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
Alana Hirtle Liberal Cumberland—Colchester, NS
Thank you.
Can you tell me a bit about the types of experiences you've had with veterans seeking care or assessments, please?
Physician, As an Individual
As I was saying, people are generally referred to our pain clinic by their family physician or by a specialist. A great many veterans do not have access to a family doctor, at least in the province of Quebec. That is the first problem. The same is true for civilians, but it is particularly glaring among veterans. Access to primary care is therefore very difficult. Without access to primary care, it’s very difficult to obtain secondary and tertiary care.
Then there are the unfortunately very long waiting lists, as I also mentioned. Since our clinic is more geared toward the civilian community, when veterans come to us, they often find themselves in settings that aren’t very sensitive to the reality of veterans living with operational stress. We’re in the city, in crowded areas, with ill-suited waiting rooms, sometimes with staff who have no training in military culture. So that’s already a barrier.
Next come the assessment, the wait times and, sometimes, the difficulty in accessing rehabilitation and integrated mental health care. Currently, the integration of our services with care from the operational stress injury clinic, for example, depends on the knowledge we have of each other, much more than on an actual established link. We rely on personal contacts, emails, or text messages to communicate with each other, rather than on a truly integrated system. Unfortunately, the same is true for the PCVRS program.
Liberal
Alana Hirtle Liberal Cumberland—Colchester, NS
That's wonderful. Thank you.
Are there common needs among the veterans you've worked with?
Physician, As an Individual
I think the first common need is recognition of this different culture, of this reality. I always tell my veteran patients that I’m just a civilian. I can try to understand their reality, but I haven’t experienced it. So, I think we need to approach this with a great deal of humility. We need to be better trained on military culture. I've been working for 23 years, so I’ve met a lot of veterans, and I think I’m better able to meet their needs. That's a common need.
The other common need is for patients to be told that we care about them or that we’re here for them. That was mentioned earlier. It's extremely important.
It's also important to have fewer administrative barriers, papers and pencils, and more human contact.
Liberal
Alana Hirtle Liberal Cumberland—Colchester, NS
Thank you.
Would you say there are still misconceptions around what chronic pain is?
Physician, As an Individual
Whether you're a soldier or a civilian, it's very hard to understand what chronic pain is. It's still seen as a sign of weakness. I often say that chronic pain is where mental health was twenty years ago, back when it was shameful to suffer from depression or bipolar disorder. Now, it’s more widely accepted. Chronic pain is still perceived—among civilians, but even more so among veterans—as a weakness, a lack of willpower. That is so wrong. There is still a tremendous need to raise awareness about this among everyone, including health care professionals.
Liberal
Alana Hirtle Liberal Cumberland—Colchester, NS
Thank you.
I have 30 seconds left.
How would challenges related to chronic pain affect other areas of a veteran's life?
Physician, As an Individual
Chronic pain affects personal life, family life and sexual life, as well as self-image. It impacts every aspect of a person’s life, whether they are a civilian or a veteran. For veterans, this is often compounded by operational stress, mental health issues and a lack of understanding of both military culture and the importance of family and group unity.
Liberal
The Chair Liberal Marie-France Lalonde
Dr. Pinard, thank you very much.
Ms. Gaudreau, you have the floor for two and a half minutes.
Bloc
Marie-Hélène Gaudreau Bloc Laurentides—Labelle, QC
Thank you very much.
I would like to draw a parallel. We are parliamentarians; we are democratically elected by the people. We enjoy privileges and are potentially entitled to a pension. One day, we will step down or will not be re-elected. Eventually, we’ll be told: “Whatever you did is now forgotten. So forget about your pension. Go home.” We’ll then become anonymous. I understand that when I’m no longer an MP, people will ask me who I am.
Is that what veterans are experiencing? Personally, I wanted to help my fellow human beings, but they tried to save lives. That’s called compassion. It’s something I strive for. I want to stay very positive, despite everything. In my view, we need to think about future generations. In politics, if we look to the future and draw a connection between the urgent needs in defence and the fact that today’s veteran community is telling their children not to enlist—even though it’s an extraordinary experience in a person’s life—and if we realize there will be concerns about the next wave of recruits, that’s when we’ll wake up. I hope that, by then, you will have been consulted and that corrective action will have been taken. I hope so, and I am confident that it will be.
I have one last question for Dr. Pinard.
Did I understand correctly that in Quebec, the Commission des normes, de l’équité, de la santé et de la sécurité du travail, or CNESST, made changes to the system early on to adapt?
In terms of culture, how did that contribute to a better understanding and to getting the work done?
Physician, As an Individual
Several years ago, the CNESST had programs that were quite rigid and somewhat similar to what is currently in place, particularly regarding lower back pain. Patients suffering from lower back pain were presented with a program that dictated the course of action. The CNESST quickly realized that patients’ health was deteriorating. There was no consideration for mental health. It was a program that operated according to a one-size-fits-all approach. People with more complex issues—
Liberal
The Chair Liberal Marie-France Lalonde
I'm so sorry, Dr. Pinard, I have to cut you off.
For five minutes, we have Ms. DeRidder.
Conservative
Kelly DeRidder Conservative Kitchener Centre, ON
I have to say that in this room today a bit of frustration I've seen personally is that not one person on the government side has asked the veteran in this room what can be done better in serving veterans who have fought for this country. I'm going to do that.
Before I continue, thank you for your service.
You said in your opening statement that you're not expecting VAC to do more, but I think we can expect to do better. I think we can agree that there's an expectation to do better. With PCVRS, do you think it's designed to help veterans or just to check a box and put them through a program, regardless of whether that program works for them?
Conservative
Kelly DeRidder Conservative Kitchener Centre, ON
Do you think a better way is to listen to veterans like you with the lived experience and the help that is required, take that guidance and turn it into systems that work for you through better management through VAC, so that we can serve you better?
As an Individual
Yes, 100%. I can do better than that. I've been working tirelessly for six years with veterans from across the planet, building programs—building recovery programs. I more or less fixed my chronic pain on my own. I've been to Mexico; I've been to the United States. They're significantly further ahead than us, and that's because they actually listen to their veterans. It's 100% the way forward. I don't understand how VAC isolates itself from the population that it's actually mandated to serve. Until we do that, we're not going to get the care that we're actually expecting, because how do you do it when you don't have input from the actual end-users? Yes, I 100% agree with your point there.
Conservative
Kelly DeRidder Conservative Kitchener Centre, ON
You also said in your opening statement that you're rallying veterans to put their boots back on and fight for themselves with the government that you yourself fought for. To me, that's incredibly disheartening. Moving forward, we need the government to put their boots on, listen to our veterans and make changes that better support the needs and services that you require when you come back into community. Can you give me your top two starting points to be able to do that for veterans?
As an Individual
Do you mean from the VAC perspective? I would say to start reaching out to the actual community. Show up to the events. We have events, and VAC doesn't show up. It's like they're scared of us. I've been to plenty of VAC events, and I don't see folks like me, meaning I consider myself that 0.01%. Tattoos on the neck...like we were war fighters. We weren't there to protect people per se, we were there to fight a war, so we're aggressive. We look scary. That's okay. That's who we are. But come to where we're at. That would be the first thing.
The second thing would be that the model of care is the wrong model. We're trying to solve the wrong problem. We're looking at the veteran like this precious China doll. As I said, it's emasculating. It is emasculating because I'm a war fighter. I will never not be a war fighter. What I did is what I did. I want to move on. I want to rebuild. I want to be stronger. I don't want to be put in this box of therapy and drugs and talk about my problems. How do I build back better? The model itself needs to be re-evaluated at VAC, and that model exists if you just look outside the box. Again, that comes down to talking with the community and talking with folks like me, who have been doing this for years. I'd be happy to share what I know with VAC, any time, any place.
Conservative
Kelly DeRidder Conservative Kitchener Centre, ON
Thank you so much. I'm going to take my last moments here to thank you for your service. To the gentlemen also in the room, thank you for your service, as well.
I think there's a better way, and I really do hope that the government takes what you have to say today—we'll put a report together in this committee—and decides to make better changes for veterans in our community. Thank you for your time.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much.
Mr. St‑Pierre has the floor for the last few minutes of this round.
Liberal
Eric St-Pierre Liberal Honoré-Mercier, QC
I'll take three or four minutes, if I may.
Mr. Morrow, I'm going to ask my questions in French, because you're from Montreal. I imagine you're a big Habs fan. I have to mention it, because we're in the playoffs. In fact, I'm wearing my pin.
Liberal
Eric St-Pierre Liberal Honoré-Mercier, QC
Thank you for your service to Canada. Thank you for your podcast. I think it’s so important to make the connection between physical and mental health. It’s something that resonates personally. I know my colleagues tease me when I do push-ups in the House, but I do it because I believe exercise is important. It’s a great way to manage stress. It makes us better MPs.
As my colleagues know, I’m an ultramarathon runner. It’s a good way to stay in shape. I hope Mr. Richards and Mr. Tolmie will join me the next time I go for a run. Some runners are a huge inspiration to me. David Goggins was an ultramarathon runner. He ran the Moab Trail Marathon. He ran some incredible races. He was in the U.S. military, and he sets a good example of how to manage post-combat stress.
So I wanted to congratulate you on the work you’re doing. On a personal note, this strikes a chord with me. I’d like to know if you can speak generally for the benefit of Canadians.
Why is it important to stay physically fit after combat? Why is it important to stay physically fit to remain mentally healthy?
As an Individual
Thank you for the question.
Quite frankly, it’s a better way to heal. Instead of focusing on mental health, the Greeks and Romans invoked the maxim anima sana in corpore sano, meaning a healthy mind in a healthy body. Two or three thousand years ago, they knew that if you’re not in shape, your mental health will suffer. So, for veterans who aren’t necessarily in good physical health due to chronic pain, that’s what happens.
From my perspective, I can say that veterans are uniquely in this position because they were all in shape. Now, because they are veterans, it is highly likely that they have gained 30, 50, or 60 pounds. Furthermore, they're in pain and suffering the repercussions of military life. So, the first step would be to promote physical health among veterans, which would be an excellent approach to improving mental health. To me, that is clear. However, the government will need a little guidance. The research is clear. Suicide rates will go down if we focus on physical health rather than solely on mental health.