Veterans Affairs Committee on April 24th, 2007

[Roger Gaudet, Bloc, Montcalm, QC]

I understand your point of view, and I don't see a problem there. However, a wife's anxiety about her soldier husband might mean that she is afraid to approach him to understand what he is experiencing. But regardless of what it is, it is the husband and wife who live with each other, and there must certainly be anxiety between them.

[Marc-André Dufour]

I agree, Mr. Gaudet, but it's not up to me to say what's best. I'm telling you what we are asked to do. Could we do more? Yes, we probably could. However, what I have talked about here is what we are being asked to do in our directive.

[Roger Gaudet, Bloc, Montcalm, QC]

Why don't you invite families to Cyprus when the soldiers come back, so that they can decompress together?

[Marc-André Dufour]

That would be an interesting approach. We would have family tournaments, most likely.

[Roger Gaudet, Bloc, Montcalm, QC]

I'm just asking the question.

[Marc-André Dufour]

Yes, I will answer that question.

The purpose of Cyprus is just to give soldiers a chance to let their emotions out while sparing their families. It's very intense there. The stories told are very particular.

I don't know whether you've ever seen thousands of soldiers coming back from the wars, but I'm told it's a very good thing their families are not there. Soldiers experience what they have to experience amongst one another, and share what they have to share. When they get back to their families, they have decompressed more.

[Maj Chantal Descôteaux]

Otherwise, they keep their emotions inside to spare their spouses. They don't want to discuss the things they see, while we want them to discuss those things. We want them to let it out.

However, as we were just saying, when soldiers come back we would like to organize some sort of get-together to which families are invited.

[Marc-André Dufour]

Exactly.

[Maj Chantal Descôteaux]

We do that before they leave, and we do certain things after they come back. We could try to organize a meeting between the soldiers and their families. We will look at the possibilities.

[Roger Gaudet, Bloc, Montcalm, QC]

Please don't drop those ideas.

[Marc-André Dufour]

At present, we have been focusing on the pre-deployment aspect, as part of the Resiliency Training Program. We are now looking more at post-deployment, and Ms. Routhier is working on that aspect. We're exploring a number of avenues to see how we can extend the program in Cyprus, where soldiers decompress among themselves, to see what we could provide.

Once again, these tasks are added to our usual tasks as mental health care providers, without the addition of any personnel, and with a continuing influx of requests. That is the problem.

[Roger Gaudet, Bloc, Montcalm, QC]

I was just coming to my next question.

It is just a short question, Mr. Chairman.

[The Chair, Conservative, Rob Anders]

No, Mr. Gaudet, I'm sorry. If I let you, then Mr. Perron goes even further next time. Monsieur Perron makes up for everybody.

Mr. Shipley, for five minutes, please.

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

Thank you very much for coming out. This is a great opportunity for us to find co-relation.

I found your comments in your presentation about the things that are changing interesting, Ms. Ramsay, in terms of, over the next five years, the increase in terms of health care services, also in terms of the connection that we need to continually make between Canadian Forces, Defence, and VAC. I think, quite honestly, we need to do that. I want to turn more toward the VAC and some of your thoughts about that, because that's actually what our mandate is.

Everyone talks about how we need to do more. I don't know that we ever will get to wherever the “more” is, but it does not take away from our desire to be fair and to provide our veterans with the services, the protection, and the health care they need.

I'm wondering if you can just talk a little bit about the relationship that has changed between National Defence and VAC in terms of being able to provide better services as that transition happens. We get caught in this in-between, transitional period; it was brought up by Mr. Stoffer and confirmed in some clarifications by Ms. Hinton. Would you comment quickly about that relationship change, if there has been any?

[Margaret Ramsay]

There definitely has been a change, I would say, over the last four or five years. We've just signed a memorandum with VAC. It's called the operational stress injury network, and what we're trying to do is work closely on a network of clinics right across the country. VAC has opened up five more OSI clinics, and we have our five. We're trying to cover off the whole country and have equal access to each other's clinics.

This is a work in progress, and there are going to be all kinds of things we have to work on, like priority access and clinical procedures of assessment—whether we agree, and who should get assessed at which clinic. But it's definitely a work in progress. We meet regularly with VAC—I'm meeting with a group from Sainte-Anne-de-Bellevue this Friday—and we talk about these issues.

We're going to set up an advisory committee to meet every three months to advise the steering committee that meets in Charlottetown, and DND and VAC are represented there. But it's a close network.

We've also included the RCMP in that operational stress injury network. They're the other organization that uses the VAC services as well, and they're out there with similar injuries as our own soldiers'.

I'd say the relationship is good. It's a work in progress, and we meet regularly.

[Maj Chantal Descôteaux]

For the situation we have in Valcartier, which is the biggest army base in Canada—and I want to point that out—this is where the gap is. When I have a really sick patient who is going to be released because of operational stress, or whatever, I need a good set-up team that can take over the care of this patient.

As you know, in Quebec, anyway, it's very hard to access a psychiatrist and a GP. A psychologist is not too bad. But we need interdisciplinary care for very difficult patients and right now it's difficult to find that. So often you will hear from veterans that the difficulty they had is when they left the military because of that hole, that gap there.

The clinic we have in Ste-Anne-de-Bellevue is a good start, but it's in Montreal. It's not in Quebec. It's not in Edmonton. It's not in Petawawa. So close by our big army bases, at least, we need clinics like Paul-Triquet, which is one we have in Quebec, but it's partly provincial and it's not working out. They have three offices in there. I know they're moving towards having something better, a big building and facilities, but that's where the gap is.

When we determine that someone has a permanent category and is going to be released medically, I need, while he's still serving, to switch the care to these people downtown so my team and I can work on the active members and get them to stay in the military.

If we are very busy with very sick people who are just waiting to be released--and this is too long a process in our system—my staff is booked weekly with those chronic cases, and the waiting list to see the sick people quickly who are new to the program is too long. So I need the care of these very sick people to be taken over by a team that is ready to do this so I can better concentrate on those who need it. That way we can have better success in treating it, if we're not too late in intervening with that.

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

My follow-through is that we have medical care treatment shortages of individuals, of professionals. In Ontario it's a big issue, obviously in Quebec and other provinces—So that is a hurdle.

There was a question the other day about when we open these clinics, where do you get the staff? Where do you get the professional people? Of course they reach out to the private sector and they work in cooperation with the private sector. That is what we were told.

When you have a patient who comes in and you're transferring them to VAC, do those professionals need a different training from what they would if I were the patient?

[Maj Chantal Descôteaux]

Yes, definitely.

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

—being a parliamentarian who has PTSD?

[Maj Chantal Descôteaux]

Unfortunately, when that big bunch of patients from Bosnia in 1992 was released and went downtown for treatment, I think VAC had to quickly react and find psychologists downtown, but the quality of care of some of those psychologists was not at the level we would like. They did their best at that time, but now I think we really have to have a special team that is specialized in working with PTSD patients. It's the same with us.

We members of the Canadian Forces and people who treat veterans, need specific funds to help us update our knowledge of the relevant issues. It is an enormous task. We see what the United States and other countries are doing. We find ways among ourselves of sending one of us to the U.S., to the convention in Sainte-Anne, but we should be doing much more of that kind of thing. For the good of Veterans Affairs, we should ensure that people who treat our patients when they are released are more competent than they are at present. I'm not saying that they are all bad, but the quality is perhaps not ideal. This issue needs to be looked at more closely.

[Marc-André Dufour]

There is also a link with knowledge of the military environment. The military is a world unto itself. By working in it, we end up understanding how it operates, but I don't know how long a civilian psychologist—and I am one—with no knowledge of military reality, who suddenly starts working at Veterans Affairs, might need to understand the jargon. That, to my mind, is a problem. However, we in Valcartier and in other bases can provide support for those people, to ensure they gain a sufficient understanding of the military environment. We could organize on-the-job training periods, organize training through universities. However, we must remember that this burden would be added to the thousand and one other tasks already on our shoulders. There again, that is the real problem. Ideally, this is something we would be happy to do, but we will no longer have time to see patients. What choices would we make?

Thank you.

[Margaret Ramsay]

We met with VAC and came up with a memorandum of understanding on who would be the providers for clients transitioning to VAC, and it's only psychiatrists, clinical psychologists, and masters-prepared clinical social workers. We came up with a common provider list in Blue Cross.

What we try to do in the military, when we know somebody's going to be released, is get them referred to one of those clinicians, so that the transition is smoother when they leave the CF and are then a VAC client.

That helped, but we still have a long way to go in making sure we identify those providers in the community who have the expertise to deal with PTSD.

[Maj Chantal Descôteaux]

PTSD is not something that is taught in school that much, PTSD; that's the reason. The two biggest challenges in psychiatry are treating PTSD and obsessive compulsive disorder.

[The Chair, Conservative, Rob Anders]

Now we go on to Mr. Cuzner for five minutes.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

I have two quick questions. I appreciate the forthright gander we've received here today at some of the disincentives. We've been through it on employment insurance reform, where there were significant changes in the mid-nineties. I'm sure that when people made the changes, they did so with a certain purpose, but all of a sudden you have these unintended outcomes and consequences. There were actually disincentives in the program, but we were able to go back to address several of them to take those disincentives out.

Is there movement within the Canadian Forces now, an ongoing evaluation of how you deal with those pension issues that you're able to assess? Is there anything you're working on now that might be able to change how it's being administered now?