Veterans Affairs Committee on April 29th, 2009

[The Chair, Conservative, David Sweet]

We'll begin our meeting now. Other members will arrive. I know there has been some delay due to votes.

We have three witnesses here from Veterans Affairs Canada. I also want to tell you that we'll have some time for business at the end of this meeting. I'm concerned because one of the debates about business will be what we'll use for all the contributions for a gift for the clerk. I wonder how long that will take. We'll suspend at 5:15 for committee business, if that pleases the committee.

Right now we'll go to the officials, Darragh Mogan, Brenda MacCormack, and Doug Clorey, from Veterans Affairs Canada.

Do all of you have opening statements, or just one person? Mr. Mogan, you have an opening statement?

I think you know the tradition of the committee. We give you 10 to 15 minutes for an opening statement, and then we'll go by rotation of party for questions.

You may begin.

[Darragh Mogan, Director General, Program and Service Policy Division, Department of Veterans Affairs]

Thank you very much, Chair and committee members, for having us here.

My colleagues, Brenda and Doug, will provide an introductory briefing on the new Veterans Charter, as you begin your examination of this. The briefing will be about the policy foundation of the charter, its content, the outcomes we've had to date, and possibly the future.

It's a privilege for me to introduce Doug Clorey, Director of Mental Health Policy, and Brenda MacCormack, Director of the New Veterans Charter Program.

Brenda will give a brief oral overview of the deck material that you have been sent. I hope that's been distributed, Mr. Chair. Then Doug will talk briefly about the mental health aspect of it.

So if I can, Mr. Chair, I'll turn this over to Brenda.

[Brenda MacCormack, Director, New Veterans Charter Program, Department of Veterans Affairs]

Thank you, Mr. Chair and committee members. I appreciate the opportunity to be here today to provide a brief overview of the new Veterans Charter. We will also provide some information on the mental health context, as well as put the programs into context.

I would like to walk you through a bit of the pre-NVC context and some of the issues we were facing at the time. I will talk about the solutions we arrived at and give you a synopsis of some of the facts and figures at present, now that we are three years in, and talk about the mental health context.

To demonstrate how this works for veterans on the ground, we'll provide you with a few veteran profiles so you can understand the nature of the clients who come before us, then we'll finish with some of the challenges and the opportunities.

In terms of the context of the 1990s and into the early 2000 period, we were seeing an increasing number of Canadian Forces veteran clients. Of course, you are aware that there was an increased operational tempo within the Canadian Forces. We also recognized at that time that we did not really do a lot for families in terms of the services that we offered.

The chart on page 4 gives you a little bit of an outline in terms of the changing demographic and provides you with some insight into the types of client groups we were dealing with. While we were seeing the increased operational tempo with the modern-day veterans, we also were seeing a decline in our traditional vets and an increased need with that group. It created a bit of pressure in terms of the varying needs of client groups.

To put the challenges in some categories, we were seeing CF veterans who were not transitioning successfully out of the military, and we knew the families needed support. We didn't have a holistic, comprehensive, integrated kind of approach to how we were managing transition out of the military and the ongoing success of transitioning CF veterans and their families.

Our response in terms of the programming we had at the time was our ability to offer a disability pension and associated treatment benefits, but there was no income stream into the future. There was no rehabilitation, so really the only mechanism that veterans had to get greater assistance was to be more ill and get more money through a disability pension. Of course, at that time the processing times for disability pensions were lengthy as well, so that compounded the problem of getting to people early.

At that time we were really feeling that our response was inadequate. The problems were not being solved and our liability was increasing, so our solution was to create the suite of programs that has become known as the new Veterans Charter. The investment that we made was to focus on wellness. As you'll see as I go through the programs, that represents the multi-faceted response that really changed the nature of government's response to dealing with this particular group.

Were I to summarize it in a particular phrase, I would say that the new Veterans Charter is meant to respond to individual client needs, to provide services and interventions based on needs, and to provide transitioning members and veterans and their families who are out of the military with opportunity and security.

Another key point is that the focus has been and continues to be trying to achieve a seamless transition from the military. As we go through the programs I'll speak about each of the programs individually, but the programs are intended to work in an integrated fashion. The strength of the programs is in the sum of all of them working together and being responsive to needs. At the time the programs came into being in 2006, the government made a commitment to invest $1 billion in these new programs over the first five years.

Rehabilitation is really the cornerstone of the new Veterans Charter in terms of offering that wellness kind of focus. It's a very comprehensive program that is supported by case management, and the design criteria of this program allow quite a bit of scope in terms of what we offer to clients. It focuses holistically on the client and the family, offers medical services and psycho-social types of supports, as well as vocational.

So the program is not just about getting people back to work, because sometimes that's not possible. It's about improving their quality of life and their functioning at an individual level, community level, and vocational level, if that indeed is appropriate.

There's an accompanying financial benefit package that is part of a dual awards scheme. The financial benefit piece is really about recognizing that there are economic impacts associated with disability, whether they're service-related or career-ending. There's a package of benefits outlined here that's really intended to provide earnings loss benefits for people in rehabilitation, supplementary retirement benefits, and other supports we can perhaps look at in more detail at another briefing.

The disability award is the other part of the economic compensation intended to provide recognition for the impact of service-related disability on the quality of life of the individual. It is a tax-free cash award that's payable based on the level of disability of the individual.

There's also access to health benefits—the public service health care plan—which is really about filling gaps and providing access to that plan for those who would not otherwise be eligible for it.

There's also a job replacement program, which is really a career transition program for folks who are well and who are transitioning out of the military. The package in its entirety is aimed at all of those who are transitioning out of the military, whether they're ill or injured, or whether they choose to leave on their own or they're at a point where they're retiring. So the job placement program is focused on providing career transition types of services that enable them to find employment when they transition to civilian life.

The backdrop of all of this is really case management, which is paramount in helping the client navigate through the system where required, to make sure that the supports are offered at the appropriate time, and to work with the Canadian Forces to ensure that case managers are working in a collaborative fashion as people transition out of the forces, and to continue to work with them as they make that transition.

We've also outlined that there are a number of family supports available through the charter. I won't go into detail on them, but there is a recognition within the charter that the family is paramount in terms of our recognizing their needs and what supports they might require to enable the veteran to make that successful transition, and to maintain that successful transition to civilian life. I've highlighted a few of them on slides 16 and 17.

To date we've assisted close to 13,000 veterans and members and their families. I've outlined some of the program activity pieces, showing how many decisions we've made in particular program areas as well as the favourability rates.

I'll ask Doug now to provide a bit of information on the mental health context, and then we'll just briefly go through a few client scenarios to give you a feel for the program.

[Doug Clorey, Director, Mental Health Policy Directorate, Department of Veterans Affairs]

Good afternoon, everyone.

Although this presentation is on the new Veterans Charter, we felt it was important that you have an understanding of the mental health context in which the new Veterans Charter is provided. As I understand, Mr. Chair, there will be a separate briefing on the full mental health strategy of the department within the next few weeks. Hopefully we'll get into a lot more detail there.

Slide 20 speaks about mental health generally within the Canadian context. Essentially, one out of five Canadians lives with a mental health condition during their lifetime.

The second bullet is interesting as well, because in the Canadian context of those who have need of mental health services, only one-third actually access them, so two-thirds don't. That seems to have some effect also in terms of the specific population we serve. The economic impacts are listed there as well. It's a significant cost to the Canadian economy.

In terms of the extent of need for mental health services, you would be familiar with this, I believe. The increased CF participation in military operations, the combat style of missions, and the more frequent deployment of members of the military with less time to recover and recuperate between deployments have all contributed to increased mental health conditions within the military.

The last bullet on slide 21 speaks to the results of the 2002 Canadian community health survey, on CF members in particular, which identified the four major categories of mental health condition within the military. In order of prevalence, they are depression, alcohol dependency, social phobia, and PTSD. The interesting thing there is that this is the order in which they occur. PTSD, which is obviously very much in the media these days, is actually fourth in the list of the mental health conditions that are experienced.

In terms of clients within the Department of Veterans Affairs who receive disability benefits as a result of a mental health condition, as of the end of March we had 11,888 who have received a favourable decision for disability benefits associated with a psychiatric condition. That breaks down into roughly 63% CF veterans, of whom 12% continue to serve in the military; 24% war service veterans; and 14% RCMP members, of whom 5% are still serving. It is important to note that our strategy on mental health in the department is not just for the CF veterans; it's also for the older veterans. It scans the whole spectrum of mental health conditions, from those related to service at a younger age to those dealing with dementia, Alzheimer's, and all of those related conditions. We've seen an increase in clients of about 8,000 since March 2003. That represents about 1,500 to 1,600 new clients every year with a psychiatric condition who enter our books.

Of all of these clients, 68% have PTSD. Again, I would recall the previous slide, which showed that two-thirds of all of our clients who come forward do so with PTSD. One of the implications there, and we may wish to speak to it at some point in time, is that PTSD seems to be a condition that members of the military and veterans are more open to coming forward with, as opposed to, say, depression.

The third bullet shows the connection with the new Veterans Charter rehabilitation program. We see that 60% of clients coming into rehabilitation--which is a conservative estimate at this point, and it's probably quite a bit more than that--are coming in with a mental health condition as well. That creates a dynamic and a complexity around rehabilitation that is quite significant.

Slide 23 has the breakdown of the numbers more specifically. Of the 2,591 rehabilitation clients within Veterans Affairs, about 1,600 or so have mental health conditions. So it's a significant percentage of clients with mental health conditions that we are trying to rehabilitate into society.

Slide 24 is a very brief summary of our mental health strategy, which is essentially providing access to or in some cases providing within the department a suite of mental health services and benefits that will assist veterans and their families to regain functioning. It's focused on early intervention. The earlier you are able to intervene with these individuals, the more chances of success of recovering and maintaining and retaining full functionality within one's life.

We're also trying to focus on all aspects of life that support mental health and well-being, which we think is unique within the Veterans Affairs mental health programming. It isn't only about health services through psychiatrists and psychologists and other health professionals, but it's also about providing social support, economic support, physical support in the home, and also dealing with individuals on a one-to-one basis based on the World Health Organization's whole-of-person, whole-of-life perspective. We're also building capacity, exercising leadership in the field of mental health, and doing this in partnership with many others.

I won't go into slide 25 in detail, but it's a sampling of some of the services we provide to assist veterans and their families in regaining their mental health and well-being.

[Darragh Mogan]

Mr. Chair, we have a scenario up there. We're beyond the allotted time by a couple of minutes. I don't know whether you want to go through those or just have them there for members to look at as the questions go. I'll leave that to your guidance.

[The Chair, Conservative, David Sweet]

What is your timing? Is it another five minutes?

[Darragh Mogan]

Another five minutes would be great.

Brenda, do you want to walk us through those scenarios?

[Brenda MacCormack]

We've included two or three veteran profiles to demonstrate how the program works on the ground for veterans and demonstrate the needs-based approach in terms of the intervention that's provided. It's very much based on the individual coming forward and what their needs are. You'll see as we go through the profiles that they certainly have varying levels of needs.

The first profile is Justin, who voluntarily released from the military and just needed some career transition, résumé writing type of help. He was able to secure a job he's very pleased with and certainly has provided some very positive feedback in terms of what that program meant to him in transitioning.

The second client, John, was medically released back in 2001. That's five years before the new Veterans Charter came into effect. This particular veteran was quite sick when he came into the program, exhibiting acute symptoms of PTSD, dealing with alcohol, dealing with criminal charges, and marriage stresses, with his wife also being a CF member.

Slide 30 outlines some of the interventions we were able to provide to John in terms of counselling, engaging his family in the plan, providing peer support, and building a trusting relationship. We're beginning to make some headway with this particular client, but I think this demonstrates some of the complexities we're facing. It also demonstrates how clients can come back to the program as many times as they need to. This client would have had some assistance coming out of the military, but he's still struggling, so he will come back and we'll work with him again. At this point, this is a veteran we're continuing to work with. He's still unable to work. We're continuing to help with improving functioning at a family and community level. The marriage certainly remains stressed. Again, that is part of one of the goals we're working on with him, and we'll see over time whether our vocational goals can be achieved.

The last one is Greg. This would be an example of someone who came out of the military with a fairly serious disability back in 1996, being a bilateral amputee, below the knee amputation, but who transitioned well out of the military. He stayed home for a number of years and was the primary caregiver to two young sons. The sons are now in school, and he feels he wants to contribute more to his family situation. We're able to offer those supports to Greg through the programming with some additional prosthesis to allow him to do the work he wants to do and the training that is consistent with what he would like to do in terms of moving forward. He has been very successful and is on his way to a final work term in the marine industry.

Again, this highlights some of the varying levels of need that are presented.

[Darragh Mogan]

Mr. Chair, in the scenarios we purposely did not put the amounts of the benefits the individuals received. They're fairly extensive in the latter case, and we can do that; however, we wanted to show what the outcomes of our interventions were compared to what we would have been able to do before the new Veterans Charter, which would have been to give a person a pension, and that would have been it.

That was the purpose of this scenario. Thank you very much for your patience.

[The Chair, Conservative, David Sweet]

Thank you very much, Madam MacCormack, Mr. Clorey, and Mr. Mogan.

We'll go to questions now. We'll begin with the Liberal Party and Madam Sgro.

[Judy Sgro, Liberal, York West, ON]

Thank you very much, Mr. Chair, and thank you all very much for coming today.

You've given us an enormous amount of material here, and you went through it very quickly. I think probably all of us have a lot of questions. I have to salute you all for the work you've done on this document, because it's very impressive. I think all of us want to ensure that our veterans, the older ones and the younger ones, are receiving the care and respect and assistance they need. I appreciate in particular having the scenarios for Justin, John, and so on to give us a better idea of exactly what you're facing and what kind of support is there.

On the job placement side, when you're trying to assist people to get back into the system, are you able to get preferential treatment from employers for men and women who have been in the service? Do they recognize the individual's qualities and the contributions that he or she has made to our country? Do they get preferential treatment when looking for a job?

[Brenda MacCormack]

The job placement program is targeted at those who are voluntarily releasing, people who generally choose to leave. I can say that there's a great deal of interest in the community at large to hire ex-military. I think they're well recognized for the skills they bring and the leadership they can offer. At this time, yes, I think there's certainly lots of interest out there.

Through the changes to the Public Service Employment Act, there are some opportunities as well for those who are medically releasing to have priority access to federal public service jobs. That is absolutely priority access. There's also an opportunity for those who are still in the military--serving members--to apply for government jobs, public service jobs, that are open to that CF population.

[Judy Sgro, Liberal, York West, ON]

Prior to the living charter coming forward, what kinds of services would John or Justin have received?

[Brenda MacCormack]

Before the implementation of the new Veterans Charter, they would have received a disability pension if they had a service-related disability. The amount that would have been payable would have been based on their level of disability and any treatment associated with that, and if the disability was minor, it might not be a significant amount. There would be no capacity to provide any kind of an earnings loss stream and no capacity to focus on what kinds of interventions might be required from a rehabilitation perspective to allow them to reintegrate themselves and their families back into civilian life.

For those releasing on a voluntary basis, there was no capacity to have a national approach to finding them jobs that matched the skills they had.

[Darragh Mogan]

I might add that there was no support for families. It's different for families now. People have a career in the military, as opposed to the situation at the end of the Second World War, when after three years of service in a civilian army, they went back home.

They don't have a home to go back to, so we need to support the families that have been moving from base to base and have experienced deployments of people overseas in increasingly risky operations. We didn't have any capacity to support them, and we do now.

We were offering the case management service primarily to traditional veterans and not to the modern veterans, and the modern veterans with severe disabilities really need that kind of help. A number of things that were both benefits and services didn't exist before the charter, and they exist now. Of course, our mental health capacity has been greatly strengthened as well.

[Judy Sgro, Liberal, York West, ON]

With respect to the issue of mental health, we were talking a lot about PTSD and the new clinics and services that are being made available. At one point, many of those services would have been referred to as mental health services. What is the difference between mental health services and PTSD? Are they not similar?

[Doug Clorey]

PTSD is one of many mental health conditions. When we speak of mental health services we're talking about services that address a variety of mental health conditions, PTSD being one, but also depression, anxiety disorders, social phobia, any of those. The operational stress injury clinics focus on all the operational stress injuries. So it could be any of those, but it tends to be primarily post-traumatic stress disorder.

[Judy Sgro, Liberal, York West, ON]

Even though we are in 2009, we still haven't got over the stigma when you talk about mental health, especially for men and women coming from the military. We all know they've had a horrific experience, especially our younger men and women. For them to go to a clinic for PTSD I would think would be a much more acceptable and an easier transition for them to say they're experiencing various things and get help, rather than 20 years ago, or 10 years ago, going and saying there's a mental health condition there. Are you paying some real sensitivity to those issues of wording and terminology?

[Doug Clorey]

Absolutely. We speak of operational stress injuries exactly for that reason. It was understood that to talk about mental illness within the military had such a large stigma that individuals would not come forward to access treatment or any other services. So DND coined the term “operational stress injury” so there was an understanding it was related to operations; it was like any other injury, physical or mental: it's an injury and it was related to the stress related to the operations. Just that nomenclature has gone a long way, especially within the military and the veteran community, to reduce the stigma associated with mental illness and to allow people to come forward to receive the services they require.

[Judy Sgro, Liberal, York West, ON]

Are the men and women in the reserves entitled to all these services as well?

[Darragh Mogan]

Yes, there's no distinction.

[Judy Sgro, Liberal, York West, ON]

There's no distinction.

[Darragh Mogan]

Being reserve service, the difficulty of course is finding them, because they can come and go at will. That's the challenge, to make sure that when they leave the military.... We offer a transition interview to anyone who is leaving the military, but if you don't come back for a second or third contract when you're on reserve we don't see you again. That's a real challenge. We have a special initiative on outreach to reservists because we believe there's a hidden problem there in terms of transition to civilian life that we need to track better than we have.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Mogan.

Thank you, Madam Sgro. It's seven and a half minutes.

Monsieur André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Good afternoon.

I have a few questions. With regard to trauma and operational stress. Have you developed, through years of research, ways of further preventing operational stress in the people we send on military missions?

With the new charter, we see that you have developed rehabilitation programs to help veterans with operational stress. What results have you achieved?

We're talking about mental health problems. Are there any other mental health problems found among former military members apart from operational stress? What are those types of diseases? In Quebec, how do you cooperate, for example, with the CLSCs, which provide front-line services?

I know very well that stakeholders have expertise with regard to certain mental illnesses, but others have less. Do you provide training for specialists, caseworkers, psychologists through health facilities in Quebec and Canada to enable those professionals to provide services to these people near where they live?

We talk about people in rural areas who often have to travel very far to access services. What are you doing in that regard? Do you have any projects to improve the quality of services for those persons?