Veterans Affairs Committee on June 5th, 2012

[Dick Harris, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

Thank you all for coming today.

Colonel Bernier, in your text you talk about seeking accreditation for your case management program. Could you maybe expand on that a little bit? I imagine that the value of the accreditation is to measure the success of the program. Maybe you could talk a little bit about that.

[Col Jean-Robert Bernier]

Accreditation Canada is the national quality assurance body for health systems and health facilities, primarily hospitals, but various other types of health facilities as well. They're completely independent. They have independent peer assessors from across the country who are experts in assessing the quality of health care provided by various systems. They do that not only within Canada but various other countries in the world ask them to accredit theirs as well, because their reputation is so good.

They have accredited our entire Canadian Forces health system and determined very favourably that it ranks among the best. What we didn't do is have a precise, more detailed specific accreditation of the case management system within the armed forces specifically. Independent assessors who are experts in case management will be coming in to assess the quality and report back to us where improvements might be made that we may not have identified on our own.

[Dick Harris, Conservative, Cariboo—Prince George, BC]

Would you use that input as a measure of the success of the program so far, but also to provide a road map for where you want to go to make any improvements that might be needed?

[Col Jean-Robert Bernier]

That's correct. When they do assessments of hospitals or health systems, even ours, even though they tell us verbally that it's one of the best they've ever seen anywhere in the world, their duty is to find things that can be improved. There's no health system anywhere that has a perfect record, although we scored pretty high. Our whole health system, as it stands now, has been improved significantly over the years, because there have been problems in the past, but it will give us a road map for things to improve to make it progressively better.

[Dick Harris, Conservative, Cariboo—Prince George, BC]

Thank you.

Ms. Carrese, thank you for the size of the font in your presentation. It's sure easy to read.

You talked about collaboration with partners in the community, the government, etc. Specifically in the community, maybe you could just review again some of the partners you would get involved with.

[Lina Carrese]

We spoke earlier about the big challenge, for example, with accessing medical professionals in the community. We are actively trying to do more outreach and network with the medical professions. We did have a collaboration with the Canadian Psychiatric Association and the Canadian Institute for Military and Veteran Health Research to have, in the five major cities across Canada, at the annual CPA conference, modules specifically on post-traumatic stress disorder and treatment for it, specifically in the context of veterans, which we know can be different.

It's really important that the medical professionals know that we are here to help. With our 200 clinical care managers across the country, if these very busy medical professionals in their private offices know there is support and that Veterans Affairs Canada has a lot to offer...we're hoping we can help with this very difficult situation in the medical system. That is an example.

We are working with the Canadian Mental Health Association. They have lots of programs. We can't reinvent the wheel. We always have to do our part in terms of making what they have available specific to the needs of our veteran population, because we know it is different. There's a lot of expertise out there, and we think we can be more effective and efficient by partnering with all the different associations, such as the Mood Disorders Society of Canada, the Canadian Mental Health Association, etc. That really allows us to do better.

It goes internationally as well. We have had symposia in the past with the International Society for Traumatic Stress Studies, where we were able to bring in all the prominent experts in the field of operational stress injuries, and lots from the different VAs across the country, so that we could learn from each other and become better in the services we offer.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Ms. Carrese.

Ms. Perreault, for four minutes.

[Manon Perreault, NDP, Montcalm, QC]

Good afternoon, thank you for being here. Thank you very much for taking care of our wounded and disabled soldiers.

In his presentation, Colonel Bernier mentioned suicide. I would like to link that to your presentation, Ms. Carrese, where you specifically mentioned telephone assistance.

[Lina Carrese]

Yes.

[Manon Perreault, NDP, Montcalm, QC]

Has the telephone assistance line been in place for a number of years?

[Lina Carrese]

It is more about the services, but I think that it goes back to 2002, as Mr. Lalonde is telling me. So it is quite a while.

[Manon Perreault, NDP, Montcalm, QC]

Have you noticed a decrease in the number of suicides since the line has been in operation? Do you have any data on that?

[Lina Carrese]

Veterans Affairs Canada is not like National Defence. It is very difficult for us to get information or statistics on the number of veterans who commit suicide or who die as the result of a suicide, because, unfortunately, it depends whether it really is a suicide. It depends on the family. Will they choose to tell us? There are confidentiality concerns. So we do not have that kind of information about suicides among veterans. But we are actively researching it. We have some data.

[Manon Perreault, NDP, Montcalm, QC]

Last May, a lady lodged a complaint. She said that it took a lot of time before she got an answer. She wanted to know whether her long-time spouse had taken his own life or had died of natural causes. Is that the same phone assistance line or are they two completely different things?

[Lina Carrese]

I am sorry, but unfortunately, I cannot answer that. I have no specific information on that case.

[Manon Perreault, NDP, Montcalm, QC]

Do family members who call, but who are not veterans or soldiers, have a specific line that they can call, as opposed to the veterans who have a line where they can be provided with assistance and be given the support they need?

[Anne-Marie Pellerin]

I can perhaps shed some light on that, Mr. Chair.

The VAC assistance service is a 24-hour, 7-day-a-week, 1-800 number that is available to veterans and family members. Family members are free to access that service. It provides short-term counselling for situations that may be of an urgent nature, and also referral to community-based services. Again, depending on the urgency of the situation, the referral could be to a hospital emergency room or to other types of services. Bottom line, the service is available to both veterans and family members.

[Manon Perreault, NDP, Montcalm, QC]

Very quickly, can you tell me one thing? Is this linked to the 200 chaplains you mentioned in your presentation? Are those two completely different things?

[Lina Carrese]

Those are two different things; two different services.

[Manon Perreault, NDP, Montcalm, QC]

Thank you.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

Mr. Lizon, for four minutes, please.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair. Thank you to all the witnesses for coming. I thank you for your great work.

I will ask my questions first, because normally I am told that I am out of time. Whether we have enough time to answer them or not, maybe we will go the same route and I will get the answers in writing.

The first question I have is for Madam Pellerin and the second question is to Colonel Bernier.

Madam Pellerin, in the beginning of your presentation you talked about the case management services process and you named six important tasks. I would like to focus on two: engagement and relationship-building, building trust, and monitoring and evaluation.

With regard to the first one, in our travels with the committee we did hear from some people that in some cases there was a problem establishing trust, and sometimes people didn't want to talk to anybody else except the person in uniform or the person who had served. How would you deal with this under the transformation initiative, and how is this different under transformation from the process that was in place before?

Colonel Bernier, in your presentation last week you mentioned, among other things, the pilot project of electronic tracking and transfer to VAC. My question is—if I understand you correctly—would this be tracking all the people you release from service, and would this be done in collaboration with Veterans Affairs so that this monitoring or tracking would continue to keep in touch with veterans?

[The Chair, Conservative, Greg Kerr]

If I cut you off at 5:30, which will automatically happen, I'll have to get the rest in writing.

Ms. Pellerin, please go ahead.

[Anne-Marie Pellerin]

The case management functions and the engagement and relationship-building that are established at the outset and throughout the case management process are not new. This is a practice within case management that has existed for a long time, and certainly one that we've had in place within Veterans Affairs since we've been engaged in the business of case management. That relationship is critically important.

What is maybe a little bit different in terms of our more recent practice and our work with our colleagues at National Defence is our integration with them at the integrated personnel support unit and getting engaged with releasing members prior to the release. We establish that relationship with the CF case manager, the VAC case manager, and the client family all together, so that once the member is released, that relationship can carry on. It's an ongoing relationship. It's one that needs to be cultivated throughout the whole case management process.

[Col Jean-Robert Bernier]

The pilot study is simply for tracking the medical records that are required for those individuals who require ongoing Veterans Affairs support. It's only the tracking digitization and electronic transfer of medical records. It's not an ongoing...we have an electronic health record for all armed forces members, so that we can track their health throughout the country and anywhere in the world where they are. But that is not part of this pilot project.

We do some studies. For example, last year we did the Canadian Forces cancer and mortality study, where we followed Canadian Forces members who had served from 1972 to 2006, and followed their causes of death. Now we'll be following up on their causes of cancer down the road to assess those kinds of things. It found, for example—from one question earlier—that there was a 1.5% higher rate of suicide among a certain cadre of released veterans.

So collaboratively we do all kinds of research to try to identify where the issues are. But this particular medical records tracking project is purely for the tracking, digitization, and electronic transfer of medical information for individuals who are being released from the armed forces and who need help from Veterans Affairs after release.