Veterans Affairs Committee on April 24th, 2007

[Maj Chantal Descôteaux]

There are also mental health nurses.

[Margaret Ramsay]

Since we started in Afghanistan we have had a psychiatrist, a social worker, and a mental health nurse in theatre at all times. We're also looking at trying to get psychologist reservists in the military as class B reservists. There's a project on right now with PSel to try to do that and deploy them in theatre.

[Marc-André Dufour]

Psychologists go to Cyprus during the decompression week. People from Valcartier have been coming back from Cyprus recently.

[Maj Chantal Descôteaux]

We've been hearing a lot about the stairway of shame from people from the outside, interestingly enough. I have been practising within the armed forces since 1993, and I can affirm that requests to receive assistance coming from soldiers is increasing. The stigma of asking for help is beginning to disappear. Ancient prejudices attached to old attitudes are on the way out with the departure of those retiring, and the upcoming generation is quite different.

The fact that we have mental health programs which allow us to talk to our troops with an eye to prevention, has created links which have slightly facilitated access to our services. On this issue, I wish to say that we want to put greater emphasis on prevention through programs like these, but that the Canadian Forces is lacking the resources and funds to do so. This does not only apply to mental health, but to other general areas. We do our best with the resources we have. This is what has facilitated ties to our troops, and I think we are going to hear less and less about the stairway of shame.

[Marc-André Dufour]

The week spent decompressing in Cyprus is also conducive to asking for assistance. In fact, during that week, soldiers meet with mental health professionals who insist upon the importance of seeking help. Perhaps you have read the document entitled Battlemind Training, written by Mr. Carl A. Castro. In very specific terms, he talks about elements of operational stress and describes the scenario of a soldier returning from a mission. Once again, it is a matter of importance of seeking assistance. This is what we tell our soldiers to do in Cyprus, and it's excellent. However, in order to be as consistent as possible, we need the necessary staff at the garrison if we are to meet the demand.

[The Chair, Conservative, Rob Anders]

All right. Thank you very much.

Monsieur Perron, just to let you know, they went four minutes and 32 seconds past your seven, so—

Poor Mr. Stoffer has been aching to ask a question, so he's next, for five minutes, please.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you very much, Mr. Chairman.

Folks, I'm not sure if you've had the chance to read the Globe and Mail this morning.

[Margaret Ramsay]

No, I haven't, sir.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I suggest all of us read it, because it really puts into light what we ask our Canadian soldiers to do. For those of us who are parents and those who know kids, I cannot imagine what it would be like to have your ten-year-old boy say, “If you die in Afghanistan, I'm going to be mad at you for the rest of your life.” Talk about suffering PTSD before you even go. I read this article, and it's extremely moving.

You said that OSI actually results from operational duties performed by a CF member, but is it not possible that they could have these stress-related duties before they even go?

At the Phoenix Centre now there's assistance. Petawawa made a lot of news recently, and I know that the federal government has now made an arrangement with the province to do something, but it took an ombudsman report and media coverage to get both governments moving, which I find quite shameful.

But in a situation of this nature, which I'm sure is not an isolated incident, what specifically are the military and the various bases—public or private—doing to assist this family, more specifically?

[Margaret Ramsay]

I think you've raised a really important question and a problem we have. The families do need a lot of support.

I don't know if you realize it or not, but the military is not mandated to treat the family. We can provide supportive care to the family, but it is still up to the provinces to provide care for the family. So we're caught in this kind of back-door support to the family.

Legislation is probably needed to change that, but we have no power over that. We try to support the family in every way, and it does have great repercussions. We have added 25% more resources in our project for mental health care providers and social workers to try to provide that support to families.

It's not just a Petawawa issue; it happens at all bases.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I appreciate your response. It is a question that we need to ask the political and bureaucratic levels, and not necessarily you. I know that most of you would do it if you had the resources.

[Margaret Ramsay]

Absolutely.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Also, the other day I spoke to a lady at CFB Halifax. They've been advised that as of March 1, when an individual leaves DND and goes over to VAC, in order for them to get a medical assessment—They used to go to their CF doctors to get that assessment done, but that's no longer possible. The person now has to go to a private doctor to get their assessment in order to make benefit claims through VAC. I'm wondering if you were aware of that. Why would DND and VAC together ask that of an individual who has been treated by CF doctors for all this time and has all their medical information there about either physical or mental concerns?

We heard the other day about the baton, one DND and one VAC. When a person moves over to VAC, if he or she is applying for a benefit, VAC will tell them they have to have a medical assessment done. They go back to the CF doctor and they are now told that they can no longer do that and that they have to go to a private doctor. I wonder why that is.

[Maj Chantal Descôteaux]

I'd like to answer that. For physicians and mental health practitioners working in the CF, our life has been very difficult, since a military member can apply for a pension while still serving. This is very important for you people to understand. If you could take this point, I think we would be very pleased.

When I started to practise medicine, the patients I was seeing wanted to get better, to stay active, and to go back to their normal military life. Now that they can access a pension while serving, they are looking for a benefit, money, so they will come more often to see me about this ankle that is not so bad any more, or for that little cut, or for their hemorrhoids, because they want a pension. It's the same for mental health problems. If you know that at the end you could have that big amount of money if you were diagnosed with very severe PTSD, what is the advantage of your getting better?

This has been a big struggle for us, trying to cope with these two elements. I preferred the way we were doing it before. If you were still serving, you were getting your care, but if you were found not able to continue in the CF and had a permanent disability, then you could apply for a pension, and the process would start and move on to VAC, etc.

Now that they can do that while still serving, it is difficult for us to see who is playing the system and who is really sick. For those who are really sick, we're almost

rewarding them for being ill. Unfortunately, it is more advantageous to be ill because of the monetary benefits provided for such reasons.

It's a struggle for the mental health people and for the general practitioner, because we're not in the business of giving a diagnosis to someone that will make money for him. We're in the business of saying “you're back to being okay”. There's a kind of expertise needed when someone wants a pension.

A psychiatrist, psychologist, or GP may get involved and say yes, he's got severe PTSD, but if I say no, he doesn't have severe PTSD, he has light PTSD, and he can get better, my relationship with my patient can change, and he can no longer want to be with me just because of that.

It's a bit like in the civilian sector. Expertise is given by experts, but if you are the treating physician, you are treating the patient to get better. This is a big struggle for all of us. We really wish that the system would change and go back to being that you ask for a pension when you're due to get out of the military. I think the Americans are not doing it the way we're doing it. They're still doing it the way we were before.

[Marc-André Dufour]

There truly has to be an independent process. Currently, they use our progress notes, psychological reports, in addition to the medical doctor and psychiatrist's report, as well as therapeutic material and clinical documents to determine the sum of money.

There are cases of soldiers who come back angry because they did not receive the compensation they thought they were entitled to, in light of the level of suffering they feel. They ask why we're not listening to them and what we have not understood. As providers of treatment, that puts us in a very uncomfortable situation.

We must truly separate the evaluation related to the treatment, that is the work that I carry out, in addition to that done by other Defence mental health professionals, from the assessment, the procedure used to establish the monetary amount of the pension. This must really be separate in order to avoid that type of situation.

I also want to point out that we are not saying that soldiers are manifesting symptoms in order to receive money. This is not the case. In fact, it's absolutely human. I believe that a soldier is financially penalized if his state of health improves. There is a financial penalty associated to improved health. It is the system which is detrimental to the treatment. There is no trace of bad intentions or manipulation, but if a soldier sees one of his colleagues receiving compensation, he will naturally ask why he hasn't received as much. Therefore, he challenges the treatment, the work of the professionals, whose job it not to establish the amount of money.

All of this confusion leads us to say that the two processes, that of the Department of Veterans Affairs, and ours, should be distinct.

[Maj Chantal Descôteaux]

That's even been the cause of acts of violence in our environment. When military personnel are suffering, their less appealing personality traits might come to the surface. If the psychiatrist hasn't said exactly what the member wanted to hear to become eligible for compensation, he or she can get very angry. In Marc-André's office, there is a hole in the wall. Sometimes, I have to call the military police to get everyone calmed down. That is often related to the issues we are talking about right now.

[Marc-André Dufour]

On the Internet, military personnel find the charts of veterans that state that a given clinical profile corresponds to a certain amount of compensation. Then they assess their situation and say that the health care providers who treated them did not assess them correctly. But we do not determine the amounts of pensions. But in their minds, since people who do determine those amounts use the notes in our files, the outcome is to some extent our fault. That is when we might see aggression. But it's understandable.

[Maj Chantal Descôteaux]

It's really not our role to determine.... We will cooperate with VAC, and we are. In Valcartier we have this great system. When someone is released, our case managers meet with VAC case managers, we transfer the care, and we talk to each other. Most of the time the psychologist involved in the treatment of the patient is already a civilian psychologist who will continue with the care of the patient. We have a nice way of communicating with each other. But it's that part about money—

You've noticed, probably, since Veterans Affairs changed its policy and has gone more towards rehabilitating people, which I think is perfect, that there's a decrease in the demand. There's not that much money involved, in the end. We're telling them that we will treat them, and there are fewer people asking for these services.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Stoffer. It reminds me of the old economic adage that a cent is matter.

We'll go to Mrs. Hinton for seven minutes, please.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

I pulled up the story that Mr. Stoffer's referring to, just so I could get a bit of background. Apparently, the family you're referring to, Mr. Stoffer, has been getting therapy for over a year now. I would like to point out that the federal government put $230,000 into the Phoenix Centre to help families such as these. So we are doing our part. I know that the panellists here are doing their part to serve our military. I appreciate that very much.

There are a few questions that come to mind. We've listened to a number of witnesses now who have been discussing PTSD. It's obviously a very difficult disease to deal with and to diagnose, as well. I'm getting the impression, from listening to the witnesses, that there is really no predictor for who might or might not come down with PTSD. It seems to be—

[Maj Chantal Descôteaux]

There are some predictors, ma'am.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Are there?

[Maj Chantal Descôteaux]

Yes.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Okay, could you explain some of those predictors when I finish the question? Then I'll give you my thoughts on it.

There are circumstances that happen, situations that people get put into, and it's a case of it building and building and building. It's usually, from what I've been hearing from witnesses, not a single incident. So I would be really happy to hear what you have to say on that.

[Maj Chantal Descôteaux]

For the predictors—and maybe Marc-André will be able to complete—we know a certain number of predictors: the type of personality you have, if you're all black and white, a very rigid personality, you don't bend a bit, you are more prone to that. If you already have a toxicomanie problem, you're more prone to that.