Veterans Affairs Committee on Nov. 25th, 2010

[Dr. Don Richardson]

For that, you could probably contact our clinic and the network of clinics to get the specific number of weeks, but you're probably looking at waiting six to eight weeks to see a specialist like me, and sometimes longer. Because we work within a team, if somebody is at a higher risk, then the wait list is modified.

[Guy André, Bloc, Berthier—Maskinongé, QC]

We know that the longer we wait to provide services to a person suffering from post-traumatic stress, the worse the person gets. That is a concern for us. Sometimes, for example, there can also be problems like drug addiction or relationship breakdown. There are certainly other consequences.

In terms of the assessment, the screening for cases of post-traumatic stress, could you tell the committee what you would recommend so that people in a difficult situation or in distress could get services more quickly?

[Dr. Don Richardson]

With respect to accessing services, the Government of Ontario came up with a paper. I think it was called “All doors are open” or “No doors are closed”. It has something to do with the analogy that wherever you access service, the answer should not be no, but that we will take you on and help direct you to where you need to go to be able to access service. It's like a self-referral, meaning that if you go somewhere, it's up to the organization to do the paperwork in the background. Much in the same way as when you go to emergency, you're able to see somebody, but once you give your health card, somebody in the background determines who's going to be paying.

If a veteran goes to emergency because he or she is in crisis, the emergency departments are not necessarily trained, and they don't think of asking if you're a veteran. If you are a veteran, you may be entitled to other services that other people may not have, and maybe you could then be referred to specific clinics, such as OSI clinics. Can a veteran go into a local OSI clinic, for example, and self-refer, meaning come in, be screened, and then have the intake person do the paperwork in the background, asking if you're a veteran and if you're eligible, and if not, whether they can refer you somewhere else?

Those are all aspects of getting somebody into treatment right away. Another aspect is promoting better shared care, which a lot of the time means seeing a specialist. If the family doctor can take on some of the initial work so that we're working in collaboration, then that frees up more time for specialists.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Could…

[The Chair, Conservative, Gary Schellenberger]

Please make it a very short question, Mr. André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

…more training be provided to psychiatrists and psychologists in Quebec and in Canada so that there is a faster response for people experiencing problems with post-traumatic stress.

I was involved in social work for a number of years. I represent the constituency of Berthier—Maskinongé and I am sure that, in the entire Mauricie region, few people are trained to handle former soldiers, veterans dealing with problems like that. I feel that the Department of Veterans Affairs should invest significantly in training a minimum number of people in each of the regions of Quebec and Canada. That could then ensure that a basic response is available. At the moment, no such training exists.

[Dr. Don Richardson]

I would agree in terms of working with the current national associations. Part of the mandate of the National Centre for Operational Stress Injuries at Ste. Anne's Hospital is to work with the Canadian Psychiatric Association, because they also have a mandate to provide education. We look at how we can partner with them so that when we have an annual meeting with psychiatrists, there are specific symposiums and education sessions about veterans' issues. It's the same thing for psychology.

I've been involved with veterans' files for one of the journals of family medicine, providing continuing medical education through papers that family physicians can read to sensitize them to veterans' issues, and I've been working with the Canadian Network for Mood and Anxiety Treatments. There too I've been providing education to specialists about how to treat PTSD and comorbidity. Educating and sensitizing and getting a network of individuals is key, for sure.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

I would advise committee members to glance this way every once in a while when it's getting close to the end of five minutes, because we do go overboard sometimes. I don't want to interject, but I might have to do that from now on. I don't like to be taken advantage of.

We'll go to Mr. Kerr.

[Greg Kerr, Conservative, West Nova, NS]

Thank you, Dr. Richardson.

What we are learning the more we go along with this process is that there isn't an easy fix or an easy answer, but it seems that as time goes on, a lot of advancements have been made. Every year there seems to be some improvement, although there is a long way to go.

We've heard the American comparison more than any other. You hear from them a couple of things that are very different. One is about their long history of active combat. Therefore, it's expected that there will be more incidence and higher statistics.

The other thing that's been pointed out strongly on occasion, and it's not a full answer, is that the Americans don't have universal access to medical care. A lot of vets here do have some advantage in getting into a referral process.

I'll stop there for the first question. Do you see that as an advantage in the Canadian system?

[Dr. Don Richardson]

That's probably an advantage, and it has been discussed among clinicians. If you're a veteran here, you are a citizen of Canada, and you have access to health care. I would assume there are many veterans--although we don't know--who are seeking and accessing treatment but are not identified or having their treatment paid for directly by Veterans Affairs. In the U.S., my understanding is that to be in their health system with the Department of Veterans Affairs, they would have to have a service-related pension entitlement.

[Greg Kerr, Conservative, West Nova, NS]

Therefore, it's hard to make the comparison as to the end result, because they're different in that regard.

I would like to follow up on something. You mentioned, as others have, the collaborative team approach for recognition during initial training. We've heard from witnesses that it has certainly advanced over where it was a long time ago. In early detection, of course, the military has made huge adjustments in very recent times, and of course it has been done in collaboration with Veterans Affairs.

I'm wondering and concerned about those in the gap period, before we made those advancements, who are perhaps still out there in the public. Are you finding that you're getting referrals from others, or, as you said, are people who have been veterans for a few years--they're still modern vets--entering the clinic themselves? Are people coming in who maybe didn't have the kind of process there is in DND today?

[Dr. Don Richardson]

I think so. We're getting a significant number of veterans who have been out for more than 10 years. We also get World War II vets, still, and Korean veterans who are seeking treatment for the first time.

In our experience at Parkwood, what has helped is to have a media announcement or some sort of presentation. Then the people are aware that there are services available, especially if they're not at all connected.

People from the peer support program, which you have probably heard about or which has been talked about, are very good ambassadors for our clinic. The ambassadors may know somebody who knows somebody else, and then they are able to tell the veterans that there are services available for them.

[The Chair, Conservative, Gary Schellenberger]

You have one minute.

[Greg Kerr, Conservative, West Nova, NS]

Thank you.

On that reference--and we have heard that it's better--there have been a number of symposiums, clinics, and conferences of late, and one of the things that seems to stand out is the stigma issue versus public education.

You talked about the social dynamic within the military. Do you find there's a better understanding in the public and a better reception from the military itself in terms of accepting the fact that mental health is a real problem and has to be dealt with? Do you find the public is more receptive, or is the stigma still a huge problem?

[Dr. Don Richardson]

Well, I think that for more than 10 years the stigma has been decreasing and I think that the public in general is more supportive. There have been a lot of good public anti-stigma campaigns, so I think it is starting to inch away at it.

I think it's still there. I think it was discussed already that as much as we have it in the public forum, it's still on the individual. If they feel that what they have is a sign of weakness, they may not take the next step and seek treatment.

[The Chair, Conservative, Gary Schellenberger]

Just before we finish, I know Mr. Stoffer said he had one small question.

I will allow you one small question, sir.

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

Thank you, sir.

I know with patient confidentiality you have to be very careful with what leaves the room, but if you notice someone who could be quite violent, either to themselves or their families, what happens in that case? Do you advise any authorities? Do you tell police? What happens in that case in order to protect the interests of the family?

[Dr. Don Richardson]

I think that in those cases we have an obligation if somebody is acutely suicidal or acutely homicidal. As a psychiatrist, part of my role is that I may have to certify them, meaning I can contact the police and have them assessed and hospitalized against their will.

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

Thank you.

[The Chair, Conservative, Gary Schellenberger]

Thank you very much. I do appreciate your answers and your expertise here today.

We're going to take a short recess so that our next witness can come on.

[The Chair, Conservative, Gary Schellenberger]

We now welcome Linda Lagimonière.

Before we go to your remarks and then our questions, I must mention that we will need to go in camera at about 20 past the hour. We have a short matter of committee business to deal with.

Please make your presentation, Madame.

[Linda Lagimonière, As an Individual]

Good afternoon. My name is Linda Lagimonière and I am the mother of Private Frédéric Couture. Frédéric had an accident on December 16, 2006. He stepped on a mine. He was then sent home. The army looked after that. I have to say that, when he came back, it was quite the scene. There were soldiers everywhere. They took Frédéric to the Montreal General Hospital, not to Quebec City. That was a first for the army. Frédéric then spent eight months at home. On November 14, 2007, Frédéric committed suicide. He died in my arms. That is very hard, I can tell you.

A little less than a year later, a commission of inquiry was held. That is when I found out that Frédéric had tried to kill himself over there. The army never told us that. We also found out that he had never received any psychological help, except for a 15-minute session with a 20-year-old psychologist who was just starting out in the profession. Physically, Frédéric received the best care possible. Psychologically, he received none.

[The Chair, Conservative, Gary Schellenberger]

That was your presentation.

[Linda Lagimonière]

Yes.

[The Chair, Conservative, Gary Schellenberger]

Okay. Thank you.

Go ahead, Ms. Duncan, please.