Veterans Affairs Committee on May 12th, 2021

[The Chair, Liberal, Bryan May]

I call this meeting to order. Welcome to meeting number 26 of the House of Commons Standing Committee on Veterans Affairs.

Today’s meeting is taking place in a hybrid format. Pursuant to Standing Order 108(2) and the motion adopted by the committee on October 27, 2020, the committee is commencing its study on service dogs for veterans.

Welcome to the witnesses who have taken the time to join us today. I'll introduce all the witnesses and then allow the opener to provide opening comments.

We are waiting for Dr. Alexandra Heber, chief of psychiatry, health professionals division. We are joined by Crystal Garrett-Baird, director general of policy and research; and Nathan Svenson, director of research.

Ms. Garrett-Baird, I believe you are going to be providing the five-minute opening remarks. The floor is yours.

[Crystal Garrett-Baird, Director General, Policy and Research, Department of Veterans Affairs]

Good afternoon, Mr. Chair and members of the committee.

I'm pleased to be with you today.

I will begin by acknowledging that the land I am speaking with you from is the traditional and unceded territory of the Abegweit Mi’kmaq First Nation.

I welcome the opportunity to speak with you today about mental health service dogs. I will be providing an overview of developments to date, both in Canada and elsewhere in the world, with respect to the use of service dogs to assist veterans with mental health issues.

It has been over 100 years since the Canadian National Institute for the Blind was founded in 1918, in large part because of the number of visually impaired soldiers returning from the First World War and the many Canadians who experienced sight loss due to the Halifax Explosion. We are forever grateful for those early advocates who recognized the need for enhanced supports for the visually impaired and stepped into action.

In the years since its inception, the Canadian National Institute for the Blind has provided guide dogs to the visually impaired, giving handlers welcome support.

As an additional support to those veterans who receive a guide dog, the Government of Canada, through Veterans Affairs Canada’s treatment benefits program, reimburses the costs associated with the care and maintenance of guide dogs, up to an annual maximum of $1,500, plus associated travel expenses, including those related to orientation and training with a dog. Other service dogs, such as mental health, hearing and mobility, are not covered.

In recent years, there has been an increasing interest in using service dogs to assist veterans with mental health conditions.

Mental health service dogs, or service dogs, are extensively trained to respond precisely to specific disabilities of their owners, including individuals with mental health diagnoses such as post-traumatic stress disorder. Service dogs are trained to detect and intervene when their handler is anxious, contribute to a feeling of safety for their handler, and promote a sense of relaxation and socialization.

In 2015, Veterans Affairs Canada funded a pilot study to evaluate the safety and effectiveness of using service dogs to assist veterans with post-traumatic stress disorder, as research was limited in this area. The project was contracted through the Canadian Institute for Military and Veteran Health Research and conducted by a research team at Université Laval.

Veteran participants in the pilot study were followed over the course of an 18-month period to examine the effects a service dog might have on psychiatric symptoms, daily social functioning and quality of life for veterans with post-traumatic stress disorder. The study was completed in 2018.

While the pilot study was small, the findings helped to inform policy decisions related to service dogs. Based on the phase one findings from this study, budget 2018 introduced a tax credit for psychiatric service dogs.

Specifically, the Canada Revenue Agency expanded the medical expense tax credit to recognize mental health service dogs. Expansion included mental health service dogs where the dog is provided by a person or organization whose main purpose is to provide this special training, and the dogs are specially trained to perform specific tasks to assist an individual in coping with a severe impairment. This measure directly benefits veterans who rely on mental health service dogs.

While there have been some advancements in this area, one of the main challenges with determining the effectiveness of using mental health service dogs is that there are no national standards regulating the industry. Authority for accessibility issues is an area of provincial jurisdiction. In Canada, different provinces are at different levels of maturity with their adoption of service dog standards.

In 2015, Veterans Affairs Canada contracted the Canadian General Standards Board to set a national standard to ensure consistency in the training and quality of the service dogs being used to assist veterans with mental health issues. While sponsoring this type of work is not typical for the department, Veterans Affairs Canada was aware that there was growing interest in service dogs in the veteran community and wanted to advance the issue in support of these veterans.

In April 2018, the Canadian General Standards Board notified committee members that it had withdrawn its intent to produce a national standard for service dogs as there was no consensus among the committee members that the standard could be achieved for the intended positive impact. The initiative to develop a standard was discontinued.

Veterans Affairs Canada continues to move forward and work with stakeholders. In 2019, Wounded Warriors Canada received funding through the veteran and family well-being fund for a project to expand its post-traumatic stress disorder service dog program.

Another interesting area is research. Veterans Affairs Canada continues to monitor studies related to service dogs currently being conducted by our allies.

The Australian Department of Veterans' Affairs is conducting a four-year study, which began in 2019, to examine the impact of service dogs for veterans with post-traumatic stress disorder.

The United States, however, may well be the most advanced in research and service dog benefits. Currently, the United States Department of Veterans Affairs’ service dog veterinary health benefit provides service dogs to veterans for issues relating to hearing, vision and mobility.

As well, the United States Department of Veterans Affairs recently released the findings of a five-year study on the impact of service dogs for veterans with post-traumatic stress disorder. The study included 153 veterans diagnosed with post-traumatic stress disorder wherein some were paired with service dogs and others were paired with emotional support dogs. Over 18 months, it was found that veterans with service dogs reported greater improvements in post-traumatic stress disorder symptoms, suicidality and anger reactions. The United States Department of Veterans Affairs has not yet advised of any changes in their current program, and whether or not they will add service dogs to their suite of benefits. Any future change in policy direction by the United States Department of Veterans Affairs is being closely monitored.

Finally, and in closing, the research and activity in this area are evolving. Veterans Affairs Canada is committed to staying connected with our allies, researchers, stakeholders and veterans and their families on service dogs.

Thank you for your time today.

[The Chair, Liberal, Bryan May]

Thank you very much.

We had Ms. Heber there for a moment. I was going to suspend due to her sound check, but we'll have to move on here. Up first with six minutes of questions we have Mr. Brassard.

Go ahead, please.

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

Thank you, Mr. Chair.

Thank you so much, Crystal, for your time today. Let me just start off by making a comment. We talk about guide dogs, and you talk about guide dogs and 100 years, and it almost feels like we're at the 100-year point emotionally in dealing with this. I know that you referenced the previous studies that were done by this committee. In 2017 there was the recommendation number 17, which said that the study recommended that Veterans Affairs Canada incorporate international research on service standards and efficacy studies on dog therapy.

I think my level of frustration, and the level of frustration among veterans and their families, is that international standards exist. Therefore, why are we not incorporating many of those standards into a Canadian-made policy? You referenced research by Université Laval. I'm aware of other research that's been done by the University of Saskatchewan. Those standards exist in many cases around the world. Why would we not simply look to adopt those standards in the development of a national standard policy?

[Crystal Garrett-Baird]

Thank you for your question.

Overall, as I indicated, we did engage with the Canadian General Standards Board to develop national standards. They have failed to come to a consensus.

I will ask Mr. Nathan Svenson, our director of research, to speak to some of the research aspects, how that is informing the position we are taking today and where we are at with our work in the department.

[Nathan Svenson, Director, Research, Department of Veterans Affairs]

Thank you.

I'll start by noting that the Canadian General Standards Board made a concerted effort to establish a consensus on this issue. They struck a technical committee with more than 15 members, including representatives from veteran groups, guide dog associations, government regulators and trainers themselves.

Early in the process, based on stakeholder input, the focus of the standard broadened from psychiatric service dogs to all service dogs. That might have made it more difficult to come to an agreement.

In 2017, the first draft of that standard was posted for public comment. The standard covered requirements for handlers, determination of disability, detailed information on training and care for dogs, acceptable breeds and acceptable sources of dogs. They gathered more than 600 pages of feedback at that time.

The fact that consensus couldn't be reached came from a number of different partners and stakeholders, particularly in the industry. That revolved around the length of time that was required for training, the age at which dogs started training and the use of shock collars. There was a wide variety of disagreement. That's really what caused the process to stop.

I'll stop there and ask if there are follow-up questions.

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

In a follow-up to that, if there is disagreement, I'm having trouble reconciling how we, in Canada, can have disagreement on those standards. When we look internationally, for example, Assistance Dogs International has standards that are considered benchmarks in the service dog training area. There are 150 programs worldwide, like the Australian rehabilitation appliances program through their Department of Veterans' Affairs. There was reference made to the United States.

Why are we attempting to reinvent the wheel here in this country, when those standards exist in the countries of many of our allies, the United States being our closest ally? Why wouldn't we simply go to them? These standards exist. In Australia these standards exist. Why can't we just supplant them into Canada? I'm having a tough time reconciling that. I think there are many veterans and their families who would feel the same way.

[Crystal Garrett-Baird]

What's important to note here as well is the role of the provinces, which are at various levels of maturity. For example, British Columbia has a legislative framework around guide dogs and service dogs and training and certifying them. They also—

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

I'm sorry, but the provinces are not responsible for veterans in this country. That falls under the responsibility of Veterans Affairs. If we want to have a national standard for veterans, it becomes apparent that it should be Veterans Affairs Canada that develops that standard.

The provincial standard may work well, for example, for DeafBlind Ontario, but it won't work for veterans.

That's why I don't buy into that, with respect.

[Crystal Garrett-Baird]

Through the veteran and family well-being fund, we were able to fund, starting in 2019, Wounded Warriors, to expand their post-traumatic stress disorder service dog program. They have actually worked with health care professionals and service providers in this realm to develop prescriber guidelines and service dog guidelines. They've done some wonderful work in this area.

The other important note is that Veterans Affairs Canada is not a provider. We support or pay for treatment. We work with veterans when they are seeking treatment and provide reimbursement or payment for that treatment.

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

I understand that, but when we're talking about the development of a national standard, if it's not for Veterans Affairs to take the lead on that with other government agencies, then who is to take the lead? Are we going to put that off to the provinces to determine those standards? I don't see how that can be a practical solution to this, if it's not Veterans Affairs taking the lead on this.

[The Chair, Liberal, Bryan May]

If you have a quick response of maybe 10 seconds, go ahead.

[Crystal Garrett-Baird]

I would just reiterate the work that we did to attempt to develop standards using the Canadian General Standards Board. Unfortunately, there was no consensus.

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

That's not good enough, because veterans need this.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you, Mr. Brassard and Ms. Garrett-Baird.

We will suspend for just a moment while we try to do Alexandra's sound check.

[The Chair, Liberal, Bryan May]

Next, for six minutes, is MP Samson.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Thank you, Chair.

I want to thank the individuals here today for sharing information on service dogs, the importance of service dogs to veterans, and how we can move with the evolution we're talking about. We're supposed to be making headway. The evidence is still not in the pudding, if you will, or the pudding is not there. So far we haven't come up with national standards or been able to adopt national standards. I know that we need to continue to work on this, but we need to find a resolution.

That being said, in 2018 we put in place a tax credit. We expanded the tax credit for service dogs. How does that tax credit work? Who can benefit from that tax credit?

[Crystal Garrett-Baird]

As you noted, the Government of Canada expanded the medical expense tax credit in 2018 to recognize, among others, mental health service dogs. This measure directly benefits veterans and others in the disability community who rely on mental health service dogs. This tax credit is delivered by the Canada Revenue Agency. As I noted in my opening remarks, it's something that is open to a variety of Canadians, including our veteran population.

More specifically, the expansion of this tax credit is for mental health service dogs where the dog is provided by a person or organization whose main purpose is to provide the special training, and it is specifically trained to perform specific tasks to assist an individual in coping with a severe impairment. As I said, it's important to note that this measure directly benefits veterans who rely on mental health service dogs.

Thank you.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

It has to be a psychiatric service dog, I understand.

[Crystal Garrett-Baird]

It's a mental health service dog.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

They are trained to do a specific task.

In the 2018 study, we didn't produce national standards, but there were some gains in understanding around service dogs. Can you share that information? We didn't get to the outcome that we were studying, but we did learn a lot that might help us as we try to move this forward.

[Crystal Garrett-Baird]

Sure. Certainly, one thing is that it actually assisted in leading to the expansion of that medical expense tax credit.

I will ask Nathan Svenson, our director of research, to provide more insight into the 2018 study.

[Nathan Svenson]

Sure thing.

This study was launched in 2015 in collaboration with the Canadian Institute for Military and Veteran Health Research. It was led by Université Laval. The purpose of the study, as was mentioned, was to investigate the potential effectiveness of psychiatric service dogs for veterans, specifically those suffering from PTSD. It was a pilot study. It was not a large group. There were 18 veterans with PTSD who completed the 18-month study. There were 31 veterans who started the study, but only 18 kept their dog for the entire duration of the study and continued to report their results.

At the end of the day, they reported fewer nightmares, improved sleep quality, and a reduction in PTSD symptoms and depressive symptoms. Some reported an overall improvement in quality of life. There was an increase in social integration in the community as well. The one observation that was taken that didn't show a measurable improvement was a decrease in dependence on caregivers. That's another aspect that is being measured now in a separate study in Australia. That's ongoing. It's to see if they can separately measure dependence on caregivers in a more robust way.

The small nature of the study and the collection of schools in Canada that were used made the findings fairly limited in their use. There were seven schools in the study. In terms of some of the challenges they encountered, first of all, there was no consensus among the schools about which breeds of dogs to train and where the sources of dogs should come from. Most of them in our study were donations or animal rescues. There was a strong variation in the duration of the training, from hundreds of hours to thousands of hours. Even the tasks that were trained were quite different from school to school. Some schools put a bigger emphasis on each unique veteran's needs. Some put more training into the dogs themselves before pairing, and then very little afterwards. For others it was the opposite.

It's important to note that there's a lot of variation, too, in the placement and the environment in which the dogs are placed. From patient to patient, there's a difference in community dwelling, their social relationships, the other treatments and medications they're taking, their personal interest in activities and also their having another pet. All of those things made it difficult to make broad generalizations from the limited findings of this study.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

With the findings of the study and the difficulty we had at that point, do you feel that we have some research that can advance this? With some of the questions that really caused us not to come out with standards, do you think we've learned something from different countries now that would maybe lend us a hand to get to where we need to go?

[The Chair, Liberal, Bryan May]

You have just over 30 seconds for an answer, please.