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Record of Discussion – Mental Health Advisory Group

Tuesday, April 30, 2019
08:30 – 16:30 (EDT)
Lord Elgin Hotel, Quebec Room
100 Elgin Street, Ottawa, Ontario

Mental Health Advisory Group (MHAG) Members

  • Sapper (Retired) Aaron Bedard
  • Michael Blais, Canadian Veterans Advocacy
  • Dr. Karen Cohen, Canadian Psychological Association
  • Colonel Colleen Forestier, Director of Mental Health, Canadian Armed Forces (CAF)
  • Dave Gallson, Mood Disorders Society of Canada
  • Sergeant Brian Harding
  • Glynne Hines, Royal Canadian Legion (RCL) (Co-chair)
  • Ed Mantler, Mental Health Commission of Canada
  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Patrick Smith, Canadian Mental Health Association
  • Robert Thibeau, Aboriginal Veterans Autochtones

Regrets

  • Warrant Officer (Retired) Brian McKenna
  • Kerry Mould, Canadian Association of Veterans in United Nations Peacekeeping

Office of the Minister of Veterans Affairs

  • Minister Lawrence MacAulay
  • John Embury, Director of Communications

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

Observer

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

Presenters

  • Dr. Alexandra Heber, Chief of Psychiatry
  • Lina Carrese, Directorate of Mental Health
  • Nathan Svenson, Director, Research Directorate

Presenters via teleconference

  • Paul Thomson, Director General, Service Delivery Modernization
  • Fiona Jones, Manager, Program Policy, Policy and Research
  • Mary Nicholson, Director, Re-establishment, Financial Well-Being and Business Intelligence
  • Mary Beth Roach, Special Project Coordinator, Strategic Policy/Policy Development

Opening Remarks

The VAC and member Co-chairs welcomed the members and the meeting began with roundtable introductions. The VAC Co-chair remarks included: highlights from Budget 2019, update on the terms of reference and membership (status quo) and the Advisory Group work plan.

Regarding the work plan items listed for the Mental Health Advisory Group, it was noted that the work plan serves as a guide to provide advice to the Minister’s office at a high level, and that the intent is not to delve into individual cases or case management. Highlights included some wording changes and brainstorming on next steps.

Discussion

  • A member asked whether there has been qualitative or quantitative analysis on whether the network of VAC clinics (e.g. Operational Stress Injury Clinics, VAC Area Offices) are well-serving female Veterans, particularly female Veterans who have experienced military sexual trauma. It was agreed that VAC needs to look into this further.

Centre of Excellence on Chronic Pain Research

Nathan Svenson, Director of Research at VAC delivered a presentation on the Centre of Excellence on Chronic Pain Research. The presentation provided an overview of the Veteran Wellbeing Framework and chronic pain, the prevalence of chronic conditions in Veterans and the Canadian general population, and links between chronic pain and mental health conditions.

Discussion

  • There were questions on whether data exist regarding the relationship between untreated chronic pain and the development of mental health conditions. It was noted that for a given diagnosis, the directionality is often unknown.
  • A member questioned whether the Centre of Excellence on Chronic Pain Research will have a strong Traumatic Brain Injury focus. It was noted that the Mental Health Advisory Group could provide advice on potential options where the Centre could focus.
  • It was raised that Canada is one of the only G7 countries that doesn’t have a pain plan, and that alternatives to opiates (e.g. Cognitive Behavioural Therapy for chronic pain) is not covered in Canada. Operational Stress Injury Clinics could be broadened to include chronic pain treatment.
  • The intent is that the Centre of Excellence on Chronic Pain Research will align with the Centre of Excellence on Post-traumatic Stress Disorder and Other Related Mental Health Conditions, include the Veteran experience and prioritize an interdisciplinary approach.

Sex Disaggregation of Data

The Sex Disaggregation of Data portion of the presentation was briefly overviewed. The upcoming Women Veterans’ Forum was highlighted.

Discussion

  • A member asked whether there has been qualitative or quantitative analysis on whether the network of VAC clinics (e.g. Operational Stress Injury Clinics, VAC Area Offices) are well-serving female Veterans, particularly female Veterans who have experienced military sexual trauma. It was agreed that VAC needs to look into this further.

Veteran Suicide Mortality Study

The Veteran Suicide Mortality Study section of the presentation was reviewed.

It was noted that in the first decade after release female Veterans have a lower rate of suicide. There is data that shows that women serve slightly less time on average and that the reasons for release are different than men.

It was remarked that there are some challenges with the reliability of the data as the data dates back to the 1970s. Privacy considerations were also noted.

Joint Suicide Prevention Strategy and Action Plan

Dr. Alex Heber, Chief of Psychiatry, offered an update on the Joint Suicide Prevention Strategy and Action Plan. She noted that in regards to women Veterans, it is important to talk about gaps, for example, at the Operational Stress Injury Clinics it may be uncomfortable for women to take part in some treatment programs.

One central item from the Action Plan is ensuring that people working on the phone lines and front lines at VAC (e.g. Case Managers and Veteran Service Agents) are obtaining training on Military Sexual Trauma and serving women Veterans.

A member raised the topic of the “Zero Suicide Strategy” which is a strategy based out of the United States. Part of the Zero Suicide Strategy will be to collect data, and use machine learning to capture measures of suicidality over time to potentially find predictors of suicide.

Veterans Affairs Canada Mental Health Strategy 2.0

Lina Carrese, Directorate of Mental Health, presented a summary of the current VAC Mental Health Strategy 2015-2020.

A new Mental Health Strategy 2.0 (2019-2024) has been developed and has been the subject of extensive consultations (need link to one page handout). While it has the same strategic objectives as the current mental health strategy, new additions include but are not limited to e-therapy, spiritual care, establishment of a VAC Mental Health Treatment Standardization Committee, and increased support to VAC field staff on mental health.

Discussion

  • Spiritual care services were discussed. The focus will be for VAC to mirror services provided by CAF and ensure continuity of care between CAF and VAC. A point was raised regarding the importance of connecting with Indigenous elders to support community healing with Aboriginal Veterans.
  • Regarding innovative technology, members raised that it is important to consider rural communities may not have access to the same services as cities.
  • On developing and strengthening partnerships, a suggestion was offered that VAC conduct outreach to establish additional regional and national partnerships with mental health service organizations, and to bring VAC health service organizations together to share their programs.
  • A member noted that there could be an opportunity to leverage provincial strategies on mental health promotion.

Plenary Session with Advisory Group on Families

The Director General, Policy and Research and VAC Co-chair of the Advisory Group on Families chaired this part of the agenda. An overview of the Women Veterans’ Forum being held in Charlottetown on May 23, 2019 was provided. It was noted that VAC is working with a Steering Committee to help frame the agenda and that the objectives of the meeting are:

  1. To present existing research on Canadian women Veterans and discuss directions for future research;
  2. To develop ideas and potential solutions to policy and program challenges facing women Veterans and their families; and
  3. To promote collaboration and build strong networks among women Veterans and stakeholder groups.

Roundtable with Minister MacAulay

The Deputy Minister attended the plenary session and introduced Minister Lawrence MacAulay. The session began with roundtable introductions. Minister MacAulay spoke to the importance of the advisory groups. He indicated that he is here to listen; is interested in their feedback as well as feedback from all Veterans; he wants to work with the advisory groups and Veterans to make things better for Veterans and their families. 

Discussion

  • He was encouraged to review the recommendations put forward by the advisory groups.
  • The members asked that a regular schedule for meetings be established with more advance notice.
  • There were questions on how funds for programs and operations are allocated and it was explained that operational dollars can be re-profiled, however program dollars are based on a forecast and cannot be transferred to other areas. 

Caregiver Recognition Benefit

The Director, Re-establishment, Financial Well-Being and Business Intelligence, Service Delivery presented an overview of the benefit and the representative from Strategic Policy reviewed the eligibility criteria as per the policy.  A link to the Caregiver Recognition Benefit Policy https://www.veterans.gc.ca/eng/about-vac/legislation-policies/policies/document/2692  was provided to the members in advance of the meeting.  Statistics were provided which indicated that over 80% of Veterans who receive the benefit have both a physical and a mental health condition.

Discussion

  • There was extensive discussion on the eligibility criteria and that it is too restrictive given that fundamentally the Veteran would need to be institutionalized if the caregiver was not in place. 
  • It was noted that the recommendation made by the Advisory Group on Families is different from what was implemented and their recommendation for a three-tier caregiver benefit be revisited.

The group agreed that a joint letter to the Minister be prepared from both the Mental Health Advisory Group and the Advisory Group on Families with their recommendation that would include a short-term solution as well as a longer term solution that would recommend a completely new model be considered. It was noted that any change to the eligibility criteria is legislative and would require changes to the regulations.

Pension for Life

A briefing on Pension for Life (PFL) – was provided by teleconference by the Director, Service Delivery Modernization with the participation of representatives the Policy and Research Division. He reviewed the presentation that was distributed in advance of the meeting along with the agenda and other documents. An information kit containing fact sheets on the PFL programs was distributed.  

Discussion

  • It was clarified that the Pain and Suffering Compensation (PSC) is not a division of the lump sum into monthly payments. The PSC is paid monthly to a maximum of $1,150 a month based on the assessed extent of disability and it is paid out over the life of the Veteran whether that is 20 years or 40 years.  
  • It was clarified that the Additional Monthly Amount was an adjustment for those who received a disability award and is not part of the PFL benefits. The intent of the Additional Monthly Amount was to ensure that those Veterans who had received a disability award would not receive less. The calculation of the Additional Monthly Amount is determined by taking into consideration the actual amount of Disability Award previously paid to the Veteran, the amount that the Veteran could have received as a monthly payment, and mortality rates.
  • It was explained that age and gender are a consideration as the complex calculation that were used by Office of the Chief Actuary of Canada must incorporate mortality rates which are sex dependent. Mortality rates take sex into consideration because life expectancy varies between men and women.
  • It was noted that scenarios are available on the VAC website

https://indd.adobe.com/view/03fea974-d869-49ac-9c9d-199ba6998d15
(no disability)

https://indd.adobe.com/view/1e08a09d-e231-4021-a08c-aeabbdd15852
(20% disability)

https://indd.adobe.com/view/c785eccf-a9e1-4429-8adf-1c7032a3c73e
(40% disability)

https://indd.adobe.com/view/3b5fd5b4-f603-45e4-b7f4-a9fb8cc411de
(100% disability)

Closing Remarks and Next steps

Discussion

  • There was a discussion on where the Mental Health Advisory Group could be most beneficial considering the skillset of the members. Responses included providing guidance on implementation of programs (e.g. Pension for Life), more input into the Mental Health Strategy 2.0, and outreach to clinicians to improve awareness of VAC programs and benefits.
  • A member suggested increasing training on VAC programs and benefits for anyone who is receiving direct funding from VAC (e.g. Operational Stress Injury Clinics), and then broaden this training to include other clinicians. This could be done through a standardized information package or YouTube videos.
  • There was a conversation on the importance of outreach to Veterans who are not VAC clients. Ideas proposed included adding a Veteran identifier to provincial healthcare systems, liaising with the provincial health care system as part of the release process, or the idea of creating a registry.
  • Several members noted that additional notice would be appreciated for Mental Health Advisory Group meetings or that meetings should be set in advance for the year.
  • Members raised the idea of having a teleconference (1-1.5 hours) with the Mental Health Advisory Group before the summer to focus on priority areas. A question was raised regarding whether Mental Health Advisory Group will continue post-election. It was noted that there is no certainty but the plan is to continue.

The meeting was adjourned.

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