Veterans Affairs Committee on April 3rd, 2008

[Stéphane Beaulieu]

The main role of the Ordre is to protect the public. One of the ways of doing that is to ensure that our members have the skills required. We do that in two ways. We have input regarding the initial training for future psychologists at university. We approve university programs. So we ensure that students receive the necessary components of a professional practice in their basic training. When it comes to clinical psychology, since clinical psychologists offer the services, particularly in the case of PTSD—

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I'm going to stop you right away, Mr. Beaulieu. You were talking about the internal workings of the Ordre des psychologues du Québec. I am sure you can do your job properly. What interests me are the services you provide and supervise for your clients. In my home town, Évain, in the Abitibi region, can I consult a psychologist with some experience to deal with my PTSD problem? If so, will you work with the Department of Veterans Affairs so that we can get three or four psychologists in the Rouyn-Noranda region who are qualified enough to get the contracts?

[Stéphane Beaulieu]

If I may, I will complete what I was saying, because I was coming to continuing education. Once a psychologist is practising, how does he or she go about acquiring new skills? Let us say that a psychologist's main training is in the treatment of depression, and that he or she must provide treatment to PTSD patients. Psychologists must take training in order to provide these services. That is required by their code of ethics. So continuing education is certainly one way of meeting this need. There are many psychologists in Quebec—probably more than in Canada as a whole—who provide treatment for PTSD.

According to information provided by the Sainte-Anne Hospital, there are 900 psychologists in Canada providing services to veterans in private practice. Many of them are located in Quebec. The problem of access to services in the region is probably not as acute as it is in the other Canadian provinces. There are more psychologists working in the regions in Quebec than there are in a number of Canadian provinces.

I hear your comment and your invitation to work cooperatively. That is definitely something we could look at. I think that one of the ways of doing this is to ensure that practising psychologists are qualified and provide a range of services. Does this specific group of clients require particular attention? That is possible.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

In terms of statistics—and here I am referring to American statistics, because unfortunately there are none available in Canada—approximately 8% of civilians need to see a psychologist because of PTSD. You may have the same statistics. They come from an American study. The corresponding figure for soldiers requiring treatment for PTSD is 18%.

So there are more clients from the military. The problems is, I don't want people to have to go to Montreal to get care. I want someone in the Abitibi region who knows about the disorder and who will develop the appropriate skills. This is the type of person we could recommend to the Department of Veterans Affairs. We have to have people in the Abitibi region who can do a really good job, because they have the qualifications for that. That is what I would like to see. I would like young soldiers as well as older soldiers to get these services, because PTSD is something that was covered up in the case of 80-year-old veterans. There are more of them who suffer from the disorder than we might think.

[Stéphane Beaulieu]

I would like to add something. Accessibility is definitely a problem. We do have psychologists distributed throughout Quebec, and we are pleased about that, but accessibility nevertheless remains a genuine problem. Earlier, in her opening remarks, Ms. Lemieux referred to an approach being studied at the moment by the Department of Health to get psychologists for remote regions or for areas with a shortage of resources.

One of the ways of doing this is to recruit psychologists when they begin their careers or even when they are at university. One approach is scholarships for interns. This would encourage students to specialize in services for veterans. They would therefore get to know this client group and what they need. Once these students are doing their internship, they develop some expertise, and the chances of keeping them are much better, of course. This is something that could be done.

That is not our responsibility, but rather that of the universities. As I was saying earlier, we do work with the universities.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I can tell you that there is cooperation in Quebec City involving Dr. Chantal Descôteaux, the Chief Medical Officer at Valcartier, and a number of psychologists in the Quebec City region. I will come back to this, because I have a number of questions to ask you. I will take up some of the seven minutes that you have.

[The Chair, Conservative, Rob Anders]

The witnesses, our guests, can always respond for as long as they like. He's the one who's limited to seven minutes.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

My time is limited. You can talk as long as you like.

[Marie-Josée Lemieux]

I see: in that case, if I may, I would like to add something.

We talked about scholarships. We understood from our discussion with Mr. Rossignol that you were looking for some ideas and strategies to get new psychologists. It is not up to us to tell psychologists that they should go to a particular location because there is a shortage there and too many psychologists somewhere else. That is not our job.

However, our members tell us that there is a serious problem at the moment involving the salaries paid to interns during their doctoral training. This is not true in most of the provinces. Most students in doctoral programs in psychology in Canada get paid for their work—either through a scholarship or in the form of a salary. That is not true in Quebec. The culture in Quebec is different.

When Mr. Beaulieu and I met with the Deputy Minister of Health last spring, she told us, that because of the danger of a shortage in some sectors, she was considering offering scholarships to attract students to take further training as psychologists in a particular sector or specialty. When we were talking about scholarships earlier, we were thinking of the Sainte-Anne Hospital, for example.

It is true that there is a specialty offered there in PTSD or operational stress, and this is part of the service provided to veterans. It could be a very good idea to offer scholarships to attract interns to specialize in services for veterans. In this way, they would develop within the system and be able to offer specialized services.

Would you like to add something, Ms. Lorquet?

[Édith Lorquet, Legal Counsel and Secretary of the Discipline Committee , Ordre des psychologues du Québec]

In practical terms, Mr. Perron, your question could have two parts: it could cover an individual in a particular region who does not know where to go, or it could be someone who knows who to see, but who lives in an area where there are no psychologists.

When individuals do not know where to turn, the Ordre des psychologues provides a reference service. As a result of this system, when psychologists pay their annual dues each year, they state their areas of expertise. If I remember correctly, PTSD is one of the areas that is mentioned in the list.

We have also drawn up a list of third parties that pay the bill, such as those involving workmen's compensation or the SAAQ. Could veterans be added to the list to spark some interest? That is an administrative matter, and it would be simple for us to do that. I promise I will check into that.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

You would have to get in touch with the Department of Veterans Affairs to find out what it wants.

[Édith Lorquet]

For example, someone looking for a psychologist specialized in family matters with experience before the courts would use the reference system. Psychology students take the calls and usually direct them toward three people in practise in their region, so that people have a choice. So our inventory includes a geographic breakdown and areas of specialization. In the short term, this is something we could consider doing with the Department of Veterans Affairs.

[The Chair, Conservative, Rob Anders]

Wow. Seven minutes of questions turned into 12 minutes of testimony--impressive. That's a record. Consider yourself lucky, sir.

Now we'll go to the New Democratic Party, and Mr. Bevington, for five minutes.

[Dennis Bevington, NDP, Western Arctic, NT]

Thank you, Mr. Chair.

It's fascinating sitting here, because of course I don't come to this committee very often. I'm replacing Mr. Stoffer, who is very much into this kind of discussion about veterans. I'm kind of wondering where I would go with this.

Certainly coming from a remote area of the country, the Northwest Territories, I know we have extreme problems attracting psychologists there. I understand the problems you have in bringing professionals into remote locations.

The best way I can serve your time here is to ask what kind of favourable outcome you think could come from your presentation to this committee. What kind of result would you see as useful?

[Marie-Josée Lemieux]

I understand that access to psychological services is a problem for veterans. Are you asking me what would be a favourable outcome for my presentation today?

[An Hon. Member]

Yes.

[Marie-Josée Lemieux]

I wasn't sure I had understood you correctly.

To us a favourable outcome would be to give you some possible solutions and to draw you a rather explicit picture of the way we operate in Quebec. You could use these solutions to increase access to services for veterans.

What we tried to get across in our presentation is that there are many psychologists in Quebec who are deemed to be very competent. Several of them are in private practice. The poll we carried out in 2005 indicated that a large number of them would agree to work within the public network, in a place such as Sainte-Anne Hospital, if they received clinical training.

There is also another option which would involve attracting young psychologists through scholarships. For instance, they could receive on the job training at Sainte-Anne Hospital. Another option would be to provide research grants. The more research grants there are, the more researchers will be interested in this issue, the more researchers you have, the more students you get. It has a snowball effect.

The final option Ms. Lorquet put forward was of an administrative nature. You could add to the third party-payer list a section for veterans, which could lead psychologists to feel they can provide services to this population.

[Dennis Bevington, NDP, Western Arctic, NT]

Is your organization active in statistical analysis of the issues in Quebec with mental health and how they relate to veterans? Is that part of your ongoing role as an association, as an order?

[Stéphane Beaulieu]

Not really. We issue professional practice licenses. We are a professional body and not an association.

[Dennis Bevington, NDP, Western Arctic, NT]

So who would actually do that kind of analysis? Would it simply be Veterans Affairs? Would it come from a larger organization within Quebec that might look at problems within the whole society?

[Marie-Josée Lemieux]

The clinical aspect of psychological practice, for instance how many veterans suffer from PTSD, is something that would fall under Mr. Stéphane Guay's area of expertise, at the Louis-H. Lafontaine Hospital. I believe that institution partners with Sainte-Anne hospital. Mr. Guay is aware of the evolution of knowledge in that area and of the breadth of the problem. That is not a part of our mandate.

[Stéphane Beaulieu]

I wanted to add that the research component is very interesting. Research is being led by universities in clinics where services are offered. So there is a synergy between the universities and the service providers. It would be very profitable to know more about veterans, the pathologies, the evolution of illness and the effectiveness of treatment. These are certainly areas of research which would perhaps help the Department of Veterans Affairs gain a better understanding of issues of pathology and service provision. In my opinion, that is certainly an area that should be further developed. It's already being done, but based on our information, it could be improved in Quebec.

[The Chair, Conservative, Rob Anders]

Thank you. Good timing.

Now we are on to the Conservative Party of Canada, and Mr. Sweet, for seven minutes.

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

Thank you very much, Mr. Chairman.

Thank you for your time here. I also wanted to say thank you because we've had successive questioning around what can be done to get more people into the profession, and you came up with a very good suggestion about offering scholarships to encourage people to get into that profession. So it's one of the better ideas we've heard here about the specific number.

There are a number of challenges, but in your opinion, is the number one challenge about adequate service, really about the number of psychologists that are in the profession?

[Marie-Josée Lemieux]

I don't know if you are strictly referring to veterans or the general public. Either way, we do not specialize in veterans health problems. We do know however how things work between Sainte-Anne hospital, the neighbouring clinics and Louis-H. Lafontaine Hospital, for instance. We do not know any specifics about access problems.