Veterans Affairs Committee on Feb. 15th, 2017

[Dave Gallson]

I might just start the ball rolling as far as a reply is concerned.

I have the honour of sitting on the Minister of Veterans Affairs' advisory panel for mental health, and part of his mandate letter was to create a centre of excellence, one focusing on mental health, and also to address suicide within the veteran and military population.

I think we have to realize that there's no one, simple, quick fix. There's no one, simple, quick answer. When we're talking about early diagnosis and early treatment, I have a real particular feeling that we've got to remember the children of the veterans who are going through these issues because we're looking at mental health issues coming down the pipe in 15 to 20 years, if not sooner, so there are a lot of issues that have to be addressed.

When I look at a centre of excellence centred on mental health and addictions, the first question we ask ourselves is this. Is it a brick and mortar research academic institution or a service delivery institution? We now realize that it's got to be a hub and spoke model. It's got to be a centre where a veteran can go into a wellness or a treatment program with other veterans so they're not sitting there with folks who have never been in service because they don't relate to them. They can't open up and talk because somebody's dealing with other issues that don't centre around PTSD issues.

Realize that there's not one answer—I don't want to take up too much time—but it's going to be a whole plethora of different services that are all tied in together and that are all working together to address a wide array of issues.

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

You touched on something that we heard earlier in regard to veterans being told to go into group therapy with people who have no experience in military life, and how unhelpful that was.

[Dave Gallson]

It's very unhelpful, and it can set them back a long time. I've had some veterans tell me that they went to see a psychiatrist for a year, and they were being completely honest and completely open, but it was only through the peer support that they really started to understand, being in a group setting with other veterans, that they were talking about things that weren't the root of the issues. They thought they were giving the psychiatrist the right answers, what the psychiatrist was looking for, but they weren't dealing with the root cause of the PTSD, which actually happened many years before service.

It's a learning process on how to use the services out there effectively, I think.

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

Ms. Spinks, do you want to respond as well?

[Nora Spinks]

I think there are a couple of things too. Most of the services that have been established to meet the needs of military or veteran families are close to installations, such as Petawawa or Gagetown. But when you talk about veterans, you're talking about every community from coast to coast to coast, and we're never going to have a military-specific program in every community.

What we can do is to make sure that every community organization that exists has some basic military literacy, that they understand when somebody explains that they went to Afghanistan, and that they know what that means and don't just have some reference from a movie they saw one Saturday night with their friends but really understand what that means.

I think there's enormous interest across this country by professionals of all kinds who want to be ready to reach out to help, and they want to learn. I think the way we need to manage that—we're doing the same with direct service—is to balance high tech with high touch. We want to make sure that people have the personal contact and those personal relationships, and that they get access to those services they need from human beings, but also have access to technology—perhaps to be part of a group—and the use of technology so they can participate over the computer.

There are lots of experiments and innovation and successes being had by those kinds of specialty programs, but if you're not in it, you have no idea that it exists. One of the things the leadership circle did last year was to try to pull together the beginnings of a one-stop shop for information so you don't have to Google what you need to add to your list but you can just plug and play a list of what's available. We created it as a 1.0 document.

In order for it be successful so you can plug and play for a distress centre, we need that to be accessible online, searchable, and almost like a Wikipedia, because things are happening so quickly. Right now that doesn't exist. The foundation is there but the technology isn't. It's in a book. It's like the old blue book in Toronto. You had it but it gets dog-eared after awhile. We need to make that accessible for everybody so that if you're a volunteer at a distress centre—boom—it's there, whether it's information about housing and homelessness, or whether it's information on food services or mental health supports.

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

Thank you.

Mr. Upshall, you made reference to moving the research. We heard some remarkable research on Monday from scientists and folks who are looking into the brain and at what is happening with those suffering from post-traumatic stress.

[The Chair, Liberal, Neil Ellis]

I'll just remind you we are right at zero time. We'll have to shorten the question and make the answer short also.

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

Okay.

You talked about moving from research into the clinical domain. How do we facilitate that?

[Philip Upshall]

This is very difficult to keep short.

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

I do it all the time.

[Philip Upshall]

One of the things you do is you get patients, in our case veterans, involved in the discussion and educate the researchers as to who they're dealing with, who they're working for, and who needs that information. In the vast majority of cases, it's the health care provider.

We work with the Royal Ottawa and the Mental Health Commission, which were your witnesses on Monday, and both are excellent organizations. The Royal Ottawa is part of the Canadian Depression Research and Intervention Network that I talked about. It's about getting them to understand that there are people out there who can help them translate that information, but they have to be motivated to make the link.

In research, one key issue is that researchers far too often stop their work when they publish. It's the way they work. I've worked with post-docs and I've worked with all sorts of people who say, “If you want me to help you translate the information beyond my publication, you'll have to pay me.” I don't have the money to pay them, and I have to twist their arm to volunteer to help me work.

One of the ways we did it was that we developed a PTSD CME. It was an outcome of the Out of Sight, Not out of Mind project. Collaborating with the Canadian Medical Association, Veterans Affairs, and others, we developed a continuing medical education resource of $200,000 which came out of the 2012 budget. This is still valuable today. Unfortunately, it's a CME and we haven't been able to get the money to move it out. Nevertheless, it's there and it has been very valuable. It has great research. We have some information here if you—

[The Chair, Liberal, Neil Ellis]

Maybe we can get you to send that to the clerk afterwards, and we'll get it to the committee.

Thank you.

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you all for being here today. You have provided great perspectives for us.

I want to start by saying that I'm very encouraged. Personally, whenever I've been talking to mental health professionals recently, the idea basically of “no wrong door” has been coming up. I've talked to some in New Brunswick who have had great success with this from the viewpoint of a youth mental health process and just as a general community pilot project. It's great to hear you talking about the same thing.

What we're studying, obviously, is suicide, and specifically during the transition, and the risks in that transition piece for veterans. Another big piece of it is identity.

I'm wondering, in the context of a family, whether from your experience the family experiences that sense of loss of identity as well. How much impact does this have, and how does it factor in?

[Nora Spinks]

We hear from military families all the time that they identify as a military family. What they don't identify with is a military family in transition to civilian life or a “veteran family”. Once you're military, you're military for life.

Little things that we've heard affect families deeply are simple things, such as the veteran's licence plate that you can put on your car, with the veteran's poppy on it. When the veteran dies or becomes divorced, the family has to give up the licence plate. Little things make a big difference.

We don't have identifiers in most data collection intake forms. We don't have them at the distress centre, we don't have them at doctors' offices, we don't have them in schools. They have them in other jurisdictions around the globe and they find it very useful—not to pry or to get into people's lives, but to help them feel welcomed and respected and included, and then to make sure that they get information and access to support, should they ever need these things.

We have much that we can draw on from other countries. We're involved in an international consortium that's looking at translating research, because so much of this is biology, so much of it is experiential, and we share this with the U.K., Australia, and the U.S., and with our other allies. We don't have to start from scratch; there are services out there that, with very little resource, could be tweaked and Canadianized and made readily available.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you. I appreciate that insight.

Mr. Gallson, I have some questions for you.

From other testimony, we've heard that it's often a barrier for families to access services that are provided by third parties because there's a requirement for them to pay up front and then be reimbursed. Is that the case with your programs as well? Have your participants expressed any difficulties with that situation?

[Dave Gallson]

Absolutely not. I am completely against fee-for-service services, to tell you the truth. I developed a program many years ago because of people in our community not being able to access services, just for that reason.

Our programs are funded by the federal government. We're a very collaborative organization. We believe strongly that programs, especially programs funded by the federal government, should be expandable programs that are shared across all organizations in Canada. There is too much of a silo effect out there whereby programs are developed and then an ownership issue arises: “This is my program”, and yada, yada, yada.

That hurts people. We have to make programs more available across Canada, to all organizations. That's something we do very well.

I can't say enough about the leadership circle and the networking that goes on within it. I'm having a meeting on Friday with another organization. There will probably end up being a new program in Canada for PTSD and for families. That's a direct result of the collaborative nature that this whole organization has. That's the way we have to move forward.

We've developed a PTSD program for the Canadian Bar Association for lawyers. It's been taken by more than 2,000 lawyers so far. We've developed programs with the Canadian Nurses Association for anti-stigma in hospitals, because we found that health care providers are, amongst others, one of the most stigmatizing associations around in terms of recognizing people who come into emergency rooms with potential mental health issues. They are triaged lower, there's a lot of hesitation to even recognize that there is a mental health issue, and many people have lost their lives because of this.

I'm sorry to make it a long answer.

We work with all organizations across Canada. We're fire-starters. We like taking projects, starting them, and then sharing them across Canada. We've been working with Public Safety over the last 18 months. Right now we have a proposal in front of the federal government for a national PTSD action plan. We're hoping that it gets a good look. It's a collaborative approach to doing this.

We are a meat-and-potatoes kind of organization. We like doing things, with the funds that are provided to us, that are going to make an impact on the family unit at the home.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Mr. Upshall, I have a quick question. You talked about early detection of PTSD. Have you seen any screening during military service, pre-, post-, anything like that? Do you think it would be helpful?

[Philip Upshall]

There has been an effort to do some screening and particularly when members are close to discharge. Russ would be a better person than me to answer this. The reality is that a lot of PTSD doesn't show its ugly face until many months and sometimes years after a person is discharged. Men, particularly veterans, are used to saying, “I'm okay. I'm fine. There's nothing the matter with me. I've been through this.” It's only when they get home and experience all of the difficulties that come with the recollection of what happened that they feel the impact.

I would like to add on your question to Nora. One of the issues, in terms of family identity, is that kids watch dad or mom go away, and they're so happy. There are pictures in the paper and big kisses at the navy wharf or wherever, and dad or mom goes off. Then dad or mom comes home, and there's a celebration, and the kids are proud of their parents, proud of their dad and mom. They talk about it in school. Their kids are there.

All of a sudden, six months later, out of the blue—mom may have seen a little bit but the kid hasn't—dad beats the tar out of mom. Holy mackerel, what a trauma. And nothing happens. Mom has heard a little bit about military issues and decides to do some checking, and then it happens again. Then all of a sudden, dad is charged. He goes to jail. There's a divorce. All this stuff happens. That is a trauma that will drag that kid for 60 more years after dad comes home from Afghanistan. We frequently forget that that happens and the impact of that trauma, which goes untreated and unrecognized. Forty years later that kid may have a real problem, and they'll never be able to track it back to that incredible trauma. They're high one minute and right at the bottom the next.

Sorry for that, Chair.

[The Chair, Liberal, Neil Ellis]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thank you all very much for being here today and sharing your thoughts. Those excellent presentations will be very helpful. Thank you also for all the work that you do that's so important in our country.

Ms. Pizzuto, I'd like to start with you. You mentioned that you don't track military or veterans as part of a demographic that you would ask questions about or find out about in terms of numbers. I'm wondering why not. Do you think it's something that could be done in order to gain a better background about the person you're talking to and keep some statistics that might be helpful for us to make different decisions going forward?

[Breanna Pizzuto]

Yes, I think it's something that could easily be done, added into our system. The reason we don't right now is because all of our statistics are provincially mandated, what they want us to keep track of reporting-wise, so we pretty much stick to what we've been asked to report back on. That's something that we've never been asked before, but it would be helpful, I agree. It's certainly doable.

[Colin Fraser, Liberal, West Nova, NS]

If the information is offered by the caller, for example, would you then put them in touch with VAC services and do that sort of connecting?

[Breanna Pizzuto]

Absolutely, yes.

[Colin Fraser, Liberal, West Nova, NS]

Do you know if that happens quite a lot? You mentioned some of the numbers of how many calls you receive from military personnel or veterans.

[Breanna Pizzuto]

I would say it happens a fair amount but probably not as much as it should. As Nora was saying, we're perhaps not recognized as a veteran-specific service. We're not a veteran-specific service, so perhaps if there was some more training given to us, or if we could grow that partnership and be more recognized as a support for veterans, we would see that number grow.