Evidence of meeting #38 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 population.
A recording is available from Parliament.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
All right, thank you.
You talked about reservists having a higher prevalence of mental health conditions than the Canadian population. It was a similar elevated level to regular force veterans. Do reservists who deploy get the same mental health services that regular force members are entitled to when they are veterans?
Director of Research, Research Directorate, Department of Veterans Affairs
First of all, I just want to go back to the record, which is that I had said that if you look at the reserve population as a whole, you could divide those into two groups. There are reservists who serve full time for a substantial period of time. That would be about three years or more. Once they serve three years or more full time, then they start to look a lot like regular force veterans in their mental health and other kinds of outcomes, whereas the rest would look a lot like other Canadians their age and gender.
I'm sorry, what was the rest of the question? I just lost it.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
The question was, do they, as veterans, get the same mental health services as regular force members?
Director of Research, Research Directorate, Department of Veterans Affairs
You would have to ask the Canadian Forces that question. I'm not absolutely certain.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
I mean when they are veterans, though. Do veterans of the reserves get the same mental health services as veterans of the regular forces?
Director of Research, Research Directorate, Department of Veterans Affairs
Yes, they would. Once they're a veteran, once they're released. Is that the question? Once they're released, they would have similar access, yes.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
All right, thank you.
Dr. Richardson, regarding Canada's OSI clinics, would you say that they have all the resources, funding, staff levels, etc., that they need to assist veterans, or do you think they could do more on the resources that the OSI clinics, in general, have?
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
Do we have enough money to do what we need to do? That's a good question. You'd have to ask my manager.
One of the challenges.... Probably what is needed is better statistics on where the veterans are currently living. My understanding is that's currently being done through the Canadian Institute for Military and Veteran Health Research. There's a veteran identifier, in Ontario, that is, on the OHIP card. That might provide some better statistics on where the veterans are, on whether the network of clinics and satellite clinics is appropriately located, and on whether they have sufficient staff to provide ready access to veterans. That's probably where I would go with that.
Across Canada? That's a good question.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
Dr. Pedlar, this may be more appropriately directed to someone in the defence end, but you might see this in your treatment of veterans. You have said how there are rates of mental illness in veterans. In terms of career progression, would you be able to identify a stage where a Canadian Armed Forces member becomes most susceptible to mental health issues?
Director of Research, Research Directorate, Department of Veterans Affairs
I could speak a little about which veterans are more likely to have mental health issues. Would that help or not?
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
I'm wondering if they have identified if they started having issues when they were serving. Did they identify during their care when they first noticed their symptoms? At what point in their career progression—or does this actually show up...? Have they reported to you when they started having symptoms, or do they generally start having symptoms as veterans?
Director of Research, Research Directorate, Department of Veterans Affairs
It would depend. Some would have symptoms before they start in the Canadian Armed Forces and could have pre-existing mental health conditions. Some will develop conditions while serving, and some could develop conditions after they leave. It's really all of those. We have learned a little bit about who is more likely as a veteran to have mental health conditions, based on the analyses we've done. They tend to be people with chronic physical health conditions and pain, lower socio-economic status, etc. If they left in mid-career, say between 10 and 19 years, they could be at higher risk, as well. For those with lower education, they would have some of the same profiles as other Canadians who have higher mental health rates, but it would be in a military context.
December 13th, 2016 / 4:15 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
The question that I have is for Dr. Pedlar, and perhaps Dr. Richardson.
The success of treatment can often depend on the attitude that the patient brings to bear. We've heard a lot of testimony from veterans who think that we should just disband our group. They feel that we don't know what we're doing, and so on. I'm wondering if you see push-back from the people you're treating, in terms of their openness to accepting the treatment.
Director of Research, Research Directorate, Department of Veterans Affairs
Dr. Richardson is a clinician, so he would see these people on a day-to-day basis. I'm more of a researcher. He would probably be able to clinically answer that better than I can. I might have a thought on it, but—
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Okay. I was going to position it for both.
Dr. Richardson, could you comment on the way people approach the treatment that they're receiving?
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
I'd have to do some of my specific research, but I think there is data out there that patient or client attitude regarding seeking treatment behaviour has an impact on recovery. There is some research that's been published on patient choice as a predictor of treatment outcome. As a clinician, being non-military, we have to look at patient attitude as something that's fluid. The vast majority of people I see do not necessarily trust me as a clinician. Trust is something that you have to build over time. That's something we take as a given at the beginning. The goal for most clinicians would be to get the patient to come for a second appointment, and then you have something that you have to work at.
I think attitudes are important. Also, as a clinician—and this is what we try to teach to other clinicians—it's important to have respect for the military member and the service that they did and not pretend that you know about the military culture, and if you have questions, to ask. These are things that we try to teach...also having a clinic that's successful across Canada at being veteran friendly, making people aware that we only treat veterans, that we only treat military members. In the veteran population, competence is very important, so having experience and treating people with respect are probably what I would recommend. Is that helpful?
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Yes.
In our considerations, we've seen the problems. We've heard direct testimony from veterans, as I said, who just didn't like the system or didn't feel they were respected, as you suggested. Hopefully, we can come forward with recommendations that will enhance the profile of the work that VAC does and that integrates more the care providers, such as yourself, so that there's a better understanding that we're all here, and there's a new approach, a new energy, and so on.
We visited the OSI clinic in London and were very impressed. Regarding the work that you do, what are the debriefing sessions like? What sort of time do you spend consulting with each other on issues that were raised during the day or the week?
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
In terms of a formal debrief, I'm not sure. Just to better understand, if we're looking at the clinical aspects, we have an interdisciplinary team meeting where we discuss the patients and the assessment and treatment plan.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Obviously, you must be constantly reviewing your processes, and you have a high reputation, so it's at a good level. How do you internally review and discuss?
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
I'm not sure if you're asking in terms of the personal self-care of clinicians and staff. Is that what you mean?
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
That's another issue.
Let's go with that one, and then we'll get to the other one.
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
Okay. I think for anybody who's in the clinical business of treating traumatized individuals—and this is not just in the military context, but in the civilian context as well—it's knowing yourself and knowing your limits. It's having a good clinical team and peers that you can rely on, and also having what I'd call just generic self-care, other interests outside of work. The work is difficult and challenging, but it's also very rewarding.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
On the other side of the picture, would someone who's had a breakthrough with a patient share that with others saying what works and what doesn't work?
Psychiatrist, Western University, Department of Psychiatry, Parkwood Operational Stress Injury Clinic
On a regular basis within our team at Parkwood, and I'm assuming across the different clinics, we discuss good cases, those that are a success, and we also discuss those that are a very big challenge in order to learn from them.
