Evidence of meeting #31 for Veterans Affairs in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pcvrs.
A recording is available from Parliament.
Liberal
Chris d'Entremont Liberal Acadie—Annapolis, NS
Thank you for that.
Madam Massunken, go ahead as well.
Clinical Director, Mindspa Mental Health Centre Corp.
We have approximately 100 veterans in the program. In total, we have close to 250 veterans. Some are in and some are not in the program. Of those who are in the program, we've had a few who have concern around the clarity or understanding the program and what the expectations are.
I meet with our clinicians every month, just to disseminate any information I receive from PCVRS to them, so that they're well aware of the changes or to clarify any questions they might have had from the clients.
Liberal
Chris d'Entremont Liberal Acadie—Annapolis, NS
When it comes to actually dealing with PCVRS, is it done through phone calls? I don't know much about the interactions. Is it emails? How is that interaction actually happening?
Clinical Director, Mindspa Mental Health Centre Corp.
It's usually a Teams meeting for me. I can speak only to my experience. I meet with the manager every eight weeks to give any updates or ask any questions the team might have about the program. Typically, it's a Teams meeting, but in between I can email, and they're quite responsive.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much to our three witnesses for your time this afternoon.
We will suspend for the next panel.
Liberal
The Chair Liberal Marie-France Lalonde
I would like to make a few comments for the benefit of our new witnesses.
Good afternoon. We will now resume the meeting.
Before speaking, please wait until I call on you.
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I would now like to welcome our second panel of witnesses.
We welcome Dr. Anne Marie Pinard, a physician, who is joining us via video conference and testifying as an individual.
In person, we have Mr. David Morrow.
Welcome back, sir.
By video conference, we have Madam Elizabeth Forbes, registered psychologist.
Welcome.
Each witness has five minutes for their remarks. Afterwards, we will have a round of questions with committee members.
Dr. Pinard, you have the floor for five minutes.
Anne Marie Pinard Physician, As an Individual
Thank you for inviting me to participate in this study.
My name is Anne Marie Pinard. I am an anesthesiologist specializing in chronic pain at the CHU de Québec–Université Laval. For the past 14 years, I have devoted all of my clinical time to caring for people living with chronic pain. I am also a full professor at Laval University.
I have been actively involved at the provincial and national levels in several initiatives related to chronic pain, some of which involve veterans. Every year, I see 10 to 12 veterans at my clinic who are struggling with chronic pain. Over the years, I have come to understand and respect military culture. Veterans of the Canadian Armed Forces have often faced difficult situations, and not just while deployed. They are overrepresented among the population living with chronic pain. Roughly 20% of the general population suffers from chronic pain, but among veterans, the proportion exceeds 40%, and is likely 50% among female veterans. Mental health issues are also very common. Among veterans living with chronic pain, an estimated 60% also have mental health issues, whereas in the general population, that figure is around 30%.
In my work, I am extremely fortunate to collaborate with an interdisciplinary team. In the most complex cases, we develop an individualized treatment plan that is realistic, progressive, and, above all, developed in collaboration with the patient and their loved ones.
Chronic pain is not simply persistent pain; it is a complex phenomenon involving a hyper-reactive nervous system, cumulative fatigue, difficulty tolerating physical exertion, sleep disorders and past traumas that have left their mark. In this context, best practices rely on fine-tuning, gradual progression, respect for limits and the genuine integration of mental health considerations.
My experience with programs offered by private clinics is quite extensive. About a dozen years ago, programs with a rather rigid structure were very common. Patients with complex cases or mental health issues were often left feeling battered by this type of program. Such programs gradually disappeared because their effectiveness was fairly limited in complex cases. The mental health aspect was rarely taken into account. Often, there were no psychologists, occupational therapists, or social workers on these teams. What I have observed in recent years—I say this cautiously, but also with genuine concern—is a tendency to replicate this rigid, standardized approach in the care pathways of certain veterans.
Over the past few years, likely since the creation of Partners in Canadian Veterans Rehabilitation Services, I have observed a significant decline in the ability to collaborate—or indeed, an inability to do so at all. I am seeing long delays before assessment and access to initial services. Based on my experience with this program, I can say that the assessment is rarely conducted by a team that includes, among others, a physician with a good understanding of both military culture and chronic pain. Above all, once the program has started, it is very difficult to influence the content, intensity, or frequency of treatment, even when the clinical situation deteriorates. This one-size-fits-all approach is precisely what was abandoned, for example, by the Commission des normes, de l’équité, de la santé et de la sécurité du travail a few years ago.
We must return to what is effective in cases of chronic pain: collaboration and adaptation.
We must then seriously consider what secondary and tertiary care clinics may be doing concurrently. If a plan already exists, it must be integrated, not bypassed.
We must also integrate mental health in a structured way. Success often depends on linking mental health and physical interventions.
Finally, professionals working within these programs need solid training in both chronic pain management and military culture.
I also believe we need to improve transparency. Opaque decisions, a lack of feedback, and a flood of paperwork undermine trust and the quality of care.
I hope you will also have the opportunity to hear the views of those who work with veterans, particularly in clinics for operational stress trauma, as well as case managers, because they are the ones experiencing the concrete consequences of the system as I see it today.
I will conclude with a simple image. We wouldn't dream of offering the same size of clothing to all veterans, saying it is standard issue and they must adapt. Yet, my clinical experience sometimes leaves me with the impression that this is what we are doing when we impose a single, fixed and rigid model on people whose clinical realities are profoundly different.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much, Dr. Pinard.
Ms. Forbes, you have five minutes.
Elizabeth Forbes Registered Psychologist, As an Individual
Thank you for the opportunity to appear today.
My name is Elizabeth Forbes. I'm a trauma psychologist. I work in both Alberta and British Columbia. I previously worked at the operational stress injury clinic here in Calgary. I now operate a private practice focused primarily on veterans experiencing post-traumatic stress and related conditions. I regularly support individuals who are navigating both psychological treatment and the rehab system under the PCVRS contract.
My comments today will focus on the clinical implications of rehabilitation timing, system structure and alignment with trauma-informed care.
Trauma treatment for PTSD and related conditions typically follows a phased model of care—stabilization, active treatment and maintenance, resulting in a gradual return to functioning. Then vocational success can be considered. From a clinical perspective, a key concern is how and when rehab services are introduced and whether or not they align with the current phase of treatment that the veteran is in. Vocational processes, such as the initial assessment and related meetings, are often described by PCVRS as neutral. However, clinically they involve evaluative and performance-based demands that can activate the nervous system in trauma-affected individuals.
PCVRS in my clinic is often introduced during the stabilization phase, when the therapeutic relationship between the veteran and me is already well established, and at a point when the individual may not yet have the capacity to tolerate these additional demands. In practice, this can result in treatment and rehab pulling in two different directions, which can be very difficult for the veteran to manage, as they are required to engage in destabilizing demands while also attempting to stabilize. This often results in increased distress, heightened suicidality and worsening of other symptoms. Over time, the rehab process itself can become associated with threat detection. The anticipation of contact or required participation may repeatedly trigger the individual's stress response. In this way, the system is experienced not only as unsupportive but also as a recurring source of distress.
Continuity of care is also a concern. Individuals are often encouraged to transition from established community providers like me to providers within the PCVRS network. When a therapeutic alliance is already in place, disrupting that relationship, particularly in trauma treatment, can result in reduced engagements and many setbacks in progress. For some individuals, this may be experienced as a breach of trust, particularly in the context of institutional or relational trauma.
Another concern relates to system coordination and accountability. In my experience, there is very limited integration between rehab planning and an established psychological treatment plan, resulting in parallel processes that are not aligned in timing or priority. When clinical recommendations are not integrated into a broader plan, care becomes fragmented. Veterans may receive conflicting directions, which can increase distress, reduce engagement and interfere with treatment progress.
More broadly, there appears to be no clear mechanism for clinical recommendations to meaningfully influence rehab planning, even when clinical risks are clearly identified. This creates pressure to engage despite clinical contraindications or limited capacity, and financial necessity overrides clinical readiness.
At a broader level, there is a mismatch in approach. Rehab frameworks emphasize activation and progression, while trauma-informed care prioritizes stabilization and readiness. What this looks like in practice is that individuals become overwhelmed. Their symptoms increase, they begin to withdraw and the progress made in treatment is disrupted.
In trauma-informed care, it is the system that needs to flex to the veteran, not the veteran to the system.
Thank you.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much, Ms. Forbes.
Mr. Morrow, you now have five minutes.
David Morrow As an Individual
Thank you, Chair, for inviting me for a second time. Clearly, the first time around, I wasn't too bad.
I was on my way here from Montreal, and on the drive I had a nice speech that I shared with everybody here, but I realized it wasn't in the right tone. It didn't capture the language that I really wanted to discuss. I think there's an inability to really communicate with each other. I speak a language of duty, honour, respect, service. The government speaks a language that is based on policy and governance and laws.
The reason I bring this up is that I'm part of an exclusive group—a special minority, one might say—the 0.01%. I invented it myself. The 0.01% is approximately how many Canadians have actively been engaged in combat and fought an armed enemy. I'm one of those privileged few, along with my brothers and sisters and Arabs now. There might be more, but go with me on this.
The reason I bring this up is that when I was patrolling in Afghanistan, kids would come up to me. I was with an American unit, so I was the only one there with a maple leaf on my shoulder. They would say, “Canada good, America bad.”
When a kid came up, I would go, “Oh, man, wow. Okay, kid, like thanks, man.” That kid had no contact with the outside world, but he intrinsically knew that there was some added virtue to being Canadian, and that's the pride I had when I signed up. That's the pride I had going to war.
When I had to do Canada's dirty work, the expectation when I came home as a young buck in my twenties was that if I needed help, the government, VAC, Canada would provide the care that I needed. Unfortunately, I guess maybe out of naïveté, or just not having enough time in when it comes to life experience, that never really materialized when I took a knee and I needed help.
Now, “care” for me means something. I'm a father. I have two beautiful kids at home. When they hurt themselves, and they need help, I ask them, “Hey, what's going on? Are you okay?” Anybody here who has kids knows the rest. My expectation of care was like a father's care, a father's love, from his country, but since that never materialized, I believe the best way to describe it was, or is, a broken heart.
I love my country, or loved my country, fiercely. I was willing to die for my country. I did the country's dirty work, along with lots of my brothers and sisters. Now, through contracts like PCVRS, and being managed and processed through a company that is owned by American private equity and Loblaws, which sells us apples and oranges, to go through that process was demeaning and dehumanizing, to be honest.
I don't know where we stand right now, to be honest. There's an unwritten contract between soldiers and our country, and that contract is not being honoured. I'm not expecting this contract to be cancelled—I'm not expecting the government to really do anything more, to be honest. It's only because I recognize that this language difference hasn't been resolved. Not enough Canadians know who we are—0.01% is so few, it barely even registers.
That being said, my expectation is actually for my fellow veterans to start talking, to put their boots back on, to start fighting again, just not in a dusty war zone, but here. We need to advocate for ourselves with policy and good decisions. The easiest way to do that is simply to start talking to our friends, to get out there. Send a message to me. I'm easy to find. Let's start building this together. As far as I can tell, that's a responsibility—the care is not being met. They are bound by the veterans charter to look after us veterans, and it's not being done.
The issue is not PCVRS, in my opinion. It's not Manulife. It's VAC. Why doesn't VAC want to take care of its veterans? That's my only question to the committee.
Thank you.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much, Mr. Morrow.
We will start our round of questions with Mr. Richards for six minutes.
Conservative
Blake Richards Conservative Airdrie—Cochrane, AB
Thank you.
Mr. Morrow, thank you for your service. I know sometimes those words can sound hollow and meaningless. Based on what we just heard from you, I want to just also say thank you for your willingness to be frank and the bravery that you've shown doing that. I know that for many veterans, it's a struggle to do that, because they're afraid of the consequences they'll see in their benefits and things like that. That was much appreciated, that you were willing to be that frank with us.
It's sad that you have to do that. As you said, when you went and served our country, our job is supposed to be to make sure that you're taken care of with what you need. As you say, for you and far too many veterans, that's not happening.
Let me start with this question. What would an ideal rehabilitation program look like in your mind for our veterans?
As an Individual
I'll explain it as succinctly as possible. I know what it is, because I did it myself. I did it before PCVRS existed.
If it weren't for the VTN, I don't think I'd be here, so I'm glad that Mr. Thorne was here. That was part of the puzzle that I had to put together on my own. I had no help from VAC, and PCVRS didn't exist. It included getting the help that I needed. It's actually finding programs that work for you.
That's the stabilization phase. VTN is probably the best program in Canada. I talk about it all the time on my show.
After that, I focus 100% on fitness and health, because, unfortunately, the rehabilitation process does not incorporate fitness and health, which is absurd. We're not looking at the cellular problems that we have as veterans.
I'll give you an example. GWOT veterans, or global war on terror veterans, like me, experienced more combat load than any other generation in history, simply because we were exposed to war every day we were in theatre. We were on forward operation bases. We could have been rocketed, vaporized or shot at every day. We were always on alert, 24-7.
World War II veterans got pulled back to France. They got pulled back to England. They knew you could sustain only so much. I did one tour. Some guys did three or four tours. The amount of combat load on the central nervous system is way too much. The average Roman soldier saw only two to three days of combat a year. Those are the Romans. In my case, I experienced over 260 days of combat.
In a rehabilitation world that is actually effective, we need to look at the cellular issues. Veterans aren't broken; they're under-recovered. It takes a whole team of people to figure that out and make it individualized, and to focus not just on the psychology of veterans but also on the physiology of veterans. We can go into all the different modalities available to veterans at this point.
Conservative
Blake Richards Conservative Airdrie—Cochrane, AB
I think I know the answer to this question, but do you believe that the Department of Veterans Affairs has ensured there's sufficient oversight on this PCVRS program? In anticipation of your answer, what does it need to do better?
As an Individual
Unfortunately, I don't know why VAC abdicates its responsibility to other organizations when it's mandated with the care of veterans. It's a slap in the face. I'll be honest. If it can't do the job, it should figure it out.
As I said, care is asking what we need and how we can be supported. We know it's not going to be perfect, but for it to be farmed out to a private equity firm that is American-owned, and to know that its goals are based on corporate policy and obviously not based on care of veterans.... We're not incapable of doing an Internet search. We know this exists, so we know this is disingenuous. They're not trying to make us better; they're trying to achieve their corporate goals.
The first thing would be to stop farming the care of veterans out to private equity firms and insurance companies. That would build a lot more trust within the institution, in my opinion.
Conservative
Blake Richards Conservative Airdrie—Cochrane, AB
The other thing I'd like to ask you about is around the bureaucratic processes. Whether they are within VAC itself or in dealing with PCVRS and the coordination or lack thereof between the two, what does having to deal with all the processes, paperwork, bureaucracy and overlapping elements of it do to a veteran, especially one who's already struggling?
As an Individual
For me, it was emasculating. You have to constantly talk about your issues with people who are not really qualified to listen to them. You think, initially, that they're trying to help, and then it's just another step that you didn't do. You constantly feel like you're failing.
That's not rehab. That's not care. It's just one form after another. It's one individual informing you of one policy, but it's not correct, and you constantly have to go back and redo things. The amount of inefficiency in the system is absurd.
We're taking it upon ourselves as veterans to start figuring this out on our own. We've created our own groups to figure this out. The problem is that when we talk to VAC, they don't even know their own policies. They don't know the law. I would argue that most have never read the new veterans charter. That being said, what are we doing? Why aren't more veterans involved in the actual planning process and oversight? That is essentially why we have all these problems. It's because we're being told what we need, when in fact it should be the other way. It should be from the bottom up, not top down.
Conservative
Blake Richards Conservative Airdrie—Cochrane, AB
Thanks again for your service, and thank you for your frank and excellent advice today.
Liberal
Liberal
Sean Casey Liberal Charlottetown, PE
Thank you very much, Madam Chair.
Thanks to our witnesses for being here.
Mr. Morrow, it's good to see you again. At the risk of it sounding hollow, thank you for your service, sir, and for your testimony, which was particularly compelling.
I'd like to start with you, Ms. Forbes. You drew a very clear distinction, I think, between trauma-informed care and a rehabilitation framework. I'd like you to expand a bit on that. It's my understanding that PCVRS is involved and engages you only if there has been a determination made that the client or the patient is someone who is seeking or is involved in a rehabilitation program. I understand the difference between trying to get someone better and trying to rehabilitate them: treating them, as opposed to the rehabilitation path, which ideally reaches a goal at some point, as opposed to stabilization.
I'd like to hear from you a bit more on Veterans Affairs Canada and PCVRS. Do they actually have a mandate for trauma-informed care or stabilization, as opposed to working through getting someone rehabilitated?
Registered Psychologist, As an Individual
I'm not quite sure I understand. I apologize. Do you mean the difference between a rehab perspective versus a trauma-informed care perspective?