Veterans Affairs Committee on June 7th, 2017

[Lisa Foreman]

It's essentially based on whether or not you've been injured. What I was talking about before is non-liability health care. You only need to have served one day to be able to access mental health support. For what we call our “gold card”, you need to have had an illness or an injury. The level of illness or injury will decide whether you get access to a gold card, which gives you access to free health care and a range of other services.

The only age-related issue for the gold card is that if you've had what we call “operational service”, which essentially means that you've fought in a conflict of some description very broadly, when you turn 70 you will get a gold card just for that reason. Regardless of your income, assets, injuries, or illnesses, you will get a gold card, which is a very valuable card to have. It's so good that everybody would like one.

[Voices]

Oh, oh!

[Lisa Foreman]

We're under a lot of pressure to give more people gold cards.

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

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Eyolfson.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

I'm going to take the question.

[The Chair, Liberal, Neil Ellis]

Okay, Ms. Lambropoulos.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

First off, what percentage of veterans would you say are on your radar and receiving benefits and services? Then, once we know that answer, what steps do you take to ensure that all veterans have access to your programs and, more specifically, to health care?

I know that you've already mentioned a mobile phone app for younger veterans, but just in general can you give us more options?

[Liz Cosson]

At the moment in our community of veteran clients, we are supporting about 170,000 veterans. As I mentioned, we know about one in three from the Vietnam conflict. We're getting to know more of them as they age because they're actually needing our services and connecting with us. From 1999 onwards, we only know about one in five.

We have a couple of initiatives in place. One is to know everyone who now enlists so that we won't have this problem in the future. We are going around the country and inviting veterans to come and speak to us. It's an outreach activity to try to bring them into the mainstream with the department.

Unfortunately, a lot of our younger veterans don't trust us. Social media is quite active, as you know, and if someone has had a bad experience, they jump on social media and they say not to go to the DVA. What we're trying to do is correct that perception of us, and to say that we're here, we want to support them, and they do have this eligibility for support and services. Also, it's so we have the early engagement, as Kate was referencing, and early intervention. If we can get our younger veterans into treatment earlier, then, as you know, that would save things in the longer term and would help them lead healthy and productive lives.

We're trying to reach out to families as well. As you can appreciate, someone with a mental health condition may be unlikely to want to reach out for support or service, but their families may. Their families will recognize that something isn't quite right, so what we want to do is connect with the families and let them know that their partner can access our services. We have an active social media campaign now under way, and we're engaging with our younger veterans, who have their own social media platform, to ask them to please pass on the message. We're trying as much as we can to reach out to the younger veterans.

[Col Stephanie Hodson]

Knowing that many people don't understand what treatment is, one very successful social media thing that we did recently was a community-based webinar with two lived-experience veterans who have been through our mental health system and who talked about their experiences. We were very careful about how we did that. In the first month, we had over 1,000 views of the webinar, and it was seen in 22 countries, which is the bit that surprised us. It's a different way of trying to talk to a younger audience in a safe way, but it's about getting over that barrier of “what is treatment, is it scary, and how do I access it?”

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

That's awesome. In general, how do you monitor service delivery and ensure a stable and effective service across all programs and benefits? What are the key metrics you use to determine effectiveness?

[Liz Cosson]

Would someone like to speak to that?

[Veronica Hancock]

For many years now, the primary role of the Department of Veterans Affairs has been to ensure that the treatment services for veterans are paid for. So we now have a lot of data about all the services for a whole generation that were paid for. By and large, veterans have treatment in the broader health system, so they would see a psychiatrist, a psychologist, or a specialist of some kind, depending on what their condition is, and they'll use their DVA-issued gold or white card to pay for that service. We get the data about the services they have had.

There has been far less visibility of the exact treatment that someone is having and good data about its efficacy. We're still working on how we can better monitor health outcomes. It's very easy for us to monitor the amount of service. We have a lot of metrics about how many services people have had, what kind of treatment practitioners they are seeing, data about their hospital admissions, including how long an admission was and what it was for, but it is really challenging to get good data about their health outcomes.

Even if you see a general practitioner, you might raise five issues with the practitioner in the course of a consultation. We can tell what prescriptions someone might have come out with, because we get the payment data for those prescriptions when they are presented at a pharmacy, but we don't know exactly what transpired in the course of the consultation. We know if you are seeing a psychologist, but we don't know what therapy they may have been using.

There are some exceptions to that. For example, the Veterans and Veterans Families Counselling Service has a much more complete set of data about courses of treatment. They require their therapist to use evidence-based forms of treatment for particular conditions, so they have a much richer source of data about the health outcomes of their clients.

[The Chair, Liberal, Neil Ellis]

Mr. Nicholson, you have five minutes.

[Rob Nicholson, Conservative, Niagara Falls, ON]

Thank you very much.

Thank you for doing this. There are so many similarities between Canada and Australia that this is very helpful to us.

First of all, Ms. Cosson, when referring to the Vietnam veterans you said that one-third of them are lost. They are lost in what sense? Is it that they don't feel the need to interact with the veterans affairs department, or have they passed on? What's behind that description?

[Liz Cosson]

In a lot of cases, they haven't felt the need to connect with the Department of Veterans' Affairs. We learn of the veteran, as Lisa Foreman was mentioning, when we issue them with a gold card because of their operational service, or because they've turned 70 and are eligible then for the gold card. Sometimes their mate has said to them “Have you been to the Department of Veterans' Affairs? You'll get this gold card.” Then they will connect with us.

[Rob Nicholson, Conservative, Niagara Falls, ON]

Up to that point, a number of veterans just feel they don't have the need for that?

[Liz Cosson]

That's correct.

[Rob Nicholson, Conservative, Niagara Falls, ON]

One of the things that was mentioned was housing loans. Even even though we don't currently have those in Canada, once upon a time we did for World War II veterans. We used to give them mortgages.

I believe yours is up to $25,000. Is it dependent upon the income or resources of the individual, or is it available to all veterans?

[Carolyn Spiers]

Mr. Nicholson, there are a number of housing loans that the Australian Government administers for the military. The older form of housing loan was $25,000, as you've mentioned, called the defence services homes loans. That was a very old scheme. There wasn't an income-based test at all; it was merely when an individual had served three years of full-time continuous service. Over the years, that was replaced by another form of defence service homes loans in which the value of the loan was slightly higher. I can't quite recall the figure, but it was more than $25,000.

[Rob Nicholson, Conservative, Niagara Falls, ON]

Would there be a lower interest rate for veterans on this money than they might get on the commercial market?

[Carolyn Spiers]

Correct. It was a sweetheart rate, obviously, which was to correct the lower—

[Rob Nicholson, Conservative, Niagara Falls, ON]

I like that term “sweetheart rate”. That's good.

Would you register a mortgage against the individual's property?

[Carolyn Spiers]

Correct, if a first mortgage were required on the property. There were some rules for those very low loan amounts. Sometimes those payments were allowed to be put toward modifications to an existing house.

[Rob Nicholson, Conservative, Niagara Falls, ON]

That's fair enough.