Veterans Affairs Committee on June 6th, 2013

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

Thank you.

Sir, one of the debates going on in Canada is the issue of mental health concerns, not just within the military and veteran community but also in the general population. One thing we have in Canada is a shortage—it's unfortunate but it's the reality—of mental health providers, psychologists, psychiatrists. Do you suffer the same concern in England? If you do, how do veterans achieve the help they require in order to obtain the counselling they deserve?

[Dave Rutter]

Yes, we have similar challenges over the numbers, with regard to mental health. There are a number of programs that are being run in the wider sphere of mental health care, including the IAPT, or improving access to psychological therapies program. A number of initiatives have been taken forward for the wider population.

With regard to veterans, partly because of the military ethos, the culture, and the type of individual likely to be within the armed forces, we realized we had a smaller, hard-to-reach group, which might be reluctant to admit to a mental health problem, and even harder still, to take steps to deal with it.

The report by Dr. Murrison that I mentioned earlier picked up on that theme and looking to recommend initiatives that would help encourage those individuals to come forward to access the mental health services that already exist. The 10 teams that I referred to earlier are very much geared toward providing that encouragement, and also to raising public awareness of veterans' mental health issues. They are able to signpost people to the services that we have more promptly than has previously been the case.

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

Are those services also provided for the spouse and children of the veteran?

[Dave Rutter]

There is a mixed community there. The teams that I mentioned earlier have set themselves up in a slightly different ways. There are some teams that have recognized the impact of mental health problems on veterans' families, and they give their services not just to the veteran but also to the wider family unit.

We are in the process of undertaking another project, with an organization called Mental Health First Aid. This is to train people who will train others in mental health first aid within the armed forces community. So they can help identify those who may be displaying signs of mental health problems. They can give initial advice, and they will be able to signpost them in and refer them to the right level of care. That's a new program that we hope to launch later this year.

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

That's very kind of you. Thank you so much.

[The Chair, Conservative, Greg Kerr]

Thank you, Mr. Stoffer.

We'll now turn to Mr. Zimmer, and I hope we won't get into a British football conversation.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

I just watched Canada play Fiji last night, and we won, so it was a good night for Canada. We won last night 22 to 18.

Thanks, Dave, for coming.

I have a question for you about OSI clinics. You referred to teams, but we have what are called Operational Stress Injury Clinics here in Canada, and we operate 17 of those. They basically deal with what you'd imagine—with psychologists, social workers, and mental health issues.

Does the U.K. operate similar clinics, and what is your opinion of the model?

[Dave Rutter]

Is the model you describe for veterans or for serving personnel?

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

Actually, it's for veterans.

[Dave Rutter]

The nearest we would have to it would be the teams I've described to you. From your description it sounds as if there may be some similarities to what we're trying to do here in the UK—bringing together the clinicians and the wider carers within that community who may be able to help.

It's often the case that the cause of the mental health problem may not be combat-related. It may be related to housing, employment, or life-changing problems. So although that person is a veteran, their mental health may be the result of another problem. Having people within the teams who can recognize that and then plug into the appropriate support and advice agencies is very important.

I'm not sure whether that's what your teams do. Ours are still fairly new. I think at the moment they're still getting the clinical expertise up to speed. They're getting the veterans in and through the system. The challenge for us is how we embed that and grow the service toward 2015 and beyond, particularly with the drawdown from Afghanistan.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

My next question is on case management. We have a system that assists former veterans and members of the RCMP and their families; they find it difficult to transition into normal life afterwards. I wondered if you had a case management system that helps a veteran along, through those steps.

It's very similar, I guess, to what you had mentioned with the teams. For me, it's just hard to understand where the mental health part is. Maybe it's just different language but the same thing.

[Dave Rutter]

Yes. There are several stages to this.

There is the work that the Ministry of Defence will do with the individual as they are coming to discharge from the armed forces. There will be a lead-up to that discharge, which will help them with re-skilling, if appropriate. Certainly if they have been injured there are the recovery centres, and lots of other training goes on that will help with that transition back into civilian life. It's not necessarily with a mental health focus but with a life skills focus, if I could put it that way.

With the mental health piece, that's a component of it, if you like. The evidence suggests that most are leaving the services fit and well, with not too high an instance of mental health problems. Mental health problems would appear to come forward a year, two years, three years or longer after the discharge from the services.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

Maybe you could just expand on that a little bit. We too have an employment initiative, called Helmets to Hardhats, that helps transition a veteran to a job. It sounds like that's part of your program as well, or that's what I heard there.

Do you have a similar system to ours? Or how would you define it? What would you call it?

[Dave Rutter]

We do have a similar system to that. As part of that transition process from the services back to civilian life, the Ministry of Defence does work with an organization called Remploy. They work with other agencies as well so that veterans can be placed into employment upon departure.

Now, that's obviously not appropriate for all who are leaving, but clearly for those who are in need, or perhaps who need some additional help, they will be identified and taken through that system.

That's very much a Ministry of Defence process that they get taken through.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

Dave, does that help with the skills component too? Let's say I was a veteran leaving the service and I needed to be trained as a carpenter or as a computer technician or something like that. Would the U.K. provide for that as well?

[Dave Rutter]

Yes, the Ministry of Defence is part of that discharge process. It depends on the individual length of service, and on which part of the armed forces they are in, etc., but as a general rule, they will look to help re-skill, retrain, and inform that individual of that process. I know anecdotally from somebody who has recently left the services that they took some time to really re-skill in relation to IT, etc.

So yes, those are available.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

Thanks for your time, Dave.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

Mr. O'Toole, you have five minutes, please.

[Erin O'Toole, Conservative, Durham, ON]

Thank you, Mr. Chair.

Thank you very much, Mr. Rutter, for meeting with us and sharing the perspective from England and the U.K.

I have a couple of questions, one related specifically to a statement you made in relation to the service charities. I loved your phrase “beyond the statutory services”. I was involved in creating here in Canada sort of the equivalent to Help for Heroes, called the True Patriot Love Foundation.

My question for you is this. In that service charity space, we have noticed that it's very difficult sometimes for these well-intentioned and disparate groups across the country—some large, some small—to coordinate and prioritize needs so there is not overlap and it's not more complicated to work with NHS or government equivalents.

How has the experience been in the U.K.? You're saying that it's critical to provide that added level of service excellence to our veterans, but how do you coordinate the groups and government?

[Dave Rutter]

With great difficulty. I met with colleagues from True Patriot Love a year or so back and they asked a very similar question at that stage. It is difficult. Within the U.K. I think there are over 2,000 service charities. Some are very small, local; others very large—Help for Heroes, Royal British Legion, Combat Stress, etc.

One of the programs that we have run over the last three years is a strategic partnership program, where we have funded a group of service charities, the larger ones—so that's Royal British Legion, Combat Stress—but also with SSAFA, Help for Heroes, and one or two others. The idea of part of that program is creating an opportunity for central government, from the department and the Ministry of Defence, to have open, honest discussions with the service charities. We're all trying to achieve the same thing, we just may attack it a slightly different way. So we all know our starting point in that respect, but we also use that relationship for them to, if you like, cascade and take the views of the other agencies and the other charities out there.

Now I've stood on many a platform at conferences, etc., with service charities and have made the point that this whole system works best when you have the statutory and the service charities working like that. I don't think you can see my hands, but working very closely together, and not overlapping because that's a waste of resource. I've certainly said publicly that one of the challenges for the service charities is, wherever possible, to avoid that overlap.

That overlap does happen. It is inevitable. There are—and this isn't a criticism—a number of very small service charities that have been set up to provide a service, to provide, again, a particular need that they see locally, and that's to be supported. I think the more that they can start to work with some of the bigger charities, or recognize what the other charities are doing and complement them, the better. I think the important thing—I think this is an early stage and the service charities recognize that as well.

We have something over here called COBSEO, the Confederation of Service Charities. That's an umbrella body that has been created to help bring together the service charities as one. I think we have some way to go before we can really start to get them to move in a far more coordinated way. That will always be a challenge. But as I say, what we have achieved, I would suggest, over the last four or five years is a transparency and honesty with the service charities so that we can have a very good conversation about what we can do, and more importantly, what we can't do. Then we work with those services charities to say, “We can take it to this level; what is it that you can bring to the game to add to that?” So it's not replicating statutory services, because that's wrong, that's what the statutory services are there for and we must provide it. It's what is it in relation to veterans and their families we can do that will provide that added value? I think this where the programs, where we worked with Big White Wall, Combat Stress, Royal British Legion, have brought that added value—for a very small budget, I would suggest.

[Erin O'Toole, Conservative, Durham, ON]

That's very helpful.

Very quickly, then, you explained the NHS structure of rehab under the heading of injured veterans, loss of limb...you broke down the categories. Is the rehabilitation for veterans who have lost a limb done through NHS in the regular system alongside everyone else, or does NHS break out specific rehab for veterans?

[Dave Rutter]

We are just in the process. I mentioned Dr. Murrison. He produced another report, this time on those who lost a limb in service. Dr. Murrison, I should point out, is now a minister in the Ministry of Defence. He wasn't at the time he produced the reports.

He identified the need for a service within the NHS that would be able to address the particular needs of veterans. You may be aware that for those who are injured in service, the Ministry of Defence provides an excellent service through Headley Court rehabilitation services. They provide high-tech, high-spec limbs as appropriate to these individuals. So the question was raised as to what happens when they go into the NHS, because the NHS was not providing to that level for the wider population.

We've identified what I think is a relatively small budget but certainly one that will more than meet the needs of veterans who have been injured. The numbers are relatively low. It's £15 million over a period of three and a half or four years. With that money, apart from the cost of the kit, the hardware that's needed, we're upscaling nine centres across England. Roughly speaking, there are three in the north, three across the midlands, and three across the south. There will be some extra financing going in from there so they can provide not only, as I said, the high-spec limbs the veterans need but also the other rehab requirements that go with those.

I should add very quickly of course that the NHS here does not want to run a two-tier service. We're very conscious of that and that does create challenges when we're creating something different for veterans.

So although we've put this extra money in for veterans who have lost a limb, the wider objective of this of course is to bring the skills and the knowledge of the clinicians and so on, within the NHS up so that the wider limbless community within England will also benefit from what we're trying to do. But certainly the needs of those individual veterans are being met and will be met in the future as they discharge from the services.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Rutter.

That's the end of round one. As we go to round two, the four-minute round, we'll start with Ms. Perreault from the opposition, please.

[Manon Perreault, NDP, Montcalm, QC]

Thank you, Mr. Chair.

Hello, Mr. Rutter. It is nice to speak to you this morning.

With your permission, I would like to come back quickly to the transition from military life to civilian life.

I know that, in order to help veterans to move away from homelessness, you have taken several initiatives, through your Single Persons Accommodation Centre for the Ex Services, which help veterans to find a home. Am I mistaken? It boils down to finding them a home during their transition back to civilian life.

Does this program really reduce homelessness among veterans?

[Dave Rutter]

I'm not familiar with that specific program you refer to. Certainly in my discussions with the Ministry of Defence in relation to that transition piece, that's not been raised as a specific issue or problem for them. The vast majority of those leaving will have homes to go back to.

The issue, where it is raised or where I have come across it, is in relation to those who have already left the armed forces, who would have had a home, but then subsequently lost it, possibly because of mental health problems, possibly because of drinking or other behaviour problems, and who would have become homeless a short while or sometime after leaving the services.

I'm not familiar with any programs to provide specific housing for those who are leaving the services per se.