Record of Discussion – 26 April 2023

Wednesday, April 26, 2023
09:00 – 15:30 (ET)

Mental Health Advisory Group Members

• Sergeant (Retired) Michael Blais, Canadian Veterans Advocacy
• Dave Gallson, Mood Disorders Society of Canada
• Cons. (Retired) Trevor Jenvenne, Royal Canadian Legion
• Corporal (Retired) Victoria Jonas (joined virtually)
• Captain (Retired) Tarik Kadri
• Dennis MacKenzie, Brave and Broken – co-chair
• Dr. Don Richardson, Canadian Psychiatric Association
• Dr. Maya Roth
• Sergeant (Retired) Alannah Gilmore – co-chair
• Warrant Officer (Retired) Brian McKenna
• Captain (Retired) Robert Thibeau, Aboriginal Veterans Autochtones

Regrets

• Sapper (Retired) Aaron Bedard
• Ed Mantler, Mental Health Commission of Canada
• Dr. Karen Cohen, Canadian Psychological Association
• Dr Gail Wideman

Office of the Minister of Veterans Affairs

• Abigail Garwood, Senior Policy Advisor

Veterans Affairs Canada Officials

• Cyd Courchesne, Chief Medical Officer, Health Professionals Division (Co-chair)
• Julie Drury, Director, Mental Health Directorate
• Pamela Harrison, Senior Director, Engagement and Events

Observer

• Sonia Poirier, Office of the Veterans Ombudsman 

Chairs’ opening remarks

Welcome/Opening remarks/Administrative updates

The member Co-chair opened the meeting, extending a welcome to all members and thanked everyone for joining in-person for the first time.

Land acknowledgement

The VAC Co-chair welcomed the members and offered a land acknowledgement recognizing that we are all on sacred land, subject to numerous treaties.

Labour disruption

The co-chair provided an update on the efforts   taken to ensure service levels are maintained as much as possible during labour disruption. Members were advised Veterans Affairs Canada’s website is updated with the most up to date information on the matter.

2016-2020 recomendations

VAC co-chair introduced the past recommendations from the group and the progress since:

Centre of Excellence on PTSD and Mental Health conditions – in the years since it opened they have achieved many accomplishments. For example:

• Provided training to community mental health providers on evidence based treatment modalities for mental health conditions;
  • next series to happen in 2023 will involve follow-up coaching/consultation post-training.
• Hosted information/training sessions (webinars) with media on how to  report on mental health and particularly suicides (an element of the Suicide Prevention strategy); and
• The establishment of four reference groups including a Veteran-reference group to determine their priorities.

Joint Suicide Prevention Strategy with the CAF (published in October 2017) and action plan within the strategy over the past five years. All of the actions have been implemented, including ongoing actions with no end date (i.e. improving processing times; mental health first aid training, etc.).

Discussion:

• Collection of Veteran Suicide data - VAC co-chair provided an overview of the findings of the annual VSMS (Veteran Suicide Mortality Study).
• The group would like to discuss this topic further to determine ways to support those at risk, including supports like peer support, early engagement protocols and how to put a safety net in place for those at risk and tracking suicides.
• The Chair shared the progress over the past five years in collaboration between VAC and CAF to ensure transition supports are available to Veterans.
• An issue important to committee members is the commemoration of those who die by suicide. Co-chairs of MHAG and the Commemoration Advisory Group are connecting on the issue.

Veterans’ Well-being Community Health Needs Assessment

Guest speakers: Margaret Fry (National Nursing Officer, VAC) and Dr. Lisa Garland-Baird (Senior Researcher, VAC)

• The Community Health Needs Assessment will help the Department gather data on all Veterans’ health needs including the community health needs of underrepresented Veteran groups such as women, Indigenous and members of the 2SLGBTQI+ community.
• Intended outcomes of the Assessment are to improve services and programs, inform well-being outcome measurements, reach underrepresented Veteran groups, strengthen partnerships with Federal/Provincial/Territorial and communities and to understand the needs of the broader Veteran community.
• Project scheduled to last one-year, engagement phases continues through to May/June and then analysis phase begins with results available in early 2024. 
• Advisory group members asked to share the information on this project to members of their community, share ideas on groups and organizations we should include in the assessment.
• Co-chair committed to share the presentation and survey questions.

Discussion

• Peggy Fry explained that the biggest challenge is how to reach the underrepresented Veterans and how to secure their participation.
• A disaggregated data approach will occur throughout the project not just at the end of the project once all data is collected.
• Need to place significant effort on “why should I complete this assessment?” “what’s in it for me?” and present the assessment to each individual Veteran group.
• The results of this Community Health Needs Assessment will be made available to everyone and be presented in a way where people will be able to see themselves in the data.
• The team will return to the group to present its findings and the intent is to complete this Assessment every three to five years.

Discussion (post break)

• Member raised his work with VAC Case Managers and the good work that they are doing but there is a need for more outreach to rural and remote Veterans.
• VAC co-chair spoke about the outreach efforts including visits to remote and northern communities.

Mental Health Strategy – Five-year Strategic Plan

Guest speakers: Julie Drury (Director of Mental Health)

• Julie Drury provided an overview of the role of VAC’s Health Professional Division within the department.
• Julie explained that her Directorate supports VAC Divisions, Directorates and providing service providers with mental health advice and expertise. In addition, DMH also support the delivery of mental health programs and services through partnerships with federal and provincial partners.
• The 3 key priority areas were also presented:  1) e-Mental Health 2) equity-seeking groups; and  3) Mental Health and Substance Use Disorder.

Discussion

• VAC co-chair explained the Memorandums of Understanding (MOUs) that are in place with provincial health authorities as part of National Centre for Operational Stress Injuries.
• Member suggested VAC research the link between CAF deployments and mental health injuries (combat injuries).
• Members noted the importance of understanding the differences between PTSD and other mental health conditions.
• VAC is connected with the RCMP and VAC help establish their Support for Operational Stress Injuries program which the RCMP administers.
• MHAG would like to explore development of an anti-stigma campaign.
• Strategic priorities should include chronic pain. Julie Drury agreed and explained it is a another issue her team is considering in the broader context of impact on mental health.
• Discussion on the gaps between men and women that exist within CAF (for example, equipment issues) and if CAF did more to address those gaps, the result would be fewer injuries and better health outcomes.
• Inclusivity needs to address rural, urban and remote. 
• Recommend an external community of practice in addition to an internal treatment review committee to complement VAC’s efforts/objectives.
• We need to be careful in combining mental health with substance abuse disorders, not everyone who has a mental health injury has substance abuse disorders and not everyone who has a substance abuse disorder suffers from mental health issues.
• E-mental health is different and distinct from tele-mental health –VAC co-chair explained the continuum of funded mental health care and the need to fill the e-mental health space that would complement the other mental health programming options.

Expectations and priorities

Group agreed the following items need to be kept as priorities:

• Suicide prevention strategy – could look at refreshing the strategy;
  • Commemoration of suicide deaths – to bring forward to CAG
• Access to MH services and strategy to reduce stigma;
• MH terminology (PTSD vs OSI vs Combat Trauma);
• Cultural competencies (Veteran-focused MH training resources);
• The need to ask/collect combat/service questions not just social status data (sex, gender, service class, race);

Discussion

• Julie Drury raised how PTSD Coach is going to be reviewed/analyzed – jointly with the Research directorate – review will analyze who is using the app, what are the benefits being gained, is it meeting needs, level of satisfaction.
• Intersectional groups, there are women groups, there are combat groups, there are Indigenous groups but there are no intersectional groups (ie. women combat groups)
• VAC co-chair thanked everyone for their willingness to share stories, it helps us understand how best to help.

Next steps

• Confirm when MHAG can meet with Commemoration Advisory Group.
• Narrow down agenda to allocate more time to discuss each topic. Possible topics include:
  • Cannabis for Medical purposes as an evidence-based treatment (future agenda item).
    • Education on use (Cannabis counsellors)
    • Research presentations (efficacy)
  • Mental health emerging treatments (selfcare treatments, sweat lodges, etc.)
  • Strategy for supporting those with suicide ideations.
  • Schematic on Veterans access benefits.
  • Session on identification of gaps.
• Advisory group to meet every two months. Next meeting in June (virtual), no meetings in July and August
• In-person meeting in September/October.

Closing remarks

Members were thanked for their participation. Meeting was adjourned at 3:30 ET.