Veterans Affairs Committee on Oct. 30th, 2025

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

That's a good segue into the stuff with PCVRS and Lifemark. You talked about it in your opening, of course.

Maybe just talk a little bit more about the effects it has. Speak to your own experience or that of your friends in terms of not being able to utilize the service providers that you've already dealt with and trust, that would be more convenient for you or that would better help you, and instead having to use ones that you're forced to because of a contract. Maybe speak a little bit to the problems that it causes.

[Shane Nedohin]

It's almost two years that I've been out now, and I have yet to receive a single rehab session from PCVRS because of bureaucracy. It's always something. It had to be this provider, but I refused to use that provider, because it was going to be somebody off in Halifax who specialized in 2SLGBTQI indigenous allyship and had never dealt with veterans. I was like, “No, I'm not dealing with this person as a psychologist because they don't understand me.”

That caused another four-month delay. There are already limited providers. Why can't I just use the people in my area, or people I'm comfortable with? I want the ability to choose, but PCVRS says, “No, you will use us, or we will take away your IRB. Gone.” I've been told that many times, and that's unacceptable. The government is weaponizing our pay and benefits against us. That shit has to stop, yesterday.

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

I couldn't agree with you more on that. I couldn't agree with you more.

Dr. Held, can you tell us how important it is, when someone is experiencing suicide, to be able to access care quicky? It's not just the emergency stuff that needs to come right away, but the follow-up care. How important is that, and what happens when someone has to keep going back five, six, seven times to get that care?

[Dr. Nicholas Held]

I think care is quite important. That's a challenge in this country across many different aspects of health. The cultural competency piece of somebody who understands military service, at least at a basic level, is something we need across the country. That's something our work actually does. We look at informing health care providers about cultural competency and military experience.

Veterans have said that within 90 seconds, they can tell if their health care provider understands even a little bit about their experiences. We're not saying every health care provider has to live in that military experience, but they have to have some basic knowledge.

[The Chair, Liberal, Marie-France Lalonde]

Thank you very much, Dr. Held.

Next, we have Mr. Clark for six minutes.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

Thank you very much, Madam Chair.

Gentlemen, thank you very much for being here this morning.

Mr. Nedohin, thank you very much for your service. Do you suffer from persistent or chronic physical pain as a result of the injuries you sustained during service?

[Shane Nedohin]

Yes.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

In your view, what impact has that had on your life since you sustained those injuries, the pain piece of it in particular?

[Shane Nedohin]

You live with pain every day. Anybody who has ever lived with chronic pain knows it affects your mental condition. It affects your mood; it makes you irritable. Do you know somebody who has a toothache? They're cantankerous and irritable. You couple the physical pain with the TBI and what's going on there. I suffer from vertigo and dizziness. Some days I'm good; some days I'm bad. It's something you live with, and it impacts you greatly. You figure a way through it.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

Thank you for sharing that. I wanted to ask about it from a personal standpoint.

Dr. Held, from a clinical standpoint, you've done a lot of work throughout your career as it relates to chronic pain. In your view, from a research standpoint, how does chronic pain impact veterans from a physical standpoint, but also in terms of mental health care?

[Dr. Nicholas Held]

That's a great question.

Chronic pain, as we know, affects Canadian military veterans at almost twice the rate it does the Canadian general population. It is highly comorbid with mental health concerns. Mental health is going to exacerbate the pain symptoms that you might feel, and vice versa. There's a relationship there that's independent. There's also a relationship between chronic pain and suicide. All of these things are connected. That was one of the pieces of my opening statement that were important. Suicide is not a point-in-time thing. It's important throughout the lifespan of somebody, with all of these conditions coming together.

One of the biggest challenges.... We've identified many different risk factors in the 10 years or longer of research. There is that understanding of what moves somebody from those risk factors into attempting suicide, but there's still more work to be done.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

You touched on the research and the work that CIMVHR is doing, which is great work.

How do you translate the academic research work you're doing? How do you inform VAC to make sure that veterans are able to benefit directly from the work you're doing on a day-to-day operational level? How do you take your research and put it into practice?

[Dr. Nicholas Held]

That's a great question.

I'll start off by saying that there's no perfect way of doing that across all nations or across the Five Eyes nations, where there are different mechanisms. At the forum, we just hosted a panel on how to do this effectively. We facilitate research out across Canada. We also have regular meetings within CFHS in the Canadian Forces and with Veterans Affairs Canada. We have such avenues as the journal I mentioned, which is open-access. It's free for anybody to access. We have the CIMVHR forum, which brings people together. We are doing some work on the ground as well in improving cultural competency, continuing medical education, credits and things like that.

It's through constant conversation. I think there is a question of whose responsibility that is. That could be a framework that gets discussed moving forward. Oftentimes, members of Parliament and government agencies might say it's on the researchers, that they need to push that information more into government. We obviously have a piece of that, because we are that bridge in between. That's something we work closely on. Researchers feel like it's up to government to kind of grab some of this research and implement it in an evidence-based way.

The key thing here is that there's no perfect mechanism, but we all have a role to play in that. Of course, we have a significant role to bridge that gap with clinicians, with veterans themselves, with health care providers and with government individuals as well.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

Dr. Held, based on what you said there, would it be fair to say that there is a consistent, regularized, formalized process for your work to be transmitted directly to Veterans Affairs—“This is what we're learning. This is what might work, and you guys can take that and implement it into your policies”—or is it a bit more piecemeal, at this point?

[Dr. Nicholas Held]

In some ways, it's a bit more piecemeal. I think it's also very simplistic to think that you can take one study and move it forward and have all the answers. We need to inform individuals, and we have to be frank. I come from a science background. I believe in evidence-based medicine. That's something that's important. However, within policy-making and decision-making, a thousand different factors are at play. Research will be only one piece of that, so it is piecemeal. There are decisions that are made, and I know that it's not always only looking at evidence. That's something we're not going to change, but we also tend to say that things are evidence-based. Many times, it becomes common nomenclature in many areas. I think we need to look at that mechanism and make sure we're able to take that research into practice.

[Braedon Clark, Liberal, Sackville—Bedford—Preston, NS]

In your opening statement, Dr. Held, you talked about the work you do with Five Eyes and our peer countries. We've heard in previous meetings during this study that, unfortunately, the issue of suicide among veterans is a familiar and consistent story across a lot of our peer countries. Have you gained any lessons learned or any insights through that work, through some of our peer countries, where they might be doing well in areas that we could be emulating? Does anything stand out to you?

[Dr. Nicholas Held]

I think we can look to the Australian Royal Commission into Defence and Veteran Suicide as a systemic and systematic way of looking at this. I think that's a critical piece. It's hard to answer that question fully in 10 seconds, but I think we need to think about an all-systems level in how we can approach this.

[The Chair, Liberal, Marie-France Lalonde]

Thank you very much.

Ms. Gaudreau, you have the floor for six minutes.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Thank you, Madam Chair.

Dr. Held, do we have access to evidence that could show, if applicable, a loss of interest in enlisting in the Canadian Armed Forces as a result of what happened in Bosnia and Afghanistan? Is there any data showing that there has been a decline in interest in officially enlisting?

[Dr. Nicholas Held]

I'm not aware of any specific studies I could pull on right now that would provide that information. I think you could look at enrolment rates, at why people are enrolling and why they're not, and at people leaving service. We have a lot of information that sits internally, especially at DND, that isn't accessed by outside organizations and that might give a bit of the answer. I'm not necessarily thinking of the enrolment phase, but of the exit interviews and things about why people are releasing and the challenges we have with retention. Those things could possibly come up, but I can't speak to that internally.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

It's clear that there's a process of care that obviously needs to change. We realize, and we heard this during Mr. Nedohin's testimony, that the focus is on treatment: We want to treat quickly and move on to something else. When I see that there are people who, among other things, act out after 20 years, I get the impression that there is a culture that needs to change when it comes to veterans and palliative care. A head injury isn't going to magically disappear. It requires treatment.

Do we have any data that could explain why palliative care for veterans is insufficient?

[Dr. Nicholas Held]

When we talk about palliative care, and especially when we talk about it in an aging context, we've had some changes within government policies so that the treatment of aging veterans has shifted over time. I think that's a key piece of consideration. We just published a report on aging veterans that I'd recommend reading. I know palliative care is not only an aging perspective, but I think that's something that we need to consider.

Within palliative care, I think it still leads into the health care system. We've worked at the level of physicians to try to increase military awareness, but it's not always the physicians who are spending a lot of time with our veterans. Oftentimes it is at different levels of health care, so we need to make sure that we are not only investing in primary care, that being frontline physicians and psychiatrists, but moving down the level of care to individuals who might see individuals in that state as well.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Thank you.

Mr. Nedohin, I'm going to speak calmly.

How can anyone think they can have a good life after serving, after being proud of their part, returning home to their family and realizing that this was not the dream they had? How does anyone live a life full of pride and serenity when they come back with trauma? What do we need as human beings to help you and all veterans?

[Shane Nedohin]

I think it's going to be different for every individual. Speaking for myself, I just want to be left alone. Recognize that vets are injured and stop putting the onus on the vets to prove their injury all the time. That's what it feels like.

I don't know how else to answer your question, because I can only speak for myself, personally.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

I understand. People need to be left alone so that they aren't traumatized again by having to explain their physical and mental problems, but at the same time, people need to be provided follow-up services as needed, meaning for the rest of their lives.