Veterans Affairs Committee on April 19th, 2007

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

[The Vice-Chair, Liberal, Brent St. Denis]

We're going to come back to you, Bev. There will be a chance for everybody.

Mr. Roger Valley is next.

[Roger Valley, Liberal, Kenora, ON]

I want to go back and deal with some of the rural issues again. It's my penchant, coming from where I live. I'm always concerned about the lack of services in my riding and other large ridings that don't have big populations. On top of being from a riding that's spread out over one-third of Ontario, I serve 41 reserves. Of those, 21 are fly-in reserves, meaning they're in northern Ontario. Some of them are 500 miles from the end of the road, so there are a lot of challenges to get services out there. We also know we can't expect the level of service that is in many communities. When I asked earlier, I got the impression that Mr. Lalonde had part of an answer to some of the comments I made.

Mr. Guptill, I don't think I phrased my question correctly. I'll give you a specific example. Somebody travels 400 miles to get to one of these sites that is going to provide the service, and they're brought by their family member, or whoever is bringing them. I was thinking more of family services putting them up in a hotel, along the line that we're actually supporting them, or is there a house that houses these people? How does the family—? Generally, these veterans from the Second World War are elderly people who may have very limited resources in my riding and in these areas.

I know it may not be in place now, but you mentioned the charter, and we're talking about providing for the families. That's the kind of drive I was getting at there.

[Bryson Guptill]

We have a provision for something we call medical travel. It allows us to pay for people to travel to medical appointments, and that would be available for someone who's receiving this sort of treatment, so we have a way of dealing with that.

[Roger Valley, Liberal, Kenora, ON]

Mr. Lalonde, did you want to answer part of that question?

[Raymond Lalonde]

If that person needs to be accompanied, we will pay for the travel for the person when there is a medical requirement for the person to be accompanied to go to a treatment. For example, we had a client in southern Ontario going to the PTSD program in Nanaimo. It depends on the need. The thing is that the clients don't choose where they go. If there is an adequate provider close to their community, we would pay for travel to go to that provider, but if the client comes from Ontario to Ste. Anne, to the stabilization beds, we would finance the travel for the person who accompanies that client to the facility when there's a medical requirement to be accompanied.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

We also never had an opportunity to discuss some of the comments I made on the challenges that have faced Canada for decades over the portability of health care and professionals who travel from one jurisdiction to the next. I didn't mean to say my daughter couldn't work in the rest of Canada east, but I know she can't work in Ontario. She can maybe work in Quebec or somewhere else.

I know this area is outside Veterans Affairs, but the federal government has to somehow deal with the issue with the provinces to get portability in health care. Do you see that as a restriction to some of the access you have to professionals?

[Bryson Guptill]

I think it's a good point, and it's not just in the area that you mentioned. My daughter is working on her PhD in occupational therapy. In some areas the rules are different for some parts of the country. This is not unusual, I think, in some medical professions, but it is from time to time a problem and needs to be dealt with. We haven't run into it as a significant problem, but if it were to be a problem, I think we have the tools to allow us to deal with it.

[Raymond Lalonde]

We will have to look at that one, because we're looking at telemental health as a means to provide services in the remote communities. We have a project on the table with the Alberta Mental Health Board in Calgary. Our west side clinic would provide telemental health through their clinic. If we have a clinic, for example, in Fredericton for Atlantic Canada, and we would want that clinic to provide telemental health services to Newfoundland, we would need to address those issues in the future. But telemental health is a way we're looking at to provide service in remote areas.

[Roger Valley, Liberal, Kenora, ON]

Just quickly, before my colleague cuts me off, the only good thing about my daughter not being able to come east is that she was going to evaluate me, but she can't do that in Ontario.

I want to point out again, and I don't want to make it trivial in any way, that with our shortage of mental health workers across Canada, we're putting.... The level of strain they're under now, because there are not enough out there, is just being multiplied by situations like the one I mentioned. My daughter will work at a level that she's not supposed to. She's supposed to be a psychiatric nurse who works with patients and brings them up so the professional psychiatrist or the counsellor can deal with them. But that's not happening, because there are no doctors out there for these issues.

So on top of a tough situation, it will get worse, unless we somehow deal with some of the shortage and capacity issues we have in Canada.

Thank you.

[The Vice-Chair, Liberal, Brent St. Denis]

Thank you.

We'll go to David Sweet.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, Mr. Chairman.

Thank you for coming.

If you look at the blues, and you mentioned that you were familiar with some of the testimony, my area of questioning has always been about our capability to—how would I say it?—prepare the soldier prior to going into an area.

Are we spending money at Veterans Affairs ourselves for research, or is most of the money going to clinical services right now?

[Bryson Guptill]

We spend a significant amount of money researching this field. I'd have to say that probably the vast majority of the dollars the department spends is for the treatment of actual veterans. We do have a small research group headed up by very competent people, I believe.

We've been able to access research that's being carried out in other jurisdictions as well, and we benefit significantly from that research. Our director of research, David Pedlar—I mentioned the name earlier—tells me, for example, that he's able to benefit from the research that's going on in the U.S. because of some of the committees he takes part in. We have an international group that compares best practices and research findings. The U.S., for example, spends about $2 billion a year on researching this and related issues. So we do get access to a lot of good findings that way.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Is there pre-screening going on now, prior to a soldier going into an area of conflict, to discriminate between those who would be able to well survive a traumatic experience so they don't end up with PTSD and those who'd be more vulnerable to having a traumatic situation become a mental disorder?

[Bryson Guptill]

This is a good question and one that probably is more appropriately directed to our colleagues in National Defence. I have gone over some of the testimony, and I've noticed that some of the folks who have appeared before you have indicated, and they've indicated it to us as well, that there is pre-screening that goes on.

I think one of the debates that was going on before your committee previously was about how effective that pre-screening is and whether pre-screening can actually identify when people might suffer from these sorts of illnesses. I think the jury, in some way, is still out on that, but there is an effort within the military to make sure that troops are being trained and are getting the right kind of training before they go out to a deployment.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Are you aware, in this $2 billion worth of research going on in the United States, and of course in the whole global community as well, if there is a focus on developing a better capability for screening?

Second, do you know of any research going on right now on how to actually prepare a person? In one aspect, we're talking about discriminating between those who have the capability of dealing with stress.... I can't even think of how you might do it, but would there be some programs in which you could actually expose someone to stressful situations in order to desensitize them to a future traumatic consequence?

[Bryson Guptill]

Yes. I think because of the nature of what some of our troops are doing you wouldn't want to desensitize them too much, but certainly the evidence we've heard is that pre-deployment training is a very big asset in terms of getting the troops ready for what they might encounter when they are deployed. Absolutely.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay. So there was substantial research going on at that time.

[Bryson Guptill]

Absolutely.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Are we operationally testing to see if some of these best practices and this kind of research in this area are working for our people?

[Bryson Guptill]

In terms of pre-deployment training, that's something DND is focusing on. We've been working with them, but they would be better equipped to answer your questions, I think.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

I have a last quick question.

Everybody is concerned about the capacity issue. Is there an awareness in our public post-secondary institutions as well as in the recruiting centres at DND of the need? Is there a high-level campaign going on to try to steer people who are interested in a psychological medical career to go into this line of clinical work?

[Bryson Guptill]

I'm not really equipped to talk much about that, but you may want to get some colleagues from DND. We've had a presentation by Rakesh Jetley, I believe. He's a psychiatrist with DND who gives a very powerful presentation on what DND is doing to prepare troops and also what they're doing to increase their expertise in these psychiatric areas.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Mr. Chairman, it would be good to have that person as a witness sometime.

[The Vice-Chair, Liberal, Brent St. Denis]

I understand from the clerk that at the next meeting we'll have DND.