Proceedings of the Subcommittee on Veterans Affairs
Issue 5 - Evidence - June 9, 2010
OTTAWA, Wednesday, June 9, 2010
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:05 p.m. to study the services and benefits provided to members of the Canadian Forces; to veterans; to members and former members of the Royal Canadian Mounted Police and their families (topic: implementation of the New Veterans Charter).
Senator Tommy Banks (Chair) in the chair.
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The Chair: I call the meeting to order. Good afternoon, ladies and gentlemen. This is a meeting of the Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence, which is dealing with an examination of the New Veterans Charter, in all of its aspects and the ways in which it can be improved or whether it is all fine.
We have with us today in Ottawa, Ms. Nathalie Pham, Manager of the Client Service Team for the Montreal District Office of Veterans Affairs Canada. We wanted to get people close to the ground who can answer questions and these are the people who are actually doing it. We also have with us Ms. Katherine Richards-Solc, Manager of the Client Service Team in the Kingston District Office of Veterans Affairs Canada. We will be joined by teleconference by Dr. Don Richardson, Consultant Psychiatrist at Ste. Anne's Hospital, just outside of Montreal. As we all know, a great deal of treatment for veterans and serving members happens there.
Doctor Richardson, I hope you have the time to spend with us. We are here until 1:20. Are you in London now?
Dr. Don Richardson, Consultant Psychiatrist, Ste. Anne's Hospital, as an individual: No, I am at Ste. Anne's Hospital.
I will introduce myself, talk a bit about my background, and then leave it for the other people to speak. I currently work at the Parkwood Operational Stress Injury Clinic in London, Ontario, as a Consultant Psychiatrist. The other role I have is the Consultant Psychiatrist for the Clinical Expertise Sector at Ste. Anne's Hospital, which is with the National Centre for Operational Stress Injury, OSI.
I have served both those roles and, for the past 10 years, I have done both clinical work and research in the area of military-related PTSD and other operational stress injuries.
The Chair: Is there anything you would like to tell us beyond telling us what you do? Do you have an opening statement with respect to the New Veterans Charter, or can we proceed with our other witnesses and go directly to questions?
Dr. Richardson: You can proceed to the other witnesses.
[Traduction]
Nathalie Pham, Manager, Client Service Team, Montreal District Office, Veterans Affairs Canada: Good afternoon, everyone. Thank you for inviting me here.
Just to introduce myself, I started working with Veterans Affairs Canada in 2006, at the same time as the introduction of the New Veterans Charter. One of my first duties with the department was to foster a better understanding and ease the transition to the New Veterans Charter, in terms of philosophy, principles, and programming and case management approaches.
In 2009, I had the opportunity to manage a ``client service'' team, near the Saint-Jean-sur-Richelieu garrison, whose purpose was to improve Veterans Affairs' interaction with our clients in order to deliver a continuum of services and establish a partnership between the Department of National Defence and Veterans Affairs Canada.
I have recently returned to the Montreal District Office and I am managing a ``client service'' team that works with our clients on the administration of programs and case management under the New Veterans Charter, and also with other health professional members of the interdisciplinary team.
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The Chair: Ms. Richards-Solc, would you tell us the view from Kingston?
Katherine Richards-Solc, Manager, Client Service Team, Kingston District Office, Veterans Affairs Canada: The view from Kingston is quite fine. I am the Client Service Team Manager in the Kingston District Office. Like Ms. Pham, I am relatively new to the department; I have been with the Kingston District Office for two years. I manage a team of approximately 20 staff. We also have a relationship with the staff at the new IPSC, which was stood up in January.
The Chair: Could you spell out IPSC for the insomniacs who watch us at 2 a.m.?
Ms. Richards-Solc: Yes, with my apologies, Mr. Chair. I realized when I came to the department that I quickly had to adopt acronyms, which I forget leave at the office. An IPSC is an integrated personnel support centre. The IPSC in Kingston is unique in that it is located off base. It has quite an interesting program. The success has been good in that new venture.
I am pleased to be here to answer questions. I feel strongly that the work we do on the ground is very important, and that we do good work with the clients. I hope we have a chance to share that with the committee.
The Chair: I have a couple of questions for clarification. Is the sense in which the teams are integrated the sense in which they deal with both serving members and veterans?
Ms. Richards-Solc: The IPSCs are units unto themselves to deal with the members who are injured. The arrangement between Veterans Affairs and DND is to provide staff on-site at the IPSCs to provide the concept of ``one-stop shopping.'' The veteran, the family, or the still-serving member can walk through the door and make use of a number of services. VAC is one of those services.
The Chair: Dr. Richardson, I have one question before we go to questions from members. We are studying the New Veterans Charter and the way in which it affects veterans. At times, the best answers we have received have come from those who are involved directly at the receiving end of services. At times, we have difficulty in learning who they are. Can you suggest a way that the committee, perhaps with your assistance, might identify and contact appropriate clients of the New Veterans Charter? Can you suggest how we might contact clients who would be prepared to meet with the committee to discuss their experiences, whether positive and/or negative, with respect to the NVC?
Dr. Richardson: One suggestion is to access the network of operational stress injury clinics. For example, at the Parkwood OSIC, most access to clients is done through the director of communications. At Ste. Anne's Hospital, Ann Kay is the Director of Communications. To date, such requests have come from members of the media who want to interview patients of our clinic. We put their names through the communication director, who takes care of that. The communications director might provide the opportunity for the committee to access the appropriate clients or patients.
The Chair: Would you say her name once again?
Dr. Richardson: She is Ann Kay, Director of Communications, Ste. Anne's Hospital.
Senator Dallaire: Should we choose to seek such witnesses, I would recommend that the committee invite the operational stress injury support organization to appear. OSIS has offices located across the country in support of both veterans who are out of the Canadian Forces and under VAC and veterans who are still serving under DND. I noticed at Parkwood that World War II veterans attend the support office on site. It is likely that we would find a good cross-section of potential witnesses if we were to inquire at Parkwood.
Dr. Richardson: I agree. We have a peer support coordinator at the Parkwood OSI clinic through OSIS. That would be a good opportunity to find individuals who are not seen by clinicians but who have access to peer support.
Senator Meighen: During my term on the committee, which has been a number of years, we have never been to Parkwood, although it is an important facility. That facility is deserving of a visit for the reasons that the good doctor and Senator Dallaire have raised.
The Chair: We will consider such a visit in the fall.
Senator Wallin: For clarification, we get into these conversations with veterans and soon-to-be veterans, injured personnel who are still serving and people who are waiting for adjudication. You talked about your offices in both Montreal and Kingston. I am particularly interested in the Kingston office. Do you deal with the veterans and CF members off site?
Ms. Richards-Solc: That is correct. We have a district office in Kingston that is staffed by VAC. We also have VAC staff at the local integrated personnel support centre, which is off base. We have staff in two locations. At both locations, we deal with current CF members and veterans.
Senator Wallin: You are working toward developing the other services so that physically the other programs are represented there. Do you attempt to manage and direct them to some other location or some other phone number?
[Traduction]
Ms. Pham: Similar to the view from Kingston, there is also the Integrated Personnel Support Centre for services offered by Veterans Affairs Canada. The centre is three kilometres from the Saint-Jean garrison. And we want to offer the whole range of services. Existing military personnel, those newly discharged and our traditional client base can have access to services when they go to that centre. We want to make sure that everyone in the community receives the services they need.
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Senator Wallin: Dr. Richardson, VAC runs five residential clinics and 10 treatment clinics for mental stress injuries. Is that correct?
Dr. Richardson: Yes, there is a network of outpatient operational stress injury clinics funded through VAC, and there is the network of five clinics under DND.
Senator Dallaire: It is not clear. There are 10 in total, of which five have in-clinic access. Is that correct?
Senator Wallin: I am asking that question. Perhaps, as I read it, there are five residential treatment clinics, plus another 10 clinics. Are you saying that the total number is 10 clinics or 15 clinics?
Dr. Richardson: We can get the exact numbers. Under Veterans Affairs, there are clinics in Fredericton, at Ste. Anne's Hospital, in Ottawa, in London, in Winnipeg. As well, there are clinics in Edmonton, Calgary, Vancouver and at Parkwood.
Senator Wallin: I am trying to clarify because there is a language difference. There are 10 clinics, nine of which are outpatient, which you described. The tenth clinic is in-house at Ste. Anne's Hospital. Is the total number 10 clinics?
Dr. Richardson: Yes, 10 clinics fall under Veterans Affairs Canada.
Senator Wallin: As compared to?
Dr. Richardson: DND has outpatient operational stress injury clinics that number five in total.
Senator Wallin: Can you describe the difference, from your point of view, in the nature of the service or the delivery of the service? I mean between the DND clinics and the VAC clinics.
Dr. Richardson: I will focus first on the clinic where I work at the Parkwood operation. At the DND clinic there may be slight changes of which I am unaware.
At the outpatient OSI clinics funded through VAC, we provide services to veterans, currently serving members and eligible RCMP individuals who have suffered an operational stress injury. We only provide services to those individuals, so we are not a general mental health clinic.
My understanding on the National Defence side, which are not called OSI clinics but they are similar clinics, is that they are part of the comprehensive mental health treatment. If someone is referred to those clinics for depression and during the assessments, they find out that the person also has post-traumatic stress disorder; the person could be referred to the operational trauma and stress support centre, OTSSC, which is a specialized part of the mental health clinic.
Senator Wallin: Do either of our guests here have anything to help clarify, or is that clear?
Ms. Richards-Solc: That is outside of our realm, other than we facilitate referrals to the various clinics, the locations and so on.
Senator Wallin: Do you do that based on geography as opposed to service?
Ms. Richards-Solc: Often it is based on need and the availability of spaces and, again, where the client lives.
Senator Wallin: One of the notes I have here states that Veterans Affairs actually is helping 12,000 veterans and their families today with mental health conditions, 2,900 of whom are treated in specialized clinics.
Does that mean of the 12,000, when it is described as treated in our specialized clinics, are they going there regularly? Do they live in, as in a residential setting? What would account for the most, then, the 9,000 of the 12,000, how would they be receiving service?
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Ms. Pham: When we talk about a specialized clinic, we mean operational stress injury clinics. For example, we have two clinics for the Quebec region. One is the National Centre for Operational Stress Injuries at Ste. Anne's Hospital, and the other is in Quebec City, near Valcartier, so that clients can have greater access.
The frequency of service is based on the recommendations of health professionals in the clinics. It depends on who the consultation is with. At the National Centre of Expertise, we are fortunate to have services specifically developed for our veterans, such as a pain management clinic, a residential program or a stabilization unit. But some clients will also use services in the community or through providers who offer services to veterans, which helps to meet the needs of all the clients.
In terms of accessibility to services, we are trying to take into account the client's geographical boundaries so that transportation is available for everyone. But, in some cases, clients will have to go to the National Centre of Expertise for services that are not necessarily offered at other operational stress clinics.
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Senator Wallin: Are there different levels of service and treatment available at different places?
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Ms. Pham: All operational stress clinics across the country use the same approach. They all fall under the National Expertise Centre at Ste. Anne's Hospital. But residential and stabilization programs may not be available at the other clinics.
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The Chair: Before we go to Senator Pépin, the IPSCs are functions of the Department of National Defence; am I right?
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Ms. Pham: Yes.
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The Chair: The Canadian Forces run the integrated personnel service centres, but you are in them, you said; you are working there. VAC does not actually control what happens in an IPSC. If we were looking at who is actually in charge here, is it right to say that the DND runs the IPSCs — I am sorry for the acronyms, honourable senators— and not VAC, and that VAC is providing services in them? Have we got that straight?
Ms. Richards-Solc: The IPSC have a director and traditionally, the director is a member of the military. In Kingston, a member of the reserves is the director at that location. A number of staff members at that facility are either still serving members or ex-members. Veterans Affairs also provides staff. While DND has the responsibility for the operation, the exact title of which escapes me, I believe there are memorandums between both departments to speak to how they are run, and there are links between Veterans Affairs and DND in this way.
Senator Dallaire: In 1998, we started one integrated capability here in Ottawa, with DND and Veterans Affairs, created an MOU and they were co-located and functioned under a lieutenant-colonel. Violet Parker was at the director level I believe. That concept simply matured and has now gone across the country, thanks to General Semianiw, plus other assets. It is a cooperative entity, not just co-located, because they are handing files over to one another.
What is not solved is that they have their computers and all their stuff, and DND has their computers and all their stuff, and those two computers are not talking. That in itself is an enormous handicap on maximizing this extraordinary integrated capability that has been brought about.
The Chair: We are heard that before, and wondered why, for how many years now, it has not been fixed. We will wonder again.
Would you like to say something about that?
Ms. Richards-Solc: It is my understanding that it is in the works.
The Chair: Do not say those words, please. I could search the archives and find out how long ago we were told that it was in the works.
Ms. Richards-Solc: I believe it is closer in the works than last time.
The Chair: We all very much hope so.
[Traduction]
Senator Pépin: Are those services also offered to the veterans' spouses?
Ms. Pham: Absolutely. When we deal with the clients, we also include their families — spouses and children.
Senator Pépin: How many cases is a manager able to handle, since there seems to be some difficulty? People have complained that they had a hard time reaching case managers.
Ms. Pham: With the introduction of the New Veterans Charter, your question has been studied and so has the question of service delivery. We are worried about the quality of services provided to the clients and their various needs.
We must review how many clients a case manager can take on in order to be able to meet the various demands, which also fluctuate in intensity.
Senator Pépin: What are the three main problems a case manager has to face? What are the three main problems that require your attention the most?
Ms. Pham: In terms of fieldwork?
Senator Pépin: Yes.
Ms. Pham: It all depends on the types of clients. Case managers tell us that one of the challenges for them and for the clients is the transition to civilian life. They must take time to help each person and consider all the various facets that make up the person.
Senator Pépin: Given how long that task takes, do you perhaps have too many clients for each manager? Should there be more managers to facilitate the process?
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It seems that maybe those people are overworked. Do you believe you need more people to help?
Ms. Richards-Solc: I think that most people in any kind of government or industry would agree with receiving new resources. We serve clients in the best possible fashion we can. Additional resources are always welcome.
In addition to what Ms. Pham was saying about time, another challenge is when the veteran returns to Canada from service. There is a transition period where it is difficult for the individual to think about the future. They are simply dealing with their present situation. Even if we had all the staff in the world, we have to guide the person through the process and assist that person in making a successful transition.
Resources are an aid. However, I think the Dr. Richardson could speak to the fact that time is an issue for clients to process the transition themselves.
The Chair: Dr. Richardson, would you like to comment on that question?
Dr. Richardson: I agree that the transition for many individuals from serving in the forces to civilian life, especially if they are suffering with mental health problems, will be a challenge. It takes time, not only to adapt, but treatment is also time consuming.
Senator Dallaire: We know what you say has been the case. People have been falling through the cracks between DND and VAC for nearly 15 years. Who does research to try to build the bridge to facilitate that capability? Who ensures you put assets forward?
We often hear from veterans that they seem to always have to beg for information versus it flowing to them on a continual basis. They feel someone owns their case. It is also part of the psychological issue.
Dr. Richardson: You raise a good point. I am not aware of anyone doing that type of research. On both the veterans and civilian sides of the equation, it is an issue of identifying that you have a problem and then accessing services. The challenges, especially when you are depressed or have anxiety, are how you come forward to ask for those services and who is there to support you to obtain the services you need.
[Traduction]
Ms. Pham: I am not aware of the studies conducted by Dr. Richardson. But I can confirm that, in the field, the Department of Veterans Affairs is making a considerable effort, on an operational level, to be more proactive with all the clients who are getting ready to enter civilian life. Before military personnel is discharged from the Canadian Forces, we are there working with the case managers from the Department of National Defence. We participate in the transition interviews before the release to make sure the clients know about Veterans Affairs Canada. We also participate in various symposiums, through partnerships and presentations, to make sure those people know what services we offer. After the clients' discharge and the transition interview, we do a follow-up to present the programs and services we offer. When the person goes back to civilian life, we also do a follow-up to ensure their needs can be addressed.
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Ms. Richards-Solc: I want to add that there have been recent developments in the Kingston area. The Royal Military College, Queen's University, hospitals, some facets of Veterans Affairs and the military are establishing what will be called the military health initiative. It will study some of the issues Senator Dallaire addressed with regard to the gaps in veterans health care and various issues pertaining to the family and client. This arose from a military planning day initiated last fall in Kingston at the base.
Senator Meighen: The presence of a spouse from clinical and other perspectives is helpful in the rehabilitation process. We have heard evidence that for various reasons, it is not always easy to obtain the participation of the spouse. Has your thinking or actions in this regard changed in an effort to ensure that both partners are involved? You may not even know the spouse's address or that their spouse will see you. Is there anything you have done or can do in this regard?
Ms. Richards-Solc: In that particular case, Senator Meighen, we have to respect the client's wishes. We have to look at each individual situation on a case-by-case basis.
Senator Meighen: That is always the problem.
Ms. Richards-Solc: It is a problem and it is also part of the solution in allowing clients to look at their individual situation. This is where case managers come into play. A blanket approach does not apply to every client; case managers look at the situation.
In some cases, clients do not want their spouses involved. In some cases, spouses prefer some distance because of their need to deal with their particular situations or family situations. On the other hand, there are situations where families want to be totally involved.
Case managers look at each situation and, as necessary, provide individual counselling. The case manager can meet with the family member as long as he or she does not divulge particular confidences unless the client agrees. At the same time, we can refer the family member to resources like the family peer support coordinators, et cetera.
The approach is individualized because each situation is different. We deal with estranged families, families of second marriages and mixed families. Each situation must be addressed individually.
[Traduction]
Ms. Pham: We invite families to get involved right through the transition process. Our philosophy is to consider all aspects of the person throughout the case management process. Family is at the core of the interventions. Under the New Veterans Charter, we work medically, psychosocially and professionally. Family is really at the core of the psychosocial aspect. Spousal and parental roles are very important.
We have been successful across the country. As my colleague pointed out, in some cases, in the beginning, the person is not always open to what is being offered. The case manager's role is to work on getting the family involved. In a number of cases, success was achieved at the psychosocial level when the spouses were also able to benefit from the new charter programs.
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Senator Meighen: Do not take it this as a criticism, but is your work largely reactive instead of proactive in the sense that you deal with the people who come to see you. I ask because one of the problems that has come before us, and which we are not sure how to solve, the service members — and it particularly pertained to the reservists, but not necessarily — go back that to their communities, which often are not London, Montreal or Kingston. They must go to you.
Do you have any mechanism to get in touch with those people and deal with them if they are having problems, or do you have to wait for them to wave their hand?
Ms. Richards-Solc: We try to be as proactive as possible. We cannot seek out clients. It would be ideal if we could put up a banner and ask them to come, but we do not to that. We do linkages with the various organizations within the community, such as our legions, as Ms. Pham mentioned earlier. We also do presentations to the various reserve units on a regular basis. We go out into the community to do those presentations, so that the message gets out and the clients are made aware of the services available to them.
We also link with the operational stress injury groups, and again the linkages with the IPSC increase our potential for outreach in the community. We have recently taken an initiative with homelessness where we sent out much of our documentation information about our programs to food banks, homeless shelters and soup kitchens, so we could reach out and possibly link up with individuals who might be able to access our services.
Senator Meighen: What about the police?
Ms. Richards-Solc: The police, as well, yes.
Senator Meighen: The police are aware that you exist? If they pick up someone who is obviously distressed, they would know how to put that person in touch with you?
Ms. Richards-Solc: Yes.
You referred to the centres. However, as Ms. Pham and I both experience within our communities, linkages are important in urban settings, but perhaps even more so in rural settings. Therefore, we try to get out and help make the VAC name known so that, if someone has a question, he or she can come forward.
Senator Meighen: I was struck a few years ago, when we visited a clinic in Calgary and saw it was in a shopping centre. Are most of the clinics we are talking about in or part of hospitals or are they located elsewhere?
Dr. Richardson: I think the majority are located within a hospital network. Parkwood is within a hospital, for instance. Some of them might be in an extension, but I think the one in Calgary and the one in Quebec City are the two located completely off site.
I also want to add a comment on how we can be more proactive. We try to publish in journals, for example, to give Canadian physicians general information on the effects of trauma on military personnel for them to sensitize themselves. In that way, if they have patients, they can ask whether they have ever served in the military or been deployed.
If those patients have difficulties, it would open the door that there is treatment available from the family physician side. We try to publish and provide information, so they can contact Veterans Affairs. If they are in the reserve, they can contact the Department of National Defence or they can contact the OSI as well.
The Chair: Dr. Richardson, would you expand on the question that Senator Meighen asked about spousal involvement and the extent to which you can bring that about given all of the difficulties that are involved?
Dr. Richardson: We try to give information to general physicians or family physicians, although not everyone in Canada has a family doctor. However, we let them know that the effects of trauma affect both the individual and the family.
I do take the point that family involvement is critical in the treatment process. Therefore, on the clinical side, when we are interviewing the patient, we try to get his or her spouse, mother, father or significant other. We get information from them and get them involved in the treatment because they can be very influential. If we are making treatment recommendations, we can get buy in from the family.
The Chair: We heard a reason why the Calgary clinic was in a shopping centre. The main reason, if I recall correctly, is that there was less inhibition for the members to go there, because they were not seen to be going through ``that door'' at the base; they could go to this place almost incognito.
Is that a factor with the location of any of the clinics you were talking about? You mentioned a couple of them were off the premises, in effect.
Dr. Richardson: I think a stigma has an impact for mental illness in general, and the location might have an impact. It has not been studied whether the treatment outcomes are better at a clinic, a mall or in a hospital setting.
For example, I have many patients who will not go near a mall, especially during any holidays, because of the traffic, the parking and the number of people. They might actually find going to a treatment centre in a hospital more calming.
It could work both ways, but I can see how a clinic set within a mental health facility could stigmatize some individuals.
The Chair: You are right, doctor. Thank you. ``Stigma'' was the word I was thinking of, not ``trauma.'' Do the other witnesses care to comment on that?
Ms. Pham: I think Dr. Richardson answered the question quite well.
Senator Plett: Since I am here for my first time, some of these questions might not be as relevant to the other members as they might be to me; they might know the answers to these questions.
Clearly, you are doing some fairly specialized work. What qualifications are required to become a case worker? What training is there and what is involved in becoming a case worker?
Ms. Pham: Do you mean a case manager?
Senator Plett: Yes, the case manager, I am sorry.
[Traduction]
Ms. Pham: As you know, the case managers involved in the transition from the old charter to the new one, which took place in 2006, have a variety of experiences in case management. We are increasingly looking for employees who are specialized in case management. So we have many social workers and people with basic training in psychology. We have some health professionals too, such as nurses who are case managers as well. There are also people who have experience with the department and who have developed ways of working with the clients.
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Senator Plett: Who supervises the case managers, and how closely are they supervised?
Ms. Richards-Solc: The client service team manager would be the supervisor and they are supervised quite closely. There are a number of checks and balances within the system, as well. If an individual needs greater assistance, we have, as Ms. Pham referred to earlier, various specialties and rehabilitation officers. We have mental health assistants. We have standards-in-training assistants and then we can go nationally as well for assistants.
Something that has been developed recently is the clinical care manager, and these are individuals within the community that we are able to contract on an individual basis. If one of our case managers is working with an individual who perhaps needs more assistance in reaching some desired outcomes, then we can contract them for a period of time and the case manager works closely with that individual. They are the supervising body of the clinical care manager as well as the rest of the team. We have physicians, nurses and occupational therapists on team. They have a lot of resources at their disposal should they need to reach out and most of them do reach out. It is an interdisciplinary approach.
Senator Plett: My last question concerns the client. What qualifies someone to become a client? Is it the case that a veteran simply believes he or she needs help? In such a situation would you automatically you accept the veteran, or does he or she have to be under a certain level of stress? Also, would the spouse of a veteran qualify to become a client?
[Traduction]
Ms. Pham: We are talking about the New Veterans Charter specifically, which means that personnel who have left the Canadian Forces are our client base. It is client-oriented. So the change with the New Veterans Charter is really focused on the clients' needs in order to facilitate their integration into civilian society.
And to answer your question about families, the spouses of veterans also have access to the new charter programs, and so do the children. The new charter is not just based on strict criteria, but it addresses the clients' needs more and more.
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Senator Plett: In plain words, under the new charter, if someone believes that he or she needs help you would pretty much accept that person.
[Traduction]
Ms. Pham: All the clients who show up. Under the new charter, our client base is certainly Canadian Forces veterans. We meet and assess all clients with needs to see how Veterans Affairs Canada could help them through our services, and also help them to access services in the community, if necessary.
Senator Nolin: I would first like to welcome our witnesses. Thank you for accepting our invitation.
I would like to go a bit further with what Dr. Richardson said about being proactive, for example, in terms of informing the medical community of the types of syndromes that affect the Canadian military community specifically.
On a number of occasions, you have expanded on the topic of transition to civilian life, but civilian life for those individuals is also having a job. So could you tell me what you do for employers, wherever they may be in Canada, to demystify those syndromes that we hear so much about and that affect some of our military when they come back home?
Canadians are always very proud of their military when they are abroad, but when they come back, there is some sort of void, especially from employers who do not want problems, but productivity.
So what do you do to help integrate your clients appropriately into the job market?
Ms. Pham: As part of the rehabilitation program, we have a component for vocational rehabilitation that, just like you say, makes for a smooth transition into the job market.
So, for a client who perhaps has functional limitations and who has to enter the job market, we work with a national provider in vocational rehabilitation who walks the client through the transition to the new employer, so who works with the client, but also works with the employer in the workplace. The client can have access to this component.
We also have the Career Transition Services, formerly known as the Job Placement Program. We work with a national provider who helps clients who do not necessarily have limitations, but who want to find a job suited to their abilities. This provider has an employer data bank and will also stay with the client through their job search. In addition, the provider will also inform employers of the potential that military personnel have.
We also have providers who are interested in hiring people who leave the military forces. So, whether in the rehabilitation program or the career transition program, we work with those providers to foster employment and integration.
Senator Nolin: You mentioned employers who are interested in hiring veterans, but I am assuming that most Canadian employers do not belong to this group, unfortunately. Is that right?
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Ms. Richards-Solc: We have received documentation from employers seeking members of the forces or veterans to be in their employ because they realize the value in employing a person from the Canadian Forces.
Senator Nolin: Employers are in need of employees, yet, they may have concerns about hiring a former employee of the forces. What are you doing with employers across the country to prepare them to be proud to employ former military personnel? Are you knocking on doors to tell employers that soon we will have men and women who have served Afghanistan who will return and be looking for new careers?
[Traduction]
Ms. Pham: As part of the rehabilitation program, the national provider CanVet is in charge of the professional component, and one of the provider's duties is to integrate our military as smoothly as possible into the job market.
Senator Nolin: What do they do? What are the clauses in their contract? Could you give me an example of how they would go about getting Bombardier, let's say, to hire someone coming out of Canadian Forces?
Ms. Pham: I do not have the details of the national provider's mandate, but we were able to see the providers in action helping clients find an employer.
Senator Nolin: A specific one.
Ms. Pham: Yes, a specific one.
Senator Nolin: What I have a problem with is that there is a lot of mystery surrounding the various syndromes that military personnel suffer from. I would not want that and I hope we are doing everything we can to eliminate the false perceptions, prejudices, and misconceptions that employers may have about the effectiveness of an employee who comes from the armed forces. That is what I want to find out. In my opinion, that is part of your responsibility. To me, it is fundamental.
[Français]
Dr. Richardson: This is an important point that involves general education to change the stigma of mental illness. Just because someone served in the military, or may come back with a stress injury, the general myth may be that a veteran is like an angry young man.
Senator Nolin: That is it, exactly.
Dr. Richardson: Do you want that person in your workforce? Clinicians work with return-to-work groups from corporations. That is at an individual level as opposed to a national level, which is done through professional associations. For example, it is done for general mental health. At the national centre for OSI, we are developing partnerships with professional organizations so that when they do psycho-education or information to the public, it also includes the special needs of veterans. We are embarking on that at the national level.
The Chair: Senators will recall asking me, and I complied, to write a letter to the Canadian Council of Chief Executives to inquire about their policy in this regard. We have received a response, which I have asked the clerk to copy and circulate to all.
Senator Dallaire: CanVet Vocational Rehabilitation Services, CanVet VR Services, and the whole process of obtaining employment for post-release injured personnel, including physical and mental injuries, is a brand new art. It has not been validated but will be validated in the study done by VAC that is due for release in December 2010. It has not proven to be necessarily the most effective tool in creating clarity for their clients and for the industry. There are many questions about whether CanVet is the most effective instrument to do it, in particular on the bilingual side. CanVet does not go to government departments, as we read in Senator Downe's article. It would seem to me that a great tool would be Veterans Affairs Canada making a deal with all other government departments to hire these people; and VAC could even pay for the retraining; but that is another story.
The Chair: That would work provided the potential employees are appropriately qualified.
Senator Dallaire: You train them to qualify them. You do not take a soldier from the infantry and throw him in. You train him to qualify him. Veterans Affairs Canada could do the training and then sell him to other government departments.
Senator Nolin: My concern is the step before. As Dr. Richardson mentioned, they will work with a specific employer when asked to do so. However, I am afraid the employer will say, no to the idea because of fear of the unknown. An employer who is not aware of the reality might say, no. It will take only a few refusals before your client knocks on your door and says I might have a problem because employers are saying ``no.''
Committee members will recall the young soldiers we heard from a few weeks ago. It is their testimony that gives me this concern; I do not want to hear the first ``no.''
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What I want is sensitivity. Everyone is proud of them when they are in combat, but when they are back, we forget about them.
Senator Dallaire: That is part of the deal. We must find an answer to that question.
Senator Meighen: It is not the offices that should take care of that.
Senator Nolin: It is the clients.
Senator Dallaire: But it is still the office that deals with the clients, and refers them to experts. So it is their duty to supervise. The expert sells our veterans to the industry. To conclude, I would like to raise the following point.
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We have a program to assist injured individuals and provide retraining. However, the individual is simply not capable of being retrained. The New Veterans Charter will move to training the spouse, who can then take over the duties. However, the spouse is employed at 100 per cent and taking care of the member who has been injured. Where is the logic? What is the delta if the spouse cannot take the training because she is taking care of the injured member? Who is being trained? What is the result? Is there a VIP program for them or are they simply going in circles?
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Ms. Pham: If I understood your questions correctly, you are asking whether the spouse has access to professional assistance, what happens if she has other duties and you are also talking about the veterans independence program.
In terms of our programs, clients who are under the New Veterans Charter are not excluded from the charter programs. A client who is under the New Veterans Charter and who demonstrates the need for access to the veterans independence program will have access to both. We have a number of clients who are in a rehabilitation program and also receive services under the veterans independence program.
Senator Dallaire: Excellent.
Ms. Pham: Second, to answer the question about professional assistance, when clients cannot participate in the professional rehabilitation program, we continue to offer them medical and psychosocial services to improve their quality of life. We also offer professional assistance to their spouses.
For families with children, professional assistance also includes daycare services so that the client can participate in treatment sessions or the spouse can participate in a professional assistance program. Those services go together.
Senator Dallaire: So the wife has access to enough services to allow her to have some independence so that, for example, she can have someone take care of the member who is injured at home and needs care, and she is able to go to work. There is a whole range of services available.
Ms. Pham: It is part of the case manager's role to ensure that the needs and objectives are met.
Senator Dallaire: Going back to the case manager, I am aware that you hold information sessions everywhere, you have representatives on the bases, and you even hold information sessions in the militia units. But those information sessions offered to injured soldiers go in one ear and out the other. Nothing important stays with them.
Let me get back to my question that does not only concern veterans in Afghanistan, but also all those before Afghanistan, who are still in the system, are now asking for assistance and stumble upon the new charter. How are you trained to find those individuals? What kind of ongoing training do you get to hone your skills? Is there a formal program in the department to increase your skills?
Finally, how many files do you study individually, including the case of the young militiaman who is in Matane while your office is in Quebec?
Ms. Pham: I want to make sure I answer your question properly. You are asking how we can ensure that the military are aware of the existence of veterans —
Senator Dallaire: Injured military.
Ms. Pham: So we certainly work a lot in partnership with the Department of National Defence. As you said so well, the information has to be presented and repeated regularly at different times in their careers. So now, as soon as they start basic training at the recruit school, presentations are made. Presentations are made before and after deployment. We also work with partners to participate in different presentations or symposiums.
As an experiment, we had case managers who have recently made presentations to the families of soldiers deployed in Afghanistan so that they are also aware of the programs and services offered to support the military. There is a lot of information, both from the Department of National Defence and from Veterans Affairs Canada.
We have to continue the work in order to keep improving ourselves. Our efforts have to be constant.
In terms of our employees' skills, as my colleague said, our department has used many internal and external partnership resources.
We would also like to offer training based on the employees' needs, not only in programs and services, but also in developing skills to address clients' issues.
Here is a perfect example: in 2007, Ste. Anne's Hospital organized a national symposium on operational stress injuries, which will also be held in 2010. We encourage case managers to participate in the symposium in order to update their skills.
Senator Dallaire: I participated in the 2007 symposium and I will go to the next one in 2010. How many of you went into the field, in Valcartier, to see what the soldiers do in order to understand the real nature of their work and their commitment to military life. Does the department encourage you to experience that?
[Français]
The Chair: When you say ``the field,'' Senator Dallaire, do you mean battlefield training?
Senator Dallaire: We took the ammunition industry into the field for a day. They built ammunition, but they never saw it used. You take them into the field on a training day to see the materials being used.
Do you have those sorts of days for the development of your case study people so they know the jargon and atmosphere?
Ms. Richards-Solc: Within the Kingston office, we currently have members who served in the military. They help with the process of understanding. We also do in-services. I believe there was training in Petawawa for case managers to observe. It is a function of being able to spend the time.
Senator Dallaire: I consider it to be broader fundamental training and development of your people.
Ms. Richards-Solc: I agree. My son recently joined the military. He speaks a different language and is in a different culture. We try to understand it.
Senator Dallaire: You never mentioned the family support centres. You talked about linking with everyone else. How closely do you work with family support centres to link with spouses and potential casualties?
Ms. Richards-Solc: The family support centres are part of our resourcing, both within the community and the military family.
Senator Dallaire: Okay.
Dr. Richardson, how much research was done for the military on PTSD 10 years ago?
Dr. Richardson: That is a good question. Most of what we know today about PTSD is related to the military.
Senator Dallaire: I mean Canadian research.
Dr. Richardson: As you are probably aware, most of the research is done elsewhere. I have done some research, but research in Canada specifically on Canadian military members is limited.
Senator Dallaire: Canada works under a different philosophy of leadership and war, a different context of social backgrounds and cultures, and a different regimental milieu within the military. Do you not find that using someone's research on PTSD may not be as effective as if Canada conducted research on our own people under the conditions in which they find themselves making these dramatic ethical, legal and moral decisions?
Dr. Richardson: Whether we look at American, Australian or British military, we are all generally the same humans with the same stressors. However, there are certain cultural differences and social networks in Canada. Research on Canadians is definitely different.
Senator Dallaire: The command relationship is completely different.
Senator Day: Dr. Richardson, has there been any clinical studies or research conducted with respect to animals, particularly dogs? Dogs are used to give comfort and assistance to people suffering from operational stress injuries. All of the honourable senators on the committee have visited places where people suffer from operational stress injury. We have seen, anecdotally, the comfort they receive from cats and dogs in the establishments.
Dr. Richardson: I would have to get back to the committee on whether research was published in this area. However, it is talked discussed. In my clinical experience, patients indicated that they find having an animal companion is helpful. I am unaware of specific research looking at specific benefits of that type of therapy.
Senator Day: Veterans suffering from post-traumatic stress or operational stress injuries sometimes find themselves outdoors, maybe in a crowd, and unable to move. If they had a properly trained dog with them, the dog could help them cross the street or back to their car, et cetera.
Senator Day: If I lost my sight as a veteran, I could have a seeing-eye dog provided by Veterans Affairs. However, there are veterans suffering from post-traumatic stress who find comfort and help from properly trained dogs, but Veterans Affairs will not make the dog available.
Why is that program not accepted?
Ms. Richards-Solc: Currently, we have an interest in this particular area. We put forth a case for subsidization for a dog. I have copies of the studies that I will make available.
Senator Day: That would be helpful.
Ms. Richards-Solc: A member of our staff has been researching this issue. We have studies from the United States and some from Canada. The problem in Canada is that there is no recognized resource for training such dogs, nor is there a provision of credentials for the dogs. I believe there is some accreditation that takes place in Alberta.
Senator Day: Would Dr. Richardson be the person to help you move that case forward?
Ms. Richards-Solc: We have other resources, but we are happy to use Dr. Richardson as well.
Senator Day: You should also send the doctor a copy of your case study and request.
Do you agree that, at the present time, Veterans Affairs will not provide a dog for someone suffering with operational stress injury?
Ms. Richards-Solc: Are you talking about a trained dog?
Senator Day: I am talking about a trained dog.
Ms. Richards-Solc: No decision has been made yet. I have not heard that Veterans Affairs will not provide the animal.
Senator Day: Have they ever provided an animal?
The Chair: All things begin in Alberta. Senator Day's point is that there are dogs trained in the same sense and with the same value as Seeing Eye dogs.
Senator Day: Absolutely.
Senator Meighen: Dr. Richardson, have you made any clinical treatment progress in identifying those people that may be more susceptible to operational stress injuries before they are placed in the situation?
Dr. Richardson: They have looked at multiple risk factors of whether someone, if exposed to a traumatic event, may develop PTSD following that trauma. The most important finding is in regard to events following the traumatic event. Lack of social support and general stress after the traumatic event are very important factors. When we look at it in general, predictors tend to show after the trauma as opposed to before the trauma.
The Chair: Thank you Dr. Richardson. I am sorry to interrupt.
I want to thank our witnesses for being here today. We are grateful. I want to thank all honourable senators for their probing questions, which I hope we find useful.
(The committee adjourned.)