Veterans Affairs Committee on April 3rd, 2008

[The Chair, Conservative, Rob Anders]

That was impressive. Five minutes turned into eight minutes and 22 seconds.

Now we'll go to the Conservative Party of Canada, and Mr. Merrifield, for five minutes.

[Rob Merrifield, Conservative, Yellowhead, AB]

Thank you for being here.

Actually, I'm just catching up on the issue, but I want to ask, what degree of influence do you have with regard to curriculum when it comes to psychiatry in Quebec? Are you involved in that at all, or do you just regulate the psychiatrists once they become professionals?

[Marie-Josée Lemieux]

As concerns curriculum, the Ordre des psychologues du Québec has, by regulation, a training committee. You will find this regulation in the documents that we prepared for you. In conjunction with the Department of Education and university representatives, this committee is mandated to ensure the quality of Ph.D. programs. The committee has established certification standards and minimum qualification standards, which were adopted by the Ordre des psychologues. That is what we oversee and what must be complied with. In terms of content, a given university may decide to place more emphasis on the community aspect. It often depends on its location. Another university may decide to develop a different option.

[Rob Merrifield, Conservative, Yellowhead, AB]

The question was actually just leading, in the sense that when you look at an illness, you look at a two-pronged approach, usually: first, preventing other people from getting the illness; and secondly, how to treat the illness appropriately.

As for post-traumatic stress disorder in the military, which I think is the focus of the study in the committee, is there something we might want to do with regard to impressing upon the military the ways they could perhaps prepare their troops so that they can prevent an illness, rather than just looking at trying to clean up after they come back home? Is there something in their training that you could perhaps assist them with and give them advice on with regard to preparing them for what they're about to have with regard to a traumatic situation?

[Stéphane Beaulieu]

I should first like to point out that post-traumatic stress is not contagious. It's not a disease that you catch.

[Rob Merrifield, Conservative, Yellowhead, AB]

It's an illness, though. If you know that they're going to come back with a high percentage—18%—how can we prepare them for it?

[Stéphane Beaulieu]

We are not experts in post-traumatic stress syndrome. However, I am a psychologist and my colleague is as well. One would have to validate what you're saying through research, but to my knowledge there is no way to prevent post-traumatic stress disorder. Generally speaking, you can do so for other mental health problems. So members of the Canadian Forces could certainly benefit from receiving treatment aimed at preventing any type of mental health problem, which can have a positive long-term effect. Hiring psychologists to work with the Canadian Forces to help them adopt a healthier lifestyle and mental health care would be a very good initiative.

[Marie-Josée Lemieux]

You cannot completely prevent post-traumatic stress syndrome from developing. Some factors increase the risk of a person developing this syndrome, and other factors can decrease the risk. Mr. Beaulieu mentioned a healthy lifestyle and good mental health. A person who, from the outset, is well grounded, has a good social network and a healthy lifestyle, may be much better equipped to deal with trauma, be it PTSS or drug addiction. Certainly, a lot of research could be undertaken to determine which factors contribute to this situation within the armed forces today.

[Rob Merrifield, Conservative, Yellowhead, AB]

That's where I'm going with it. If you're saying we need more research, perhaps that's fair.

With regard to the military and the people we recruit for the military, we choose a very small number of those who apply. There is the potential, if we could be alerted quickly enough, not to take individuals who are perhaps prone to do danger to themselves because of putting themselves in risk situations, such as a high-stress situation. They might be pruned out early for their own protection.

My question, then, is this. Do we have to reinvent the wheel with regard to research, or are we doing work with other countries that have already gone through this process? Do they have something that perhaps we can learn from them with regard to the prevention side as well as the treatment side—such as working with the United States, Great Britain, or other countries that have been in theatre over many years, with perhaps more experience than we have?

I'll let you answer for five minutes. That's a neat trick; I never get away with this—I chair another committee.

[Marie-Josée Lemieux]

We can't really answer that question. Indeed, it might be much better for you to speak with experts in the field. As far as I know, the military can apply selection tests and psychometric tests. Some employers make potential employees undergo psychometric tests. They do so to find the right person for the job, if they're looking for one type of personality rather than another, so they will base their choice on the results of those tests. The same approach could be taken to help a person deal with the potential fallout from an event before or after it happens. The way trauma is treated can affect the way PTSS develops. So what you're talking about is doing research on the ground within the military.

[The Chair, Conservative, Rob Anders]

Thank you.

Now it's over to the Liberal Party of Canada, to Mr. St. Denis, for five minutes.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, Mr. Chairman.

Thank you for being here today.

We need people like you to help us understand better the challenges we face as we try to assist the veterans.

Much of the discussion today was more about the challenges you face as a professional group, but I'd like, as much as possible, to talk about the veterans specifically.

Within the field of your profession—I'm speaking as a layman when it comes to medicine—you have specialties within the various medical fields. Can one specialize in operational stress, with PTSD injuries? Can somebody say, that's what I'm going to focus my career on?

[Marie-Josée Lemieux]

If you're talking about the medical model, and if you define “specialty” in that way, like a cardiologist is a doctor specialized in cardiology, specialties don't exist per say in psychology in Quebec.

Each psychologist who is a member of his or her professional order is responsible, under the Code of ethics, to provide services and take measures only within the limit of his or her skills, training and rights as a psychologist.

That being said, when it comes to training, certain psychologists choose to work at the community level, others in groups, and yet others in a clinical setting. Clinical psychologists can develop expertise in the treatment of post-traumatic stress syndrome. Yet the field of clinical psychology is extremely vast.

So it really all depends on the area the psychologists has chosen to train in and the environment. The institutions which provide psychological services indicate to universities and other educational institutions the specific areas where psychologists are needed. Some psychologists become extremely specialized in their field, such as working with autistic children.

In Quebec today, there are nearly 2,000 psychologists who have been trained to treat post-traumatic stress syndrome. There are no statistics which might indicate how many of them treat Quebec's veterans. Saint-Anne Hospital has an employee support program which retains the services of 900 psychologists for its people in Canada.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Merci.

With a shortage of psychologists, one would assume that leads to longer wait times—longer periods of time between appointments, follow-ups, and so forth. I'm assuming that research has been done. Obviously the longer somebody with a heart problem waits, the greater the risk of something getting worse before the next appointment. Is it a fair assumption that for a veteran coming back from service, leaving the service, or still in the service and needing treatment, because of the shortage of professionals there is a longer wait time for service? Do we know whether, on the whole, that actually costs us all more? Not only is it worse for the client—the military person or the veteran—but it's worse for society in terms of costs and impacts on families. Do we have any measures on the cost of the shortage?

Your answer might be a general one, and I'm assuming that a general answer would apply to soldiers and veterans as well. Did I make my point clear?

[Marie-Josée Lemieux]

I will give you a general answer. In Quebec today, there is no shortage of psychologists, but there is a lack of psychiatrists. Further, it is very hard to find a general physician, but there is no shortage of psychologists. The problem lies with the referral process, and that is because people have to wait such a long time to see their doctor. The doctor then refers them to a psychiatrist, and then the psychiatrist refers them to a psychologist. That's what takes so long.

But, generally speaking, there really is no shortage at all of psychologists. On the contrary, with everything happening in Quebec today with regard to the reorganization of the mental health care system, the role of psychologists has become much greater. A psychologist is included in every front-line mental health team. When Bill 50 is adopted, and we hope this will happen soon, the psychologist will have access to the file containing a patient's mental health history and evaluation, and this will compensate for the difficulty in finding a psychiatrist.

I don't want to bother you with the jargon, but psychiatrists will usually step in in extremely complex second- and third-line cases. PTSD is a first-line condition. So if, from the very start, a psychologist is involved and makes a diagnosis, the patient will not have to first wait to find a doctor or a psychiatrist.

Does that answer your question?

[The Chair, Conservative, Rob Anders]

Thank you.

Now we're over to the Conservative Party of Canada, and Mr. Stanton, for five minutes.

[Bruce Stanton, Conservative, Simcoe North, ON]

Thank you, Mr. Chair.

I'm delighted to be here for the first time at this committee, and I'm happy to stand in for my colleague this afternoon. I picked up some of the dialogue in the later part of the meeting today, and I understand that the committee is currently working on a study of the veterans independence program that takes a close look at the ability of veterans and their families to maintain their independence in the home.

Would you be in a position to comment on how that type of ongoing independence in a home-type environment assists veterans and their families from a psychological point of view?

[Marie-Josée Lemieux]

Are you referring to a specific program?

[Bruce Stanton, Conservative, Simcoe North, ON]

The program that is run through Veterans Affairs Canada. It concentrates on assisting veterans and their families to remain in their homes. I wonder if you could comment on the psychological benefits to the veterans of remaining in their home environment. What benefits are gained?

[Marie-Josée Lemieux]

I can't really talk about a program I am not familiar with and I have not read about. But generally speaking, it's best if a person can receive treatment without leaving the people who love and support him or her, as far as that's possible. But we can't say much more because we are not familiar with that program.

[Bruce Stanton, Conservative, Simcoe North, ON]

Maybe I'll try a different line of questioning, then. This is more general.

Because your organization represents your profession in psychology--a very important profession, I must say, and certainly one we have a growing need for, not just in Quebec but across the country--I wonder, do you take an active role in helping to dismiss some of the stigma attached to mental illness in general, and what steps do you take in that regard?

[Stéphane Beaulieu]

The Ordre des psychologues du Québec is very involved with public education. We deal with the media on a weekly basis, sometimes even on a daily one. The order has a pool of psychologists who are readily available to answer questions from the media and the public. Of course, newspapers and television are ideal vehicles for us to get our message out. The order has a pool of psychologists who are available to answer any questions with regard to the topic of the day. So we do a lot of education in that regard.

[Bruce Stanton, Conservative, Simcoe North, ON]

Very well, thank you.

I will now give the floor to my colleague, Mr. Sweet.

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

I just want to clarify one thing. Mr. Merrifield mentioned psychiatrists, but you regulate psychologists only. Is that correct?

This is more for my personal interest. You mentioned that you had observed in other provinces—I hope I didn't get this one wrong as well--that generally speaking, the PhD students have the capability of working as they're getting their doctoral degrees, but that's not the case in Quebec.

Did I hear that correctly, and if I did, could you tell me why that is? What is the root cause of that?

[Stéphane Beaulieu]

You are asking why psychology students are paid while they're still learning, except in Quebec. First, it is true that in other Canadian provinces, there are many more paid internships than there are in Quebec. However, that is not the general situation. It's not true that 100% of the internships throughout the rest of Canada are paid positions, but certainly there are more than in Quebec. When the Canadian Psychological Association grants an institution internship status, it automatically becomes a paid internship, except in Quebec.

I could not tell you why. It is certainly an historical issue. Internships and practicums in the areas of mental health and human relations are not traditionally paid positions in Quebec. However, there are more and more paid internships in psychology in Quebec. But there aren't enough of them and only a minority of internships are still paid. But in universities, there is a movement involving students and professors which is trying to change that.