Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 8 - Evidence
OTTAWA, Wednesday, February 23, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, met this day at 3:35 p.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Honourable senators, we are continuing our study on mental health and mental illness, and today we have two panels of government officials, the first panel being from Treasury Board, the Correctional Service and Citizenship and Immigration, and the second panel being from National Defence and Veterans Affairs. We will begin with short statements from each of you, and then we will ask you questions.
Mr. Phil Charko, Assistant Secretary, Pension and Benefits Division, Treasury Board Secretariat: I would like to begin by thanking the committee for inviting me to this session to provide comments on your study on mental health and mental illness and addiction. During this presentation, I will try to answer the committee's questions on the effectiveness of the federal government in accommodating individual employees with mental illness and addiction and what needs to be improved. I assure the committee members that this is an objective that I share with you.
I will start with a bit about our role as Treasury Board Secretariat. TBS oversees the government's financial, labour relations and administrative responsibilities. In a way, you could think of it as a general manager or employer of the federal public service. As such, we are responsible for the policies and programs that affect the mental health of employees. TBS shares those responsibilities with the new agency that was just recently created, the Public Service Human Resource Management Agency.
In my view, to be successful in the management of mental health issues in the federal public service, you need to focus on three domains: First, good human resource management; second, work place policies; third, how the government supports employees with mental illness and addiction problems.
Why is good human resource management important? If HR management is not properly organized and accountabilities are unclear, then the policies and programs that the employer puts in place will not be effective. Several years ago, the Auditor General pointed out that the way in which human resources are managed in the public service was not as effective as it could be. I am happy to say that the government has passed a new act, the Public Service Modernization Act, which is an ambitious agenda to foster excellence in people management. We are optimistic that this new act will clarify responsibilities and, in particular, one of the key themes is to place more responsibility for HR management in the hands of deputy ministers and line managers. That will be critical for the management of mental illness in the public service.
It also includes requirements for more consultations with unions and measures to reduce conflict in the workplace. As well, it provides increased facilities or an emphasis on a common learning service. That will allow for better training of line managers in HR issues.
Although this modernization act was passed last year, you could ask how well are we doing with its implementation. I am happy to report that the Auditor General's report last week indicated that they felt this was a good foundation for managing HR reform. Deputy minister advisory committees have been created, and some of the institutional changes associated with the modernization act are being put in place. Although there is still a long way to go in terms of modernizing HR management in the public service, there are signs of cultural change. The fundamental challenge will be to ensure that deputy ministers and line managers take on ownership of HR issues, which will involve ownership of the mental health issues of their employees.
The second area of activity where success is required is appropriate employee assistance and workplace well-being policies. There are many programs in the federal government to address issues such as mental health and addiction problems and workplace well-being. We have a comprehensive set. They include things like flexible working arrangements, telework, job-sharing, mobility policies, child care. We have generous leave policies, anti-harassment, fitness, duty-to-accommodate policies, employment equity, pride and recognition, and policies with respect to the code on values and ethics.
Not only does the Treasury Board Secretariat and the Public Service Human Resources Management Agency, or PSHRMA, have these policies, we often have programs to assist in the implementation of policies. Therefore, we publish guidelines, best practices, and offer training to managers. To elaborate on how some of these policies can affect mental illness issues, for example the code of values and ethics, one of the areas deals with people values. If we have a workplace where individual differences are respected, we can do a lot to eliminate the stigma associated with mental illness, which is a problem in the public service. The Duxbury-Higgins study several years ago noted that the public service has one of the best sets of workplace well-being policies of all employers.
I would like to talk about the employee assistance program, which is mandatory in all government departments. It provides for short-term, confidential counselling. It is paid for by the department and allows for counselling of employees with all kinds of problems, not just mental health, without prejudice to job security or career. That is an important element in our suite of policies.
One can ask, how well are we doing? We have been offering regular public service surveys of all public servants. We had them in 1999 and 2000. In the 1999 survey of public servants, a number of problems were found, but since then, the second survey in 2002 indicated improvement in areas of, for example, employees being better recognized by supervisors, and a greater sense of team work in the public service than in the 1999 period. Those are elements which indicate a reduction in stress in the workplace.
The committee of deputy ministers made some recommendations in 2002 to encourage departments to address workload, imbalances in the workplace and other workplace management issues that had been identified. As an indicator of some progress, Statistics Canada was awarded a Healthy Workplace Award from the National Quality Institute, an award which is difficult to obtain.
The government is continuing to examine its policies in terms of mental health. Michael Wilson has been appointed special adviser to the Minister of Health to assess mental health issues in the public service, and his report is due at the end of the year. There are some indications that our suite of policies does make coherent sense.
If you have managers that are focused on HR issues and well trained, that is one success factor. If you have a suite of workplace policies that deal with leave and duty to accommodate employees with mental health problems, that is another success factor. The third deals with your insurance programs when, in fact, the employee finds himself in difficulty.
I would like to talk about the disability program, disability insurance, the health benefits and the pension plans. We have the largest group benefit plans in Canada. As the largest employer in Canada, these are large programs. We are probably the largest customer for most big insurance companies, such as Sun Life, Great West Life and Manulife.
In terms of the health plan, we have over 1 million people in the plan, about 500,000 plan members and another 500,000 dependents. It covers pensioners as well. In fact, 45 per cent of people in our health plan are pensioners. Our department oversees the disability, life insurance and dental plans as well.
I would like to give a few statistics on mental disorders. With respect to the health plan, $64 million was spent on prescribed drugs and $10 million for psychologist services. With respect to our long-term disability program, in terms of our statistics, in 2003, 44 per cent of our new long-term disability cases were for depression and anxiety. That is a fairly high number. However, we have a fairly high rate of recovery and return to work. Approximately 70 per cent of people who go on LTD do come back to work.
To elaborate on the approach to coming back to work, we have a flexible approach whereby individuals can come back temporarily in a less demanding job, or can come back on reduced hours. If they are coming back on reduced hours, the DI benefit is continued to the point where they are back to their main income. With respect to pensions, if at the end of the day the individual is unable to come back, the Federal Public Service Pension Plan does offer a disability pension. The pension benefit, plus the DI, will guarantee 70 per cent of the income up to age 65.
We think we have good coverage on our basic insurance programs. I would say that we do not have a recent assessment of the effectiveness of these programs and we have initiated a renewal initiative where we will examine the effectiveness of these programs. We will ask ourselves: Do they meet all of the needs of the various stakeholders, and are they well integrated with policies in the departments? As part of that study, we will be looking at industry best practices and ensuring that we have the best that we can. We hope to learn more from some of the major insurance companies in terms of the management of these issues. As part of this review, we will be discussing these questions with the bargaining agents.
In terms of what the public service needs to do to improve and to lead by example, we need to continue with the cultural change in management of HR. We need to be innovative in addressing mental illness and addiction through our suite of policies and programs, and we need to more formally assess our disability management program.
Although many challenges remain, I have tried to give you a sense of where the federal government is going as the employer. I want to thank you for the opportunity to make these comments and wish the committee good luck.
Dr. Françoise Bouchard, Director General, Health Services, Correctional Service Canada: I spoke to the committee last May regarding the issues facing mentally disordered offenders. I want to express how pleased Correctional Service Canada was to have the issues affecting inmates reflected in the committee's report.
I want to begin by discussing CSC's role with respect to the provision of mental health services to federal offenders. Correctional Service Canada is responsible for administering the sentences of two or more years imposed by the courts. We are responsible for approximately 12,000 incarcerated offenders and another 8,000 living in the community on some form of release. Eventually, almost all offenders return to the community. CSC has a direct role in the provision of mental health services to offenders. Our legislative mandate, the Corrections and Conditional Release Act, require that we provide every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate's rehabilitation and successful reintegration into the community. We must remember that mental health needs extend beyond the sentence.
A high percentage of these offenders have mental health problems, and this is a growing challenge. Twelve per cent suffer from a serious mental disorder which requires immediate intervention. The percentage of offenders with the diagnosis of mental disorder on admission has risen 61 per cent in seven years, and during the same period the number of offenders on prescribed medication has increased by 80 per cent.
Your report refers to the issue of treatment for individuals with dual diagnosis, such as drug, substance abuse and mental health problems, and to the issue of suicide. This is relevant for CSC where almost half of those with substance abuse problems also have an additional disorder. The rate of suicide is also higher than in the general population. We would welcome a discussion on these issues that leads to a comprehensive, integrated framework which involves all criminal justice and community-based service providers. The mental health problems of federal offenders are numerous, complex and longstanding. How well we provide mental health interventions to offenders has a direct impact on the success of their release into the community and therefore, ultimately, the safety of the public.
Although CSC has some psychologists providing direct care to offenders in regular institutions, and five treatment centres for those with more serious mental health problems, we are faced with challenges in our attempts to provide mental health care. As a result, we recently completed a review of our mental health services. In order to develop a comprehensive continuum of mental health care, we have identified four key areas where strategic investment needs to occur and where we must focus our efforts.
The first area is the need for a full mental health assessment of offenders at the time of their arrival. This will allow for the establishment of appropriate treatment plans, improved placement of offenders into the most appropriate facilities, and better data on offenders' needs to assist in future planning.
The second area is ensuring that our five regional treatment centres function at a consistent level with regard to their status as hospital facilities, accreditation, the number and types of staff, the admission criteria and the type of security required. This also includes identifying the clientele for which treatment interventions should be developed and made available: for example, those suffering from FASD problems and personality disorders diagnoses.
The third area addresses the provision of mental health services in our regular institutions, as well as the establishment of intermediate-care mental health units in some institutions. These units will provide a level of accommodation and services to those who do not necessarily need a hospital bed, but who need more structure and support.
The last area is the need for a community mental health strategy that will ensure continuity of care for these offenders when they are released. This would include the development and implementation of specialized services and supports to address employment, accommodation and mental health needs of offenders with a view to enhancing their chances for safe and successful release into the community.
We are now in the process of quantifying the additional resources needed to implement the system of care. Clearly, we cannot realize this plan without additional capacity being allocated to us. A population health approach will help in bringing together the stakeholders who have a role to play. In the case of offenders with mental health problems, this approach shall be taken as an integrated initiative involving all jurisdictions and communities. It is important to remember that existing community-based mental health resources will be more taxed if we do not take an overall integrated approach. We also need to link with the police, judiciary, provincial correctional and health partners to make this plan more effective.
CSC is one part of the puzzle in the area of management of offenders with mental health problems. Given that the number of mentally disordered offenders is relatively small, especially when it comes to community supports and services, partnerships with our provincial correctional and health partners will be critical.
While CSC deals with offenders once they have been sentenced, we believe that action needs to be taken to try to reduce the burden of criminalization of individuals with mental health problems by enhancing community-based services and supports. Innovative approaches such as courts equipped to identify mental health issues and develop options to address these needs should be further explored. I want to point out that we need to work closer with First Nations, Metis and Inuit communities and service providers to address the mental health needs of Aboriginal offenders. This is a growing issue that we cannot ignore.
We welcome suggestions about a comprehensive and integrated framework for standards of service delivery for offenders with mental health problems. This will help to identify appropriate benchmarks for these services and will bring a health focus to the delivery of health services within a correctional setting.
In conclusion, we welcome a comprehensive and integrated approach to this issue.
[Translation]
Dr. Sylvie Martin, Acting Director, Immigration Health Program Elaboration, Citizenship and Immigration Canada: Honourable senators, it is a pleasure to be with you today to present to you the role of Citizenship and Immigration Canada with respect to mental health. Under its mandate, Citizenship and Immigration Canada is not a department that plays a major role in the delivery of mental health services. Under the Immigration and Refugee Protection Act and its regulations, the department admits temporary resident and immigrants who contribute to the economic and social growth of Canada, it provides resettlement, protection and a safe haven to refugees, it assists newcomers to adapt to Canadian society and eventually obtain citizenship, and it manages access to Canada in order to protect the security and health of Canadians as well as the integrity of Canadian laws.
If mental health is defined as each person's ability to experience, reflect and act in such a way as to obtain the greatest enjoyment from life and to cope with different challenges, it can be said that Citizenship and Immigration Canada is responsible for a number of initiatives that are either directly or indirectly linked to mental health.
Several of our programs are aimed at facilitating and improving the social, cultural and economic integration of newcomers, thus reducing the stress involved in settling in a new country for the benefit of such newcomers.
These different programs provide information relating to existing resources and facilitate the access to such services.
Citizenship and Immigration Canada is also responsible for the federal interim health program providing essential and emergency medical services, including certain mental health services for specific groups, particularly people who are applying for refugee status and refugees.
Citizenship and Immigration Canada also funds various initiatives and research projects relating to mental health. I would like to present some of these to you in greater detail.
[English]
The Government offers Health Services to a specific population of immigrants, since the Order-in-Council of 1957. The current program, the Interim Federal Health Program, was launched in 1995 and it offers health services to migrants, currently refugee claimants, refugees, detainees in immigration detention centres and failed refugees still in Canada who are unable to pay for their health care services. It covers essential and emergency medical services, including mental health services such as consultation with physician, hospitalization and essential medication. The overall budget for this program was $52 million in 2002-2003, with 97,000 users and 700,000 claims.
CIC provides also a range of integration and resettlement programs to newcomers in Canada. The Immigrant Settlement and Adaptation Program funds service provider organizations to deliver direct essential services to newcomers. These service provider organizations will assist the clients to access appropriate help, including health care services, and will refer newcomers to resources in the community. We also have the Host Program. CIC funds the recruitment training, matching and coordination of volunteers that will help newcomers with the adjustment to life in Canada that includes helping newcomers to deal with educational and health issues and to inform and facilitate access to available services. The Resettlement Assistance Program provides income support and a range of immediate services for government assisted refugee. In 2003 we had 7,500 government-assisted refugees landed in Canada, and from those about 400 to 500 had special needs, including mental health needs.
For those with special needs, in addition to income support, the department endeavours to find private sponsors who will provide emotional and moral support, including ensuring that the refugee has access to services required. Citizenship and Immigration Canada also funds the Canadian Centre for Victims of Torture and a program for newcomers who have experienced war, violence and post-traumatic stress. The centre provides some services and is a link between survivors and a network of professionals in the community, including lawyers, physicians, social workers and all the required services by these persons.
Citizenship and Immigration Canada is also involved in different projects and research related to mental health. It funds projects to complement or improve the delivery of settlement services. Some of these initiatives will address mental health issues, such as post-traumatic stress, alcoholism, anxiety, addiction, depression and drug addiction.
CIC, Citizenship and Immigration Canada, is one of the federal departments and agencies that support the Metropolis project launched in 1996. The goal is to improve policies for aging migration diversity in major cities through enhancing academic research capacity, plus research for critical issues and in developing ways to facilitate the use of research in decision making. Migration and mental health issues have been addressed through Metropolis.
[Translation]
Citizenship and Immigration Canada is involved in various partnership arrangements at different levels, namely federal, provincial, territorial and interdepartmental. For example, the task force on immigration settlement is a forum where multilateral issues relating to settlement and integration are identified and discussed.
Recently we also undertook a joint initiative with Citizenship and Immigration Canada and the Canada Public Health Agency on the health of immigrants. This initiative and the task force on the health of immigrants identified the present challenges in public health resulting from immigration to Canada. There was also discussion about the importance of cultural diversity and the management of health care, including mental health, and the importance and the need for training focusing on cultural diversity was emphasized in the context of health care, as well as the importance of including immigrants in health research.
Citizenship and Immigration Canada is also responsible for various linguistic programs. These programs facilitate integration into Canadian society and adaptation at all levels.
Although the initiative is an interdepartmental one, we are also responsible for a website known as ``Coming to Canada.'' This site provides a good deal of very useful information relating to the various community and government services available in Canada, including health and social services.
In view of our mandate, we are not a department that plays a major role in the provision of mental health care. However we are involved in research, in education and the promotion of mental health issues. We fund various initiatives relating to mental health. By facilitating and improving the overall integration of newcomers to Canadian society, we make a contribution to the welfare of such newcomers and to their mental health.
Citizenship and Immigration Canada works in partnership with the provinces, territories and various shareholders and acknowledges the importance of continuing to collaborate with our partners, and of pursuing research and development to gather additional data supporting informed decision-making on immigration, integration and the health of newcomers in Canada.
[English]
The Chairman: I want to ask a couple of questions of the various members of the panel and then I will begin with my speaker's list. Let me begin in the order you actually spoke.
Mr. Charko, I was actually about to ask you for the data that turns out to be in your report, which is the LTD cost, the long-term disability cost and the percentage of people who come back to work. The 70 per cent, I believe, is relatively high compared to any other employer, which is terrific. Do you have, or have you attempted to get, comparable data, for example from the business round table on mental health and addiction, on the costs or the percentage of returnees to work?
Mr. Charko: We have not done that research, yet. That is part of the assessment of disability management on which we intend to embark.
The Chairman: What is your time frame to obtain the numbers?
Mr. Charko: For numbers like that, we could probably return to this committee in a few weeks with some information.
The Chairman: That would be terrific. As we have discovered in going across the country, the database on this area of public policy is abysmal. There has been little research done on it, even at the academic community level. That would be helpful.
I will turn now to the page where you talked about the need for culture change. You point out, correctly, that unless we achieve the culture change, progress will be slow in coming. Other countries have discovered that that takes quite a bit of time. Are you just starting down that road or are you some distance along it?
Mr. Charko: The Public Service Modernization Act is a major step forward.
The Chairman: In what year was that passed?
Mr. Charko: That was passed just last year. That step is in refocussing the attention of managers and recalibrating the accountability of deputy ministers and line managers for HR resources. We are in the early days of that cultural change. The Auditor General has said that we have a good foundation but there are many challenges yet to face in that area.
The Chairman: As an aside, it is our experience that there is much to be learned by talking. For example, you will find that both CIBC and Dofasco appear to have outstanding programs in this area. You might find it worthwhile to spend some time talking to those people and others to whom they might direct you. It seems to me that there is no sense in re-inventing the wheel.
Mr. Charko: The key is to educate not just managers to deal with these issues but line managers and other colleagues. Office colleagues can have an influence on this issue and can help to identify early problems.
Senator Cochrane: I have a supplementary question to your first question, Mr. Chairman.
Mr. Charko, I realize that you said $74 million per year has been spent on this issue, and 44 per cent seek assistance for mental health issues or addiction problems. What number is 100 per cent?
Mr. Charko: That is the number of claims for long-term disability. I will check to see if I have that information. There were 8,824 long-term disability claims for the year 2003. The approval rate was about 84 per cent, and mental disorders represented 43.7 per cent of those claims.
Senator Cochrane: Did you say that 70 per cent of those came back to work?
Mr. Charko: Over a longer term, it was a 70 per cent return to work, but not necessarily of that group because long- term disability is just beginning.
Senator Cochrane: Could you give us the figure that 70 per cent represents? How many would come back to work? I would like to have a figure.
Mr. Charko: I would have to obtain that information for the committee.
The Chairman: I will ask either of the officials from Citizenship and Immigration a couple of questions. First, I have an observation. You said that the percentage of offenders with a diagnosis of mental disorder has risen 61 per cent in 7 years. It is interesting that, roughly seven or eight years ago, de-institutionalization began to accelerate. The observation that we made in our report was that the prisons have become the asylums of the 21st century. That is a pretty reasonably accurate description just on the basis of that trend data. You may comment on that.
I understand the four points that you outlined in terms of your strategy, but knowing a fair bit about the meagre amount of resources available to deal with mental health issues in the correction service, I do not know how you will do that unless you can find other resources. I would be in favour of that but, as you said, the first need is a full mental health assessment of offenders at the time of their arrival. My guess is that you are not even close to having the resources required to do that.
You also talked about the need to provide services in your regular institutions, which I take to mean regular prisons. You said that you cannot fully realize this plan without additional capacity being allocated. Correct me if I am wrong, and I will stop here, but my guess is that you have about 10 per cent of the capacity, or I could be generous and give you 20 per cent for many reasons, such as salary scales and the lack of attention paid to mental health in the service for a long time. This is not a new problem, although the magnitude of it is new to you. I understand that you have a plan, but is there any hope of making progress on it? Is the answer that you are hoping people like us will make it such an issue that you receive extra resources?
Dr. Bouchard: I guess the answer is, a bit of both.
The Chairman: We are quite prepared to do that.
Dr. Bouchard: I would say both. In developing our plans, we realized that we have some gaps. We also have to build on the existing capacity. To improve the intake assessment, we can do things within our own capacity. Already we have begun to explore that with our staff in the reception centres. We certainly realized that, at some point, we will reach the limit of our capacity.
Currently, the idea for the orientation intake is to improve what we are doing and add to it as much as we can. We cannot say how much more we can do right now in the field. There is some capacity to work internally but we know there are limits that have to be defined.
The Chairman: Can you give us any historical tracking data on the kinds of mental illness? Can you give us any numbers in terms of dollar cost to implement your four-point plan?
The next one I find really bizarre. In your presentation, you referred to the Corrections and Conditional Release Act. Section 86 of that act states:
The Service shall provide every inmate with
(a) essential health care, and
(b) reasonable access to non-essential mental health care...
Could you define non-essential mental health care? It sounds a bit like an oxymoron.
Dr. Bouchard: I do not know if there is an official definition but I can try to find one.
The Chairman: Do not give me the official one; just give me a clue. Does anyone know what ``non-essential mental health care'' was meant to mean?
Senator Cook: I will offer an opinion: ``affordable housing.''
Dr. Bouchard: In the community, psychology services are not covered by health care all the time. We cover everything in the community plus additional psychology services. We have psychology services covered within our own services. That would be an example of what we might call ``non-essential.'' In the community, psychological services are often available in the private sector and not in the public sector.
Dr. Michael Bettman, Acting Director General, Offender Programs and Reintegration, Correctional Service Canada: Non-essential health care adopts an illness model. Perhaps we are looking at ancillary counselling, personality disorder and other interventions that are not necessarily directly related to a mental illness.
The Chairman: That suggests to me that you are adopting a relatively narrow medical definition of mental illness.
Dr. Bettman: For the most part, when we talk about mental health issues, yes. We have to differentiate to a certain extent our population, not all of whom are mentally ill, but who certainly have troubles with the law, and anti-social personality behaviour. To a large extent, the efforts we make in mental health are directed to that area.
We also have correctional programs and rehabilitation efforts that are ongoing for our general population that is not mentally ill.
Senator Callbeck: Welcome, and thank you for your presentations.
First, I assume that public mental health programs are generally much better than those in the private sector. However, are there a lot of companies that provide better mental health services than the government?
Mr. Charko: Unfortunately, I cannot answer that question. We are just beginning our assessment of best practices in the private sector. There is much we can learn from other employers in terms of practices in this area.
Senator Callbeck: You mentioned a survey of public servants done in 2002 through which problems were identified. I think you said that the deputy ministers came up with a list of recommendations. Have those recommendations been carried out?
Mr. Charko: For the most part, there has been progress made. One of the recommendations dealt with issues like workload balancing. If you recall, in 1999 and earlier, after program review, there were workload imbalances. Work- life balance was difficult in departments, and I think that a number of those situations have been corrected with additional resources. As well, the attention that deputy ministers are now paying to human resources issues has significantly increased since that period as a result, in part, of those recommendations.
Senator Callbeck: You mentioned several things that you are planning to do with regard to Correctional Service Canada. You say that CSC has some psychologists providing direct care to offenders. How many do you currently have in the system and how many should you have in order to provide proper mental health treatment?
Dr. Bouchard: I can provide you with the exact number later, but we have about 250 psychologists working in the Correctional Service Canada. However, psychologists do not provide only mental health services. They also carry out risk assessment for correctional purposes. In fact, most of the activities of the psychologists within CSC are directed to the risk assessment part of the correctional agenda.
We are in the process of assessing our need for additional psychology resources. I cannot give you an estimate today.
Senator Callbeck: That review did not include numbers?
Dr. Bouchard: It did not conclude the amount of additional resources needed. The next step is assessing the amount of additional resources we need.
Senator Callbeck: Do you have psychologists on staff or do you hire them from outside?
Dr. Bouchard: In most regions, they are on staff. In some regions, we also have them on a contractual basis, mostly for the purpose of risk assessment.
Senator Callbeck: Is there a lack of psychiatric services? I ask that because I have heard that at the penitentiary in Springhill, which houses several hundred people, a psychiatrist attends only once a week.
Dr. Bouchard: We have had difficulties recruiting psychiatrists in New Brunswick. We have now been able to recruit a group of psychiatrists that is mainly located near our treatment centre in Dorchester. Under our plan, we want to expand the ambulatory role of the psychiatrists to the institution.
That brings me to an issue that we did not raise, that is, telemedicine. One of the issues is bringing psychiatric services to the institution where the inmates are, because they do not always need to be transferred to a treatment centre for care. However, the relationship between the treatment centre and the institution has to be reinforced in terms of support and consulting services.
Senator Callbeck: To return to your review, you have completed the review of the mental health services and you have identified areas. In what time frame will you have a plan completed?
Dr. Bouchard: We hope to complete it by this summer, or the fall at the latest.
Senator Callbeck: The last area you mentioned is the need for a community mental health strategy that will ensure continuity of care for offenders when they are released. What happens now when they are released? What services are they getting?
Dr. Bouchard: In the case of people who have an identified mental health diagnosis and are under treatment and in need of follow-up with a psychiatrist, it is our responsibility to try to assure continuity of service and to find a psychiatrist, clinic or hospital that will see the offender upon release and ensure that he or she will have access to that service. We are engaging services in the community release plans.
However, the offender may decide not to go to appointments or to the clinic to which he is referred. It is not always easy to find appropriate service in the community for each offender. It also depends upon where they are released. When they are released to residency in one of our community centres, we provide services there until they are completely outside of the institutional settings.
Senator Callbeck: There is much work to be done in that area.
Bill C-10 is currently before the Senate. It would give more powers to the police and the review board.
Dr. Bouchard: I am not familiar enough to comment on it.
Dr. Bettman: I am vaguely familiar with it.
[Translation]
Senator Pépin: I heard you refer to treatments for inmates. We were told that, oftentimes, when there is a shortage of hospital beds, inmates wait in prison because they cannot be transferred. We held a series of hearings in Toronto. As the committee chair said, prisons have become this century's mental institutions. At this point, we were told that at this time, if you had to transfer a seriously ill inmate, you would choose to keep him, and often, he would be kept in complete isolation.
I am sorry I missed your presentation, I was in another committee. We were told that such inmates were kept in isolation and often did not receive adequate treatment. I wonder what type of training is offered?
Is there special training for offenders? There seem to be more and more of them. What is the relationship between your services, federal correction services, and provincial mental health stakeholders?
Dr. Bouchard: With respect to access to treatment beds for inmates in crisis, in our federal system, there are five treatment centres in each region, and we have our own hospitals. Access is often available through our treatment centres. Obviously, sometimes, it can happen that a person is kept in isolation because he or she is vulnerable when faced with the general population and waiting to be transferred to one of our treatment centres. I do not know if this situation applies to provincial correction systems, but when it comes to access to community hospital beds, as far as we are concerned, that is not always the first place we would send someone for mental health care.
Senator Pépin: I do not think we were referring to provincial services. I know you have health care centres in Quebec.
Given the significant number of offenders with mental health problems, do you believe that your centres are full, do you have enough beds or availability to meet the needs?
Dr. Bouchard: One of the findings that came out of our assessment of treatment centres is that there did not seem to be a need to massively increase the number of beds but rather to reassign them to better meet the needs of inmates, especially when it comes to mental health. This is currently being done to redirect the use of beds in our treatment centres. That was one of the findings to come out of our assessment.
Based on the data within correction services, we could not conclude that we needed to increase the number of intensive care hospital beds for mental health problems. That does not mean that it will never happen. Based on the data we had, we needed to make better use of the beds.
The other finding was that yes, there has been an increase in the number of inmates and people with mental health problems coming through our systems, but very often, these people can be accommodated by special units within our regular institution centres: they either need more structure or support, but not necessarily more intensive care, or they may need to be protected from the general population and may need more structured services than the general population.
We also based ourselves on the experiences of other jurisdictions; if you look at the United States, they may have a more serious problem than us in that, according to their reports, 80 per cent of inmates with mental health problems could be accommodated by units such as those that exist in regular institutions. It is on this basis that we have chosen to assess the need to have such units within our regular institutions. We do not believe intensive care beds need to be in every unit. We need to reassign some of these beds so that some of them can be made available in regular institutions, but within a supervised and more structured unit.
We do not have training programs designed specifically for our health care workers who work with offenders with mental health problems. Our psychologists are employed on the basis of their prior qualifications and on the results of our recruitment and analysis process which allows us to determine their capacity to provide clinical mental health services.
[English]
The Chairman: Someone suggested to us previously that the initial assessment was frequently being done using a computerized test rather than a face-to-face meeting with a psychologist; is that correct?
Dr. Bouchard: That is for the lifestyle, and I think Dr. Bettman can comment on that. When we talk about health needs assessment, it is an interview with a nurse. The case program manager can refer to a psychologist for further assessment based on the first interview when the inmate comes in.
Dr. Bettman: We have to recognize that not all federal offenders are mentally ill. Dr. Bouchard mentioned that we have an increase in serious mental illness, but it does not necessarily equate with every single federal offender.
The computerized assessment refers to our assessment for substance abuse. It is a method which is currently in revision and is specifically only for substance abuse. It relates to a much larger, comprehensive intake assessment. There, through a set of self-report questions, we determine the exact pattern, the level of intensity, the need of every single offender, and then we determine what kind of substance abuse programs they require. It is not specifically for mentally disordered offenders.
We do have methods of delivering this assessment battery in multiple ways. For example, one way is auditory. It is read out through the computer, and that is for those offenders who have literacy difficulties. It is, frankly, a state-of- the-art method of determining the intensity required, the intensity of abuse, the intensity of use, the kind of lifestyle associated with substance abuse, directly linked to the kinds of programs and interventions we deliver for substance abuse.
[Translation]
Senator Gill: I shall primarily be asking questions on the First Nations. Do you differentiate between the Inuit, the Métis, Status Indians and the First Nations?
[English]
Dr. Bettman: In our legislation, we do not. We have approached, through our programming, special Aboriginal programs, and within that we have a margin of adapting those programs. Those programs are designed in the area of substance abuse, in the area of violence in practically all our domains, including sex offenders, to specific populations. We do have unique programs for unique populations. For Inuit, we have a substance abuse program specifically designed for Inuit offenders. With respect to Metis, we do not have many Metis in our system, but the programs we have developed are able to be geared towards the Metis population.
[Translation]
Senator Gill: The Inuit, the Métis and Indians are different peoples. They live in different regions. The Inuit live further north in the arctic region; the Métis tend towards urban or semi-urban environments; and Indians live on the reserves.
A few years ago, when Indians and Inuit came under the auspices of the Department of Citizenship and Immigration, I would have addressed my questions to Ms. Martin; however, times have changed.
I would like to know whether there are adaptation programs for Indians and Inuit similar to those offered to the immigrants; perhaps there are adaptation programs or programs for those facing difficulty in adjusting to life in an urban setting. Do you have a specific means of supporting those who appear to display signs of mental health problems, but are, in fact, often simply experiencing adaptation or social problems arising from the fact that they come from a different background? How do you handle this? It must be very complicated.
[English]
Dr. Bettman: It is a complex issue, on many levels. If you are looking at specific cultural treatments, and you are adding the dimension of urban versus rural, it becomes more complicated. That is why we embarked on, not so much recreating but building from the ground up, many of our programs for Aboriginal populations specifically — designed by Aboriginal people, often delivered by Aboriginal people for the overrepresented Aboriginal population in our federal system. Whether or not those deal with the issues of rural versus urban, they are more sensitive to those issues than perhaps most of our other correctional programs — and even mental health programs. It is definitely a complex issue.
[Translation]
Senator Gill: Do you have any statistics comparing the general population to the present population, as well as comparing the number or Indians and non-Indians receiving treatment?
Dr. Bettman: Yes, but I do not have them with me.
Senator Gill: Would we be able to have access to these statistics?
Dr. Bettman: Yes, that would not be a problem.
Senator Gill: I would be very interested in seeing them, as it would allow me to make some comparisons.
[English]
The Chairman: That would be helpful to us, because one has the perception, at least in urban Western Canada, that the percentage of offenders who are Aboriginal are substantially higher than the percentage in the population as a whole. To the extent that you have any documentation on that issue, that would be great.
Dr. Bouchard: In our report that was provided to you when we came in May, we have some data on the Aboriginal population within Correctional Services of Canada, so we can update that. To the extent that our programs can provide some data, we will.
Dr. Bettman: Offhand, I can tell you, clearly, that Aboriginal people represent 3 per cent of the population but 17 per cent of our offender population. In the Prairie region, that number is approaching 65 per cent. It is a very large —
The Chairman: Sorry, 65 per cent?
Dr. Bettman: Sorry, 40 to 50 per cent, for under 3 per cent of the population; but I do not know the actual percentages in the West.
Senator Gill: That is why I was asking. When you talk about Aboriginal offenders, I would like to know where they are coming from — urban, up North — and it will explain to us certain —
The Chairman: That is terrific.
Senator Gill: I know that there are a lot of Aboriginal people in jail in the West.
Dr. Bettman: We can provide the enrolments in Aboriginal programs. Whether or not we can give you rural versus metropolitan, because people change in terms of where they have lived, that might be a little difficult to provide, but we will try to do that for you.
Senator Cochrane: My question is first directed at Mr. Charko. I would like to continue on that line on which the chairman started at the beginning. How much funding is in the public service health care plan? The second part of that is how much is spent on administration?
Mr. Charko: With the health care plan, basically the total value of the plan — and this is reimbursement of claims — is about $500 million a year. In terms of administration, what I would talk about is the administration fees we pay Sun Life — the health care plan is administered by Sun Life — and I believe we are probably spending, although I would have to confirm this, around $15 to $20 million a year for that administration.
Senator Cochrane: Are there other administration costs? There must be.
Mr. Charko: I do not think so. I think that would be the bulk of them.
Senator Cochrane: Of that spending, $74 million goes to mental illness and addiction, is that right?
Mr. Charko: Yes.
Senator Cochrane: Of that $74 million, how much is spent on administration?
Mr. Charko: For example, to explain the first number — the $64 million — that is essentially reimbursement of drugs. The classification is ``central nervous system agents,'' and it is basically the reimbursement of the drug claims. In terms of the psychologists, the other figure, the $10 million, was for psychological counselling services. That is reimbursement of the psychologists' claims, or psychologists' services.
The administration of those claims is a very small portion of that $15 to $20 million that I talked about earlier. What happens is that it is a reimbursement system, so that as the employee is prescribed by his doctor, say, anti- depressants, for example, he will go to the pharmacy, he will pay the claim, and then we will send that claim in to Sun Life and they will reimburse. Similarly, if he is referred to a psychologist, the psychologist will deliver the service, the employee will pay the psychologist and we will reimburse.
Senator Cochrane: Could each one of you provide the committee with one example of a typical case of a client with a mental illness or substance abuse disorder, and how each one of you would address that concern?
Dr. Bouchard: Do you mean the pathway this offender can go through when he comes into our system?
Senator Cochrane: Yes, either with a mental illness or with an addiction problem.
Dr. Bouchard: Or both. I will leave Dr. Bettman to go with the substance abuse and I will deal with the other.
Usually, most offenders come to us through the provincial system. Often, offenders have resided in the provincial system before they come to us — most of them, in fact. They will come in with a medical file already, with some information regarding their treatment, diagnosis and the medication they are on at that time.
In most of our regions we have reception centres, except in the Prairies. The reception centre is an institution or centre that is dedicated to receive offenders who are newly arrived into our system, and where they will stay for approximately one to three months for a full assessment and a decision on their placement in an appropriate institution.
Senator Cochrane: This is what they call somebody on the front line.
Dr. Bouchard: It is the front-line reception centre where people are channelled through.
In the Prairies, this is located in six institutions, because we also have a women's institution there. Because of the distance and the geography, it is not one centre for the Prairie region.
I will start at a reception centre where the person comes in. It is standard that every offender, within 24 hours of his arrival, will be seen by a nurse to renew his medication and prescription, if there is a need for maintaining his treatment. Full assessment of his health status by the nurse will occur within the first 14 days.
If he is already identified as having a mental health problem — in other words, he has been diagnosed and is under medication — the nurse might decide to refer him to the institutional physician for a review of his medication and his needs. If there is any report of his behaviour problems while he comes to us, he might need a further assessment by a psychologist, depending on how he behaves in the institution at the time.
There is also a suicide risk assessment that is done, a standard screening risk assessment for suicide when they come in. If there is any problem, in terms of being potentially suicidal, he or she can be put under observation for a period of time by the team, and be reassessed accordingly — his level of risk of suicide reassessed.
For the first three months, the offenders will reside in that reception centre. They will be receiving their regular treatment. If, for example, the person develops significant health problems during that time, he would be seen; and it could be decided that he might need to be admitted into our treatment centre in that region. We also have psychiatrists who come in to the reception centre. Usually, they are also attached to the treatment centre. They can see him and decide if he should be admitted to the treatment centre, because we cannot stabilize him in the centre where he is residing right now, which is like an institution. If he has a diagnosis of schizophrenia, he might be transferred to our treatment facility on an emergency basis, where he would be admitted and provided a bed, and our team will provide care in that area. It is a 24-hour institution in terms of care. They will stabilize him, perhaps change his medication, and the further assessment will decide, once he is stabilized, if he can be transferred to a regular institution.
We do not view our treatment centres as centres where the offender will spend his whole sentence. Once he is stabilized, he will be assigned to a regular institution. He might end up in a maximum, medium or minimum security institution; that is a correctional assessment. Within those institutions there are also health care teams that will follow this person. The challenge, depending on the length of the sentence, is to prepare him for release. While we say we administer sentences of two years and over, the majority will be released within three or four years. I think the average time stay within our prisons is that. We have to start planning the potential release of this offender.
We have what we call our CCC's community centre, which are also CSC institutions but are usually located more in the community setting. He could be referred there as part of his release plan, where they go out of the CCC for interventions and back at night to the CCC.
We have some services for those CCCs but they are not very much developed. The challenge for an offender who has a mental health diagnosis is that he can easily become destabilized and might come back to our regular institution or treatment centre, like someone with schizophrenia who does not follow his medication and keep his appointments
Senator Cochrane: Do you have many of them coming back?
Dr. Bouchard: I cannot give data on that, but it can occur.
Dr. Bettman: Would you like to hear about the addicted offender? I will try to make it short. We are dealing with offenders who are doing two or more years, and because many have already spent time in provincial institutions, we do not have a requirement to do detoxification for the offenders. It is usually done while they are waiting for a trial in provincial court. It is rare that we have a detoxification component.
I will take over from the reception centres where we do a comprehensive assessment on the criminogenic, the underlying factors that cause criminality, not just for the index offence for which the offender has been convicted, but for his entire life. You find that close to 80 per cent of our offenders have had problems with substance abuse. It should not be a big shock to discover that.
It does not stop there. Our assessments are very much designed to determine what intensity of treatment the offender will require in order to mitigate those factors. Substance abuse is connected to reoffending as well.
For those offenders with serious substance abuse problems and who pose serious risk, we have programs in place in almost all of our institutions, at all security levels, to address those particular problems. We have a national substance abuse program in our maximum, medium and minimum security institutions, with maintenance afterwards. These are programs focussed on harm reduction strategies for the offender to reduce and prevent further substance abuse. These programs are followed up by maintenance throughout the offender's sentence, both in the institution and in the community, once they are released.
Frankly, we are proud of our substance abuse programs, which have an international reputation. We have representatives of countries from all over Europe visiting us to observe our correctional program model, including Sweden, Scotland, and a list of other countries. We have an international accreditation for our substance abuse program, so we invite international, recognized experts in the area of substance abuse to comment on and to accredit the substance abuse programs that we have in place, including the maintenance programs.
We have a very rigorous standard for each site to ensure that they are following quite methodically the guidelines and the qualities necessary that we have prescribed for the programs.
Senator Cochrane: How many sites?
Dr. Bettman: We have 166 sites, actually 300 in all, for the delivery of substance abuse programs.
Senator Cook: I will begin with Mr. Charko. Your numbers are mind-boggling: In 2004, the federal government was the fourth largest payer of drug benefits. Do you have a breakdown of those drug benefits? Could a single federal agency be responsible for all federal clients? If so, could the provision of mental health services and addiction treatment be a first step towards a centrally-managed system? To all of you who are in this complex system, where for me the individual is of the utmost importance, where are the gaps in your system? How do you link with other providers, that is, federally and provincially? How can we help you arrive at the point where we are offering to that person the very best care that the system can offer?
Last but not least, we hear the word ``stigma.'' We hear it over and over again. The people whom you have as clients have a double stigma: the stigma of mental illness and the stigma of incarceration. How do we move the person who finds himself there through the system, back into society, so that they can live a life that is fulfilling?
Mr. Charko: I will comment on the drug benefits. To give you a sense for our drug plan in the health care plan, 20 per cent of drugs are cardiovascular, 14 per cent are central nervous system-type drugs. That is the second largest group of drugs, followed by hormone synthetic substitutes at 6 per cent and therapeutic agents at 6 per cent. Central nervous system agent drugs are a key part of our health care plan. I will not comment on your question of the machinery of government or the centralizing of services. I think that is more program-related.
On the question of stigma, I am very concerned about that in the workplace as well. I think that some of the ideas that we suggested earlier is the way to go, where we are changing the culture for HR management, where employers, supervisors and work colleagues are trained, where there are opportunities to talk and learn about mental illness. It has been shown that if you can provide that type of education in the workplace and the managers feel responsible for HR issues, we can eliminate some of that stigma in the workplace.
Dr. Bouchard: On our issues in terms of the gaps in our system, one of the challenges we have, and we should it see it positively, is that we cannot separate our mental health care from our physical health care. It has to be integrated. Our nurses and professionals have to be multi-skilled with competencies to address the needs of offenders when they come in. Therefore, for us it is a challenge because there is a need for training and maintaining the competence level of our health care workers. For example, our nurses in the reception centre need to be able to better assess, identify and diagnose those mental health needs. These have been identified as a challenge for us.
The management of offenders with mental health problems in our institutions cannot be done without a multi- disciplinary approach. That includes the training and awareness of the correctional officers who work with those people, to break down the stigma. That is also apart of the challenge we have. They have to be part of the team in terms of the understanding that the behavioural problems sometimes are not related to a criminal issue but more an issue from a mental health problem. Therefore, the management and education is necessary.
We are always challenged by this, and that is part of the orientation that we strive to go on now. I will limit myself to that. I know there is a lot of time, but we have been looking at all these elements: The security management when you deal with offenders with mental health problems; the use of force, in terms of addressing and adapting it to the issue of mental health has been part of all the issues we need to look at.
Senator Cook: Do you see a role for the nurse practitioner in your system? I come from Newfoundland, so in Atlantic Canada the offenders sometimes get rehabilitation, what they need. Their sentences are determined by whether they served their sentences for their misdemeanour in the province, or whether they went to the mainland. Therefore, often I feel a judge will sentence accordingly. It is a choice whether you lock them up for the period or put them somewhere where they can be rehabilitated. It is a challenge in this country as diverse as ours. I see that as really stressful on the individual, and on the families who cannot visit, who cannot get to see their family member. They are cut off from everything that is familiar.
Dr. Bettman: I wanted to add one other challenge. I find in the community we really lack the kind of integration that we need. Basically, I think our biggest challenge is, to a large extent, that stigma. These offenders are part of our community and people do not really recognize that. They want to encapsulate them, not only in a prison but even when they are in the community, and they say that their mental health care is the government's responsibility, it is not our town's or our city's responsibility, and as a result, we are often left alone in trying to service the needs of our offenders.
Senator Cook: Health care professionals are not readily available in my part of the country.
[Translation]
Senator Pépin: My question is on the issue of all immigration. The way in which we receive immigrant families who have come to Canada is an important factor; these families have chosen Canada and we must live up to our good name. However, several immigrant families have informed us that there is a lack of reception services.
When you are responsible for a family for a period of a few weeks, or a few months, and you notice that an individual, be it a child or an adult, is suffering from some form of intellectual disability, what services are you able to offer them? More specifically, when these families are free to choose the city in which they would like to live, do you ensure that somebody who is suffering from mental health difficulties will be able to have access to the appropriate services in his or her new community?
Although many of those people take language classes, they are not necessarily able to communicate. It can be very difficult for somebody who has mental health needs if they are unable to communicate.
You spoke of a language program; however, we have been told that, in the majority of towns, no such program exists for immigrants. I would therefore like to know if you are in a position to make their life easier, either by providing them with the name of a place they can turn to, or the name of a doctor. As for the language issue, it remains an unsolved quandary.
Dr. Martin: There are language programs up and running, but they do have certain eligibility criteria.
Senator Pepin: I realize that some such programs are available. However, many people have told us that they would have great difficulty in communicating where they suddenly to fall ill in a new city. No services are available to help people in such a situation.
Dr. Martin: Different kinds of immigrants have different needs. Some immigrants are admitted under the economic class, while others have refugee status or are asking for asylum. People who are refugees or who are asking for asylum sometimes have different needs from those arriving under the economic class.
Many of our settlement or integration programs would target this group. Some services, of course, are offered to a different population than the refugees. Our role is to facilitate access to existing provincial services. We offer no specific services. We are only a link that facilitates access, for example, by giving information on what already exists in the regions.
Government-sponsored refugees have special needs. They often have private sponsors who will receive information on those special needs. The private sponsors facilitate integration into Canadian society and facilitate access to the services required by the new immigrants.
We work with various groups and organizations. People are free to settle wherever they wish in Canada. There are several things that must be taken into consideration when one is to offer services.
Senator Pépin: Generally speaking, when the immigration service finds itself faced with a family that has an autistic child, they hesitate to accept the family. However, if a family that has already settled in Canada is discovered to have members that suffer from depression or need other services, it is often difficult for people to find a centre that offers the services in their language.
Dr. Martin: This is why we have a joint initiative with the Public Health Agency. Our document entitled Migration Health Task Force stresses the importance of training health care professionals to deal with a new Canadian society that is multicultural and has different needs. These are some of the challenges that we must accept in the area of immigration in Canada. We are well aware of these needs and we have pointed them out to the task force.
[English]
Senator Callbeck: Dr. Bouchard, I want to return to this review that you completed. Have you looked at the contribution that volunteer groups make, or the role they play in correctional services here? I am asking this because I had a letter recently from a volunteer group that is connected with Springhill Penitentiary and they provide a lot of services to families and to the inmates, both in the prison and outside of the prison.
One thing that Senator Cook touched on a minute ago was that there are people from Newfoundland in the prison whose families cannot afford to visit unless they have a place to stay. This is one of the services that that volunteer group provides. They get $22,000 from the government. I think it is incredible what these people do, the fund-raising they do, the hours they give, and so I am wondering, has this been assessed? If it has, I would like to know what the conclusions are because I understand that two years ago, the government cut back the funding to this group.
Dr. Bouchard: In our assessment of our mental health services, we have not looked at the contributions by volunteer organizations or NGOs, so I do not have that information to provide to you. However, I certainly can look at what contributions we are making to those groups.
Within our community release plan, in terms of our strategy, we will certainly look at how we can facilitate better release and what type of interventions or linkages have to be made. We probably will be raising that issue more within that area.
Senator Callbeck: After having looked at the situation, I am telling you the $22,000 that was spent was some of the best use of government dollars. This group is just incredible.
Dr. Bettman: We are actually very fortunate to have across the country a substantial number of volunteers who work with the Correctional Services of Canada. One of our pillars of strength is that we have all kinds of volunteer groups and non-governmental agencies advocating on behalf of the offenders, working closely with us in all kinds of domains, whether it be leisure, recreation, even the delivery of programs. Again, it is something that certainly could benefit the mental health care of our offenders, but it is not one of the areas that would be the primary intervention for the mental health care needs of our offenders. However, it is certainly an important support, and I believe that that support is there.
In terms of funding for our volunteers, I am surprised to hear that we have cut funding. In the past few years, we have really worked hard to recruit more volunteers and have enhanced our volunteer capacity through memorandums to cabinet — effective corrections. Maybe in some areas it has been cut, maybe in some areas it has been expanded; but our volunteer area, as a whole, has grown substantially in the last few years.
Senator Callbeck: Perhaps, in view of time, I will talk to you afterwards about this particular situation.
The Chairman: We may try to get some data. Thank you all for coming. The fact that we are way over time is an indication of our level of interest.
Mr. Charko, I have just one question. When you talk about the percentage of people who are off on long-term disability, largely from depression and stress, I would love to have a breakdown of that by sex. My guess is that that is hugely biased in favour of women; that there are far more women in that group, just because they are trying to do two jobs: one at home and one at work. That is conjecture on my part, but if I am right I would love to know the data.
Mr. Charko: We will get that for you.
The Chairman: Thank you for coming. We will be in touch with you on a bilateral basis of some kind.
May I ask the next witnesses to come forward, and accept my apologies for being more than a little late? I noticed that you have been here for a while, so you can understand that there is no shortage of interest here. As I think you may have heard me say when we began, we have to adjourn at 6 p.m., so this may mean we will invite you back for another visit.
Since you have given us your opening statements, because I want to ensure we have time for questions, please hit the highlights and then we can have questions. We will begin with Brigadier-General Jaeger, who is the Surgeon General of the Canadian Forces. Thank you very much for coming.
Brigadier-General Hilary F. Jaeger, Surgeon General, National Defence: Since this is my first time appearing before you, I would like to cover some fairly broad ground. I will try to summarize the high points as we move through. I am accompanied today by Colonel Randy Boddam, who is the Canadian Forces practice leader for psychiatry and mental health, and he can fill in all the hows whilst I can describe the whats.
I would like to point out, and it may be evident to senators, but the CF is a distinct group of Canadians in many ways. Of particular relevance to this committee is the fact that the federal government has responsibility for, and authority over, all aspects of health care for regular force members from the time they join until the time they retire, and entitled reservists, including mental health care. For the roots of this, you can go back to the constitutional lawyers and look all that up, but it does give us a certain degree of control that not many other entities exercise over the totality of health care.
We believe in a very holistic look at mental health. We believe that it is that component of health that pertains to cognitive, emotional, organizational and spiritual matters, and is much more than the mere absence of psychiatric illness; so that sets us a fairly high standard.
You may or may not be aware that we have recently been fortunate in the Canadian Forces to have had the opportunity to engage in a systematic mental health care renewal. In engaging in this renewal, we are putting into place a model of mental health care delivery that considers all of these factors, and I will try to go into more details of that later.
Before we designed the model and attempted to put it into place, we needed to know what the burden of suffering was for members of the regular and reserve forces. We worked with Statistics Canada to develop the Canadian Forces supplement to the Canadian Community Health Survey, version 1.2. I think you have heard a lot about this survey, which examined the prevalence of certain mental illnesses, perceptions of well-being and use of services in members of the Canadian public at the same time that the CF supplement examined these issues in the Canadian Forces, giving us a ready basis for comparison.
I would like to share some of the statistical highlights with you. One can hardly think of mental illness in the Canadian Forces without thinking immediately about post-traumatic stress disorder. Therefore, it may surprise you to hear that this illness is not among the three most prevalent mental illnesses in members of the Canadian Forces. Depression is our leading cause of suffering, at 7.6 per cent in the year preceding the survey. Alcohol abuse or dependency hit 4 per cent, and social phobia 3.6 per cent. PTSD was 2.2 per cent and panic disorder 2.2 per cent — all in the regular force, which, generally speaking, has a somewhat worse incidence of mental illness than the reserve forces.
All told, members of the regular force reported annual prevalence of mental illness of about 15 per cent, compared to 13 per cent in the reserves. Those figures, while quite reflective of the suffering, do not include personality disorders or adjustment disorders, which also carry a burden of difficulty.
Although many of the conditions approximated the prevalence found in civilian society, there were important exceptions. Our prevalence of depression in the year preceding the survey was 80 per cent higher than that found in the general population. I think you have seen that reported recently in the media. Similarly, the lifetime prevalence, at any point in their lives, was found to be 60 per cent higher. The survey cannot tell us why this high prevalence has been found but it does give us valuable data on which to scale our response.
Concerning PTSD, we were somewhat challenged in comparing data with the civilian world, as Statistics Canada chose not to measure the prevalence of that disorder in the general population in the same survey. Fortunately, a research study had been conducted by the anxiety disorders group at McMaster University and found that their civilian lifetime prevalence was, within experimental error, the same as we found for members of the regular force.
Those prevalence figures tell only part of the story when it comes to understanding the toll mental illness takes. Mental illness ultimately can lead to the release of a Canadian Forces member and the disability associated with forms of mental illness can lead to time off work or the imposition of employment limitations. We have an advantage in that we can shape employment for our members to a degree that most people cannot. We can direct part-time work, we can direct work of less stress, and we can direct work of less physical stress. Leaving that aside, about 42 per cent of all sick leave days — sick leave is our expression for time off work for medical reasons — 42 per cent was for mental health issues, the leading cause of time away from work. There is a strong propensity for mental illness to be responsible for longer periods of sick leave for an individual.
More serious is the issue of medical releases from the military and employment restrictions. About 2,300 of our members every year undergo a review of their suitability to continue serving in the Canadian Forces. About 23 per cent of these cases every year are due to mental illness, and that perhaps is not surprising. They are disproportionately likely to end up being released from the Canadian Forces. Forty-two per cent of CF members who actually are medically released have mental illness as their primary diagnosis.
What has been and what is being done to address the needs of our members? Building on this knowledge about depth and breadth of mental health in the CF, the mental health initiative, which Colonel Beaudoin led under the auspices of our overall health care renewal project known as RX 2000, undertook an options analysis and, after obtaining departmental approval, is now embarking on implementation of an initiative that will roughly double the number of mental health providers available to CF members across the country. These providers will be working in an interdisciplinary team model involving psychiatrists, clinical psychologists, mental health nurses, social workers, addiction counsellors and chaplains, who share care responsibility with primary care providers and optimize preventive services by working closely with preventive health program authorities. By providing team-based care, we hope to reduce or eliminate the concerns that have been raised by CF members when they said that they had unmet care needs. That was in the same Statistics Canada survey.
We have developed standardized approaches to assessment and treatment of key conditions, and efforts are under way to ensure that all of our staff are equally comfortable with the preferred therapeutic approaches. The new initiative further seeks to fine-tune deployment-related psychosocial screenings to allow for earlier intervention, improve educational outreach services to monitor and conduct research, and to improve practices and measure outcomes. A significant level of new funding totalling $98 million over six years, has been committed to enhancing CF mental health care delivery.
Developing this care delivery system I have just described requires a significant infusion of personnel. I mentioned a rough doubling. While funding has been secured, we still have to face the challenge of finding the trained people to fill these positions. This is a major issue as, of course, for these positions we have to recruit professionals from the civilian sector, where we know that there is already an overall shortage of care providers.
Another serious challenge that faces us is our dependence upon the civilian health care system for acute intervention of our more severely ill. Psychiatric beds exist at a premium. We do not run our own, and we cannot always readily access such beds. This is a particular concern for us as the highly mobile nature of military careers means that support systems such as extended family and friends of long standing are less likely to be able to provide help when a member is suffering.
A concerned chain of command and the efforts of the Military Family Resource Centres can mitigate this somewhat, but a gap nonetheless remains. A challenge facing those members who release from the Canadian Forces is the transition to civilian care providers; sometimes they cannot be found. Even getting a family physician may be difficult, and it is a particularly serious problem when you are medically released with a mental health concern requiring regular follow-up.
Our relationship with Veterans Affairs Canada is critical to meeting the needs of patients suffering with operational stress injuries. Over the past few years, cooperation has deepened. I think you are all aware of the activities of the Centre for Care and Support of Injured, which is jointly run by DND and the CF. We now have a mental health steering committee with a joint chairmanship meeting regularly. We are working towards common assessment and treatment protocols and we have a memorandum of understanding allowing for limited reciprocal access to services. We are planning to further integrate our services for our mutual clients and have agreed, this past Friday, to the establishment of an interdepartmental project to assist us with this process.
CF members suffering with operational stress injuries such as PTSD want to be able to continue with the care provider or team with whom they have developed a relationship, even though they may no longer be members of the Canadian Forces. The vision is to have VAC mental health resources available to members of the CF where this makes sense, and CF mental health resources available to VAC where this makes sense. It is desired by us that blended staffing eventually take place. This is an example of one of the issues to be addressed by the new joint project. We are optimistic that great strides can be made.
In the Canadian Forces, we are mindful that closer integration with VAC, as positive a development as this is, will not bridge the mental health provider gap for all of our releasing members; only those whose disability meets VAC criteria for eligibility.
To summarize, mental illness causes significant suffering and loss of productivity among members of the Canadian Forces. Our health service has invested considerable effort into addressing this problem and the department is committing significant additional resources. These are very real and practical problems that we will be facing in the future, but we are hopeful. We believe ourselves to be on the right track as we implement the improvements that we have planned.
The Chairman: Thank you, General Jaeger.
Senators, our next witness is Brian Ferguson.
Mr. Brian Ferguson, Assistant Deputy Minister, Veteran Services Branch, Veterans Affairs Canada: Mr. Chairman, thank you for the opportunity to speak to your committee today.
[Translation]
This is perfect timing for us because Veterans Affairs Canada is currently working on improving the services provided to members of the Canadian Forces and to veterans suffering from operational stress injuries.
[English]
First, I will deal with the improvements that we are making under existing regulatory frameworks, that is the Pension Act and the Veterans Health Care Regulations, and then I will give you an overview of the activities that we are undertaking to better meet the specific needs of Canada's veterans.
Under the Veterans Health Care Regulations, if a need for health care is related to a pension condition, Veterans Affairs Canada will pay for those treatment benefits directly. For eligible veterans, we will pay for non-pension conditions if the service is not covered under provincial health care plans. With the exception of those services provided at our own Ste. Anne's Hospital, all health services provided to our clients are delivered either by provincial jurisdictions, non-governmental organizations or private registered providers. Through our network of regional and district offices, we have an ongoing relationship with provincial governments.
To our knowledge, Veterans Affairs Canada and DND are the only federal departments currently involved in responding to the specific mental health issues relating to Canadian veterans and still serving members. However, we both enjoy a very productive relationship with Health Canada, which provides us with a telephone assistance service for veterans and their families who find themselves in crisis situations and require counselling support.
I know your committee has provided three interim reports. We have reviewed those reports and they offer important evidence into the state of affairs in Canada. We look forward to your final report and recommendations later this year. We share many of the areas of concern that you have addressed in your reports.
For your general information, Veterans Affairs is responsible for providing disability pensions and health care to a little more than 209,000 clients, 18 per cent of whom are Canadian Forces members and veterans. Their numbers have increased 58 per cent in the last three years and we anticipate having more than 58,000 Canadian Forces clients by the year 2013.
I do not need to tell you that the growing incidence of post-traumatic stress disorder, PTSD, amongst our clients is a concern. We have more than 8,000 clients pensioned for mental health-related conditions. More than half of these clients suffer from PTSD alone, and the incidence among our younger CF members is increasing each year.
Given the time constraints for this appearance, we are providing you under separate cover a comprehensive slide presentation for the review of your committee. It contains some or most of the statistical information that the clerk requested that we provide.
Not only is the number of clients pensioned for PTSD increasing but so is the effort required on the part of our staff, and those of DND, to meet the complex needs of these clients. Let me briefly outline a situation that illustrates the need some of our clients face today. It fits in with some of the earlier remarks.
A forty-year-old male veteran was pensioned 80 per cent for PTSD related to his service in his special duty area. He is suicidal at times and his wife and children have left home in fear for their own safety. After being discharged from his local hospital, he was faced with a lack of medical resources to help him in his time of need, a familiar refrain. He called Veterans Affairs Canada and spoke to an area counsellor who worked with his local district office staff to explore options. We had to make arrangements with our partners in the United States to get him treatment, but then a local opportunity presented itself. Through our partnerships with DND and local medical practitioners, we were able to get him treatment at the local DND Operational, Trauma and Stress Support Centre, OTSSC. This client will be assisted through case management services at the local Veterans Affairs Canada district office to maintain contact with his clinical service providers.
While this case resulted in a successful outcome, it illustrates the need to improve immediate access to mental health care that is comprehensive, integrated and that delivers services consistently to a high standard of excellence. Currently VAC, like DND, must compete for scarce acute psychiatric services along with other Canadian citizens. For this reason, we are putting our emphasis on early detection and intervention to detect problems early and prevent acute crisis situations from escalating. Our district office health professionals can intervene on behalf of clients to assist them in receiving the appropriate acute care and monitor their progress after the acute phase.
We have already done a lot and plan to do more to address this need. I would like to state a few examples of what we have attempted so far. As previously explained, we have established a VAC assistance line in partnership with DND and Health Canada. DND and Veterans Affairs have established in Ottawa the joint centre that Ms. Jaeger mentioned for care of the injured and released members, veterans and families where veterans can have their requests for assistance expedited through a 1-800 number.
VAC and DND have established case workers on a major basis across Canada to achieve early identification of the transitional needs of clients, including their need for disability assistance. We are establishing a network of operational stress injury clinics across the country with St. Anne's Centre as the clinical lead. Three clinics in addition to St. Anne's have been opened in the last year with good results, in London, Ontario; Winnipeg, Manitoba and Quebec City. These clinics are part of a joint VAC-DND mental health strategy announced in 2002 by the then ministers of the departments. They are affiliated with DND's five operational trauma and stress support centres and our goal is to ensure seamless and consistent treatment and care to both serving and released members.
Other components of the mental health strategy include educational fora and continuing education. We know we need to continually educate our staff and keep them up to speed with changes to services and programs designed to meet the needs of our changing clientele. Therefore, a critical part of our mental health strategy focuses on increasing the capacity of health care providers, and specializing in PTSD and other operational stress injuries. We have done both within the military structure and the civilian medical community.
VAC has also actively supported the establishment by DND of the Operational Stress Injury Social Peer Support Program. This is an interesting program. The peer support program is made up of Canadian Forces members and veterans across the country who have experienced an operational stress injury themselves, and who want to help others heal and recover. DND has established 13 peer support coordinators located across the country and, to date, they have helped more than 1,400 clients. This network uses a large number of volunteers and we have a brochure we will circulate to the members that shows some of the work volunteers do in helping with these peer support coordinators. We conduct research in the area of operational stress injuries and have an excellent partnership with DND and others in this area.
For telemental health, VAC is working with Memorial University School of Medicine in Newfoundland to extend existing telemedicine services to VAC clients through community providers starting in Newfoundland and Labrador. Learning from the Newfoundland experience will facilitate extension of telemental health services to other regions.
Our partnerships in this issue extend beyond our own country's borders. We are working internationally with our partners in the United States, United Kingdom, New Zealand and Australia in a senior international forum to establish international protocols for the prevention, assessment, treatment and follow-up of operational stress injuries. Also, a joint collaborative venture is in progress with the United States Department of Veterans Affairs on education, and we have undertaken a contractual arrangement to expand the World Health Organization Educational Program to include a module on PTSD.
I know I have said a great deal about all that we have done to address the mental health needs of our clients, but we know that there is more that needs to be done. We are committed to improving access to treatment for our clients, improving continuity of care and case management services and expanding the knowledge of qualified service providers, both inside the department and in the community. Working with DND, as Hilary Jaeger has mentioned, and provincial authorities, we hope to achieve an integrated network of support for veterans suffering from operational stress injuries by utilizing our joint resources and ensuring that our medical practitioners follow standard diagnostic and treatment protocols. Good mental health is a critical component in the veteran's successful transition to civilian life.
My remarks that I am tabling contain details concerning our services to the RCMP, but in the interests of time, Mr. Chair, if you agree I will forego those remarks and go to the end. Thank you for inviting me here today.
[Translation]
Senator Pépin: I would like to point out that I have great respect for the Canadian Forces. I have been working with groups of military families for the past four or five years. I am aware of the excellent work that you do.
You mentioned certain newspaper articles; we are also reading them. Concerning mental illness, it was pointed out that it is important to be able to ask for assistance in the beginning, when symptoms first appear. Of course, we sometimes have the impression that mental illness is rather a taboo subject with the military, one that no one wants to talk about. The perception is that people in the military will not ask for help because they are afraid of losing their jobs. They fear losing their careers. What one reads in the newspapers gives the same impression.
There has been a cultural shift as far as this illness is concerned. You gave us some statistics for people suffering from stress; can a serviceman who has been treated and is recovering come back? If I understand correctly, the majority of them leave the service. Can they return to the army and continue their careers? It would be important.
In the documents that you distributed to us — I thank you for the fact that they are bilingual — it states that 15 per cent of the clients coming out of the Canadian Forces are not collecting a disability pension related to psychiatric problems and yet are reporting related symptoms; and 10 per cent more are showing symptoms.
If they are not receiving a disability pension, how many years of service do they need to be entitled to a disability pension or some other insurance?
You told us that you also deal with the veterans association in the United States; who looks after them? Can they return to their jobs? What happens to the people who leave their jobs and who are not entitled to a disability pension? How many years does it take to be entitled to a disability pension?
[English]
BGen Jaeger: I will try to address your question in an organized fashion. If I conveyed the impression that most of our people who have mental illness issues end up being released, that is not the impression I wanted to convey.
Senator Pépin: It is published in the media.
BGen. Jaeger: That is not the case. The vast majority of people who present with a mental illness receive appropriate treatment and go back to work. They are invisible to everyone else. We would like to have a spokesperson that is willing to stand up and say, ``I did that.'' We have General Dallaire, who has been an eloquent spokesperson for post- traumatic stress disorder and operational stress injury, who did end up having to take his retirement from the Canadian Forces. However, we would like to have a public example who is willing to be a spokesperson from the other side. With confidentiality concerns, we cannot force people to do that. We can only ask for volunteers.
On the question of pensionability, if you are medically released from the Canadian Forces at any point past 10 years of service, you are entitled to an immediate annuity based on the number of years of service, 2 per cent per year of service. If you are released after 16 years of service, it is a 32 per cent pension indexed to the rate of inflation. You are entitled to the Service Income Security Insurance Plan, SISIP, which augments that to 75 per cent of your salary but only if you meet their criterion, which is all-occupation disability. It is a stringent disability to meet.
If you make the case with Veterans Affairs that your disability is attributable to military service or has been exacerbated by military service, you will receive a favourable response from their administrators and would be eligible for whatever per cent disability you end up being awarded. Does that answer the question?
Senator Pépin: We see more and more members of the military, and they are so young.
BGen. Jaeger: They are not as young as they used to be.
Senator Pépin: I am seeing cases who are 19 and 20, and when they are coming back from a mission, we know many of them suffer from stress.
Mr. Ferguson: You have raised an important issue for Veterans Affairs Canada. You mentioned our handout that said 15 per cent of Canadian Forces clients without a psychiatric pension reported symptoms consistent with PTSD. This handout was the result of a survey whereby we canvassed Canadian Forces members and ex-Canadian Forces people and we found that 15 per cent of them that had the symptoms of post-traumatic stress disorder but never applied for a pension. That deals with the argument that people use this as a route to get into the pension process. There are at least 15 per cent of them who have never applied.
The other point that many members of the military need assistance for transition into civilian life has been the subject of a major study by the Canadian Forces Veterans Affairs Advisory Committee. That report resulted in the two then-Ministers of Veterans Affairs and National Defence stating that we will look into the recommendations and attempt to figure out an improved re-establishment program, and we are working on that and consulting on it. I would commend that report to the committee because it is relevant to the whole mental health issue, the idea that good mental health is important for re-establishment, and that good re-establishment programming is important for mental health.
Senator Cook: I have two questions. One for Mr. Ferguson: I want to ask you, does the department have a specific program to cover areas of mental health and addiction falling outside the provincial/territorial health plans, and how do you address the needs of your aging population?
For BGen. Jaeger, I want to ask you: Is there a particular reason why members of the Canadian Forces are specifically excluded from the Canada Health Act? Does the Canadian Forces Health Program have a special legislative base? Lastly, have you developed any specific policies for mental health services and addiction treatments within the military, or do your members need to go outside the loop to the community at large?
Senator Cochrane: What percentage of the overall members would have these mental health problems? Then, what percentage of those people with mental health problems who have received treatment for that concern — how many of them returned to work, and worked on a normal basis?
I understood that at one time the Veterans Affairs people would get a percentage of the beds in hospital. Do you still do that? If so, perhaps you would elaborate on that. Also, with regard to your mental health issues, perhaps you would do the same thing. How do you get into these institutions? Is there a special number of beds or spaces set aside for veterans affairs?
[Translation]
Senator Gill: What are we supposed to say in French? ``Brigadière'' or ``brigadière-générale?''
BGen Jaeger: ``Brigadier-général.''
Senator Gill: There is no problem in English. Some things have always struck me; among others, I always remember the American soldiers who returned from Vietnam. I would like to ask you a question related to this situation. Generally speaking, in Canada, we want our soldiers, our army, to be peacekeepers who build peace and maintain security in the countries where they are deployed.
However, I am a layperson; we continue, nevertheless, to train our soldiers, I imagine, for war. Does that not create certain problems in the Canadian Forces when these service members return — in that they are trained and mandated for peacekeeping, but they are still being trained traditionally for war?
My second question deals with Aboriginals, former members, and veterans. I would like you to take a serious look at this issue, because it is something that concerns me a great deal. I have been told that there are aboriginal veterans who were never recognized as such and who do not receive services as veterans. People have told me this, but I do not have any statistics. I will find those numbers some day. If you could shed some light on that for me, I would be very happy. I have been told that some people who went to war from 1939 to 1945, and others who were older, and whom I knew, were never considered veterans and never managed to receive veterans' pensions.
[English]
The Chairman: I have four questions.
Mr. Ferguson, we have found out from civilian consumer survivors the huge value that they place on peer support groups. No government anywhere that we can find offers any financial support to peer support groups. In the questionnaire we put on our website — and we got over 500 responses, which is amazing given the way we did it — it was very clear that peer support may be the dominant service that they want to have.
Given the fact that you said you had a brochure, any information that you have, any attempt that you made to evaluate the peer support — we have a dearth of information and we need some help, so anything you have would be great.
The second question is related to that. This is not because we have two Newfoundland senators on the committee. We have been looking for data on telemental health actual experience. Since the only one that has been run is in Newfoundland, at Memorial — am I wrong?
Colonel D. R. Boddam, National Defence: There has been telemental health experience in other parts of the country. Toronto and Hamilton, for example, have engaged in telemental health projects. In addition, a few years ago, I was presenting at the Alberta Psychiatric Association and they had a specific presentation on the Albertan experience.
The Chairman: If you can direct us to where to find that, anything you either have or can tell us where to go would be welcomed.
For the Canadian Forces, in the Statistics Canada survey, I was not surprised when you said that Canadian Forces members tended to avail themselves of services more than their civilian counterparts. My guess is — and you can tell me if I am right or wrong — I believe if they do that, you pay for the service. In other words, where psychologists typically are under an EAP program, it is only six visits a year or something like that. How much of that difference in the percentage is driven by the fact that it is a free service to your members and not a free service to others?
Perhaps there is something that we can learn from the fact that there is not quite the stigma attached to seeking help among your members than there is among the general public? If the latter is true, have your people conducted an education campaign, something that has an impact on stigma, because the broad issue of stigma in the public is enormous. We have had consumer survivors tell us that the stigma they suffered was worse than the mental illness they had in the first place. Depending on what the reason for that is, whether it is money or attitude, it would be helpful for us to understand either of those issues.
Finally, just a comment on your PTSD numbers. I agree that your data shows it is a small number, but one chart you gave us showed that it had gone up by 500 per cent in five years. That dramatic an increase, even from a small base, is bound to attract a lot of comment just because it is so escalating.
I should just tell you, on the record, that we had a terrific visit at St. Anne's, and with your chief medical officer there, particularly on the issue of Alzheimer's disease.
If you can answer all of those questions in the seven minutes we have left, that would be great. Seriously, what we will do is have each of you make some brief comments and we will adjourn so that our colleagues have the table for six o'clock, and then you can give us notes. However, we may also have you come back and continue the discussion.
Mr. Ferguson: We provide the same basic approach for aging veterans and for younger veterans with mental health. We have case workers within the department, and we track where they are in the particular development of their illness. If they have a pension condition and they require treatment, we pay for it; and we keep track of the treatments that are made on their behalf. The short answer is that we have a caseworker system and we can provide you with more detail on that, if you would like.
On the Aboriginal veterans, if I may — and I will check to make sure if I missed any in my remarks — we will get back to you.
Senator Cook: The insurance question is the one I was asking. Do you have any specific insurance plans for people who fall outside the territorial/provincial health insurance plans?
Mr. Ferguson: We do not have those at the moment. That has been raised as an issue in the report I referred to earlier. We have received that report, and we are studying it to see what we can do in those areas.
The Chairman: We will send all three of you a transcript so that you can give us the answers.
BGen. Jaeger: I will leave aside the legislative questions. We will send you notes and also copies of all of our policies that underpin mental health services. On the percentage of overall members who have mental health problems, if you take an annual incidence, it is about 15 per cent; if you take a lifetime incidence, then between 30 and 35 per cent will have a diagnosable mental illness. It varies a little bit from component to component.
What percentage of those return to work after treatment? I will ask Col. Boddam to make an educated guess.
Col. Boddam: I would say that a majority of them return to work. As BGen. Jaeger was saying, about 300 CF members per year are released medically for mental health reasons. If you look at 15 per cent of 50,000, then 7,500 people have it. Therefore, only a very small number of people are medically released as a result.
BGen. Jaeger: On the question about role confusion between warrior and peacekeeper, and whether it is causing undue stress, more specific than that is being placed in situations where you feel that you have no power to act. You think ethically you should act, but there are artificial constraints placed upon you. The difference is not necessarily between the warrior culture and the peacekeeper cultures; they are happy to be peacekeepers if they are given the tools they need to influence the system in terms of the right rules of engagement. That is the approach I would take to that, although Col. Boddam is much more qualified to speak on the internal wiring and what goes on in people's thought processes.
We are funding the operational stress injury support network. We pay our peer counsellors; there are also volunteers who do extra work over and above that. I could not tell you that the budget is.
The Chairman: You may have a model that many of the provincial governments ought to think about.
BGen. Jaeger: There is a senior officer in the Canadian Forces charged with organizing that network. He has a small staff and they hire peer counsellors who are veteran survivors.
Mr. Ferguson: We had the co-manager here with us today.
BGen. Jaeger: In terms of people availing themselves of our service, yes, we do better than the civilian stream; but our data would suggest that about half of the people who do have issues are not coming forward to seek help, so we are still working on that. Is there a stigma? There is less than there used to be, but I am concerned that we are creating a two-tiered category of mental illness. It is perhaps acceptable to have an operational stress injury or PTSD; it is not acceptable to have ordinary depression in the military. We are working hard to get past that perception. It is almost a badge of honour to have OSI, or operational stress injury, but you are just weak if you have depression. We have to work hard to have a single approach to all our mental health issues.
The Chairman: Let me add one last question. I am troubled by the fact — I think Col. Boddam said — that you release roughly 300 people yearly for mental illness reasons. They go into a civilian system that is abysmal. In many ways, they would get better treatment if they stayed in the military. Maybe I cannot ask you this, but I would like to know what sort of obligations you think you ought to have — as opposed to legally have — to look after those people once they have gone? In a sense, if their mental illness had in any way been related to being employed by you, there is a moral obligation, if not a legal one. I would ask you to think about that.
Col. Boddam: You are asking a huge question. This is, in fact, one of the reasons we have set up a project to work with VAC. For those people who have sustained a mental injury as a result of their employment, we wish to work together to be able to provide that continuity in a seamless way, from where they start to get care to when they become civilians.
The Chairman: The point I am making is that if someone was under stress and had heart trouble, he would get good care on the outside. If someone has a mental problem, he will not get good care on the outside.
Col. Boddam: That is a fair statement because we are dependent upon the civilian system once the person exits from us. Many of our practitioners have private practices or work in the civil sector as well, so sometimes they are able to get in; but we see that as a huge gap that we wish we had some sort of magic wand to address.
BGen Jaeger: We have a group of people called case managers who start working with our people once we know that they are most likely to be released. About six months ahead of time. they start looking, combing the civilian world —
The Chairman: Looking for help.
BGen Jaeger: Looking for services to help them transition out.
The Chairman: I thank you for coming. We will have you back.
Senators, before we leave, I need a quick motion for an $8,000 amount in our legislative budget. It turns out that with respect to the E-consultation item in the motion we put through before, I did not name the firm that is involved. It is a firm called Ascension, which has been picked by the Library of Parliament, not us.
Hon. Senators: Agreed.
The Chairman: The motion is passed. Thank you.
The committee adjourned.