Veterans Affairs Committee on Nov. 16th, 2010

[Lise Zarac, Liberal, LaSalle—Émard, QC]

I'm always looking for information; I was looking for—

[Raymond Lalonde]

If you want information on the kind of research that's being done in the world, in the trauma field, the ISTSS.org website has all the information on the symposium—

[Lise Zarac, Liberal, LaSalle—Émard, QC]

I could find information on the symposium there.

[Raymond Lalonde]

—and hundreds of topics were presented—several hundreds of pages of topics. It can also be helpful in understanding the state of research, the questions that are being raised in the field.

[Lise Zarac, Liberal, LaSalle—Émard, QC]

Perfect. We'll go and visit that site. Thank you for the information.

The press releases I found on the subject concern the clinics you referred to, among other things, and I'm pleased to learn that five more of those clinics have been opened. That's good news.

Do they have the necessary resources, qualified staff? We see—and you said it clearly—that 10 clinics have been established. However, I wonder what can be funded with $9 million. You're also telling me that this is a provincial jurisdiction.

So, first, I would like to know whether we indeed have the qualified staff to meet needs.

[Raymond Lalonde]

These are provincial clinics, which are funded by Veterans Affairs Canada to serve the clientele of veterans, military members, RCMP members and their families. These are specialized clinics for our clientele. We fund the premises and so on.

[Lise Zarac, Liberal, LaSalle—Émard, QC]

Is funding adequate for the clinics to be open from 9:00 a.m. until 5:00 p.m. every day of the week?

[Raymond Lalonde]

Yes, nine of these are out-patient clinics. Every regional health board, every hospital has managed to find staff, and nearly all the clinics have enough staff. Obviously, there is always turnover, but the clinics have normally been able to find the staff they need. That's harder in certain professions, such as psychiatry, but they're managing.

[Lise Zarac, Liberal, LaSalle—Émard, QC]

That's why I was asking the question. A psychiatrist I know did interviews for a year and a half before being hired to do the work. That's where my question comes from. Do you have qualified staff? If it takes a year and a half to hire a psychiatrist... Do you have all the necessary psychiatrists to meet the needs?

[Raymond Lalonde]

Yes, all the clinics have almost all the resources they need. It's always hard to replace mental health staff because there's a shortage in Canada. However, we've managed to fill the positions in the clinics. Currently, I can tell you that we have more than 1,500 clients at our clinics. That's a 30% increase since the start of 2010. So the clientele is increasing and the—

[Lise Zarac, Liberal, LaSalle—Émard, QC]

How may psychiatrists are there?

[Raymond Lalonde]

I don't have the exact figure for the entire network. There are approximately one and a half psychiatry positions per clinic. Some have two.

[Lise Zarac, Liberal, LaSalle—Émard, QC]

Do I still have time?

[The Chair, Conservative, Gary Schellenberger]

The last time we had short questions it took a long answer, so we'll move now to Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I know you can't give any specific examples, but I think for the purposes of this committee we want to get right to the root of the issues and make sure we feel satisfied that the Department of Veterans Affairs is reacting where it needs to react.

I want to go back to the case manager or area counsellor issue again. I know you can't give specific examples, but I would be interested if you could provide us with general examples of where a case manager has come across an issue that was of concern to him or her and responded and the chain of command has worked. I think we've all had jobs before and we've all worked in management and we know in theory it all sounds good, but in practice does it actually work? If you had some examples you could provide to the committee for our report, it would be helpful in satisfying us that the chain of command actually does work.

[Janice Burke]

Obviously I can't pinpoint any case manager or any particular staff. We look for this kind of feedback from all our front-line staff, whether they work in our contact centres or they're actually case managers on the ground working with the veterans. In some of the areas we're looking at in terms of reducing complexity in policies, they have no doubt arisen from ideas from staff.

I'll throw out some that are in the disability process. We know, for example, that the quality of life form that we ask veterans to complete as part of their disability application was intended for veterans who had indicated that they wanted the impact of their disabilities on their everyday life to be considered, as opposed to the medical piece. However, we've found out since, through feedback from staff, that they find some of these forms very daunting to complete. It's not clear to them why it's required. In fact, some of these forms are not mandatory for the veteran to complete either. So we're really looking at the different forms that are used in the pension process, the medical information that we collect, the forms we give to the veterans to take to their doctors--too long, too complicated. We're reducing that as part of the disability process.

[Ben Lobb, Conservative, Huron—Bruce, ON]

We're running short of time, so I want to ask another question.

If a person is stressed out and obviously under some strain from post-traumatic stress and all the other things that go on with even regular life, if that person is in the queue within Veterans Affairs and they are under the earnings loss benefits program and they want to get some training, whether it's in school or whatever vocational training they may pick, I understand there is a bit of a lag between the time they get into the queue before they're actually able to get into the training. I understand the reason is because they have to meet certain criteria for either mental or physical health. Is that accurate?

[Dr. Tina Pranger]

No, that's not accurate. This is part of the rehabilitation program, and there is medical rehabilitation, psycho-social, and vocational. When someone is referred and it's deemed that a person is ready for vocational rehabilitation, we have external providers, vocational--

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay, if I can go on that point, you said when “it's deemed”. What does that mean?

[Dr. Tina Pranger]

That is a discussion between the client and the case manager and often the interdisciplinary team.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay, that is the point where I understand the frustration comes from, the length of time it takes to be deemed ready. I understand it can be a long time. They're very anxious to get into this training, but the length of time it takes to be deemed ready for it is what frustrates--

[Dr. Tina Pranger]

But they are part of that discussion. They are clients. They work with the case managers. They are part of that discussion. They have input into it.

Perhaps sometimes the case manager and the interdisciplinary team and all the treatment providers have information about the client that the client may not be aware of themselves. They may not be aware of what some of their limitations are. They might not have the insight into it.

[Ben Lobb, Conservative, Huron—Bruce, ON]

How long would it take until you're deemed ready?

[Dr. Tina Pranger]

But it--

[Janice Burke]

I think the point you're getting at, though, is that there is a delay in needed access for a veteran to get the support. The other program we are looking at within the department in terms of reducing some of that red tape and the delay is the rehabilitation program and looking at the front-end piece, because staff have given a lot of feedback. For example, some of the things we've started doing is putting the decision-making down closer to the case manager, who knows the client and can actually make those decisions without having to involve a whole team of people, or without having to elevate that to head office, which was the case. So in the rehab program--exactly what you're talking about--they are looking at that front-end piece. They recognize there could be a delay in terms of getting the veteran into the program.