It's still not.
Evidence of meeting #18 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was way.
Evidence of meeting #18 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was way.
5:55 p.m.
Conservative
5:55 p.m.
As an Individual
The initial one was done by my psychiatrist, who hinted that he was of the opinion that he really thought I had it. There were problems with psychiatry, especially at CAMH, with the requirement in 2012-13, when they decided that all patients at CAMH must also be receiving pharmacotherapy. At that point we had already gone off the psych drugs, so I got shifted over to a psychotherapist. Thankfully, my case manager at the time, the first one I had, went out of her way to ensure that I got the psychotherapy covered, because I had been accepted under major depression.
5:55 p.m.
Conservative
5:55 p.m.
As an Individual
These clinicians are not at all associated with the Department of National Defence or Veterans Affairs.
5:55 p.m.
As an Individual
No. Again, my case manager...because I had received and been approved for a claim for major depression, and under that, we were able to get the coverage for the psychotherapy. The first assessment with him was approximately four hours long, going through and trying to figure out what was actually happening.
We have since done a reassessment, in August or October of last year, and in both cases PTSD came up as his primary diagnosis. We have submitted the paperwork twice now.
5:55 p.m.
Conservative
Alupa Clarke Conservative Beauport—Limoilou, QC
Did they explain why they don't recognize the diagnosis?
5:55 p.m.
As an Individual
I've gotten no answers back from Veterans Affairs yet, despite the fact the first application we made with my psychotherapist was back in 2012 or 2013, and we reapplied last year. We have not received any answer. My case manager can't find anything to let me know on this.
5:55 p.m.
Conservative
Alupa Clarke Conservative Beauport—Limoilou, QC
Just before turning to Madam Northey, I have a last question for you. I would first like to let you know that it would be good if you could send us the list of each of those papers that you have to fill out. I would like to know what exactly those forms are.
My other question for you is in regard to your saying you have concerns about the OSI clinic. You said you didn't really want to talk about it because you don't want to put it in jeopardy, but it will not be in jeopardy; it will stay there. I would like to hear those concerns you have about the way it is run.
6 p.m.
As an Individual
Again, where you say these conversations “stay here”, the veterans community is very aware of these meetings and do access them. I don't want to misspeak in any way or discourage any veteran from seeking the help, because there is help available. The OSISS clinics do work. They don't work for everyone, but they do work.
6 p.m.
Conservative
Alupa Clarke Conservative Beauport—Limoilou, QC
Could you please write those concerns to the committee and send that through the clerk? Thank you very much.
Madam Northey, I'd like to hear what you have to say concerning the effectiveness of VAC. I think it might be true that they're not plan-centric, outcome driven.
I would just make note of this brainstorming here, so you know. There is the law that has services and benefits. On the other side, you have the veterans who are recipients of these delivery services or benefits, and you have VAC in the middle.
I'm mean I'm just going out there to try to find solutions. When I meet with VAC employees, they're all good people. I might say bad things right now, but it has nothing to do with the people working there.
Sometimes it seems that the ministry is more of an organization there to deal with the restraint budget and to allocate, in the most restrictive manner, the allowances and benefits and the service delivery. It seems it is that instead of being an organization which has to make sure that the people who most need it will receive the benefits and services and that they reach out to the most possible number of veterans.
In a way, its logic is more serving the state than it is serving the beneficiaries, who are the veterans. I think that's what you're saying.
6 p.m.
As an Individual
I think what I'm trying to say is that this is not even just about VAC or DND. I speak as an executive director of a social services health field, and I've also done some workshops across Canada about an outcomes-based model, so I speak from the point of view of a cross-section of agencies that were output driven. People don't understand what “output driven” means, or even what “performance driven” is. People think performance means outcomes. There's a lot of confusion about language.
Let me put it in a very simple form. A lot of organizations are based upon.... I hear from Walter, and it's funny: in the report, they said that access had improved immensely in Veterans Affairs. I'm not really sure on that end. I'm just reading reports. What government tends to focus on is the number of participants. What I've heard is that we offer the most services of any NATO country. The question I would ask, as a follow-up to that, is not about how many services you're offering, but about how great those services are that you are offering. That's the point that's always missed.
As for what the focus should be when you talk about a client centre, if I can be indulged just a little, I'd like to talk about my experience at the Mayo Clinic. I was very lucky to be able to experience it, but it relates a bit to PTSD, which is that grey area.
I had some symptoms of inner ear dizziness. It was diagnosed. I also had some other issues, such as flushing of face. They couldn't define what it was. It was a grey area. I went from doctor to doctor. One of them closed the door and said, “You know what, we're going to test you for cancer.” Another one said, “We're going to test you for MS.” In terms of the anxiety, I understand what the veterans are saying when they're waiting. The anxiety level increases even though your diagnosis at the end of the day may not be so great....
At the end I was tested for one thing in a pure scientific test. I was told that I had a carcinoid tumour, for which there is no cure. I was going to be dead. The doctor I went back to with this test said, “It's all in your head.” I thought, how can you make up a science thing and it's all in your head? We tested again, and it turned out that it was negative. He said, “You see, it was all in your head.”
My family doctor at that time said it was disgraceful and that I needed to do one more test to make sure, because I had the symptoms. Luckily, I was able to get to the Mayo Clinic. Let me talk about this experience so that you understand. I think it would be wonderful to be able to put that in the JPSU site going forward.
They asked me what my symptoms were and said they wanted to know because they wanted to know whether or not they could cure me. Well, that was interesting. I mentioned my symptoms and heard back in a couple of days. They said, “All right, Ms. Northey, we don't know if we can cure you, but we will make sure we can manage it so you can work again, and we will do that in three to five days.” I thought, right, I've been going at this for a year and a bit, and they say three to five days, come to our site....
I showed up. When I arrived, I had a team leader who was a doctor. That team leader explained all this through manuals. There was not a lot of software at that time. With the manual, they said, “All right, Ms. Northey, here is a list of all the people you're going to see today and here are the locations, and you just need to show up.” That's what I did on that day. I had appointments booked for me by the team leader, who could be a case manager. They could be called a team leader and they could be called a navigator.
I went to these appointments. My sheet with my information didn't go by software. It got sent through this fancy kind of departmental bullet. The package did not follow me as a patient. I did not carry those files. It went indirectly, but it got to the next appointment. The information was opened up and the doctors read through all the previous notes, so they were not asking the same questions. They were not wasting my time and not wasting their time. It was all written down in terms of further tests that needed to be done.
Once I'd gone through it, the team leader summed it up at the end of the day by saying, “Here's what they have said, here's what's left to be done, here are the results of the tests we have to date, here's tomorrow's schedule, and off you go.” This went on for three days. After about a day and a half I started smiling. I didn't know why. I could still be dying, but the thing is that I started to relax. Somebody was paying attention. Somebody with expertise was managing my process. I found that the symptoms.... Anyway, at the end of the day, they said, “Ms. Northey, your symptoms have actually left.” It ended up that they were right: it was in my head for part of that, because I thought I still had the dizziness. It was because of the anxiety that it was prolonged. He said, “We can give you these drugs to manage it. In two months, though, you're going to be fine.”
In two months, I was fine. In that interim period, however, I struggled with one of the tests and I was quite sick. I put a call in thinking I was going to have a secretary or receptionist. I got the key doctor; he was paged. He was thought to be the best doctor in the Mayo Clinic for this area. He personally called me back and said, “It's okay, we'll see you in the operating room.”
I come back and I look at the homeless situation. I look at people with mental health issues. I hear poor Walter's story, and I hear this from the civilian side. Hospitals are not geared for long-term crisis care. They're geared to the short-term. They're fantastic at doing that, but the resources, including CAMH, don't have the outpatient services to help people with mental health issues. CBT, cognitive behavioural therapy, is being looked at as an alternative to taking a lot of the drugs, which would help resolve the situation of people like Walter.
All that information, all the research, is there. The problem is, it's all in all these different spots all over the place and we don't access it. The Privacy Act comes into play. People do not want to share, so when you send somebody from one organization to another, the first organization doesn't have to share the information with the next one.
Going back to the Mayo Clinic, that was a critical link. Information could be shared from one physician to the other, making a team approach more likely. Drummond, in his Ontario provincial health report, wrote about the doctors being the quarterbacks. We need to create a system where there's a quarterback for every single veteran or soldier leaving. Who's paying what, this is something that should be worked out in the department. It should not be the client's issue to resolve. This way, clients can relax—they know somebody is paying attention, somebody is managing. It's all based on the first conversation, in which they hear your expectations, and they tell you theirs. At the Mayo Clinic, they told me they were going to be able to manage or solve my problem in three to five days.
Just imagine if we were able to offer that kind of service to our veterans and soldiers. All this paperwork would become the department's role. It should not be the client's role to manage the paperwork on top of managing the anxiety surrounding the problem.
6:10 p.m.
Liberal
The Chair Liberal Neil Ellis
Thank you.
Mr. Callaghan, I've heard about medication and how it's paid for by the service provider. Could you clarify that? I believe that we farm this out to an agency, Sun Life, Met Life, whatever the company is. Are you dealing with them directly? If that's the case, how often are you turned down for meds after the fact? In your statement here, you say that you're paid after the fact. Are you paid 100% on medications? Are some approved, then denied later? Other vets have told us they've gone to the drugstore with their card and been standing there on a Saturday night at 11 o'clock, only to be refused help.
6:10 p.m.
As an Individual
When I was taking pharmacotherapy for the psychological issues and for the back injury, Veterans Affairs was the one that the pharmacies turned to. Veterans Affairs paid the pharmacies. This, however, only occurs once you actually have a diagnosis and the claim is accepted by Veterans Affairs. Until the claim is accepted, Veteran Affairs doesn't pay crap.
So it gets a little problematic there. I've long since gone off meds. Because of the nature of my demons, I ended up developing an opioid dependency, so I ended up going off pain meds quite some time ago. Damn near killed me. Of course, Veterans Affairs and the military said, “Here, have some more meds.”
I ended up going off the psych meds because the side effects were even worse than waking up every morning wanting to kill myself. Living in a fog, though, was worse yet. Some days I didn't even know what my bloody name was. So I ended up going off meds. Since I went off meds, I know the system has changed. Now the coverage is being farmed out to Medavie Blue Cross, I believe. I had one veteran contact me this morning, going up and down the walls, freaking out because Blue Cross and Veterans Affairs were not willing to pay for the meds they'd previously approved to treat his condition. These meds cost upwards of $100 a day.
Even when we have the claims accepted, we're still being denied. There's some magical list out there that we're not always able to get. The list is with Veterans Affairs, and we used to be able to look at it. The guy from Canadian Veterans Advocacy, Sylvain Chartrand, was excellent at digging up all this material, which allowed us to see what was being approved. With the shift over to Blue Cross, it seems to have become a bit of a black hole. It's not until we put something in that we're getting told whether or not it's covered.
Did that answer your question fully?
6:10 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Mr. Callaghan, thank you for your service.
Ms. Northey, thank you for creating that context because, in your description of your experience at the Mayo Clinic, it very much seems that there is a solution there.
One of the things that the defence ombudsman recommended was that we start from scratch. We take this very convoluted system and we simply start from scratch and build something that works. One of the things that bothered me, and I never really got an answer that I could understand, was the fact that DND does the analysis. You go to the doctor if you're a reservist or if you're a member of CAF and that individual takes note of what's going on with you.
When it comes time for the benefit piece, those medical reports are transferred to VAC. I was assured that VAC had the expertise to look at those medical reports and make a good decision. It struck me that if I'm going to a medical specialist, they shouldn't just be charting what is going on with me, they should be making observations and be able to submit a clinical report based on their expertise. There seems to be a gap there.
Walter, did you feel there was a gap and were you thrown into an adversarial situation in your struggle to get what you needed?
6:15 p.m.
As an Individual
As a reservist, I was not really able to access the military medical system. With the back injury, going through my GP, he's the one who turned around and sent me up to Sunnybrook to an orthopaedic specialist who took one look at me walking in the door and said I had done something to my back. She could tell just from looking at the way I was walking. She worked everything up. Again, because all that came from the civilian sector, the military was saying that I had a back injury, they didn't really know what to do with me, so I was put on light duties.
That's the official stuff that exists in my military medical records, which of course was then sent over to VAC. They then said that it all came from a civilian doctor. The military doctors weren't saying that it's due to military service. They were making no mention of it at all other than acknowledging that there is some physical limitation. It gets screwed up.
The psychiatric part ended up going through my GP. He made the referral to CAMH because here in Toronto it's pretty much the only way of getting a psychiatrist. I ended up waiting a period of time, but a few people who I knew were in slightly higher positions of power pulled some strings and got me fast-tracked into CAMH.
Again, because I wasn't being seen by a military doctor, all the reports coming out were asking what this really meant on top of that. In an effort to protect me from the system itself, the military, those who were aware were trying to hide my diagnosis for me, so that if I was not immediately ejected...That's why, even though my demons started surfacing in 2005-06, I managed to stay on until 2010. The moment that things shifted and people became aware that I had these diagnoses, my days were numbered.
The moment of people finding out, certain people at the higher level finding out that I had depression, had PTSD, the PCat system was initiated and very shortly after that my medical release notification came in, even though I was finding a way of functioning.
Having said all that, there's also this weird disconnect that's occurring with Veterans Affairs where when we're being medically released, it states in our medical releases the nature and the reasons why we're being released. Yet, we're still having to fight with Veterans Affairs frequently after our release to get those benefits, to get claims done.
Especially with the OSIs, those can be so discombobulating that sometimes when you end up full on facing your demons, you don't know what day it is. Trying to figure out that you should apply to VAC before you're released, sometimes that's not happening. VAC is not simply taking those release documents and saying that there is obviously something there. If the military is releasing them for injuries, they should be given the benefit of the doubt, they should be put into the program, given the care they need, and then they can start questioning once people have stabilized, and then ask, especially on the OSIs, where the actual source of it is.
I've got other issues with how psychiatry even tries to figure out causation. That's actually the topic of my Ph.D. thesis, so we may not have time to go into that.
6:15 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Do you still have connections with comrades who may be still reservists or haven't released yet?
6:15 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
Do you get any sense from them that things may have improved or changed? Do you have any idea if it's gotten better?
6:15 p.m.
As an Individual
The ones who are open about their own mental health are scared shitless about coming out. It has not changed. The moment you come forward, the moment you have a severe diagnosis, the days are numbered. Even for reservists, the military is a life; it's not just a job. Coming forward and knowing that by coming forward your current life is going to radically change and not under the design of your own doing, it becomes so problematic that, no, there are people who are suffering in silence. Thankfully for reservists, we are able to access the disability and health care system. However, that also causes problems because the psychiatric system is so pharmaceutically heavy that you end up with those drugs, which can mess you up. Eventually people find out, so we either suffer in silence and hope that peer support gets us through the day, or we risk losing our lives, our livelihood.
6:20 p.m.
NDP
Irene Mathyssen NDP London—Fanshawe, ON
We've heard in a number of situations about the reticence to identify the need for help among either CF personnel or reservists, and that nobody wants to admit to that stigma. But you seem to be suggesting that it's more than that, but that an individual has now become a liability.