Veterans Affairs Committee on Nov. 15th, 2016

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Colonel Downes, you and I know from our common medical training and from the military that there is always a stigma around mental health and there are people who are reluctant to come forward because of mental health issues.

What is the Canadian Armed Forces doing to reduce the stigma around mental health issues to encourage members to come forward?

[Col Andrew Downes]

You're right. Mental health carries a stigma in Canadian society, as it does within the Canadian Forces. We've recognized that the stigma is one of the many barriers to seeking care that exist for our patients. But it turns out that it's not the most significant barrier to care. We have put a lot of energy into improving the mental health literacy of our members, because we know that when people better understand mental illness, the stigma is reduced. We've also participated in a number of activities designed to reduce stigma, such as discussions at the brigade level or the unit levels, and things like that. We participate annually in Bell's Let's Talk activities, again, with the goal of reducing stigma. We have actually found, from some of our research, that Canadian Forces members are much more likely to speak openly with their supervisors and their colleagues at work about their own mental illness than are civilians.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

That's very useful to know. Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Brassard.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you, Mr. Chair.

I want to focus on transition—and I know Mr. Fraser brought up this point earlier—and I want to speak more about the working group that's currently in existence. Obviously, they're going to come back with some recommendations.

Brigadier-General MacKay, and perhaps Mr. Downes, you might want to get in on this as well. What is your view of how a transition from being a member of our armed forces to being in VAC's care afterwards would ideally work? The working group is going to come down with a recommendation. I want to hear what Brigadier-General MacKay thinks should happen in that situation.

[BGen Hugh MacKay]

As we identify persons who are ill or injured and who no longer meet universality of service and are therefore going to be released for medical reasons, we want to be able to have the discussions between our case managers and VAC case managers to understand the treatment and support requirements of those individuals still in uniform as they're going to transition. We want to have the opportunity to have decisions from Veterans Affairs Canada with respect to what they will be entitled to from a benefits perspective, and we want to be able to identify health care providers in the civilian sector who are going to be able to pick up their care before they actually take off their uniform and go into the civilian sector.

That really is the goal we hope to be able to achieve for transitioning members and their families.

[John Brassard, Conservative, Barrie—Innisfil, ON]

I was at Base Borden and there's a sense of frustration—I know Mr. Kitchen brought this up earlier—with the fact that VAC doesn't speak to DND on behalf of the soldiers with respect to the information that's available, and the reverse is also true; DND and VAC computers don't....

Brigadier-General MacKay, notwithstanding the privacy issues, do you think there's a way for us to overcome those issues? There's informed consent, and I know we talked about that, but is there a way we can integrate that information together to make it much more seamless?

[BGen Hugh MacKay]

I believe the key is at the case-manager level. If, with patient consent, we can have the case managers communicating effectively on what the treatment needs are and what the treatment plans need to be—and it doesn't necessarily have to be that full medical file but just having those discussions at that case-management level—that is really going to go a long way to facilitating that transition and helping that conversation to happen. That's one of the aspects we're working on, that coordination between the two case-management teams.

[John Brassard, Conservative, Barrie—Innisfil, ON]

So in terms of roles, then, in that transition, should the emphasis be on DND, more on VAC, or should they be partnered equally as someone transitions out of the military?

[BGen Hugh MacKay]

I think we have to be in it as a team at that point. We want to be working on it together to get to the ultimate goal, to the benefit of the member and their family.

[John Brassard, Conservative, Barrie—Innisfil, ON]

I want to focus on the issue of institutional fatigue. New missions will be evolving. There are going to be some new challenges, obviously. We talked about the difference between World War I, World War II, and Afghanistan. New troops are also going to be needed and new missions will require new assets. Are you concerned that as we deal with these new issues there is a risk of institutional fatigue? Do you see the potential of the military having to do more with less? Could this cause a greater problem in dealing with cases that these new sets of problems bring with them, or are we prepared to deal with them?

[BGen Hugh MacKay]

We're currently organized to deal with the current suite of options that the chief of the defence staff has to offer up, from a deployment perspective. I don't think I can speculate as to what these other unknowns may be and what the requirements of them will be for us.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Well, there has been direction that we are going to move more into a peacekeeping role. That brings a new dynamic to the situation. There may be a chance that the military will be expected to do more of that, with perhaps fewer resources. Do you think we're capable of dealing with some of these challenges going forward?

[BGen Hugh MacKay]

I'm not sure about the comment that there are going to be fewer resources. I am prepared to support the current Canadian Armed Forces as it is. Whenever there's a consideration for a mission to go out the door, we look at what we have for resources to support that mission.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Chair.

The Canadian Forces Ombudsman made some recommendations in his report, and I know we've skirted around this a bit, but I want to come back to simplifying the service-delivery model. There were three very solid recommendations and I wonder if the changes he suggested could help the mental health of military members transitioning out. To what degree do you anticipate being guided by these recommendations?

[Col Andrew Downes]

Could you refresh our memory on which three recommendations these are?

[Irene Mathyssen, NDP, London—Fanshawe, ON]

They were that the Canadian Armed Forces retain medically releasing members until such time as all benefits and services are in place at VAC; that the Canadian Armed Forces establish a concierge service so that there is someone there who would be a liaison between DND and VAC; and that the forces lead, through a phased approach, the development of a secure web portal that would contain all of the information needed for a servicing-cum-security program and that would enable members to put their information in just once. This would allow them to automatically apply for services and benefits.

[BGen Hugh MacKay]

Those recommendations do not really fit within my mandate with respect to the provision of health care. My comment would be that we believe any effort to smooth the transition process is going to help our members as they prepare for that transition. We recognize that anything we can do to reduce the stress and time for that is going to be beneficial.

I would say, though, that there are times when members may want to leave more quickly, and it may be to their benefit to be able to leave more quickly. I would hate to hold people in the forces when they themselves want to leave before those services are all in place, as recommended by the Ombudsman.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

It was also suggested in the course of our deliberations that the planning for civilian life begin right at the start of service, that it be something that doesn't just come up at some point, but is thought through right from the beginning.

Do you have any thoughts on that?

[BGen Hugh MacKay]

It's really an opinion that you're asking for, and I think everybody is going to be different with respect to what their needs and desires are with respect to planning their future going forward.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Kitchen, go ahead for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Colonel, you indicated to one of my colleagues that the suicide rate is higher in the army than in the navy and the air force, mainly because they were the bigger contingent in Afghanistan.

Recognizing that fact, I wonder if you have looked at the prevalence of suicide in those soldiers—not the whole navy and air force, but those who deployed—and are the rates higher or lower than what you would see in the general population?

[Col Andrew Downes]

Yes, we have looked at that, not broken down by commands, but, overall, when you look at all the people who have deployed, they do have higher incidences of mental illness compared to military members who have not deployed. Those include depression and PTSD and general anxiety disorders, for example. We also know that, overall, the military has a higher level of mental illness than does the civilian sector.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Do you think it would be a good epidemiological study to determine those cohorts?