Veterans Affairs Committee on Nov. 25th, 2010

[Robert Vincent, Bloc, Shefford, QC]

Thank you.

[The Chair, Conservative, Gary Schellenberger]

Go ahead, Mr. Stoffer, for five minutes, please.

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

Sir, thank you very much for coming, and thank you for your service as well.

I've never asked this question, so I thought I might as well try to be as diplomatic as I can with it.

The other day we heard someone say that within 40 minutes you can tell whether or not a person has PTSD or whether they're showing signs of it. Would that be more or less accurate?

[Dr. Don Richardson]

Do you mean in 40 minutes of a...?

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

If I walked into your room as a veteran and told you what my problems were, could you diagnose me within 40 minutes as either having symptoms of, or displaying, PTSD?

[Dr. Don Richardson]

I think 40 minutes would be quick. However, if you're seeing a clinician you're comfortable with and have a good rapport with and trust as someone working for your benefit and are therefore willing to tell them about traumatic things that most people would be afraid to talk about, yes, the clinician could make that diagnosis within the confines of those 40 minutes, if they asked enough questions.

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

Would the reverse would hold as well? I had a conversation the other day with a group of guys over a few beers. They were quite adamant that a fair number of these guys were faking it to get a pension. They're faking PTSD, faking these mental health problems, in order to get a pension. It's the “me too” effect.

In the reverse situation, as a trained psychiatrist, is it possible for you to tell fairly quickly if someone is faking it?

[Dr. Don Richardson]

Well, I think it would be the same thing. I don't think I'd say we could do it quickly. What we do is that we look not only at what they're saying but also at how they're reacting, even before they come into the waiting room. For example, suppose somebody came in and said they're nervous or vigilant regarding their surroundings and that they are constantly checking. If I saw them in the waiting room and they looked relaxed and were talking to other people, and then they came into the interview and didn't actually look anxious or nervous, then I would bring that up in the interview. I would note that what they were saying might not be consistent with what I was observing and ask how we could better understand it.

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

The other point that we heard before is that PTSD can be transferred to the family. If a guy comes back home and he's not the same person he was when he left, it puts tremendous stress on his partner and the children, and thus, in many ways, they suffer from PTSD too.

Do you have an opportunity through your practice to interview and assist family members--spouses and children--or is it just the veterans and RCMP veterans?

[Dr. Don Richardson]

In part of the evaluation, we traditionally see their spouse or significant other.

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

Okay.

[Dr. Don Richardson]

In the case of some of the younger vets, we're interviewing their parents. At our clinic we are treating the spouses but usually not the children, because that's a specialized service we would refer out. However, we may see the family and assess them.

As for the question of whether or not PTSD can be transferred to somebody else, I probably wouldn't say that the other person has PTSD, but that person might be suffering similar symptoms. For example, a way to explain it would be that if the individual with PTSD jumps or becomes very angry every time he or she hears a loud noise, then the people in that person's environment will quickly learn to expect something if they hear a loud noise, so they become nervous and jumpy regarding their surroundings. It doesn't necessarily mean they have PTSD, because if you remove them from that situation, their level of anxiety may well decrease. Yes, they may be suffering anxiety disorders or depression, but I wouldn't necessarily call it PTSD.

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

Thank you very much.

[The Chair, Conservative, Gary Schellenberger]

Go ahead, Mr. Lobb.

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

Thank you, Mr. Chair, and thank you, Mr. Richardson, for attending today.

Parkwood Hospital is not too far away from my hometown. It's about an hour away. Of course, people on this committee are concerned about the issues at hand. We want to make sure, in particular, that people in rural communities such as mine aren't left behind.

You mentioned outreach care when we were discussing this before the meeting started. Once somebody has made contact and is in the system, but is from a rural area, can you explain to the committee how the OSI clinic would work with somebody in, say, Goderich or Exeter or Kincardine, or wherever they may be from?

[Dr. Don Richardson]

Sure. We try as much as we can to provide services locally. Our clinic and the clinic here in Ottawa and I think those across the whole network are connected by video conferencing. In Ontario it's called the Ontario Telemedicine Network. They are telling us that it's a completely secure line. It's not on the Internet.

I would see individuals who find it difficult to drive to our clinic using the Ontario Telemedicine Network for psychiatric care. The patient would go to their local health centre—most of the hospitals are connected—and then I would go to our office, which has video capability, and we would connect that way. I will be providing psychiatric care in that format.

We also have outreach services. That's what I was mentioning. We have a nurse from our clinic who provides services directly to patients and their families in the Grey Bruce area.

We would try as much as we could in that way. The challenge often is for psychiatric care. We would provide that at our clinic, but we would try to find providers in the community who would see the individual on a weekly basis. If we know of a psychologist in the community who has experience in military-related trauma, we would tend to refer that individual to them. They would do the weekly psychotherapy, and then patients might come to our clinic in person or by video or by phone for the psychiatric care.

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

For the benefit of the committee as well, Senator Dallaire was in last week and talked about the OSISS peer support network, psychologists, and psychiatrists.

Could you explain for the committee and for this report how that relationship works? How do you interact with the psychologist and with the OSISS peer networks for the benefit of the veteran?

[Dr. Don Richardson]

At our clinic we have embedded a peer support coordinator. That is an individual who has had PTSD or an operational stress injury and has gone for treatment and has recovered to the degree that he can provide support to other peers and go through the whole program. Any patients who come to our clinic are referred for peer support. We do that automatically. We refer their spouses or their families to the family peer support network.

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

My understanding is that at the OSI clinics, the idea is that assessment and treatment services are provided under the same roof. That's the goal, anyway. Is that the case at Parkwood? What is the benefit to the veteran of being able to have, at least in the initial phases, a kind of one-stop shopping for their treatment?

[Dr. Don Richardson]

You may have to clarify what you mean by the assessment and treatment.

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

It would be that when they would be screened initially, you or whoever would see them. After that, is it a benefit to the veteran to be able to come to the same spot, one that's familiar to them, time and time again?

[Dr. Don Richardson]

This is what we have heard from veterans. They do like the idea that there is a clinic that is veteran-friendly. It means that the majority of people who are at our clinic are either veterans or currently serving members. The pictures and most of the stuff we have around have a military theme. I think it gives them a sense of belonging. Having clinics like that, I think, is beneficial in helping them feel more relaxed and feel that this is part of where they belong.

When somebody is referred, they are assessed. Then we usually start treatment right away. Once they are seeing somebody, we would be recommending treatment. They may come back to see me in a month's time, but meanwhile they may be receiving psychotherapy locally. Some people prefer to see a therapist at our clinic. That's offered also. Some people don't mind driving.

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

I have one quick final question. In my area there's a large nuclear power plant. Again, it's not related to Veterans Affairs in any way, but the nuclear power plant has a very difficult time finding nuclear engineers because there aren't any nuclear engineers in Canada, except maybe from McMaster University.

My point is that as a psychiatrist or psychologist, there is no track in your education that is specifically focused at treating a veteran or any of the combat military disorders. Do you think that DND or Veterans Affairs should work with colleges and universities throughout North America to try to develop course tracks that would be embedded into university curricula, or should the training take place right on site, hand in hand?

[Dr. Don Richardson]

I think that has been talked about. Even at our clinic, we provide training for psychologists. We're in the process of developing curriculum to train residents and give them exposure to military-related trauma. The reason I got involved in treating veterans is that I did my residency at Ottawa and they had a six-month rotation at what was then NDMC.

I think that is a very good point. By giving somebody an exposure to a certain area, you may attract some people who are interested in treating veterans, which is how I got involved with it. I think that's a good point.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Ms. Zarac is next, please.