THE SUBCOMMITTEE ON VETERANS AFFAIRS
EVIDENCE
OTTAWA, Wednesday, May 10, 2017
The Subcommittee on Veterans Affairs met this day at 12 p.m. to study on issues relating to creating a defined, professional and consistent system for veterans as they leave the Canadian Armed Forces.
Senator Mobina S.B. Jaffer (Chair) in the chair.
[English]
The Chair: Honourable senators, joining us today is Adam Thompson, Clerk of the Committee; and our Library Analyst, Havi Echenberg. I would kindly ask senators to introduce themselves, starting on my right with the vice-chair.
[Translation]
Senator Dagenais: Senator Jean-Guy Dagenais, from Quebec.
Senator Saint-Germain: Senator Raymonde Saint-Germain, from Quebec.
[English]
Senator Manning: Senator Fabian Manning, Newfoundland and Labrador.
Senator Lang: Senator Dan Lang, Yukon.
Senator Boniface: Senator Gwen Boniface, Ontario.
The Chair: And I’m Mobina Jaffer from British Columbia.
[Translation]
The Subcommittee on Veterans Affairs was given a mandate to examine issues relating to creating a defined, professional and consistent system for veterans as they leave the Canadian Armed Forces.
We are pleased to welcome the Honourable Kent Hehr, Minister of Veterans Affairs, and retired General Walter Natynczyk, Deputy Minister of Veterans Affairs Canada.
[English]
Minister Hehr was appointed Minister of Veterans Affairs and Associate Minister of National Defence on November 4, 2015. The minister’s mandate includes several priorities, including to work with the Minister of National Defence to reduce complexity overhaul service delivery and strengthen partnerships between Veterans Affairs and National Defence.
Deputy Minister Natynczyk has served as Chief of the Defence Staff from July 2008 to October 2012 before becoming President of the Canadian Space Agency for a year and then Deputy Minister for Veterans Affairs.
I would like to thank both of you for being here. Just by way of background, I want to say to you that we heard General Vance, the Chief of the Defence Staff, speak about when you enter the army everything is professional. He wants to make the leaving of the army also a very professional setup so that people who have given everything to our country are served in the best way possible.
We look forward to hearing from both of you and to working with you in the future. Minister, please start.
Hon. Kent Hehr, P.C., M.P., Minister of Veterans Affairs and Associate Minister of National Defence: Thank you very much. It’s an honour to address this committee again and to work towards creating a defined, professional and consistent system for veterans as they leave the Canadian Armed Forces.
On average, 9,000 Canadian Armed Forces members, regular and Reserve Force, release from the military each year. Of those 9,000, each veteran has their own unique story and their own distinctive needs, some of whom will need help with their transition to civilian life. In fact, 73 per cent of those veterans transition successfully. They leave the military to jobs or new lives and are good to go. The corollary is that 27 per cent struggle upon leaving the CAF. It is for these men and women that we are working towards better outcomes.
This is why I have been working closely with the Minister of National Defence and the Canadian Armed Forces to ensure that the transition process is as seamless and smooth as possible. These changes we’ve been making and the improvements on the horizon will all help us accomplish that goal. In short, we are professionalizing the transition process.
With my appointment as Minister of Veterans Affairs and Associate Minister of National Defence, the Prime Minister gave me the mandate to ensure that veterans receive the respect, support, care, financial security and education opportunities they have earned through their service to Canada.
If there’s one thing all Canadians can agree on, it is our debt of gratitude towards our veterans for their services and their sacrifices; that after all their selfless contributions, the government owes them the means to get back on their feet and on with their lives. We have committed to doing just that, to help them transition to civilian life, to help rebuild their lives and to join the middle class.
In Budget 2016, the first phase of our approach, we increased the disability award from a maximum of $310,000 to a maximum of $360,000, and the earning loss benefit was raised to 90 per cent of a pre-release salary. We reopened nine offices closed by the former government — we even opened one new one -- and hired over 400 new front-line staff, which includes new case managers.
All of these initiatives should be familiar to you following the historic actions we took in Budget 2016 when we committed approximately $5.6 billion in additional financial benefits for our veterans and their families. Rest assured any ill and injured soldier who cannot work as a result of their injury will now have greater financial security as a result of these changes.
In fact, 67,000 veterans have received or will receive a disability award top-up as a result of these changes. About $425 million in top-ups were awarded since April 1, 2017, and my department is working diligently to identify those veterans with out-of-date banking information to ensure the remainder is issued in a timely manner.
Budget 2017 builds on those initiatives to create a more holistic and comprehensive approach to veteran well-being and focusing on the family.
When I meet a veteran, whether they’ve served one year or 10 years, they want to talk about it because they feel strongly that once in the military, always in the military. We know that veterans struggle with the loss of military culture. We want to keep them in the family. We want to recognize their service, which is why we are expanding access to the military family support program and are opening up all 32 Military Family Resource Centres, MFRCs, to ill and injured veterans and their families. Traditionally reserved for serving members, now medically released veterans and their families will have access to MFRCs across Canada where and when they need support.
Second, we are improving and increasing the Family Caregiver Relief Benefit with a tax-free monthly payment of $1,000 that will go directly to the caregiver. Time limits will also be removed for spouses and survivors to apply for rehab services and vocational assistance so they can re-enter the workforce. What this means is that spouses, partners and caregivers who provide day-in and day-out support to our ill or injured veterans will get better assistance and recognized by the government for their invaluable contributions.
Third, we are investing almost $14 million over four years into a new Veteran and Family Well-Being Fund that will be used to research on issues and new initiatives that will further support veterans and their families.
In addition to the supports for families and caregivers, we are doing more for veterans transitioning to their post-military life. We are introducing the Veterans’ Education and Training Benefit to cover up to $40,000 in tuition and other costs for members who have served six years and up to $80,000 for members who have served 12 years. Five thousand dollars of this benefit can be used towards professional development, such as getting a real estate licence.
Supporting education and professional development will ensure more released military members can find a new sense of purpose to put their skills to use.
We are also redesigning the Career Transition Services we offer so that more people can make use of them, including survivors, spouses and partners and those members of the Canadian Armed Forces who might not want to go back to school. They will have access to job search assistance and counselling to work with the veteran and the employers to ensure success, from coaches who understand military culture.
These, senators, are game-changers for our veterans and their families. This allows them more avenues for their post-military careers.
One of the most critical components of a successful transition from military to civilian life is early engagement. Something you may have heard about here from my CAF colleagues is the enhanced transition services, a joint Veterans Affairs Canadian-Armed Forces initiative, which aims to engage members earlier and to give them assistance in what they need to do. This is now integrated in all 24 of our Integrated Personnel Support Centres.
Of utmost importance in support for our veterans is mental health. It’s an issue that continues to garner headlines in the media, and it’s one of our top priorities. This is why we are committed to ensuring veterans, RCMP members and their families have the mental health support they need, and why, in Budget 2017, we followed through on our commitment to establish a centre of excellence on PTSD and related mental health conditions.
We are investing $17.5 million over four years on this hub, which will provide research, education and outreach services for veterans and their families, as well as contribute towards the development of new best practices.
We are also creating a Veteran Emergency Fund that will provide immediate relief to veterans and their families should they have to address an urgent or unexpected strain.
Additionally, we commit to finalizing the details of a monthly-pension-for-life option through the disability award for ill and injured veterans in 2017, further adding to their financial security. I am confident that we will get there.
The last thing I want to mention today is our service delivery review. We recently announced its completion, and I’m pleased to say we now have a plan to deliver services that are faster, more agile and more responsive, placing greater emphasis on veterans when they first contact the department, providing a personalized response that addresses all of a veteran’s needs and ensuring there is no wrong door when a veteran reaches out.
Whether a veteran calls, visits an office, goes online or mails in an application, it is important they receive the same positive service experience.
The bottom line is we’ve listened, and we know we need to change the current system to create an easy-to-access, simple-to-navigate, veteran-centric process. We need to do something transformative, to do more than just slap on another piece of policy tape each time the system springs a leak. It’s time to rebuild.
At the end of the day, our mission is to improve the well-being of veterans and their families. Their well-being consists of having purpose, financial security, shelter, medical support, family and community support and a sense of identity, and we are committed to helping them achieve that.
I know that everyone at Veterans Affairs Canada continues to work tirelessly to ensure that Canada’s veterans receive all the benefits and programs they’re entitled to, delivered with care, compassion and respect.
In his address to this committee on April 12, Chief of the Defence Staff General Jonathan Vance said, “Loyalty is a two-way street.” I could not agree more. In practical terms, that means providing support, services and programs veterans need, when and where they need them. Thank you very much.
The Chair: Thank you very much, minister, for your remarks. Before I go to questions from my colleagues, you mentioned the service delivery review in your remarks. May I ask you to go into further detail? It’s something that has come up in our meetings. Could you tell us what this review entailed, what the results were of this review, and what changes are expected as a result of this review?
Mr. Hehr: Yes. The service delivery review started in the fall of 2015, and we carried it through. We got the results of that. We’re busy implementing many of the initial things right now, but the entire review will take some time to totally get through, for us to revamp our services full scale to make them more veteran-centric.
In a nutshell, we’re reducing the complexity of the disability program. We’re enhancing delivery points of access, be it in person, by phone call, by mail or online. We’re introducing guided support by expanding our successful Veterans Service Agent pilot project and enhancing outreach to our veterans.
Essentially, we’re moving away from a pull system, where veterans had to pull information out of us to get the programming they needed, to a push system. If I can give an example: A veteran who needs a walker will come to our service agents or our front-line support system, which will then say, “If they need a walker, what else are they going to need from Veterans Affairs Canada? Do they need vehicle modifications, other programs or VIP services? The veteran asked for a walker. Let’s get him a walker, and let’s think this through.” They’re getting a range of benefits to better support their lives and to allow them to do better.
A veteran once said, “I only know what I know.” So if they don’t know about our services or programs, how can we make their lives and situation better? That’s why we’re going to a push system.
[Translation]
Senator Dagenais: Thank you, Minister and Deputy Minister, for joining us today.
At a previous committee meeting, we heard about delays in the assessment of benefits for medically released veterans. I am sure that you are making every possible effort for the assessment to be done as soon as possible, so that people can quickly access their benefits. What prevents you, in some cases, from taking action as soon as the release decision is made?
[English]
Mr. Hehr: What you’re essentially talking about is having a seamless transition from being released from the Canadian military to a post-military career. Right now that is happening in some cases and not happening in all cases, but we’re working towards having those situations increase. For instance, in Closing the Seam, we’ve already embedded, as I mentioned in my initial speech, Veterans Affairs staff with our IPSC units throughout the country to better serve those ill and injured soldiers who are transitioning from the military.
I know we’re also having Veterans Affairs staff brief every person who’s leaving the military about the programming at Veterans Affairs Canada. Right now we’re at about 80 per cent.
What we’re essentially going to, as Chief of the Defence Staff Vance has said, is a more professional leaving of the service. In particular, when you have an illness or injury, you have your pension cheque and you are signed up with what Veterans Affairs programming you need. If you need a case manager, you have it. If you need help at an operational stress injury clinic to deal with mental health issues, that’s good to go. We don’t let you out of the military until those things are lined up, and we’re working towards those.
I know we’ve had some very productive meetings over the last year with the Chief of the Defence Staff as well as Minister Sajjan. I can say we’re lining up well on numerous items and we should be getting there soon, to have all of that lined up. That was your question dealing with that release from the military. Am I correct, senator?
Senator Dagenais: Yes, you are correct. That’s a good answer, minister. Thank you .
Senator Lang: First of all, I want to take a moment to thank the Department of Veterans Affairs for the visit they organized to the commemoration of Vimy Ridge. I had the opportunity of attending representing the Senate, and Senator Hubley was there as well as Senator Campbell. I would ask that you convey on their behalf and my behalf a thank you to members of your staff for all their hard work and commitment during the course of the visit.
I want to say, colleagues, the visit to Vimy Ridge was very memorable, and Canada did themselves proud. All Canadians, at one time or another, if ever they get the opportunity, should visit the site at Vimy Ridge and take that time to reflect back on what happened at the beginning of the last century. Mr. Minister, I would like to convey my thanks.
Mr. Hehr: Senator, thank you so much for recognizing the hard work of the public servants at Veterans Affairs Canada, who really did yeoman service in getting the mission to France accomplished, so to speak, to pay tribute to those who took part, not only in the battle of Vimy Ridge, but to recognize the contributions of the 2.3 million Canadians who served in the Canadian Armed Forces since we became a nation 150 years ago.
You and I and the rest of our delegation got to take part in a historic journey to remember that service and sacrifice, and it was all made possible by the public servants under the leadership of General Natynczyk and those others who worked on this, from General Wayne and Brigadier-General Jorgensen all the way down. We had a whole team of people working around the clock for a long time to make this happen, so thank you for recognizing that.
Senator Lang: Like I said, Madam Chair, Canada did themselves proud and it should be recognized.
I want to go back to the questions at the outset that Madam Chair raised regarding the question of the delivery system.
Mr. Minister, I’ve been on this committee for at least four years, if not five years, and there is a continuous question about the number of programs that are available for the veterans and how well coordinated they are, whether they are actually doing the job that we’re asking them to do and what we can do to further make fewer programs as opposed to more programs.
I listened to what you just said here and it sounded to me like we’re adding programs on top of the programs. I don’t think that’s necessarily, at least from my perspective, the route that we should be taking. Perhaps you have a comment on that.
Mr. Hehr: I’ll clarify that. What I meant by what I said around transition services and how we’re going to have it more veterans-centric, was in the service delivery arm of our department: having our staff fully prepared to engage with veterans and their families, get them the existing programming they need to better their lives and, in many cases, our service delivery review, which, while we believe is broad-ranging and will deliver results for this, will be more focused, nimble and more directed to our veterans.
I will also say we are consolidating. We are in the midst of consolidating our financial benefits and programming right now. Here’s an example: When a person in Veterans Affairs has an inquiry from a veteran or their family, they have up to — and general, maybe you can make sure I’m not giving a wrong number here — more than 700 possible responses they can give to that veteran or their family. Over 700 possible responses, programs or ideas to better their lives.
You’re right, senator, that’s way too many. We have to have it under our core capacities on delivering financial security, wellness, making sure they’re at their new normal and reacting to different time periods in their lives.
The trouble is, we need some options here too, senator. We have 20-year-olds in our department and people who are 100. Different ages, different stages and different solutions to their complex needs. But I get it. I agree with you, and we are working on that.
Senator Lang: I’m pleased to hear that. I know it’s not an easy task because if you consolidate something, you’re going to get some criticism, but you have to know the long-term objective of what you’re looking for to get there.
I want to turn back now to the actual delivery. You talked about the walker for the veteran. In the reality of where I come from, the walker for the veteran will come from the provincial and territorial medical program, not from Veterans Affairs. It seems to me that we have to be very careful that Veterans Affairs, in meeting these demands in the area of the delivery of medical services, doesn’t try to take over those responsibilities.
I would recommend that there be an agreement that the veteran be a priority with the provincial or territorial medicare program, clearly outline what the veteran is eligible for and then work out a contractual arrangement with the provincial and territorial medical health program.
That way, when you talk about these centres, that doesn’t include Grande Prairie or a program up in Thompson, Manitoba or in Dawson City, Yukon, because they’re not big enough. But if we have a clear and unequivocal understanding with the health programs in those particular provinces, and where appropriate, perhaps, in some municipalities, then we can deliver the program quickly and expeditiously and the veteran gets taken care of and it’s a done deal.
Mr. Hehr: Senator, you bring up an excellent point. Since 1968, when we brought in national health care, we have gone to a system where the provinces have delivered the essential services that most of our citizens need.
Veterans Affairs has a history of having hospitals. In fact, we’re a leader in this. We started our first Veterans Affairs hospital in Montreal in 1917 at Ste. Anne’s and, of course, had a framework of nine or ten hospitals across the country that looked after veterans. A lot of that model then went to saying, “If veterans are getting health care, why not our citizenry?” I think that led to the advent of national health care.
Since that time, Veterans Affairs has been getting out of the health care business, like you said, senator. Ste. Anne’s Hospital was the last long-term care facility that we transferred back to the provinces, and again, we work with our provincial partners on long-term care with our veterans. We are a payer for these services. We don’t provide the care or the lodging. The wait lists are sometimes from that end. We do have a role to play, but you’re right, it is limited by those things.
We have relationships with provinces, and I will let General Natynczyk fill in some of the details on relations we have on mental health services and some other things that maybe we do that tie into that.
General (Ret'd) W. J. Natynczyk, Deputy Minister, Veterans Affairs Canada: To reinforce the minister’s comment, the federal government, including Veterans Affairs, does not provide health care services to veterans. The first payor is always the provinces and territories. But if a veteran has an injury, or disability, or illness as a result of service, and the province does not pay for it and the veteran would be out of pocket, then, as the minister indicates, we have reimbursed veterans. In addition, given the mental health challenges in Canadian society, Veterans Affairs, since 2002, has partnered with all of the provinces to enable a higher level of access to mental health practitioners across the country. Again, it’s not Veterans Affairs providing the support, it’s the provinces on a reimbursement basis. We are providing support not only to the 11 operational stress injury clinics but also to about 4,000 mental health care professionals from coast to coast.
In the case of the walker, if the province or territory provided for that, then there would be no support. But if the veteran was to be out of pocket — and each of the provinces is somewhat different — then Veterans Affairs would back up that requirement.
Senator Lang: Are you saying to us that you have signed contractual arrangements with each province and territory and that when it comes to services, the veteran is given the priority? If we don’t have that type of contract, should we not get it so we know that the veteran is in front of the line?
Gen. Natynczyk: Senator, what I’m saying is that for mental health, Veterans Affairs is in a contractual arrangement with 10 facilities where the provinces and the municipal health authorities are providing mental health care for veterans and Royal Canadian Mounted Police veterans. For services, such as walkers, pharmaceuticals, or other health care requirements, for a veteran with an injury or disability as a result of service, we would reimburse that veteran for out-of-pocket requirements.
[Translation]
Senator Saint-Germain: Good afternoon, gentlemen, and thank you for your presentation, which includes some very specific commitments. We see that additional investments will be made and that you are ensuring to integrate the services and to make them more consistent.
My concern is not about the proper use of funding, but about the service culture. We have heard here from veterans groups, but also from the ombudsmen of National Defence and Veterans Affairs, who talked to us about an approach that is sometimes similar to that of an insurance company trying to minimize its investments and manage its risks. I don’t want to make the situation sound worse. I believe that the majority of benefits are provided within an effective service culture. Are you looking at measures to foster a service culture, so that veterans would not be seen as people who are trying to abuse programs, but rather as individuals who have served their country and whom we want to help in a difficult transition period?
[English]
Mr. Hehr: That’s an excellent question. From day one we began to look at things and said that we want to take an approach of expanding the ability of a veteran to get the services where and when they need them. We are taking a benefit-of-the-doubt approach to our model when a veteran applies -- it’s not an insurance model. That approach applies if the illness or injury can be reasonably tied to service, even though it may be somewhat of a tenuous connection. You get the point of where we’re going. Can this somehow be tied to military service, the illness or injury the veteran complains of or has issue with? We’re trying to address it in that fulsome fashion.
You can see the results as a result of this change that has occurred since we were elected. We have had an 18 per cent increase in the number of claims that have come into the department. We have an increased flow-through of claims that have been recognized from our department — many that had been denied in the past — because we’re taking this new approach.
We think this is a good thing, where more people are getting the help they need because of this mindset change that we have instituted from the top down.
I can’t comment about what was there in the former years, but I can tell you what we’re doing now. We want to take that approach with the way we’re delivering.
[Translation]
Gen. Natynczyk: As you said, Senator, the challenge always lies in culture change. With the minister’s approval, we have changed the department’s culture by providing services to our veterans with compassion and respect.
[English]
The strategy that the minister has authorized in the department is one of care, compassion and respect which will operationalize what the Pension Act says, namely that we should give veterans the benefit of the doubt. This is across the department. Our mission is to provide care. If we have to default in decision-making, we default to compassion, always showing the veteran and their family respect.
With regard to adjudication and how this is being applied, when we look at a veteran’s medical file, often it does not portray exactly what a veteran went through during his or her service. There are many infantrymen, or tankers, or sailors, or airmen or air women, who, when they get ill, don’t go to the doctor. They maybe take a Tylenol and they go back into duty. So the medical file may not have all the information on it. But the very fact that they were an infantry man, or artillery, or a search and rescue technician, or a medical technician, all of that is evidence. The fact that they went to Rwanda, Somalia, Kosovo or Bosnia is evidence. We’re able to broaden the evidence model in looking at the individual’s files.
As a result , as the minister has indicated, our approvals of disabilities have increased. For example, we have an infantryman, a paratrooper who has hundreds of parachute jumps but nothing on the medical file that says they had an injury to their ankles, knees or hips. Afterward, they have problems with all their joints. Under this model that person would be accepted.
Mr. Hehr: We’re also streamlining the disability benefit process. One thing that has been very important since we were elected is we’ve hired more staff. There are 400 front-line staffers working throughout the system, through case management and through service agents and the like, which is allowing us to help the veteran and their family. We’re also simplifying the decision-making tree on many of these things. For instance, we’re simplifying mental health claims. If the veteran has an issue with mental health, boom, you’re going to get the help you need. We’re going to figure it out later as to what was the cause or the concern .
For instance, we’re doing the same thing on musculoskeletal injuries to make the process streamlined. We’re improving the vast majority of these claims here. They’re real and profound. The veteran needs help; let’s get it done.
[Translation]
Senator Saint-Germain: I have a second question about your delocalization objectives. In response to the closing of nine offices over the past few years, you say that you will reopen offices. Will they be reopened in the same locations? In terms of investment, would it be possible to adopt other outreach-type approaches in order to reach out to veterans? Those facilities will cost a lot of money. What is your vision when it comes to reopening those offices?
[English]
Mr. Hehr: We are proud of the fact that we did reopen these nine offices in the locations where they were closed, and I believe we’ve done now eight of those nine offices. There are two more that need to be opened.
Let’s face it. There’s going to be a continuing evolving cohort of veterans moving across the country. We identified a cohort that moved into Surrey. We have a large catchment of veterans living in Surrey, British Columbia, so we’re opening an office there.
One other thing, for the first time we’re having outreach services in the North. It’s not by a bricks-and-mortar location. It’s having a remote access team working towards that large area where many veterans choose to retire because they served up there, and we’re able to get them the help they need because of that capacity.
We believe having these offices folds into what we’re doing on our service delivery review, whereby it doesn’t matter how they get ahold of us whether it is in person, by mail, computer, smoke signal or whatever; we’re going to be able to assist them and better their lives. It’s part of our role here.
Senator Saint-Germain: If I understand well, the reopening of the offices is part of the outreach strategy.
Mr. Hehr: Of course. We did the analysis. People need these services, and we’re going to continue to find them and be where veterans are located.
Senator Boniface: Thank you, minister and general for being here. We certainly appreciate the efforts that you’re making.
I wanted to zero in a bit on the mental health. One of the issues that was raised by one of the advocacy groups who came was the accessibility to mental health services, particularly in communities across the country.
I come from a fairly small city, and I know how limited the mental health services are within that city. Then you add on the special needs that veterans would have from a mental health perspective.
I think general access for all people is a challenge in this country. Add that to the very special needs of veterans, and one of the particular points they made was around having psychologists who actually understand the environment that veterans would have worked in in war zones.
I’m wondering if you’ve done any work in terms of accessibility at the local level. Secondly, do you foresee any assessment around what type of training psychologists should be receiving to provide the specialized services?
Mr. Hehr: Excellent question. As of right now, we deliver mental health support for veterans and their families as a result of the unique role they played in the Canadian Armed Forces and what they suffer as a result.
We work with 4,000 mental health professionals from coast to coast to coast who work with our veterans to provide them with those supports. We have an operational network of 11 operational stress injury clinics. These are primarily devoted to those mental health concerns that have come up as a result of military service. We have them all over this nation. In fact, we just opened one in Dartmouth, Nova Scotia, to assist veterans in that community. So we’re very proud. We have coverage in that area.
We also have a 24-7 mental health hotline, and to be fair, when a veteran calls with mental health issues, that is a priority for us. As the general alluded to earlier, our partnerships with the provinces in regard to mental health are very strong, interconnected and linked. We do have access to those 10 different places where our veterans can get help.
In the main, I see this as working. No system is perfect. We have to continue to be nimble, advocate and find better ways. There are two ways we’re doing that. One is that in Budget 2017 we’re following through on opening a centre of excellence in terms of mental health and PTSD. We’re putting some teeth behind this too, $17.5 million over the next four years to invest in cutting-edge research to look at what’s happening out there and develop best practices so we can get that to the front lines to better support our veterans and their families. We’re very proud of that.
The second thing to be released shortly is our suicide prevention strategy that we’re working on with Minister Sajjan. Let’s face it. One suicide is one too many, and if we can do our best to recognize the signs, to work with veterans who are struggling, to get them the help they need, it’s our obligation to do so.
We’re not just standing on our laurels; we’re working towards facing this issue in a strong, reasoned way that is evidence-based and allows for better outcomes.
Gen. Natynczyk: If I can just reinforce the minister’s comments, the toughest part for someone with a mental health injury is getting them in the front door the first time, getting them to come on in and say they have a problem. Often they come in the back door. This is the biggest challenge.
Going back to how we have changed the culture, let's take a veteran who is a no-kidding veteran and has a diagnosed mental health injury. In terms of the disability adjudication from the statistics we have, over 90 per cent of all those claims are approved. But we have to get them in the front door. Only then are we able to get them into treatment. It’s about how quickly we can turn those around.
With respect to some of those we have not approved, the people haven’t even served in the Canadian Armed Forces or don’t have a diagnosis. We’re pretty close to 100 per cent or as close as we could get when someone makes a declaration they have a challenge and they are diagnosed therein.
To your question, our case managers in all the additional offices and all the offices across the country and the veteran service agents know those practitioners are out there because they have had to be certified to be a provider of services to our veterans. Again, we have a chief medical officer and a departmental psychiatrist to ensure that the health care practitioners, psychiatrists, psychologists and mental health nurses meet the level of certification required Only then are they able to work with veterans and make sure they get the right kind of care. Sometimes the first partnership doesn’t work out, but to work with those veterans to make sure they get access to the right health care practitioner.
In addition, in the remote communities we have telemedicine, so, for example, the practitioner at Deer Lodge Hospital in Winnipeg can speak to someone in Thompson or Churchill, Manitoba or anywhere else.
It’s about leveraging all that technology so the veteran has the best care possible.
Mr. Hehr: One thing, with the addition of the 400 new hires, we are working towards a 25 to 1 standard, case manager to veteran. This is very important. When I came into this position, our numbers were much higher, 35, 40, sometimes 45 to 1, and those are based on best practices in other Veterans Affairs offices and social work and the like. That is also a very important component to the new hires.
Senator Boniface: Thank you. I raised it only because it was raised by one of the advocacy groups as to whether or not the professionals who were providing this service had the expertise that was necessary, so I appreciate your answer.
In my former life, in policing, mental health calls have always been a significant proportion of the work, and it’s even greater now. I’m wondering if you’re working at all with the police community in terms of responding to any such calls, which, in that mix of mental health calls, may include veterans.
Mr. Hehr: If I’m understanding your question correctly, we do work with the RCMP. We know their work on the front lines. You’re dealing with people who have had a bad day. You’re dealing with human beings who are struggling in situations and who view horrific things on a daily basis.
I just had a session that said how police officers front-line service directors like you witness between 600 and 1,000 situations that could cause the average citizen to really reflect and have to undergo some very grave mental challenges as a result.
Through a memorandum of understanding, we are working with the RCMP to be able to go through that process and support our RCMP. We’ve had over 60 years to administer certain programs and benefits to serving members on behalf of the RCMP. When this happens, we represent them in service-related disability pension allowances, we have treatment benefits for pension conditions and access to the Veterans Affairs-DND network of operational stress injury services.
Anyone who comes in to get help from Veterans Affairs who is an RCMP officer will not be turned away. They also have transitioning management and counselling services available to them, and the like.
The RCMP sets the direction and has the authority over what programs and services are available to its current and former members, and funding for these benefits is provided to Veterans Affairs Canada by the RCMP.
Senator Boniface: Minister, if I can just clarify, my point was from the other side of the response by police. For veterans who are in crisis, are you doing any work with the agencies so that the response that the police give can be the appropriate response in terms of education or anything like that?
Gen. Natynczyk: We work with the police. We’ve actually created a video with the policing professional development academy. We have created part of a training package for police forces across the country on how to deal with veterans, homeless veterans and veterans in crisis. We worked with a community college in Charlottetown to produce that. It was produced about a year or a year and a half ago. It is out there now to educate police forces across the country to deal with veterans who are in crisis, those they find homeless on the streets and those with mental health injuries. It helps inform them of the resources that are there in order to get them in contact with Veterans Affairs to get them on a better path.
Mr. Hehr: I misunderstood the question. My apologies.
Senator Manning: I welcome our witnesses here today.
To get back to your opening remarks, minister, correct me if I’m wrong, but 9,000 people leave our services each year.
Mr. Hehr: On average.
Senator Manning: Seventy-three per cent transition well and 27 per cent have issues adjusting. Is there a breakdown of male and female soldiers in regard to that 27 per cent? Also, what would be a couple of the major issues you’re finding with the adjustment?
Mr. Hehr: I’m not certain whether we have any numbers. The general, after I’m finished my answer, will look as to whether we have a breakdown.
After they leave the CAF, veterans will have a whole host of issues. If I can break it down to the simplest, when people take off the uniform for the last time, it’s very difficult. They have a sense of team and camaraderie and a sense of what they wanted to do with their lives. Often when they leave, in particular with an illness or injury, it is tremendously traumatic. They wanted to serve their country, and it was cut short for whatever reason. Finding that new normal is often difficult.
That’s what we’re trying to get to — finding a place for them to have better outcomes so they can find a sense of purpose. At the end of the day, it’s a sense of purpose: “What am I here for?” That could be through education. That could be from career transition services, which we’re doing better on, around getting a job. That could be from getting mental health support and just being able to leave their houses again after having suffered from a mental health issue as a result of their military service. It could be a whole host of things.
I said in my outline that every veteran’s story is unique and different, and yet that number, 27 per cent, is far too high, considering that when they come into the military, they’re 100 per cent certified, physically able to perform, and 100 per cent certified mentally to perform. They serve on missions and serve our country well. They develop unique skills and have an ability to be part of a team, take orders and follow through, which are great skill sets.
On that end, much of what we’ve done here since we’ve come into this situation is tried to better those outcomes. I’d like to focus on how we’re doing that too.
Right now, in Budget 2017, we’ve allowed for education benefits to provide $40,000 for going back to school after six years of service. After 12 years, it’s $80,000. If you don’t want to go back, there’s $5,000 to go and be a real estate agent. If you’re interested in massage therapy or dog grooming — something unique. It’s career transition services in helping a veteran get a job. You get a new job, you have your new normal, and you’re like everyone else. You can complain about your boss.
I look at those elements of Budget 2017 as being game-changers for veterans. When we get them set up and running, when we give people options on how to build their lives — that’s why we put this together. I’m really excited about where we’re going to be, maybe not tomorrow, but 10 years from now.
This may sound defeatist, but if we can move that 27 per cent down to, say, 20, that would be huge over the next 10 years. We think we have the building blocks to do that.
Gen. Natynczyk: Senator, just to reinforce what the minister has commented on, the 73 per cent and 27 per cent has been extracted from a study we do every three years. It’s called the Life After Service Studies. Those numbers have been pretty consistent: 73 to 75 per cent transition well and 27 or 25 per cent thereabouts don’t transition well.
For those who don’t transition well, it’s exactly as the minister indicated. Often, they don’t land a new purpose, whether that be a job, a career or an activity of some sort they feel satisfied with. There’s a direct correlation.
Those who are at risk — and we can make available to you the Life After Service Studies — are often more junior ranks. They’re privates, corporals, master corporals and sergeants. They leave the service voluntarily or for whatever reason before they receive superannuation. So they are short of 20 years of service. That’s especially if they’re in the combat arms, which is the infantry, armoured and artillery, where their skills are not readily transferable to civil society. It’s the same in the navy for a bosuns.
I don’t have the breakdown in terms of male or female, but we could share the data with you.
Mr. Hehr: But on the male-female breakdown, we know some numbers. We obviously have more males in the military than females, currently, although we are working on things to raise female participation in CAF to 25 per cent. But if you look at the percentage of women who have served in the military and are in homeless shelters, my understanding is that their members are disproportionately higher than men who served in the military who are in homeless shelters.
There are some corollaries that have a gender-based analysis to them, and we have to continue to drill down in this in our department regarding how to serve both our men and our women.
Senator Manning: Very quickly, given the average of 27 per cent — and we’re talking averages here -- we’re talking a little over 2,400 people.
I understand in regard to the offices where a person who has served comes up, knocks on the door, goes in and receives help. I’ve had the experience of running into a couple of veterans who are on the street, and I’m just wondering about the outreach efforts.
I know we’re all concerned about that aspect. What mechanisms are in place to provide that outreach, to be out on the street and to help?
Mr. Hehr: Veterans’ homelessness is unacceptable in Canada. Frankly, I come from the school of thought that one homeless Canadian is unacceptable. It’s going to take a whole-of-government approach.
Obviously, one component of it is our national housing strategy, which is going to put $11.2 billion into housing over the next 10 years. Veterans have been identified as a priority group for this program, because we know we have many veterans who are struggling and we have higher homelessness numbers than we’d like.
I would also say that we have done things within our own department to look at this. Our Veterans Priority Program Secretariat is looking at homelessness as one of those issues of how do we get a handle on this? At the end of the day, although we can say this is a provincial responsibility, and the national government has some, when every year they put out the veterans homeless study, who do they look at in terms of “What are you doing about this?” It’s the Minister of Veterans Affairs. We recognized this when we came into government, and I’ve discussed this with the general. We are working with our secretariat to tie them into better services, better supports and better transition into housing-first models. Have we locked this down totally? No. We’re working towards it and we’ve got some good people on it.
Also, in this year’s budget we had the Veteran Emergency Fund. This may sound strange, but for the first time we have the ability. Say a veteran is in the process of being evicted from an apartment and needs short-term funding, we now have the direct authority to have the flex money in our department so that we can reach out and help that person. It seems like the department should have had it all along, right? But we didn’t. Here’s what happened: We had to go through charities and other non-public funds to help in certain situations. We now have that flexibility.
We’re moving into the field where we recognize we have to do a better job of preventing homelessness, as well as tying it into better services in terms of the national housing strategy and the like.
General, do you have anything to add?
Gen. Natynczyk: I’ll add a couple of words, if I could, minister. Our approach is to find, inform and assist. By finding the veterans, we are partnering with the Royal Canadian Legion and with Veterans Emergency Transition, VETS Canada. The department is funding VETS Canada, which has groups across the country out there on the streets looking for veterans who are homeless.
In some cases, the veterans don’t want to be found. This is a challenge. Again, I’ve walked with groups on the streets of Ottawa. There are some folks who don’t want to be found. We walk in the front door of the Royal Canadian Legion with our case managers and we know veterans are going out the back door. We’re walking the streets with police officers who are veterans, and they know folks.
But when the veteran does want assistance, using the emergency fund that the minister just mentioned, we can put these folks under shelter and sort out their eligibility. As we mentioned before, we’ve made changes to how we adjudicate mental health in terms of a high acceptance rate in terms of getting them in the door and into mental health treatment. We then move them into vocational rehab; and now, with the initiatives coming on board next year, we land them a job or send them to school.
Senator Manning: Thank you.
The Chair: One of the things we have heard in the committee is that in the transition system for veterans there’s a serious accountability issue. I understand — and maybe you can correct me — that currently there are at least 15 different organizations involved in the members’ transition process, each with its own accountability framework, mandate and process. The Veterans Ombudsman and the National Defence and Canadian Armed Forces Ombudsman agree that there are too many points of contact from separate organizations and this often confuses the veterans.
Do you have any forward planning where there could be one-stop shopping?
Mr. Hehr: I think that’s where we’re going as we work towards this, having a full, seamless transition so that when a person is transitioning from the Canadian Armed Forces, they are good to go day one, set up in their communities for success, having their pension cheque and any services they need. If they’re an ill or injured soldier, having the services they need from Veterans Affairs lined up on the day, and having access to case management and mental health supports should they need them.
General Vance has stated publicly that he’s going to keep people in the military as long as they need shelter from the storm of life and to get those things lined up.
I think what you’re referring to are the many partnership organizations we work with in Veterans Affairs Canada. To be honest, we need all of them rowing their boats in the same direction. They do different, unique things and help veterans in different subsets, whether they be Wounded Warriors, Canada Company, or the Prince’s Operation Entrepreneur program. They all do slightly different things, so we have to ensure that the things we do dovetail with them.
Now, in our Career Transition Services , we are going to allow for outside organizations to set up so they can take advantage of our $2,000 funding for someone to get help in terms of getting a job, learning a trade or finding the initial post they need, working with a career coach. We need all these organizations helping out. What I’ve learned as Minister of Veterans Affairs is that we can’t do it all by ourselves; we actually need their help.
Senator Lang: I want to follow up, and time is not our friend here any longer. I did ask the question whether we had formal agreements with the territorial and provincial governments in maybe all aspects of the responsibilities of the provinces and territories, whether it be education, health, or any other area where Veterans Affairs would pay, on a contractual basis, for the services they provide.
In other words, what I’m asking is this: Do you have an agreement whereby a vet goes to the Department of Education in the Yukon and says, “I want to take a program,” and the Department of Education says, “You will be number one on the list because you’re a vet. You won’t have to wait two years”?
Mr. Hehr: Senator, my understanding at this time is that we have agreements with some provinces and individual facilities on long-term care. It’s my understanding that we have some support systems in place with a mental health provision in terms of our operational stress injury clinics and how that care is delivered. To my knowledge — and I may be mistaken in this — we do not have those educational agreements with provinces or the like. We provide the money. Obviously, provinces are in charge of delivery of education at universities and colleges, and there would be an application program from there. Am I correct?
Senator Lang: I’m not going to belabour this — or maybe I will. I’d like for you to make an undertaking to ask the Department of Veterans Affairs to look at this particular area to see where the federal government could come to a general agreement with the provinces and territories on the general principle that when a veteran applies for a program at the provincial or territorial level, he or she will be given priority, as opposed to a shotgun approach from facility to facility. Would you be prepared to make that undertaking?
Mr. Hehr: We can look.
Senator Lang: Thank you. That’s all I ask for.
Mr. Hehr: I always take seriously what senators say, so of course.
[Translation]
Senator Dagenais: I realize that you are making efforts to improve the situation, as not everything is perfect. There will always be challenges or dissatisfaction. Have you developed a quick and effective method of processing complaints, so that veterans can obtain a response or a decision within a reasonable time frame?
[English]
Mr. Hehr: There are two things I’m proud of. Our department is going forward and surveying our Veterans Affairs clients and will now be starting to get feedback in that format. We haven’t done this for a long time, and we think it’s important to get a real cross-section of our services. The goal of our national survey is to gain additional information from veterans and the people that Veterans Affairs Canada now serves on how well our benefits and services are meeting their needs. We believe this is an important step for us to be able to get more of that information.
Regarding the decision-making process, if a veteran applies for a benefit and that benefit is not received or the veteran doesn’t like the decision, we actually have a pretty good system the arm’s-length Veterans Review and Appeal Board, where there are two levels of appeal. We will pay for a lawyer to organize your claim, work through the medical evidence and tie it to your military service at both levels. This is a reasonable way to go. Each hearing is de novo. You can bring new evidence at each of these levels of appeal. Couple that with our benefit-of-the-doubt approach, I am hopeful that veterans will be getting the benefits they’re entitled to. Hopefully we have a reasonable system that recognizes that there has to be an attribution to service as well.
The Chair: Regarding the issue of people being dismissed because of injuries or permanent disabilities, every panel that we’ve had here talked about medical assessments by the department. What confuses me, minister, is that there is a file that the person has at the Canadian Armed Forces. I would imagine there would be an assessment done at the Canadian Armed Forces. Then when that person leaves the Canadian Armed Forces, your department starts all over again.
I’m confused. Why can’t you use the assessment from the Canadian Armed Forces? Why do you have to reassess everything? I still haven’t got a handle on why that has to happen.
Mr. Hehr: Ma’am, I can agree with you 100 per cent that we should be doing much better on this file. In fact, we are. We now have the ability recently in that Canadian Armed Forces medical records are now digitized, so we can easily share the information required to determine eligibility for VAC support. This has resulted in the routing of 56 per cent of claims through a streamlined decision-making model and we’ve also reduced the average transfer time of these service health records from CAF to VAC by 54 per cent, from 35 to 19 days. I think that’s important.
We’ve also simplified the process for most common conditions, including hearing loss, PTSD and musculoskeletal conditions.
General Vance mentioned that when a diagnosis happens in the military, we need to follow through and recognize that it’s still attributable service going forward. I understand we’re showing good faith in moving towards this system and not having it back 100 per cent. I’ll ask the general to fill in the gaps .
Gen. Natynczyk: Senator, when veterans come to us, they come to us at different times of their life. Of our total clientele, 25 per cent of them come to us while they’re still wearing a Canadian Armed Forces uniform. There are folks who are injured at basic training or at Collège Militaire Royal du Canada in their trades, training or during service in the army, navy or air force. If they have a permanent injury, they can make application right then and there, even if they have 30 years left to serve. They can make application and become clients of Veterans Affairs, receive a disability award. Keep in mind that they’re under salary and have full medical care under the Canadian Armed Forces. When they leave, there’s no change, they are still clients of the Canadian Armed Forces.
For the rest of our clientele, 25 per cent of them come to us within two years of release. We understand the latency of a mental health injury and musculoskeletal wear and tear. We know where the files are. We sort out the eligibility and get the diagnosis. Fifty per cent of our clientele come from year two to year 50. We have World War II veterans who are walking in for the first time. In those cases, we are doing all of the confirmation of eligibility, looking through their old service records and medical records and trying to adjudicate them.
As the minister indicated, we are working closely with the Canadian Armed Forces as they digitize health records, deal with privacy issues and third-party information in order to expedite all of the Canadian Armed Forces health records so we can make an adjudication even before people take off the uniform. Efforts are being made. We’re also dealing with these other cohorts who come to us later in their careers. Hopefully that’s helpful.
The Chair: That’s very helpful. We’ve been told that a number of times. Sometimes it may take years before somebody becomes sick. It can be because of what they have done while serving our country.
One of the things that we have heard over and over is that it takes time when the transfer happens from Armed Forces to Veterans, but you’ve made that clear. Maybe we can have the same kind of thing that we have for pensions, that you will not be released, if you are injured, until all that is in place.
Mr. Hehr: We believe we’re working on speeding up that transition. Of course, there are privacy concerns here, especially if in a person’s file they have third party information and things of that nature. But we’re working towards solutions to work this release process even quicker. Actually, timing is everything. The general and I had a good conversation on this yesterday at my office, so we’re working on it, senator.
The Chair: I know you have to go, you have cabinet. However, I would be remiss if I didn’t ask you this: In the last year, we’ve had some terrible situations with PTSD and veterans not receiving service on time, among other things. I would like either of you to assure us that veterans are getting the services they need. We had a terrible incident happen not that long ago, and I’m wondering how you’re dealing with that now.
Mr. Hehr: No system is perfect.
The Chair: Absolutely.
Mr. Hehr: Part of the issue is destigmatizing our whole society’s approach to mental health. I believe that once a veteran has contacted our department and is accessing our services, they’re actually in a pretty good position. Yet we know better is always possible. That’s why we’re setting up our centre of mental health, centre of excellence. That’s why we’re working on our suicide prevention strategy. Although we can’t comment on any individual case, I can say that often times we work extraordinarily well with veterans, family members, community members. We know we have to keep moving in that direction to do things even better in the future.
The Chair: Minister, general, we really appreciate your testimony today. I’m sure this won’t be the last time you appear before us because we intend to have further studies on these issues. I want to thank both of you for taking the time to be here and giving us fulsome answers. We look forward to working with you in the future.
Mr. Hehr: It was a real thrill. Thank you so much.
(The committee adjourned.)