Veterans Affairs Committee on May 13th, 2010

[The Chair, Conservative, David Sweet]

Good morning, ladies and gentlemen. Bienvenue à tous. Welcome to the 14th meeting on a review of the new Veterans Charter.

Our witnesses have given me the nod to say they're ready, so I will introduce them briefly.

I believe Madam MacCormack will make the opening remarks. She's a director of rehabilitation. Janice Burke is the acting director of mental health. Jane Hicks is the acting director of operational direction and guidance.

Now we'll allow Madam MacCormack to make her opening remarks. I think you're familiar with how the committee works after that. We'll go through the rounds of questions.

I would like to point out that Mr. Vincent's request was fulfilled. You have samples of application forms for benefits in your packages, as well as the decks that the witnesses will be using.

Madam MacCormack.

[Brenda MacCormack, Director, Rehabilitation, Department of Veterans Affairs]

Thank you.

Mr. Chair and committee members, my name is Brenda MacCormack and I'm the director of rehabilitations at Veterans Affairs Canada.

It's my pleasure to appear before you again today with my colleagues: Janice Burke, the director of mental health; and Jane Hicks, the director of operational direction and guidance.

You heard from other colleagues last week on the disability and income support programs. We are here today to talk about rehabilitation, career transition services, and mental health.

As you requested last week, Mr. Chair, we provided a presentation in advance, including four case scenarios. We gave the clerk hard copies for distribution today as well. I'll be referring to that presentation in my remarks, and we'll be happy to walk through those case scenarios in more detail if members wish.

We have been following your committee's study closely and have noted one important question that is arising: is there anything really new with the new Veterans Charter? So I'd like to start by responding to that question for you today, from the perspective of the rehabilitation program.

First, a veteran doesn't need to be receiving a disability benefit to be able to get rehabilitation services. This is new and critically important to making sure veterans and their families get services early, which I know you've heard before is essential to success. We don't have to wait for a disability award to be approved, which can sometimes be a lengthy process and can delay getting someone into rehabilitation services.

Secondly, we can now provide economic support while the client is in rehabilitation. We could not do that under the Pension Act. We could provide disability pensions, but in many cases there would certainly not be sufficient income to allow the person to undertake rehabilitation. As my colleagues emphasized last week, having an appropriate level of financial support at the time it's needed is critical to achieving successful rehabilitation outcomes.

Third, we now have the authority in legislation to help veterans who are not eligible for SISIP because they were not medically released from the military, or perhaps were medically released a number of years ago and are once again experiencing challenges. I know many of you are concerned about this group of veterans who were falling through the cracks before the new Veterans Charter. I want to be clear that these veterans could not before, and still cannot, receive services from SISIP because they were not medically released, or they may have been released quite some time ago and have emerging challenges.

VAC is now able to help them get back on their feet. An example of Ron, starting on page 17 of the presentation deck we've provided, shows how we might do that.

I know your committee has also heard about veterans who start showing signs of post-traumatic stress disorder ten years after leaving the military. The new Veterans Charter was designed to help these people as well, no matter when the disability manifests itself. In fact, one-third of our clients currently in the rehabilitation program have been out of the forces for at least eight years.

Fourth, we now have the authority in legislation to provide rehabilitation to spouses and survivors if the veteran is unable to participate. As you'll see in the Paul case scenario, starting on page 22 of the presentation deck, this is vital to helping restore the family's earnings capacity. You'll note that Paul's wife Kelly can now pursue a nursing degree and get the support she needs to be successful. Kelly and the children can access counselling in their own right--and I'll speak more about our mental health services in a moment. This example of Paul shows the shift to seeing the veteran as part of a family and a community, not an individual in isolation.

Now, we can take a more holistic approach to the treatment and support required for disabilities that hinder successful reintegration. Previously, under the Pension Act, we could provide health care services only in cases where veterans were receiving a disability pension.

On page 27 of the presentation, we have André's case scenario, which is based on the example that Mr. Vincent asked us to examine. André lost his right arm and three fingers on his left hand as a result of an IED. Of course, André will receive psychotherapy, occupational therapy and prosthetic care, among other services, but we can also support André by offering him driver training to help him overcome his anxiety, which resulted from his traumatic experience. If he experiences depression such that it becomes a barrier to him, that can also be taken into account to achieve the objectives set out in his rehabilitation plan.

We can go beyond treating just the amputations. Under the New Veterans Charter, our medical and psycho-social programming is much broader than our traditional treatment programs. It allows us to meet the specific needs of a younger population making the transition to civilian life.

The rehabilitation program recognizes that injured and ill CF members and veterans are committed to getting well. They want to engage in treatment, establish goals for themselves, and accept their own roles in their health and treatment. It's premised on a more holistic and integrated approach that focuses on the goal of independence and return to active engagement in family, work, and community.

Clients in the rehabilitation program receive individualized case management. What does this mean? It means that case managers sit down with the client and their family, assess needs, develop goals and intervention strategies in collaboration with health professionals, and help them transition to VAC services, benefits, and programs, as well as community resources.

The committee requested examples of our approval forms, which we have provided. I want to stress that we don't just give these forms to veterans and abandon them. The case manager can help the client and family every step of the way, advising them as required, including gathering evidence.

Mr. Oliphant commented earlier this week that CF members experience a significant cultural shift when they're released from the military. We recognize that as well. That's why case management begins prior to release from the military, in collaboration with CF case managers, to ease them through that transition and provide support as early as possible.

The 19 integrated personnel support centres set up across the country are playing a vital role in making sure that CF members and their families are aware of the full range of benefits and services available to them, and that they can get all the information and help from both DND and VAC in one place.

As you'll see on page nine of our presentation, 50% of clients entering our rehabilitation program have an identified mental health condition. So to support the new Veterans Charter we have also invested in mental health supports. We have a comprehensive mental health strategy based on four pillars: providing a continuum of services, building capacity across the country, showing leadership through research, and nurturing partnerships.

Our strategy is based on a whole-person approach that recognizes the impact of personal, physical, social, economic, and health circumstances on mental health. The objective is to promote wellbeing, symptom reduction, recovery, community integration, and enhanced quality of life.

Our network of ten operational stress injury clinics across the country and the operational stress injury support program, or OSISS, as it's better known, are key to reaching out to potential clients battling the stigma associated with mental health conditions, and helping people get support and treatment.

Serving members and veterans of both the CF and the RCMP and their families can receive services. Over 2,700 people have been helped by our OSI clinics, which is more than 20% of our total number of clients receiving disability benefits for mental health conditions.

The final topic I'd like to touch on today is VAC's career transition services. Whereas SISIP and our rehabilitation program are focused on those with health difficulties, the career transition services target those who are voluntarily leaving the forces, both regular and reserve. It offers practical advice and help in finding suitable civilian employment. There are three key services: job-search training workshops, individual career counselling, and job-finding assistance. This program can begin while the member is still in service. This is a new benefit under the new Veterans Charter.

In summary, we are now able to help a wide variety of clients in a wide variety of circumstances. So whether it's someone who has a minor injury but is unable to pursue his or her occupation, or someone who is releasing from the Canadian Forces after suffering a catastrophic injury, the new Veterans Charter can help, proportionate to the level of assistance each one of them needs.

Thank you for the opportunity to appear before you today. We look forward to responding to your questions.

Merci.

[The Chair, Conservative, David Sweet]

Thank you, Madam MacCormack.

We will go to our first round of questions.

Seven minutes, Mr. Oliphant.

[Rob Oliphant, Liberal, Don Valley West, ON]

Thank you.

I want to focus on spouses, partners, and family members for a moment. I put an order paper question in on this regarding what percentage of veterans' spouses, partners, and family members who were eligible to receive rehab services availed themselves of those services. Veterans Affairs has told me that 11% of eligible spouses and family members have actually availed themselves of your services.

Do you have an understanding of why that would be? Why would 89% of eligible spouses not avail themselves of that? Have you done studies on that?

[Brenda MacCormack]

I have to admit I'm not familiar with the stat of 11%, but....

[Rob Oliphant, Liberal, Don Valley West, ON]

It's from your department and you're the director.

[Brenda MacCormack]

We have the capacity to offer rehabilitation services to families and spouses in their own right when the veteran himself can't participate in the rehabilitation. In that case they can partake in training and all the vocational components. There is also capacity for the spouses and children to participate in treatment when that's required to meet the goals of the rehabilitation program.

[Rob Oliphant, Liberal, Don Valley West, ON]

I understand the program. My concern is that 89% of those who are eligible don't avail themselves. So I'm wondering, what is your outreach program, what is your analysis? And what are your case management workers doing to make sure that spouses actually understand what they can get? What systems do you have to make sure that it doesn't just go through perhaps a mentally ill, multi-disabled veteran to get to his or her spouse? Are there programs that you are doing to actually promote this?

[Brenda MacCormack]

Yes. The point that you raise in terms of outreach and communicating the programs and having them understood by our clients and their families is one we have done some work on but we need to do more.

Jane, from the operational guidance perspective, can offer some particulars around what we're doing on the outreach piece, and maybe speak a little bit about case managers and how they link with families and make them aware of services.

[Jane Hicks, Acting Director, Operational Direction and Guidance, Department of Veterans Affairs]

Certainly case managers will contact family members to find out if in fact they are eligible or are interested in the benefits and services through the rehab program, and ensure they understand them. Often if it's an ill or a disabled member. However, they do have to go through the member. But what they will do is seek the permission of the member to go to the family or speak to the family, because we try with the rehab to have a comprehensive.... It's all about the family and the member and how they work with the family.

Sometimes the member does not want us to do so, and we have to respect that. But certainly the case managers work with the family. There are a variety of supports in place for family. We have OSISS, the OSISS family peer support program if the families require assistance. So there are a variety of services.

In some instances family members often have their own careers as well and don't require the assistance of the rehab program and are coping well. It all depends on the individual circumstances of the family.

[Brenda MacCormack]

And just in terms of outreach generally, I think I stated that we do need to do more. I think that's clear. We are aware there are many who don't understand the benefits that are available, so we do have an outreach strategy that is looking at who we need to be speaking with. We do transition interviews. We do a number of briefings within CF environments before they go on deployment, when they come back, during second-career transition workshops. Again, the message may not be landing at the time because maybe it's just not a message that is relevant to them at that time.

We also do briefings at family resource centres, and we've found that to be very valuable, because the more the spouses and families know, the more likely they are to avail themselves of services.

We do publishing in the CF Maple Leaf, as well as our own newsletter, called Salute!, which reaches 260,000 on a regular basis. We've had some publications as well in Canadian Family Physician, a quarterly kind of publication where we can write articles from a VAC perspective that touch on the kinds of issues that you're raising.

[Rob Oliphant, Liberal, Don Valley West, ON]

My concern is that less than 3% of spouses and families eligible for vocational rehab are availing themselves, so 97% aren't getting there. That tells me there's a systemic problem.

So my hope is that the department will listen to its own numbers and really recognize that there is a problem of either geographical isolation or mental isolation or something is not working.

[Brenda MacCormack]

Yes. Thank you.

[Rob Oliphant, Liberal, Don Valley West, ON]

I want to move on.

With respect to the disability award lump sum payments—and I don't know whether this actually falls under rehabilitation—financial counselling is available for families, but only 1% of veterans who are eligible for financial counselling actually avail themselves, and 99% of veterans don't take the opportunity for advice. It's sort of a similar problem.

[Brenda MacCormack]

Yes. In that particular instance we are doing some follow-up with disability award recipients to just have some discussions with them about the disability award. And one of the questions we'll be asking them will be “Did you access financial advice, and was it enough to assist you in managing the money?” That client contact is beginning as we speak, and the results of that should be available some time over the summer.

What were you going to say?

[Jane Hicks]

I was just going to say also that with some preliminary contact we have had with veterans, there are a number of institutions that offer financial advice free of charge, so they don't take Veterans Affairs up. They may go to the institution they're comfortable with, such as their own bank or whoever they're dealing with in managing their funds.

[Brenda MacCormack]

Yes, and that has been offered.

[Rob Oliphant, Liberal, Don Valley West, ON]

In your case management, have you been in touch with the Association of Occupational Therapists and availed yourselves of their professional expertise in case management?

[Brenda MacCormack]

I can start by saying that we have a regular, ongoing relationship with the Canadian Association of Occupational Therapists and liaise in looking at best practice. They also play a very important role in mental health, and in rehabilitation in particular. So yes, we have a linkage and in fact have a speaking engagement at their upcoming national meeting.

[Rob Oliphant, Liberal, Don Valley West, ON]

Is Elizabeth Taylor advocating for a more formal relationship?

[Brenda MacCormack]

Yes.

[Janice Burke, Acting Director, Mental Health, Department of Veterans Affairs]

Let me add that we have about 2,000 service providers registered across the country around mental health, and a large majority of them are occupational therapists as well.

[The Chair, Conservative, David Sweet]

Thank you.

Thank you, Mr. Oliphant.

Now, it is over to Mr. Vincent for seven minutes.

[Robert Vincent, Bloc, Shefford, QC]

Good morning.

In your presentation, you talked about an individual with an amputated right arm below the elbow and three amputated fingers on his left hand. It says that the person received his disability award of 100%. Last week, however, we received another document describing someone who became a paraplegic as a result of a spinal cord injury, but that person did not receive a disability award of 100%. The first person received $260,843 in 2008. Is that how much he would have received under the new charter?

[Brenda MacCormack]

No. For a disability award under the new charter we are using the same rules that we were using under the disability pension. The terms by which they become eligible for a disability award are the same. How we would assess level of disability is the same as well.

There is an assessment instrument called the table of disabilities that provides guidance in terms of looking at functional capacity and how it impacts upon one's ability to do something. In this particular case, if he was right-handed, that would have an impact.