Proceedings of the Subcommittee on
Veterans Affairs
Issue 7 - Evidence - October 1, 2014
OTTAWA, Wednesday, October 1, 2014
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:07 p.m. to study the medical, social and operational impacts of mental health issues affecting serving and retired members of the Canadian Armed Forces, including operational stress injuries (OSIs) such as post-traumatic stress disorder (PTSD).
Senator Joseph A. Day (Chair) in the chair.
[English]
The Chair: Colleagues, today we are continuing our study on the medical, social and operational impacts of mental health issues affecting serving and retired members of the Canadian Armed Forces. That includes operational stress injuries, sometimes referred to as OSI. One of the operational stress injuries that we hear quite a bit about is post-traumatic stress disorder.
We are very pleased to welcome with us today as a witness who will help us understand the injury and what is taking place, Victoria Huehn, Executive Director, Frontenac Community Mental Health and Addiction Services.
I'll have you tell us a little bit more, Ms. Huehn, about your particular institute, but I did want colleagues and those watching to know that you are a certified psychiatric rehabilitation practitioner. That takes up the entire door with your titles, I'm sure. You have a BA in psychology from Wilfrid Laurier University and a master's in public administration from Queen's University. I will give you the floor to give us your opening remarks and then perhaps we'll have a bit of a discussion.
Victoria Huehn, Executive Director, Frontenac Community Mental Health and Addiction Services: Thank you very much, Mr. Chair. I also have a Certified Health Executive designation and I think an important thing to remember as we move forward is that this is indeed an illness that we are talking about, and health is a very important part of that.
I'm attending your meeting today as Executive Director of the Frontenac Community Mental Health and Addiction Services and if you can say it, you can join. It's a lengthy title and it says exactly what we do. We are in Kingston.
The Chair: Ontario.
Ms. Huehn: Yes, not out east. We are in Kingston, Ontario. I was a member of the Service Systems Advisory Committee of the Mental Health Commission and I've also been a member of the Ontario Minister's Advisory Group to design and develop the 10-year strategy on addictions and mental health.
I've also chaired the Ontario Human Services and Justice Coordinating Committee for six years, which looks very carefully at diverting people from hospitals and jails that get in trouble with the law because of their illness.
I began with FCMHAS as the sole part-time staff member in 1982. Since that time — and this is indicative of how acknowledgment of illnesses, mental health and addiction issues have grown — our agency has undergone three name changes. When I started as a volunteer we had a budget of $15,000. We now have a budget close to $15 million. We have close to 200 staff members and we serve over 3,000 people a year.
We used to have five rental properties 33 years ago and now we own 17 properties with a total of 165 units, and we have close to $15 million in equity. So the umbrella of support services is broad and includes such things as a mobile crisis unit, case management, assorted community treatment teams, court diversion, residential support and a myriad of other supports that people need when they're on their journey of recovery.
I want to let you know that my involvement and the opportunity to develop, plan and implement is not a career for me; it has been a passion. That is how I come to you today, to talk to you about people on their recovery.
Originally I was asked to give you some idea about provincial health systems, and to talk about housing. I have been very involved in housing across Canada, both on the national advisory committee for At Home/Chez Soi and while on the Service Systems committee I co-led Turning the Key, which was a report that went into all of the opportunities across Canada.
With that report, the executive summary is over 20 pages in length. The report itself is over 100 pages and the appendices are 600, so I will not even try to get into it today, in particular. We found out that Canada desperately needs more housing with supports. We talk a lot about needing a national housing strategy, but it's clear that people who have mental health, addiction issues need to have support, and we are woefully missing that boat.
Our recommendation in that report is that we need at least 100,000. That follows up from Senator Kirby's report, when he had mentioned 57,000. Our report came out at least four years ago, and we cut it down to 100,000 even though the numbers at the time said 210,000.
Senator Lang: People or units?
Ms. Huehn: Individual people. Yes, most of them are singles, so those would be people.
The Chair: If you need to expand on that further, I'll put you on a list.
Senator Lang: I don't want her to lose her train of thought.
Ms. Huehn: I can lose it quickly and get back with something else, just as fast.
What I will touch on, though, because I think it relates very clearly to the subject that you're going to be considering, is what the provincial strategies are moving towards in terms of mental health and addictions issues. I can say all of them are clearly focusing on client focus, choice, inclusion, anti-stigma and meaningful involvement of users, as they say overseas, but here we say clients — we certainly get away from ''patients'' — and family members.
All of the strategies really focus on those issues moving forward. The question is why. It's very clear; it's evidence-based. We know that when we give people the right to make choices in their lives about what they need to feel successful, they are going to have a much greater chance of reaching their goals. British Columbia has taken their strategy one step further and they are putting together what is called a psychosocial rehabilitation framework where they are defining how they want their services to roll out.
Let me take a minute to explain this to you. A lot of the main strategies now are talking to the issue of recovery. Recovery is not a ''model'' any more than you can say that someone uses a model when they get better from cancer. We have all known someone who has been ill with cancer. Do you say that they're using a model to get better? No, they're recovering. It is likewise with people with mental health and addictions issues.
One of my favourite definitions of recovery — and I'm going to read it — is from Dr. Bill Anthony. He was one of the founders, first major promoters of recovery in terms of identifying it and doing the research. He also closely links psychosocial rehabilitation as the tools, as the competencies you need to roll out recovery. He said recovery is ''a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life. . . . Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects'' of a psychiatric disability.
Now, Bill came out with that in 1993. Over the years, a lot of the research, except for those that specifically talked to medication, continued to come back to that strength around psychosocial rehabilitation that allows people to recover. Our agency, since I've been involved with it, has been using recovery oriented services. There have been a myriad of other organizations across Canada that have also been pioneering. I know you've talked about Jennifer and Howard from the Mental Health Commission. They talk about how, in the Mental Health Commission strategy, we move forward with this whole idea of recovery. We need to make sure that we have the skills and opportunities to do that and the staff, the work that people do is indeed focused that way.
I speak from experience as, over my years, I have been belittled, I have been ignored. I can handle that. The whole concept of allowing people to make their own decisions has been very difficult to carry forward, because it was very much based on a medical model. Believe me, psychosocial rehabilitation includes a medical model. I am the first one to say that medication is an important part of one's recovery journey. However, there are many other things that need to be taken into account. And as we move forward in this new paradigm of recognizing that the person has to be at the centre of the plan, and not medical staff, we're bumping against the paradigm that a medical professional needs to be at the centre of controlling how a person moves forward on their recovery journey. There is very little evidence to prove that's going to be helpful.
Over my years, I have gained many friends who have been moving forward on their recovery journey. I have had the opportunity and gift to walk with them as they move forward. It is really exciting to see people regain their lives in a way that they feel is meaningful for them.
That's why I speak to the importance of recovery and how we need to look at it in terms of all illnesses, especially people who are dealing with trauma injuries, any other anxiety, manic illnesses and any kind of mental health issue can really benefit from this look at recovery.
I chair a national organization called Psychosocial Rehabilitation Réadaptation Psychosociale Canada. We have hundreds of individuals and dozens of organizations, made up of educators, users, family members, service providers, all across Canada who are absolutely dedicated to this concept of recovery and the fact that people need to be supported, no matter where they are, no matter where they're going to be, they need to be supported in order to move forward.
This isn't just in Canada. There is a World Association of Psychosocial Rehabilitation that has chapters in 70 countries, including ours. As of last week, the President of WAPR and the Secretary-General came to our national organization's meeting in Toronto, and they are thrilled by the opportunity to work closely with Canada in terms of our education plan.
This group that I work with — we are volunteering; this is something we do, because we are passionate about it. We have developed competencies for practitioners who want to practise recovery-oriented practices and who want to provide those kinds of services.
I remember one time I went into an institution and they said they were doing recovery. The way they did it was they were going to have a recovery picnic that afternoon in the park and could everyone please join them. My heart sank. I also then knew why they didn't understand what recovery was: I was walking down the corridor and a woman came towards me and introduced herself. She was a lovely lady, but what was her role? She was the recovery coordinator. You can't impose recovery on someone. They have to embrace it themselves. I just wanted to mention that it is worldwide.
The WAPR also has a direct connection with the World Association of Psychosocial Rehabilitation and recognizes that psychosocial rehabilitation is a well-researched and required strategy to move forward with recovery. As I said, when our provincial strategy started focusing on this, it's really exciting. But we have to make sure that people understand that.
In terms of people who have special needs in terms of their illnesses, there are a lot of strategies. It doesn't mean because you do psychosocial rehabilitation that you don't also use a number of other strategies, as well. For example, motivational interviewing is a really important skill for people to have when they're trying to encourage someone to define their goals and what they need to feel well.
Trauma-informed education is absolutely necessary. You need to make sure that people understand the impact a trauma has. We know that one in four of us — or five of us, depending whose numbers you pick — suffers from mental illness. That means that at least five or six of us in this room do.
We also know that we're touched by many events in our lives. The old adage of ''just get over it'' or ''just pick up and move on'' isn't working. We're seeing people all the time who suffer from this trauma, and I see them and know them from personal example. Whether it's the young man at Queen's who is afraid to come out for fear his father will disapprove of him being gay to the young man or woman who feels that they failed that last exam and therefore won't make the cut-off to whatever — they go and hang themselves.
Obviously, that is where we have to start the education to move forward with people so that they understand how important trauma is in your life and how we all have to acknowledge and deal with it.
There are other things that are important; for example, we also undertake a coaching culture. We find that's very good, only to make sure our staff can deal with their own issues and find their problems, but it also goes forward to the people who come to us for assistance.
Treatment isn't us telling people what to do; it's welcoming and walking with them as they discover their own journey. It's an inclusive thing; it's something that can't happen in one organization only. We work very closely with our hospitals, our other service providers in the community, friends, family members — we have a family resource centre, and we support them however we can — anyone can come, call and be there. We need to support them so that they can support the other folks.
It's not a siloed kind of event. Obviously, Kingston has a military base, there are lots of friends, so on and so forth. But I think there are opportunities there to move from a kind of isolation where you have someone who is on the base and so on, but the base is within the community. So we have to look at the literature and figure out what is important to ensure that the system, our community and our whole sense of working with people is seamless, to make sure that people feel that, no matter whether they're at the base, in the community, elsewhere, or wherever they are, that they feel supported.
We need to make sure that there's a translation of the knowledge of recovery and psychosocial rehabilitation throughout all parts of the system — no matter where it is — to understand that we need to be there for that individual, deal with them where they're at and to make sure that they feel supported.
The Chair: That's a good beginning to our discussion. We thank you very much for letting us know about the important work you're doing.
I'm going to go first to Senator Lang, because he had an earlier intervention about numbers.
Senator Lang: I want to thank you for coming. You mentioned a figure of 100,000. I wasn't quite clear if you were talking about housing units or you were talking about possible clients, or both.
Ms. Huehn: We were talking about people. Most of the people that we're looking to house are often single. There are some families, but most people are single, so we were indeed looking at that. In that sense, we were also identifying it as those units we would need, recognizing that we were looking for individuals being able to go into their own units.
I know At Home/Chez Soi and Housing First promote that. I also know that we, in our agency, have been doing Housing First for over 30 years — we call it Flexible Portable Supports — and that some people can live in congregated situations. I've got a group of gentlemen who have actually been there longer than I have, and they are a family. They live together. So we would consider those four bedrooms to be units, as well.
Senator Lang: We're not talking about housing in this particular committee, obviously, but it is a question. Whether we talk about 100,000 or 50,000 units, you're talking a significant commitment by governments in respect of being able to provide that. But that's a separate issue, and I'll leave that alone.
Could I perhaps go to another area? I believe you mentioned that you have 3,000 clients presently; is that correct?
Ms. Huehn: Over 3,000.
Senator Lang: Can you tell me what your success rate is? When an individual does come for help, how often are you successful such that they can go out, establish their own life and move on?
Ms. Huehn: We have a number of functions. For example, I could tell you that out of our high-intensity supportive housing — and one plug I have to make is that you can have housing, and if you don't have the appropriate supports, I can tell you right now, those people will not be successful. That's a given. I'll put that out there.
So we make sure that people do have the supports. For example, in this intensive housing project that we've done, we've taken people who have been very ill and who were in hospital, and we've moved them into the community. We moved out 13 people six months ago. Six of them are left in the housing that we put them in with a lot of support. Seven have already moved on to other housing with less support; they're more independent. We've only had one hospitalization.
I can tell you that in a 10-year period, just with supportive housing, we went from having about 10 or 12 per cent of re-hospitalizations go down to zero.
In our vocational program — and we do not have a ''day program,'' as such, because people want to have lives, whether it's volunteer, part-time or whatever it is. So we moved from that day program, where people just come and sit. There's still a place for them to come and sit, but they can go out and get a job, and we support them in that. I can tell you that we have had a very high success rate with that. I can't give you the exact numbers right now, but we have individuals move through that; I would say at least 80 per cent of those for sure have been moving through. We have had clients who are no longer on disability. They're off disability. They have their own lives. They're working.
What is important in all of this is that you give them hope. I can tell you that when we're not successful is when people don't get the support they need and don't have the hope they require.
It is hard to give an average, because there are so many people in so many different kinds of places. As I said, our housing program has a very high positive rate, because we make sure that people have the support. For example, crisis services, we've probably diverted 350 people from hospital last year, and we do mobiles daily, either 12 or 18 hours a day, depending on the day. Weekdays are different than weekends.
Does it work? Yes. Does the evidence show it works? Yes.
The Chair: Thank you for clarifying that. It is still not clear in my mind, and I'd hoped it would be from Senator Lang's questioning, but regretfully I'm a little slower picking this up. You have 3,000 clients, 200 staff, huge expenditures, for what geographic region?
Ms. Huehn: We cover the county of Frontenac and the city of Kingston. We are fortunate in that over the last number of years we have been able to bring together an umbrella, or a buffet of services, as I like to say. So if someone walks in our front door and they say, ''Well, that's it. I've lost my family. I lost my last money out at the casino last night. I need help right now,'' we can triage them right away. We have a whole access team, and they say, ''Okay. So you need help with problem gambling. Where are you living? Oh, you don't have a place to live. Well, let's talk about getting you into housing.''
We have these functions that, rather than have them streamlined over there, we have done a huge amalgamation and we have two major hubs so that people go in and the services wrap around them according to what their needs are.
I'm sure there probably are some other areas. We have been lucky that over the years we have been able, as the funding came out, to move them in; whereas in some areas you go, the crisis team is run by the hospital and the case management is run by this and addictions is over here. We have a more complete service for folks.
The Chair: You are getting tired just telling us about it.
Ms. Huehn: Yes, I just think about it. It is all about the person who needs the service, right? If they have to bounce around from pillar to post trying to figure out the system, they're exhausted. If you are unwell, imagine if you had to go from here to there to wherever if you had a broken leg, because you just weren't sure who was going to help you out with it. Again, it is very client-centred, very focused on what they need.
Senator Stewart Olsen: Thank you for coming and for your presentation. I will bring my questions back to the issue of veterans and their recovery. I do like that word. One question I have is: Are you involved at all? Do base facilities, or facilities specifically set up by the military for treatments, do they interact with your facility at all? Is your expertise being utilized? Do you know?
Ms. Huehn: My personal interactions with them have been very limited. I know that some of my staff have reached out, and certainly at times there's been some interaction. I think that's an opportunity for development.
Senator Stewart Olsen: That's a good point. It is my feeling we should move more towards a community-centred approach, but we're still dealing with — and I know you will understand this — a military culture that doesn't feel exactly that their particular situation relates to the community. These are barriers we have to look at.
You suggested supportive aids moving forward in recovery. I will give you an example. One is family. If you could give me a list of what supportive aids you would consider for our military veterans, because I think maybe you have to develop programs around each of those aids — for instance, for the family, for wives, for children. I need more of that.
Ms. Huehn: What research shows and what our own activities have shown is that, for example, for families and friends, one of the greatest needs is education. They need to understand, if they're going to support their loved one, what their loved one is experiencing.
Senator Stewart Olsen: Yes, but the family is the aid. We can go to what the family would need to do.
Ms. Huehn: Right.
Senator Stewart Olsen: What we need to identify are some aids for people, for instance, therapy dogs. That's an aid.
Ms. Huehn: Yes.
Senator Stewart Olsen: Do you have more examples of aids? I guess housing would be one. Do you know what I'm saying? I'm taking it down to the simplest possible denominator. I'm not a psychiatric worker, so bring it down to the simple parts that people can easily look at and say, ''Oh, yes, okay.''
Ms. Huehn: The simplest part is what the person wants to do in terms of identifying exactly what they want to do. Obviously, with some people you can start right off, and how can anyone get well from anything if they don't have appropriate housing? That's why our organization started with housing. Housing is key.
I'm a strong believer that you have to have housing with supports. If you just put someone in a house and they don't have the appropriate supports, they're not going to be well.
We also know that folks with mental illness — and you know it yourself from some of your papers, about how the incidence is even stronger with veterans around poverty, about lack of income. We know that that will also impact considerably on a person's mental health. Surprise: You don't have a place to live. You don't have money to buy food. You are going to be unwell, probably. If you have an illness, it is certainly going to be very hard to get better from that.
There's a very well-used phrase in our field, and it is called ''a house, a friend, a job.'' What do we all want in life? We want to have someplace to live, we want to have people who are there for us, and we want to have something to do during the day or night or whenever. Those are the really basic things that people have to have in order to thrive — not just survive, but thrive.
You mentioned veterans. I know there's been a lot of work in rolling out family centres in the military bases again, but — and I'm not just saying this about those centres; I'm saying this about any place where they think that what they offer the person is complete — I believe they're not thinking about the person.
For example, we can have a client come in and they need housing, support and all that kind of thing. We can go ahead and set up our own softball league. We could do this or that, but what we want that person to do is to create a life in the community. We don't want to become their life. We don't want to walk beside them as they do. So for some of our folks who have a disability and who want to go to Special Olympics, we make sure they're there. If they want to go swimming we take them to the local swimming pool for lessons and so on. In this way, people are re-engaged in their community.
Whether it is us dealing with someone who is a veteran slowly returning to the community without hooking up to the military or vice versa, we are missing that focus and trying to put that person into what we think their slot is. All of a sudden they walk out and they're hit by something else that really they've been a part of but we've been shielding from them.
Senator Stewart Olsen: Those are quite good to take forward as we look at what the centres offer our people. Thank you very much.
The Chair: Since we're focusing on veterans and the military, there's a large military unit in Kingston.
Ms. Huehn: Yes, there is.
The Chair: There are also a lot of veterans. Could you tell us about focusing specifically on how many of the 3,000 clients are military or ex-military? Do you have any statistics on that?
Ms. Huehn: I wouldn't know that. We would only know that if they had disclosed that to us. Quite frankly, that isn't something that our funders ask us to look for, whether or not they're veterans.
The Chair: This person suffering from some mental illness or disorder, how do you determine what might have been the root cause of that? You talked about poverty and sexual orientation and that kind of thing, but what about operational stress? What about the first-responders, police officers and army personnel? First you have to get to the root cause before you can start a strategy for recovery, I would assume.
Ms. Huehn: Absolutely. We often go out with the police, our crisis team will attend with the police, with someone who is having a mental health incident, again trying to divert them from going to jail or whatever.
Our crisis team is trained specifically to look for symptoms that would indicate that this person has some sort of specific issue. For example, trauma-informed is absolutely key training, as I have mentioned. People have to be. They're trained to make sure they can recognize that. As well you have got the others like bipolar disorder or schizophrenia or whatever it is, so they're trained.
What we can then do is if there's police involvement and the police determine that this person is not a risk to the community or to themselves, then they will indeed let us work totally with that person. We have a psychiatrist who is available to our crisis team. This is not an ongoing therapy for the person, but at least to pull them in and the psychiatrist will work with them. It's that whole team model. People come together, and that whole counselling, working with them, having them develop, this is what you've come to us with, what do you really want to do, so on and so forth.
It's training to be able to know what to do and how to interact. As I said, the competencies and the psychosocial rehabilitation strategy is to build on people's strengths, of course. If they need to talk about what happened and so on, that is all counselling, but also to make sure they are the centre of what they want to do. We also, frankly, hold them accountable for that.
There's also what we call ''the right to failure.'' Sometimes people make bad decisions. I know in my life I've learned the most from some of my bad decisions. What's important is that people have the right to make those, of course as long as it is not a risk to life and limb and all that stuff, but then we have to be there to support them in getting back up, to learn from that and move forward.
At any rate, the specific thing is that, yes, we would have the team be able to do that, and then we have these other functions that, once the person is engaged with us and chooses to be, of course — we are completely voluntary — then we have a number of services. That would include community and vocational support or addictions issues.
You all know that the literature would say that at least 50 per cent — and I would say from a personal basis over the last 33 years it is closer to 70 per cent — of people have concurrent illnesses. If you have a mental illness you'll often have addictions. The most obvious reason is it's simply self-medication.
Senator Mitchell: I'm interested in your discussion of the psychosocial rehabilitation. I'm not going to say ''model,'' I'll say ''method'' or ''approach.''
Ms. Huehn: Thank you.
Senator Mitchell: How widespread is that as a therapeutic approach across Canada? How deeply is that integrated into the curriculum of university psychiatric/psychological training?
Ms. Huehn: Oh, excellent question.
Senator Mitchell: Finally.
Ms. Huehn: We're just so passionate about this. It was quite interesting at our national meeting last week. We have a board of 10 or 12 people from across Canada. Last week the provincial person in charge of addictions and mental health in Nunavut joined us. We are well represented across Canada. There were people there from coast to coast to coast.
We have psychiatrists involved. As I said, it's a multi-professional thing. If you're a nurse, you belong to the college of nursing, psychiatry, social work, whatever. Anyone who practises can do psychosocial rehabilitation, so you become skilled in that.
We have many educators. We have Dr. John Higenbottam at the University of British Columbia. He is the gentleman who was asked by the province to write the framework for PSR for B.C. He teaches residents. If he were here today, he would be saying he continues to advocate for that to be embedded in psychiatry training. He certainly is doing that.
There are a number of others. Queen's University's rehabilitation school has Dr. Terry Krupa, who is very much involved in this.
If you look in Quebec, Quebec has AQRP, L'Association québécoise pour la réadaption psychosociale. They are having a conference in a few weeks, and they will have over 800 people there.
It is embedded. The issue is that it does push up against the paradigm where the most professional, highly educated health person is at the centre, rather than the person in recovery. At times that's a little hard to break into. However, there are a number of psychiatrists who have sat on our board who are very involved with us and understand this and promote it. We continue to work on that.
Senator Mitchell: You mentioned in passing, at the outset of your comments, the relationship between the courts and the criminal system for mental health issues, and the statistics are overwhelming. If we could do away with mental health issues we would have 5 per cent as many people in jail, probably.
Ms. Huehn: Quite a bit fewer than that, actually.
Senator Mitchell: There is a movement and practice — in fact, in the States and emerging in Canada — for the creation of an approach that deals with veterans, military veterans in particular who have PTSD. Are you aware of that? Can you give us your impressions of that and what needs to be done there?
Ms. Huehn: Absolutely. There are several in Canada, and more are popping up. When I say there are several, I'm not talking a particular boardroom or courthouse or whatever. It can also be a time of the day for the court, a time and date chosen. There are mental health courts and substance addiction courts. I believe one is in Oshawa. I am sure many people have heard of the one in downtown Toronto.
They are specific times for people who have been identified by the Crown as being involved with the justice system because of a mental illness or addiction, and actually, that's one of the things that started underneath my purview, a diversion program in Kingston where we actually work with the Crown and the defence attorneys so if an individual comes in and they have gotten into an altercation, or whatever, and it is because they were very upset because of their illness, we put together a plan to move forward with them on that recovery plan, rather than going and sitting in a jail where they're not going to get any help and will probably come out much worse than they went in.
These are wonderful institutions when they can be established. My issue with them is that you need to have a judge who is prepared to do that. You have to have Crowns who are also willing to divert. Now, of course, there are criteria around how that can happen. At one point my former MPP John Gerretsen was Attorney General, and we worked closely around that to make sure that we could embed that as far as possible, but again, it is the justice system. You will see pockets of it pop up in various places. They won't always be consistent. They won't always follow.
I don't know how often ours happens, but it's a couple of hours once a month, where some of them will be every day or every afternoon. I don't know if you know how they work.
Senator Mitchell: Not really.
Ms. Huehn: Someone comes in. They have been found stealing mouthwash because it has a little bit of alcohol in it. They come in and the judge says, ''Okay, let's talk about this. What would you rather do? I would like to divert this.'' Their staff support worker, our court diversion worker would walk in and say, ''Judge, I have this and I'm prepared to do this. Crown, do you agree?'' Yes, Crown has already seen it and signed off on it. Often the defence is involved as well, obviously. Then that person says, ''Okay, I agree to do this.'' The judge says, ''Well, we will see you next week, whatever, when we get back together and see how you are moving along.''
Eventually if the person can get the supports they need and move forward, then we will figure out how we can deal with the base issue of why he felt he had to steal in order to deal with his issues. Again, I think they're great. They're just very inconsistent, and it really is dependent a lot on who is sitting there and who wants to do it. If you don't have a judge that wants to do it, then you won't have it in your community.
Senator Lang: I would like to follow up from Senator Stewart Olsen. We talked about the community organizations and the facilities that are, as you said, coming into place across the country, in the Armed Forces bases. You are relatively close to one of the military bases.
Ms. Huehn: Oh, yes.
Senator Lang: I'm wondering what your knowledge is. I would ask, from your vast experience, are you satisfied with the existing programs that are there with the Canadian Armed Forces, the Department of National Defence, in some cases the RCMP, and with Veterans Affairs? Are you familiar with what they provide?
If you are not, I would wonder why you aren't. It would seem to me that we're all in this together, and perhaps you can comment on that.
Ms. Huehn: Thank you. I feel that we should be. It is embarrassing to say that I don't know much about their programs. It's a huge hole that we own in our system, that there is this kind of segregation. I'm not going to project why it might be, but the bottom line is that there are different cultures in Canada — RCMP, military community — and sometimes those are way too isolated, and the fact that I don't know what's going on there I think is a huge problem. We could probably do a lot more work together, but there has been acceptance on both sides. All of us bring strengths that we can share with each other and that we can learn from each other so together we can be there for the person.
I had a very interesting meeting. Two years ago I was in P.E.I., and the national Veterans Affairs office is in Charlottetown. I met with some directors and folks there that were interested in talking to me. I was presenting at a conference, and they heard I was in town. They said, ''Can you give us a couple of hours?'' It was absolutely wonderful. Those people seemed really interested in figuring out how to move forward.
I talked to them about education and the whole recovery movement and PSR and how we have competencies, if we make sure people are trained in it and make sure people understand this is to bring the humanity back into it around the person in pain. I thought it was really exciting when I left that office that day. I thought we had a really good chat. Regretfully, that's been the last time that I have been able to talk to anybody about that. I know there was really a lot of interest in it.
I am almost wondering if that wasn't the reason that I'm here, because I'm not sure how I got an invitation.
The Chair: We saw the good work you were doing and we wanted you to come and tell us about it.
Ms. Huehn: I don't know about that, but I think there's a lot of opportunity. When I was thinking about the comments that I wanted to stress with you, and I did bring along some material, and I am going to ask that you do share those copies, because there's information there I didn't touch on. It also gives some information to senators that there is a huge opportunity for us to work better together.
Provincial strategies, fine, and veterans is national, but there's lots of us who work on the national basis for this, and there's lots of great ways to integrate these things.
As an executive director, I have, absolutely, a mandate to work with anybody in my community, and I would be more than pleased to do that.
Senator Lang: What really comes home to me is that it would seem to me — and this may not be a fair observation — that on the surface we're almost working in silos. We have Veterans Affairs over here, and then we have an organization such as yours over here, and we're within two blocks of each other, but people haven't gone across the street to talk to each other.
It would seem like perhaps tomorrow that could happen. It would seem to me this is what we have to do in respect of this particular very troubling issue that is facing so many Canadians and, more particularly in our case, because of our mandate, studying veterans. Of course we have people within National Defence as well currently.
That is one issue, Mr. Chair, that we have to maybe pursue further, to see why people aren't comparing notes and how can we facilitate that type of comparison. Because most of this treatment — I would like to hear what you have to say — quite frankly, at the end of the day, will come from the province because they have the hospitals, they have the facilities, and everybody should be taking advantage of that, if it's possible.
Perhaps you want to comment on that.
Ms. Huehn: Oh, absolutely. It has got to be a consolidated effort, and this is why those of us, as I said, in this national organization, we have had an education plan sitting there for three years. We are all doing it off the sides of our desk, but we know it's absolutely critical. If we could get out and let people know about the best evidence, and so on, and say let's be working together, this can happen.
We've made lots of inroads, all of us, including the people here, everyone. Look at the provincial strategies in terms of how they talk about inclusion and recovery. Not so long ago the strategy was to put people in a back ward and turn the key and walk away. We've come an awful long way, but we need to realize that it's not about the different structures, it's about the person. Yes, that person may be a pilot, but she's going to be a mother. She's a daughter; she's a friend. It's about the whole person.
We do have a society where some people are in a particular place or in a particular role at a particular time, but we can't forget that that other thing is going to impact them, and we have to really be working together.
The Chair: This concludes the time that we have allotted for this meeting. Ms. Huehn, we want to thank you very much for the work that you're doing and for being here to help us understand a bit more about the broad approach.
We continue to focus on one aspect of the type of work that you're doing. Sometimes veterans who suffer from post-traumatic stress, or Armed Forces personnel, are in need of some of the services you're offering. We've got to know if it's best that they go to the Frontenac unit, if they happen to be in Kingston; or, because the origin of their illness might be different from a lot of the other clients that you have, they go elsewhere.
Ms. Huehn: Can I say one thing?
The Chair: Absolutely.
Ms. Huehn: I think it's really important, when you're considering that, to remember that — and I hate to use this phrase — no door is the wrong door. People need to reach out for help wherever they feel comfortable. It is not about coming to Frontenac or going to the centre, it's about those places working together so that it makes it feel comfortable for the person. Forty per cent of people will first disclose to their family doctor. It's not about just one way of doing it. It's about making the system, all of us, work together for the individual.
The Chair: That's a good ending for this. You have been very instructive and we thank you very much.
(The committee adjourned.)