Evidence of meeting #20 for Veterans Affairs in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was training.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Marie-Josée Lemieux  Vice-President, Ordre des psychologues du Québec
Stéphane Beaulieu  Secretary General, Ordre des psychologues du Québec
Édith Lorquet  Legal Counsel and Secretary of the Discipline Committee , Ordre des psychologues du Québec

3:30 p.m.

Conservative

The Chair Conservative Rob Anders

Good afternoon, ladies and gentlemen. We're off to the start of another veterans affairs meeting here, where we're studying the veterans health care review and veterans independence program.

I'll have to attempt some of these titles en français, so bear with me.

Today our witnesses are with the Ordre des psychologues du Québec, and we have Stéphane Beaulieu, secretary general; Marie-Josée Lemieux, vice-president; and Édith Lorquet, legal counsel and secretary of the discipline committee.

The way it generally works around here is that guests have twenty minutes, so you can split that up however you wish. If you wish to do six minutes and some fraction each, or ten minutes and five and five, or twenty for one person, it will be as you see fit, and then after that we go to this lovely predetermined roster of questioners. First and second rounds have already been predetermined.

Other than that, I guess I will just turn it over to you and say the floor is yours.

3:30 p.m.

Marie-Josée Lemieux Vice-President, Ordre des psychologues du Québec

Thank you very much.

Good day everyone. My name is Marie-Josée Lemieux. I am the Vice-President of the Ordre des psychologues du Québec. I am accompanied by Mr. Beaulieu, Secretary General and by Mr. Lorquet, the order's lawyer.

The primary mission of the Ordre des psychologues du Québec is to protect the public. Our association ensures quality of services provided by its members, promotes development of the profession and defends access to psychological services. Currently, our order has 8,150 members working either in health care, in private practice or the public health care network, in educational institutions or for major companies.

We are aware that the Standing Committee on Veterans Affairs is concerned with access to psychological services for victims of trauma related to operational stress, and concerned with a future shortage of psychologists. So it is a pleasure for us to have accepted the committee's invitation to come and provide information on the following issues: the reasons for the increased educational requirements providing access to the profession of psychologist in Quebec; an overview of training for psychologists within the Province of Quebec; the changes in the numbers of psychologists given the need for a Ph.D. degree and the aging of the population; as well as strategies to be considered to encourage more psychologists to develop expertise in treating veterans.

For the past two years, psychologists have been required to have a doctorate. This standard came into force following a regulatory change in July 2006. The new regulation on degrees was amended by the Quebec government, pursuant to section 184 of the Professional Code of Quebec, following an extensive consultation process particularly with the Quebec Professions Board, universities, the Quebec Department of Education and the Quebec Department of Health.

Under the old regulations, the order licensed psychologists who had a master's degree. The new regulation means that only those holding doctorates can become psychologists. Students are now enrolling in doctoral studies after they get their undergraduate degree.

Over the past few decades the evolution and diversification of practices in the area of psychology has meant an increase in initial training needs in order to properly prepare psychologists to treat diversified clienteles and ensure a constantly changing range of services. For many years, young psychologists coming out of university did not feel sufficiently prepared to deal with the demands of the profession, particularly with regard to practical training. They were then able to access additional training to complete their training.

Six studies conducted during the 1990s indicated that students graduating in the field of psychology and their trainers felt, first, that the theoretical and practical training they received was insufficient and that young psychologists did not feel prepared to exercise their profession without having additional training. Second, they felt that their university courses and activities should focus more on clinical practice. And finally, they felt that the amount of practical training time dedicated to serving clients should be extended and there should be a greater number of hours spent with clients as well as a greater number of hours spent under supervision.

In light of those facts, in order to address those deficiencies, the majority of psychologists sought out complimentary practical training or individual supervision related to the fundamental aspects of their practice once they graduated from university. A large proportion of them said that they felt sufficiently prepared to go into solo practice and sufficiently competent in psychology only when that additional training had been completed.

In light of those facts and pursuant to its mandate to protect the public, the Ordre des psychologues du Québec had a duty to propose a solution that would take into account the changing knowledge and the diversification of professional services provided by psychologists.

Consequently, towards the end of the 1990s, the Ordre des psychologues du Québec, in partnership with Quebec universities, proposed developing a training model based on seven professional competencies. Furthermore, the Order also recommended increasing the number of hours devoted to practical training during the university course work. So, the former standard, which allowed for a 600-hour internship was increased to 2,300 hours. The universities which had up till then been providing professional programs at the master's level, felt that these new requirements could only be offered within a doctoral degree program.

Furthermore, having a Ph.D. standard based on competencies is widespread throughout North America. Most Canadian provinces, as well as most American states, require students to obtain a Ph.D. in order to independently practice this profession.

It should also be noted that the Canadian provinces have signed a reciprocity agreement allowing all psychologists to work anywhere in Canada. This agreement is competency-based, and was inspired by the Quebec training model.

During the consultations that preceded the adoption of the new regulation, various stakeholders consulted expressed some reservations and asked questions about the impact of making students obtain a doctorate on a future shortage of psychologists in Quebec.

At that time, the universities made the commitment to increase the number of spots in programs and to shorten their duration. As a result, since the 2006-2007 academic year, the year that the new regulation came into force, an additional 39 students were admitted into programs in Quebec, a 17% increase.

Furthermore, the Quebec government recently amended the Professional Code in order to give professional associations the regulatory tools they need to facilitate the recognition of foreign credentials. Furthermore, the Department of Immigration and Cultural Communities of Quebec is providing funding to the professional associations so that they can develop in partnership with the universities programs that ensure access to complementary training for candidates from outside Canada who apply to have their diplomas recognized.

The Ordre des psychologues du Québec, in partnership with the University of Sherbrooke, recently proposed a project to the Department of Immigration and Cultural Communities to develop a framework program for such candidates. This measure should help to facilitate access to professional training courses and, consequently, accelerate the licensing of immigrants.

Finally, the Ordre des psychologues du Québec is currently taking part in the round table bringing together the Quebec Professions Board, the Department of Health and Social Services of Quebec, and the Department of Education Recreation and Sports of Quebec in order to update occupational outlook information for health care and education and private practice.

Furthermore, Quebec currently has 2,300 psychologists working exclusively in the area of private practice. A poll conducted in 2005 by our association told us that a vast number of them are interested in a full-time or part-time position within the public network. The marked interest of psychologists in having a public sector position could be of interest to the Department of Veterans Affairs, which is concerned with ensuring ongoing services to veterans.

As I said earlier, the Ordre des psychologues du Québec currently has some 8,150 members, which is nearly half of all psychologists in Canada.

Over the past 10 years, the increase in the number of members has remained quite stable. The average increase in the number of psychologists was 200 a year. Of our more than 8,000 members, at the moment close to 2,000 of them provide care for people with post-traumatic stress disorder. Slightly over 4,500 members provide services for the treatment of anxiety-related problems. Close to 5,000 of them provide services to treat depression and almost 500 provide services for the treatment of alcoholism and drug addiction.

As regards a possible strategy, I should mention that there are a number of training options available in doctorate programs in Quebec universities. I am thinking particularly of options in clinical psychology, neuropsychology, children and families and work/organization, not to mention community psychology. It is mainly the professionals with training in clinical psychology who work with the victims of operational stress and their families.

Internships play an important role within the doctoral training program. Interns are students who do most of their practical training in clinics that specialize in treating trauma caused by operational stress. This can be a good way of ensuring the availability of services geared to the needs of veterans.

For example, the Quebec government is currently considering offering scholarships for interns as a way of recruiting psychologists in areas of practice with the most limited resources. A scholarship program for interns could definitely be an effective way for the Department of Veterans Affairs to encourage students to show an interest in providing services for veterans. Clinical training with veterans would also enable students to develop specific expertise geared to the veterans' needs.

Grants for clinical research, in cooperation with the universities, is another possible way of improving the overall availability of services for veterans. The money being invested by the department to treat trauma resulting from operational stress definitely deserves support from clinical research so as to assess how effective it is and to improve practices.

That completes my presentation. We will be pleased to answer any questions you may have.

April 3rd, 2008 / 3:45 p.m.

Conservative

The Chair Conservative Rob Anders

Just to let you know, you're at 13 minutes. You still have seven minutes, if somebody wishes to add something to your presentation.

3:45 p.m.

Bloc

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

I'll speak for seven minutes.

3:45 p.m.

Conservative

The Chair Conservative Rob Anders

I know you would, Monsieur Perron.

Mr. Sweet.

3:45 p.m.

Conservative

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

Are there copies of the opening remarks that were just read?

3:45 p.m.

Conservative

The Chair Conservative Rob Anders

I don't have one, sir. I believe they were just oral.

3:45 p.m.

Conservative

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

All right. Thank you.

3:45 p.m.

Conservative

The Chair Conservative Rob Anders

Now we will go to our predetermined list.

We will start with the Liberal Party of Canada, Mr. Russell, for seven minutes.

3:45 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Thank you, Mr. Chair.

Welcome to our committee, and thank you for that particular presentation.

I believe it is fair to say that there's a lot more focus on this particular area within the military in the last number of years, and certainly with some of the studies, if we can call them that, that have been conducted around people returning from areas like Afghanistan. There is even more of a light being shone on the need for psychology or mental health within the military itself to help veterans and people currently within the military structure deal with certain situations.

We have to segue into this in some way, shape, or form. Your organization is the order of psychologists of Quebec, right? You are a regulatory body that develops standards and that type of thing. Do you have an advocacy role, as such? I see there's an association of psychologists of Quebec as well, which it seems to me would have more of an advocacy type of role apart from a regulatory approach. Is that fair to say?

3:45 p.m.

A voice

There is no such association.

3:45 p.m.

Liberal

Todd Russell Liberal Labrador, NL

According to our notes, there is an association of psychologists of Quebec that speaks on behalf of approximately 1,000 psychologists who have joined its ranks. That is differentiated in the notes from the Order of Psychologists of Quebec.

3:45 p.m.

Stéphane Beaulieu Secretary General, Ordre des psychologues du Québec

If you do not mind, I will be speaking French.

In all the professions in Quebec, the role of the association is sometimes included with the professional body. So, of course, there are associations. The main role of the professional body is to protect the public. But the association movement is not as developed in Quebec as it is in other provinces or in the United States. Obviously, there are variations from one discipline to another. In psychology, the association movement is less developed than in other jurisdictions or other professions.

So yes, sometimes the Ordre des psychologues du Québec plays an advocacy role, as you say in English.

3:45 p.m.

Liberal

Todd Russell Liberal Labrador, NL

I guess what I'm getting at is that the access to psychologists or that level of professional is far less, I would think, on a per capita basis in rural areas than it is in urban areas. We do have veterans living in rural or northern and remote areas. There's no doubt about that. Is there a strategy for reaching out to those areas to provide those particular services? Is that a role that your organization would necessarily play in terms of reaching out to areas that might not have these particular types of services?

As well, if we want to bring the focus back on the military or the veteran, is there specified...? You say you can go into clinical or some other stream within the broad category of psychology, become more defined in terms of your interest or your field of study. Can one look at PTSD and the needs that exist within the military or with veterans within the scope of study that one would undertake, or is it more broad-ranging in that it applies to a variety of different situations?

3:50 p.m.

Vice-President, Ordre des psychologues du Québec

Marie-Josée Lemieux

You've actually asked two questions. The first is about access to the services of psychologists in the regions, and the other is about training. You ask whether there is specialized training for people who wish to provide services to veterans suffering PTSD. Is that correct?

3:50 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Absolutely.

3:50 p.m.

Vice-President, Ordre des psychologues du Québec

Marie-Josée Lemieux

With respect to the first question, as I said earlier, the mandate of the Ordre des psychologues du Québec is to protect the public. In Quebec, it works in cooperation with the department of health and social services, which is responsible for providing health care services in all regions of Quebec.

The Department of Health must ensure that services are available in Matapédia and Gaspé as well as in Montreal. So, it is—

3:50 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Labrador. I throw that in for your benefit.

3:50 p.m.

Vice-President, Ordre des psychologues du Québec

Marie-Josée Lemieux

As I said earlier, the Ordre works with the departments to help them develop strategies to encourage psychologists to go and work in these regions.

As in any profession, if the salary is the same in Montreal, Quebec City and Gaspé, people tend to prefer to live in Montreal or Quebec City. We need some incentives. The departments or the employer in question must come up with some.

Does that answer the first part of your question?

3:50 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Yes.

3:50 p.m.

Vice-President, Ordre des psychologues du Québec

Marie-Josée Lemieux

The second part of your question was about specialized training in PTSD. Earlier, we were saying that there were a number of training options or streams. Students in the clinical psychology stream will be the ones to work with patients with mental health problems. PTSD is one of the mental health problems, as are depression and anxiety.

There are no universities in Quebec at the moment offering a specific program in PTSD. However, there is a psychologist by the name of Pascale Brillon at the Sacré-Coeur Hospital, whom you met, I believe, who does specialize in this field. At the Louis-H. Lafontaine Hospital, a psychologist there, Stéphane Guay, also specializes in PTSD. Both of these psychologists work with trainees and interns from the Université de Montréal, UQAM, McGill and even Sherbrooke University.

During their training, students decide in which area they want to specialize.

Does that answer your question?

3:50 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Yes, and I'm out of time. I guess my point is that if the curriculum is not there, you can't choose it.

3:50 p.m.

Conservative

The Chair Conservative Rob Anders

He will have copious opportunities to further his questions later, I'm sure.

I will now give the floor to Mr. Perron from the Bloc Québécois. You have seven minutes.

3:50 p.m.

Bloc

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

I would like to thank our witnesses for appearing before us today.

I want to talk about really practical considerations. As you no doubt know, the Department of Veterans Affairs enters into service contracts with psychologists in Quebec.

With respect to services in remote regions, would the Ordre agree to give the Department of Veterans Affairs a say in choosing the best psychologist in a particular region with some experience in the treatment of PTSD?

I would recommend that the Ordre des psychologues du Québec pay a visit to the Sainte-Anne Hospital in Sainte-Anne-de-Bellevue. It does some very good research. Both Mr. Guay, Ms. Brillon and people from McGill work there. Efforts are being made to get more psychologists specialized in the treatment of PTSD, not only for the military, but for people who are rape victims, and so on. This type of stress can be caused by various situations.

I think the Ordre should be more proactive in the media and on television to get the message out. We need experienced psychologists to treat young soldiers and civilians suffering from post-traumatic stress disorder.

3:55 p.m.

Vice-President, Ordre des psychologues du Québec

Marie-Josée Lemieux

Mr. Beaulieu will answer part of your question, and I will answer the rest.