Veterans Affairs Committee on Dec. 13th, 2016

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Great. Thank you very much.

Also in the testimony we've heard about delays during the transition period from military medical care to Veterans Affairs care. Is that an irritant in the treatment of mental health? If so, what is the impact of delayed treatment? For instance, if someone is not able to get a family doctor and a referral, what impact does that have?

[Dr. Don Richardson]

It's a good question: does delayed treatment affect overall treatment outcome? Put another way, does chronicity—how long you've had an illness—have an impact on treatment outcome? When we looked at our treatment outcome research, chronicity was not shown as a predictor of treatment outcome. My colleagues in the U.K. who have also examined it did not find chronicity as a significant predictor of treatment outcome.

This is looking at treatment outcome. That being said, however, there is a challenge that we often hear from our patients and clients. By the time I see them, they have a family doctor and things are set up, but to get there can be a challenge, especially if they move to an area in which there are no family physicians available. That becomes a barrier to seeking specialty care.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Would it be fair to say, then, that there are some people you wish you had seen sooner?

[Dr. Don Richardson]

Yes, it would be for sure, and not just me: if they needed care and were waiting to seek treatment, for sure.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Brassard.

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

First of all, Dr. Pedlar, it sounds as though you've been hanging around with Minister Dion. He has the same voice going today in the House of Commons.

One challenge, as I sit around this committee table, is going last, because oftentimes things have been covered, or we'll have a long list of witnesses who will have covered many of the things we're looking to answer.

This committee is charged with looking into mental health and suicide prevention among veterans, so I'm going to give my time to you. You have two minutes and 15 seconds each to provide this committee with your expert recommendations.

What would you suggest we do in order to prevent mental health and suicide issues among our veterans?

Now you have two minutes each.

Dr. Richardson.

[Dr. Don Richardson]

One thing I've already indicated is adopting, as we're trying to do within Western, a zero suicide strategy. There is an excellent website that you can get more information from, and I can provide it for the committee to review. It's really the general consensus that suicide is preventable, and the strategies whereby each person has access to an individual plays an important role.

The other area that I think is important is accessing care. Whether there are enough clinics and whether they are located in the right areas is something we still need to have a decision on. What is the waiting time in order to access services? Are veterans aware that treatment is available?

A public awareness campaign, then, much as you see in other countries, is needed: “If you are a veteran and you are reliving your experiences or having problems sleeping, there is help available. Contact this 1-800 number”, and how to access services.

In the transition period, is it better coordinated? Is there a navigator? I'm calling it a navigator, but a person who would be able to assist in coordinating services.

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

We would call it a concierge, Doctor. Thank you for that.

Dr. Pedlar, in two minutes, what recommendations would you make to the committee that you would like to see us pursue?

[Dr. David Pedlar]

I'll just underline some of the things that I started with in my statement.

With respect to suicide, I think it's important.... I don't look at suicide as just a mental health problem. I consider it a well-being problem. When I say “well-being”, I mean that, if you look at the individual stories through file reviews of veterans who die by suicide, you see that there are always a number of factors going on in their lives. You really have to take a comprehensive approach that maps out those factors and takes them into consideration when you move forward.

Mental health is a big deal in terms of addressing suicide, but you also want to look at social issues, financial problems, problems functioning in social roles, and also the issues I mentioned about pain and physical health.

When it comes to mental health, I'll go back to the point I made earlier, which is that, with veterans specifically, the pathway to mental health problems is often thought of particularly as trauma, and PTSD gets discussed the most. But when you do the work that I've done, what you typically see is that there is a real multiplier effect if somebody has a mental health problem, a physical health problem, and chronic pain. All those things come together more frequently in veterans than in other Canadians.

We need that kind of complexity if we want to do the best job possible.

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

Thank you, gentlemen.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen, go ahead.

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

Dr. Richardson, I would like to go back to the OSI clinic in London, because it is so very important in terms of recovery.

We've heard from some veterans that they need to feel they are in a place where they are in control, and very often they're bewildered. I wonder if you could comment on this in terms of the OSI clinic in London. How do you create that atmosphere where the veteran knows that they have control of the situation, that they're not vulnerable or at the mercy of someone?

[Dr. Don Richardson]

I never thought of it in that way, but that's a very interesting question and comment.

I think that, for a lot of veterans, a need to control their environment often has to do with their symptoms. One of the potential symptoms of PTSD is hypervigilance, constantly scanning for threats and not feeling safe. Providing an environment that is what we would call veteran friendly probably has to do with their own attitudes or experiences they've had in other mental health settings. Creating an environment where the waiting room is larger, or having either symbols or pictures that have to do with veterans or the military context....

I think we also have to keep in mind the power or the influence of peer support. If veterans have a positive experience, they will let other veterans know, in the same way that if they have a negative experience they will let other veterans know on social media and things like that. I think it's building a reputation in that type of context.

Also, like most organizations, we survey the veterans and ask them questions. When I refer patients for any treatment, I do ask them, when they come back, “How did they treat you?” in order to get feedback. I let them know that the reason I'm asking is that if I refer another veteran I'd like to know how they were treated, because that's helpful.

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

It's interesting. It's a very obvious thing, but it perhaps is something that has sometimes eluded those who take care of not just veterans but the general population.

We've heard a great deal about the importance of family support for the mental health of the veteran for that hope of recovery. What can we do better? Is there anything we can do better to support families caring for veterans with an OSI? In terms of that family member or the caregiver, we've heard from some who say they didn't have the training and they didn't know what to do. They couldn't support their loved one because it was just outside of their experience.

We heard from the ombudsman for the Department of National Defence that financial security is key. If we resolve those financial issues, and I think Dr. Pedlar made reference to this, we could go a long way to paving the way to a healthier outcome.

I wonder if you could shed some light on any or all of that.

[Dr. Don Richardson]

I'll comment on a few things, and I know I will have to do this very quickly.

In terms of family support, I think it's clear that not only with mental illness but if anybody has a significant medical problem, it affects not only them but those around them. What we identify as the family is different in the context of an older veteran, though not necessarily “older older”; it might be their spouse. For many younger veterans, it might be their parents or significant other. That's important when we're doing the assessment, and we would recommend seeing the individual and those they consider to be their family unit in order to provide the support.

The other thing we also try to emphasize is that we will treat the spouses and we will assess children and refer them to appropriate resources if necessary, but we will also provide education to the family members, adult children also, so they don't become the natural caregivers. Part of what we try to do in treatment is to let people know that their role is to be a spouse, not a caregiver or nurse. We take ownership of the treatment and of working together. Part of it is for someone as a spouse to become a spouse. That's their primary job.

[The Chair, Liberal, Neil Ellis]

Thank you.

That ends today's meeting.

I will give each group a couple of minutes to wrap up if it wishes, starting with Dr. Pedlar.

[Dr. David Pedlar]

I just want to thank the committee for the opportunity to speak today. If there's any follow-up research material that we have, we'd be absolutely delighted to share it with the committee to support its deliberations and final report.

[The Chair, Liberal, Neil Ellis]

Great, thank you.

Dr. Richardson.

[Dr. Don Richardson]

I'm not sure how much time I have, but if I can, I will just say that there were a lot of comments about the number of medications that patients are sometimes taking. I think it's important to focus not necessarily on the number of medications but really on the risks and benefits. If they need a lot of medication to fully recover, then the benefits might outweigh the risks. I think that's important to clarify. It's not looking at numbers and saying now it's too much or it's not enough.

Again, I thank you for inviting me to speak. If there are additional inquiries, the clinic or I will be able to provide you with some information or details.

Thank you.

[The Chair, Liberal, Neil Ellis]

That's great.

I'll remind the witnesses again that if there's anything they want to elaborate on in questions or in their answers, they could send that to the clerk and the clerk will distribute those answers to the group here.

On behalf of the committee, I'd like to thank all three of you for testifying today and for all the help that you give to our men and women who have served.

We will suspend now for a few minutes and come back in camera.

Thank you.

[Proceedings continue in camera]