Veterans Affairs Committee on May 13th, 2010

[Brenda MacCormack]

All right, I'll go very quickly.

I guess the key point here is that we can offer the individual rehabilitation and we don't need to have a disability award or a disability pension for us to do that.

With respect to the lump sum amount and the concerns about mismanagement, those are concerns that we've heard. We've listened to them. We're currently doing a survey of clients who have received disability awards to understand how they're coping with it. We do believe this is a very important issue; it's a very important problem. It probably is affecting a fairly constrained number of clients, but we have to get to the bottom of that, understand how many clients it is impacting on. The financial advice is really important; case management is very important. That's an area that continues to be of focus for us.

In terms of your comment of the lack of support for spouses and caregivers, I think we touched on it earlier in terms of the importance of having people aware of the nature of the services. As we ramp up our outreach efforts, we will do more in that area. The new Veterans Charter offers significantly more for families than we could ever do in the past. We don't just treat an individual veteran as an individual any more. We look at how they function in their family and what kinds of barriers might be existing in the family in terms of having that individual move forward. We can probably do better in terms of making the programs better known, and we will continue to do that. Certainly there is significantly more there now, and they're actively engaged. In the example of rehabilitation, they would be actively engaged with the rehabilitation program, with the case manager, and children may also be....

[Jane Hicks]

Under the old system it was particularly difficult to meet the needs of the family. It was mainly focused on the veteran, and that's where you get into the challenges of how do we get benefits and services for the family, for the children. It doesn't fit with the system and the treatment that we have. With the new Veterans Charter there's so much more flexibility, and I think it's much better with respect to families and children.

[The Chair, Conservative, David Sweet]

Thank you very much.

Mr. Kerr, for five minutes.

[Greg Kerr, Conservative, West Nova, NS]

Thank you, Mr. Chair.

Welcome here today. I think you've given some very concise, very important information.

I want to start by saying I'd probably disagree with where Mr. Stoffer came from on a couple of things. I want to make it clear why. Ever since we started this review I've gone back to the department to try to dig into what's going on, what's happening, and so on. I've become more of a believer in the charter, with its flaws, with the changes needed. I think it's fair to say we had people in here as witnesses who had individual problems with government, with the department, or it may have been with the politicians themselves. It was people who just simply said “We want to get back before the charter”, and so on.

What I understand is the whole point is the change in direction the former government put in place, which we all endorse, and that is, go away simply from the money and look at the long-term benefits and treatment and support for the individual and the families. They've answered a lot of that, particularly on the mental health side, on some of these things that just would not have been addressed that are being addressed today. I just want to get on there. I think we have a job ahead of us, but I think it's fully on us to ask, “How do we strengthen the charter? How do we make it better?”

Having said that, I know there are some legitimate complaints, and you are or we are addressing some of them. I guess the point is we know that one of the complaints we've heard is that government has not reacted to some of the recommendations coming in. Again, that's not your job so much as it is the minister's and the government's to do it.

If the recommendations that have come through from the review committee were in place--the big 16 we're talking about--what difference would that make in the kind of service you could provide?

[Brenda MacCormack]

I think the recommendations we've seen coming out of the various parties have been fairly wide-ranging in terms of what they're looking at. They're indicating gaps in terms of those with catastrophic injuries, whether the financial stream is adequate over time, whether we're providing enough support to families, whether we're using health professionals adequately. There's really a great deal of good information there, and I think there are a couple of ways we're dealing with that.

There are certain recommendations we can look at now to strengthen what we do within the current authority we have, some of the red-tape issues Jane talked about, strengthening case management, making sure our staff are well trained, trying to reduce and simplify. So there are many. The other one is maximizing the authorities we currently have in terms of providing services to families. All of that is under way and will take some time.

Then the remaining gaps or remaining recommendations we do need to look at and assess what kind of an impact they would have in terms of the overall scheme. I'm a firm believer that we've built the right foundation, that we have the right principles. Whatever changes we're making and whatever recommendations we're dealing with need to respect the fundamental foundation that's been built, because it is very much built on current practice, and the most available research, and is strongly supported by academics and experts in the field of disability across multiple kinds of jurisdictions. So I think we would have to make that a priority.

Again, it will not be for us to decide, obviously. It will be a decision of government in terms of what might occur.

[Janice Burke]

Yes, and I certainly could add to that. Again, it's going to be a decision of the minister at the end of the day. As you know, in terms of what we can do for families, particularly on the mental health piece and health care, the provinces have the jurisdiction for health care for families. I believe we have maximized to the extent possible what we can do under our current authorities and under the current jurisdictions we have.

I really want to add to that to give you a picture of the landscape across the country in terms of mental health. It is problematic. I think you could say it's a fragmented system right now for people who are living in the provinces and communities. I think the stats are that two out of every three adults who require mental health help are not getting it. I think it's three out of every four children who require mental health supports are not getting them either. So there is a real crisis across the country in terms of mental health, which we hope the Mental Health Commission of Canada will help address in terms of its national strategy. Until we can build that capacity at the provincial and community level for families, we probably have maximized to the extent we can, certainly at the federal level.

[Greg Kerr, Conservative, West Nova, NS]

Do I have a little time left?

[The Chair, Conservative, David Sweet]

No, you're all out. Sorry, Mr. Kerr.

Thank you, Madam Burke. That was an issue we faced when we did the study in the 39th Parliament on PTSD: there's simply not a lot of incoming graduates in psychiatry, psychology, and counselling.

Now to Madam Crombie for five minutes.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Thank you, Mr. Chairman.

Ms. MacCormack, I guess I'm going to bring up an issue that's already been addressed by a few people because it's so important. I had the opportunity on Saturday evening to speak to the Polish Combatants Association in Toronto. They were honouring an organization called Wounded Warrior. Are you familiar with this organization and the kind of work it does?

[Brenda MacCormack]

I've heard of it.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

The executive director pulled me aside after she heard I was sitting on the veterans affairs committee, of course, and wanted to address the issue of the lump sum payment. In fact she asked if she might come to our committee herself to make a representation. They have some very serious concerns. Her son, as well, is in the armed forces. He was injured in Afghanistan and just came home.

The ability of the newer veterans--or especially the older veterans--to manage the lump sum benefits has been an ongoing issue. I wonder if you might want to address that. We have heard in testimony from witness after witness that they preferred the old system of the monthly pension benefits rather than the lump sum payment. Since it's supposed to be a living document, isn't there any way we could accommodate this overwhelming cry from every single witness that they prefer the old system with respect to the pension benefits?

[Brenda MacCormack]

At this point, I don't think we have enough evidence to understand how widespread the problem is, which is why we've undertaken a review. We'll contact all disability award recipients to understand the extent of the problem and how they have dealt with it. We have a number of current strategies in place to try to mitigate the problem. I certainly have heard the criticisms. I think our challenge right now is to really understand just how big the problem is. Is it fairly contained in terms of affecting just certain individuals?

Until we have more information that's actually evidence-based and that actually reflects the total population, I think it's really difficult to know the solutions. Certainly it's an issue that's on our minds and that we're looking at. There have been other suggestions in terms of what we might do, such as having structured settlements and paying out over a longer period of time. But I don't think we're at the point yet where we have enough information to get to a solution.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Ms. MacCormack, I just want to interject quickly, because I didn't get the opportunity. There has not been one witness who has come here to tell us that they prefer the lump sum settlement over the monthly pension--not one.

[Jane Hicks]

There are examples we've seen of people who have been really wise with their money. They've bought a home or have made a down payment or have paid off their debts. We have examples, and we don't hear about them. We always hear about those who are.... That's why I think it's important to have more evidence. The survey we're going to be doing in the next little while to determine what people have done with their disability awards will be a statistically sound study, and I think we'll have some more information to support or negate.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Well, we do look forward to it. We do hear about those people who go out and buy a home and buy a car, and then they don't have any money to live on to pay their expenses.

Let's move on.

I want to go back to the issue of the catastrophically injured. What percentage of veterans are catastrophically injured?

[Brenda MacCormack]

I guess it depends on how you define that, but it's a fairly small percentage overall that would fit into that category. It certainly would be fewer than 10%.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Let's go over again what is offered to those who are catastrophically injured.

[Brenda MacCormack]

Under the new Veterans Charter, those who suffer catastrophic injury would get the lump sum disability award at 100%. They also would be entitled to the monthly financial stream, which is the earnings loss benefit, if they can't work to age 65. They would be entitled to a permanent impairment allowance of between $500 and $1,500, which, again, would be indexed over time. At age 65 they would be entitled to a supplementary retirement benefit, which is 2% of the gross earnings loss benefit that was payable.

Just to touch a little bit on your earlier point, I think when people say that they prefer the disability pension over the disability award, I think we need to understand better why they're saying that. There is the mismanagement issue, but there is also the challenge of having people understand the program and the opportunities here. In my own personal experience, I can say that having talked to a number of veterans, and to members of the forces, for that matter, once you sit down and have an opportunity to explain to them what these programs are, what they offer over time, and how they might impact them, they come away with a different impression. Maybe they're not saying that the old system was better. The old system was broken. We had lots of evidence that told us it wasn't working.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Just briefly, where I wanted to go with this was that we heard repeatedly, as well, that the attendant allowance was really important. I wonder if you might want to talk about that. And obviously, there was groundskeeping. They had access to those kinds of benefits previously that they don't have any more. We heard from witnesses that they would like to see those reinstated.

[Brenda MacCormack]

The groundskeeping services you're referring to would be available under the veterans independence program. That program remains available to Canadian Forces veterans under this scheme. Any of those benefits that were available previously are still available. So that may simply be a misunderstanding.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

What about the attendants allowance?

[Brenda MacCormack]

The attendants allowance was a benefit that was available under the Pension Act. Again, it was payable at various grade levels, and it was intended to help people with housekeeping and with personal care, if they needed it. It was a monthly allowance, tax-free, that supplemented the monthly income.

I think that looking at what kind of help was available in the past will be helpful in terms of looking at where we need to make some changes. Some of those services can be provided now under the veterans independence program. Some are under rehabilitation programs, if they're needed.

This charter is about investing in and providing the services people need at the time they need them, which research tell us has the biggest impact in terms of positive health outcomes. But it is a culture change. It represents a significant culture change not only for our veterans and members of the Forces but for our staff and employees as well.

We still have more work to do to achieve the full potential of the new Veterans Charter. And when we combine that challenge with the fact that we have some communication issues in terms of people not understanding the charter, it makes it even more challenging. But I think that's certainly part of the solution.

[The Chair, Conservative, David Sweet]

Thank you, Madam MacCormack.

Now to move on to Mr. Casson for five minutes.

[Rick Casson, Conservative, Lethbridge, AB]

Thank you, Mr. Chair, and I thank my colleagues for this opportunity.

I want to address my questions to Ms. Burke, to deal with the mental health aspect here. I think at the same time that the Veterans Affairs committee was looking at PTSD, we were doing a study at National Defence on quality of life focusing on PTSD, and there were a number of revealing things that came out of that. I was glad to hear you mention the families because a lot of the witnesses who came with us came with a family member for support, and there were all varying degrees of stress or trauma from quite mild to very severe.

Some of the things that came forward were that if you were in the regular force and you were close to where your unit was stationed, you had more opportunity for treatment. If you were reserves and you were far away from where your unit or any of your colleagues was, it became harder to get service. There is an urban-rural split, it seemed, just generally; you mentioned that in Canada alone, just the general population, getting help for mental health issues.

So I certainly hope that some of these issues have been addressed. Maybe you can address that, and the fact that PTSD sometimes is not apparent for quite a while, and then the addictions and the instability in the family and the inability to work and cope with people around you start to appear. So you may leave the forces and you may sign something to say you feel good, you're young, you're ten feet tall and bulletproof, nothing is going to bother you, and then months later you collapse.

So I'd like you to talk a bit about what has been put in place—maybe not so much with the Veterans Charter, but try to relate it to that if you can—for these types of folks.

[Janice Burke]

Thank you.

Actually, as you indicated, on the impact on families in terms of people with mental illness, it's recognized that it doesn't just impact the individual, it's the whole family, and the whole family needs to be part of the solution and be part of the planning too. So I think it's recognized that that's an issue.

When you talk about the rural-urban split, about 33% of our clients with mental health conditions live in rural areas, and the remainder are obviously urban. So that is creating a challenge not only for our department. Other federal departments have clients in rural areas, and the same with the provinces and communities. So what we're doing is we're implementing tele-mental health, for an example. We have that in most of our clinics across the country. We have ten clinics. We also have now providers who have come on board with tele-mental health, and we've done a few pilots and we find that that's helping. Through the pilots, we found that the clients are actually benefiting from it. It's probably the health professionals who don't feel as comfortable utilizing that capability, but we are doing things like that.

I don't know if you know this about our OSI clinics, which I think is just fantastic: they do spend time in the communities going to different providers and putting on conferences to share the knowledge and transfer the knowledge around how to treat people who have PTSD and their families. So we're doing a lot of work in that area. We also have peer support people who do travel to the rural areas, obviously, and provide support to families, and to veterans as well, who have mental health conditions. So that's happening. And we do have the VAC assistance line, which they can call 24/7 if they're struggling, if they need some assistance. So that is available as well for the people in the rural areas.

But it is an issue, and it's interesting that you raise it, because we are starting a pilot in Newfoundland. We thought it was a good place to start because of its vast geography and the fact that a lot of their clients—more than the national average—live in rural areas. We're working with the province, with communities, and with other federal partners to see how we can better support people who live in rural areas. It will be interesting to see what comes out of that that would have applicability across the country. So we are certainly doing more around that.

Your second question was around mental health...? I should have taken notes and I didn't. I was too intrigued by your questions.