Veterans Affairs Committee on Nov. 16th, 2010

[Raymond Lalonde]

I don't have the figure to hand.

[Robert Vincent, Bloc, Shefford, QC]

No one at Ste. Anne Hospital has figures. You treated Private Couture. Does his name mean anything to you?

[Raymond Lalonde]

Not to me.

[Dr. Tina Pranger, National Mental Health Officer, Department of Veterans Affairs]

The information we have is anecdotal. We hear from the district office staff who hear from the treating clinicians that people have died from suicide, but at this point we don't have a mechanism for recording that, and this certainly is one of the recommendations we have for ongoing work.

[Robert Vincent, Bloc, Shefford, QC]

I'm trying to understand. In that particular case, the man lost a leg after walking on a bomb. He was treated by you for a post-traumatic stress problem and committed suicide. No clinician or any other person who monitored that man told you that you had lost one of your patients, that that person had committed suicide, whereas it occurred in your hospital?

[Raymond Lalonde]

There have been no suicides in hospital.

[Robert Vincent, Bloc, Shefford, QC]

No, he committed suicide at his home.

[Raymond Lalonde]

We have to get the information from the family to determine whether there has been a suicide.

[Robert Vincent, Bloc, Shefford, QC]

The media were all over his case.

[Raymond Lalonde]

Some cases get media coverage, but it's still anecdotal in that the information disseminated here and there isn't systematic. If the family doesn't inform us, based on a coroner's decision, that it's a suicide case, we can't count those cases, determine their number. On the other hand, the Canadian Forces have their own health service. The doctors belong to the Canadian Forces and handle... It's not the same situation.

[Robert Vincent, Bloc, Shefford, QC]

I agree that an individual wounded in a theatre of operations or suffering from post-traumatic stress disorder isn't a veteran, but he is nevertheless treated by you.

[Raymond Lalonde]

Not necessarily.

[Janice Burke]

If I could respond as well, you're absolutely right that we do know what causes suicide is multifactorial. We do know that serious physical injury like amputations, serious chronic pain, psychiatric disorders, stressful life events, even imitation.... And when people may see their colleagues or the media report suicide, that can also be a trigger. We know that access to lethal means is also another factor, also effective care and barriers to care like self-stigma.

I understand the point you are trying to make, that there are causes to this. We do know that. Yes, you're right, these are causes. What we're trying to focus on within Veterans Affairs is how, to the extent possible, when we know that these risk factors exist, that someone has chronic pain, amputations, severe psychiatric conditions, they are undergoing serious life situations.... In our rehabilitation program we have a number of clients who are very complex. They have combinations of psychiatric conditions, physical conditions, physical pain, musculoskeletal, they have addictions to either prescribed medication or to--

[Robert Vincent, Bloc, Shefford, QC]

I don't want to cut you off, but our time is limited.

Even if these are people who are treated by other clinicians, will you monitor all the cases so that you know what is going on and if there have been any suicides? Are measures already in place for this purpose or are you going to implement any to determine whether people commit suicide following a post-traumatic stress problem?

[Dr. Tina Pranger]

Absolutely, that is one of the recommendations of our suicide prevention review. We do need to follow up with the clinicians and have better communication between us and the people who are treating clients so that we communicate with each other if someone's at risk for suicide, has attempted suicide, has suicidal thoughts, or potentially has died by suicide. So there needs to be better communication.

[Robert Vincent, Bloc, Shefford, QC]

Are you making recommendations—

[The Chair, Conservative, Gary Schellenberger]

Mr. Vincent, your time is up for this round.

[Dr. Tina Pranger]

Good questions.

[The Chair, Conservative, Gary Schellenberger]

Mr. Stoffer, for five minutes, please.

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

Thank you, Mr. Chairman.

Thank you folks for coming today.

On page 25 you put as your second bullet point that the suicide rate is lower than that of the general population. I ask this in a very respectful manner: Why did you put that in there? Why did you say that?

I had a brief of this and I showed it to a family going through these problems, and they were very pissed off, to be honest with you. It almost makes it look like, “Oh, it's okay”. You said that one suicide is too many, so I highly recommend that you take that out of there; it's not fair to compare the military service with the general population.

Second, a lot of veterans I've been dealing with lately are complaining about the fact that they're not getting help regarding their teeth problems--because as you know, they're grinding their teeth--and their sleep apnea problems. Both of these concerns are very serious for people who have PTSD. They have to go back to DVA, get another assessment, and it literally takes months and months before they get adjudicated once again on these claims.

Is there is a way DVA can balance all of the concerns of post-traumatic stress disorder and the symptoms arising from it together, so that if a person has PTSD and claims they have sleep apnea, they should automatically have the programs available to help them immediately, without having to be re-assessed once again?

My last point is that I noticed that a lot of this is based on our modern-day veterans from Afghanistan and Bosnia. But I'm going to give you the case of Stanley Eisen, from Nova Scotia. He was an 86- or 87-year-old World War II veteran. He claimed he had post-traumatic stress disorder from his World War II experience, and his claim was flatly denied. He died shortly afterwards.

I know many World War II and Korean War veterans who, because of the news from our military in Afghanistan, every time we lose one of our soldiers, relive that moment. They're suffering just as much. But I don't see the department reaching out to World War II and Korean War veterans and those who served from say 1953 to 1994. A lot of those individuals are suffering as well, and I don't see a reach-out to them looking for assistance.

I just put that out as a comment to you. I do thank you for coming.

[Janice Burke]

Thank you for your remarks.

On your first point, about the suicide rate, we'll certainly remove that reference. It wasn't intended in that way. We just tried to accurately report the results, because it is a CF study and it's based on the age group that's within the Canadian Forces versus the similar age group in the Canadian population.

On your second point, about the grinding of the teeth and sleep apnea, bruxism, as we all know, is a consequence of post-traumatic stress disorder. People do grind their teeth, and their teeth can be affected as a result, and they may need crowns and those kinds of things. So we are actually looking at those cases, because you're absolutely right. What ends up happening is that the veteran has to come back through the department for a consequential disability claim for bruxism, or for the replacement of the teeth, in order to get the treatment. At the end of the day, what they really want is the treatment.

We have expanded considerably the treatment range for post-traumatic stress disorder. We are looking at that and including those other conditions. Hopefully, the next time we're before you we'll be able to say that's been fixed.

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

Okay.

[Janice Burke]

Now, with respect to World War II and Korean War veterans, and veterans after those wars and maybe prior to the implementation of the new Veterans Charter, you're absolutely right that we need to be doing more outreach. We actually have an outreach strategy in place where we are trying to reach out more to that particular group. It is a group that's perhaps most at risk simply because they did not have the early intervention that we have been offering since the implementation of the new Veterans Charter, and since the Canadian Forces have implemented significant changes to their mental health system and deployments. We are doing so much more now in transition, with our integrated personnel support centres, than we've ever done before.

So there is a strategy where we are going to try to reach more veterans. We have our Salute! magazine. We try to get that out there. When I talked earlier about our partnerships with communities and really trying to do more in communities, you will see listed in the deck that we have things like community covenants mentioned, and that we are working more with the Canadian Mental Health Association, and working with communities, because veterans and their families live in communities. We have not tapped into the networks that exist to ensure that every veteran knows about our programs and our services and how they can be helped. So we are putting a major focus on that. Hopefully, the next time I'm here we can report on progress in that area.

[Dr. Tina Pranger]

And in all fairness, the veterans who are post-Korea are eligible for the new Veterans Charter program, so as Janice said, it's a matter of the outreach to them. But we've had a great uptake by them.

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

Thank you.

The other day in the news we heard that a clinic outside of Petawawa is stopping or reducing services for approximately 400 individuals who are seeking their services. I'm wondering if you can tell us.... First of all, I'm surprised they have to go to a provincial body for assistance. So I just wonder if you could comment on what DVA is about to do for those 400 individuals.