Veterans Affairs Committee on March 10th, 2015

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

The Canadian Psychiatric Association has said that almost a third of Canadians who seek mental health care report that their needs are unmet or only partially met. That speaks to the evaluation component with respect to mental health care.

I want you to talk a bit about the quality of what's provided, and how you evaluate whether the members are receiving what they need, or is there an evaluation methodology?

[Col Hugh MacKay]

CROMIS is going to be our main evaluation methodology. That is really going to be how we're going to look at outcomes.

However, we have looked at the patient satisfaction with the care they are being provided through two venues.

Our directorate of force health protection does a health and lifestyle information study every four years. In it there are questions about accessing mental health care, and whether or not the person felt they got the help they needed when they did access care. Also within the recent survey that we had done by Statistics Canada, which was a follow-up to our 2002 study looking at mental health in the Canadian armed forces, we also had questions about satisfaction with care.

That would be the latest data we've collected. Unfortunately, I don't have that analysis available to me just yet, and I'm not sure that analysis has been completed from that 2013 survey just yet, but we did look at it.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Good.

Thank you.

[The Chair, Conservative, Royal Galipeau]

Mr. Lizon, you may go ahead.

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

Thank you, Mr. Chair.

Thank you, gentlemen, for coming here and thank you for your service.

I will go to mental health again and I will read a portion of your presentation here:

Within the mental health program there's a strong research element. Currently the main research efforts are focused on the analysis of the 2013 Canadian Forces mental health survey and through the recently announced Canadian Military and Veterans Mental Health Centre of Excellence, where research is conducted on unique aspects of military and veterans mental health.

Can you expand on that and maybe tell us what exactly that research is focusing on?

[Col Hugh MacKay]

The mental health survey from 2013 is really trying to help us understand the extent of mental illness in the Canadian Armed Forces and look at the change between 2002, when we initially did this survey, and 2013. We designed that study in a way that also used questions that were very similar to the civilian survey that was done by Statistics Canada, so it gives us the ability to compare numbers in the Canadian Armed Forces with those in the civilian health sector as well, which is useful for us to be able to understand mental illness in the Canadian Armed Forces.

We have also looked at things like how military personnel access care. Who do they go to if they feel that they have concerns with mental illness? What is it that would stop them from going for care if they feel they have mental illness? We try to evaluate access to care, barriers to care, and those kinds of things so that we can try to put in place measures to ensure that people are able to come forward for care when they need it.

Our centre of excellence is going to be looking at things from a more clinical perspective than we're able to do in a survey. The centre of excellence really wants to try to keep track of what's going on cutting edge with respect to care. This is where we're going to try to undertake some of the studies that are looking at personal life mental health care, looking at neurofeedback, looking at neuro-imaging, what we're learning with respect to how the brain responds to post-traumatic stress disorder, and whether or not there are changes that we can track and see when people are being treated.

We're also trying some new medications and are looking particularly at control of nightmares and sleep disturbance in post-traumatic stress disorder. I think that those are probably the main differences between the Centre of Excellence and what we're doing with the survey.

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

You were talking about treatment, but it would be a great success if we could prevent to a great degree mental illness. Therefore, is there anything being done on that side, and then the findings incorporated into a training program of Canadian Armed Forces members so they will not actually get mental illness? That would be a great success.

[Col Hugh MacKay]

That's a very good point. Absolutely.

We have our education program called the road to mental readiness. We do have a study to look at the road to mental readiness and the effectiveness of the road to mental readiness program.

One of the things that we've identified is that you can't use a cookie cutter education program within the Canadian Armed Forces. We have different populations within the Canadian Armed Forces and we've started to tailor some of the road to mental readiness program to those different communities that we have.

There are, for example, the special forces community, the group of people who do intelligence work and fly remotely piloted vehicles. Those types of communities may have different needs, so we're starting to try to tailor that education and prevention program through the road to mental readiness to those particular populations and to try to do an evaluation of the effectiveness of those programs.

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

Just quickly—I don't have much time left—you mentioned 66 case managers and that they have very heavy workloads. Can you maybe expand on this? What is a heavy workload? How many people would they have to look after?

[Col Hugh MacKay]

We have 66 case managers, who are carrying on average 70 cases per person. It is a difficult workload for them, so we need to examine how we can make sure that they are able to provide, from a case management perspective, for the care that our personnel need. We are able to prioritize the people who have the most complex care needs to the top of the list; they're able to see a case manager within seven days of a referral from their primary care provider.

We're also looking at things such as how to redo their work. For example, instead of doing individual sessions with some people, they're able to do group sessions for people who require case management education.

We're also looking at the integration of case management between our case managers and Veterans Affairs', to try to share the load as we look at transitioning patients.

[The Chair, Conservative, Royal Galipeau]

Mr. Rafferty.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Thank you, Chair, and thank you both for being here today.

I'm a little confused about something you said earlier regarding medical files. One of the recommendations from this committee was to ensure that all regular force members had their files before they were released. If I heard you correctly, you said that is being done.

[Col Hugh MacKay]

That is being done.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

It is being done?

So there is a disconnect for me. Why would Veterans Affairs even have to get back in touch with you again, if all the members who are now accessing Veterans Affairs already had their medical files. Could you clear that up for me?

[Col Hugh MacKay]

Usually our members make application to Veterans Affairs before they leave. We're giving them a copy of their medical file around the time of their release, but Veterans Affairs certainly wants to become engaged and to be able to evaluate what entitlements they may have before it is time for their release. Members at any time, even if they are not going to be potentially released, can make application to Veterans Affairs for benefits. Particularly, if they have suffered some illness or injury that isn't causing them a great deal of medical problem within a special duty area, they may make application to Veterans Affairs.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

The member who doesn't access Veterans Affairs immediately but may do so, say, five or ten years down the road, will have their medical files with them. So there won't be any need for Veterans Affairs to get back in touch with you to get their files, because they will already have them from their service.

[Col Hugh MacKay]

Giving the members those files as they depart is relatively new for us. Traditionally, the files have gone to Archives Canada, and Veterans Affairs has not had to come back to us. If it's five years out that a member applies to Veterans Affairs, they would get the file from Archives Canada, typically.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Then let me ask you what changes you would make to ensure the continuity of care between Canadian Forces and Veterans Affairs. Is there something in your daily work about which you would say, we could make this better? Are there any changes you would make to improve that continuity of care?

[Col Hugh MacKay]

I think the work we're undertaking right now, trying to better link up our case management systems, is the key for us with respect to ensuring that we don't have a gap or potential break in the continuity of care as they transition from us to Veterans Affairs Canada. That's where I think we need to focus our efforts.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Colonel Bilodeau, did you want to make a comment on this?

[Col Marc Bilodeau]

I took a few notes while you were speaking, but early case management involvement is, from a VAC perspective, really key, and we're working on this. The other piece we're working on is to try to establish similar competencies between the two groups of case managers. Our case managers are nurses; VAC case managers are not all clinicians. This creates an issue from the perspective of sharing the medical information. VAC is working to bring itself to a similar level of clinician case managers.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Would it be helpful if every member, when released, automatically kept their number, for example, whatever their member number was, and automatically everything went to VAC, so that everything happens whether they access VAC services or not. Is there a way to make sure that people don't fall through the cracks as they try to access services that they might be confused about?

[Col Hugh MacKay]

I know there is work under way within our VAC CAF steering committee, including discussions around My VAC Account, which I think is a good idea. The intention is that, as members join the Canadian Armed Forces, they become aware of Veterans Affairs Canada and may start a VAC account so that they already have something in place with Veterans Affairs Canada. I think we're far less likely to have people leave the service, go off into their civilian lives, and then have some trouble reconnecting with Veterans Affairs Canada at a later date if they have something like that in place.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Thank you.

Do I still have time for one more question, Chair?

[The Chair, Conservative, Royal Galipeau]

You have time for a quick question, not a Valeriote kind of question.