Veterans Affairs Committee on Dec. 8th, 2016

[Jean Rioux, Liberal, Saint-Jean, QC]

So the clinic in Sainte-Anne-de-Bellevue primarily serves people in the Montreal area.

[Dr. Cyd Courchesne]

Yes.

[Jean Rioux, Liberal, Saint-Jean, QC]

Thank you, Dr. Courchesne and Mr. Doiron.

I have finished, Mr. Chair.

Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Brassard, the floor is yours.

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

Thank you, Mr. Chair.

Thank you both for being here. Michel, it's good to see you again.

I want to focus on the issue of best practices. In your earlier comments you spoke about the need to better understand PTSD and mental health issues with respect to some of the best practices. You also mentioned the fact that the advisory group is studying best practices in mental health.

I guess this question is for the doctor.

Surely, there have to be examples of best practices in other countries, namely with our allies in the United States, Britain, or the European Union, because PTSD and the issues of OSI are very human conditions. I'm sure that other countries have studied these.

Why aren't we engaging in or following some of their best practices? I don't see the need for us to take the lead or further study some of these conditions.

[Dr. Cyd Courchesne]

Thank you for your question. It's an excellent question.

We do in fact work with our allies. We work closely in the military with our NATO allies, and through the network of other veterans affairs organizations in the United States, Australia, the U.K., and New Zealand, we exchange. People look to Canada for the best practices. We are recognized for our leadership in mental health. I think if someone had found a magic bullet out there, we would be all over it and we would be implementing and adopting it.

I think what we see through our discussions at forums, such as the Military and Veteran Health Research Forum, where it's becoming more and more international—at the beginning it was more Canadian—is that people are exchanging. We're all struggling with the same issues. We're all using the same practices to treat. We're all looking for the same answers to questions and recognizing the need for further research.

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

If Canada is seen as a leader on these issues by other countries, then what more do we need to study to ensure we're taking care of our veterans who suffer from PTSD and occupational stress injuries? What more can we do, if anything?

[Dr. Cyd Courchesne]

There are lots of advances in research through brain imaging, and again I'm going to turn to your colleague, who is from the London area. The University of Western Ontario is doing some leading-edge research. Dr. Ruth Lanius is using imaging techniques to look at the brains of people affected by PTSD.

Advances are being made in genetics, where now we can do little saliva tests that tell us that this medication is not going to work for this patient with PTSD and we have to go to this class of medication. There is still a lot to be done in research to understand this, so we can increase our better outcomes in treating it.

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

The thing that's frustrating to me—and I've only been in this role for six or seven weeks—is that I hear of a lot of studies going on. I know there are currently some best practices in place, as I mentioned earlier, and as you agreed.

Michel, you brought up the issue of service dogs and I'll bring that up again today. I know I brought it up with the minister the other day.

In terms of studies and the evidence, the Americans have studied this issue. They've studied service-dog issues, equine therapy issues. My understanding is that for those who suffer from epilepsy, blindness, and diabetes, there were no studies that were done with respect to those service animals. For veterans who are suffering from PTSD, what more do we need to study in that area that we can't get elsewhere?

[Michel Doiron]

Thank you for the question.

We use the information that's available. I want to be very clear that our researchers.... Dr. Pedlar may have appeared in front of you at one point. He was on a scholarship to work on mental health and health of veterans. His group leads a lot of research. We read what the other groups are doing and we talk to them.

I was in England three weeks ago talking to their veterans affairs organization. It was interesting, London was mentioned, even in England. No pun intended, I just realized what I said...London, Ontario. We do read what's going on. The other thing we have to make sure is that, often we say “research”, but it's not just having a dog, because some people out there may try to give you a dog that is not well trained.

Mr. Cousineau, as an example, has an excellent dog, very well trained, top-notch. I've met Medric, and his dog is top class. But you have to make sure that the tool—the dog, the horse, or the program—is going to help the veteran. We recognize dogs, but that dog must be well trained and trained for what it is supposed to do. It's not just somebody working somewhere who says, I can.... A lot of the work we're doing right now is certification. It's not necessarily studying the dog.

For some of the other stuff that people say helps, anecdotally they say it helps, but where's the evidence? Where are the clinical trial? Does it work for any case? What cases does it work for?

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

I know we're out of time, but that's my point. There is evidence that exists elsewhere that we can tap into without having to reinvent the wheel as a country.

[Michel Doiron]

We absolutely do.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Eyolfson.

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

Thank you.

We've talked about the earnings loss benefit, the increase. Now I'm unsure, have we decided that's going to be increasing or has it been implemented?

[Michel Doiron]

It has been. It was implemented October 1.

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

Okay. Thank you.

Has there been any reported impact on veterans and their families at this point or would you say it's too soon to tell?

[Michel Doiron]

I would say it's too soon to tell. The 6,000—and I round off the figures—who we have as clients have been processed, so they're in pay. They're eligible for all their programming and that has been done, but as to the impact on the family, on the person, we'll have to see.

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

Sure.

We've talked about the importance of peer-to-peer support with other witnesses in this committee. How could VAC best facilitate these relationships in how they can provide help?

[Dr. Cyd Courchesne]

We partner with the Canadian Armed Forces and their OSISS program, the operational stress injury social support. We assist in training peers to be good peer supporters, and all of our OSI clinics have OSISS peer supporters and they're very well appreciated in the clinics. When I go around and visit them, I always make sure I meet those one or two individuals who work there. As for the OSI clinics, they could not function without that important partner.

I think it's well used. It's well established. It is a Canadian Forces-led program. I don't know how well they use it, but I know that in our system it's very well used, very well appreciated.

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

All right.

There are some other peer-to-peer support systems or organizations we've heard of that are more or less volunteer-run and independent. Do you see a role in partnering these organizations with VAC?

[Dr. Cyd Courchesne]

I think for all our stakeholders, all the stakeholder groups, the Legion, Canadian Veterans Advocacy, they could all be considered peer support groups. They all do excellent work at representing the needs of the veterans and providing support. We see it through the members who are on the mental health advisory group. They're a great support to each other.

[Michel Doiron]

We work very closely with many of these stakeholder groups. For example, the Legion, I think most people know the fantastic work they do. We don't necessarily call them peer support. I guess you could say they're a type of peer support, but they are also a very good service provider.

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

Thank you.

We've heard from some witnesses about how transition is that pivotal moment. In regard to making sure that veterans are aware where mental health services are available, where would you say VAC should be involved in the transition? At what point should they get involved in plugging them into the awareness of mental health services?

[Michel Doiron]

We should be involved as early as possible in the transition process, because once the decision is made, there is a series.... I gave you some, but I didn't even talk about pastoral services. There are all kinds of other services available and sometimes it's not service related, but you can get these services there. As early as VAC can get involved in the transition of the individual and make the individual and the family aware of the services available, because people don't often.... That's why I handed out that document earlier. I think the clerk circulated it. There is a series of programs for mental health available to our veterans, and we very rarely hear about the programs.

The committee is studying suicide and studying mental health. It's proven—and I'm not a clinician—that the faster you can get them into treatment and get them help, the better your chances of success.

It's important that we get out to the Canadian public, to our veteran population, and that's why we gave it to the stakeholder groups, that here are the services available. It doesn't matter if you're service related or not. Yes, there may be a box that's more for the service-related injuries, but if your injury is not service related, here's a whole other series of services that VAC has out there that we'll pay for and you can have access to.

I think it's important that the Veterans Affairs organization, and the government as a whole, get that message out there, that the services are there.

Sorry, I'm passionate about that one because often—

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

No, that's okay. It's a very good answer. Thanks.

We talk a lot about PTSD. It's something we still don't understand completely, despite the fact that it's been around for a long time. Do you believe there's a role for any specialized centre of excellence that would concentrate on PTSD?