Veterans Affairs Committee on March 20th, 2017

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

It's interesting that the numbers tell us some things, and yet you can't infer anything concrete sometimes from those very same numbers. I understand your frustration.

Dr. Heber, you were talking about the warm handover. Obviously, we hear from veterans who do not feel very warm and fuzzy, and they talk about the frustration, the barrier, financial problems such as the pension cheque not arriving on time, and the fact that they feel abandoned, alienated, and something important has been take away from them. You talked about that, so obviously there must have been a recognition that there was a problem in terms of that warm handover. There's obviously been a conscious effort to change that. Is that ongoing? Is that something that you're going to continue, and how so?

[Dr. Alexandra Heber]

Yes. Again, part of the reason we are doing a joint suicide strategy is that we want to make sure that we put special emphasis on that time. Again, with some of the research that's being done in Veterans Affairs Canada, we're really looking at these issues like identity and what happens to a person's identity, especially people who joined the military when they were very young and this is not just the only employment they've ever known, but that they've grown up in the military and this is the family they've known, because it really is. We have a fairly small military in our country. People get to know each other. I served only eight and a half years, but I knew everybody in health services in the Canadian military. There is a strong sense of shared identity.

[The Chair, Liberal, Neil Ellis]

Thank you. That ends our time for this panel.

I'd like to thank both of you for all the work you do helping our men and women who have served.

We'll take a quick four-minute break, and we'll start with our next panel.

[The Chair, Liberal, Neil Ellis]

Welcome, everybody. In our second hour we have, from the Department of Veterans Affairs, Dr. Courchesne, director general, health professionals division; Johanne Isabel, national manager, mental health services unit; and from the Department of Health, Chantale Malette, national manager, employee assistance services.

I don't think we're going to use the whole 10 minutes, but we'll have an introduction by our panellists, and we'll start with Ms. Isabel.

[Johanne Isabel, National Manager, Mental Health Services Unit, Directorate of Mental Health, Department of Veterans Affairs]

Good evening, everyone. My name is Johanne Isabel, and I've been working at Veterans Affairs Canada since 2001. My spouse is a retired member of the Canadian Armed Forces.

Mr. Chair and committee members, we're pleased to be talking about the Veterans Affairs Canada assistance service, a counselling and referral service offered 24 hours a day, seven days a week to our veterans and retired RCMP members and to their family members. The service is confidential. If a veteran isn't registered for a Veterans Affairs Canada service or program, the veteran can still use this program.

Here's a brief history of the program.

In 2000, Veterans Affairs Canada worked with Health Canada to provide a service that was similar to the Canadian Armed Forces member assistance program. We wanted to make sure that veterans and their families could transition more smoothly from military life to civilian life. We wanted to provide this service to serve our clients properly during the transition.

On December 1, 2014, your committee recommended that the assistance program for veterans be improved. From 2000 to 2014, veterans could receive up to eight individual counselling sessions with a health professional. As I already mentioned, based on your recommendations and since April 1, 2014, the program has been providing 20 individual counselling sessions to all our veterans and their family members and to retired RCMP members.

I'll now turn the floor over to Ms. Malette.

[Chantale Malette, National Manager, Business and Customer Relations, Employee Assistance Services, Department of Health]

Hello. My name is Chantale Malette.

The services that are offered through the VAC assistance service are mainly confidential, bilingual services, accessible via a 1-800 number and through the Health Canada phone line 24 hours a day 365 days a year. Mental health professionals answer every call. All counsellors have at least a master's or a Ph.D. The veteran then has access automatically, right away, to a mental health professional.

Telephone services are also offered for the hearing impaired. There is immediate access to crisis support and counselling by a mental health professional with a minimum of a master's degree. If the person calling is in crisis, the mental health professional will take whatever time is necessary to stabilize the person before referring them for face-to-face counselling.

We refer to our national network of specialized private practitioners, according to needs, anywhere in Canada. We have face-to-face counselling. We also offer telephone counselling, especially when services are required in an isolated area or if they are required by the client. We also offer e-counselling when appropriate.

We refer to external resources or VAC if the time required to resolve the issue exceeds the coverage provided by the program. We use the sessions and the hours covered under the program to bridge the person, to support the veteran until long-term care is available.

In terms of suicide prevention, for every call the client's state is verified. We verify the level of stress. We verify the suicidal or homicidal thoughts. If the caller is identified as having suicidal ideation, the counsellor will ask for the caller's authorization to contact their VAC case manager and inform him or her of the situation.

In terms of counsellors, we have access to over 900 mental health professionals across Canada. They all have a minimum of a master's degree in a psychosocial field and at least five years' experience in private practice. They have had a government security screening. They have malpractice insurance. They're registered with a recognized professional association. Professional references are checked as well.

In terms of quality assurance, every time a veteran consults a mental health professional, we provide this person with a satisfaction survey to get more information on their satisfaction with the program. We also do yearly visits to counsellors' offices. We visit at least 5% every year. We also are accredited by EASNA, the employee assistance society of North America, and COA, the Council on Accreditation. We adhere to the highest standards in the industry.

[Johanne Isabel]

Here are a few statistics.

From 2012 to 2016, the number of people who used the service went from 614 to 1,140. Therefore, there was an increase. This was mainly the result of the decision to improve the services by increasing the number of counselling sessions to 20. For a veteran or a veteran's family member who wants to address a major issue, it's worthwhile to have counselling sessions over a longer period. It's very positive.

Of the 1,143 people mentioned here, 68% are veterans, 28% are veterans' family members and 2% are retired RCMP members. The people who use the services are, on average, in their late forties or early fifties. People use the Veterans Affairs Canada assistance service mainly for psychological issues not related to military service or for couples counselling.

Thank you.

[The Chair, Liberal, Neil Ellis]

Great. Thank you.

Mr. Kitchen, I believe you're going to split your time with Mr. Brassard.

Mr. Kitchen, go ahead.

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

Thank you, Mr. Chair.

Thank you all for being here.

Doctor, thank you very much for coming back to the committee.

I appreciate your presentation and your giving us some of the statistics. When you talk about 24 hours, seven days a week, 365 days, how does someone access that with this number? For example, I come from Saskatchewan. You talk about having 900 mental health professionals. If someone in Saskatchewan is phoning at midnight, who are they phoning?

[Chantale Malette]

They are calling Ottawa. All the counsellors who answer the VAC assistance service are in Ottawa, so when the person dials the 1-800 number they will automatically have access to a mental health professional, who will verify the state of the client and refer them for face-to-face counselling anywhere in Canada, including in Saskatchewan if they want.

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

We talked about knowledge translation. One of the things I see here is knowledge translation and getting this knowledge out to veterans.

Have you actually done a survey or a study to find out how many veterans know about this?

[Johanne Isabel]

Many efforts have been made to further promote the service. The information has been posted on our website. The information is also consulted a great deal on our Facebook and Twitter platforms. The information on the service is sent to veterans on a monthly basis. Ms. Malette works extensively with the Canadian Armed Forces, the RCMP and all the Veterans Affairs Canada offices to explain and show the benefits of the program.

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

How do we get this information to the homeless veteran who doesn't have a computer, doesn't tweet, doesn't use Facebook, and may be living in northern Saskatchewan or northern Ontario or wherever it may be? How do we get that information to them?

[Johanne Isabel]

That's a very good question.

You're right. We can always do better. Our case managers receive information. Since 2012, the VAC assistance service has been used more often. Could it be used even more? Yes. Is it effective? Yes. Could homeless veterans benefit from it? Yes, and we're constantly working to make that happen. Could we do more? The answer is yes.

We try to vary the ways we let them know about the assistance service. We have various programs to ensure that homeless veterans also receive information about the assistance service. We distribute brochures to them to let them know about the service.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Brassard.

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

Thank you, Mr. Chair.

The committee is studying mental health and suicide prevention among veterans. You're on the front lines of all that's going on here.

What sort of recommendations would you like to see the committee make in terms of dealing with the issue of suicide prevention and some of the mental health issues?

Do you want me to pick somebody? Doctor? I know you have been here before.

[Dr. Cyd Courchesne, Director General, Health Professionals Division, Chief Medical Officer, Department of Veterans Affairs]

Yes I have, and we look forward to the report. As Madame Isabel mentioned, it was based on recommendations that came out of this committee that we increase the counselling sessions from eight to 20, because our numbers show that this is a service. I would like to remind you that this is a service available regardless of whether someone is in receipt of benefits from Veterans Affairs. It is for anyone who is one of those 600,000 veterans out there in Canada.

In terms of suicide prevention, you heard from my two very articulate colleagues that we continue our research to understand this very complex problem. We're working together more closely with our Canadian Forces colleagues, especially around the periods of vulnerability that are identified through epidemiology or research, so that we can strengthen our programs.

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

Do you work with stakeholders? For example, do you work with the provinces and municipalities? Is there any of that outreach to deal with the homeless population? Municipalities, for example, do numbers, and there are other organizations, as we found out through testimony, that count homeless veterans. Do you reach out to those organizations?

[Dr. Cyd Courchesne]

I'll start, and then I'll pass it on.

Within the Department of Veterans Affairs, we do have colleagues who are working specifically on a strategy for veterans in crisis, for the homeless. These are issues we can't work alone on, so they're very much connected with municipal and provincial organizations, with all these people out there on the beat. We wouldn't be able to do that without these important stakeholders.

I don't know whether my colleague has something to add.

[Johanne Isabel]

No.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Eyolfson.

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

Thank you, and my thanks to you all for coming.

Dr. Courchesne, welcome back. Am I saying your last name correctly?

[Dr. Cyd Courchesne]

Yes, that's very good.

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

Okay, thank you.

I'd like to follow up with what I was asking Dr. Heber before. It sounded like there was a communication. You might have had an answer there. In response to the outreach to primary care physicians, is there any specific communication with the emergency medicine community?

[Dr. Cyd Courchesne]

We don't communicate with emergency medicine specifically, but we work very closely with the College of Family Physicians of Canada. They've struck a special group to produce educational material for all the family physicians in Canada, educating them on the health issues of military families. They've also expressed that they wanted to produce a best-advice guide on veterans' health.

The Occupational and Environmental Medicine Association of Canada has invited us to come and present on veterans' health issues, and I'll be presenting there with my colleague Jim Thompson on what the research has shown us about being able to educate as many doctors as possible. We're also connected with the Vanier Institute of the Family. We're very interested in families and veterans. So, yes, we do a lot of educating.