

I think that the recent cultural evolution and all of the initiatives we're coming up with are really making a difference. It's bringing new Canadians and Canadians into the recruiting centre.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Just to complement that—

[The Chair, Liberal, John McKay]

Sorry—

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

I'll save it for next time.