Veterans Affairs Committee on March 16th, 2010

[Brenda MacCormack]

Just as a bit of background around the new Veterans Charter, back in the late nineties, early in the 2000 period, there was a recognition that the system that we had currently in place--the disability pension and associated treatment benefits--was sorely lacking in terms of what it was achieving. We knew that people were not transitioning. They continued to have health issues. Their families were not transitioning. The system that we had was outdated.

So yes, there was a lot of analysis, a lot of input from academics, practitioners in the field, and disability management experts to come up with a new kind of framework for programming in services that would better enable veterans and their families to make a transition to civilian life.

That has now become known as the new Veterans Charter and is part of that analysis and policy advice that was put forward to government for a decision. The costing would have been done in terms of what this is going to cost overall to put into place.

The initial investment was made, and essentially the new Veterans Charter represents a totally different focus in terms of what we're providing and represents a reprofiling to a certain extent to invest more in those who are more seriously disabled.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Just really quickly, because I know we have to go--

[The Chair, Conservative, David Sweet]

You're way over, Mr. Mayes. Sorry, I have to call you on that.

Now we move on to Madam Fry for five minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

I'm just going to ask you two questions and then let you answer them. They're kind of related.

How do you do case management for veterans who live in small rural areas and who have a family physician who may have no idea how to deal with some of these issues? How does your case management occur? How do they get access to occupational therapies, to psychological care, etc.? As a physician, I want to know that.

The second thing I want to find out about is families. As we well know, many families of veterans, especially of those who have post-traumatic stress disorder, are very strongly impacted by this. We know also that there is a chance that some of the young people in the families may themselves grow up to have post-traumatic stress disorder and have the inability to cope with any stresses that come their way later on.

Is there anything you're going to do to help families? I know the families are really in need of some kind of assistance when they have a veteran who is disabled, either mentally, physically, or in other ways.

[Bernard Butler]

With respect to the first question, on case management, certainly we do outreach to communities where we may not necessarily have a district office. Our case managers are folks who have training in this respect and who have the qualifications. They're the ones who broker services where needs are identified. If we can't deliver them through our own programming, we make sure that arrangements are made to provide them. There is certainly an outreach feature there in terms of our service delivery, which enables us to work with those veterans who live in more remote communities.

The mental health and families issue that you raised is a very important issue, and I'm certainly glad you raised it. The department is pursuing a very involved or detailed mental health strategy. A key portion or part of that is the establishment of our occupational stress injury clinics across the country, of which we now have ten. They are a complement to the trauma clinics that the Canadian Forces have established. Family members have access to these clinics to help them work through problems arising out of the challenges the members may be experiencing. Counselling is available to families and to spouses and to children as well. So we do have a defined strategy to try to meet that evolving need, which, as you identified, is a very important one for our veterans and their family members.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Will this go on as long as it's needed by the families, or is there a finite time limit so that you only get assistance for up to say two years or three years? Is it continued throughout the family's need cycle, whatever that is? It may be 10 or 15 years or it may be less. Is there a finite timeline on this?

[Brenda MacCormack]

This gives me an opportunity to speak a little bit about the rehabilitation program. As Bernard mentioned, counselling and so forth are available, and there is no finite timeframe in terms of the rehabilitation program. The services are available for as long as they need them in terms of achieving certain goals. As I mentioned, a veteran is functioning within a family unit, within a community, and hopefully within some kind of vocational environment. If families need help to improve effective functioning to adapt to disabilities, then those kinds of services, such as counselling or group sessions, are provided, and there is no finite timeline.

[Hedy Fry, Liberal, Vancouver Centre, BC]

This goes for mental illnesses as well?

[Brenda MacCormack]

Absolutely, and certainly we have seen an increased prevalence of that. We see a lot of addiction issues associated with mental health issues. There are a lot of musculoskeletal types of injuries involving a lot of chronic pain, and there are family issues associated with those. The new Veterans Charter certainly takes us a little further forward in terms of recognizing that a veteran doesn't exist in isolation, that he is part of a family.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Do you have any training programs set up for small family practitioners in rural areas who can actually be helpful to the veteran as the veteran continues to need care, to be able to bridge those two things, the veteran's ordinary illnesses and the ones that are related to post-traumatic stress disorder or to other disabilities?

[Brenda MacCormack]

I certainly can't speak in detail, as that is not an area of expertise for me, but we do have a centralized centre of expertise in Ste. Anne's. It is centred around mental health and really sets best practices and then communicates those out. So there certainly has been, as part of the mental health strategy that Bernard referenced, a real conscious effort to build capacity in the various communities across this country, because we recognize that veterans and their families live first in their communities.

[The Chair, Conservative, David Sweet]

Thank you, Madam MacCormack and Madam Fry.

Now I'll go back to the Conservative Party, and I suspect it will be Mr. Mayes, because he didn't finish the last time.

Mr. Mayes, you have five minutes.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

As a quick follow-up question to the determination of that $740 million, was that a large enough allocation? Are there problems where you say we just don't have the money to provide more services, or would you say that it has been reasonable and has met the need?

[Brenda MacCormack]

I don't have the detailed expenditures. I think we've taken that away as an item, but generally speaking I would say yes.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Okay. That's just a question.

Thank you, Mr. Chair.

[The Chair, Conservative, David Sweet]

It appears that most of the questions have been exhausted, but Mr. Vincent and Mr. Stoffer may have other questions, if it's the pleasure of the committee.

Okay, Monsieur Vincent.

[Robert Vincent, Bloc, Shefford, QC]

Earlier, you stated that physical and mental rehabilitation services would be available as long as needed. However, you also said that your CF doctor assessed the person's state of health. At some point, the person's condition stabilizes and he is released. That does not mean that the person receives services as long as he needs them, but only for as long as the doctor deems it necessary. Is that correct?

[Bernard Butler]

Again, sir, just for clarification, the context you're referring to is while the member is still serving in the military. Is that correct?

[Robert Vincent, Bloc, Shefford, QC]

A veteran must have been wounded while serving in the Canadian Forces. He then undergoes rehabilitation. It doesn't necessarily mean that he will be rehabilitated or able to rejoin the regular Canadian Forces. That veteran may have to find a job outside the military.

I have a question about the level of disability. How is that level of disability assessed? I read in your statement that when a veteran is assessed as having a full disability, an award is provided for pain and suffering. How is it possible to compensate someone for pain and suffering? How is the level of disability assessed?

For example, how would someone determine that I am 10% disabled? How is one compensated for pain and suffering? Pain varies from person to person. How do you determine an individual's pain threshold, or level of disability?

[Brenda MacCormack]

I'll start with the disability award. That is a payment that can be made to compensate someone for illness or injury, and I guess it would be types of injury that we see in the military. It's any amount. It's hard to say whether it's enough.

But what happens is that they make an application for a disability award and the determination of level of disability is made by Veterans Affairs Canada based on objective medical evidence that's provided by medical practitioners who do examinations and record information such as range of motion, functional limitations, and x-ray reports. We have a table of disabilities, which is a regulatory instrument that defines various assessment levels and how that relates to functional incapacity.

That is how the percentage level is determined, and it is done by Veterans Affairs Canada adjucators. Subsequent to that, while the member is still serving, he might well have received a disability award. He continues to be under the care of the Canadian Forces health services unit, and at some point it will be up to the medical folks and others within the Canadian Forces environment to decide if the member is going to be medically released.

Up until that point, the Canadian Forces have responsibility for the healthcare of that injured member. Once the member is going to be medically released and a decision has been made on that, VAC will start working with them. We begin to make plans in terms of the rehabilitation using a variety of experts, medical doctors, vocational experts--where that's appropriate--occupational therapists, and mental health specialists. It's an interdisciplinary kind of approach to identify problems and barriers to them achieving independence. They could be medical, they could be psycho-social. A plan is developed and that's carried into the post-release period.

The plan continues to change based on the goals and how the veteran progresses and how the family progresses. Input is received on an ongoing basis from a variety of health professionals in the field, and best practice evidence tells us that an approach that is multi-disciplinary, that involves multiple health professionals accompanied by intensive case management, produces the best results.

[Robert Vincent, Bloc, Shefford, QC]

Is a CF member entitled to seek another expert medical opinion from a doctor who is not with the Canadian Forces?

[Brenda MacCormack]

I don't know. I don't know what capacity the Canadian Forces has.

[Robert Vincent, Bloc, Shefford, QC]

If we look at your area of expertise, namely rehabilitation—

[The Chair, Conservative, David Sweet]

Monsieur Vincent, you're way over again.

The analyst tells me, Mr. Vincent, that in fact a member of the CF could seek a second opinion in that regard. I think it's also one of the things that—you've answered a lot of questions—I just know from experience in the constituency that even though a CF member may be severely wounded, they won't necessarily go into the care of Veterans Affairs. In fact, they stay with the CF, and I have a constituent who was quite severely wounded and continues to work at the Canadian Forces and happily so.

I think they're making quite a few advances on how to employ those who are disabled.

Mr. Stoffer.

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

Mr. Chair, that's actually a very good point.

I have a couple of things. If this question is out of your realm of responsibility or advice, you can just tell me to forget about it.

Right now, as you know, we have the various contract beds for World War II and Korean War veterans across the country, including at Ste. Anne's, our last federal hospital. By the time we go to bed tonight, we're going to lose approximately another 90 World War II and Korean War veterans. When they're all gone, what happens to the two corporals that you have here on your form? They're both 31. Will they have access to a bed like a World War II or a Korean War veteran when they become, say, 70 or 80 years old?

Right now the answer is no, I believe, because those beds won't be available. Right now they're only available for World War II and Korean overseas veterans under certain circumstances. But what happens to the modern-day veterans 30 or 40 years from now when they seek permanent long-term facilities like Camp Hill, the Belcher, Ste. Anne's, etc.? What will happen to them?

Are you able to answer that, or should I move on? I just saw program direct management here, and I thought maybe that would be you.