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Record of Discussion – Mental Health Advisory Group

March 3, 2020, 0830-1600 (EST) and
March 4, 2020, 0830-1300 (EST) (in-camera)

Location: Lady Elgin Boardroom
Lord Elgin Hotel, 100 Elgin St., Ottawa, Ontario

Mental Health Advisory Group Members (8)

  • Spr (Retired) Aaron Bedard
  • Michel Blais, Canadian Veterans Advocacy
  • Ed Mantler, Mental Health Commission of Canada (March 3 only)
  • Dave Gallson, Mood Disorders Society of Canada
  • Glynne Hines, Royal Canadian Legion (Co-chair)
  • WO (Retired) Brian McKenna (March 4 only)
  • Glenn Brimacombe, Director of Policy and Public Relations on behalf of Dr. Karen Cohen, Canadian Psychological Association
  • Robert Thibeau, Aboriginal Veterans Autochtones

Regrets

  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Karen Cohen, Canadian Psychological Association
  • Sgt (Retired) Brian McKenna
  • Col Helen Wright, Director of Mental Health, Canadian Armed Forces
  • Kerry Mould, Canadian Association of Veterans in United Nations Peacekeeping

Office of the Minister of Veterans Affairs

  • Andrea Waselnuk, Policy Advisor, Stakeholders and Events

Veterans Affairs Canada (VAC) Officials

  • Joel Fillion, Director, Mental Health (VAC Co-chair)
  • Sylvie Thibodeau-Sealy, Director, Stakeholder Engagement and Outreach
  • Christina Clorey, Senior Analyst, Stakeholder Engagement and Outreach

Presenters

  • Dr. Patrick Smith, Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions
  • Dr. Ramesh Zacharias, Centre of Excellence on Chronic Pain
  • Dr. Alex Heber, Health Professionals, Service Delivery Branch
  • Dr. Lina Carrese, Health Professionals, Service Delivery Branch

Presenters via teleconference

  • Rhonda Nicholson, Caregiver Recognition Benefit (Policy)
  • Kirsten Johnston, Caregiver Recognition Benefit (Service Delivery)
  • Danica Arseneault, Caregiver Recognition Benefit (Service Delivery)
  • Trevor Nicholson, Program of Choice 12: Mental Health Supports to Family Members (Policy)
  • Shawn MacDougall, Program of Choice 12: Mental Health Supports to Family Members (Policy)
  • Dennis Manning, Program of Choice 12: Mental Health Supports to Family Members (Service Delivery)
  • Beth Smith-Cooper, Program of Choice 12: Mental Health Supports to Family Members (Service Delivery)
  • Tammy MacWilliams, Program of Choice 12: Mental Health Supports to Family Members (Service Delivery)

Observer

  • Duane Schippers, Office of the Veterans Ombudsman (via teleconference)

Opening Remarks

The VAC and member co-chairs welcomed the members, and thanked them for their work. It was noted that an in-camera session will be held with members the following morning. The meeting began with roundtable introductions.

Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions

Dr. Patrick Smith delivered a presentation on the Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions. The presentation covered the vision, mission and purpose of the Centre; the international and Canadian landscape; a review of the function of intermediaries; and highlighted some of the research and partnerships of the Centre.

Discussion

  • Mapping peer supports for Veterans was noted as an area of importance.
  • A member remarked that he is hoping for collaboration between First Nations communities and the Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions.

Centre of Excellence on Chronic Pain Research

Dr. Ramesh Zacharias delivered a presentation on the Centre of Excellence on Chronic Pain. The presentation highlighted statistics on chronic pain and the Veteran community; the creation of the Centre; and the results of its engagement strategy. Dr. Zacharias also discussed the Centre’s vision and mission, research priorities, and its conceptual framework. Continued engagement with Veterans was noted as a key priority.

Discussion

  • The differences in wait times between publicly-funded clinics and the pain clinic was discussed.
  • The importance of engaging with Indigenous Veterans was highlighted.

Caregiver Recognition Benefit

Veterans Affairs Canada’s Policy Division delivered a presentation on the Caregiver Recognition Benefit.

Discussion

  • A member raised that the Policy Advisory Group is recommending a return to the Attendance Allowance model, which may exclude a percentage of Veterans that could be served through the Caregiver Recognition Benefit.
  • A member asked whether the departmental evaluation will look into Caregiver Recognition Benefit denials to confirm whether the majority of Veterans being denied have a psychological condition.
  • A question was raised regarding the formula and amount for the Caregiver Recognition Benefit, and the distinction between recognition versus compensation.
  • Members noted that this topic is on the agenda for the in-camera portion of the meeting, and that recommendations on the Caregiver Recognition Benefit will be shared with the Minister.

Program of Choice 12: Mental Health Supports for Family Members

Veterans Affairs Canada’s Policy Directorate and the Health Care Benefits Directorate jointly delivered a presentation on Program of Choice 12: Mental Health Supports to Family Members.

Discussion

  • A member noted that supporting a Veteran living with Post Traumatic Stress Disorder may be more difficult for family members if they don’t have mental health coverage in their own right.
  • It was highlighted that in Australia, they are now providing access to mental health services to families of Veterans in their own right to help support the Veteran.
  • A concern was raised regarding the number of letters going out to Veterans stating that their services are being rolled back.
  • It was noted that the Department is only able to do what legislation and regulations allow and that the VAC Assistance Service remains available to family members.

Veteran Suicide Mortality Study

The Veteran Suicide Mortality Study is now in its third year. Statistics Canada have provided two more years of data and the next iteration of the study will cover 39 years. The results of the 2019 study have not yet been published.

The results of the first two years of the Veteran Suicide Mortality Study were highlighted. These studies provided information on the risk of suicide in the Canadian Veteran population. The 2017 Veteran Suicide Mortality Study can be accessed here and the 2018 Veteran Suicide Mortality Study can be accessed here.

Joint Suicide Prevention Strategy and Action Plan

An update was provided on the Canadian Armed Forces/Veterans Affairs Canada Joint Suicide Prevention Strategy. A 2nd anniversary report (not yet released publicly) was distributed as a reference point only.

Some key accomplishments resulting from the Joint Suicide Prevention Strategy were highlighted, including the Mental Health First Aid for Veterans program. Successful research collaborations were noted, including the Canadian Association for Suicide Prevention (CASP) conference, the Canadian Institute for Military and Veteran Health Research (CIMVHR) roundtables on suicide prevention, and a report detailing VAC suicide prevention research publications prepared for the international 5 Eyes Mental Health Research and Innovation Collaborative.

Discussion

  • A member noted that there is a national collaborative group contributing to suicide prevention across the country. The Mental Health Commission of Canada will make the connection to link Veterans Affairs Canada into this group.
  • A question was raised regarding whether causality was explored in the Veteran Suicide Mortality Study (VSMS), particularly in reference to opioid deaths. Veterans Affairs Canada noted that the VSMS is not the kind of study that provides information about causation. Also, the determination of whether or not a particular death is a suicide (i.e., rather than an accident), is a coroner’s decision.

Feedback on Operational Stress Injury Clinics

In the past year, Veterans Affairs Canada has visited all Operational Stress Injury (OSI) clinics and associated Area Offices to assess the strengths and what requires improvement. The questions put forward included:

  • What types of clientele are being referred?
  • What programming is offered?
  • Is the present composition of the OSI team meeting the current mental health need?

Feedback received included an interest in streamlining the referral process for OSI clinics, and improving the exchange of information between VAC and the OSI clinics.

Discussion

  • There is interest in more options for virtual treatment, both for people living in rural and remote locations, for those not ready to access face-to-face service and for those who may not necessarily need this latter level of care. As certain First Nations communities do not have access internet access, a suggestion was made for OSI clinics to connect to health services on reserves to coordinate access to care for Veterans.
  • VAC noted that clinics have mobile teams for outreach to remote locations. The option of establishing more satellite services if a need is identified can also be investigated.
  • Determining minimum common standards of care at different OSI Clinics was discussed. VAC noted that the Department requires some standardization while allowing for regional differences.

Associate Deputy Minister

The Associate Deputy Minister delivered remarks on the theme of mental health, including the work of the OSI clinics, the Veterans Affairs Canada Assistance Service, the Centres of Excellence and the focus on suicide prevention.

Discussion

  • The disability benefit application backlog and the digitization of health records was discussed.
  • A member expressed that he has seen improvement in Veterans’ services over the past four years, and encouraged further investment in the Veteran and Family Well-Being Fund to provide a stronger evidence-base for new Veteran programs.

VAC Mental Health Strategy

The VAC Mental Health Strategy and strategic objectives were reviewed. Key areas discussed included:

  • E-mental health
  • Veterans Affairs Canada’s Mental Health Treatment Review Committee and
  • Treatment outcome monitoring.

Discussion

  • Research is indicating that e-therapy results may be as good as face-to-face treatment. The requirement of seeing a clinician in-person may be a barrier for some so there is a focus on hybrid models for therapy.
  • Mobile applications for Veterans were discussed, including “OSI Connect” and “PTSD Coach Canada.” An idea was suggested for a diary-style app which could include integration of smart technology and health data. The Centre of Excellence on Post Traumatic Stress Disorders and Related Mental Health Conditions suggested they could explore what apps are currently in use, and potentially look at developing a Veteran-centric app.

Closing Comments

The meeting closed with a roundtable of final comments. Members noted that there have been improvement in services from Veterans Affairs Canada in the past five years, but there continues to be more work to do. It was noted that the in-camera portion of the meeting will focus on drafting advice to the Minister and updating the Advisory Group work plan, with submissions to follow. The co-chairs thanked the group for their participation.

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