Veterans Affairs committee  One issue with larger organizations such as the Canadian Psychiatric Association and the Canadian Mental Health Association is having them inform primary caregivers, whether physicians and nurses or emergency departments, to actively screen for trauma-related illnesses, including depression, and asking the simple question, “Have you ever served in the military?”.

Veterans Affairs committee  I think that having more partners and having more people talk about mental health is always beneficial.

Veterans Affairs committee  That's a good question. Nobody has ever asked me for a wish list. The issue is accessing services and the challenge in terms of how to coordinate health care between primary care and specialists. The majority of people in Canada are receiving mental health services from their family physicians.

Veterans Affairs committee  I initially started working with National Defence as a consultant in 1996. In 2000 I moved to southern Ontario, and in 2003 I started working with the Parkwood Operational Stress Injury Clinic, so it would be over 10 years now.

Veterans Affairs committee  Have I...?

Veterans Affairs committee  Yes. My clinical practice right now is all veterans, currently serving members of the Canadian Forces, or eligible RCMP.

Veterans Affairs committee  It wouldn't necessarily be contested in the way you're asking. The diagnosis we will make is a clinical diagnosis, meaning that if somebody comes in and presents with symptoms that are consistent with PTSD, we make the diagnosis and then pursue the treatment. It may be not necessarily contested, but if they were applying for pension entitlement, whether or not the PTSD they're claiming is related to service, it would go through adjudication, if that's what you mean.

Veterans Affairs committee  In my experience at Parkwood, you don't have to have pension entitlement under the new Veterans Charter to receive services. They would continue treatment while a pension claim is pending. If they are not being treated at our clinic and they're seeing a psychiatrist in the community, treatment would continue, because it would fall under medicare.

Veterans Affairs committee  Do you mean the lowest rate of...?

Veterans Affairs committee  If we look at what has been presented, it really depends on how the survey was done—

Veterans Affairs committee  If we look at the concept of “no doors are closed”, meaning that if you have the opportunity to do self-screening, which is available online for Canadians as well--you can go online and complete all kinds of self-screening instruments—it generally will provide you with information at the end saying that if you scored at a certain level, you should see your primary health care provider.

Veterans Affairs committee  I think it's been demonstrated that regular periodic screening tends to work better, because in this way, if you're going in for your regular medical checkup and you get screened at that time, and it's not necessarily deployment-specific.... Somebody coming back from deployment, for example, may minimize their symptoms or may not have acknowledged their symptoms at that time, but maybe if the screenings are repeated regularly as part of their general health assessment, then....

Veterans Affairs committee  I'm not sure how often they would normally be screened. I wouldn't want somebody to be going in too regularly, but I would imagine that they usually go for periodic screening at least once a year.

Veterans Affairs committee  —and on how the data were collected, so it would be very difficult to come to a conclusion. If one population has a lower rate, it would be very difficult to have a basis for the conclusion that they are doing something different without knowing exactly how the data were collected.

Veterans Affairs committee  Just so I understand, are you talking about the transition out of the military—