Veterans Affairs Committee on Dec. 8th, 2016

[Michel Doiron]

Yes, and Mr. Parent reminds us often.

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

Good. He struck me as an individual who would be very diligent about reminding.

[Michel Doiron]

Absolutely.

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

I have a question about service animals. I've gone to events. I have met with organizations that are involved in the training of these animals, and it's a very long, very expensive process. Are you in contact with them? Do they approach you to provide that conduit, to make sure that veterans, those in need, receive the right animal for their needs?

[Michel Doiron]

They're not in contact with me, but I know our research group, especially on the dog side, is working very closely with the industry to make sure we have the right standards. They're working with us at Standards Canada, I believe that's the right term, to make sure that a dog that is certified as a service dog has the right certification, that it's not just Michel Doiron in his backyard, training a dog. I'm being a little facetious, but we're always a little concerned about some of the areas that say a lot of stuff, but have they...?

Some organizations are excellent, by the way, but let's make sure that the dog the veteran will receive is able to do what it's supposed to do. It does help, so let's make sure it's well trained.

[The Chair, Liberal, Neil Ellis]

Thank you. That ends the second round.

We'll have time now to do another round. Mr. Kitchen is going to split his time with Mr. Brassard.

Mr. Kitchen.

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

Thank you, Mr. Chair.

I would like to go back to the centres of excellence. What I've heard basically is talking a lot about research. Research is one thing in a centre of excellence. We all know that to do a RCT it takes time to get it done and completed, and then take that information and, through knowledge transfer, get it out to the practitioners.

Can you tell me what sorts of treatments would be set up so there's a take-home for our veterans and their families when they go to these centres of excellence?

[Dr. Cyd Courchesne]

Thank you. I'll take that question.

When we talk about research, we're not just talking about doing RCTs because those are the highest level in clinical research, but we can do some other research, research about what's working elsewhere and things like that.

The research drives the practices that we can then push into all of our OSI clinics, but also to the entire medical community to advance the practice of treating these injuries.

The centres of excellence, yes, there's an essential part that needs to be researched to understand because we need to understand in order to drive the best practices that will be implemented and give the tools to the medical community to deal with that. It's not just research in isolation. It will be to drive new practices to get better outcomes.

[Michel Doiron]

If I may—the doctor had mentioned it earlier—it's about the understanding of the issue but also educating our health professionals across the country, not just the ones who work in an OSI. It's to get that education out and actually translate some of that terminology so that people understand, because our OSI clinics are professionals in dealing with our military colleagues.

I'm from Edmundston, New Brunswick. That's where I was raised. I'm not sure how many of our doctors in Edmundston, New Brunswick, have experience dealing with and even recognizing some of the injuries related to PTSD. I think that's the other part, the education and pushing that out.

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

I understand that part of it. I realize that's a goal, but is there going to be a component, and if so, what percentage of it will be providing treatment to these veterans so they get some treatment, and their families have some take-home they can use, whether it be a situation of training them with skills on how to care for their loved one with PTSD or that sort of thing?

[Dr. Cyd Courchesne]

Again, the understanding will drive more education for the caregivers and for the family. It's the entire package. The treatment will continue in our OSI clinic network, which will continue to grow.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Brassard.

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

Thank you, Mr. Chair.

I've been trying to eeny, meeny, miny, moe, which question I'm going to ask here because I know I have only a short time, but I'm going to stick with the issue of PTSD.

One of the things I've learned in talking to some veterans is that, when a condition is too complex for somebody they are referred to, if it's post-traumatic stress disorder related, sometimes there are psychiatrists who just can't deal with it because the issue is too complex.

Can you walk me through the process of what happens at that point if it is determined that a person who is suffering is referred to a psychiatrist who can't deal with it. How long of a process does it take to find another doctor? It's something that has come to my attention recently.

[Dr. Cyd Courchesne]

I would say it would be unusual for a military veteran to not either be connected.... Either they were diagnosed while they were still in the military, and they were put into care in their specialized clinics, which have a different acronym from ours but do the same thing, the same function....

Is it possible there's a veteran who's not one of our clients and shows up to their family doctor who refers them to a psychiatrist? PTSD is not unknown to psychiatrists. If it's with respect to their military service, I think they would know that Veterans Affairs pays attention to this and I would hope they would refer them back to their case manager who would say that they should be going to an OSI clinic.

I haven't encountered cases where people have been prevented from accessing care because their psychiatrist was uncomfortable with treating it.

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

If the psychiatrist is uncomfortable dealing with it because perhaps it is too complex a case, how long would it take for them to be able to seek other doctors?

[Dr. Cyd Courchesne]

It would be as long as anyone who would show up for the first time in one of our VAC offices and said—

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

Which is typically two weeks?

[Dr. Cyd Courchesne]

Yes, it's two to four weeks.

[Michel Doiron]

I want to put a bémol. That's for our OSI clinics. In some parts of the country—I think we were hearing about the challenges in Saskatchewan, and I'm sure other parts of the country have the same challenges—it may take longer if we're trying to get a psychiatrist who is not in one of our OSI clinics. That is the Canadian health system.

As the doctor said earlier, the Canadian Armed Forces is a health provider; VAC is not a health provider. We use the Canadian health system. Our OSI clinics, as an example, are staffed by provincial health professionals. We pay the province to dedicate the clinic purely to veterans and RCMP members, but they are provincial employees dedicated to veterans. In some parts of the country, if you're not going to an OSI clinic, there could be a delay in the medical health system.

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

I see the chair is not in his chair, so I'm going to take advantage right now and ask the other question.

There will be a significant challenge for VAC going forward. This may not necessarily relate to PTSD, but in terms of long-term care for those veterans from Afghanistan, Somalia, how much planning is VAC doing? I know we're going to have to be really quick here.

[Michel Doiron]

We are planning. We're doing the demographics, and we're working on the entire long-term care scenario.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you very much.

Thank you both for being here today.

I understand Mr. Brassard has been talking a lot about the need for research. We are all looking for the answers here.

Do we have a need for research or do we have a need for more information sharing with our allies? Does anybody else have this sorted out?

[Michel Doiron]

I think you missed an earlier part on this.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Sorry.