Thank you very much, Mr. Chair and distinguished members of the House of Commons Standing Committee on Veterans Affairs.
I'm very pleased to have the opportunity to talk to you about the medical care offered to our Canadian Armed Forces, or CAF, members, the treatments and services offered to our members in the operational trauma stress support centres, known as OTSSCs, and the support they receive from the case management program when they are transitioning out of the CAF as the result of a medical condition that makes them unfit for military service.
Joining me today is Col. Marc Bilodeau, Director of Medical Policy.
The Canadian Forces Health Services Group's main objective is the provision of care to Canadian armed forces members both within Canada and abroad. In consideration of the fact that regular force members are excluded from the Canada Health Act, Canadian Forces Health Services Group is responsible for their care, as all provinces and territories are for that of their citizens.
In-garrison ambulatory care is provided through a network of more than 40 military clinics from coast to coast and overseas. Our interdisciplinary approach, consisting of a mix of military and civilian physicians, nurses, nurse practitioners, physician assistants, medical technicians, and a varying range of other health care providers, depending on the location, enables high-quality health care and is considered the way forward in the civilian sector. It is similar to the College of Family Physicians of Canada's “Patient’s Medical Home”. Should a service not be available in a military clinic, the patient is referred to the most appropriate civilian health care provider in order to ensure that they receive the care they need.
As long as a CAF member is serving, they will receive the care they require in accordance with the CAF Spectrum of Care document. The Spectrum of Care provides CAF members access to the types of care that are similar to those available to Canadians; however, when a member needs a very specific type of treatment that is not included in the Spectrum of Care, a process exists to provide for these exceptions where necessary.
The inclusions and exclusions are based on medical evidence and are reviewed as technology, medications and knowledge advance in the medical world.
To address the sometimes complex physical injuries that Canadian Armed Forces personnel face, Canadian Forces health services has undertaken the integration of additional physiotherapy personnel into our affiliated civilian rehabilitation centres of excellence, through the creation of the Canadian Forces rehabilitation program, to bolster the services normally provided by these centres. The acquisition of two CAREN, computer-assisted rehabilitation environments, located in Edmonton and Ottawa, has also added to the complement of standard therapies available to Canadian Armed Forces members. These measures aim to ensure that injured and ill Canadian Armed Forces members who wish to remain in uniform are provided with optimal conditions and opportunity to achieve that goal whenever possible.
The provision of care regarding mental health treatment is a priority. Canadian Forces health services has a comprehensive mental health system that provides evidence-based clinical care in most of our military clinics across Canada and in Europe. We continue to enhance our efforts to combat mental health stigma and prevention through our road to mental readiness program. Mental health care often starts in our primary care clinics. Where necessary, they are referred to our multidisciplinary mental health teams consisting of psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors, and pastoral counsellors. These teams specialize in the diagnosis and treatment of all mental health conditions, which includes operational stress injuries, but also depression, anxiety, and addictions problems.
We also have seven specialized operational trauma stress support centres, centres of excellence specialized in the delivery of care of such operational stress injuries as post-traumatic stress disorder. Our OTSSCs are located on the larger military bases, but also serve as regional referral centres for military personnel from other bases. Additionally, the seven OTSSCs are part of a joint network of operational stress injuries, which also includes the Veterans Affairs Canada OSI clinics. Through a tripartite MOU, this network allows for care of military members, veterans, and members or former members of the RCMP in either military or Veterans Affairs Canada facilities when it is deemed appropriate for a given patient.
In an effort to enhance our mental health program, we're in the process of piloting CROMIS, the client-reported outcome management information system. It will allow for rapid treatment outcome assessment and will guide the optimization of individualized care. We are also in the process of implementing enhancements to the Canadian Forces health information system, which will add direct-entry capability for mental health notes. This will enable the improved timely communication between primary care clinicians and mental health professionals, further strengthening the collaborative care they provide.
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.
Canadian Armed Forces members with more complex medical needs also benefit from the case management program. This program was established more than ten years ago. It offers services in all Canadian Armed Forces clinics located in Canada. Case managers are specialized nurses who are integral to the care delivery team and facilitate ongoing care for patients through a complex period of medical care. The goal of the case management program is to assist the Canadian Armed Forces member to navigate the medical and administrative system. The primary goal, where possible, is to achieve a return to duty after a complex disease or injury. However, for those members who have chronic medical conditions that have led to permanent employment limitations and do not meet universality of service, they work closely with VAC to assist with transition to civilian life in the safest way possible.
There are presently 66 case managers working with and for Canadian Armed Forces members. They carry a heavy caseload, which requires prioritization of patients based on the complexity of their case and care requirements. Our case management program works very closely with their counterparts in VAC. Analysis and work are presently being done to optimize the transition of the releasing member from the DND program to the VAC program.
A working group under the VAC-CAF steering committee has been established and has the mandate to broaden the definitions of case management in order to analyze the elements associated with the continuum of care for soldiers and their families. The transition period around release is a critical time to ensure long-term continuity of care for releasing members. A standardized assessment of all transitioning CF members is being done to determine the level of complexity involved in their transition from DND to civilian life. Whenever a member is identified as having complex needs regarding transition, a multidisciplinary team meeting is convened with the goal of proactively eliminating the identified barriers to allow for a proper transition from a health, financial, occupational, academic, and/or psychosocial perspective. In certain circumstances, additional transition time will be requested by the team in order to secure a safe transition. Each case is handled individually, on its own merits.
The multidisciplinary team will facilitate the transition of care, including referral to specialists and to a family physician in the local community where the released member has decided to reside. A case manager will also help the releasing member to obtain a provincial health card before release and to apply for all other eligible benefits such as SISIP, VAC, CPP and vocational rehabilitation.
When a member reaches the release date, although there is no longer an entitlement to care through the CAF, everything possible has been put in place to ensure the continuity of care via the provincial health care system and/or VAC.
In conclusion, the Canadian Armed Forces are committed to optimizing the health of our members in uniform during their years of service and to maximize their chances of returning to duty after an illness or an injury. For those Canadian Armed Forces members who are unfortunately unable to return to duty, our commitment is to provide them with access to high-quality care and assist them the best way we can to ensure continuity of care through VAC or the civilian health sector as they transition to civilian life.
Thank you, Mr. Chair, for your attention.