Veterans Affairs Committee on Nov. 19th, 2009

[The Chair, Conservative, David Sweet]

Good morning, ladies and gentlemen. Welcome to the 34th meeting of the Standing Committee on Veterans Affairs. We're continuing with our study and review of the new Veterans Charter.

We have some very distinguished guests with us. We have Gordon Sharpe, who I understand served in the CF and retired as a general.

Is that correct, Mr. Sharpe?

[Brigadier-General, Retired) Gordon Sharpe (As an Individual]

Yes.

[The Chair, Conservative, David Sweet]

We have Don Ethell, who is chairman of the committee of the New Veterans Charter Advisory Group. Of course we've heard from Don. I merely have to say to you to look at his chest and you'll realize the great service he's been to this nation and frankly to the world because of his United Nations and NATO service that he's also had in the past.

We have Muriel Westmorland, who is an occupational therapist, and also Patrick Loisel.

Do all the witnesses have opening remarks?

[Professor Muriel Westmorland, Professor and Chair of the Committee, New Veterans Charter Advisory Group]

I'm the chair of the committee, and I do have the opening remarks, which I submitted ahead of time.

[The Chair, Conservative, David Sweet]

I'm sorry. The chairman of committee number 3, family support, is Mr. Ethell. And Muriel Westmorland is professor and chair. Thank you for correcting me.

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

Point of order, Mr. Chair. We received a document, but it is not in French.

[The Chair, Conservative, David Sweet]

The clerk is looking after the documents.

I would just ask the witnesses whether you all have opening remarks. It's just the chair? Okay.

Ms. Westmorland, you can go ahead with your opening remarks. We like to keep it to around ten minutes, but we're fine if you need some extra time, and then we'll go to a rotation of questions.

[Prof. Muriel Westmorland]

I've actually timed it. It should be well under ten minutes.

Thank you very much, Mr. Sweet, for your welcome.

It's a pleasure and an honour for me to appear before you today to present a brief overview of the work of the New Veterans Charter Advisory Group and to highlight the key elements of our report. I am also very pleased today to have with me two of the three chairs of the three subcommittees we formed. Colonel Don Ethell chaired our family support committee. Brigadier-General Joe Sharpe chaired the economic needs committee. And as Dr. Vivienne Rowan, who is chair of the rehabilitation committee, could not be with us, I asked Dr. Patrick Loisel if he would appear, because he is an internationally known researcher who is well respected in rehabilitation and return to work. I'm delighted to have these gentlemen with me. They will be pleased to respond to questions later as well.

The aim of these opening remarks is to set the scene, as it were, and to highlight the recommendations in our report. As I mentioned, my colleagues and I will be happy to answer questions you may have to the best of our ability.

The New Veterans Charter Advisory Group was established in 2006 and had its first meeting in the spring of 2007. I had previously been a member, as had Don Ethell. Joe Sharpe was also involved with the VAC-CF Advisory Council, which produced the report "Honouring Canada's Commitment: 'Opportunity with Security' for Canadian Forces Veterans and Their Families in the 21st Century”, under the chairmanship of Dr. Peter Neary. In the last paragraph, this report states that the men and women of the Canadian Forces, wherever they serve, “ should be assured at all times that our country has a comprehensive, coordinated, and easily understood plan for their future”. This statement, of course, was also echoed in the title of that report: "Opportunity with Security".

As you know, Veterans Affairs Canada took this advice seriously, and in 2006 the act that is now known as the new Veterans Charter came into effect. It is also known as the living charter, in that there was an initial commitment and continued commitment to continuously review and evaluate the programs developed under the new Veterans Charter.

The New Veterans Charter Advisory Group was established in the context of the latter. Its role was to provide advice and guidance to the Department of Veterans Affairs as it implements its modernized services and programs and to monitor the ongoing responsiveness of these initiatives in meeting the needs of CF clients, RCMP clients, and their families. This advisory group has representatives from several veterans organizations, a family member whose husband died as a result of injuries in service, and academics with backgrounds in rehabilitation, treatment of mental health conditions, disability management, return to work, and policy issues affecting health and wellness.

At our first meeting we were charged with developing a report on the new Veterans Charter suite of programs over the next 18 months. We immediately established three working committees to focus on families, economic needs, and rehabilitation. This structure proved to work well as the three groups met in committee and shared their thoughts and experiences related to these areas. There was much experience in each group, which had a mix of membership from veterans organizations, both VAC and RCMP, academics, and at times VAC staff. The development of the report was based on major principles encompassing determinants of health, wellness, and life course. It is important to stress these.

The evidence regarding the key determinants of health is solid. There is no doubt that families, economic support, and early intervention are very important factors in not only preventing illness but in maintaining wellness. The life course is a concept stressed in the Gerontological Advisory Council’s report “Keeping the Promise” and reminds us that when we think about the needs of veterans, we need to think about them within the framework of their lives, not within just one period in time.

It is with these principles in mind that the New Veterans Charter Advisory Group has developed the 16 recommendations contained in the report. The following recommendations are accompanied in the report by a detailed rationale. I will just highlight them here, as I am sure that you will follow up with specific questions.

The first area is strengthening family support services. This is an area that is no surprise, I am sure, to this committee. There has been a growing awareness and sensitivity to the families of our serving military members and veterans, but there is still more to be done. We provided five recommendations.

First, number 1.1, take steps to create and maintain a respectful family-centred culture in all Veterans Affairs Canada programs. Second, number 1.2, fill service gaps to ease transition to civilian life. Number 1.3, improve access to skilled, knowledgeable health care providers. Number 1.4, provide more support for family members caring for veterans. Number 1.5, provide more support for survivors and families of the fallen.

The second area is on ensuring financial security. Socio-economic stability is essential to the optimum health and wellness of our veterans. It is with this in mind that we submitted the following recommendations under ensuring financial security. Number 2.1, end the legacy of the insurance-based approach to economic benefits. Number 2.2, ensure disabled veterans receive a fair, equitable income consistent with a normal military career. Number 2.3, increase access to the permanent impairment allowance. Number 2.4, ensure non-economic loss awards are comparable to those offered in civil society.

The third major area is raising the bar for rehabilitation services and outcomes. Veterans Affairs recognizes the importance of rehabilitation in assisting veterans to resettle back into their communities, but our committee felt that there is still more to be done: 3.1, modernize the rehabilitation programs; 3.2, improve case management services; 3.3, improve access to Veterans Affairs rehabilitation services; 3.4, repair damaged relationships with providers.

We then added two more major recommendations. Number 4, actively promote new Veterans Charter programs and services. Number 5, establish performance measures to gather data and assess impact of programs. Under that number five item, we had two recommendations: 5.1, monitor programs and services; 5.2, invest in research, because there's still more research to be achieved in the area of rehabilitation, and other areas too, and its impact on the veteran, particularly the area of transition to civilian life and work.

The New Veterans Charter Advisory Group considers all these recommendations to be important, and therefore has not prioritized them. We feel it's not our job to do so, and therefore present them as equally important and informing an integrated whole.

Thank you for this opportunity to make these opening remarks. I will close by emphasizing the importance of moving forward as quickly as possible to the process of implementation, in order that our veterans receive the kind of care they not only need but deserve.

Thank you very much.

[The Chair, Conservative, David Sweet]

Thank you, Madam Westmorland, for your opening remarks.

We'll go to our rotation of questions, first to the Liberal Party for seven minutes. Madam Sgro.

[Judy Sgro, Liberal, York West, ON]

Thank you very much.

Welcome. It's very nice to see you here. We were looking forward to the work we're doing on the charter. It's most important to have you come before us to help ensure that we understand the complexities of some of these issues and the importance of them. So thank you for your contribution and being here today.

I'd like to focus specifically on the issues of the disabled, and the economic issues. You clearly made some mention of them and you've done some work on them, so I'd like you to further discuss that whole issue.

We've just finished dealing with Mr. Stoffer's Bill C-201, which talked about the bridging issues and all of the funding problems that seem to have occurred to people unexpectedly. We heard from the department about the way that system works, and it's not uncommon and it's unfortunate that people didn't know.

I'm particularly interested in issues in and around the disabled because I believe they need additional assistance, not less. Especially when they've reached that point of 65, I think it's a serious problem, and the legacy of the insurance industry. Would you elaborate more on that particular part?

[Prof. Muriel Westmorland]

Certainly I can respond, and then I think we have other comments from my colleagues, if that's okay.

I have actually had a fair amount of experience myself working in the insurance industry as a therapist, very much in auto insurance and the LTD and STD areas. There's been a major concern about the constraints that an insurance context lays on the disabled individual. It not only is stressful because they have to deal with the rules and regulations, but there is a tendency, and it's rampant throughout the insurance industry, to really curtail what can be offered. When a person is going through enough trauma, they really don't need that kind of constraint. So that's a major concern of mine.

I have listened to the expertise around the table, and certainly when I was first on the VAC/CFAC Council that came up as a major item. It was very much in the discussion our committee had. I know Joe, in particular, has some comments he'd like to make about that, please.

[BGen Gordon Sharpe]

I'll keep my comments fairly brief.

None of us have a grudge against the insurance industry, by any stretch of the imagination. Our concern is that the principles that are inherent in an insurance approach work well for houses, cars, and things like that, but they don't work very well for people, partly because it's very difficult to put an accurate cost figure on things, but it also renders, if I can use the term, the individual who's the subject of this sort of claim into a victim, almost, into somebody who has to defend the approach. From an organizational point of view, from a bureaucratic point of view, the insurance principle tends to drive you to minimize payouts, because the reward is the minimum that you can pay out, and it drives us in the wrong direction, particularly in bureaucracies.

I think one of our concerns is that the service income security insurance plan piece of work inside the Department of National Defence was built upon that principle, and a lot of those thoughts have progressed or migrated out into the veterans affairs side as well. We tend to see a lot of the programs in veterans affairs driven by that insurance principle. That's our concern with that one.

It's kind of an underlying or a foundational type of thinking that goes into the approach to some of these benefits, and I think that's really where our concern is. We need to walk away from that altogether and start looking at this from a human dimension and take that approach, as opposed to the insurance principle.

[Prof. Muriel Westmorland]

Dr. Loisel would like to make a comment, if that's okay.

[Dr. Patrick Loisel, New Veterans Charter Advisory Group]

Yes.

I will speak in French, as it is easier for me, even though I am bilingual.

I'm working at the University of Toronto now, but I am from Quebec.

As has been pointed out, the medico-legal model does not work well for rehabilitation in general, and it is even worse for work rehabilitation. This is a problem that affects the worker's compensation board, as well. As you said, it works well in the case of house or car insurance. It ties the cause to the incapacity. In this case, with an injury or accident that occurred on the battlefield or in the course of military life, insurance has to be responsible for the consequences. In actuality, modern scientific models show that is not the case. A person cannot dissociate the amputation of their right leg from their psychological condition, their family problems or their difficulty returning to work. All those factors are intertwined for that person.

Insurers, in general, want to avoid having to provide compensation related to those other problems. As I noted to this committee, that is a major problem, but one that holds a lot of interest for me. I was very shocked to see that the same thing was happening with Canadian armed forces and veterans. Veterans and members of the military need insurance coverage that protects them from the consequences of incidents that can arise in combat or in the course of military life. When they become injured and have to undertake rehabilitation therapy, the insurance company inevitably tries, for obvious reasons, to impose limits on access to services.

It is not a matter of providing unnecessary services, but a range of services are needed to treat the person as a whole. That is the trouble with the medico-legal model in insurance.

[Judy Sgro, Liberal, York West, ON]

We've heard many comments from veterans on that issue of how they are treated.

You set out a variety of issues here and you didn't want to prioritize any. If I could just suggest to you, over and above the work that we do, one of the things you might really want to champion is that very issue and try to get on with dealing with that, and we could work in a bit of a coordinated manner. I think that's a really important issue that we should go after and make the change that's necessary to ensure that the lives of our veterans are treated with respect.

Thank you.

[The Chair, Conservative, David Sweet]

Now on to the Bloc Québécois.

Monsieur André, seven minutes.

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

Good morning, everyone. I am always happy to hear someone speak to us in French; it is pretty rare here, in the House of Commons.

In your document, you talk a little bit about support for natural caregivers. I would like to tell you about the story of Frédéric Couture, a former member of the military, who tried to commit suicide in Afghanistan, while with his colleagues. He had just lost his leg after stepping on an explosive. He then ends up here in Quebec, in the Granby area. He is depressed, suffers from post-traumatic stress syndrome and has trouble accepting what has happened to him. One year later, Mr. Couture takes his life.

During a television program on Radio-Canada, his mother, who was his natural caregiver for a year, criticized the fact that she had never been told about what happened in Afghanistan. You probably heard about the case. Enquête, a television show, did a story on it two weeks ago.

It is a lack of respect for natural caregivers, the parents, those taking care of their children. I would like to hear your thoughts on that. Is it a serious problem? When an accident like that happens in combat, do you think that the individual's family should be told what is going on?

[Prof. Muriel Westmorland]

Thank you for that question. I know that both Colonel Ethell and Brigadier-General Sharpe want to respond, so I'm going to ask Colonel Ethell to respond first.

[Colonel, Retired) Donald S. Ethell (Chairman, Committee No. 3 - Family Support, New Veterans Charter Advisory Group]

Sir, it's a very good question.

You may be aware that there are a number of other committees that are run by Veterans Affairs Canada. To go back to Madame's question, there's the advisory group on special needs, which is 80% physically and psychologically damaged, to make sure that people don't drop through the cracks. That's chaired by Major Bruce Henwood, a double amputee. He had his legs blown off in Croatia. They in fact are going to meet next week, and Professor Westmorland and myself will be there as chairs of other committees.

In my own case, I chair the joint DND-Veterans Affairs-RCMP mental health advisory committee, and we will be meeting here for the third time on December 1 and 2. That advisory committee is divided into the family, the clinical, and innovative methods, and we are leaning on and seeking advice from what we call external experts—psychologists and academics, psychiatrists and so forth—from across the country. General Sharpe in fact is the vice-chairman of that committee. I can't go anywhere without him. He contributes, and they all contribute.

We will not be concentrating on suicide, but there's a great deal of concern, not only in Veterans Affairs Canada, but in DND. As you may have heard, there was an initiative put forward by the CDS in regard to mental health a number of months ago, and recently an enhanced suicide prevention program.

And it's not just Afghanistan. I've talked to many psychiatrists, and I'm a sufferer from PTSD myself, so I understand the process you go through, where an incident or incidents in Afghanistan.... I'm not a clinician. However, having personal experience, it's not necessarily that event that is causing their problem. It's triggered something that may have happened in Croatia. It may have been something in Bosnia. It may have been something in Central America, and so forth. It's accumulative.

So when you say the family should be told what happened in Afghanistan, first of all, there's a privacy issue. And secondly, with the individual, when he is going through the process, particularly with the OSISS group, the group that's going to refer them to the professionals, be it at an OSI clinic or a DND OTSSC clinic, as it's called, they're very careful that they don't ask the individual what happened. That's really what you don't want. That's for the psychiatrist and the clinical people to determine.

We have had a number. We're all well connected in the veterans community, and it's very tragic when we hear of J.T. Stirling in Calgary, who, a week after we talked to him, overdosed. Master Corporal Macdonald, back from Afghanistan, a year and a half with the Strathconas up in Edmonton, still got in uniform and killed himself. These are very tragic. And rest assured that there are many people, not only in the military but in Veterans Affairs and in the RCMP.... The RCMP is playing catch-up in regard to this. With all due respect, they need to play catch-up and they are participating in this committee.

So that's a rather rambling answer to what you have asked, sir, and hopefully it does clarify it.

[BGen Gordon Sharpe]

If I could just talk on two issues, then you can follow up with Don.

You really raise two issues here: one is that dealing with mental health issues in general is not a medical issue, it's a leadership issue. It's a chain of command issue. That's a drum we've been beating from the mental health advisory committee for a bit of time with the Canadian Forces. There is a tendency to transfer responsibility for people when they're injured psychologically to the medical community and say, “Okay, that's their job, let them take care of it”. That's a serious mistake for the average soldier. He or she doesn't respond to the medical community the same way they do to their leadership chain. So we need to increase the involvement of the chain of command, the leadership, with these young men and women, whether they're in the service or they're not.

That's the second point. There's a transitional period when the soldier transfers from the military to civilian life or whatever follows. That is not being well handled, in my personal opinion—and this is a personal opinion. We lose them when they transition. It happens with great frequency with our reservists. Ten years ago, this was an issue that came up during the focus on the Croatian veterans who had come back. I chaired a board of inquiry looking into some of the issues, particularly suicides and serious physical and mental problems from that. At that point, ten years ago, we said, “You have to do a better job of tracking reservists as they transition back to civilian life”. The answer was, it's hard. It's hard to do that. I understand it's hard to do that, but we're ten years later, and a lot of these young men and women who are having the problems are having the problems because we've lost track of them. We have to do better there.

I think that leads to the other point that you've raised about the interaction with the caregivers, who are almost always the families—as long as families are able to stay with these people. If we were tracking them better, I think the interaction with caregivers would be better. If the interaction was with the chain of command, it would be better than if it was with just the medical community, because the medical community—and I have tremendous respect for that community—is a bit hung up, if I can use the term, on privacy and all these rules and regulations. The chain of command has a tendency actually to work around that, when they need to.

So that's the other point I would stress, that we have to focus on transition and we have to focus on the continuation of the responsibility of the leadership. That means Andy Leslie, the commander of the army, and all the guys down below him continuing to be responsible for these people as they transition.

[Col Donald S. Ethell]

If I may, I'd just add a comment there, sir.

[The Chair, Conservative, David Sweet]

Go ahead, Mr. Ethell.

[Col Donald S. Ethell]

I apologize for taking your time. I just had one more comment.

To go back to the note that Professor Westmorland made regarding the Veterans Affairs Canada and Canadian Forces Advisory Council, which we set up, the term PTSD was foreign to a number of us—quite a few of us. It was the old expression of the army to “suck it up”—you haven't got a problem, go and have a beer with the boys and we'll get over it—until Lieutenant Colonel Stéphane Grenier came aboard and gave a very emotional speech. General Roméo Dallaire was a member of our committee, and of course he's the one who came out of the closet, to use that term, to emphasize that problem. That penny dropped on many of us, and we started looking at PTSD, operational stress injuries. If you look at the Neary report, you'll see that it evolved into a major issue, and it carries on, of course, into the New Veterans Charter Advisory Group and the mental health advisory committee.

I'm sorry I took your time.

[The Chair, Conservative, David Sweet]

No, that's fine. We have to keep the time on the members, but we've always allowed flexibility for the witnesses to answer, so thank you.

Monsieur André, you'll have another round to follow up on those issues.

Now we go to the NDP and Mr. Stoffer for five minutes.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you, Mr. Chairman, and I thank everyone for coming today.

I would advise our committee to turn to pages 16 and 17 of the report you gave us, and the examples of Alain, Maria, and Terry. I just want to say how disappointed I am to see these three examples--and there are probably thousands out there--of people who have to suffer the way they do because they've been medically released. In Terry's case, he believes he was kicked out of the military. I find it unconscionable that in 2009 we still have these examples, and many, many more.

Have you brought these up to the veterans ombudsman or the DND ombudsman? Does your advisory group work closely with those two ombudsmen in order to assist DVA and DND in mitigating what I heard referred to the other day as “cracks”? These aren't cracks; these are crevasses and major holes.

I want to give you an example from Roddie Ohandley's testimony. He was here the other day. He is a disabled RCMP officer who gets 64% of his salary from his annuity, but because he was entitled to 75%, Great-West Life, that fantastic insurance company, topped it up by 11%. That 11% top-up only goes for two years. After that he's told he should apply for Canada Pension Plan disability, which he does. He's entitled to it and gets a $16,000 lump sum.

The first thing the RCMP's annuity does is take $11,000 of that back, and Great-West Life wants $8,000 back. The total of $11,000 and $8,000 is $19,000. He only got $16,000, so he owes money because of his disability. Then, when he turns 65, bang, he gets hit again--not once, not twice, but three times.

I ask you folks this: in the spirit of fairness to a person who wore the uniform of Canada, is that fair? What can your advisory group advise the government and all of us as to how we can fix this, not two years from now, but right now?

Thank you.