Veterans Affairs Committee on Nov. 25th, 2010

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Do you think Health Canada or CIHR has a role to play here in talking with Veterans Affairs Canada to try to highlight this issue?

[Dr. Don Richardson]

I think that having more partners and having more people talk about mental health is always beneficial.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

As someone who treats people with mental health challenges, what would be your three big asks of the government in order to improve services?

[Dr. Don Richardson]

That's a good question. Nobody has ever asked me for a wish list.

The issue is accessing services and the challenge in terms of how to coordinate health care between primary care and specialists. The majority of people in Canada are receiving mental health services from their family physicians. As specialists, psychiatrists, we're another line behind, so it's partly educating primary care physicians and nurses on the effects of mental health and how to screen. That's one aspect.

The other aspect is providing general education to the public, almost in the same way as an anti-stigma campaign is done. It's letting people know that if they're having difficulties, whether it's depression or PTSD, they can identify that they have a problem, and then it's making them aware that treatment is available.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Is there any--

[The Chair, Conservative, Gary Schellenberger]

We have to move on. Maybe you'll get another chance.

Go ahead, Mr. Vincent, please.

[Robert Vincent, Bloc, Shefford, QC]

Thank you, Mr. Chair.

Good afternoon, Dr. Richardson. How long have you been a consultant with the Canadian Forces?

[Dr. Don Richardson]

I initially started working with National Defence as a consultant in 1996. In 2000 I moved to southern Ontario, and in 2003 I started working with the Parkwood Operational Stress Injury Clinic, so it would be over 10 years now.

[Robert Vincent, Bloc, Shefford, QC]

In the years you have been practising, have you been called on to treat veterans, or serving members of the Canadian Forces?

[Dr. Don Richardson]

Have I...?

[Robert Vincent, Bloc, Shefford, QC]

Have you provided medical follow-up to people with symptoms of post-traumatic stress?

[Dr. Don Richardson]

Yes. My clinical practice right now is all veterans, currently serving members of the Canadian Forces, or eligible RCMP.

[Robert Vincent, Bloc, Shefford, QC]

In your practice, when a veteran or a serving member of the Canadian Forces is diagnosed with post-traumatic stress, has that diagnosis ever been challenged by the Canadian Forces or the Department of Veterans Affairs?

[Dr. Don Richardson]

It wouldn't necessarily be contested in the way you're asking. The diagnosis we will make is a clinical diagnosis, meaning that if somebody comes in and presents with symptoms that are consistent with PTSD, we make the diagnosis and then pursue the treatment. It may be not necessarily contested, but if they were applying for pension entitlement, whether or not the PTSD they're claiming is related to service, it would go through adjudication, if that's what you mean.

[Robert Vincent, Bloc, Shefford, QC]

Yes, that is what I mean.

I have met veterans, and even serving members of the Canadian Forces, who have told me that, when a diagnosis of post-traumatic stress is objectively made and the paperwork is sent to the Department of National Defence or the Department of Veterans Affairs, the diagnosis is challenged.

So that causes a number of problems. First, the patients cannot get any pension money if the diagnosis is challenged. Second, they may have to wait two or three years to get the matter resolved.

So, during that time, does the veteran or the serving member continue to be seen, or do all the services stop, given that the diagnosis is not recognized?

[Dr. Don Richardson]

In my experience at Parkwood, you don't have to have pension entitlement under the new Veterans Charter to receive services. They would continue treatment while a pension claim is pending. If they are not being treated at our clinic and they're seeing a psychiatrist in the community, treatment would continue, because it would fall under medicare.

[Robert Vincent, Bloc, Shefford, QC]

Doesn't the fact of knowing that their diagnosis is being challenged cause an even bigger problem for people? When someone in that situation comes to see you, does he not tell you that he has no income because his application is being contested by the Department of National Defence? Does he not tell you that he does not know where to turn and that he does not know what will happen to him? Does that not cause that person additional stress?

[Dr. Don Richardson]

In my experience, any time somebody is putting in a claim and waiting for a claim would be an added stress for them.

[Robert Vincent, Bloc, Shefford, QC]

From your knowledge of your clinic and of other clinics with which you must surely be in contact, has someone waiting and under additional stress like that ever committed suicide?

[Dr. Don Richardson]

That I'm not aware of.

[Robert Vincent, Bloc, Shefford, QC]

You said that if you could make recommendations, they would deal with access to services. Is the difficulty of access to psychologists, psychiatrists and other medical personnel not one of the major problems? You have to be able to access the services in order to identify the problem. People can be waiting several months before being able to see someone.

[Dr. Don Richardson]

What I mean by the challenge of accessing services is that if you're an individual, for example, do you know you have a problem, and do you know where to go if you have that problem? That's one aspect, and it's based on the individual.

Once you have identified that you potentially have a problem, whether it's depression or PTSD, how do you access service? The challenge, in my experience, is that in the military context they provide comprehensive health care, so to access service it's always the same person within their health care system. Once you become a civilian, it's a little bit more complicated, because in general you can't access specialty services without going through primary care. You have to see your family doctor first and then be referred.

As you're probably aware, in Ontario and probably across Canada there are many civilians, including veterans, who don't have a family doctor. It's that process, in terms of accessing care. If you want to see a psychologist, that's not covered by medicare, so to access psychotherapy, you would have to have an entitlement in order to have it paid for. If you're working full time, in another aspect, it would be paid through your private insurance.

[Robert Vincent, Bloc, Shefford, QC]

If I understood your testimony correctly, things get more complicated and more difficult when soldiers are discharged from the Canadian Forces and become veterans. That is when we have to find out whether they are suffering from post-traumatic stress.

We heard that General Dallaire was once found walking around a park naked. That is a major symptom, in my opinion. I gather that a number of people have shown similar symptoms, even four, five, ten or fifteen years later.

The problem is that it is difficult to see a doctor quickly enough, giving the medical situation at the moment. I understand that that is the crux of the problem, and you can understand how people can end up committing suicide.

[Dr. Don Richardson]

I'm assuming this committee has probably seen people from the military, and it's a different culture. For us as civilians--I speak for myself, as I'm not in the military--our culture is to try to find a family doctor, and then we know how to access services, but if you're coming from a different system and you get released, and you also have depression or problems with concentration, low motivation, finances, or your family, those add another barrier to trying to find out who you can see to access services in a community.

[The Chair, Conservative, Gary Schellenberger]

Thank you.