Yes.
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.
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.
Registered Psychologist, As an Individual
In PCVRS, the rehab often focuses on action—on taking action, getting going, getting back to work and all those kinds of things. There's nothing wrong with a rehab program. The issue I have is that these mandatory assessments, programs and engagements in PCVRS are often at times when veterans are not ready. They're not ready at all for another system.
In trauma-informed care, we talk about slowing down. We talk about not overwhelming your system. When they're introduced, especially early on in treatment in my clinic, it is so very destabilizing. What happens is that I'm pulling back, trying to stabilize my client, and I actually have to pause the treatment. What happens is that PCVRS is activating them: You need to do this. You need to have this assessment. We need to see where you're going. We need to know what you need to do.
They actually work against each other. I usually have to pause my treatment and deal with the fallout from what happens in this system. To a lot of the things folks mentioned today, I could just nod and say, yes, that's the case.
I hope that answers your question. As far as what their policies are on trauma-informed care, I can't speak to that. I know what I can speak to in terms of how I am trained and what my specialities are in this area.
Liberal
Sean Casey Liberal Charlottetown, PE
I would like to ask this a little more concisely. I understand what you said. You are addressing what I'm getting at. My question is about whether or not the rehabilitation framework and trauma-informed care are mutually exclusive. Can they coexist, or should they coexist, in your treatment of a patient?
Registered Psychologist, As an Individual
Understood. Thank you. That's a great way to reframe it.
Prior to this current model, VAC case managers functioned more as coordinators of care directly with treating clinicians, whether it was in the OSI or whether we were community psychologists. We determined timing and readiness together. Rehabilitation services were introduced more flexibly. We were typically aligned with wherever the client was. If I got a call from a case manager and they asked me, “How is this person doing? Can we move them on to this stage?”, it would be a conversation.
There are no conversations with PCVRS. They do not respond to any of my emails, faxes or phone calls...or I guess I should clarify that this is not quite true; I would say it's “most” of my communications. It's a timing issue, but also, they're not understanding that they're actually contributing to this veteran's distress. I've tried to have conversations and meet with higher-ups. I'm also an affiliate provider, so that creates an added barrier for me, especially being a community psychologist as well.
Liberal
Sean Casey Liberal Charlottetown, PE
Dr. Pinard, I will reiterate that I don't have much time for a conversation with you.
You are a medical specialist, and I'm sure you have a team.
Can you tell me what level of communication exists between you and the provider, Partners in Canadian Veterans Rehabilitation Services?
Physician, As an Individual
Thank you for the question.
The answer is none. I had exactly the same experience as Ms. Forbes. When we follow patients who are enrolled in the pain clinic program, I am unable to have a discussion with the health care professionals who are treating them. For some patients, I had to stop what we were doing as a team at the pain clinic because they were completely exhausted. There is also a problem with—
Liberal
The Chair Liberal Marie-France Lalonde
Dr. Pinard, I'm going to have to cut you off there. I'm so sorry.
Ms. Gaudreau, you have the floor for six minutes.
Bloc
Marie-Hélène Gaudreau Bloc Laurentides—Labelle, QC
Thank you very much, Madam Chair.
I'll go to Ms. Pinard.
I understand, then, that not only do these vulnerable individuals need specialized care—because they are part of a unique population—but they also have to fight to access a continuum of care. On the one hand, we want every person to get better, but on the other hand, when they arrive at the ER in cardiac arrest, they're told there are forms to fill out first.
What happens when you meet clients who are struggling to receive PCVRS services?
Physician, As an Individual
In fact, our patients are referred to the pain clinic either by their family physician or by a specialist.
I won’t hide the fact that access to specialized care for chronic pain—whether you’re a civilian or a veteran—is extremely complex. There are very long waiting lists, and currently, in Quebec, there isn’t really any way to get around this waiting list, even for veterans. I wish it weren't so, but that's the way it is.
First of all, most of the time, when a veteran comes to our clinic, we don't even know they're a veteran until we meet them. We find out at the first encounter. Sometimes I don’t find out for six months, because if people don’t tell me, I have no way of knowing. I’ve learned to ask, but sometimes we find out later than we should.
Then, sometimes the veterans we treat are already in a rehab program or are being treated by another rehab team, through PCVRS—even though we're already treating them. Plus, it’s siloed care. It’s done completely separately. It doesn't really account for the fact that they are already being treated by a pain clinic team.
Obviously, pain clinics aren't able to provide very long-term care. For example, they can't offer two or three sessions of physio or psychotherapy every week. However, in the past, we were able to collaborate, establish a shared plan, and take into account the challenges veterans sometimes face. Under the new approach, things have become extremely rigid. There is very little communication, as Ms. Forbes mentioned, and this sometimes hinders the work we’re doing with the patient.
I have had to stop what we were actively developing regarding medication or mental health care, for example, because my patient was completely exhausted by the program they were following. Moreover, we know military culture. When you’re told to do something, you do it. That’s really a distinctive feature. So people do it, and they burn out. I’ve had the same experience as Ms. Forbes. People burn out, and then it’s hard to find the energy to implement other strategies we suggest. Quite often, I’ve had to tell a patient that we were going to take a break for a few weeks and that they would have to call us back once they’d finished their program to pick up where we left off.
Moreover, access to mental health care is often very limited. Sometimes, patients are being treated by us, by the operational stress injury, or OSI, clinic and a third program is added. It becomes quite overwhelming.
Furthermore, as I was going to mention earlier, veterans often live a bit farther from major urban centres, for various reasons. Sometimes they have to travel 30, 40, 50, or 75 kilometres to attend their program. Driving places a significant cognitive load on them. That adds to everything else.
In addition, even though we don’t always have to fill out paperwork in our setting—at the pain clinic—the demands placed on us and the paperwork we’re given are extremely onerous. What I see represents only a tiny fraction of what needs to be done and filled out. For example, I was asked if my patient suffered from fecal incontinence. I’m a chronic pain specialist. How can I answer that?
It’s also difficult to access medical histories. I understand that this is “Protected B” information, but it’s extremely difficult to care for people because there are endless steps involved in obtaining, for example, what was previously done to avoid repeating something that didn’t work in the first place. So, it’s quite burdensome and, unfortunately, it ends up compromising the quality of care we’re able to provide.
Bloc
Marie-Hélène Gaudreau Bloc Laurentides—Labelle, QC
Yet again, I am at a loss for words. However, what reassures me—even though we’re in politics, with laws and power struggles and all of that—is that everyone wants things to go well. Please understand that. In this case, everyone wants the situation to improve. Now, how will we achieve that? It takes resolve, and you’re here.
I’d like Ms. Forbes to speak to us for a few seconds about the concept of “care” mentioned by Mr. Morrow.
In 30 seconds, do you think the program truly takes care of veterans?
Registered Psychologist, As an Individual
That's a tricky question.
Honestly, I don't. I see it as such a huge barrier. I feel as though there are just so few individuals who sign up for jobs in which they could potentially die as part of their role. Veterans do this so willingly for our country. That level of sacrifice just really warrants something much greater, a level of care that's responsive, care that actually listens to its providers—whether we're in big clinics or in community—and is respectful and really understands their needs. I just have not had that experience with PCVRS.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much, Ms. Forbes.
We'll go to Mr. Tolmie now for five minutes.
Conservative
Fraser Tolmie Conservative Moose Jaw—Lake Centre—Lanigan, SK
Thank you to the witnesses for joining us today.
Ms. Pinard, I appreciate your comment that one size does not fit all. We've brought that up in committee before.
Ms. Forbes, I really do appreciate that your experience bridges two provinces, Alberta and British Columbia.
Mr. Morrow, you've called for a full-scale independent audit of this program. The minister has now committed to an independent review. Based on what you've experienced, do you believe that a review overseen by VAC can be independent? Given that VAC designed the contract, set the KPIs, conducted no audits and has defended the program's performance figures at this very committee, what would independence actually require, and what should we be watching for to know if this review is genuine?
Conservative
As an Individual
I think you already know the answer, but the reality is, how many veterans are forensic auditors? I ask because that would be the best way to get it set up. Get a team of veterans who are independent and on the outside. If Veterans Affairs constantly wants to do internal investigations, then how about we get a bunch of veterans to do this investigation?
Aside from that, no, I don't trust VAC as far as I can throw them. This is not going to be objective in any way, shape or form. We can see it for what it is. The veteran community will see it again as another dog and pony show, as we call it. We'll just shake our heads and let the politicians do their stuff, but we still won't have the care that we're actually looking for.
I won't have any faith in it if it's not independent, meaning that we have an independent body that is outside, at arm's length from the government.
Conservative
Fraser Tolmie Conservative Moose Jaw—Lake Centre—Lanigan, SK
Right.
You opened your testimony with the difference between the languages of military culture and politics, that is, between “duty, honour, service, respect” in the military world and “governance, law and policy” in the political world. Moreover, with VAC, there's also “administration” and the requirement that administration follow governance and a vision.
I would like to get your thoughts on that. What do you feel? Do you feel the tail's wagging the dog or the dog's wagging the tail here?
As an Individual
I don't know. Again, that's a good question.
If I could get my eyes on it and see what happens at VAC under the hood.... All I know as an end-user is that it just seems very chaotic. The reality is that things didn't get bad until it went to PCVRS.
VAC lost my trust at one point with an incident. As I mentioned in my last testimony, trust is so important for our community. I go back to my 0.01% analogy and that our whole job was to distrust literally everybody we came across, from little children to men. Whether they had a weapon or not, they could kill us. Therefore, coming home, we distrust everybody, including the government. As soon as you break that trust, it does a lot of harm.
To answer your question, I don't know. Is the tail wagging the dog? Maybe it is, but I don't have a good enough answer to point you in the right direction, to be honest.
Conservative
Fraser Tolmie Conservative Moose Jaw—Lake Centre—Lanigan, SK
We have no confidence in the review. We're not sure of the operation of this organization. Do you believe this is going to get turned around after audit, the independent review?
As an Individual
No. As I mentioned during my initial five minutes, I think the only way this gets fixed is like this: We—I mean veterans—need to take charge and organize, so that we can actually share our voices reasonably with government. It seems as though you're operating in a dark room. You don't know what you don't know, because you don't talk to us. There's nobody to talk to except me, individually. We don't have a room of 100 or so veterans, speaking through our spokespeople, saying, “These are the things that we need to fix now,” as they do in the United States. If we can start establishing that.... I know it won't be for our generation, but it will be for the next generation of veterans, who probably aren't even born yet. They could benefit from an advocacy arm of veterans.
Conservative
Fraser Tolmie Conservative Moose Jaw—Lake Centre—Lanigan, SK
Thank you, Mr. Morrow. I appreciate your time.
Liberal
The Chair Liberal Marie-France Lalonde
Thank you very much.
Now, for five minutes, I have Ms. Hirtle.
Liberal
Alana Hirtle Liberal Cumberland—Colchester, NS
Thank you, Madam Chair.
Dr. Pinard, I'm going to ask my questions in English. I apologize for that.
I wonder if you had a chance to finish your response to my colleague Mr. Casey's earlier question.
Physician, As an Individual
I guess I will answer in French, because it's easier for me.
Indeed, I was able to include those aspects in my previous answer, which focused primarily on the fatigue caused by the program and by distance. That's what I was going to mention when I answered Mr. Casey's question.