Veterans Affairs Committee on Nov. 23rd, 2010

[Dr. John Whelan]

That's a wonderful question. Thank you.

Regarding improvements, that really comes back to the point that we really need to look at outcomes. With all our energy invested in our veterans and our people living in the military, with in-patients and out-patients, and various kinds of medications and interventions, I think we really need to look at outcomes.

Does something improve the veteran's quality of life and that of his or her family? I don't think we have good data on that.

As for improvements overall, I think we've come a very long way since 1993 when I first did my clinical rotation at the Stadacona psychiatric hospital and we saw our first folks come back from Bosnia. But we've come a long way since that time in terms of identifying.

I think we still have some problems in identifying reservists who leave our system, and then we can't track them. I think that's an issue.

In terms of programs, we have all worked pretty hard at trying to stay in line with evidence-based programming. The problem is trying to implement those in the community as we are civilian external providers to any system. There are many gaps and problems.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Mr. Stoffer.

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

Thank you very much, Mr. Chairman.

What Mr. Maguire doesn't tell the committee, because he's very modest, is that even though he is suffering himself, he has helped an awful lot of individuals in the Halifax area in their discussions. It would take too long for him to describe some of the cases, but I just want to thank Bill on behalf of the committee for the work he's done in helping other soldiers, airmen, and veterans recognize that they have a problem and that there is help out there if they seek it.

Dr. Whelan and Mr. Cann, I'm wondering about short-term facilities at which a person can stay, because one of the difficulties we hear about is the family. First, then, do you treat any family members? We heard evidence a couple of years ago that post-traumatic stress can actually be transferable from the veterans to the family and especially the children. Are you treating any of those families?

Second, do you have short-term facilities where someone like Bill, for example, whose wife feels threatened in some way or feels afraid, can go for a weekend or a couple of days in order to get out of the home environment just to have a breather, some discussion, and some time?

Those are my two questions for you. If you don't have those short-term facilities, what would you recommend in that regard?

Also, I'd like to ask about your interaction with the case manager at Veterans Affairs. I know they usually send out people who are under contract to them, such as the VON and so on, to give an assessment of a particular person. Do you feel the contractors who are contracted to DVA have enough knowledge of post-traumatic stress disorders to recognize it, understand it, and make the proper diagnosis or recommendation to DVA so that they in turn can make the recommendation to you?

I thank all three of you for coming.

[Dr. John Whelan]

I can start with part of that answer and then turn it over to Mr. Cann.

Do we see family members? We do very minimally, and it's usually the spouse of a veteran. I really don't understand ratios, but there's a formula that for any veteran who is being seen for psychotherapy or ongoing counselling, of every ten visits for the veteran, the spouse can come for two. That's the latest thing.

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

Time out. Who made those ratios?

[Dr. John Whelan]

Veterans Affairs.

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

Where do those requirements come from?

[Dr. John Whelan]

It's usually under our authorization as a provider, if we attempt to provide services to the family member of the veteran. We have not seen children or adult children, and that may be because of the particular kind of practice that we offer.

As for the second part of your question on whether we provide short-term facilities, no, we don't. In the past I've had some assistance from Stadacona. Usually if it's a requirement for safety, we call the police or our emergency line to try to have some intervention. That's the only option we have.

So we don't have those resources. We don't have those facilities.

[Steven Cann]

As for the case management, basically there is a knowledge gap, at least in the Atlantic region. There's a very broad knowledge gap about PTSD and especially anybody with a comorbid disorder of PTSD and addiction. Most of the people who would encounter these individuals would have no idea that they had PTSD or that there was some other issue going on. Some of the case managers even inside VAC would not have the expertise that I would say would be of sufficient content knowledge to know exactly what that is.

[The Chair, Conservative, Gary Schellenberger]

Mr. Kerr.

[Greg Kerr, Conservative, West Nova, NS]

Thank you, Mr. Chair.

I'd like to thank all three of you for joining us today. As you're well aware, the committee puts this as a very important priority, by trying to help in some small way to bring about some changes.

Given the limited time, I'm going to go to the Whelan clinic folks.

When you said “referrals” very early in your remarks, Dr. Whelan, you said they come from outside. Are they coming from family? Or are they coming from others in the community? How does that happen?

[Dr. John Whelan]

I'll try to give you a straightforward answer. It's a bit of a complicated issue.

Often a veteran will arrive at our office--that was early on--at the suggestion of a family member, at the suggestion of an OSISS peer support person, a military comrade. It could be a formal referral by a civilian physician. But I guess the point is that they were outside the system at that point. They were not known to be a military person who had suffered a mental health injury because of their military service.

[Greg Kerr, Conservative, West Nova, NS]

But the referrals do come from outside, so there's some connection there.

[Dr. John Whelan]

Yes.

[Greg Kerr, Conservative, West Nova, NS]

Okay.

I guess being Nova Scotians, we understand some of the challenges we face. I worked as a volunteer and a board member in a hospital system and so on. Collaborative practices become a big focal point within the health system and for two reasons, which I understand from the 12 years I spent as a volunteer. One is the silo system that tends to exist in the delivery. Communication was abysmal, and that's a national problem. It's not located just in Nova Scotia.

In the collaborative practice, we've seen in Annapolis an example go ahead whereby the teams literally sign contracts so that they work together. You know what happens to the patients; they have to see the doctor, they won't want to see anybody else, and so on. Although there are glitches, the process and the principle seems to be a very valued one.

Not to make an absolute parallel, but is that the kind of context you're trying to push that forward in?

[Steven Cann]

Yes, that's exactly what it is. I worked a little bit with the valley hospital in some of those collaborative relationships, me as a federal employee with provincial counterparts, psychologists inside mental health, to gain access to services for, in that case, offenders, but it would be the same principle here.

When people are together and you destroy the boundaries, people can move from one system to the other without having this break. What happens now when you come out of the military is there's this break. We lose touch with them. They disappear into the ozone layer and by the time they resurface, their problems are much worse and have been there for a long time.

[Greg Kerr, Conservative, West Nova, NS]

I know time is short, but I'd like to follow Mr. Maguire's story back into this--early diagnosis, early capture, early entry. One of the things that is seen in a statistical response to that on the civilian side is that it has been quite phenomenal because mental stress issues come up regularly in the conversation. As opposed to going immediately to your medication, it's going to how we are going to fix this and so on.

One of the things I know that is happening and will continue to happen is this, and you referenced the case worker. Part of the real priority within the department is recognizing--there's been enough said in the last year, particularly--that the case workers are going to be empowered to do a lot more, including referrals and being able to do it on the ground.

But I sense from all of you that one of the things that has to happen is the appropriate training, regardless of who it is, to understand what it is they're dealing with and to ask the right questions--to Mr. Maguire's point, I think the peer part is critical--to somehow couple those who have been there and done it with those who professionally are paid to help out.

Do any of you see that as a working possibility?

[William Maguire]

I tried that approach. I took my job very seriously and as I progressed with my job I met more and more veterans. Through what I was suffering and by observing other veterans, I knew these men were suffering. Again, I use the word “men”, because I refuse to work with women.

They and their families need help when they have PTSD. I have gone seeking help and was told to back off. It's not your job to bring that to our attention.

I said, well, during my peer helper course, that was one of the things they stressed. If I picked up something from a veteran, I was to report it. I am reporting it. What's the follow-up? This man needs help and he needs help now. Do you have a list of doctors, psychologists, and GPs who can look after him?

My answer was that I should open the phone book and pick out a name.

[Greg Kerr, Conservative, West Nova, NS]

But just to--

[William Maguire]

Now, hang on.

[Greg Kerr, Conservative, West Nova, NS]

I was going to ask Dr. Whelan to comment on the opportunity to connect the caseworker with the process.

[William Maguire]

Do you mean the caseworker himself, the case manager?

[Greg Kerr, Conservative, West Nova, NS]

Yes.

[William Maguire]

The case managers I have met think that they're psychologists, but they're not.

[Greg Kerr, Conservative, West Nova, NS]

They need training.