Mr. Chairman and members of the committee, as Surgeon General, I thank you for the opportunity to speak to you about the measures being taken by the Canadian Armed Forces to address the two recommendations made by the Auditor General in chapter 3 of his 2014 report, entitled Mental Health Services to Veterans.
These recommendations relate to timely access to psychiatry and psychology assessments at specialized Operational Trauma and Stress Support Centres, or OTSSCs, and the accelerated transfer of medical records to Veterans Affairs Canada.
Also with me today is the Canadian Forces director of mental health, Colonel Andrew Downes, MD.
Access to mental health care is impacted by the demand for care, available clinician resources, and the efficiency of practices. We don't want to limit or control the demand for care but on the contrary do everything we can to encourage those who need care to come forward. We must therefore focus on maximizing clinician resources and the efficiency of our practices in striving to minimize wait times. In doing so we must be careful to avoid compromising other aspects of care such as its quality, basis of evidence, and collaborative approach.
To measure access to mental health care the Canadian Forces health services group applies the widely accepted metric of the third next available appointment. This is considered a more sensitive reflection of true appointment availability than the first or the second next available appointments because those metrics are more affected and skewed by cancellations and other unexpected events. The third available appointment, however, does not necessarily reflect the patient's actual experience. It can often overestimate true wait times since referrals scheduled for the first and second available appointments are seen sooner, particularly when there are cancellations.
The third next available appointment metric also only applies to routine referrals. Cases that are clinically deemed to be urgent are seen much sooner, and virtually all patients awaiting OTSSC assessment are under the mental health care of a primary care physician, and in some cases, a psychologist or psychiatrist from a clinic's General Mental Health Section.
OTSSCs provide monthly reports on the average wait time between receipt of a routine referral and the third next available appointment for an initial diagnostic psychiatry or psychology assessment. Our benchmark target is no more than 28 calendar days. Although few civilian health facilities achieve this target, we pursue it in accordance with the recommendations of the Canadian Psychiatric Association and the national Wait Times Alliance.
In 2014, four of the seven OTSSCs provided an annual average third next available appointment within that benchmark. The other three experienced longer wait times, averaging 49 days among them, primarily due to staff absences for such things as extended sick leave and parental leave.
By January 2015—this year—only one centre exceeded the benchmark and then by only two days.
In 2014 the Canadian Armed Forces was authorized to hire an additional 54 mental health staff. Of these, 21 were for clinics with operational and trauma stress support centres. As of mid-January 2015, 94% of our 455 authorized mental health positions were filled and efforts continue to fill the remaining vacancies. This is a dynamic challenge affected by normal staff turnover, heavy competition with the civilian sector for mental health professionals, and difficulty recruiting personnel to certain non-urban locations.
We're in the process of installing high definition secure video teleconferencing systems in our mental health clinics to help balance short-term increased demands for care in one location, with staff capacity available in other locations. This will also reduce travel requirements for our patients in outlying locations and improve their continuity of care when they're posted to a new location.
To improve efficiency and quality of care, we have hired a mental health quality and patient safety officer to review business practices in the clinics and help establish additional performance measurement metrics.
We will also soon implement the electronic mental health record and a digital outcome measurement system called CROMIS. This system, which is also used by mental health clinicians contracted by Veterans Affairs Canada, will allow for early identification of people not responding well to treatment, thereby prompting the clinician to adjust the treatment.
With respect to the transfer of medical records to Veterans Affairs Canada, Canadian Forces health services group has been working jointly with VAC for a year on a project to accelerate the file transfer process. In particular, VAC and DND have created a 14-person records disclosure team with the sole focus of expediting files between the two departments, and they have established a full-time VAC adviser within that records disclosure team to provide timely and expert advice on VAC requirements.
A second team has been established to address the backlog of outstanding files due for transfer to VAC. Through their joint efforts, the backlog has been reduced by almost 50% and the overall process has become increasingly effective and efficient. We monitor the process daily and are constantly striving to pursue innovative business practices to provide the best possible service to both our serving and retired personnel.
Thank you for your attention, and I'll be happy to answer any questions you may have.