Veterans Affairs Committee on June 3rd, 2008

[Adam Luckhurst]

Yes. Under Veterans' Affairs we have arrangements for doctors. They're actually called local medical officers rather than doctors, but we have a special arrangement in place. It's not really a contract, but we encourage them to provide services to veterans. They did, and I think still do, receive extra money to provide services to veterans in recognition of the extras that we expect of them in terms of doing things like case management and that sort of thing, as much as general practitioners can.

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

I'm going to jump in for just a second.

What you raised, High Commissioner, I find very interesting. When the federal level started to take on more of the responsibility for the health care aspect of things—rather than provinces, you have states in Australia—did they scale back the funding that went to the states to compensate for the fact that they were picking up a larger share of it, or did things remain status quo? Did the states still have the same amount of funding, or did that funding get scaled back when the federal level took over some of the aspects of health care?

[William Fisher]

Let me preface by saying that I'm not a great expert on this.

Secondly, I think you'd get a different answer from each state from what you'd get from the federal level.

The principle, of course, is that the total funding does not alter. How it's delivered is an organizational issue, and the funding is supposed to relate to the issue and not to who does it.

I'm just making a guess, but I think the very fact that the states have been contemplating voluntarily giving more authority to the federal level seems to indicate that they see a concern, not so much for the amount of money they're getting now, but with the future commitments they'll have to face as the population gets older and with the sorts of health issues we have in western societies these days.

That said, there has been a lot of disagreement between the federal and state areas about the most efficient way of delivering good health care. In fact, it was an issue in the last election. The previous Conservative government took over two hospitals forcibly from state authorities because they said the state authorities were not doing a good enough job in managing them and using the funds that were available.

As far as I know--and as I say, I'm not an expert--it seems to be more a question of organization of the portfolio than absolute levels of funding.

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

What about the At Ease website?

[Adam Luckhurst]

In terms of At Ease, I don't know if there was any one particular event that prompted its establishment. I think there was a general recognition of the need to provide more promotional material around mental health. It's not just an issue for veterans, but a broader issue, I think, in the general community. There's a recognition of the need for greater awareness around mental health issues.

Clearly, there are mental health issues for veterans. We all know that. I guess it's an attempt to be proactive in terms of getting information out. They've had all sorts of other information as well, but it's always good to update and enhance where you can. I think that's what At Ease has done.

In terms of numbers calling, I'm sorry, I don't have any figures on that at the moment.

[The Chair, Conservative, Rob Anders]

Thank you very much.

That completes the first round, where we had some people asking seven-minute questions. Now we're into the second round, and they're all five minutes.

We're back over to the Liberal Party of Canada. I believe Ms. Minna is up, and she can pass time on to Mr. Valley.

Ms. Minna, for five minutes.

[Maria Minna, Liberal, Beaches—East York, ON]

Thank you, Mr. Chair.

I want to go to the issue of post-traumatic stress syndrome, which you mentioned earlier.

I was on another committee not too long ago in our Parliament that was studying this issue. General Dallaire, who was in Rwanda, has been very open about this issue and is an advocate. He was talking about the need for early intervention in this area, but also the need to recognize that the onset can be later, in some cases seven or eight years after the fact. Most of the soldiers who need help don't go on the base or anywhere near where they might be seen by others, because there's a stigma attached to it. It's considered a mental weakness and so on.

He was recommending that programs be offered off the base, where there's more of a civilian population, and that mental health experts or psychiatrists who work with other paramilitary types of organizations, like the police, could be identified because they would have a better understanding of what these people would have gone through. These are the kinds of things he was talking about.

I wonder if you've had similar experiences and to what extent you've put in place any specific mechanisms that we might be able to look at to address some of these things.

[Adam Luckhurst]

We certainly have in terms of services off the base. As I understand it--and I'm not an expert on this--our Veterans' and Veterans' Families Counselling service has arrangements with the defence department so that people can go to the counselling service to receive help and assistance through that avenue—which is certainly off the base.

Also, I think there's still a lot to be learned about post-traumatic stress disorder or any sorts of post-traumatic mental health conditions. We're certainly working with our academic colleagues to get a better understanding of how to provide the treatment that is going to be the most efficacious in achieving a much better outcome. There's certainly new information becoming available, looking at, for instance, what role the family plays and on keeping the family together, or on how important that is in helping people get through post-traumatic mental health events. So I think there's still a lot to learn.

In terms of the issue you raised about timeframes between an event and the onset of symptoms, that basically equates with my understanding that there can be a considerable time period between the two. Of course, we may only see it within the Department of Veterans' Affairs, plus people can access our counselling service. We may only become aware of the situation when someone puts in a claim to our organization for assistance.

So it's a bit hard for us to provide a comprehensive range of services if they haven't come to us in the first instance. That's one of the challenges of the system, and we're trying to get around it by providing some counselling services to people who don't have any accepted mental health condition at the time.

All of these things, I guess, add to the picture and help us to move forward in providing better care, but we still have a long way to go in getting to where we probably all want to be.

[Maria Minna, Liberal, Beaches—East York, ON]

Go ahead.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

Adam, you're going to be here 18 months, I think. Obviously you're here to teach us or to learn from us; I'm not sure which.

[Adam Luckhurst]

It's definitely to learn.

[Roger Valley, Liberal, Kenora, ON]

After being on 11 bases in the last 12 months, I know what our complaint is.

What is the single biggest complain that you hear from your veterans? I want to know if it's access to health care, the red tape, or all of the above.

[Adam Luckhurst]

I think there's a range of different issues they raise. I don't know what the main one is, but the complexity of the process is one, and we're trying hard to manage that. When we have three main pieces of legislation, sometimes people have multiple eligibility under those different pieces of legislation. That, by its nature, creates complexity. So we're trying to work on and come up with some ways of simplifying that.

There are other issues around levels of payment and levels of access to service, and those sorts of things, which come up from time to time. But generally, there's a very high satisfaction rate with the system in Australia. I think our last veterans satisfaction survey had a satisfaction rate in the 90th percentile, so there's a fair degree of satisfaction overall.

[Roger Valley, Liberal, Kenora, ON]

That's very impressive.

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you.

Now we're over to le Bloc Québécois, et Monsieur Gaudet, pour cinq minutes.

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

Mr. Chair, I will speak in place of Mr. Gaudet, because he is absent-minded.

Here, we are trying to move more and more toward home care, to keep veterans or old age people at home as long as possible and to give them the best care possible. I find the idea interesting, but I do have a concern. We have developed a detailed statement. Will we have enough qualified personnel? Will the responsibility to take care of older people fall on the shoulders of children and grandchildren, as is often the case in native communities?

Do you have some experience in the area of care provided at home in your country?

[Adam Luckhurst]

Not necessarily in relation to home care, but I do understand that within Australia generally, because of the aging nature of the population, particularly the voluntary care that's given and with our veterans home care program, it is paid staff. But certainly in voluntary care, which provides a significant amount of support to veterans and all other older people in the community, the issue we're facing is that as people get older, as our population gets older, there aren't the same numbers of people to provide that voluntary support that we may once have had in the past.

I think it'll continue to be an issue into the future.

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

Have you begun to implement some solutions, including for veterans, in order to provide the best possible care at home?

[Adam Luckhurst]

Home care is provided through paid staff. I'm not familiar enough with the program to know what the pressures are on the employers to know whether they are finding it difficult to attract employees, but that may well be the case.

In terms of other guidance I could give you, I can't think of anything at the moment.

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

Mr. Chair, I will conclude by making a comment to my friend William Fisher.

You are a diplomat and you are restricted in what you can say. You are a federal government employee in terms of the relationships with provinces or states, as you call them, regarding the health system. Perhaps we would not have the same point of view if we had representatives of the states sitting at this table. Your federal government is involved more and more in providing health care, just as our federal government is doing in the provinces.

[William Fisher]

The new government in Australia has taken the initiative to have a meeting with all the state premiers, which is part of the normal process, and the main purpose of that has been to look at ways of improving the function of the federal system. The prime minister and the premiers of the various states and territories have come up with a very large list of things they feel they should do over the short and long term to make the federation function well.

I think the motivating force here is what works best, what is the most efficient way of delivering services and handling policy. We face a number of major challenges in Australia that really have to be done at the national level. Obviously, we face climate change. We face tremendous problems of desertification, of water shortage. We face national problems with respect to aging. We face indigenous problems. All of these really require being answered at the national level, and that is what the governments are trying to do, governments at the state and federal level. I doubt you'd get a very different answer from representatives of the state governments to those issues.

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

It's about the same problem we have here.

[The Chair, Conservative, Rob Anders]

Mr. Gaudet, I'm sorry, I can't. You're already over time collectively. I'm sorry. I'm bound by these agreements already set up, so it is what it is. But there will be time later on.

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

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

Thank you, Mr. Luckhurst and High Commissioner, for being with us today.

You talk about 500 private practitioners that you use. Are they on the base, off the base, and are they specially trained to deal with the effects that people who come back from deployment and emergency service will have, which are different from those that an ordinary person like you and me might have?

[Adam Luckhurst]

These are the 500 practitioners linked with the Veterans' and Veterans' Families Counselling Service.

I will say that I'm not 100% familiar with what level of training those individuals have. Certainly, a part of the role of the Veterans' and Veterans' Families Counselling Service is having strong links with the Australian Defence Force, and they do tap into local bases and those sorts of things.

In terms of how those 500 practitioners operate outside of the actual shopfront, if you like, I'm not 100% sure. But certainly one of the things they try to do is make sure that all their staff are aware of the particular issues that face our serving personnel and those who have served in the past.