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Record of Discussion – Mental Health Advisory Group Teleconference

Tuesday, July 21, 2020
13:00 – 14:30 (EDT)

Mental Health Advisory Group Members

  • Michael Blais, Canadian Veterans Advocacy
  • Dr. Karen Cohen, Canadian Psychological Association
  • Dave Gallson, Mood Disorders Society of Canada
  • Glynne Hines, Royal Canadian Legion (Co-chair)
  • WO (Retired) Brian McKenna
  • Kerry Mould, Canadian Association of Veterans in United Nations Peacekeeping
  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Patrick Smith, Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions
  • Robert Thibeau, Aboriginal Veterans Autochtones
  • Col Helen Wright, Director of Mental Health, Canadian Armed Forces

Regrets

  • Spr (Retired) Aaron Bedard
  • Sgt (Retired) Brian Harding
  • Ed Mantler, Mental Health Commission of Canada

Office of the Minister of Veterans Affairs

  • Andrea Waselnuk, Policy Advisor, Stakeholders and Events

Veterans Affairs Canada Presenters and Officials

  • Joel Fillion, Director, Mental Health, Health Professionals (Co-chair)
  • Mitch Freeman, Director General, Service Delivery and Program Management
  • Trudie MacKinnon, A/Director General, Centralized Operations Division
  • Karen Walsh, Centralized Operations Division
  • Christina Clorey, Senior Analyst, Stakeholder Engagement and Outreach
  • Jean Davis, Analyst, Stakeholder Engagement and Outreach

Observer

  • Laura Kelly for Duane Schippers, Office of the Veterans Ombudsman
  • Dr. Alexandra Heber, Chief of Psychiatry, Health Professionals

Opening Remarks

The member co-chair welcomed the group and spoke to how the Department has adapted since the start of COVID. since early March. He addressed the fact that the Department is learning from and coping with the pandemic.

COVID-19 Working Group Update

These meetings began in early April and focus on input from Veterans. Members of the working group include Advisory Group representation, stakeholder organizations, and RCMP. The purpose of the working group is to provide Veterans input into the COVID-19 response and promote effective communication. The COVID-19 Working Group will continue to meet as necessary.

Issues discussed with the COVID-19 Working Group include the backlog/wait times, Caregiver Recognition Benefit, access to care, Program of Choice 12 (Mental Health Supports to Family Members), Long Term Care, disability claims applications, Royal Canadian Legion issues (e.g., no training for disability claims service officers), the Veterans Emergency Fund and outreach to vulnerable Veteran populations.

Discussion

A member noted that they felt very positive about the mental health supports to family members and that VAC responded quickly and positively to requests.

Veterans Affairs Canada noted that as part of the COVID-19 response concerning the authorization levels for the Veterans Emergency Fund, front line staff were given the decision-making authority. This authority will continue past the COVID-19 response. The amounts awarded ranged from $2,500-$10,000; the decision times ranged from hours to several days. The longest waiting period was 5 days, although every effort is made to provide the funds as soon as possible.

It was noted that there has been a positive response for accessing treatment through virtual care. However, there are challenges in accessing chronic pain resources. It is hard to understand the specific needs of Veterans who are not seeking treatment. Presently the Canadian Psychiatric Association is surveying the mental health and wellbeing of Veterans and families, and effects of the pandemic on treatment and recovery.

Update on Caregiver Recognition Benefit (CRB) and Mental Health Supports to Family Members (Program of Choice (POC) 12)

An evaluation of the Caregiver Recognition Benefit is underway and will be released soon [note: Evaluation of the Caregiver Recognition Benefit was since released July 2020]. Veterans Affairs Canada noted that existing program information/data to identify the Department’s seriously disabled Veterans who have not applied for the CRB and could be eligible for the program should be used. An example was provided. Of a cohort of 137 Veterans, for individuals with a disability assessment 80% or higher, 29-30% had already applied and received Caregiver Recognition Benefit (CRB), 7% did not receive and 63% had not applied for the benefit. Of the 63% who had not applied, the disability conditions present in those cases were amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), post-traumatic stress disorder (PTSD), cancer, or similar. Veterans Affairs Canada noted that Service Delivery and Program Management should be proactive to the 63% either to recommend that they apply or have VAC apply on their behalf.

Program of Choice (POC) 12:

In May 2020, Veterans Affairs Canada issued a guideline that applies the POC 12 Mental Health Policy with increased care, compassion and maximum flexibility. As a result, under treatment benefits, VAC may cover mental health services for family members when the Veteran’s treating health professional indicates that it will have a positive impact on the Veteran’s mental health, and the need must be established in the Veteran’s treatment plan. Since May, 700 applications have been processed – 97% were approved and those remaining were not approved principally due to missing information. Telehealth services have been approved and paid for through mental health services.

Backlog:

VAC noted that improving wait times is the top priority for the Department and noted that delays in wait times is the top concern of Veterans. As of July 2020, there were approximately 45,000 claims in the queue, 20,000 claims in a backlog. Over the past several fiscal years, intake has outpaced processing by 5% to 10%. The plan for improving wait times was presented. This includes continuing to keep 200 additional employees until 2022 and with regular staff focus on regular and complex claims and hiring 300 more staff to process high volume claims (e.g. hearing, musculoskeletal (MSK), etc.). Process and innovations improvements have been implemented with Veteran benefit teams; we are exploring ways to simplify approvals for consequential conditions; and, we are working with our five eyes partners to leverage research and evidence to better inform our decision making tools, such as the Table of Disabilities and the Employment Eligibility Guidelines. The goal for the additional employees is to complete over 80,000 decisions and a reduction of the backlog to approximately 5,000 by March 2022.

Note: Since the meeting, the hiring and training of 350 new employees has been completed. The spike teams are now making decisions. The recently published Q3 Disability report shows positive progress – the backlog was at about 16,000 down from 20,000 the previous quarter while the number of applications increased

Presentation on Moral Stress Amongst Healthcare Workers During COVID-19: A Guide to Moral Injury

Dr. Patrick Smith, Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions, presented on his organization’s new guide, A Guide to Moral Injury: Supporting healthcare workers during COVID-19. The Guide, developed in partnership with Phoenix Australia, focuses on responses to Moral Injury at the Organization, Team, and Individual level. The Centre of Excellence has prioritized co-constructing tools to help Veterans Peer Support organizations effectively implement the recommendations in the Guide. Dr. Smith noted that the pandemic experience for health care workers is a unique context as they are experiencing the pandemic and helping in the pandemic. The experience of Veterans is not being equated with health care workers’ experience; however, the outcomes of these studies may lead to a better understanding of the Veteran population and Veterans and their family members who are, themselves, also on the front lines of response have also expressed support for the Guide.

The Moral Injury Guide speaks to organizational, team, and individual supports. These supports can provide preventative structures and early intervention structures to support individuals and compress the curve of moral injury events/post-traumatic stress disorder (PTSD). The development of a peer tool kit is being explored with peer representative organizations – for the Veteran population through the lens of VETS Canada with Brian McKenna as strategic advisor. It was noted that Canada has been the first country to have a cross-departmental framework for PTSD at the federal Government level that involves multiple government departments. This Framework has been useful in guiding Canada's response to the pandemic.

Closing Remarks

The member co-chair concluded the meeting by thanking the presenters and group members for their engagement and participation.

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