Veterans Affairs Committee on April 21st, 2021

[The Chair, Liberal, Bryan May]

I call this meeting to order.

Welcome to meeting number 20 of the House of Commons Standing Committee on Veterans Affairs.

Today the meeting is again taking place in the hybrid format.

I've been made aware that there may be a vote today regarding a subamendment to the budget. I'm told the bells could start to ring at 5:15 for a period of 30 minutes and that the vote would be held at approximately 5:45 today.

When the bells start ringing, we'll have 15 minutes left to the meeting, theoretically. I will be interrupting the proceedings at that time to seek unanimous consent to continue to sit during the bells until our normal end time of 5:30. This should give us plenty of time to get prepared for the vote. I wanted to make sure that everyone understood that was coming.

Pursuant to Standing Order 108(2) and the motion adopted by the committee on October 27, 2020, the committee is resuming its study on supports and services to veterans' caregivers and families.

Welcome to all the witnesses who have taken the time to join us today. I will introduce all of you and then we'll get right into the opening remarks.

Appearing as individuals, we have Mr. Glynne Hines and Dr. Greg Passey. From the Association du Royal 22e Régiment, we have Richard Gauthier. From The Perley and Rideau Veterans' Health Centre, we have Mary Boutette, chief operating officer. Coming back to us again—thank you for taking the time to join us again after technical challenges—we have Mary Bart, chair of Caregiving Matters.

Again, thank you to all the witnesses. You will each have five minutes for your opening remarks.

We'll start off with Mr. Hines.

The next five minutes are all yours.

[Major-General, Retired) Glynne Hines (As an Individual]

Thank you, Mr. Chair.

Mr. Chair, members of this committee, and fellow panel members, good afternoon. I'd like to thank you for the invitation to appear today.

Before I get into the substance of deliberations, I'll give a brief background of myself. I am a veteran of 41 years' service of the Canadian Armed Forces, in the regular and the reserve forces, having served in the army, the navy and the air force. When I retired in 2012, I remained in Brussels, where I was the civilian director of NATO's intelligence-sharing enterprise.

None of this has anything to do with veteran mental health care. However, since that time I've been involved with supporting and advocating on behalf of veterans and their families in a variety of capacities, with my emphasis being on veteran and family mental wellness.

I understand the focus of your committee right now in this session is on the supports and services to veterans' caregivers and families, and that today you wish to focus on three elements: the impact of the caregiver recognition allowance since its introduction; the relevance and possible means of enabling family members to get VAC services on their own behalf; and to reflect more generally on the support offered by VAC to family members, particularly when it comes to veteran health that requires ongoing care.

Starting with the caregiver recognition benefit, I just want to correct a statement that was made in my invitation, which referred to something called a “caregiver recognition allowance”. It's actually the caregiver recognition benefit, and this nuance is important. It's not an allowance per se, but it's a $1,000-per-month benefit to recognize, and not compensate, the contribution of a family caregiver to the care and recovery of our most severely disabled veterans based on their disability, not necessarily based on the impact on the family. It does not replace income or earnings lost by these family caregivers; it merely recognizes that they have a role to play in caring for the veteran.

As I indicated previously, in my advocacy role my emphasis is on veteran mental health. I'm particularly interested in the caregiver recognition benefit as it applies to veterans with a diagnosed mental health condition.

Since raising this issue of equitability—that is, the equitability between a veteran with a mental health condition and a veteran with a physical disability—I have focused on some data from VAC. It indicates that approximately 70% of the applicants for the caregiver recognition benefit are in receipt of disability benefits for a mental health condition, and that 81% of those eligible for that benefit actually have an approved disability entitlement for mental health conditions. So, in fact, it does appear that the award of the caregiver recognition benefit is equitable for veterans struggling with mental health conditions as it is for those with physical disabilities.

When we talk about enabling families to obtain VAC services on their own behalf, I think we could take a lesson from our allies in Australia. In Canada, there are very few supports and services provided to family members, and there are no supports and services provided to family members on their own right from VAC. Family members will only get support from VAC if it is directly related to the veteran's condition and recovery. This means that the family's need for support must be directly related to the member's condition and treatment. Thus, if a veteran himself or herself does not have an awarded condition, a family member who may be suffering as a result of the member's service is not able to access VAC support for themselves, and this is especially important when we're dealing with family mental health. The veteran may choose not to apply for a disability award or to seek help, for whatever their own personal reason is, but that doesn't mean that his or her dependants aren't adversely impacted by the veteran's service, or that they don't need help.

Consider for a moment the teenager who has moved with their parents every few years while growing up. A parent is deployed every few years, school has been disrupted, the teen starts struggling with their own mental health. They don't have access to mental health care, because they're always moving, and they go on a rather lengthy provincial waiting list to get care. They don't have access to VAC services because their veteran parent doesn't have an awarded condition, so they suffer without help, even though their condition may well be attributed to the veteran's service.

We used to say that members joined the Canadian Armed Forces, but their families were drafted. I chose to join. My wife and my kids didn't choose to join, but they have been subject to all the career implications and the lifestyle implications as a result of my service. Unfortunately, in retirement or after release, this continues, whereby the dependants are struggling sometimes with conditions that their veteran parent has, but they don't have access to services and support.

The care and support needed are often in the area of mental health, and it's a discipline that is stigmatized, making access even more difficult for spouses and children. Veterans and their families face a unique experience during a military career and transitioning to civilian life, and it is very difficult for them to get the care they need while they're on lengthy provincial waiting lists, especially for mental health conditions.

Military life can involve significant challenges, not the least of which is exposure to life-and-death situations. For many veterans, military service and operational deployments can lead to a strong sense of identity and belonging. For clinicians working with veterans, demonstrating an understanding of the military experience enhances the therapeutic alliance so they can get effective treatment.

[The Chair, Liberal, Bryan May]

I'm sorry to interrupt, Mr. Hines. We're well past time, so I'm just wondering if you could conclude your statements.

Thank you.

[Glynne Hines]

I certainly will.

The Australian situation is one that we would welcome, whereby veterans' family members can get access to care through Veterans Affairs in their own right, without having to rely on the provincial system, which often has a very lengthy wait time and doesn't have clinicians who are trained in the veteran lifestyle.

My apologies for going over.

[The Chair, Liberal, Bryan May]

That's okay, Mr. Hines. That's my job. I'm the official chief interrupter of this meeting. I apologize to you and to everyone I may need to cut off.

Up next, we have Dr. Passey for five minutes, please.

Do we have Dr. Passey? Did we lose him? I don't see him on the screen.

Mr. Clerk, do you know if he's still with us?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

He just dropped off.

[The Chair, Liberal, Bryan May]

Thanks, Cathay, I didn't see him drop off.

We'll reach out to him, Mr. Clerk, via the technical staff to see if we can get him back. In the meantime, we will stay calm and carry on.

Up next is Mr. Gauthier for five minutes.

[Richard Gauthier, Association du Royal 22e Régiment]

Good afternoon, everyone.

I would like to thank you for inviting me to discuss a very important topic for veterans and caregivers across Canada.

My name is Richard Gauthier. I served for 16 years in the Royal 22nd Regiment.

I founded a veterans group in June 2019 despite the pandemic. There are 1,200 members on my Facebook page, and 400 of them are very active. I can say that 98% of those who follow me on my Facebook page are people who served in Afghanistan, Bosnia, Rwanda, Haiti, Germany, the Cold War, Cyprus and so on. So the data and testimony I have collected are straight from the source.

The reason why I founded a group was precisely to get people out of isolation and depression. The procedures often take far too long, which leads to some quite serious problems. A soldier is a person who wants to give and serve. That's why I have established an annual calendar of events. For example, on February 21, 2020, in collaboration with the City of Montreal, we served 350 hot meals and donated warm clothing to homeless people in the City of Montreal. The 400 very active members of my group participated in this event, which was a great success. We will be repeating it annually.

By the way, my group is not a biker gang. It is a registered non-profit organization (NPO). You can visit the veteransr22er.com website if you want to find out about the mission and fundamental purpose of my group.

I surveyed the group on the topic at hand, namely caregivers. Let me list the points mentioned to me and then I will give you my suggestions on the issue.

The eligibility criteria are too narrow. The file processing is too slow, the procedure takes really too long and it doesn't make sense. That's what the ombudsman told me. In addition, there is a lack of staff to respond to requests in French. Perhaps this aspect should also be fixed because it is not right for the procedure to take 36 or 48 months when we are told that it will take between 12 and 16 weeks. The system really must be changed in order to process files more quickly. You will understand what I mean when I make my recommendations.

The allowance amounts are not high enough. Caregivers must have direct access. The lack of French-speaking staff to process the files should be addressed. I don't know how long the wait times are for anglophones, so I won't speak for them.

Following the points I have just listed, here are my recommendations. I suggest that a committee solely for caregivers be set up to go more directly to the source. Individuals would register with their representatives in the area and the information would be sent directly to the committee. The committee should be composed of a general practitioner, a psychologist, a senior administrative officer and a social worker. This would allow the committee members to understand the case more quickly and to provide a response within 30 days of approving the request.

It would be important to provide documentation to caregivers and veterans with a letter of explanation and a pamphlet outlining all their rights. A website should be created with videos of health care professionals giving advice to help caregivers do a good job.

There should be a 1-800 hotline to provide support and a safety net for caregivers. Veterans may suffer from some quite serious psychological problems and the caregiver role can be very demanding. At some point, they may be struggling and a help line needs to be set up for them. It could also be used to lift their spirits and provide access to a psychologist.

The $1,000 per month is not enough. Being a caregiver is an incredible amount of work. I suggest that the amount be increased from $1,000 to $1,500, and that it be tax free.

I can give you an example. The spouse of a member in my group decided to work only three days a week to help her spouse. Her annual salary was $84,000, which has now dropped to $51,000. This person, who decided to help a veteran who served his country, is now losing $33,000 a year. The $1,000 is absolutely inadequate. We can say that it is not to compensate the person, but those are the facts.

Veterans who qualify for the caregiver recognition benefit could be added to a priority list for a service dog or animal to help them deal with boredom. Boredom kills these people the most. It is important to address that.

The selection criteria should be broadened a little. The spouse is often the caregiver. We must not forget that many veterans are single, sometimes because their spouses and children left them as the situation was a little too hard to bear.

In my opinion, the closest people to a veteran are the family members. So the father and mother could be included. If a young veteran is 30 years old and his mother and father are 50 or 55, one of them could become his caregiver. It could also be an uncle or an aunt. A close friend could also be eligible for this program.

[The Chair, Liberal, Bryan May]

I'm sorry to interrupt, but again we're over time. Could you wrap up your opening statement, please?

[Richard Gauthier]

Okay. I am almost finished.

I noticed that the eligibility criteria refer a lot to hygiene, food and the selection criteria, but make no mention of post-traumatic stress disorder (PTSD), as was discussed earlier. PTSD should also be considered. It must not be forgotten.

I also want to thank all those who have served their country.

Thank you very much for your attention.

[The Chair, Liberal, Bryan May]

Thank you so much, Mr. Gauthier.

We have Dr. Passey back.

Do we need to do a sound check, Mr. Clerk?

Apparently our sound check is good, Dr. Passey, so the next five minutes are yours. Please go ahead.

[Dr. Greg Passey, Psychiatrist, As an Individual]

Thank you very much for this opportunity to address the committee.

My background is that I'm a veteran. I served 22 years in the Canadian military as a doctor, and later as a psychiatrist. I'm an expert internationally and nationally in post-traumatic stress disorder. I currently have about 133 veterans on my caseload in Vancouver. I've assessed and treated hundreds of veterans, as well as serving members in Saskatchewan, Alberta and British Columbia. As such, I've had a lot of experience dealing with VAC offices and have a long clinical and corporate history with them. I've served on two separate veterans affairs committees that are listed in my paper that I've given to you.

From the late 1990s until about 2010, the PTSD claims that I put forward were typically awarded within six weeks. There has been a significant degradation of VAC service and an increase in denial decisions, starting about six years ago, especially in the year prior to the 2015 election, when funds were cut to VAC. Even since that time, VAC decisions and Veterans Review and Appeal Board decisions now can take as long as 18 months. Of even greater concern to me is the increased level of denial of claims, up to and including the last level of appeal at the Veterans Review and Appeal Board.

In regard to the caregiver allowance, I've listed seven different items in my speaking notes: one, lack of adequate VAC resources to provide timely service, decisions and support to veterans; two, inconsistent application of the eligibility criteria, resulting in some applications being approved and others with the same level of disability being denied; three, lack of flexibility when applying the eligibility criteria, with a seeming bias against mental health diagnoses and disability, especially in our young veterans; four, overly restrictive eligibility criteria; five, excessive time to review the application, and the appeal system is likewise slow and inconsistent; six, lack of any VAC quality assurance program, first recommended by the VAC-Canadian Armed Forces advisory council in 2000, and to date, nothing has been done in regard to this; and seven, lack of any ability for veterans or their family members to give appropriate feedback to VAC in their interactions.

I've given you two separate examples of veterans, and I'm going to quickly run through one.

Regarding veteran A, I stated in July 2018 that the veteran should not be left alone at home for more than a few hours. Despite this, the caregiver allowance was not awarded.

In November of that year, I stated that the veteran actually had significant deficits meeting the majority of the ADLs listed in the denial letter. He had problems with his balance and fell easily. He might not be able to get up by himself. He was unable to shave himself partly because of osteoarthritis in his fingers and because he typically will cut himself, so his wife had to shave him. He had to be reminded to shower. He couldn't wash his lower limbs because of restricted flexibility. He often wouldn't eat or remember to eat even when it's premade. He had difficulties outside the house on uneven ground and had fallen easily a number of times. His wife did not like to leave him alone for any significant amount of time because she did not feel that he was safe on his own. He could leave the stove on and start a fire because he would forget when he's trying to cook.

At that time, again, I stated he was incapable of safely staying by himself for more than a few hours, and I recommended caregiver recognition benefits. Again, it was denied.

I noted on April 23, 2019, that the veteran had fallen on more than one occasion and had not been able to get back up by himself. This put him at considerable risk for his physical safety, especially if it occurred outside. Again, my opinion was that he was no longer safe to be left alone, and his wife likewise confirmed this. Again, it was denied.

Finally, in January 2020, he revealed to me that he had felt suicidal after VAC rejected any increase in his PTSD award and rejected the caregiver allowance. He made a serious attempt at suicide, and by pure luck, he didn't hit the tree square on; otherwise he would have died.

In March, I noted that he had fallen at the end of January, fractured his left elbow, had a hairline fracture by his right ear and left eye, and he had no memory of the event.

He remained quite angry at the VAC, because of all the denials of various claims. He basically remains home alone a lot. Finally, after over two years, this veteran was awarded the caregiver allowance, despite all my letters and only after fracturing his elbow and having two skull fractures in January 2020.

This is one of many denials. He's an older veteran from the 1960s and 1970s. The other veteran is younger. His wife has written a letter that you can read.

There are ongoing problems with the entitlements and decisions within Veterans Affairs. We need to find ways to correct this. It cannot go on like this. We're losing too many people, and we're not tracking all the suicides.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much, Dr. Passey.

Up next, we have Ms. Boutette.

The next five minutes are all yours.

[Mary Boutette, Chief Operating Officer, The Perley and Rideau Veterans' Health Centre]

Thank you very much for the opportunity to make a representation this afternoon.

I'm the chief operating officer of The Perley and Rideau Veterans' Health Centre. We support over 250 older veterans, their caregivers and families, both in long-term care and in supportive living apartments.

Monday evening as I was leaving work, I had the opportunity to speak with the daughter of a veteran who was admitted to our long-term care home two weeks ago. The daughter had been supporting her parent, who has Alzheimer's disease, at home for several years. The daughter shared that she had failed her mother, first, by letting her fall while at home, and then in hospital as she deteriorated due to lack of physical and social activity. She was crying. The daughter was struggling with her mother's transition to long-term care, and the profound change this meant for her day-to-day life as a caregiver. Her caregiving role had not ceased, but was profoundly changed, aligned with her mother's transition.

Her story is but one of countless examples of families and loved ones who are caring for older veterans. How can we ensure these families and caregivers receive the support and services required to optimize their quality of life, and also that of the veteran whom they care for?

Families and caregivers are essential to the physical and psychosocial health of veterans. Indeed, they've often been described as the strength behind the uniform. This is true not only when an active member transitions to civilian life due to illness or injury, but also as veterans age and their capacity declines.

The needs of veterans and their caregivers are intrinsically linked. To support the veteran, one must support the caregiver. To support the caregiver, one must support the veteran.

In August 2017, the Office of the Veterans Ombudsman published its report “Continuum of Care: A Journey from Home to Long Term Care”. The report clearly articulated the need to ensure that aging veterans and their caregivers receive appropriate support across their life-course trajectory. The recommended changes were designed to help reduce complexity and enhance benefits and services to those who need them, when and where they are needed, while ensuring that eligibility was not tied to the veteran's status or location of residence. Benefits and services should be flexible enough to move and adapt seamlessly with the veteran as the needs and care settings change.

Required improvements to services and supports for veterans, their caregivers and families can be grouped into three broad themes: close the gap, enhance outreach and reduce complexity.

With regard to closing the gap, Veterans Affairs has a long tradition of supporting priority access to long-term care for veterans of World War I, World War II and the Korean War. Additionally, the department needs to support veterans and their caregivers to remain in the community as long as possible through the veterans independence program. This program provides annual funding to eligible veterans to help cover the cost of home care services, and it is an excellent support for those with limited needs who are capable of independently navigating a wide variety of service providers.

Unfortunately, there's often inadequate support for veterans and their caregivers as their needs change and remaining at home is no longer an option. The burden of care falls to families. Accessing long-term care is challenging, particularly so for those who served following the Korean War. It's not just access; it's about quality care.

Veterans Affairs must shift its focus to the continuum of care, aligned with the diverse life-course trajectories of veterans. Families and caregivers should have confidence in access to quality services based on need, whether that be in the community, a supportive or assisted living environment or long-term care. This should include support for caregivers when veterans are unable to perform instrumental activities of daily living, such as household management and child care.

In terms of enhancing outreach, as veterans age, family and caregivers age with them. Navigating health and support services is challenging for the most privileged among us, but it is particularly difficult for those with declining cognitive capacity and for those who aren't comfortable with technology. It's too easy for veterans and caregivers to fall through the cracks.

It's essential that Veterans Affairs enhance its outreach programs and communications. This can be accomplished through systematic and planned reassessment of veterans at risk and by partnering with established veterans service organizations to ensure awareness and organization of appropriate supports.

The veterans health care regulations are notoriously complex, with benefit eligibility often tied to type of service. In addition, federal supports and services are often layered upon provincial and municipal programs. Care is frequently fragmented, and negotiating and managing services on behalf of the veteran can be overwhelming and exhausting.

Access to a continuum of care and support must be as seamless as possible, ideally with a single point of entry. Eligibility criteria should be clear and equitable—that is to say, based on physical and psychosocial needs rather than type of service.

In conclusion, it's important to note that very little research has been conducted that examines the trajectories of older veterans and their families. A deeper understanding of the journey lived by older Canadian veterans, their families and caregivers would enable the development of more tailored supports and services.

Thank you for the opportunity to make representation on behalf of veterans, their families and caregivers.

[The Chair, Liberal, Bryan May]

Thank you very much.

Up next, we have Ms. Bart.

The next five minutes are yours.

[Mary Bart, Chair, Caregiving Matters]

Thank you so much. I'm so glad to have the opportunity to meet with all of you.

My goal today is very simple. I would like to tell you a little bit about myself, our charity, what I have learned about caregiving, and a special assignment I did around caregiving for veterans. That's my goal today.

I am the founder of our registered Canadian charity. We have been established since 2008. We're different. We're an Internet-based charity. Most of our work is done online through video and podcast.

For the last 12 years or so, I have been a regular contributor to a Canadian magazine called Caregiver Solutions.

Here are a few fundamentals about caregiving. I'm sure you've heard or experienced some of them, but I think it's important to note what the life of a caregiver is.

No one ever wants to be a caregiver. It's not like we wake up one day and say, “Gosh, I can hardly wait to be a caregiver; that's what I've waited my whole life to do.” It doesn't happen that way. It starts gradually. Our efforts increase as the health of our care recipients declines.

Our job is so varied. We have only two hands, but really, every caregiver needs eight hands. We should all be octopuses; our lives would be a lot easier.

Our jobs are often horrendous 24-7. Often we do a lot of physical lifting. We help with hygiene care and feeding. We help with shopping. We are the taxi service. We go to medical appointments. We deal with the care recipient's frustrations, whatever they are. We deal with our own frustrations. We also have legal and financial responsibilities. Sometimes we pay bills and sometimes we are named in the legal documents for power of attorney. Often, when our loved one dies, we have another job, which is executor of the estate.

We do the whole gamut of everything that needs to be done for our care recipient. Many of us do it 24-7. We give up our jobs. We give up getting promotions.

It is a pretty tough job to be a caregiver. I always say that when I took care of my mom and dad for 10 years—my dad had cancer and my mom had dementia—truly, many days I was honoured to do what I did. Equally so, many days I went out of my mind. You have to know that's the life of a caregiver.

I'd like to share some experiences on the positive and the negative sides of being a caregiver. There are four that instantly come to mind on the positive side: joy, feeling honoured to help, feeling valued and feeling appreciated.

On the negative side, I must tell you that my chart is much longer than four items. We often feel out of control, stressed and burned out. Our number one issue is guilt. Caregivers deal with guilt every day for every reason. We have resentment. We could have anger. We are exhausted. We lose sleep. We lose income and promotions. We often spend our own money and are not compensated. We can be awfully isolated, which is a horrible place to be as a caregiver. We lose relationships, either with friends or spouses. We have poor health. I can tell you that no caregiver I have ever met is in better physical and mental shape once they become a caregiver. It's just the opposite. We are often overwhelmed and we often lose hope.

In my role in terms of helping this magazine and contributing, I was asked a few years ago to write a series of articles about caregiving to Canadian veterans. I found that to be a very interesting topic. My dad and most of my aunts and uncles.... Actually, my uncle lives at the Perley, as did my aunt until she died, so there's a great connection there. I was very interested to look at this topic of caregiving for the magazine that I write for.

I'd like to share with you now my thoughts on what I learned as I did that research.

Obviously, everything I've mentioned about caregiving is a given, but I would put it down to what I would call the “three Rs” of caregiving to veterans. I'll explain them, but they are retribution, repercussions and resilience.

Retribution is the first one.

As I did my research, I was astounded at how difficult it was to find people who wanted to talk to me. It was the hardest thing I've ever done in terms of research for this magazine. Veterans and their caregivers, I found, are afraid to speak out. They are afraid to be cut off, refused help or blacklisted. I often heard, “I'd love to talk to you, but my wife won't let me because Veterans Affairs is the evil empire.” Okay, that's pretty...speaking of a culture of distrust. Veterans and caregivers live in fear. That's my first “R”.

The second one is repercussions.

Am I over?

[The Chair, Liberal, Bryan May]

I'm really sorry. I let you go for another minute or so. If you could conclude.... It sounds like you have quite a bit left in your opening statement.

[Mary Bart]

No, I have two slides.

[The Chair, Liberal, Bryan May]

That's perfect. Go ahead.

[Mary Bart]

I'll go fast.

The repercussions are what happens when the caregiver has a bad experience with Veterans Affairs. Obviously, it comes back to bite the caregiver. They are less likely to want to give care. They're more likely to be abusive, and they'll want to run away and escape, because it's all on their shoulders and they take the brunt of the frustration that the vet feels through the dealings with caregivers.

This comes to my final one, which is resilience. When caregivers are dealt the repercussions, their resilience is weakened. They are less likely to want to be caregivers. Their spirit is broken. They may be physically abused and what they often really want to do is run away and hide.

I say to you, as you write policies and programs, to be mindful of what I'm calling the retribution and repercussions, and that you're impacting the resilience of caregivers.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much, Ms. Bart.

Thank you to all the witnesses for their opening remarks.

Up first for our questions is MP Brassard. You have six minutes, please.

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

Thank you, Mr. Chair.

Thank you, everyone, for taking the time to be with us this afternoon on this very important study.

Dr. Passey, thank you again for being here. You've been here many times, and I'm not sure that you've seen actual effects of some of your testimony come to light, because not much has changed, not much does change, and I think you'll agree with me on that.

One of the things I found interesting was that, when you were talking about caregivers and veterans, you went through the criteria, and if I didn't know any better, Dr. Passey, I would have thought you were talking about Max Gaboriault. I don't know if you know Max or know of him; he's been to this committee. In fact, he was invited to this meeting but didn't get a chance this time around. He has spoken publicly about his situation, that he's 115% disabled and has been rejected five times for his caregiver allowance.

You talked about seven different things, and I was only able to write down six of them, but you said at the end of it that it comes back to entitlements and decisions. You also said there is inconsistent application, lack of flexibility, often dealing with mental health, and that it's overly restrictive.

I'm just wondering, based on your experience with veterans like Max—whom I know you haven't dealt with, but in similar situations—how have you been able to overcome some of the problems you've seen for those veterans who have applied—many times, in the case of Max—but have been rejected by VAC?

[Dr. Greg Passey]

It's difficult. Talking about resilience getting worn down, I've been doing this a long time and to be honest, I feel worn down by Veterans Affairs. Initially, they were very good, but now they're obstructionist; they're restrictive. We have lay people typically overruling medical specialists and stuff. The reality.... The only thing that keeps me going is my loyalty to my fellow brothers and sisters veterans. I would have quit a long time ago. I have multiple examples, multiple denials, and then you get to the second level...last time, it's over with, end. I found out that if you wait about six months or a year, you can start the whole process all over again.

It's very wearing, not only on the caregiver and the veteran, but also on the professionals who are advocating for the veterans for these entitlements. It's perseverance. It's the only thing I can do. I just can't walk away.

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

Oftentimes when a veteran is dealing with mental or physical injuries, occupational stress injuries or mental health, they just can't take it anymore, can they? If you're exhausted, I can't imagine how exhausted veterans and their families are in going through this process time and time again, as is the case with Max. Finally you just throw your hands up, and he told us that this week in a separate message system. He said, “I don't know what to do anymore.” Is that the kind of thing you hear often?

[Dr. Greg Passey]

Yes. I deal almost exclusively with post-traumatic stress disorder, and about 49% of people with PTSD think about suicide; 19% actually act on it.

I've been very fortunate. I think it's partly the therapeutic relationship and the bond I have as a fellow veteran. In all my years—in June I'll have been a doctor for 41 years—I've never lost a patient to suicide, but the example I gave you would have been my first, and I didn't know about it. That's telling me that not only are they getting worn down, but they're now starting to not reach out, because had he reached out, I could have done something about that.

It's a really dire scenario. We're not tracking the suicides when our veterans leave the military. To be honest, every one of my veterans—and I mean every one—develops anxiety when they get a letter or an email from VAC, because the vast majority have had negative interactions.

There's a reason why there's bulletproof glass in the VAC offices now, and that shouldn't be there; it should be a supportive environment.