National Defence Committee on May 9th, 2023

[The Chair, Liberal, John McKay]

I call this meeting to order.

Colleagues, there have been some disruptions, of which you are intimately aware.

I've asked two of the panellists to return at another date and re-empanelled this panel, so that, instead of having two witnesses, we now have three. I particularly appreciate the patience of Madame Tam-Seto, Colonel Pucci and Madame Lafond.

Colleagues, as you know, if the bells start ringing, I have to suspend unless I have unanimous consent to continue. I'm not going to ask for unanimous consent now. I will be asking for unanimous consent when the bells start ringing. I'm hoping to at least get statements done, then go from there.

With that, I will ask Dr. Linna Tam-Seto, then Myriam Lafond, then Colonel Pucci to give their opening five-minute statements.

Again, thank you for your patience, and I look forward to what you have to say.

[Dr. Linna Tam-Seto, Assistant Professor, McMaster University, Canadian Institute for Military and Veteran Health Research]

Good afternoon, Mr. Chair and members of the committee. Thank you for the opportunity to come before you today to speak about some of the work I've been part of, which is to better understand the experiences of Canada's military veterans and their families, particularly during periods of change and transition.

I come before the committee as a health researcher from McMaster University and the Canadian Institute for Military and Veteran Health Research. I am a civilian with no military experience. I'm not from a military-connected family. I am, however, a registered occupational therapist with over 20 years of clinical and research experience.

I'm here to share with you what we currently know about the experiences of members as they go through the process of releasing and shifting where they receive health care services. Doing the work that I do, I often hear people ask what makes veterans and their families so special: Why should they be treated any differently by the health care system than me and my family?

The answer is simple. Veterans and their families are unique because of the personal sacrifices they have made to serve this country. They should not be put at a disadvantage for that service. That is why my colleagues and I do the work that we do and will continue to do it.

My statement this afternoon will focus on two specific phenomena experienced by Canadian Forces veterans during their military to civilian transition, regardless of the type of release.

First, there is no consistent mechanism by which the health information of members is moved from CF health services into the civilian health care system. Unbeknownst to most Canadians, there is no dedicated health care system that provides services to veterans. Upon release, veterans are placed in the same health care system used by all Canadians and thus face the same challenges, barriers and delays.

Some veterans have preplanned their inevitable transition to the civilian system by reaching out to primary care providers who may already be connected to them through family or friends, which facilitates this process. For many, however, this abrupt stopping of services creates real potential for a gap in their health care. For people with complex or chronic health conditions, the gap is even more severe. We hear stories about veterans who are left to put their names on countless waiting lists or who are forced to use walk-in clinics, urgent care or emergency rooms for routine care. Many veterans have shared that in cases when they are able to see someone, they need to prioritize or choose which of their health conditions will be seen that day. This can be extremely tedious for veterans who are living with multiple health problems.

The second point I would like to highlight is what happens when veterans finally enter the civilian health care system. As I mentioned before, most Canadians are not aware that veterans access health services provided through provinces and territories, and that it is therefore unlikely that these health care professionals and institutions are aware of what it means to be a veteran and how experiences in the military directly impact not only the risks for certain health conditions but also how veterans engage with health care providers.

In other words, for the most part, the Canadian health care system, which includes providers, institutions, policies and processes, does not have military cultural competency. This is necessary to provide veterans, and by extension their families, with quality care that meets their unique health needs, which have been shaped by military service.

Cultural competency is seen as the ability to appreciate the differences among people. Each person is culturally unique and, as such, a product of their experiences, cultural beliefs and cultural norms. Therefore, military cultural competency is the extent to which health care providers like me, who are working with veterans and their families, are aware, knowledgeable and sensitive to the distinct needs and relevant issues related to them. Most importantly, it's what I need to do as an occupational therapist to adjust my practice once I know about their connection to the military.

There are increased efforts by Canadian health professional associations, such as the College of Family Physicians of Canada and the Canadian Association of Occupational Therapists, to create materials aimed at developing a military-specific knowledge base for their members. This is an excellent and commendable start. However, there is much to be done in the training and certification of health care providers.

I've been leading much of the work in Canada, trying to understand what it's like for veterans and their family members when they are receiving care in the community. In addition, I've also been exploring the experiences of health care providers to identify gaps in their awareness, knowledge and skills to be able to be more culturally confident when working with members of the veteran community.

Thank you again. I look forward to our discussion.

[The Chair, Liberal, John McKay]

Thank you, Dr. Tam-Seto.

I've been remiss in not acknowledging that a former colleague of ours is in the room. Karen McCrimmon is a former chair.

Welcome once again, Karen.

I will now give the floor to Mrs. Lafond for five minutes.

[Myriam Lafond, Managing Director, Crisis Center and Suicide Prevention of Haut-Richelieu-Rouville]

Thank you very much, Mr. Chair.

I'd also like to thank the committee members for having me.

My name is Myriam Lafond and I am managing director of the Crisis Centre and Suicide Prevention of Haut-Richelieu-Rouville.

The centre is in Saint‑Jean‑sur‑Richelieu, the city where the military base, the Canadian Forces Leadership and Recruit School and the Royal Military College Saint‑Jean are located.

The centre opened in 1993 and we provide telephone intervention and in‑person follow‑up services for individuals with suicidal ideation or who have lost someone to suicide.

From 2010 to 2015, the centre put together its crisis shelter. It provides two beds for people in crisis.

During the time the crisis beds were deployed, the military base contacted the centre for training. Military police and chaplains therefore received suicide prevention training, and they learned about the full range of services we provide, including the crisis beds. They then asked us to set up a service trajectory.

Since 2015, we have therefore being housing military recruits and serving military personnel who need a break, and try to regain their footing and defuse the crisis they are experiencing, whether suicidal or psychosocial. Our team of counsellors, all of whom have a university degree in counselling, welcome them. Our counsellors are perfectly bilingual, given the proportion English-speaking military personnel that we accommodate. We have a bed reserved for military personnel who are sent to us.

The service trajectory was implemented in cooperation with the 41 Canadian Forces Health Services Centre. All military personnel staying at a crisis centre must first go through this medical centre, which, after assessing them, contacts us to refer them to our services.

Rather than sending these service members to the hospital, it's much better to refer them to a crisis centre that can provide real psychological support, administer specific treatments to defuse the suicidal crisis and help them to regain some control over the situation and the suffering they are enduring.

The fact that we're not military ourselves really allows service members to take a step back and be open about what they're going through. From experience, I would tell you that these are very uprooted people. They generally leave their homes to spend 12, 13 or 14 weeks in Saint‑Jean‑sur‑Richelieu in an environment completely different from the one they know. This often generates crises, and going to a non-military crisis centre helps them regain some control over their situation.

The relationships we have with the military base are smooth, necessary and significant. They work well. Over the past two years, we've had a number of military personnel stay with us. We keep them on a weekly basis in their stay can last anywhere from 3 to 10 days until the crisis is resolved and they are able to return to the base or are released from the base if the military is just not for them. So during their time in the centre, they can really step back and see what's best for them, and then make the best choice they can, being fully aware.

That's what I wanted to say to you. I would be very comfortable answering any questions you may have.

[The Chair, Liberal, John McKay]

Thank you very much.

Colonel Pucci, you have five minutes.

Some colleagues were wondering what our finish line would be. It's a six o'clock hard stop.

Colonel Pucci, you have five minutes, please.

[Colonel, Retired) Richard Pucci (Senior Health Care Executive, As an Individual]

Mr. Chair and distinguished colleagues, good afternoon.

My name is retired Colonel Richard Pucci. I'm a health care executive. I had the honour of serving in uniform for 30-plus years. I retired in 2016 out of the position of Deputy Commander, Canadian Forces Health Services. Prior to that, I served as the chief of staff to the Canadian Forces surgeon general.

Since retirement, I've had the pleasure of working with a multitude of veterans and veteran groups from coast to coast to coast.

One of the primary challenges facing veterans seeking health service is the lack of access to care. In many cases, veterans must travel long distances to access health facilities, which can be tiring, expensive and, of course, time-consuming. Additionally, the waiting times for appointments are often long, leading to delays in treatment and to increased risk of health complications.

Addressing this challenge requires a paradigm shift in how primary care delivery is available to our veterans. What veterans want and need is access to care upon retirement. We need in place an independent body to help facilitate a smooth transition to the civilian health care continuum.

Working with strategic partners, I am ready to launch a proof-of-concept trial here in the Ottawa area. I have developed a network of two health care facilities that are ready to be part of this revolutionary veterans health care multi-site trial.

The first site is Beechwood Physical Medicine, which is an interdisciplinary clinic where clinicians use the best practices, evidence and innovative solutions to assist our veterans experiencing physical and psychological pain and distress.

The second site is the establishment of a veterans' primary care clinic at the Tay River Reflections location in Perth, Ontario. I would like to reiterate that both locations are ready to take part in this innovative shift in delivering health care to our veterans. Both sites have generously offered up their infrastructure to support this most important shift in health care delivery for our veterans. The proof-of-concept trial would run over a six-month period with a goal of expanding to key sites across the country.

I have the following four recommendations.

Number one is to establish a veterans health services task force. Initially, the task force would work independently and have no affiliation with Veterans Affairs Canada or the Canadian Armed Forces transition group. However, a level of synergy would be developed once the task force rolls out the proof-of-concept trial. The task force would report directly to this body or to another entity, as deemed appropriate by the chair. This task force would be made up of veterans with expertise from the health care sector, as well as representatives from across other health authorities and jurisdictions.

Recommendation two is that the veterans health services task force develop a governance structure that would support the rollout of this model across the country.

The third recommendation is for the allocation of funds to launch one of our program sites forthwith. As you may be aware, the program has been developed to cater to the needs of the veteran community, and we have completed extensive planning and groundwork to make it a success. The funding would primarily be used to cover the necessary expenses to launch, including logistics, medical equipment, consultants and staffing.

The fourth recommendation is that the veteran health services task force complete a detailed review of the veteran primary care models of our allied nations.

In conclusion, I want to express my gratitude to the members of the Standing Committee on National Defence for studying health and transition services, and for their leadership and commitment to our military members and, of course, to veterans.

Let us work together to strengthen these essential services and ensure that our men and women in uniform and out of uniform receive the care they need and deserve.

Thank you.

[The Chair, Liberal, John McKay]

Thank you, Colonel Pucci.

Colleagues, the bells are not ringing yet, but I'm anticipating that they will be ringing.

I intend to launch into our first round of six minutes each and then to ask for unanimous consent to proceed.

I'm rather hoping that we have unanimous consent. Then, at some point, we'll figure out what the timeline needs to be to actually vote.

With that, Ms. Kramp-Neuman, you have six minutes.

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

Thank you.

I'll start with you, Madam Tam-Seto.

The impacts of serving on the mental health of CAF members have often been studied. Can you speak to whether or not there's much attention being paid to the impact this may have on the children and families of CAF members?

[Dr. Linna Tam-Seto]

There is emerging research within Canada, particularly research being done within DND, around the impacts on children. However, we continue to look, quite often, stateside and internationally on that. We know access to mental health care looks different here in Canada, because there is a dedicated health care system for family members down in the States. We're just beginning to look at that here in Canada.

There is some indication...and there's some preliminary research being done, but there definitely need to be more dedicated research resources for that.

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

Thank you.

To complement that, as it stands, do you think there are sufficient specialized mental health supports for the children and families of CAF members?

[Dr. Linna Tam-Seto]

Absolutely not. I'm going to be very blunt about that, simply because I worked in child and adolescent mental health care prior to becoming a researcher myself. I know, in terms of our training, what we have and don't have. I speak passionately about military cultural competency and the work I've done around that.

We know that there are unique stressors for military families and military-connected children. What we don't know is how good the quality of care is that they are getting in the community.

To answer your question, no, they are not sufficient. Children's mental health care is not great at the best of times, for all Canadian children. However, for specialized populations, there's definitely a gap.

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

Thank you.

Do you think the challenges and barriers to health care and other basic services for CAF members and their families could serve as a barrier to new recruitment?

[Dr. Linna Tam-Seto]

I think that is something people probably don't realize as they are joining.

When we are recruiting folks, we need to provide them with an opportunity that...this is a career that will span the lifetime. Quite often, new recruits who come in are not thinking about themselves at retirement or as having families. I think, throughout the process—as people are going through the ranks and training—that we in the Canadian Armed Forces should provide people with that insight and support...as they consider.

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

Thank you.

Colonel Pucci, could you address how readily available you feel mental health treatment modalities are made to former CAF members? How do they transition to other supports following their time with CAF, in order to ensure long-term support for veterans?

[Col (Ret'd) Richard Pucci]

First of all, I'm not a clinician or a mental health care provider. I'm a health care executive and an operational planner.

I can mention that there are a lot of issues, and this is from personal experience in meeting with our veterans out there. There is a huge gap from the time a member releases and goes out the back door of the Canadian Armed Forces and the time they enter, as a civilian, the continuum of health care. That gap is very hard. As for all Canadians, there's a gap out there regarding mental health providers, unfortunately. I've talked to many veterans and worked with many companies that are trying to put in place capabilities to support our veterans in the mental health realm.

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

Thank you.

Given the unique forms of stress and challenges experienced by those in positions of leadership within the military, can you think of any specific or specialized resources that currently exist for their mental health?

[Col (Ret'd) Richard Pucci]

Within the civilian sector, I think there are a lot of new, up-and-coming companies trying to bring forward new, innovative clinical capabilities to support the mental health challenges out there. Unfortunately, at this time, Veterans Affairs Canada is not allowing access to some of these new, innovative technologies.

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

How do we support them? How do we support our veterans with potential burnout? What is currently being done to support them in that regard?

[Col (Ret'd) Richard Pucci]

Each veteran has a case manager within Veterans Affairs Canada. I had a case manager for the first two years of my retirement. I no longer have a case manager, so I'm on my own at the moment. However, clearly, when I retired, I had access to a clinical psychologist. I had access to a care team before I retired. I was quite fortunate.

Many members retiring today do not have the same level of access I had. There are gaps. However, there are capabilities now being developed out there to further support the men and women who retire.

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

That's excellent. Thank you.

Madame Lafond, with regard to your experience working on the hotline, could you address whether you currently receive frequent calls from CAF members reaching out to you on the hotline for continuous support?

[Myriam Lafond]

Unfortunately, that's not the case. We get a lot of calls from the clinic wanting to refer people to us, but military personnel can't seek out our services directly.

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

Okay.

To complement that question, how much awareness or training is provided to hotline workers surrounding the resources that would be unique to CAF?

[Myriam Lafond]

All our counsellors complete three days of accredited training. One part deals with treating people who are suicidal and the other deals with crisis management. The training is recognized by the ministry of education. In addition to their academic background—

[The Chair, Liberal, John McKay]

I am sorry. I am going to have to interrupt. The bells are ringing.

Are these 15-minute bells or half-hour bells? They're half-hour bells.

Can we get 15 minutes or 20 minutes?

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Say that again, Chair.