Proceedings of the Subcommittee on Veterans Affairs
Issue 3 - Evidence - May 5, 2010
OTTAWA, Wednesday, May 5, 2010
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:10 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 Fabian Manning (Deputy Chair) in the chair.
[English]
The Deputy Chair: Honourable senators, I am Senator Fabian Manning from Newfoundland and Labrador. I am the Deputy Chair of the Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence.
Our chair is part of an entourage visiting the Netherlands today. I wish him all the best. I am sure he will be back here in his full glory next Wednesday. In the meantime, I will do my best.
I will ask members of the committee and our guests to introduce themselves. However, before we move to our business today, Senator Wallin needs to deal with another matter before we hear our witnesses.
Senator Wallin: I am Senator Pamela Wallin from Saskatchewan. I am the Chair of the Standing Senate Committee on National Security and Defence, of which this is a subcommittee.
[Translation]
Senator Dallaire: My name is Roméo Dallaire. We are celebrating the 65th anniversary of the liberation of Holland and that is where I was born. I am Dutch through my mother. I am the Deputy Chair of the National Security and Defence Committee. I represent the Senate division of Gulf, Quebec.
[English]
Senator Day: I am Senator Joseph Day. I am an interloper here. I used to be a member of this committee but I am no longer. I continue to be interested in Veterans' Affairs matters so I continue to attend. I am the Chair of the Standing Senate Committee on National Finance and a member of the Standing Senate Committee on National Security and Defence.
[Translation]
Senator Meighen: My name is Michael Meighen, I am a senator from Ontario and I was born to an anglophone mother in Montreal.
Senator Pépin: My name is Lucie Pépin. I am a senator from the Senate division of Chaouinigane, Quebec, and I am very involved with military wives.
[English]
The Deputy Chair: I will ask our witnesses to introduce themselves, including the positions you hold.
[Translation]
Charlotte Bastien, Director General, Quebec Region, Veterans Affairs Canada: My name is Charlotte Bastien, Director General, Quebec Region, Veterans Affairs Canada, and Acting Regional Director General for the Ontario region.
[English]
Lieutenant-Colonel C.M. Hand, CD, Commanding Officer Joint Personnel Support Unit, New Brunswick/P.E.I. Region, National Defence: I am Lieutenant-Colonel Chris Hand. I am the Commanding Officer of the Joint Personnel Support Unit in New Brunswick and Prince Edward Island.
Lina Matos, Regional Director, Client Services, Western Region, Veterans Affairs Canada: I am Lina Matos. I am the Regional Director of Client Services for the Western Region of Veterans Affairs Canada based in Winnipeg.
[Translation]
Robert Cormier, Director, Montreal District, Veterans Affairs Canada: Good afternoon. My name is Robert Cormier, Director, Montreal District, Veterans Affairs Canada.
[English]
The Deputy Chair: Thank you and welcome.
First, we have a piece of in-house business to take care of.
Senator Wallin: I move that we terminate our meeting today by 1:15 p.m. or when the bells commence. We all need to get to the house. I do this in fairness to honourable senators and the witnesses so that everyone hears the testimony and that our witnesses can gauge their time.
The Deputy Chair: Is this motion applicable only for today?
Senator Wallin: It is only for today. However, I would prefer for the end time to always be 1:15 p.m. If senators are agreeable, we can pass that. Have you any concerns, Senator Dallaire?
Senator Dallaire: We will start at 12:15 p.m. and end at 1:15 p.m. We will have one hour now?
Senator Wallin: Yes.
Senator Dallaire: We used to have 1.5 hours.
The Deputy Chair: We have to be in the chamber at 1:30 p.m.
Senator Dallaire: Let us proceed for today and then discuss it later. You are cutting the committee's time by one-half hour.
The Deputy Chair: The committee will finish at 1:15 p.m. today. All those in favour?
Hon. Senators: Agreed.
The Deputy Chair: Carried.
[Translation]
Ms. Bastien: Mr. Chair, thank you for the invitation to appear before you today. I am going to give you an overview of the service delivery network in the regions of Veterans Affairs Canada.
The environment in which Veterans Affairs Canada is currently working is in a state of change and is unique for a number of reasons. At present, we have four regions: Western, Ontario, Quebec and Atlantic.
The regions also have a network of complementary resources, including health professionals, mental health clinics and other professionals on a contract basis.
It is the job of the regional office to ensure the efficient delivery of programs and services in the region, to meet the needs of the clientele. It is also responsible for providing guidance and leadership in the planning and management of all programs and initiatives of Veterans Affairs Canada. The regional office is the front line for the delivery of Veterans Affairs Canada services, its window for the public and partners and the liaison with headquarters, to represent regional and local needs and regional achievements.
For example, the Quebec region is currently divided into two districts; the Western region has seven districts; Ontario has four districts; and the Atlantic region has four districts.
I am going to talk a bit more about examples from Quebec. The Quebec City district is located at CFB Valcartier, and has dealings with many Canadian Forces veterans. It is one of the districts that deals with the highest number of cases involving a mental health condition in the country, 14 per cent, although it is responsible for only about four percent of all of the Department's clients. With its Valcartier service point, it was the first, nearly 10 years ago, to offer programs and services directly on a Canadian Forces Base.
In spite of the growing numbers of deaths among its traditional clients, it is estimated that the Quebec City district's clientele will hold steady or increase slightly. This can be explained by the fact that the area covered by the district includes an operational military base whose members are regularly deployed on missions abroad. The Quebec City district is representative of what the future holds for district offices, with the attrition of the traditional clientele.
We also maintain a presence on Canadian Forces sites to offer transition services. Members of the Canadian Forces can now access Veterans Affairs Canada services and programs at various Canadian Forces sites. The Western region currently has six sites; Ontario has seven; and Quebec has three.
Transition services are information about the services and benefits provided by Veterans Affairs Canada; transition interviews to determine how Veterans Affairs Canada can help the member and their family; assistance in relation to the process of applying for compensation or a disability pension; access to a case manager; referrals to other services providers if necessary; and referrals to case managers in the Canadian Forces and representatives of other Department of National Defence programs, if required.
VAC personnel organize information sessions for Canadian Forces personnel at orientation days, seminars and presentations before or after deployment, or on request.
Implementation of various initiatives is underway, to strengthen the case management capacity in the regions. Case management services are offered to clients, their families and their caregivers, to ensure that the appropriate programs and services of Veterans Affairs Canada, other departments, community organizations and local service providers are in place to ensure that clients have the highest level of independence, autonomy and quality of life and assist with integration into civilian life.
Case management includes the following phases: (a) preliminary examination, (b) assessment of the client, (c) planning the actions to be taken, (d) coordinating services, (e) follow-up, (f) reassessment, and (g) withdrawal.
For example, since November 2009, the services of a clinical consultant assigned to the district office have been offered in Quebec City. Under the direction of the district director, the clinical consultant is responsible for offering a service to provide specialized clinical support, guidance and vocational orientation, a specialized case management clinic for case managers in the Quebec City and Valcartier district offices.
With respect to the delegation of decision-making responsibility for rehabilitation for exceptional requests, we have given the Quebec City case managers the power to make decisions relating to services and benefits in all aspects of the rehabilitation program, including exceptional benefits. The conclusion from this pilot project in Quebec City was that this power should be delegated in all regions starting in April 2010.
We have also reviewed the workload allocation among personnel in the district offices so that case management capacity can be better identified.
We are continuing to review our procedures and improve service, to ensure that clients receive the right service at the right time. As well, public information work is ongoing, so we can reach the greatest number of members and veterans of the Canadian Forces and ensure they are well informed about our programs and services.
[English]
Senator Wallin: Thank you again for being here today. We are pleased to have both Veterans Affairs Canada and Canadian Forces folks before this committee.
Could you give us your views on how this relationship works? I know there have been some improvements. However, there are the silos and no overarching authority that would not only include DND and VAC, but there may be other departments that would be brought in. From each of your perspectives, how do you see the relationship?
Lt.-Col. Hand: The relationship is much improved from what it was. I say that as a serving member, not touching on the veterans earlier; I did not have much to do with them as I did not require their services. Since taking on this job, and with the New Veterans Charter, the mandate, and the standing up of the Director of Casualty Support Management, DCSM organization, we have a closer relationship with Veterans Affairs Canada.
I can speak for New Brunswick and Prince Edward Island. We are integrating our offices to have a service component inside our office, as well, so that, if issues arrive with an ill and injured member seeking benefits, he will remember that he is in transition from military service into the Veterans Affairs Canada side of the house. That is better facilitated because the veterans' affairs officer is right there, collocated with you. It solves many problems in terms of going in between to find out what the problems are and to get the answers you need; whether the soldier or their families have questions about benefits; and setting them all up.
We are designed to bring in all the partners that are part of that transition component, from the Canadian Forces health side to public health in New Brunswick. In our area, we are networking with the community development branch of the provincial government to see what we can do for veterans. We maintain close liaison with the legions that connect with the veterans, as well, and with the district and regional offices in Halifax.
Of particular note, we have a reciprocal arrangement in Charlottetown in terms of what is the norm in Canada. Normally, the Veterans Affairs Canada offices are being collocated on military infrastructure, close to military bases where the majority of the new clientele is coming from; we have a reciprocal arrangement on the Island where we have a military officer inside the veterans affairs district affairs in Charlottetown. It is working exceptionally well.
We are not as far ahead as some of the other areas in that the main district office for VAC is in Saint John where the predominantly new client base is coming outside of CFB Gagetown. That is in transition. We have an agreement to move those personnel when the positions become available in the public service to get them into Gagetown to get a full regional office inside Gagetown to meet the needs of the client bases.
From my perspective, and because the joint personnel support unit, JPSU, is the military unit closest to Veterans Affairs Canada, which has the greatest access and deals most with VAC, it is going very well.
Ms. Matos: We have a similar experience in the western region. At the field level, the relationships between DND and VAC are quite strong. In particular, in the offices such as Edmonton and the garrison, where we have a full client service team, those relationships have a better opportunity to engage, collaborate and work collectively, particularly as members transition from the military to civilian life.
In smaller sites where we are just starting off, particularly the ASUs in, say, Calgary, or CFB Shilo, where we have only one or two staff, it might be more challenging to manage operationally. However, in terms of the relationships, they are quite strong and it will only get better with more experience.
Senator Wallin: Would you like to comment, Mr. Cormier?
Mr. Cormier: Yes. In Montreal, a year ago, we established a team of VAC staff near CFB Saint-Jean. It has been very successful. We are still working out some kinks, but that relationship has allowed us to quickly identify issues around transition. It allows us to work closely with DND before a member is released and allows us to consult and to anticipate any difficulties that a member might have when he or she is released.
For us, it has been a positive experience. Quebec City has a stronger history in terms of that working relationship. Perhaps Ms. Bastien wants to add to that.
[Translation]
Ms. Bastien: Co-location has really helped to improve the collaborative working relationship between Defence and the Department, in the best interests of the client. We are in the transformation and restructuring process precisely to be able to move our personnel so they are closer to the clientele's bases and also co-located with Canadian resources. There have been a lot of improvements in their relationship in the last two years and that is precisely because of co-location.
Senator Pépin: What are the three most common injuries you see in members of our military when they consult you? Is there a problem or problems that come up regularly?
[English]
Lt.-Col. Hand: The old community of veterans has a multitude of injuries. However, we are predominantly seeing a mental health issue or an OSI related to operations or some previous injury. That takes the bulk of the soldiers that come to our unit and the ones currently transitioning into VAC services.
The next would be those with a visible physical injury, such as an amputee type of injury. In most cases, that is directly related to an operational experience overseas. We do not have large numbers of those in New Brunswick because New Brunswick tends to be a training base. We only have one or two operational units that only hit the operational cycle infrequently, whereas Valcartier, Edmonton and Petawawa have the units that are taking the bulk of the operational tours.
In the training systems, those physical injuries are posted down to my region because they have a physical injury and are incapable of functioning in the training system, unless they return to health.
The next level of injury is those that appear from long service injuries, or that are workplace related not attributed to an operation. Long service injuries could result from years of riding around in armoured personnel carriers or old jump injuries from being parachutists. Workplace injuries manifest themselves in bad backs and joint injuries, that type of thing. We get a large number of those coming through as well. Basically, those are the three types of injuries — two related to operations and one related to just years of being a soldier.
[Translation]
Senator Pépin: Do you have anything to add?
Ms. Bastien: I can try to get the figures. As Lcol Hand explained, it all depends on the nature and function of the base. There are some differences from one base to another. I could give you a national profile, but it would not be representative of all the bases.
Senator Pépin: Thank you. Earlier it was mentioned that veterans affected by post-traumatic stress syndrome, among other things, are getting younger and younger. Are a majority of those soldiers married? Are you familiar with the family problems caused by such trauma? Are services offered in those cases?
[English]
Lt.-Col. Hand: The family component is very important. Returning a soldier to health, if he is still in service and the intent is to do so — which JPSU is mandated to do — involves the family. It involves all aspects of his workplace and his return to work program, if we can put him in one. It involves the military chain of command, including anything he does after work hours at home.
The family is affected in every case. Whether it is a physical injury or an OSI, it has an effect on the family as to what that family member can do compared to what he used to be able to do.
We have very good connections to the Military Family Resource Centre, lots of resources available inside the military and outside on the civilian service providers to allow spouses and the families access to those things that they may need to help them deal with their husband's or wife's issues. Also, we keep getting better. As we learn more about it, we seek and find new resources within the community to deal with these issues.
Senator Meighen: What kind of success do you have in attracting people to your resources? We have heard testimony that it is not always easy to persuade people that they need help, particularly to get the spouses of the injured members there.
Lt.-Col. Hand: It can be difficult. It has been my experience that almost all of our clients or soldiers start in denial and that expands into the family. They have had a dramatic change to their lifestyle. They are not fully functioning as soldiers anymore in a certain capacity. What they thought their life would be has now changed. That affects the family.
It is hard to get them to admit that they need to seek help. Once they have done it and they come to us, we have a whole raft of things that they can access in terms of services. I have no mandate to force a family to the table or to a service. It is always offered, but they have to come and request it.
Senator Pépin: If a member of the military dies, what immediate services do you provide to the spouses? Does she or he still have to go to the military family centre to get them?
Lt.-Col. Hand: No. There is a structured process for when a spouse or a military member dies. The immediate response is through the chain of command from the member's unit. It provides an assisting officer who then has access to many benefits across the system, including VAC, SISIP, financial help, medical help and the chain of command in the system. That AO will then manage that family through the process of the funeral, and for probably a period of six months to a year that the spouse and the family are still connected to the military for the help they need to sort out their affairs.
At a certain point, that file or that family's file is transferred from the chain of command of the unit to the JPSU. We track that family forever, depending on how much they need from us. Some families are still very connected with us; some families are capable of moving on and doing other things.
Currently, we are tracking 28 families of fallen soldiers. That goes back a number of years. Some families are still talking to us four or five years later; some we only phone once a year because that is all they request.
Senator Dallaire: That is fine for those who are still serving. For those who are released and now are totally in the hands of Veterans Affairs, how do you handle situations of people dying as a result of suicide? What investigations do you do to determine the reason for that and the follow-up of that dossier?
[Translation]
Ms. Bastien: If it is a veteran who was released some time ago and he is one of our clients, we will be informed of it and we will work with the family to determine what support we can offer. However, we do not investigate the causes of the death. Our role is rather to look at how we can help the family get through that difficult time.
Senator Dallaire: No investigation is done into the cause of the death or the suicide, even if the veteran committed suicide because of their military service and the care they received? You have no responsibility for determining whether the cause of death is attributable to those reasons or other reasons?
Ms. Bastien: Depending on the circumstances, we can hold a case conference to see whether something went wrong. However, the Department's primary objective is to focus on how we can help the family get through the difficult time and the support they will need.
Senator Dallaire: You offer technical care and certainly the financial aspect has to be considered.
Ms. Bastien: We are talking about support for the family.
Senator Dallaire: With this new generation of veterans, where we are seeing cases of suicide, would it not be essential to see whether your responsibility might not extend to analyzing the reasons behind these deaths?
Ms. Bastien: There are research programs, but I am not in a good position to talk to you about them. In some circumstances, we look at the question. If something went wrong, we make recommendations to see how to improve services and prevention. However, there is no formal process.
[English]
Senator Meighen: How long do you think it will take to move the personnel from Saint John up to Gagetown?
Lt.-Col. Hand: We are in the process right now. This is a Veterans Affairs initiative. The base and the JPSU certainly would like to see the regional office in Gagetown. It depends on the tenure of the public servants and when those positions become open to be reposted in a new location.
Senator Meighen: What would have motivated the establishment in Saint John, where there is no base, and where there is one down the way?
Lt.-Col. Hand: I do not think I can answer that question.
Senator Meighen: I do not blame you; only the military could.
Senator Day: There are many older veterans living in the Saint John region, and the old Veterans Affairs office dealt with a large clientele in the greater Saint John region.
Senator Meighen: Even when Gagetown was in existence after the war?
Senator Day: Yes.
Senator Meighen: Anyone can answer this question. What is your largest challenge right now? What would you fix if you were king of the kingdom?
Ms. Matos: Our largest challenge is balancing the service delivery to our traditional veterans, trying to meet their needs as they age and move into the elderly stages of their lives, compared to our younger veterans, who can be as young as 18 years of age. We are looking into that challenge. We are looking at our service delivery model, and our technology and how we interact with our clients. Our clients access all social media outlets, such as Facebook, but we are not equipped technically to serve them in that arena. We are trying to modernize our efforts to serve our clients. In our region, that is one of our biggest challenges in meeting the needs of our clients.
Senator Meighen: Some of your older clients do not communicate via the Internet, I suppose.
Senator Dallaire: The link between Veteran Affairs Canada and National Defence started with Ms. Violet Parker and Lieutenant-Colonel R.G. MacLellan in 1998. We have been at it for 12 years.
Are the military medical records transferred automatically into the computer system of Veterans Affairs Canada at your level and at Charlottetown?
Ms. Bastien: We have had access to medical records for a number of years. VAC has staff in the medical clinic whose job is to photocopy medical records that we require and request. We are working on developing the interface because military records are being digitized at DND. In the next couple of months, we will be able to access the electronic medical records of VAC members.
Senator Dallaire: You are able to look at a file to determine the reason for the demand. However, other materials have not been considered so you have to go back into the file and recopy. Do I understand correctly that you will be able to absorb a full digitized medical file into the system at Veteran Affairs Canada in the near future?
Ms. Bastien: Until four years ago, the request would select specific parts of the document. For the last four years, if my memory serves correctly, we have been photocopying the entire file so that we have full access.
Senator Dallaire: You mentioned the challenge of operating two charters — the old charter, which still has growing pains, and a new charter.
What formal training have you and your staff received in order to fully comprehend the complexities of the new charter, assess the contracts you need for retraining and rehabilitation and comprehend the dimension of the injury scale. In particular, I wonder whether the operational stress injury clients are supported when trying to fill out all the forms or are they on their own to do that.
Ms. Matos: In response to your question on formal training, it is quite a transition from the old charter to the new charter. Starting in fall 2005, all our front line staff, including regional staff, went through a stringent set of training modules that included not only the history around military culture and information about the typical medical conditions but also operational stress injuries, information on the New Veterans Charter legislation, the policies, business processes, and the rehabilitation models. These were important to all of our staff because they were shifting significantly. After that initial training was complete, about mid-2006, we recognized that we needed to build additional modules for the staff, which included a refresher of all the information I just shared. As well, we needed to deliver training in areas such as applied suicide intervention and motivational interviewing. We need to know how to engage a challenging client who might not be ready to work with the department and who might have too many issues, psychiatric, physical or other, that prevent them from working with VAC. All of that training has occurred. In 2006, our statement of qualifications for hiring our case managers also changed. Currently, all our case managers must have a degree in social work or psychology or other related field, plus experience in case management. We have gone to that extent to ensure that our front line workers, who work most intensively with our clients, have the best possible skill sets and competencies to work with our clientele. However, at this time not all of our case managers have those skills sets. We know that there is still work to be done, and the department is working on our capacity to case manage, which includes supporting our case managers. Ms. Bastien spoke earlier to the role of the clinical consultant. That position offers support, coaching and professional practice supervision of front line workers.
Those are some of the things we have done. We recognize that individuals you referred to with operational stress injuries require more intensive support. The role of the case manager is to work with that individual and his or her family to help them to build the supports they require.
Senator Dallaire: We no longer need bulletproof glass counters because we are doing more training. Do you think that because of the continued complexity, you need a training establishment to formally run people through the training processes? More and more families are being recognized under the New Veterans Charter because it has a strong emphasis on families. Yet, we have not heard much about how that side has evolved. Perhaps they do not want to engage even though they have the right to services. Do we need more capabilities, beyond a crash program, to engage them in the available processes?
Ms. Matos: We have considered options in terms of how to keep our staff trained, which will be an internal challenge. We work with local universities and any other resources available in the various offices that are cost effective to link with the community partners. I have a team of health professionals at my regional office that include rehab officers, mental health officers and nursing and medical professionals. They provide support and consultation to the front line workers. The case managers have access to those supports. We have a mirror image in head office that offers support as well. Our staff has the ability to connect with the individuals they might need to work through complex cases. Your point is taken that we need to do more work with regard to staff that might not have the competencies to which you refer.
Senator Dallaire: They will acquire more experience.
[Translation]
Senator Dallaire: I have an example. Take the case of a reservist in Matane who thinks he has a problem that calls for his case to be looked at by Veterans Affairs. He is still a Class A reservist. Does he have to go through his unit, through the militia brigade or the militia headquarters? Does he go directly to Valcartier? What instrument will give this individual all the information he needs in order to get care? I am using Matane, but there are several other places.
Ms. Bastien: There are several mechanisms that can be used and he will be able to receive the help he needs. He can go through his chain of command. We regularly make presentations to reserve commanders so they are well informed about the services offered and what we can do for reservists. Or he can visit a district officer, whether in Campbellton or Valcartier.
Senator Dallaire: Does he have to pay for the service out of pocket?
Ms. Bastien: Yes. He can also start by calling the 1-800 number if he doesn't want to go through his chain of command. He can also go to our Internet site. And he can also go and see the Legion. I know there is a very active service officer in the Rimouski area who is very familiar with our programs, and who can refer and guide him in his efforts to get in contact with us.
[English]
Senator Dallaire: Does the reservist get engaged?
Lt.-Col. Hand: Yes, they do.
Senator Dallaire: If injured, does the reservist stay on full employment and salary?
Lt.-Col. Hand: It depends on the contract. We can carry a class B reservist if the injury is not mission related for a number of months until he establishes himself elsewhere. Class A reservists are more problematic because of parameters in their terms of service. If a class B reservist was on service overseas, and the injury is directly attributable to service in Afghanistan, it is much easier to facilitate because a reserve compensation package can be applied.
The class A, class B, class C side of the house is problematic because the terms of service limit what benefits he can access. However, we have all classes coming through our door. We try to help them as best we can and to point them in the right direction.
Senator Day: My question has been answered in large part. I was interested to talk about the transition from traditional veterans and the Veterans Affairs offices. We are all probably familiar with offices like that in Saint John, New Brunswick where individual case managers had a list of veterans and their families that they kept an eye on. They dealt with VIP or pension issues and transition of the veterans into hospitals or nursing homes.
You now have a new realm of responsibilities. Ms. Matos described training done in the western region. Has new staff been hired? How do you maintain the case management role and ensure that traditional veterans are not forgotten, although that caseload is decreasing? Is new staff with new academic qualifications replacing existing case workers? How do you manage that transition?
Ms. Matos: The training I discussed applies to all of Canada.
The issue you refer to is an operations issue in how district operations provide an equal level of service to traditional and new clients. Robert Cormier may be better situated to speak to that issue because he manages those operations.
Mr. Cormier: It is a challenge to maintain a high level of quality service for our traditional veterans while, as you said, the new generation of veterans require an entirely new skill set for staff.
People came to our department years ago with a desire to work with aging veterans. They came with a certain skill set and knowledge. They are now confronted with the reality that their caseloads of senior veterans are declining, and they have to shift into another mode of interventions.
To put it bluntly, some staff have chosen not to make that shift. That is okay and it is something we have to address. Managers must communicate with our staff to ensure they are at the right place to give the service we expect them to give. Some staff have chosen to leave because they are not interested in continuing. Other staff decided to take up the challenge, even in mid-career, and to gain the skill sets they lack through their own initiative and the training offered by the department.
The situation is dynamic and evolving. We look at our client profile, the difference between traditional and young veterans, and the challenges that profile poses. Internally, our staff has that similar challenge. Older staff are, perhaps, more interested in working with traditional veterans. Newer staff are, perhaps, more skilled and interested in working with rehabilitation and those kinds of issues.
That is a daily challenge for the department.
Senator Day: Are you allowing this transition to happen by attrition through retirement and departures or was there a major realignment where it was suggested to some people that they find work elsewhere and you hired new people?
Mr. Cormier: The situation varies across the country. In my office in Montreal, we have been able to manage through attrition or by people coming to the conclusion that they want to work in another area. We have not had to take a more aggressive approach.
That luxury of attrition may not be possible in other areas of the country. Western and Atlantic Canada may have offices where they have to be more direct.
Ms. Matos: Operations are exactly as Mr. Cormier indicated in the western region. Where an office in the west has available capacity, we have used a concept we call service without borders. Staff from an office that has capacity will support another office that perhaps lacks in a particular capacity. We have managed the transition in that way and it has worked well. This approach is more challenging with case management.
However, this form of case management has worked well in British Columbia. The Victoria office has the second highest volume of New Veterans Charter clients and clients on rehabilitation. The office has a shortage of staff, and it has received support from the Vancouver district office and the British Columbia interior office, which have excess capacity.
To an extent, the service without borders concept works. It allows us to manage ourselves through a period while we try to deal with changing dynamics with our traditional client population decreasing and additional clientele from the New Veterans Charter.
Senator Day: Although the committee is focusing on the New Veterans Charter and we are interested to learn how it is being implemented, it is also important to us and to Canadians that traditional veterans are not lost in this transition. We do not want to see all of your focus go to training for the New Veterans Charter. I know you are not doing that, but it is important that we put this on the record.
My second question pertains to how you handle situations. Consider a situation where a person in the military has been injured. He ends up in a hospital that may not be anywhere near where his unit is lodged. His family may be in different places — some may be on a base with access to a family resource centre, but the extended family certainly would not all be there.
Do you exchange best practices across the country? How do you ensure that individuals get the needed support at this critical time when he or she has just returned to Canada and is in hospital?
Lt.-Col. Hand: The member is still serving so he is within the realm of the military chain of command.
Senator Day: Yes.
Lt.-Col. Hand: He would not come to a JPSU or be seen by a JPSU until Canadian Forces health authorities place him under medical restrictions of some sort. Those restrictions will determine whether his recovery will be a certain length in terms of him still being carried by his unit and returning to work in his unit in his original capacity.
If the restrictions look like they might take longer, a decision is made by the chain of command and the local base surgeon to determine where that recovery would best be facilitated. Such a decision could see the member being posted to the local JPSU, taken out of the line unit, where he has nothing to do but follow his recovery aspects of returning to health and then into a return-to-work program.
If the medical restrictions are such that the member should be sent to another location in the country because that is where his family support network is or where it better supports him, we move that member there. We have a number of young private soldiers with no immediate family other than their parents getting hurt from one of the operational bases, Petawawa in particular, where the recommendation was that the young man be sent to New Brunswick to be closer to his mother and father. We do that. However, it is predicated on the medical assessment, how long the recovery takes, and the start point.
Senator Day: Let us talk about that front time. The early time is very important in terms of family support.
Lt.-Col. Hand: There are benefit packages from within the DCSM organization to allow spouses to travel to the hospital.
Senator Day: Who follows up on that?
Lt.-Col. Hand: The request will normally come through the chain of command to JPSU, which accesses it almost immediately. There are padre funds and base commander emergency funds; there are a number of mechanisms out there to provide that service at the start point.
We hold the purse strings inside DCSM to get the people over to the hospitals in Germany, and we do that as required on a regular basis.
Senator Day: This committee visited that hospital. It was a very good one.
Senator Wallin: We talked a little earlier on today and in other sessions too about the inclusion of families. It is one thing to deal with a CF member who returns with PTSD, but often the family members themselves have the same or related mental injuries. My understanding is they are required to seek their care and treatment in the community, not through the base or through any other system.
It seems obvious that, on one level, you would want them to be able to go onto the base. In the first place, many families do not live on the base so they might be connected, but I wonder about the implications of that down the road. If there were to be ongoing treatment or claims, this becomes a new financial issue.
Lt.-Col. Hand: It is problematic. The Canadian Forces health system does not treat spouses or family members. Other NATO countries do, but we do not.
The capacity of the clinic in Gagetown to accept that responsibility would be problematic. It is overworked as it is. That is compounded by the fact that, in a lot of areas, military families transferring across the country have to change medical cards, there is a waiting period between provincial jurisdictions and finding family doctors in new locations is difficult. It is still up to that family to have that.
We will still take them through the door and try to provide whatever services we can. Sometimes, it is easier because we are networked and we have the points of contact. If the family is not familiar with what is available to them, we can point them in the right direction. However, accessing Department of National Defence services is not done.
[Translation]
Senator Pépin: Ms. Bastien, if I understand correctly, you are saying that in the Quebec region we had a higher percentage, about 14 per cent, as compared to the rest of the country, of young veterans with mental health problems.
Is that because they are younger when they enrol in the Armed Forces? Given that you have more people who have these problems, do you have the support services needed to meet demand?
Ms. Bastien: I am going to clarify, I referred to the Quebec City district and when I talk about the clientele, I am not talking only about people who are in the Forces who have served in Afghanistan. Often, members of the military who are released from Valcartier will tend to stay around Valcartier. That percentage includes people who served eight or 10 years ago, and who have been released, but are clients.
But there is a trend. When we look at the profiles for the clientele near a base like Petawawa, Valcartier or Edmonton, there is an impact on the percentage of the clientele who have a mental health problem in comparison with other district offices where they don't have many clients who are former military or veterans of the Canadian Forces.
We also have a network of mental health clinics. They exist across the country, and there is one in Quebec City, between Valcartier and Sainte-Foy, which has been operational since 2004. When a client has a file at the clinic, the OST clinic can offer services to the wife and family. We also work with community organizations and the Legion to identify resources, to a network of resources that the family can deal with.
[English]
Senator Meighen: One of the areas of the New Veterans Charter we have had some conflicting testimony on is the pros on cons of the lump-sum payment as opposed to periodic payments, in the event of a serious injury. We realize that the lump-sum payment comes along with the whole suite of other benefits available to the injured person.
What financial counselling are you able to provide, if any, upon receipt of that money? Can you do it yourself, contract it out, or do you do any of that?
Ms. Matos: One of our suites of programs within the New Veterans Charter is financial benefits counselling. It provides up to $500 for the member to seek financial counselling as to how to finance the funds that he receives from the departments in order to use it wisely. That is currently available to individuals who receive the lump sum disability award.
Senator Meighen: Has there been a reasonable take-up on that?
Ms. Matos: To this point, no. Part of the reason is that there are a lot of financial companies out there — banks and other institutions — that provide that type of counselling, usually free of charge. Therefore, we have not seen a huge uptake. I do not have the statistics available, though.
[Translation]
Senator Dallaire: I know the work you do in Quebec. You have really been in the vanguard in several areas. A client who goes to your clinics must be a patient who is already stabilized and be at a stage where they are able to participate in a care program, and not clients in crisis. Clients in crisis go to civilian hospitals. Is follow-up done from the civilian hospitals, and do you take them at some stage? For example, patients in Sainte-Anne de Bellevue are followed up in the same way as patients at the CHUL. Do you anticipate having the capacity to do that in future?
Ms. Bastien: The client will be followed up by a case manager, a member of the district office personnel. If he is in treatment or follow-up at a clinic, there will be interaction between the clinic personnel and the district office personnel to follow up on the client.
Certainly if there is an episode or crisis that calls for acute care, we can't substitute for the provincial system. That type of care is under provincial jurisdiction.
If, for one reason or another, he is followed up or is hospitalized for some time in order to be stabilized, at that point we work in cooperation with the hospital personnel, the social worker and the attending physician, to determine what the individual will need, when he leaves the hospital, in terms of follow-up.
Senator Dallaire: But if he is a reservist outside the army who falls ill and is in a crisis, and he is in the civilian system, you can't go and find him. So he will have to find out about your existence in order to get your services.
Ms. Bastien: There is public information work being done; if he is known, we will be informed fairly quickly. But if it is an individual we don't know who has never called on our services, that is more problematic. So we have to work together with the community resources and the provincial system so they know about us.
That is especially the case if the individual is identified as a reservist or a veteran of the Canadian Forces or a member of the Canadian Forces, because for the others who are hospitalized, we are in contact with the CLSCs in Quebec and with the hospitals.
Often, the social workers will contact us to tell us that an individual or a Second World War veteran has been hospitalized. At our end, we check to see whether he is known and what we can do to help him.
The work we have to do, then, is to inform that network that we can also help younger veterans; we also have a suite of programs and services. So that is one of our challenges, to disseminate that information through the provincial network.
[English]
Senator Dallaire: Do you believe collocating your IPSCs with family support centres would be a good idea?
Lt.-Col. Hand: No. We have a family resource centre liaison officer inside the IPSC, and that is sufficient. There are a number of other services provided by the MFRCs, such as daycare, social workers and community centres; it is not a complementary service dealing with the ill and the injured. Having a family resource officer there as one of the service officers inside the IPSC allows us to focus on the ill and injured. This is the model we have chosen.
Senator Dallaire: Right; I think that will have to be reviewed.
Senator Day: Can you tell us what the acronym IPSC stands for?
Lt.-Col. Hand: Integrated Personnel Support Centre, senator.
The Deputy Chair: To follow up on Senator Meighen's question with regard to financial counselling, I understand that VAC supplies not necessarily financial counselling, but financial assistance for a client to get financial counselling somewhere else, up to $500. Is that correct?
Ms. Matos: That is correct.
The Deputy Chair: Thank you very much, senators, for your questions and thank you, witnesses, for a very frank discussion. We look forward to having you back here again someday soon.
(The committee adjourned.)