Veterans Affairs Committee on Feb. 15th, 2017

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

Thank you, Mr. Chair.

Very quickly, Ms. Spinks, you tweaked my interest when you made a comment about support for families after a crisis. Can you expand on that?

[Nora Spinks]

One of the things we've heard from families is they identify as a military family. They're a military family forever. Oftentimes what happens is the care that's available, as limited as it might be in some locations, is focused on the individual. It's partly silos, partly privacy, but an individual is going to get care. But it's the family affected by that crisis that also may need care. So it's those kids who Phil was talking about. It's those classroom teachers who see this little 10-year-old crying at his desk and need to reach out.

We haven't yet come up with a good way to provide comprehensive, family-based support, whether it's health care community services or the like. Yet we know that if families are there, they're the ones who are going to provide the linkages. They're the ones who are going to provide the connection. They're the ones who are going to be there in that basement at three o'clock in the morning to call the crisis line. We need to think more holistically.

In most provinces now all their health care services are patient first. What about the family first, the circle of support that is going to make that treatment a success, that is going to provide the continuity, the navigation, that's going to be there when they need to reach out for support?

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

Do you perceive that families after a crisis, in particular a suicide, are abandoned by that?

[Nora Spinks]

I can't speak specifically for VAC, but by and large families are neglected after a crisis.

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

Would having some of those services provided by VAC be a valid service?

[Nora Spinks]

We're certainly hearing from spouses and family members that they too have a need for peer support. It's being able to chat with another spouse at three o'clock in the morning because they finally got their partner back into bed, calmed down, asleep and resting. Now they're wired and so they need somebody to talk to as well. Having peer support for the spouses or the parents who are managing the situation on a day-to-day basis has been seen to be really important.

As Phil mentioned, to connect that back to the data building, the knowledge sharing, is critically important. We talk a lot about evidence-based programs. We also had evidence-inspired and evidence-informed. A lot of that happens among families. It's not just evidence-based experience, but it's experience-based evidence. When listening to those families, it doesn't take much to get them talking. It does take much to trust them to talk a second time if you don't listen to them in the first round.

How do you support those veterans? You start talking to them from the day they enter the military, and you continue that all the way through and try not to pass the buck. It doesn't work.

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

Thank you.

Mr. Upshall, you talked about knowledge translation. I appreciate your comments on that because it's very important. Being a primary care practitioner myself, I've always gone to seminars, etc. What's my take-away from this seminar? What can I do the next day in my office?

This is an issue that I think a lot of primary care practitioners do not know about. Would you agree that it would be worthwhile that all regulatory bodies mandated that their primary care practitioners had a CME program such as you're suggesting, such that every practitioner might be able to have an understanding of what to do the moment someone who has a veteran's experience walks into their office?

[Philip Upshall]

I agree absolutely. We go further than that, however. We've approached the Royal Society; we hit a brick wall on that. But it's important for the entire spectrum of health care providers to understand mental health issues.

I'm outside the veterans side of things now, but we've moved back also to trying to get the medical educational community, particularly at universities, to understand doctors and to get new doctors trained in mental health, just as they're trained in cardiovascular and other issues. Unfortunately, up until very recently they spent hours on cardiovascular issues or on cancer and maybe half an hour or two hours on mental health issues.

As I'm sure you all know by now, mental health issues are comorbid with cancer, cardiovascular disease, diabetes, PTSD—you name it. Depression particularly is almost always present in all those chronic illnesses.

We would be entirely supportive, but it's a major project, because we have these historical silos. We have organizations that insist, and this is true in Health Canada and in Ontario Health as well, that, “We've always done it this way. For years we've done it this way, and this is the way we're going to do it.” We have to beat our heads: we continue to do that.

We support it. That's the short answer.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Shipley, Mr. Kitchen has left you a minute.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you, Mr. Chair.

Thank you all for coming out and being so forthright.

I was on the veterans committee a few years ago, and the unfortunate part is that we were talking about the same sorts of things. This is not to say that things haven't changed; it's just that the situation seems to multiply on top of itself a little bit. DND and veterans constitute a big problem. It has been big, and it seems it hasn't resolved itself yet.

One thing I wanted to ask, though, concerning mental health and PTSD, is about the psychological effects and then about what professionals they are referred to. At one time it was a concern—and you mentioned it—that 95% of PTSD is attributable to the experiences shared by all Canadians, and so when they go to a psychiatrist or psychologist, 5% is attributable uniquely to the military, either to combat or to specific causes.

Is it true, though, that this percentage may be higher than that, if the professional has never walked in their boots, has never shared that same experience of combat and the sorts of things they have to deal with when they get back?

Are there enough professionals to meet the demand? I guess that's really my question.

[Philip Upshall]

No, there aren't enough.

[The Chair, Liberal, Neil Ellis]

You'll have to keep your answer in the minute also.

[Philip Upshall]

These demands are very difficult.

The issue is that you're talking about a specific veteran's trauma activity that the professional may not have been involved in and may not have had boots on the ground for or whatever.

If the professional is properly trained they will be able to ask, “What's your background?” and in their discussion get issues of trauma coming out. The trauma could be early childhood abuse; it could be residential schools; it could be whatever. In this instance, it's a military activity.

The doctor should then be able to say that there is somebody to refer you to who has specific experience in this, but it would be focused on that 5% or maybe 10%. That to me is the way to go, again from the community point of view.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen, we'll end with you now.

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

Thank you, Mr. Chair.

Thank you to the witnesses.

I wanted to say to you, Mr. Upshall, it's interesting that you talked about the research that had to happen before the service dogs could be utilized, and the research took up all the money, so there were no service dogs. That question was asked early on of the assistant deputy minister, who said, “Well, the research is not conclusive with regard to how effective these dogs are.” I sympathize and understand your concern about this never-ending circle.

We're going to be writing a report here, and I want to underscore some of the things that I think should be in the report.

I'll start with you, Nora.

We're talking about the importance of the family. It's a critical part of a veteran's wellness. You talked about them dealing with the issues and the need to have the tools to deal with them. We've heard from spouses that they need training, specific training. How do I deal with and cope with and help this veteran, who is a different person from the one I met and married 10 years ago? We need marriage counselling, because marriages are unravelling, relationships are unravelling. We need mental health care for the spouses and the children, and that comes back to what you said about respite care, because you can't do this 24/7. Finally, we need access to VAC for better care with regard to the family's and spouse's needs. That should be in the report, yes.

The second thing—and it goes back to what Ms. Wagantall was talking about—is making sure, as the military ombudsman recommended, that everything is in place before that veteran leaves the military—the pension and the health care. Would more active involvement by mental health workers be an important thing to add in there? That's so that they're not financially vulnerable, so that they have these coping mechanisms for what is going to be a remarkably stressful, difficult change in life because they are, and always will be, military. They just don't have the accolades.

If we include those things, are we on the right track?

[Philip Upshall]

I'll shut up because I've had too many lately—

[Voices]

Oh, oh!

[Philip Upshall]

—but I have some views on the matter, if I can have a minute later on.

[A voice]

Oh, sure.

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

That's up to the chair, and you know he's brutal.

[The Chair, Liberal, Neil Ellis]

Go ahead, and we'll wind this up.

[Philip Upshall]

Well, first of all, you haven't mentioned this, and I meant to mention it earlier. One of the things that you can do—and I'm sure everyone would agree—is recommend the provision of system navigators. It's really important, and a trusted system navigator—not a guy like me, but a guy like Russ—who knows his stuff can take a person by the hand. When you're in crisis, you don't know who to call, you don't what to do, and you don't know where to go. Even before you're in crisis, when you're in the discharge phase, if there's someone who says, “I will take your hand and I will work with you”.... We found it terrific in hospitals. If you have a system navigator, you can get somebody discharged and get them the help they need as opposed to saying, “Look it up on Google”. System navigators would be very helpful, and I'd certainly recommend that.

I'd recommend funding peer support for family caregivers as well as for veterans. Mood Disorders Canada is a peer-support community for both patients and families.

Those would be the key things. I'm going to leave it to everybody else, because otherwise I'll keep going.

[Dave Gallson]

I'll just add one thing to it. Speaking of family physicians, you have to remember that family physicians have a business to run as well, and they've only got a limited amount of time to see a patient. We have found that there are a lot of family physicians who don't know all of the resources that are available in the community and therefore cannot take a patient and say, “Hey, listen, you have to go down to this group over here and go meet with them because they have some services down there that would really support you.” It's not just all about a pill, a prescription, and stuff. A whole wealth of resources needs to be implemented, too, for wellness.

[The Chair, Liberal, Neil Ellis]

Thank you, all. This ends today's panel. Bells are going to ring in a minute here.

I'm sure I speak for all of us in that we could probably do another round. The information and testimony you've given us today have overall been excellent. On behalf of the committee, I want to thank all of you and your organizations, not only for your testimony today, but for what you do for the men and women who have served.

If there's any other information—and I know, Mr. Gallson, you said you had some to send to us—you could send it to the clerk, and he'll get it distributed throughout the committee.

Can I have a motion to adjourn?

This meeting is adjourned.