Proceedings of the Subcommittee on Veterans Affairs
Issue 6 - Evidence - December 9, 2009
OTTAWA, Wednesday, December 9, 2009
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:16 p.m. to study the services and benefits provided to veterans and their families (topic: implementation of the New Veterans Charter).
Senator Michael A. Meighen (Chair) in the chair.
[English]
The Chair: Good afternoon, honourable senators. Welcome to the Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence. As we all know, the subcommittee has been studying the implementation of the New Veterans Charter for the past several weeks, the charter that the minister himself described as a living document, which will be amended over time to ensure it meets the needs of veterans.
Evidence we have heard so far indicates there might be some inequities, anomalies and gaps in compensation benefits awarded under the New Veterans Charter when compared to those under the old Pension Act. It also seems that, after three years of being in force, the New Veterans Charter has not yet been substantially reviewed, nor have changes been made.
Today, we will be turning our focus toward one specific aspect of the service delivery system in place for veterans. Before doing so, we have one item of business that I would like to dispose of, with members' indulgence. It is with respect to a response we received from Mr. Patrick Stogran, the Veterans Ombudsman. These materials were distributed to members on June 16, 2009, but we wish to have a motion, if we could, to file them as official documents of our hearings.
Senator Banks: So moved.
The Chair: It is moved by Senator Banks. All in favour?
Hon. Senators: Agreed.
The Chair: Anyone opposed? It is adopted unanimously. Thank you very much. Now we will go back to our business today.
Senator Dallaire: When we received the Chief of Military Personnel, he indicated he was working on a campaign plan for the improved Care of Injured and their Families Program. I have been able to receive a copy of it. However, I am wondering whether the committee received it formally from the Chief of Military Personnel.
The Chair: I do not believe so. Perhaps, the clerk can answer.
Senator Dallaire: It is this document. It has significant information with regard to the evolution of the care that he mentioned. However, I was not sure whether we had called it forward. Therefore, I call it forward and I think it is worthy of us to get.
The Chair: Thank you, Senator Dallaire. Perhaps you could follow up on that. When you get it, once it is in both official languages, if it is not already, please circulate it.
Senator Dallaire: It is only in English.
The Chair: We will turn our attention to the matters at hand. We are very pleased to welcome as our witness Colonel (Ret'd.) Donald Ethell, who is Chair of the Joint VAC/DND/RCMP Mental Health Advisory Committee. Many people will recall that Colonel Ethell has been a witness before this subcommittee on other matters at other times, and you will also recall that he is Canada's most decorated peacekeeping veteran.
Senator Banks: He is also a proud Albertan.
The Chair: Yes, he is a proud Albertan. He claims responsibility for bringing us this Alberta clipper beating at our windows today. Colonel Ethell is also a member of the New Veterans Charter Advisory Committee, chaired by Ms. Westmorland, who we heard from a few weeks ago.
I could go on about Colonel Ethell's exploits, but suffice it to say that he is a very distinguished Canadian and we are fortunate to have him with us today.
[Translation]
I would also like to add that Colonel Ethell is Canada's most decorated peacekeeper, as I just noted, and an Officer of the Order of Canada. Between 1987 and 1990, Colonel Ethell served in National Defence Headquarters as the Director of Peacekeeping Operations. As such, he coordinated Canadian Forces operations in Afghanistan, Pakistan, Iran, Iraq and Namibia. Colonel Ethell retired from the Canadian Forces in July of 1993 after 39 years of distinguished service.
[English]
Colonel Ethell, I believe you have opening remarks, after which I hope you will be open to questions.
Colonel (Ret'd) Donald Ethell, Chair, Joint VAC/DND/RCMP Mental Health Advisory Committee: Thank you very much, senators and Mr. Chair. I do have a few remarks and I will be initially keying on the Mental Health Advisory Committee. I will try not to take too much of your time because I know you want to get on to the New Veterans Charter Advisory Group, and the two are related.
As discussed earlier, there are four committees under the auspices of Veterans Affairs Canada. One is the Gerontological Advisory Council, chaired by Professor Victor Marshall. Last year, they submitted their report, Keeping the Promise, which deals primarily, but not solely, with traditional veterans — those of World War I, World War II and the Korean War. The second committee is the New Veterans Charter, and I do not need to get into that because Ms. Westmorland is the chair and she and CMP from the military appeared before your subcommittee. The third one is the Special Needs Advisory Group, called SNAG, chaired by Major (Ret.) Bruce Henwood, a double- amputee; he had his legs blown off serving in Croatia. His group is a small group and consists of a number of members — the numbers fluctuate — who are suffering at least 80 per cent or 85 per cent disabilities, loss of limbs or PTSD and OSI. In fact, two of them are rated at 100 per cent. It is a very unique group.
I mention those three because I chair the Mental Health Advisory Committee, which includes three departments, so it is slightly different. We were told there will be some restructuring of the other committees next year to cut down on a number of things, not the least of which is cost.
I have mentioned those three committees because the arrangement is that the chairs of each committee will attend each other's meetings. This has paid off very well. All of them are interested in the New Veterans Charter and have provided input, which prevents duplication.
In the case of the Mental Health Advisory Committee, you have a brick in front of you. I will not go through all of them because I am sure you will have time to study them. However, I will go through the first few just to establish the background and then move on to the three reports in point form. I will come back to that in a minute.
In terms of background, obviously the programs and services are within DND and VAC, and now the RCMP. The RCMP finally came on board this particular committee, because they have significant problems in regards to OSI. OSI is not the purview of the military. I am sure you can appreciate that the RCMP, police forces, EMS and the general public, anyone involved in a serious traffic accident might suffer from an OSI. It is not only the military.
The Chair: Do we know the meaning of OSI?
Col. Ethell: It is operational stress injury. I am sorry.
The Chair: Please watch the acronyms, if you could.
Col. Ethell: I will, senator. I was brainwashed by a couple of generals in this room to use the acronyms. The other acronym I will use is post-traumatic stress disorder, PTSD, which is one of the aspects of OSI.
Members and their families, must be continually be examined and approved to ensure they are integrated and effectively promote positive mental health and prevent mental illness, including reducing symptoms and length of illness.
Just as an aside, I will talk about post-traumatic stress disorder. I am not a clinician. However, I am a sufferer like Senator Dallaire. It is chronic; you have it for life. That comes from quite a few clinicians. Once you accept that fact and go through the hoops with regard to medication and counselling and so forth, you can live a normal life, whatever "normal'' is.
This is a fallout from the Operational Stress Injury Social Support Advisory Committee, the OSISS Advisory Committee. This committee was formed after Lieutenant Colonel Stéphane Grenier formed OSISS, about six years ago, with the help of Senator Dallaire and General Couture, may he rest in peace. It is a peer associated organization and it works effectively to the extent there are 40 of them across the country. They are not clinicians or counsellors, but they can refer people — serving CF members, RCMP, retired folks and families — to the appropriate authorities.
It was a very successful advisory committee, raising the awareness of mental health and operational stress injuries in assisting DND and VAC to better the means of the members and their families. I emphasize "and their families.''
To digress once again, there is a huge emphasis on families. I will come back to that when we get to one of the committees here and when we get into the New Veterans Charter. It is families, families, families.
That was emphasized when we sat around the table, the better part of 10 years ago. The Canadian Forces Advisory Council evolved into the Neary report which was handed to VAC and which was the catalyst to write the New Veterans Charter. The first thing we had to decide — or that was decided for us — was whether to go with a new charter or the old charter. We decided to go with a new one. We had a blank sheet of paper, and we had to create one without infringing on the rights and privileges of the World War I, World War II and Korea veterans; the traditional veterans covered under the veterans act.
As we were going through this, for many of us, including some of us from the old school — who used to think in their early days that, if the army wanted you to have a wife, they would have issued you one — it came to the fore that families, families, families were important.
In fact, I remember a vote in our council as to which came first: The veterans or the families. There were 21 of us and one said "member.'' Guess who it was and guess who ended up chairing the family committee? It was me. I think the general may remember that.
That committee was very successful. However, Veterans Affairs and DND decided that we needed to go a step further. The OSISS program will continue and is continuing very successfully with spinoffs to bereavement members: Those available to talk to parents and spouses of those who paid the ultimate sacrifice. In the case of the Mental Health Advisory Committee, they wanted to include not only OSIs and PTSD but also the other aspects concerning mental health. Addictions are a big issue. In fact, Edgar Kaiser, Jr., of the Kaiser Foundation in Vancouver said that he would like to get away from mental health and do addictions and mental health. We will not do that for a number of reasons. Addictions are such things as gambling, drinking, smoking and all of the other things that some of us went through in our Army career because it was the accepted norm, unfortunately.
In the case of the Mental Health Advisory Committee, our mandate is to provide information, expertise and advice to DND, VAC and the RCMP on trends, new ideas, research, programs, models, strategies and best practices in the field of mental health and social supports. That is a big mandate. If you look at all those aspects, we have just scratched the surface.
We have had three meetings and the first two were organizational and information briefings. As you look at the members' list, which the clerk issued, you will see an extremely talented group of people.
Veterans Affairs and DND at the senior level went out and solicited the support of quite a number of senior, well- thought-of, and well-placed clinicians to serve as members on the committee.
Let me give you a few examples of the committee's membership. Dr. Dan Bilsker is the chair of one of our committees. He is a psychiatrist at Vancouver General Hospital and a professor at Simon Fraser University. Peter Collins is a Lieutenant Commander in the Reserves, serving currently in Afghanistan. He is a forensic psychiatrist at the University of Toronto and provides service to the OPP and other police forces. I had to bend his ear to find out what a forensic psychiatrist is. We also have Nick Kates of McMaster University and Dr. Taylor Alexander, CEO of the Canadian Mental Health Association. We are developing a working relationship with CMHA. Cheryl Regehr is the Dean of Social Work at the University of Toronto. She is the chair of our family committee and produced an outstanding report, to which I will return later. I mentioned Edgar Kaiser previously. Professor Allan English teaches history at Queen's University. Why do we have a historian on the committee? He is past member of the OSISS advisory committee and has written extensively on operational stress injuries. He is a former serviceman himself. He and General Joe Sharpe, my deputy, lecture frequently at the Canadian Forces Command and Staff College.
I will not discount the other 11 to 14 people who are peer support coordinators and family support coordinators. The evolution of this new committee includes not only new aspects, but drags in the OSISS advisory committee in part. The first thing we questioned was where the advisory committee from the field was. We call them the grassroots, coal- faced people, with all due respect. The other coal-faced people are the district directors, Kim Ray and Anne Marchand. Unfortunately, Anne Marchand could not attend our meeting last week, due to a family tragedy. Kim Ray is the District Director for Eastern Ontario and she tells it like it is. She relates effectively, not only from mental health, but also with all aspects of the military. We are obviously keen on Petawawa, which is her bailiwick along with Pembroke and Ottawa. She is a key member.
We also have DND representatives on the advisory committee. We are blessed in having the Base Commander and Chief Warrant Officer from Petawawa. Unfortunately, they had to cut out at the last moment. We heard from Chief Warrant Officer Kit Charlebois, who is the Regimental Sergeant Major of the Combat Training Centre in CFB Gagetown. He is a dynamic individual who is appointed as the Canadian Forces Champion for CF Persons with Disabilities. All regimental sergeant majors keep their ears to the ground, but this one, in particular, is on the go all the time and reports back to his superiors. We have other psychiatrists in the military and so forth. We have a religious and RCMP representatives.
Why do I mention representatives and members? It is because the thinking is that the external experts — the psychiatrists, clinicians and so forth — will provide advice to the representatives of the three departments. That is all well and good. However, in the first couple of meetings, I talked to a number of the psychiatrists, including one in Calgary and two on the committee. They told me that mental health in Canada is somewhat of a disaster. The Calgary psychiatrist says mental health in southern Alberta is a mess. Civilian clinicians are coming into the OSI clinics and operational trauma and stress support centres, OTSSC, seeking advice on how we are treating soldiers and veterans. In the case of veterans, approximately 70 per cent of the clientele or peers for OSI clinic are veterans. It has grown to the extent that many veterans — recent Canadian Forces, Korea and some World War II veterans — are coming forward after finally looking in the mirror to admit they have a problem and asking what we can do to help them. They go to Veterans Affairs in some cases through the military.
I am jumping ahead, but OSI clinics of Veterans Affairs and the OTSSC clinics from DND have come to a meeting of minds recognizing that their mandate is slightly different. However, a veteran can now go into a military OTSSC operational trauma and stress support centre and a soldier can go into a Veterans Affairs operational stress injury clinic.
The Chair: If 70 per cent of the clientele are veterans, who makes up the other 30 per cent?
Col. Ethell: They are acting service Canadian Forces and members of the RCMP. OSISS did not have a mandate to provide service to the RCMP. The RCMP has not signed onto the New Veterans Charter, as you are probably aware. Some of their benefits, in their opinion, are better than what the New Veterans Charter offers. There has been dialogue between Veterans Affairs Canada and the RCMP. It has also included the military to a certain extent.
There are a number of constables, retired and otherwise, who have come to OSISS peer support and family peer support coordinators to say they have a problem and can we help them. Technically, we cannot, but this is what we will do. Most of their offices are in Tim Hortons and places like that. That way, people do not have to go into headquarters or see someone in uniform. They simply want to talk someone. Eventually, they walk through the program.
The Chair: On that point, some years ago — perhaps Senator Downe was with us — we went to see a clinic in Calgary in a shopping centre. Is that still operating?
Col. Ethell: I know it well. It is operating so well that they have expanded it twice and hired new staff. It is in the ideal location. Why a shopping centre? It is away from the main flow. It is not on a base or in the Veterans Affairs office. When the peer support and family peer support coordinators find someone with a problem, they will meet in the food court, have a coffee, talk it through and so forth. At lunch hour, they will probably take them upstairs, walk them through the area and eventually introduce them to the clinical nurse, who will take the individual through the program, assessments and so forth.
Within two weeks — this is common for Veterans Affairs OSI clinics — they will have an assessment done, a program established and be off and running with that individual. That clinic is successful because it is a P3.
The Chair: What is a P3?
Col. Ethell: Private-public partnership. Staff are hired by Carewest, which is responsible for many health matters in southern Alberta, and Veterans Affairs will pay the freight. The advantage is that their wage scale, which is in the summary of the New Veterans Charter, allows them to get people. The military is subject to Treasury Board guidelines and cannot offer the same wage scale. It is very advantageous for OSI clinics across the country. The OTTSCs still have that Treasury Board problem because the wage scales are different.
Senator Banks: The other advantage with respect to the chair's question is the relative anonymity and non- institutional setting the clinic is in. We were told at the time that this is less inhibiting to members and veterans who want to go there and might otherwise be intimidated. Is that true?
Col. Ethell: You are absolutely right. In the early days, there was a movement afoot to put "mental health'' above the door. If you put mental health above the door, soldiers will not walk through the door.
We had the same problem when soldiers in Petawawa were put on a bus to come for treatment to clinics in Ottawa. They had to make an adjustment because they were dropping off those going to the Civic Hospital and then were taking the "nut cases'' to the clinic. Once it became known where they were going, were soldiers getting on the bus? No way.
They have made adjustments to try to alleviate that problem. We have come a long way in the last 10 years in regards to mental health. Still, there are many soldiers who, at a certain point, do not want anything to do with the military, do not want to see a uniform and so forth. In some cases, they certainly do not want to walk through the front door of a district office of Veterans Affairs Canada.
That is the strength of peer support coordinators and others. They have been there; they have been assessed, they are all sufferers, they are being treated and they know what it is like. The key with them is that once they have you, you are not alone. You will always have someone with you.
The Chair: I will suggest we do something a little unorthodox, which is to let Senator Downe ask his question during the course of your presentation because he has to leave early.
Senator Downe: The colonel did touch on an issue I want to raise, which is why the RCMP did not join under the New Veterans Charter. We have members of the RCMP overseas. You have indicated that the RCMP is advising that they have superior benefits in some areas. Is that the reason they have not joined?
Col. Ethell: I cannot tell you the reasons. I just get that from the RCMP members. A week ago at the Mental Health Advisory Committee meeting, when I asked why they had not come on board, the answer was because of some of the benefits, but they did not articulate them.
Remember, the RCMP, God bless them, are going through a change in mindset, as Veterans Affairs has had to go through on the military, in regard to operational stress injuries. There are still the hardliners who believe, as the old expression goes, you should suck it up; do not come to me with that.
I think back on a very senior officer who was a surgeon telling me to my face, just before the individual presented to the OSISS Advisory Committee, "I would much rather have my hands in somebody's chest than talk about mental health. I do not know anything about it and I do not want to know anything about it.''
We have come a long way from that to where we are today. The RCMP is still going through that evolution. I do not speak for the RCMP, but having to negotiate with them — either myself or the secretariat in Veterans Affairs Charlottetown — their organization is siloed, as you are probably aware. It is nice to have crossover, but sometimes the left hand does not know what the right hand is doing.
At the senior level, we had Deputy Commissioner Peter Martin, who I understand will be retiring. He presented to the Mental Health Advisory Committee in June, emphasizing that the RCMP is finally coming on board, but they have to go through the hoops. Like many government departments, they are going through reductions in budgets and so forth. What is the first group that gets clobbered in any organization — any government, any provincial government? It is mental health.
Senator Downe: You are quite diplomatic, but there is obviously some disconnect between the senior ranks of the RCMP and the membership on this issue. As you indicated, the military and Veterans Affairs went through it a number of years ago.
It is good news that the RCMP has now joined the Operational Stress Injury Advisory Committee. However, I notice that in 2006, the RCMP prepared a report entitled, The Future of Disability Programs and Services for RCMP Members and their Families: Needs Assessment, with which I am sure you are familiar. The report indicated that the RCMP should move forward in working in partnership with Veterans Affairs. That is under way but it is very slow.
Mr. Chair, it might be advisable to instruct our researchers to do an analysis of the benefits the RCMP members are receiving versus what the New Veterans Charter provides. If the RCMP is getting better benefits, we might want to improve the veterans, or vice versa, to put some pressure on the RCMP to join what might be a superior program.
Senator Dallaire: What Senator Downe has indicated is not only dead on, but it is done in most gentlemanly fashion. The problems within the RCMP are vast concerning the mental health status of their troops and the leadership. That disconnect is not foreign to us as we lived through it in the 1990s.
That organization should be brought forward in regard to their assessment of the New Veterans Charter, on how they are handling operational stress in their organization and what we might want to recommend. It would be within the mandate of the New Veterans Charter to do that because it was built with them in mind. They have held back, both the association and the senior leadership, but the troops out there are under severe stress.
My last point is that we have 600 police overseas right now, of which about 200 are RCMP; 400 are from all the other police services in the country. What are we doing about them? How do we continue to encourage municipalities to send those men and women on these missions; and should we not be entertaining, when we review the New Veterans Charter, what angle might be best employed to provide a venue for them to be dealt with. Although it is not directly related to federal responsibilities, they are under federal employ when they are deployed.
The Chair: What about diplomats and support personnel who are in a theatre of war?
Senator Dallaire: Mr. Chair, one of the great reasons why development work in Afghanistan is going nowhere fast and why our diplomatic corps is not overly keen in deploying there, is because the whole process of the public service concerning them being deployed in this insecure area does not exist. Therefore, they stay within the wire and the DMs are ordering them to stay within the wire because if not, they would be put in jail for putting them in a risk area. The whole arena of the three Ds that is being deployed in conflict zones now has to be assessed and be brought into the process.
You are dead on; and it is worthy, within our mandate as we look at the charter, to look at those other departments.
Col. Ethell: Senator Dallaire brings out good points. It goes back to when I was a director of peacekeeping operations in 1987 and 1990, during what we call the "peacekeeping epidemic,'' when we were mounting one mission after another, and the RCMP was participating in our some of our ventures. The first question was what happens if the OPP officer gets killed? Well, he is on his own.
As you know, an RCMP sergeant was badly injured in Afghanistan. He is being well cared for by both the RCMP and Veteran Affairs, to my understanding. However, there is still a concern. The soldiers and the RCMP are all serving, wearing the same uniform except for a different shoulder patch, and they should be treated alike for all the benefits.
The Chair: I think you have inspired us to consider calling somebody from the RCMP as a witness when we come back after the Christmas break.
Col. Ethell: I will go through the MHAC, Mental Health Advisory Committee, quickly because I know you want to get on to the New Veterans Charter.
I direct your attention to the second piece of paper, which lists the five priorities. I initially divided those priorities among the three subcommittees, family and social issues, clinical and innovative methods. Since we have the recommendations, I have taken that away and all of the members can participate in any one of the priorities. You can see the division of talent across the board.
The committees have submitted their reports. I wanted them by October 1, but I did not get it until two weeks ago. I will go through some of the highlights quickly today on the three committees.
In the first case, family and social issues, as I indicated, we have an outstanding chair in Professor Regehr. She considered three things: what already exists; improved gaps — what is really helpful; and outreach to the family — programs for children and youth.
The subcommittee's recommendations include "improved access to practical supports for family members of deceased or injured members and veterans.''
In the advent of the death or injury of a member of Canadian Armed Forces, family members experience a great deal of stress in dealing with practical issues. These issues include issues regarding pension and benefits, entitlements for children (such as scholarships), and return of personal effects. Specific issues identified by family members included that military deployment monies of fallen soldiers are not tax exempt and that personal effects do not have adequate security to ensure that they are not tampered with or lost in transit.
I think back on our participation and I think Professor Westmorland might have mentioned that one of the committee members of the New Veterans Charter Advisory Group — committee three, family — was Gwen Mandeville. She is the widow of the Lieutenant Saunders, who was killed in a submarine incident, and has been a magnificent addition to the New Veterans Charter Advisory Group. She put a practical face to our deliberations not only in the family committee but in the plenary commission because she was covered by the old charter, such as it was. She has remarried and still participates in various things to do with veterans. She married an RCMP officer in Halifax, to which I said: "Congratulations! Could you not find a bank clerk?''
She said that when her husband was killed, she would have loved to have someone take care of her kids — a babe in arms and a two-year-old; but that was not in the regulations. That was changed eventually and, certainly, it has been changed in the New Veterans Charter and in our recommendations.
Second:
This committee recommends a review of policies and procedures regarding notification and communication in light of privacy legislation in order to improve the timeliness and quality of information provided to family members. It is recommended that more humane, inclusive, and respectful processes of notification and communication be established.
Veterans Affairs sits in on these meetings when we write and discuss these reports. To their credit, they will look at these recommendations and will action them if they agree and if they are able to do so.
The New Veterans Charter report was submitted in June. It has just been officially translated and can now be published, although the committees of the Senate and the House of Commons have had it in both official languages.
Senator Dallaire: Is that the Westmorland report?
Col. Ethell: The New Veterans Charter Advisory Group report was tabled in June.
The Chair: We received it informally.
Col. Ethell: As an aside, I found it mind-boggling when I heard Ms. Westmorland and Major General Semianiw present it to this committee, including an official translation. It was the same with the House of Commons Standing Committee on Veterans Affairs. I asked why they were going through the process of translation when it had been done twice already. The reply was that they had to do it themselves. Bureaucracy run well. I should not have made the comment but it is official and it is out.
Third:
This committee recommends the enhancement of services to families through expanding services for families within DND and VAC (such as in OSI clinics; educational resources regarding OSIs); an increased focus on building and enhancing community partnerships; capacity building with service providers; enhancing communication with members, Veterans and their families regarding available services for social and mental health issues.
This has been an uphill battle because there are legal ramifications for families receiving services at an OSI clinic for a veteran. At one time, the veteran or the member had to consent to the family going forward and determine who would pay for the services. That should not be an issue in the minds of many, and they have made great inroads. If not, we will continue to push the envelope. I have indicated "and families'' all through this 10-year process.
Four:
The committee recommends that housing options be available for victims of intimate partner violence at all bases that meets both emergency and longer term services.
The fifth recommendation states:
This committee recommends the development of services and programs specific to children and youth of soldiers and Veterans. Given the disbursement of these children and youth throughout the country and the cyber-world in which these children and youth live, the exploration and piloting of on line counseling, group programming, and facilitated forums is recommended. Further, external resources such as Camp Grief should be investigated, with a view to build, share and grow expertise and knowledge in this specialized area with the input of the children and youth.
We had a 16-year-old son of a pilot, who was killed. His mother is a member of our committee. She asked to bring young Adam, a very articulate young man, along to the committee. We heard from an individual first-hand what it is like when a father or a mother is killed. This young man related his experience to us. You think of the trauma associated with the local schools. I use Petawawa as an example when they went through the terrific loss of life and bore the effects on the mental state of the children in the local schools. The teachers had to intervene on children who were devastated because their fathers were away in that place and there had been two more deaths. They could only think is my daddy going to be next? The children became very important to us.
I will skip to the second committee, which is straightforward.
The Chair: I do not know whether we have a copy of those recommendations that you read, but we will get them. Is that the sum and substance of what the committee suggests you would like to see to ensure the best possible functioning of your committee?
Col. Ethell: That is from one subcommittee only, and there are three subcommittees in all. I will highlight the other two. These reports were presented on December 3. I have them in hand. You are listening to the recommendations first. My job now is to report to Brian Ferguson, Senior Assistant Deputy Minister, Veterans Affairs Canada; Major-General Semianiw, Chief of Military Personnel; and RCMP Deputy Commissioner Peter Martin. I also have a governance committee, nicknamed the God Squad, with the director of mental health from the three organizations plus the secretariat. However, I am required by the terms of reference to write a report to the top three, as I have indicated. That will happen within the next couple of weeks. It will be condensed to an executive summary. The material that I have read from the family committee has backed up documentation to go with it.
The second report is straightforward. The clinical group has assessed the effectiveness of the OSI clinics from DND for the services they deliver. DND and VAC have moved forward such that you can cross over now from one to the other. There is a difference in that the OTSSCs include other services to the service members, including family physicians. They do not do that for Veterans Affairs.
They have assessed it. The challenges are straightforward in the geographic disparities and the way in which the clinics and services are linked. Veterans Affairs has nine OSI clinics, but I do not remember how many OTSSC clinics there are across the country. People have to travel to get to them. I have indicated a couple of them. The people from Coal Lake, our air force brethren, have to travel to Edmonton for that service. Veterans Affairs is trying to get their act together. It sounds simple: They drive 200 plus kilometres to Edmonton on the most boring highway in the world. They are not satisfying the claims quickly. It takes the better part of six months for the individual gets a replacement. I understand that ADM Keith Hillier from Veterans Affairs is addressing that issue because it is about a shortage in staff within VAC. VAC has brought aboard 1,200 new employees following the legislation and leading up to the implementation of the New Veterans Charter. They have begun a massive training program. They are still short of people because of attrition and so on. Some of them are the old veterans charter and the New Veterans Charter; some are both, which makes it awkward for them.
Reservists accessing programs close to their home communities are an ongoing problem. We talked about it 10 years ago. What we know about the reservists has been almost a monthly issue — that is, when they come home, they go back to their unit and go to Saskatchewan, or wherever. They either do not want to be found or cannot be found. They are finished their service and they have a problem. Something has recently occurred. The military, through the leadership of General Semianiw, has come up with support services. Have you been briefed on that?
The Chair: Yes.
Col. Ethell: I will not go through that again, then. That is paying huge dividends in that the reservists now have a "unit'' where they are monitored closely. For example, they will parade. They are not told to go home and come back to see us next year because the operational unit has other things to do.
There is still a reluctance on the part of some of the veterans to take advantage of these services — not so much with the OSI clinics because they are, as you have indicated, located in shopping centres and elsewhere. You probably will not get a veteran to go into an OTSC clinic that is located within a military facility because they do not want to be associated with the military.
Senator Dallaire: I do not want to interrupt you more than necessary, Colonel Ethell, but this has come up twice. Both you and Senator Downe have raised this point. The House of Commons committee that reviewed operational stress, PTSD, came out with a significant report that I reviewed. I know it is potentially inappropriate for one chamber to look at another one, but I found significant deficiencies in it. There was a contention issue, namely, whether the military, which has 30 per cent of all the casualties that you indicated earlier, should have their clinics on bases or in towns. The report said that it should be on bases and that they must stay on bases, and so on. However, more and more data is coming out that those places should be located in town. I would like the colonel to respond. As we become more mature in these programs, maybe these facilities can come back on base, but they should not be on base now because many clients are not getting treatment. Would I be correct in stating that?
Col. Ethell: You are absolutely right. I used the example of the OSISS office in Gagetown. Some of them are co- located with Veterans Affairs Canada offices; some are located in Tim Hortons buildings; some are on bases. In the case of Petawawa, the support group commander gave them a renovated married quarter, and so on. However, it was stepped off so that it was not near the clinic or the base hospital.
I agree with you, but it is a question of money, too, as to what they can afford to do with regard to having accommodations off base.
Senator Dallaire: Both Veterans Affairs Canada and DND have stated that they do not have money problems. That is, money has not been an inhibitor to the implementation of these offices. It will be interesting to return to that. Maybe they have problems hiring the right people, but no statement has been made stating that money inhibits implementation of any of these programs. I propose that we take another go at that later on.
Col. Ethell: I am sure you will get into it. In one of my other lives for the six veterans associations, we meet quarterly. During those meetings, and in the briefings to all four committees and Veterans Affairs Canada, there were significant concerns in regards to money. Having said that, they are attempting to implement what they can within the existing regulations; that is, within the envelope. They are trying to stretch it by using, as one of my old comptrollers told me, creative financing to try to make it work.
A couple years ago, a certain army commander said that money is not a problem in DND, as you may have heard. It is a problem now, however, from my understanding. Both departments have concerns.
The implementation of the recommendations in the New Veterans Charter — and, for that matter, when we get into the Mental Health Advisory Committee — will obviously have a cost factor.
I will skip onto number three, which is the innovative methods of service delivery review and the recommended innovative technologies in supporting technology for mental health conditions. Cyber counselling has caught on well for those who have tried it, particularly for those who are living in the outback and need to talk to someone by arrangement with a psychologist, a psychiatrist or a clinical nurse. Within that field is also e-therapy and i-therapy, prolonged exposure, and other things that will help, such as telehealth simulators; a website for bereaved children and an extension to access telehealth across jurisdictions; development of a dissemination of mental health self management tools; and the utilization of web-based learning methods.
You must remember that the people that we are dealing with, to a certain extent, are computer literate and want to and will follow through. I will give you an example.
I said to Col. Stogran, the Ombudsman for Veterans Affairs, "Why have the Afghan vets not formed an association?'' He replied, "They have; it is called Facebook.'' It is not a question of people getting together; it is a question that they are talking all the time. I still have not figured out what "Twitter'' means, but I am getting there.
I think you want to get on to the New Veterans Charter. I listened to the presentation of our chair from the New Veterans Charter, Professor Westmorland and General Semianiw, the Chief of Military Personnel. I do not need to go through that again. I was the chair of the family committee for that group and we came up with the recommendations, as I am sure you are aware.
We went through the process at the request of DND, who asked, "Will you prioritize the recommendations?'' I think Professor Westmorland indicated to you that it was a long discussion within the committee and the final decision was no. The feeling was that it would be up to Veterans Affairs to prioritize the 16 recommendations.
It is obvious to some of us involved in the process that some priorities will take precedence over others. At the risk of incurring the wrath of our chairman, rehabilitation is one of them, as is financial security. At the top of the list, in my mind, with my background, are families and strengthening family support groups. I may be speaking out of turn, but those three will come to the fore. Under the three headings that I have just provided, there are subheadings that can be articulated.
I will stop there, unless you wish me to go into some of the other details in regards to the family economics and rehab, a comparison of the CF and Veterans Affairs families chart. For the sake of time, I think we are down to only a few minutes for questions. I apologize for rambling so long on the Mental Health Advisory Committee, but it is near and dear to many of our hearts. Like many of my colleagues that used to wear a uniform, it is a labour of love. You get passionate about these things.
The Chair: Thank you very much, Col. Ethell. It is a great interest of this subcommittee as well. We have demonstrated that over the years. We know we have a lot to learn and we appreciate the input that you have brought here today.
There may be time for you to add more at the end that you might have missed. We will go to questions and see whether there are some areas you want to explore further. Senator Downe had to leave, unfortunately.
Senator Wallin: I just want to clarify one thing: the police officers, the RCMP and the civilians, all of whom are actually going outside the wire, cannot opt into this. Is that right?
Col. Ethell: They cannot opt into what?
Senator Wallin: They cannot opt into the services provided under the charter. There is no way, given their specific assignments in Afghanistan, that they would be covered by that?
Col. Ethell: Remember, we are talking about the New Veterans Charter Advisory Group. The New Veterans Charter itself is really a question for Veterans Affairs. As I indicated a few moments ago, if Veterans Affairs can make it work, they will, within the existing regulation. They have to obey the law like everyone else. They are very conscious of this, the RCMP brothers-in-arms business. You see them on television; you cannot tell the difference until you look at the shoulder flash.
Senator Wallin: They are in military fatigues.
Col. Ethell: It was the same in Haiti. They had over 100 RCMP in Haiti and that was not the safest place in the world, along with domestic police forces, OPP, Toronto Metropolitan Police, Montreal police and so forth.
Senator Wallin: I have just come back from there and it is my understanding that the civilians now moving out with the police and with the army and who are outside the wire are somehow in the embrace now. Maybe we can track that down.
This is probably not directly on point in terms of the reports and the recommendations you have put forward, but because we have been looking at this issue over the last couple of months, I want to get your opinion, because of your own experience and your passion and dedication. How do we distinguish, or do we, between stress-related injuries or disorders that lead to behaviours in life later on that are unacceptable that are caused by service and those that are not? Can we make that distinction?
Col. Ethell: Yes, you can. I will answer that in a couple of ways. Early on in the process, when I viewed this OSI PTSD, I was from Missouri; I said, "What is this stuff? I think it is nonsense.'' That was until I talked to some commissioned psychiatrists on our committee and asked, "Can you tell me if someone is suffering?'' The answer was, "Give me an hour or two with them, probably with some tests, and I can tell you whether they have PTSD or not.'' I took that as a given.
Going back to your question on where it happened, psychiatrists who serve in Afghanistan are now being embedded. In Croatia, they were being sent out for two weeks: "I am from NDHQ and I am here to help you.'' That just did not work with the soldiers; they would not talk to them. The psychiatrists embedded there, such as Peter Collins and others, are over there and they are with the troops and they do go outside the wire. It is bad enough when an IED takes out a vehicle and kills one or two and the troops are required to go and talk to what they affectionately call the mind-benders. They will talk to the clinical people there and will listen to them. When they get home, they indicate that it is not necessarily the incident in Afghanistan. It may be because of Rwanda, from the camp wars in Beirut, from the Medak Pocket, or from the Turkish invasion of Cypress when the Canadians defended the Nicosia airport. It can even go back to the Congo when we fought the Belgian forces. It is triggered by an incident.
The other thing is accumulation. I speak from personal experience, having documented the things that could be bothering me that came to the fore five years after I got out of the military. That was when I started to listen to people like General Dallaire, General Couture and others and said that I may have a problem. It was cumulative; it does not necessarily mean one incident. I still have an aversion to sudden noises. A certain smell can trigger a massacre site is a real problem with many of us. We look at that. It is not necessarily the incident in Afghanistan. Does that answer your question?
Senator Wallin: We are trying to wrestle with it because it could be so broad with the number of people who serve in all these different roles and now, as we have talked today about the RCMP and the civilians. I understand exactly what you are saying, and I do not think anyone argues with that. The question is, 20 years down the road, if someone who once served who is out of the force but who is still in the veteran category engages in some unacceptable behaviour, how do we tie that, or should we? Is it an extenuating circumstance? If I rob a bank 20 years from now, is it because I was a senator? If I have an alcohol problem or engage in some violent behaviour in my family, is that because I served in Afghanistan? How do we do that? Is it your view it just does not matter? If it was a member of the force and there is a problem, then it should be within the embrace of the charter.
Col. Ethell: It always matters. It is a question of how it will become known. If the individual is in trouble with the law, as an example, and if he has a lawyer that has his or her act together and is aware that the individual is a veteran, then he or she can seek advice from Veterans Affairs. There is no sense in talking to the military because they would direct them to Veterans Affairs. They can talk to one of the OSISS peer support coordinators. There are a number of cases where a veteran has ended up in jail. I will use an example. Dave McArdle in Halifax is an outstanding peer support coordinator who has an arrangement with the police forces. If a veteran is in custody or has a problem, he says to give him a call, particularly if it is concerning a mental issue. That is not just in Halifax but it is across the country. That is part of the education process. It is part of the Joint Speakers Bureau, DND and VAC, who are spreading the gospel with respect to operational stress injuries and the strength of the OSISS program and now the Mental Health Advisory Committee. It is a question of the authorities finding out if the individual is a veteran and whether the behaviour could be because of military service.
Senator Wallin: Do we have any precedents? Has a judicial body ruled and said no, this bad behaviour is not a result of his military experience; he is just a person who would have done this regardless of what he did in life? He could have been a bank teller. Have we had anyone, to your knowledge, ever make a statement on that?
Col. Ethell: I cannot give you figures, but I do know that having an OSI in the military is not an excuse to violate the Code of Service Discipline. Let me give you an example: the chap who drove the vehicle through the headquarters of Base Edmonton. He had an OSI problem, but he did not escape the Code of Service Discipline.
Senator Dallaire: That has been controversial. Your question is most appropriate. First, they do not even ask if they are veterans. It is a fact that you can relate it back, but it is not absolutely necessary. We do find that clinicians are more often than not trying to find a whole series of reasons, not just the operational one. If they find other reasons, be it family breakup or this or that, it relieves the federal government of a bunch of benefits that they would have to provide and support.
Sometimes you get the clinicians not necessarily taking the full weight of the operational stress in their analysis; they are just adding it to a bunch of other things and saying, you cannot base it enough on that. I would contend that that has had a very negative impact on their effectiveness with the troops because they have tried to diffuse it.
As an example, a colleague of mine committed suicide last year, 14 years after the mission. You can do bad things, as I have helped a full colonel, after an OSI guide warned me to get out of jail, and he was a full colonel. Although the clinician said it was amongst other problems, ultimately it was very much his operational stress that guided it. It is not clean, but it exists. We do not even ask the first question, which the colonel is trying to spread through the VAC, is are you a veteran and were you deployed and start with that information. The Americans have the same problem.
My question, if I may, Col. Ethell, is in relation to your advisory committee. We are getting a lot of queries on new methodologies, family situations and deficiencies in the programs, clinical friction between clinicians and non- clinicians, like OSISS people are non-clinicians, and there are clinicians, and one is fiddling with the other.
Do you have a research capability that permits you to assess and fund this research in all these different areas? Second, are you the person we should be referring all these cases to in order to have them assessed and reviewed? Do you have that mandate at large?
Col. Ethell: I will answer the second question first. Most of us on the committee adopt the same principle, although it is not in our mandate or terms of reference. We will ensure that we steer anyone referred to us in the right direction. That is the best I can do, general, because it is not in our mandate. To be quite frank, it is also time consuming and so forth.
As for research, one of the aspects — and you may recall in my deliberations early on — was research. We have not scratched the surface on that. We have had a number of presentations by Dr. David Pedlar who is the research guru at Veterans Affairs Canada. We are trying to tie him with Dr. Mark Zamorski at DND, who you may have heard of, and match him up with Professor Bilsker in Vancouver, who has an interest in research. A number on our committee have an interest in research. Dan Bilsker is also interested in providing an abstract to the international OSI clinic in Montreal, which Veterans Affairs is organizing next November in regards to suicides.
As you may be aware, DND has come up with an enhanced suicide prevention program. I do not know what that means; I have not seen it. There is a great deal of concern. Dan Bilsker, at Vancouver General, is looking at suicides.
With the case of suicides in the media, we have heard about that, you and I have both experienced it. A young lad I was talking to went home, went upstairs and blew his brains out. How do you prevent that? You cannot. You can do what you can, but if someone is bound and determined to do away with him or herself, it will happen.
Senator Dallaire: You are saying, essentially, that there is no research money, as such. You are trying to establish that capability, correct.
Col. Ethell: There is no research money available within our committee. I do not control the finances. If I did, all three departments would be broke.
You may recall from the CFAC days, where there was one person in VAC looking at research. That has come a long way, listening to the presentations of Dr. Thompson and Dr. David Pedlar, who is not an MD but at PhD.
Senator Dallaire: There is an article by the CF Surgeon General in Frontline that espoused — I do not know how many times in three pages — that we have the best operational stress program that exists in the world bar none and that we should not be hearing so much negativity for only three cases.
Saturday we buried a master bombardier in my regiment who committed suicide. He was just over 30 years of age, did two tours in Yugoslavia, three tours in Afghanistan, just got back and warned people he would do it. The regiment and everyone in the system apparently tried to help him, and within 10 days, he killed himself anyway. Do we have the best program in the world so that we can actually sit there, espouse that, and not take negative critique?
Col. Ethell: I have a lot of respect for Commodore Jung, the Surgeon General. He has come a long way since he took over from his predecessor. I think I recall the article you referred to where he indicated we had the best system. We have a system that is a hell of a lot better than what we had five or 10 years ago. When we say "best,'' compared to what?
The U.S. Marine Corp., as you know, has come on board with regard to the OSISS system. The U.S. Army, being large, has not gone that way. The Australians have been briefed on it and are interested in it, as are the troops from the Netherlands, because it works.
I find it disconcerting that the Surgeon General would make that kind of remark, remembering that the welfare of the troops — including mental health — is not the purview of the clinicians. It is a leadership issue, as articulated by the Chief of the Defence Staff a short while ago. The responsibility of all levels of command is to their subordinates in all aspects, including mental health. The days of, "Oh, you have a problem, go over and see the doctor,'' are gone. Go see the doctor, but I want follow-up as to what will actually happen. That is a cop-out. Been there, done that. It is a problem, go and see the doctor. They are very good at it. It is his or her responsibility, as commander at all levels, to follow through to see what is happening.
There was a statement made by a medical clinician, senior in the military — not Commodore Jung — "What do you expect us to do?'' "Do you want us to call each one of them every day to find out how they are feeling?'' That will not happen, obviously, but it is not the type of thing you want to put out in the paper.
The Chair: Senator Banks, do you have any questions?
Senator Banks: No, I will have a private conversation with the colonel when we leave.
The Chair: Thank you, Col. Ethell, for being with us today. I remind colleagues this is our last meeting before the Christmas break. I wish you all a joyous Christmas and a happy, healthy and even prosperous New Year.
I suggest that perhaps at our first meeting at the end of January, when we come back after the break, with the assistance of the Library of Parliament expertise, we might review a bit of what we have heard, what we have not heard and decide where we go from here.
Col. Ethell, I will give you the last word. We must end before 1:30 or I will get into a great deal of trouble.
Col. Ethell: I just want to indicate, as you have heard many times, the New Veterans Charter is a living charter; it is not perfect. There are a number of things we did not get to that we are not happy with; disability allowance, lump sum, long-term care and so forth. It is not perfect, but they are working on it. It is a heck of a lot better than what we had before, which was nothing. There is a strategic framework in relation to mental health between DND and VAC, agreed to by senior management, but it is hung up at the staff level, which is very disappointing.
As for the New Veterans Charter, as you may have heard before, in regards to families and early intervention, we have gone from the DND at one end of the table and VAC at the other end to almost this seamless approach; in other words a transition. That requires massaging and working on it all the time. There will always be others who have their own interests.
The Chair: Thank you Col. Ethell. We made it by 30 seconds. This meeting is terminated.
(The committee adjourned.)
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