National Defence Committee on May 12th, 2023

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

It's a cop-out.

[Gregory Lick]

That's not a bad word for it, actually.

We continue to make that recommendation. In fact, for primary reservists now, the CAF does this. It does service attribution for primary reservists, so why does it not do it for all the regular force? In fact, for certain conditions a bit later on, as a result of some of the changes in SISIP, it will have to occur as well, even for regular force members.

I think we're moving along the path to get to the point of this. It may require a different process within the CAF, so that—

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

What is the recommendation we need to make at this committee, in this report, to make that happen?

[Gregory Lick]

The same recommendation as we put in our report.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Is that true also over on the Veterans Affairs side, Colonel Jardine?

[Col (Ret'd) Nishika Jardine]

I understand that the CAF doctors have offered a reason that they don't make attribution to service.

I would ask the committee to ask Veterans Affairs Canada how many claims are denied because of attribution to service, in other words, when they are unable to draw the link between service and the illness through injury. I would ask the committee to ask Veterans Affairs Canada that question. I think it's an interesting question to ask.

I understand it is currently Veterans Affairs Canada that makes the attribution to service. It's what it has always done. It has access to service health records. That access has been simplified. When I'm out on the road, when I meet with military members and with veterans, I tell them about the importance of making that connection to service with their illness and injury. When they submit their disability claim, they should always get advice on how to do that.

I've said repeatedly that the veterans service officers in the Legion are trained to help people do that—making that connection to service in the disability claim, drawing that connection themselves in their own words and telling their story. Then, when VAC accesses their service health records, they can make that connection as well.

A lot of work has been done by the department to better understand the conditions of service on every single trade and occupation in the Canadian Forces. What Mr. Lick is asking for is—

[The Chair, Liberal, John McKay]

Unfortunately, we're going to have to leave the answer there, Mr. Bezan.

The final four minutes go to Mr. Zuberi.

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

I wanted to touch base on the practices we have in Canada, and to look at allies and other militaries that are similar to the Canadian military, to see the spectrum of treatments they have for prevention and for transition to a post-service life. What are the best practices of these other militaries that are comparable to Canada's? Do you have any positive examples that are out there that we can emulate and implement here, within Canada?

[Gregory Lick]

Certainly the United States has a very different approach to how it serves veterans, after their service in this case. They have veterans hospitals. They continue their treatment with experienced military doctors, or doctors who have military experience. I think that, in general, is a good thing. It's a good question, I would say, for medical professionals, rather than for me.

Certainly there are lots of countries out there that do it differently. Are they better? It's hard to say. There's also a resource issue that goes along with that, and there's also a legal issue of jurisdiction over civilians as well. There are legal issues that go along with it.

Are there better examples out there? It's likely. I always go back to the United States, but it is a very different process down there for dealing with veterans medical issues. Is it better? I would probably say yes, but....

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

I'm curious. It's been a long time. I mentioned that it's been 20 years since I was in the military. Back then, back in the day, we used to get something called SHARP training, which was once a year. It was this diversity and harassment sort of refresher. We talked a lot, as you know, about the services that are available to people who are serving and those when they clear out.

Is that information being shared in the same way as diversity training was done back then?

Are there seminars given on an annual basis in terms of the suite of services that are available to personnel?

[Gregory Lick]

That's a very broad question. If we're just focusing on the issues that we learned, and likely Colonel Jardine learned as well, during SHARP training, which was the first seminar approach that was taken after Somalia.... In that regard, I took it too. That has changed dramatically since then, into something that I think is much better.

At the same time, your question is talking about all the services and supports. One of the things we note is that the more informed a military member or military family member is about the services and supports they need and require at different times in their lives, the better.

That would be an area where, if we can focus on one thing that is relatively simple to do, it's to get more information out there and more efficient information out there that gets people knowledge.

[Sameer Zuberi, Liberal, Pierrefonds—Dollard, QC]

Certainly.

In the 40 seconds that I have left, the reason I ask is that I was a non-commissioned member. Many who are testifying, who are in the visioning, were officers. Officers get this sort of training continuously, but rank-and-file privates, corporals and others are not as well informed; nor do they necessarily get the information in the same way officers do.

The reason I highlight that type of training is that it was forced and annual.

Do servicepeople get a similar suite of information that's forced and annual as there was for the SHARP training of the past?

[Gregory Lick]

In different areas, yes, but your question is quite broad and for all the services and supports, probably not. I think what we're finding, and what you'll see in our report on mental health for primary reservists, is that there's an information or awareness gap there that needs to be addressed as well.

The answer, generally, is no, not all the information is shared in the best way. In certain areas, yes, for instance suicide prevention, those things should be done on an annual basis, absolutely. I would say they are being done better than when you and I or even Colonel Jardine took it years ago.

[The Chair, Liberal, John McKay]

Thank you, Mr. Zuberi.

Unfortunately, I'm going have to draw this meeting to a close. I offer an insincere apology for cutting each and every one of you off.

[Voices]

Oh, oh!

[The Chair, Liberal, John McKay]

As you can see, the time is our enemy. With that, again, thank you for your informative dialogue with the committee. Hopefully, we'll start to move the yardstick forward a little.

With that, the meeting is suspended while we set up the next panel.

[The Chair, Liberal, John McKay]

We're back in order.

Again, we've already lost a number of minutes off the clock. I'm not going to go through any formal introduction, but simply ask Senator Rebecca Patterson for her first five minutes. Then we will have Dr. Karen Breeck for her five minutes, and then Mr. Booth, who is online, for his five minutes.

I'm given to understand that, Mr. Booth, you have a hard stop at 10:45, so we'll try to respect that.

Senator Patterson.

[Rebecca Patterson, Senator, As an Individual]

Good morning, honourable members and colleagues.

Thank you for your invitation to appear today as part of your study on the military health system and the provision of health and transition services under the Canadian Forces Health Services Group. I didn't add veterans there as I kept serving.

As the chair mentioned, I am a senator but I'm also a veteran, having just recently retired from the Canadian Armed Forces as a rear-admiral. I'm a service spouse. I'm a mother of two. I'm also a military mom, because my son is a reserve force member.

I enrolled in the Canadian Armed Forces in 1989 as a nursing officer. During my 34 years with the military, I've been posted across Canada and deployed overseas to Saudi Arabia, Somalia and Afghanistan. I've served as commander of 1 Health Services Group in Edmonton, covering the west and north of Canada from a health perspective. I was the deputy commanding officer of the Canadian Forces Health Services Group and ultimately the commander—or, in effect, the CEO and COO—of health services within the Canadian Armed Forces.

I continue be a member of the College of Nurses of Ontario, the Canadian College of Health Leaders and the Royal Canadian Medical Service Association. Suffice to say, I have quite a bit of experience in the domain we are about to discuss today.

The military health care system is not like the sort most Canadians are familiar with. Unlike provincial and territorial health care systems, the military system provides a spectrum of occupational health services in Canada. This includes medical, dental, pharma, mental and physical health across Canada and around the world. However, it is also responsible for medical and dental procurement of material and equipment, research and development, logistics and recruitment, retention and the training of military health human resources.

International operational health services support involves a high degree of interoperability with our allies and within multinational alliances like NATO and ABCA. The Canadian Forces Health Services Group is, in essence, Canada's 14th health jurisdiction, because serving members of the Canadian Armed Forces are excluded under the Canada Health Act. Despite paying provincial taxes like any other resident, CAF members are not issued provincial health cards and cannot access health care delivery via their respective provincial health care systems. Instead, CAF members receive health services through military health care facilities and not via a local provider in their community.

Health services that are not provided by the military are sourced through the provincial health care system, or through private medical and dental facilities. The CAF must purchase those health services for its members from providers, often at exaggerated rates, just like non-Canadians.

Despite what you've heard, funding for the health care system, which includes everything I've previously mentioned, is a concern. As recently as 2018, an internal evaluation of military health care found that in the period between 2010-11 and 2016-17, so pre-COVID, health care spending in Canada generally rose at a rate of 3.3% per year. In other words, it was greater than the national inflation rate, whereas within the Canadian Forces, it was only funded at 0.7%. This demonstrates the diminished buying power within the CAF relative to the health care it is expected to provide.

As I've mentioned, the CAF often purchases services for its members at higher rates despite having less to spend on health care. This is where the Minister of National Defence, with her respective colleagues in health and intergovernmental affairs, can emerge as a champion for CAF members by working with provincial governments to negotiate better rates more closely aligned with those charged within the provincial health care systems, if not the same rate.

However, colleagues—and I use the term “colleagues” because we are fellow parliamentarians—funding isn't the only issue. There are structural issues related to service delivery and to the human resource side of health care provisions in the military. Health service personnel in the CAF are fully trained sailors, soldiers and aviators in addition to being health care providers. You can appreciate there is no other career quite like it.

You've talked about retention. Salary and quality of life are often higher outside the military for health care providers. We're posted all over the world on a regular basis, and it's extremely hard to maintain required clinical competencies. There is also a mental and physical toll. While the CAF is not a licensor or regulator of health professionals, there is an opportunity for the CAF to lead on either a federal regulatory approval system or greater interprovincial recognition of licensing, in other words, portability.

As I mentioned, military health care is unlike the provincial medical or dental care systems. Given resource challenges within CFHS, both human and financial, coupled with the urgent need to recruit new and more diverse CAF members in general and policy changes that have led to the retention of members for longer and with more complex health requirements, it is critical that we rethink health care in the Canadian Armed Forces.

Thank you. I welcome your questions.

[The Chair, Liberal, John McKay]

Thank you, Senator Patterson.

Dr. Breeck, you have five minutes, please.

[Dr. Karen Breeck, As an Individual]

Thank you.

The current approach to military health care and transition is much more person-centred and trauma-informed than when I, as a medical officer, was released in 2009. Despite the significant improvements made over the last decade, there is always room for more improvements, especially for ensuring the health and well-being of military women.

Ideally, women’s health issues will become normalized, expected and fully integrated parts of the future military medical system. We should all be able to talk about and care for menstrual bleeding suppression, perinatal mental health, urinary incontinence and menopause with as much ease as we talk about a sprained ankle. Thanks to the ongoing political will and targeted funding from budget 2022, a military women’s health strategy is now under way. However, one area in particular, military women’s reproductive health, will require a multidepartment collaborative approach.

Many military and veteran women are challenged to get pregnant, stay pregnant, stay healthy during and after their pregnancies and have healthy offspring. I have followed the medical journeys of hundreds if not thousands of military and veteran women. In my opinion, reproductive loss and its complications are often more soul-crushing and life-altering for women than any other form of trauma the military has to offer them. Although reproductive challenges are possible for anyone at any time, the question that tortures those so impacted is the unknown around what role the military workplace played, if any, in their individual cases.

Most military reproductive hazard research is still only available on men, yet men make new sperm every 90 days. Women reproduce with the eggs they were born with. The potential reproductive health impacts from military-specific workplace exposure to chemicals, extreme temperatures, pressures, vibrations, sound, radiation and traumas are simply not the same for men and women. It is critical that the risks and effects of non-traditional workplace exposures are better understood for women.

Military women usually love their work and are happy to continue working for as long as they can while pregnant. However, when there are complications, it is often only then, in retrospect, that these same women and their health care providers start to research deeper and understand just how little is actually known in this area. The outcome for many of the impacted military women is a living purgatory of self-blaming guilt around what-ifs. Society at large aggravates this topic, as reproductive loss and its complications are still largely viewed as a taboo topic to discuss in public settings. The internalized, rarely vocalized emotions often manifest into health-related conditions that can accelerate some of these women’s release from the military.

Women sign up to the military prepared to give their lives if so required. What military women are not prepared for is to lose their individual potential to create a healthy life because their employer has not yet seen fit to conduct the needed research for women’s full and meaningful inclusion into federal workspaces.

The Minister of National Defence’s mandate letter already directs her to ensure that resources are available for military women’s health. However, the type of foundational occupational research required here cannot be done by the CAF alone, nor should it. Workplace reproductive hazards are not unique to military women. Women in many of the operational new roles in the federal government, including the RCMP, Coast Guard, Corrections Canada, Canada Border Services Agency, Transport Canada and even the Canadian Space Agency all need more knowledge on how to better enable and support women in non-traditional workspaces.

I challenge the committee members to think “big picture”. The Minister of National Defence could, on behalf of military women, help develop a strategic plan for the occupational health needs of all federally employed women. Together, Canada could become the world leader in enabling and supporting the health and well-being of women wishing to work in non-traditional workplaces throughout their life cycle.

If not Canada, who? If not now, when?

Thank you.

[The Chair, Liberal, John McKay]

Finally, Mr. Booth, you have five minutes, please.

[Nick Booth, Chief Executive Officer, True Patriot Love Foundation]

Thank you to the committee for the opportunity to contribute to this important piece of work.

True Patriot Love is Canada’s national foundation for the military and veteran community, and we work closely as a trusted partner with the Canadian Armed Forces, Veterans Affairs and the federal and provincial governments.

It would be remiss of me not to take this opportunity to thank the government for its tremendous support of the 2025 Invictus Games, for which True Patriot Love was honoured to be able to coordinate the successful bid on behalf of Canada. We look forward to welcoming the world to Vancouver and Whistler for the first-ever winter edition of this inspiring event. The committee may also like to note that we have made both supporting transition and the mental health of military and veteran families key legacy strands for the games.

As the national foundation, True Patriot Love works across the spectrum of issues facing our service members and veterans. We support our military families and children, especially as they navigate the issues of multiple deployments or location away from their home community, and provide significant support through the military family resource centres and other local partners.

We fund a range of programs to assist the health and well-being of both serving members and veterans, including mental health, homelessness, and employment and transition support. For those who may have become injured or ill, we contribute to their recovery and rehabilitation through sport, expeditions and the creative arts. We help with their reintroduction back into local communities post-uniform, often a challenge after long periods away.

We are pleased that the committee is reviewing this subject. Our service members deserve the best support while in uniform as they transition and post-release. We know that many struggle both through illness and injury, and also with the change in their status, access to support systems and the lack of a sense of purpose once they release.

An estimated 10,000 military families are required to relocate each year, of which approximately 8,000 must move to a new province or territory. Approximately two-thirds of families experience periods of absence from their loved ones due to operational requirements. In a recent survey of Canadian Armed Forces spouses, 24% found child care extremely difficult to re-establish after relocation.

The nature of military life also makes health care more challenging, especially for families. There can be multiple moves and a lack of family doctors in local communities. Military families may experience an unfamiliarity with civilian organizations and have little time to navigate this before moving on again. I recently spoke to a military mother who said she had spent the whole of her child’s formative years with her fingers crossed.

This can have a corresponding impact on mental health, which may in turn be a challenge in accessing support but also brings the associated stigma or fear of losing duties or status. Serving members may seek mental health care off base so that their chain of command is not aware and it does not impact their careers.

This situation is not new nor unique to Canada. However, it has been made more challenging through the COVID-19 pandemic, with many programs either being cancelled or switched to digital delivery. While this can have some positive implications, especially as we try to provide services to a geographically dispersed Canadian Armed Forces and veteran community, people suffering from service-related mental health conditions may simply not be able to take advantage of virtual services. We should seek, where we can, to ensure in-person provision is available and that these are reopened where they still remain closed as soon as practicable.

However, technology can also offer opportunities. In 2019, True Patriot Love received funding from the Veterans Affairs Canada well-being fund to explore how innovative technology can benefit veterans’ mental health. In particular, we stood up an expert advisory council that has been focused on how to allow better access to a serving member's or veteran’s own health records.

Following a two-year study involving veteran focus groups, the technology sector and representatives of Veterans Affairs and Canadian Forces health services, we are developing a proposal for a veteran health record digital safe. As the committee may be aware, traditionally these records have been provided either in paper form, often long and cumbersome, or in a technological format, such as a disc or memory stick, which are outdated and often not usable. This digital repository would be far more portable and user-friendly and would allow veterans to grant permission to access medical records to authorized health care service providers.

Second, we have proposed a feasibility study to test the electronic transfer of medical records for health care clinician use. This also would have the advantage of preventing veterans from having to repeat their story on numerous occasions, something we have heard can be very challenging and potentially triggering.

Third, the system could provide a repository of anonymized information to allow researchers to have a better understanding of the issues and prevalence. We hope that Veterans Affairs will grant permission for a feasibility study shortly.

I would also flag two other matters for the committee, in brief.

Firstly, they will be aware that the government is developing a new national employment strategy for veterans. I would encourage the two studies to align, as mental health challenges for our veterans cannot only be combat-related or service injury-related, but also drawn from the stress, anxiety or depression following release.

[The Chair, Liberal, John McKay]

Could you come to your conclusion, please?

Thank you.

[Nick Booth]

Yes.

We're working with the Government of Ontario on a major pilot to strengthen hiring former service members into the health care sector and the private sector, mirroring the U.K.'s “step into health” program.

To conclude, to ensure that military members and their families can remain in service for the optimal time and complete a positive and healthy transition to civilian life, we would hope the government both promotes the comprehensive provision of care to our military community and recognizes the value of community supports that might often provide essential services and offer choice to a service member or veteran from a more formal Canadian Armed Forces or government program, should they wish.

Thank you.

[The Chair, Liberal, John McKay]

Thank you, Mr. Booth.

Colleagues, we have 35 minutes left. We'll get through the first round if I cut it back at least a minute for everybody. Then we'll see where we go for the second round.

You have five minutes, Mr. Bezan.