Veterans Affairs Committee on May 1st, 2023

[Rachel Blaney, NDP, North Island—Powell River, BC]

I want to make sure I really understand this. Is this a list that is being added to, to make sure that process is done? If so, could we actually have what that preliminary list looks like or where you're going with that?

One of the concerns I have, of course, in this study is that we're hearing from women veterans that they're having to prove that the impact of their service is actually the reason for their health issue. What they're doing the vast majority of the time is fighting to get that recognized and appealing and appealing and appealing, which means they're not getting the support they need because they keep having to appeal.

I just want to clarify, Colonel Wright. Can you give us information that gives us some guidance so that as a committee we understand?

[Col Helen Wright]

We're in the process of making the list more robust, let's say. I wouldn't describe it as a list exactly. It's a screening form the member goes through, but it helps remind the member of things they might want to bring up with their clinician. They might not think about something that day with all of the things going on, so it helps remind the member as well as the clinician what to say. That's the goal that we're getting on both sides, to make sure these things are addressed.

[Rachel Blaney, NDP, North Island—Powell River, BC]

You said there's a screening form. Can we have access to that? Would you prefer that we ask for access to that, because this study is quite long, maybe in September?

[Col Helen Wright]

That would be perfect, because we really are working on it right now, and I'd like to be able to show you the final version as opposed to the interim version. Of course, if you would like the interim version, we can provide that as well.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Okay. Maybe we'll have both just so we can see the change. I think that would be excellent, so thank you for that.

One of the things we've also heard—and I'm going to go to Colonel Wright on this, and advise me if I need to go somewhere else—is that often women veterans, when they leave, don't go to VAC. I'm wondering if you see a benefit to or need for a transition group to offer barrier-free mental health support—no claims, no paperwork—just for a period of time, say maybe the first two years, so that we can fill that gap and make sure that people transition smoothly. It seems as though currently there's a process in which they're getting lost and sometimes being found many years later. I'm just wondering if you have any thoughts on that.

[Col Helen Wright]

Given that your question involves mental health, I'm going to direct it to Captain Beck.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Excellent.

[Capt(N) Iain Beck]

Well done, Helen.

No, that's obviously an important process. As I mentioned, we need that smooth, seamless transition of care.

One of the things we try to do is that, if somebody's going to have long-term care—particularly if they're going to be medically released, but even if they're not—we ensure that there's a civilian provider. For instance, if it's seeing a psychologist in the civilian community, then let's get that established before they are released from the military.

We do have a very close relationship with our community civilian providers, whether it's in psychiatry or psychology. I think that we have a mandate to treat military members. We lose that mandate once they are released, which I'm sure you're aware of. However, it doesn't mean we forgo our responsibility in taking care and smoothly transitioning them to a mental health provider in the community. There has to be very good communication, just like if I referred somebody to the emergency department. I would pick up the phone and say why I was sending you.

It's really about communication, both with civilian providers and with our Veterans Affairs colleagues, through our nurse case managers and their case managers. We're really trying to close the gap by having some continuity and also some alignment of services and benefits. That work's been ongoing for several years, to be honest, but I think we're getting there.

[Rachel Blaney, NDP, North Island—Powell River, BC]

How many clinical psychologists actually work for the CAF, then?

[Capt(N) Iain Beck]

That's a good question. I was trying to pull that up before we started.

I can't answer that. I can certainly get that back to you, as far as the number within the clinics.

All of our psychologists are civilian providers. They're not uniformed. We use a lot of community psychologists, particularly in more remote areas.

Honestly, I wish I could give you that number right off, and I should be able to, but I certainly can provide it afterwards.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you. I would appreciate that.

Thank you, Mr. Chair.

[The Chair, Liberal, Emmanuel Dubourg]

Now I invite the first vice-chair of the committee, Mr. Blake Richards, for five minutes, please.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Thank you.

One of the challenges that I quite often hear about from veterans kind of relates a little bit to what you were just discussing with Ms. Blaney. It's the alignment of the CAF and VAC in terms of how things are assessed and treated. I think there certainly needs to be a lot of work done to ensure that they're better aligned.

One of the areas that I hear quite frequently about is when a member of the military is assessed with a service-related injury that then causes them to be deemed to no longer be able to serve; they're too disabled to be able to serve. Then they go to Veterans Affairs. When they're assessed there, it's determined that, perhaps, the injury isn't service-related. We have one assessment saying that the member has a service-related injury that's not allowing the member to be able to continue to serve, and we have another assessment from Veterans Affairs saying that it's not really service-related, so VAC can't provide the member with benefits. You can obviously see where the huge problem is in that.

Obviously, we see veterans who are falling through the cracks as a result. I wonder if you could tell us a little bit about that. Why can't we use the same standard for injury assessment or perhaps even the same doctors? It seems to me like this is a really problematic—we'll put it nicely—situation.

I don't know who wants to address that. Is there any way that we could better align that so that we don't see those kinds of things where veterans are falling through the cracks as a result?

[Capt(N) Iain Beck]

If you're okay, Mr. Chair, I can start.

I was the medical adviser for the transition group for a couple of years some time back. It's definitely one thing that we'll work on very closely with our VAC colleagues—the alignment of services, benefits and the drug formulary, in fact. I understand.

One thing that the CAF does not do is attributions of injuries or illness to service. One would think that that's not intuitive, but that is something with regard to services and benefits, which VAC is responsible for.

However, obviously, there has to be that close communication.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Why is that? Why is that not happening? Why is the CAF not determining a service-related injury?

[Capt(N) Iain Beck]

Again, we're not responsible for attributions and services of benefits. It doesn't mean we don't document in our files that it is service-related.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I'm sorry. I hate to interrupt you again.

What I'm trying to understand is why that is. I understand you're telling me you're not responsible. At the end of the day, this is someone who has come forward and they are serving our country. When they are serving, they are in your care. When they leave, they are, of course, in the care of Veterans Affairs.

I don't understand why we have to act as if there are two different situations here. The same person has served this country, whether they're actively serving or now a veteran. You would think there would be a desire to try to align these things—that you all would find a way to work with Veterans Affairs to ensure this is happening. We want to ensure these men and women are getting the services they deserve and need.

I guess I'll be blunt. I don't want to hear about whose responsibility it is. I want to hear about what we're going to do to make sure we address it so that they're getting the services they need. Can't CAF and VAC work together to figure this out, so we can make sure the services are there when they're needed?

[Capt(N) Iain Beck]

Sure.

I'm going to let my colleagues respond—certainly, Colonel Noonan—but I will say that we do work closely. We document our medical providers in our charts, then have that communication with VAC. They certainly have access to our charts for the VAC adjudicators. It does happen.

Should we say whether it's service-related? I don't know, but I definitely think we should be working together to come up with this solution for those members. Obviously, being one, I believe in that.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Absolutely. On that, we can certainly agree. I hope some more work will be done in that regard.

I think I have a bit of time.

I want to talk about this again: When a member is being released, there's generally a fairly long period of time—I think up to about six months—until they have a release date. From what I understand, often, to be able to apply for benefits at Veterans Affairs, they have to wait until the actual day of their release, or maybe the day after.

Is there anything you could be doing to be more proactive—to work with Veterans Affairs to ensure veterans can begin to apply for those things before the actual release dates, so they can be adjudicated? Then, hopefully, we don't have this gap where veterans are waiting for six months, a year or two years after they've been released. Is there anything you're working on there, or that you could be working on, to ensure that happens in a smoother transition process?

I'm not sure, again, who that should be answered by.

[Capt(N) Iain Beck]

I don't want to pass the buck, but maybe Colonel Noonan can speak to that.

[Col Lisa Noonan]

I think we're almost out of time, but I'll be very quick.

To your first question, I am co-chairing a working group with VAC and our insurance provider, Manulife, as well as SISIP—SISIP is part of the CAF—in order to make sure nobody falls through the cracks, whether it's service-related or non-service-related.

We're doing that sort of work in an ongoing fashion. I can provide more details to the chair, if you require them.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Are you going to touch on the second part?

[Col Lisa Noonan]

I think we're out of....

[Blake Richards, Conservative, Banff—Airdrie, AB]

If the chair will allow it, I think it's pretty important information. If she has it available, give her a second to answer it.

If you can't answer it in the time you have, send it in, please.

[Col Lisa Noonan]

Part of our co-location and integration with VAC in the transition centres is to ensure members are becoming aware of all the benefits they may get—not only through the CAF but also through VAC—before the date of release, and that they're applying for those prior to the date of release. Obviously, the actual benefit can't be administered until they're a veteran, but it's an early warning system to let them know all the things they're entitled to.

This is for non-medically releasing, not just medically releasing, because there were lots of people in the past who weren't aware of, say, the education and training benefit VAC has, etc.

It's awareness that we're creating within the transition centre process.