Veterans Affairs Committee on April 19th, 2007

[Raymond Lalonde]

That's not exactly what—maybe I should clarify.

We have five clinics, actually. These are out-patient clinics. We have one in Ste. Anne, which is a departmental clinic. We have MOUs with four provinces for our clinics in Quebec; in London, Ontario; in Winnipeg; and in Calgary. We're looking to open other clinics in Fredericton, Ottawa, and Edmonton, and there's another one that we still need to find a location for. There will also be, for sure, a clinic in B.C., which will complement the five out-patient clinics that DND, the Canadian Forces, has. These are out-patient, ultra-specialized clinics.

We have beds with private providers for the co-morbid PTSD program and substantive use. We have two clinics providing that in B.C., two in Ontario, and one in Quebec, and one provides that program on an out-patient basis in Halifax. So there are six clinics providing that co-morbid program.

[Roger Valley, Liberal, Kenora, ON]

The two in Ontario are where?

[Raymond Lalonde]

In Homewood and Bellwood, around Toronto. And there's Edgewood, in Nanaimo. So there are six together.

We have beds in Ste. Anne's for a specific program called the stabilization program, and we're looking at how we could expand that program.

The problem we have, related maybe to the question you raised earlier, Mr. Stoffer, is that balance between critical mass—to have experts dedicated to people with military background—and the fact that people are scattered across the country. As you were saying, the balance we need is to have integrated services.

We'll have 15 clinics across the country—ultra-specialized. We'll have service providers. We also have private providers providing specialized services. It's a balance between both. We need a balance between specialized services and access in the community to service providers and public health services. We're trying to meet the balance between all of these services.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

I have a question for Mr. Guptill.

Slide 11, on lack of capacity—I don't lay this at anybody's door, but I think a lot of the problems are from some of the provincial boundaries we have—the portability of health care.

Very quickly, because I have a question and I don't want to run out of time here, I'm personally going to the issue.

My daughter is graduating in three weeks as a psychiatric nurse. A huge class in Brandon, Manitoba, is graduating; none of them is allowed to come east and work. They can only work in the west. In Ontario you have to become an RN and then you specialize. It takes two to three years longer. These people are actually being bid on right now to travel all across the west, because for one thing they can't get any doctors. So psychiatric nurses are providing services that doctors would normally do because there are no doctors either. You have a huge challenge in the capacity.

I would very much like Mr. Perron to deal with the rural part of Canada. My riding is one of the largest in Canada, the Kenora riding. Even in your district offices, if you look, there are 11 in southern Ontario. Then you go 1,000 miles from North Bay to Winnipeg; there's one office in between and that's in Thunder Bay.

I want to know, when somebody has to visit a clinic, has to go to one of these contract beds, service is provided wherever they go, but what kinds of supports are in place for the families now? You mentioned families in the charter. Do we have the support? Say a spouse has to take him in or a child has to take their father or their mother in? What kind of support is there when the family tries to look after this person? They may have to travel hundreds of miles. Do we have some kind of support network there for them?

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

Thank you, Roger.

Go ahead.

[Bryson Guptill]

That's a good question. I have to say that we do have support. The families can get support. In particular, I'll go back to the example I gave in the Calgary area. The clinic there gave me some specific examples of how they treat the families of veterans. One of the issues they highlighted for us was that they can't provide treatment to the family unless the veteran is also getting treatment. I will come back to the issue that Mr. Perron raised. Sometimes these veterans, especially in isolated areas, are reluctant to come forward. So what we've been working on is to develop a policy work-around that allows us to determine whether or not the veteran is likely suffering from a condition. If so, then we will provide treatment to the family. So we're working out some of the bugs in this area. I think it's a good approach. I think we have the tools we need, and those tools are available to us as a result of this new piece of legislation we have.

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

Thank you very much, Mr. Guptill.

Monsieur Ouellet, please.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

Thank you, Mr. Chair.

Mr. Guptill, you said that there was a lack of expertise and a lack of identification capacity. What staff do you need in order to permanently stabilize your clients?

[Bryson Guptill]

As I said, we have the tools that allow us to respond appropriately. We sometimes have challenges in recruiting people. I'll give you another example that I recently ran into where I had a psychologist in one of our clinics talking to me. This chap was actually a psychiatrist. In the community he was treating a lot of different types of cases and was very overworked. When he came into our clinic he was able to focus specifically on folks with these occupational stress injuries. He said to me that it was such a relief for him to be able to focus on clients with specific needs and not to have to spread himself so thinly, as he would in the general health care system.

That was nice for me to hear as an employee of Veterans Affairs, but it reminds me of the challenge we have, because these resources don't come cheaply. We also have difficulty attracting some of these folks, and we have difficulty holding on to them. So it's a constant balance for us. I think we have the tools and the resources now to deal with it, but it will always be a challenge, because, in general—and this is not news to this committee—we don't have enough resources to deal with mental health problems in the country, so we're constantly having to recruit.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

Mr. Lalonde, earlier you said that your institute provides ultra-specialized health care services. If you compare your care to that provided by regular hospitals, would you say that the quality is better, worse or the same?

[Raymond Lalonde]

In the public hospital system, there is the same classification of services, that is primary care, emergency services and walk-in clinics. There are also secondary services, for example when somebody is referred to a cardiologist, etc.

There are also ultra-specialized services, such as child psychiatry, brain surgery, and so on. These are highly specialized clinics. There are ultra-specialized clinics for people suffering from anorexia.

Thes services are comparable. There are highly specialized services in the province which are comparable, but we cannot say that our services are better than any other services provided.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

So these services are of similar quality.

[Raymond Lalonde]

The quality of the services is the same, but they are specialized and deal with operational stress problems, and our clinicians also take into account the military culture.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

Could you talk about the support you get. What about the hospital buildings, for example at the hospital in Sainte-Anne-de-Bellevue, which was built 90 years ago and renovated 40 years ago.

[Raymond Lalonde]

It's currently being renovated.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

Are the needs of people with mental health problems being met?

[Raymond Lalonde]

The facilities are fine. The main problem is access to treatments. The other problem is with people who live in the regions; that's a major issue. People need to be able to actually go and get health care, ask for help, and we must be in a position to provide the best of services possible.

That's why I refer to a balance between high specialized services, the public network services and those offered by community providers. It's about working together. Part of our clinics' mandate is to work hand-in-hand with people in the community so that they can be supported in the work they do.

Take the example of a client from Abitibi seen at Sainte-Anne's hospital who then returns home. When this person re-enters the community after six months of treatment, we want to make sure the general practitioner or the psychologist in Abitibi is able to contact our specialists to discuss the treatment program. This collaborative approach between the various stakeholders is extremely important, much more than the facilities themselves.

[Christian Ouellet, Bloc, Brome—Missisquoi, QC]

Thank you.

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

Thank you, Christian.

We'll go to Bev Shipley. We'll give you a couple of extra minutes because you missed a few--I mean a couple of extra seconds.

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

Thank you very much, Mr. Chairman.

Mr. Lalonde, I want to thank you for welcoming us last fall, I believe it was, to Ste. Anne's Hospital. For me, it was a first time, and I very much have a great respect and appreciation for what you're doing.

Mr. Guptill, thank you for coming today and for the work that you, through the Department of Veterans Affairs, are doing.

I think everyone around this table is looking to the goal of better treatment and what we can do to facilitate veterans, which leads to my first question.

If I go to slide 10, just to comment at the start of this, clearly in anything we do, any time we can have early analysis and early diagnosis, prevention is the opportunity that we need to be seeking, and we obviously need to have things in place so that we can do that to the best extent we can.

I would see that this is what we're doing now. We are doing pre-screening before they go into deployment, returning as they come out, and doing some screening trying to detect—correct me if I'm wrong—when something is not as stable, that we can actually go in and start to work with individuals. Doing that saves anxieties, and I think there's likely quite a close connection between high anxiety and post-traumatic stress disorder.

On page 10 you talk about the delays in seeking treatment. I'm hoping that when you say that that some of these pre-screening things have taken that stigma away, that really we aren't in the same situation today as we were yesterday—yesterday being in the past.

I'm concerned about the last four bullets, because if these are in any chronological order, then where the condition starts to work on an alcohol dependency, obviously that rolls down if they have a job, and it leads to family violence and sometimes breakups, and then the ultimate, the worst scenario is that they have suicidal tendencies.

It takes me back to my first comment, about early diagnosis and prevention. Are those in an order, and are you dealing with those in an order to activate the early diagnosis and prevention as much as you can?

[Bryson Guptill]

They aren't in any particular order, but they do show the magnitude of the problem. Something called the Canadian community health survey was carried out by Statistics Canada recently, and that survey indicated that the most common mental disorder of people who are serving in the military is major depression, followed by alcoholism. Social phobia was third, and PTSD was fourth.

So there are some significant issues that need to be dealt with, and all the research has shown, and all the work that we've been doing emphasizes this, that early intervention is the key. So it's very important for us when we start to see people from the military who are coming to the Department of Veterans Affairs with issues that we be able to deal with these people on a very, very rapid basis, because the faster you intervene, the sooner you get people back on their feet again.

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

I don't want to interrupt, but I don't want to run out of time, because I have a couple of other questions.

On the records that come from DND, then, if there were a circumstance where there was a notice of alcohol dependency at the DND area, at the post-deployment part when they return, is that triggered early so that you know there's already a hint of an issue?

[Bryson Guptill]

We're working very closely with DND during the transition phase. So while people are still serving, they're the responsibility of DND's case managers, but if DND notices that someone has some serious issues and they're going to be transitioning out of the force, then they contact us and we get involved.

The analogy we like to use is two hands on the baton. For a while, both of us are case-managing, and then as someone makes the transition out of service into civilian life, we're there to help out.

We're doing that in a whole lot more comprehensive way than we were previously, because remember, under our old legislation we had to focus entirely on whether a person was suffering from a disability that we can call a pensioned condition, and then once we'd gone through that adjudicative process we could start dealing with them. Now we can deal with these issues at the same time. So they can apply for a disability award, but at the same time, with our front-line offices—to come back to Mrs. Hinton's point—the 31 or 32 offices across the country, we can have our area counsellors dealing with that person right away, talking to them and their family members, making a judgment that they seem to have some issue that relates to their military service, even without defining it, and start putting them into a treatment program.

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

I don't know if Mr. Lalonde has anything to add.

[Raymond Lalonde]

I think early intervention or prevention is really a key factor that helps improve the outcomes. DND has put a lot of work and effort on this, and we have to realize that someone who comes back from Afghanistan with PTSD will not become a Veterans Affairs client the day after. He may be treated by the Canadian Forces for a year or two before we see him, so we work in collaboration with them at that point. We share our best practices. We work in clinical programs with them so that there's continuity of treatment when they're released and they don't, the day they're released, come and get services with us that are so different from what they're receiving that there is discontinuity. We really work together on that front too.