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Record of Discussion – Mental Health Advisory Group Meeting

August 10, 2016
0800 – 1600 (EDT)

In Attendance

  • Sapper (Retired) Aaron Bedard
  • Michael Blais, Canadian Veterans Advocacy
  • Dr. Karen Cohen, Canadian Psychological Association
  • Joel Fillion, Director, Mental Health (Co-chair)
  • Dave Gallson, Mood Disorders Society of Canada
  • Sergeant (Retired) Brian Harding
  • Glynne Hines, Royal Canadian Legion (Co-chair)
  • Ed Mantler, Mental Health Commission of Canada (on behalf of Louise Bradley)
  • Warrant Officer (Retired) Brian McKenna
  • Robert O'Brien, Canadian Association of Veterans in United Nations Peacekeeping
  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Patrick Smith, Canadian Mental Health Association
  • Robert Thibeau, Aboriginal Veterans Autochtones

Regrets

  • Dr. Ruth Lanius, Western University
  • Colonel Scott McLeod, Deputy Surgeon-General, Canadian Armed Forces

Presentation by Dr. Cyd Courchesne

Dr. Cyd Courchesne, Director General, Health Professionals Division at Veterans Affairs Canada, provided background about her division at VAC, her role, the evolution of Operational Stress Injury (OSI) clinics, and the five objectives of the Mental Health Strategy.

A member observed that care for Veterans’ mental health should be more holistic, integrating the gamut of services available to Veterans, including peer support. Dr. Courchesne stated that the long term vision is to develop and build capacity of tiered services, from self-help care to front-line care to long term care, with more health care providers (e.g., counsellors, psychiatrists and psychologists) better versed in Veteran mental health care, Post-Traumatic Stress Disorder (PTSD), and other military-related health issues. A list of VAC's mental health services and partnerships was distributed to members.

Members discussed outcomes and evidence as well as resources available to Veterans. One mentioned that peer testimonial is the best evidence, and that some Veterans are building a Veterans’ “Yellow pages” of services, with locations, phone numbers etc.

Members learned that Veterans Affairs Canada Task Forces have been created for all mandate letter deliverables, including the creation of the Centre of Excellence for Mental Health and a Suicide Prevention Strategy. Dr. Courchesne invited members to advise her on the qualities and attributes of the Centre of Excellence for Mental Health which will be considered as the task force develops options to propose to the Minister.

Centre of Excellence for Mental Health

Some members of the Mental Health Advisory Group formed a sub-group to consider what advice the Advisory Group would provide to the Minister on the Centre of Excellence for Mental Health. The lead of the sub-group outlined what that group had accomplished to date. He reported on their two, half-day teleconferences held July 14 and 15, one of which was attended by four doctors from a Vancouver OSI clinic who had been invited to share their expertise. The doctors founded the Veterans Transition Network and have conducted peer-led support workshops.

Sub-group members identified the following attributes of a Centre of Excellence for Mental Health:

  • A physical establishment whose primary function is in-patient treatment and therapies only for Veterans. It would provide a personalized approach to treatment and involve families.
  • Secondary functions would include various forms of research, including new cutting-edge sleep studies and Eye Movement Desensitization and Reprocessing (EMDR). There would be connection to all OSI’s.
  • If it is an asset to Royal Canadian Mounted Police (RCMP) and first responders, then it could be made available to them. (Some MHAG members questioned why the COE would be available for any other group, other than first responders, which was in the Minister’s mandate letter).
  • The facility should not look like a place for sick people. There should be no triggers. It should include activities and opportunities for Veterans to gain clarity (hiking, canoeing, climbing, etc.).
  • It should be located near an airport, within 1.5 hours of a major hospital, with families accommodated nearby.

The sub-group requested information to help them with their work, including access to the Canadian Institute for Military and Veteran Health Research (CIMVHR) conference, and to those in government working on the COE.

Alternative Mental Health Treatments

A MHAG member briefed on Aboriginal mental health treatments which could be considered for treatment of Veterans’ mental health issues such as PTSD.

In North America, Navajo Indians were first to recognize PTSD, calling it a Warrior’s Sickness. Elders found that reconnecting to Mother earth was the way to bring the Warrior’s spirit back, and developed ceremonies involving sweat lodges where individuals could purge toxins and find mental, spiritual and physical healing. For this reason, it is important to have “genuine” Elders in any program. These ceremonies have been quite successful and could be an alternative for some Veterans, not just Aboriginals. The sweat lodge ceremony can heal in the following ways:

  • Mental: allows individuals to free their minds of distractions and offer clarity.
  • Spiritual: provides connection to the planet, nature, Mother Earth.
  • Physical: provides anti-bacterial and wound healing (depending on the extent).
  • Family: the strongest element of healing, and to the healing ceremony.

Mental Health Strategy

Members expressed an interest in advising Veterans Affairs Canada on its draft Mental Health Strategy. The department committed to seek the Advisory Group’s input at a future meeting.

Suicide Prevention

It was suggested that a sub-group be formed to address the issue of suicide prevention. Others preferred that the Advisory Group as a whole provide advice and recommendations on ways to prevent Veterans from “getting to the brink.” Members agreed that the focus should be on experience-based research, and any program built must take the military culture into account. Mental health care should take place before a soldier releases from the Canadian Armed Forces. Additionally, peers who can be there for a colleague in crisis are an essential part of any suicide prevention strategy.

The VAC co-chair indicated there is a suicide prevention framework, and that VAC is working closely with the Department of National Defense on it. National Defence is looking at a comprehensive approach, throughout the career journey of a member, from recruitment to retirement or release from the Forces and transition to civilian life. It has a program called the Road to Mental Readiness (R2MR).

A member suggested they look at an already-existing blueprint developed by the Canadian Association for Suicide Prevention that calls for a National Suicide Prevention Strategy, outlines its main pillars, and provides budget considerations.

It was suggested that the Advisory Group review the DND Suicide Prevention Strategy and the Canadian Association for Suicide Prevention Blueprint, and a document produced by a national consortium including the Canadian Association for Suicide Prevention Blueprint, the Mental Health Commission and the Public Health Agency of Canada and a number of other organizations for suicide prevention, and provide Veteran-specific advice on them.

Mental Health Advisory Group Terms of Reference

Members agreed to the June 7, 2016 Record of Discussion and the Mental Health Advisory Group Terms of Reference. A member added that the Advisory Group should consider a mandate for “knowledge mobilization,” meaning medical professional members could provide their knowledge to Veteran members who in turn would help the medical professional to learn more about working with Veterans so they could take that knowledge back to their respective memberships. A presentation to their professional organizations on military culture and how Veterans “present” would be helpful.

On this latter point, the VAC Co-Chair noted that VAC has access to 4000 Health Care providers who may understand Veteran health and mental health issues and that health and mental health professional organizations can be conduits to reach those 4000.

Establishing Values and Setting Priorities

Members identified and agreed upon the fundamental values that would inform their advice, and set out to determine their short, medium and long-term priorities.

  • Veteran-centric, family-inclusive
  • Encompassing all mental health problems arising from any situation or context
  • Recovery-oriented practice: Veterans are able to make own decisions about their care/living life to the fullest/owner of his or her journey
  • Focus on closure/wellbeing
  • Honour the Veteran (the Veteran is unique)
  • Strategic and qualitative advice at all times
  • Comprehensive and holistic (evidence-based practice, practice-based evidence)
  • Valuing lived experiences
  • Innovative approaches
  • Diversity (gender-informed, culture-informed)
  • Inclusive of all views, all perspectives, all walks of life

Priorities:

Short-term (nine months to one year)

  • Input into the Suicide Prevention Strategy
  • Reducing the stigma of PTSD and OSI

Medium-term (up to two years)

  • Advising on the attributes of the COE
  • Raising of Veterans’ awareness and better use of what services/treatments are available to them
  • Outreach and services to remote areas and Reserves
  • Outreach to the 500,000 Veterans who are not VAC clients
  • Education for families on the care and support of Veterans with mental health issues
  • Educating medical people and caregivers so they are better informed about the Veteran culture and Veterans’ needs, as well as PTSD and other OSI

Future Meetings

The group proposed a teleconference on or around October 15, 2016. The next face-to-face meeting would likely take place in mid- November 2016.

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