Evidence of meeting #39 for Veterans Affairs in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was within.
A recording is available from Parliament.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
The patient, the member, has access to that. He gets a question with some regularity about his condition improving or worsening and if the treatment is effective and so on. The patient is involved in that?
Col Hugh MacKay
When they come for their appointment, sir, they have an iPad and they answer the questionnaire. When they go in with their clinician, the clinician reviews the results with them and looks at their position on the plot.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
To go to the CAREN system for a minute, I was fairly involved with that in Edmonton, as you may know, and I've seen it in operation many times. It's a great piece of gear.
Last night I talked to the folks who were here at another meeting. They said they're mainly using it for research right now in Ottawa. In Edmonton, I think they're using it for some clinical work as well. How is that system developing in terms of it being used not just for research but for actual clinical work in difficult areas like PTSD? How is that coming?
Col Hugh MacKay
We are still in the research phases with respect to using the CAREN system for PTSD. We have another virtual reality system that we're using for PTSD that's more portable and office-based. We are working with our allies. The Israeli defence force in particular has some skills with respect to CAREN and its use for mental health treatment. We're working with them and looking at creating a study to better utilize that CAREN system with post-traumatic stress disorder patients.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
The first time I saw it, we were hooked up between Edmonton, Israel, and the Netherlands, and the technology was quite startling.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
As for the capacity of members to remain attached to the Canadian Forces' medical system after they release, the point Mr. Stoffer and Mr. Chicoine were making, there's limited capacity within the CF in terms of the numbers of doctors. Is it as tight within the CF as it is within the civilian world, in terms of the numbers of doctors to numbers of patients who want them?
Col Hugh MacKay
I would say that we do not have any members of the Canadian Forces who don't have a family physician. We're able to provide for everybody in that regard. For us to undertake additional care, we're only staffed to manage our current cadre of military members and those reservists for whom we do provide care.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
Even if you wanted to hire them, do you think those doctors exist on civilian streets to be hired into uniform to provide the kind of after-service care that was mentioned?
Col Hugh MacKay
We do know we have challenges both recruiting uniformed physicians and hiring civilian physicians to work within our clinics. I suspect we would have difficulty filling additional physician positions.
Conservative
Conservative
Col Hugh MacKay
It is more acute on the mental health side. We have a shortage of mental health providers, yes.
Liberal
Frank Valeriote Liberal Guelph, ON
Thank you for appearing before us today, Colonel MacKay. It was curious that you...[Technical difficulty—Editor]...presentation. On my iPad I was looking up the Israeli efforts into the study of PTSD, so I'm pleased that you mentioned it. I'm very curious about this. Can you elaborate a bit on the degree to which our Canadian Forces are looking at best or better practices in other countries? I know that Israel is studying the use right now of certain medications with the active forces before they are identified as having any kind of PTSD, so that, while in combat, there's an effort to train our forces to perhaps better or more stably respond to circumstances that might otherwise trigger PTSD. Can you elaborate a bit on that?
Col Hugh MacKay
As you can well imagine, trying to keep up with what's going on in the world of mental health care is not an easy challenge today. There are a lot of people spending a lot of time and energy researching mental health care and we're learning tremendously. We recognize these advances. We work very hard to keep up with what is going on, and to achieve that we participate in the NATO Human Factors and Medicine Research Panel, where all of the NATO countries and other invited countries are able to discuss what's going on in research in mental health, as well as other aspects of health care and medical care and protection. We also participate in a quadripartite group, the TTCP. I'm sorry, but I can't remember what that stands for right now, but it consists of Australia, Canada, the U.S., and the U.K, and it's where we share what's going on within health care. We've just stood up the centre of excellence in mental health, with Dr. Rakesh Jetley as the chair of mental health research at that centre. His role and that of the other members of that centre of excellence is to track what's going on with advances in mental health care treatment and to try to make sure that the knowledge is translated across our organization and within Veterans Affairs so that we can best apply those new practices.
Liberal
Frank Valeriote Liberal Guelph, ON
Are you aware of any breakthroughs on the horizon in treatment? Are we still stuck in the same old treatment or are there some new treatments forthcoming?
Col Hugh MacKay
I think that the greatest advances and greatest potential we have right now is where we're looking at more personalized health care. In the past, mental health care has been a little bit a case of, well, “We'll try this medication with the patient and see if it works, and if it doesn't then we'll try another medication.” We're starting to see through some forms of neurofeedback and genetics that some medications may be better for some patients than others, which is going to allow us to better target those things. We're also looking at neurofeedback to guide the actual treatment the individual is undertaking. Those are the kinds of things that I think are going to help us better care for our mental health patients.
Liberal
Frank Valeriote Liberal Guelph, ON
You mentioned an acronym, CAREN, a computer-assisted rehabilitation environment in Edmonton and Ottawa. If I were a member being moved to Edmonton or Ottawa and it wasn't my normal place of residence and I was suffering from PTSD, I would have a certain amount of anxiety and trepidation just in that move. To what degree are families accommodated in the treatment of CAF members when they are asked to go to these rehabilitation centres, if I'm getting it right? Do they spend long periods of time there? Is it days, weeks, months, and are their families accommodated so that they're not just phoning home from time to time?
Col Hugh MacKay
As I explained, we're really not at the point of using the CAREN system too much for the treatment of mental health casualties. It's mostly people who have physical injuries that we're using the CAREN system for right now. When we're treating patients with mental health concerns, we do bring in the family as much as possible, in discussion with the patient, in order to help the family member assist that patient. For the physical injuries, when we move a patient to Ottawa or Edmonton to use the CAREN system, at present we would not necessarily move a family member to do that.
Liberal
Frank Valeriote Liberal Guelph, ON
While still in uniform, can a CAF member who will be medically released meet with VAC representatives to prepare for the transition to civilian life? In other words, we've perceived a kind of Death Valley between active service and Veterans Affairs—this is what we've all heard about—and there is no doubt an effort to close the gap. Can you tell us about that transition from active service to becoming a veteran? While you're telling us that, can you talk about the family members who may be involved in the transition process?
Col Hugh MacKay
At the present time, our case managers usually pick up the case early on and start to manage it. Prior to release, we do engage with the Veterans Affairs case managers to make sure that things start to link up. Within our joint personnel support units and our affiliated IPSCs, there are Veterans Affairs case managers present. Most of the patients who are going to transition into civilian life are within JPSUs or IPSCs, where they are able to have contact with Veterans Affairs case management personnel.
As I said in my opening remarks, we are working, through a working group right now, to look at how we can make sure that there isn't that gap between the Canadian armed forces case manager and the Veterans Affairs case manager, trying to integrate them more fully into the planning of the transition for the member and the family.
