Veterans Affairs Committee on Dec. 8th, 2016

[Michel Doiron]

That's okay.

Canada is recognized as one of the leaders in this. Our OSI clinics and the practices and CROMIS are recognized internationally. We work very closely with the other Five Eyes: Australia, United States, New Zealand, and the U.K.

Senior officials, our researchers, and even ministers usually meet every two years. The last one I attended at West Point was on mental health.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

We heard testimony not too long ago from Dr. Sareen who estimated about 15% of those transitioning had mental health issues, and he mentioned that was a conservative estimate. When I asked if that's a conservative number, what did he think the real number was, he said upwards of 30%.

Does that reflect your experience?

[Michel Doiron]

That sounds higher than our experience. I think we typically see probably around the 20% mark.

[Dr. Cyd Courchesne]

It's about 23% of our clients who we have right now. It doesn't mean that there are.... We know from our research that another 20% have left the military not for medical reasons. They're not quite so sick that they would become our clients, but they struggle. It's probably an accurate number.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

We estimate about 20% to 25% of those we have identified.

[Dr. Cyd Courchesne]

Of our clients 23% have a mental health disorder diagnosis.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Taking into consideration that there are those who wouldn't be tracked, that is possible.

[Dr. Cyd Courchesne]

Yes.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Does our lack of a national suicide prevention strategy impact how we're dealing with veterans?

[Dr. Cyd Courchesne]

Are you speaking about a Canadian suicide prevention strategy?

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Yes. Will it be helpful if we have one?

[Dr. Cyd Courchesne]

I think it will be helpful for everyone, veterans included. It is a public health issue. I think some work is being done. For the two years I've been with the department, we've collaborated with the Public Health Agency of Canada in developing a national framework. The CAF and several partners have also been engaged with them.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

The other thing that we heard recently in testimony is about what I think was referred to as “death by a thousand cuts”, so there is a PTSD issue or there is a mental health issue, but on top of that there's a service delivery issue or there are other outside factors like relationships or money issues and what have you.

There are some things that we can't control as a government, obviously, but do you expect the work that we're doing on service delivery to have an impact on suicide prevention?

[Michel Doiron]

I look forward to your report on service delivery. I'm not sure when it will be tabled, but I do look forward to it. The last time ACVA tabled a report, there was stuff that we did use and it was very useful, so I'm looking forward to it.

For sure it is known, not just with suicide but in treating mental health in general, that the faster we can get them into treatment, the faster we can get them the care they need and the better it is for the individual. It's probably true for all illnesses. With any delays in approvals or getting them into treatment, there's an impact. That's why we're working so hard on the service delivery review that the department has been doing, but also on how to modernize our systems, get more stuff online—eliminating some of the bureaucracy is maybe the best word to use—to move it forward.

Understanding that we are governed by a multitude of acts and regulations that are laws, I can't just decide that I'm going to do X. There's a law that I have to comply with. That said, we are doing some work on that. The health care provisions are one we're starting to look into, and the financial benefit suite that we have. At the end of the day, where we're trying to go, and we've really undertaken this in the last little bit, is focusing on the veteran's well-being. You'll hear a lot about veteran-centricity, veteran-centric not program-centric, and not just making sure all the boxes in the system are.... What does the veteran need, when, and how? Let's get to it and let's get them trained.

Unfortunately, we're still heavy on the administration, and I don't mean staff when I say that, please. I mean the documentation and some of the stuff that we need to do, and sometimes it's to comply with acts. People like to say, that's what the act says. I am not a lawyer. I've been in the public service a long time, so I ask them to show me in the act where it says that. Often, over time, and this is my eighth department, people start adding requirements because of one bad apple somewhere throughout the years, and all of a sudden that becomes the policy.

Let's eliminate that policy, and our minister and deputy minister have really challenged the department to get rid of these areas, ensuring though that we don't break laws and we follow what we're supposed to. We have to or the OAG will come in and give recommendations, but let's take care of our veterans. The bottom line is care, compassion, and respect, and not just saying those words but getting them there.

In mental health, with 16 weeks, okay, I'm meeting my service standard but it's a long time to get your diagnosis and treatment. We know that and we're trying to do that much faster. For some other stuff, maybe it's acceptable.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen.

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

Thank you, Mr. Chair.

We had the Canadian Forces ombudsman here, and I'm sure you know that he has reported. We've seen the simplified service delivery model for medically releasing members. In that he suggested a concierge service, a web portal that was accessible and enabled veterans to see what it was that was available, and just a general sort of support system.

I wonder if you could comment on how these suggestions might help those suffering with mental health issues.

[Michel Doiron]

That was the CF ombudsman? Just to make sure, because our ombudsman has also put some stuff out, and I wanted to make sure I answer the right thing.

I agree with some of the statements from the CF ombudsman. It is really for the CAF to debate or not debate the findings. When I look at Mr. Walbourne's comments, I agree with the concierge service, and that's what we're trying to do with the guided support. Let's make sure we do that transition, not just for mental health but for all transitioning veterans.

His comments about the service attribution being done by the Canadian Armed Forces, that I don't agree with, because what happens to the people who have left? If we know that 60% of the people who are not medically releasing are having issues and they come to us two to 40 years down the road, who will be adjudicating those cases? Who takes care of that population that is already gone? It won't be the CAF doctor.

I have some concerns about Mr. Walbourne's comment on that area. We have met with him, not me personally, but my RDG has met with him and Mr. Butler, who was here, also sat down with him to go through the findings. I agree with a lot of the other ones. Simplify the process. Have it online so somebody can apply online. Let's facilitate the usage of the medical health records, so that we only use what we need to use—and we've done a lot of work on that already, by the way. I talked about the concierge service. Those parts I absolutely agree with. How do we get there?

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

We also heard from veterans who came and talked about the brown envelope syndrome, the fact that this ominous envelope arrives and it says they're rejected. One of the things we did hear from veterans was the need for a more human approach.

Is this something you've considered? Here's a very fragile human being and the news is not good. Can we help them deal with the rejection in a one-on-one situation?

[Michel Doiron]

Absolutely. We are piloting one right now in the Montreal office, and we'll see how it works. When they send documentation, they make a phone call to ask five days later if they have received their documentation. We're trying to facilitate, make readable, I guess, the letters we're sending out, to make sure that the veterans understand the content. We're trying to use a language that is understandable, not jargon.

We have to be careful, though. Right now our first application approval rate is 84%, so a lot of people are being approved for what they come in for, but 16% is still not being approved yet. We are working on that. We're looking at how we can make this.... In the adjudications, I have a team who now calls the veteran before sending the letter to say no. They will call and say that based on the information we have, it doesn't look favourable. Is there anything you can add to the file that may help us make a favourable decision?

There are some exceptions. We had somebody claim that we addicted them to cocaine when they were in Afghanistan, and we should pay. When we get a claim like that, we're not going to make the phone call. I apologize. We're going to deal with him in a different way, and this is an actual case. But they call and ask if the veteran is okay, and can something more be provided, because if the veteran doesn't provide anything more, then that's their file.

A lot of that is being done, but we are trying to put a much more human, personal touch, and that's the care, compassion, and respect.

Sometimes the answer is no. Let's be honest. It's not service related. There will always be those letters that say no, but let's do it in a way that is not traumatic for the veteran.

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

That's less adversarial.

[Michel Doiron]

That's less adversarial.

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

Defuse that sense that it's us against them.

[Michel Doiron]

Yes, and the Veterans Affairs employees are some of the most committed employees I've seen. They believe in helping the veterans. They are committed. They sometimes take abuse. Any worker in the mental health realm would know about this. They are totally committed to helping those veterans, and we just want to make sure that it gets out that we are there for the veterans. We're not there to deny. We're there to help, and even if a veteran cannot get a disability award, there are other programs, and we will put the veteran in touch with other people who can help. Our staff in the field does that.

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

I want to thank you for the fact sheet.

One of the things in the fact sheet is this online tutorial designed for anyone wanting—

[The Chair, Liberal, Neil Ellis]

I'm sorry, we'll have to make it very quick, please.