Veterans Affairs Committee on March 20th, 2017

[Johanne Isabel]

We did also work with the CAMH in Toronto. They have a series of mental health modules online, and one on mental health and addiction 101 was added. It's a 20-minute bilingual online module that could be used by all health professionals.

We also are working with the Canadian Mental Health Commission and Mental Health First Aid Canada. There's a two-day training course being provided to the veterans community. What do we mean by “the veterans community”? It's being offered to all primary care providers, families members, and friends. Our goal is to have 3,000 members, or as many as we can, who will take the two-day training course before the end of 2020.

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

All right. Thank you.

To expand on this, has there been outreach towards the medical schools in Canada to put these issues into the actual curriculum?

[Dr. Cyd Courchesne]

I'm trying to think if there was an outreach when I was in the military. Through the Canadian Medical Association, the Canadian Forces were represented at the specialist and the GP levels. I sat on the GP forum, and we had representatives at the Canadian Federation of Medical Students. So there has been a start towards socializing these issues with them. Certainly the Canadian Medical Association has been very good, in making a declaration in 2014 that they were encouraging family doctors to take veterans on in their practices. We've had very good support from our medical associations in Canada.

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

All right, thank you. That's good to hear.

Are there any trends in how these veterans with mental health concerns are presenting themselves? We know that in the military and in society in general, there's always a stigma with mental illness. Everyone's been working hard to reduce that stigma. With general public education to reduce that stigma, are we seeing a positive result in veterans presenting themselves earlier or presenting before they're in crisis? Is that having the effect we want it to?

[Dr. Cyd Courchesne]

You heard from a professional statistician epidemiologist, and I would be going out on a limb if I said that we were definitely seeing positive results, because they would ask me where are the statistics to support that.

I am going to bring it back to our veterans assistance line. One of the reasons for that—because we're talking about stigma—is that it's anonymous; it's available 24 hours a day, seven days a week. You don't need to qualify for any of our programs to use it, and I think that goes a long way.

That might be the first phone call, the first step they take to talk to someone, and to realize that maybe they have a bigger problem. The professionals that work the VAC assistance line work with veterans. They know our programs. They know when to say, “Well, maybe you should connect with a case manger and explore more supports to help you with your situation”.

That's what I wanted to say about stigma, and bringing it back to the VAC assistance line. You don't have to pre-qualify for anything; you just call, and you get access immediately.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen.

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

Thank you, Mr. Chair.

Thank you, Dr. Courchesne, for coming back and filling in some of the gaps for us.

I want to go back to some specifics. You're now offering 20 face-to-face sessions plus sessions for the family. In terms of those 20 visits, is there a specific time frame you could count on? When those 20 visits end, is there a follow-up to evaluate their efficacy? What happens if there is still that need for more?

I wasn't sure if you had commented on that.

[Dr. Cyd Courchesne]

I'm going to let Madame Malette answer the question with respect to the length of the sessions.

[Chantale Malette]

Normally, we can provide up to 20 hours, and most of the time that is sufficient. When we have situations that require more than 20 hours, we will certainly have a conversation with VAC regarding the required services, and we will normally provide the intervention that is needed. It can be up to 25 or 30 hours, if necessary.

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

I was very interested in the reference made, both by Madame Malette and you, Dr. Courchesne, to interacting with practitioners, talking to the providers, talking to family doctors, and the idea of family doctors taking on veterans.

Is part of the intent to verify the quality of the service provided and to find out from those family doctors what they're discovering in the course of their interactions with veterans? Are you learning from them, I guess, is what I'm asking?

[Dr. Cyd Courchesne]

Are you talking about the health professionals that provide the counselling to the veterans through VAC assistance?

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

You talked about educating family physicians, and I wondered if it's a two-way street.

[Dr. Cyd Courchesne]

That was in response to your colleague's question as to whether we were doing outreach with associations and family doctors. We're not in a position to contact those family doctors. I'm not sure—

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

Perhaps Madame Isabel said that you have quality visits to practitioners' offices, and I wondered if, in that process, you're learning important things from those practitioners.

[Dr. Cyd Courchesne]

Those are not family physicians that provide the service through VAC assistance. It's Health Canada that monitors the quality of the services provided through the VAC assistance. Am I right?

[Chantale Malette]

Yes.

[Dr. Cyd Courchesne]

Again, this is anonymous, so none of the information is shared with us. We just know how many people use the service and perhaps whether they're satisfied with the service.

Once in a while, we do deal with some complaints and all that, which we follow up on, but the providers would never communicate with us to exchange that information.

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

It just seems that we're constantly in quicksand regarding how to prevent suicide and how to address the needs of people. It seems to always come back to this ambivalence and not knowing exactly what course to take. I'm trying to sort through that, not very successfully obviously, but I'm trying to sort through all of that.

Dr. Heber referred to VAC updating the mental health strategy and collaborating with DND to create this joint strategy in regard to suicide. I wonder if you could speak to that. I wanted to ask the question before about what those pieces look like. What does that strategy look like?

[Dr. Cyd Courchesne]

I'll answer that, if you'll allow.

You have heard that suicide is not a simple issue. Many factors play into it. I know people don't always like to hear about research, but research is very important because it provides us with so much information, so we can formulate programs, services, and strategies to confront this issue.

There are several aspects to the strategy. There is prevention, intervention, and what we would call “post-vention”. That's just a fancy way of putting things in baskets and organizing our activities.

I would say that everything that you've heard here about the VAC assistance line and, I would say, all the programs that Veterans Affairs offers to the veterans, is all part of the prevention strategies or prevention actions.

We also learn from research that the transition period is an important period of vulnerability for our releasing members, so we want to concentrate on that. What more can we do besides exit interviews, getting them case managers, helping them navigate the system, and getting them the benefits and the treatments that they need. All of that exists. All of that will be improved and that's all part of the strategy that we're developing with our Canadian Forces colleagues.

[The Chair, Liberal, Neil Ellis]

Thank you.

Go ahead, Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thank you, Mr. Chair.

I want to thank you three for being here today to give your presentations and answer our questions.

I want to start with you, Ms. Isabel. You mentioned the 20 in-person counselling sessions. The number of counselling sessions therefore increased from 8 to 20.

Can you explain the steps a person must take to receive these 20 counselling sessions? Is it easy to obtain approval? Are there forms to fill in? Do the members encounter difficulties before obtaining approval for these sessions?

[Johanne Isabel]

No. The first step for a veteran, a veteran's family member or a retired RCMP member is simply to call the 1-800 number. As Ms. Malette said, the team is in Ottawa. A staff member will ask questions and ask how things are going. The staff member will also determine the urgency of the call. If a client has suicidal thoughts, the protocol will be a bit different. However, if the client says they want to meet with a counsellor or mental health professional in person, depending on the client's region, the staff member can refer the client within a time frame ranging from 24 hours to five days. The time frame is based on the level of urgency. The veteran or the person making the request can receive the service in person, with a counsellor.

The client isn't the one who will determine the number of counselling sessions required, whether that number is 2 or 20. The decision is made after a health professional conducts an assessment. The veteran or client and the health professional will discuss the issue and the difficulties to address. This assessment will determine the number of sessions.

Earlier, it was asked whether the number of sessions ever needed to be increased to more than 20. The answer is yes, and it's important. A judgment call must be made, based on a client's needs. Sometimes, it's necessary. However, I also want to mention that this doesn't happen in the majority of cases. In a given year, Ms. Malette may call me three or four times to increase the number of sessions. In this case, we're talking about approximately five or six additional sessions.

[Colin Fraser, Liberal, West Nova, NS]

Ms. Isabel, do you think the program steps are working well right now? Do you have any recommendations for improving the program?

[Johanne Isabel]

I've been working with Health Canada since 2012. We've received very few complaints or negative comments regarding the number of counselling sessions, especially since we increased the number of sessions to 20. The service is used more often. I don't have any recommendations in this regard.

[Colin Fraser, Liberal, West Nova, NS]

Okay. Thank you.

I would now like to speak to Ms. Malette.

You said the service was accessible through the 1-800 number. You also mentioned Facebook, Twitter and other similar things. Is there a way to communicate instantly with a staff member, online, by computer?