May to September 2016
Background
The Mental Health Advisory Group (MHAG) is one of the most recently formed of the six Ministerial Advisory Groups tasked to provide advice to the Minister of Veterans Affairs. The MHAG is to provide advice to the Minister of Veterans Affairs and Associate Minister of National Defence to ensure that Veterans, Canadian Armed Forces and Royal Canadian Mounted Police members, and their families receive the care, compassion, respect, support, and economic opportunities they deserve.
To this end, and within its particular mandate to provide advice, the Mental Health Advisory Group will:
- examine gaps and weaknesses in the support and services to Veterans, and their families that are related to the mental health of Veterans, CAF and RCMP members, including post-traumatic stress disorder (PTSD) and other operational stress injuries (OSI).
- provide the Minister with advice that prioritizes and addresses the significant gaps and weaknesses in the support and services related to mental health.
- contribute timely input to Veterans Affairs Canada to ensure stronger, more responsive policy and program development.
Members
The MHAG members are drawn from a cross-section of Veterans and mental health professionals:
- Sapper (Retired) Aaron Bedard
- Michael Blais, Canadian Veterans Advocacy
- Louise Bradley, Mental Health Commission of Canada
- Dr. Karen Cohen, Canadian Psychological Association
- Dave Gallson, Mood Disorders Society of Canada
- Sergeant Brian Harding
- Major General (retired) Glynne Hines
- Dr. Ruth Lanius, Western University
- Warrant Officer (Retired) Brian McKenna
- Colonel Scott McLeod, Deputy Surgeon General, Canadian Armed Forces
- Robert O’Brien, Canadian Association of Veterans in UN Peacekeeping
- Dr. Don Richardson, Canadian Psychiatric Association
- Dr. Patrick Smith, Canadian Mental Health Association
- Robert Thibeau, Aboriginal Veterans Autochtones
The Group is co-chaired by Joel Fillion (VAC Director Mental Health) and Glynne Hines (Veteran).
Mandate
As with the other Ministerial Advisory Groups, the MHAG is focused on providing advice relevant to the Minister’s Mandate Letter. Although other advice may be provided if deemed relevant to the members, the Group is focused on informing the Minister’s decision-making process with respect to mental health issues facing veterans and their families.
While there is clearly an overarching need to ensure that VAC implements all of the Auditor General’s recommendations on enhancing mental health service delivery to veterans, there are specific areas that need priority attention. As such, the MHAG agreed on three priority areas (no specific order) on which to provide advice:
- Create a new centre of excellence in Veterans’ care with a specialization in mental health, post-traumatic stress disorder and related issues for both Veterans and first responders.
- Provide greater education, counseling, and training for families who are providing care and support to Veterans living with physical and/or mental health issues as a result of their service.
- Work with the Minister of National Defence to develop a suicide prevention strategy for Canadian Armed Forces personnel and Veterans.
Other areas of focus could be to provide advice on education, counseling or training for Veterans providing peer support to other Veterans, and to provide advice on the ways to de-stigmatize and remove the barriers to care associated with mental health.
The scope of the Mental Health Advisory Group includes the consideration of medical and ethical evidence to support the development of policies and programs and the provision of services and benefits associated with the mental health of Veterans, CAF and RCMP members and their families. The MHAG is aware that VAC has previously submitted its Mental Health Strategy for approval and anxiously awaits its release for review. This strategy should inform the policies and programs being considered by VAC. It should also be informed by the work of the advisory groups, particularly the MHAG.
Activity Summary
Since its establishment 10 May 2016, the MHAG has met three times: twice in person in Ottawa and once by teleconference. Additionally, a sub-group to address the Centre of Excellence for Mental Health was created. This sub-group also met on numerous occasions both by videoconference and in Ottawa. The following summarizes the activities of the MHAG to date:
Centre of Excellence for Mental Health
The Centre of Excellence for Mental Health or CoE has been the primary focus of the MHAG. This was a conscious decision taken by the MHAG because it was seen as potentially the most capital-intensive of the three priorities and in part, it could overlap with part or all of the two other priorities, thus addressing them concurrently. Considerable discussion has taken place both within the sub-group and within the greater MHAG itself. The sub-group went outside the membership of the MHAG to solicit input and advice from other Veterans who had successfully completed programs and from other mental health professionals with extensive experience treating Veterans and first-responders. The sub-group is in the process of developing a Mental Wellness Framework/Model based on the attributes and criteria that have been ascribed by the MHAG. This framework will further inform the recommendations for the CoE.
The Centre of Excellence for Mental Health must:
- Include an in-patient/residential care facility
- Include an outpatient component
- Be focused on recovery
- Include a comprehensive research capability (including evidence-based research)
- Be scalable to meet the needs of the Veteran community
- Include complementary, non-traditional treatment alternatives
- Be culturally relevant and sensitive
- Have reach into other disciplines (i.e. pain management, addiction, physical injury) as well as mental health through formal agreements
- Be innovative in its approach to research and services
- Be accessible to all Veterans, their families, and support network
- Be Veteran-centric and integrate families into every aspect of care
- Conduct education and training for Veterans, families, care providers/peer supporters, and the public (through educators and the media)
- Be under a strict governance model that includes at least 1/3 Veterans
- Be subject to rigorous performance standards and standards of care
Education, Counseling and Training
While not addressed as a discrete topic, education, counseling and training were discussed in the context of the Centre of Excellence for Mental Health. It is the assertion of the MHAG that a key component of the CoE must be education, counseling and training, not only for Veterans but also equally for their families and peer-supporters/caregivers. Education, counseling and training do not stop at the doors of the CoE. These must also be made available to CAF and RCMP members and their families throughout the member’s careers, to those providing care to these members, and to the general public. One of the roles of the MHAG is to provide advice on the ways to de-stigmatize and remove the barriers to care associated with mental health. This can only be done through greater awareness of the public and health care providers in general.
Suicide Prevention Strategy
It was disturbing to learn that Canada was the only G-7 Nation without a National Suicide Prevention Strategy. This does not excuse DND or VAC however from having such a strategy. Although there may not have been clear strategies, VAC has indicated that about 1/3 of identified action plan interventions have been completed. It was also disturbing to learn that there are no definitive statistics available on Veteran suicide in Canada. While it was often heard that “one is too many” and we were questioned on what would be different if we knew the numbers of Veteran suicides, the point stressed by the Veterans was that the number is important if we are to bring awareness to the problem and therefore address it head on. There are dissenting views as to whether the availability of accurate statistics would change priorities and action plans, with the disagreement generally along the lines of Veterans and mental health professionals. The Minister’s Mandate Letter calls for him to work with the Minister of National Defence on a collective suicide prevention strategy however, no information is forthcoming on that strategy and it is unclear how VAC is influencing that strategy. While the MHAG has been assured that information is continually provided to Deputy Minister office, and VAC has taken the lead to ensure momentum, concern has been expressed that there is no visibility into the strategy that the MHAG is meant to influence. It is also contended that a Veteran suicide prevention strategy has to be more closely aligned to the national strategy than does a CAF strategy, hence the urgent need for a National Suicide Prevention Strategy.
Advice to the Minister
The MHAG will continue its work refining recommendations for the CoE; education, counseling, and training; and suicide prevention with a view to providing this advice in the Spring of 2017 or sooner should the opportunity present itself or should advice be requested by the Minister.
Based on the above details, the following would comprise the advice as of September 2017 (in no particular order):
- The attributes and criteria outlined for the CoE represent the minimum expected by the Veteran community. A recommendation of geographic location(s) and numbers (although “centre” implies one, it could be the centre of a network of service locations) was discussed but not debated or agreed, nor is it considered relevant to the advice as long as the attributes and criteria are satisfied. Therefore, the resulting CoE must satisfy all of the attributes and criteria listed above.
- Education, counseling and training are considered an integral part of the CoE. However, work on those can continue or be accelerated and rolled into the CoE when it is operational.
- Collect and analyze data pertaining to Veteran suicides as a matter of priority.
- If the Suicide Prevention Strategy is to be a joint DND/VAC strategy, share the draft currently being developed by DND/CAF with VAC in order to have retired Veteran input.
- VAC and DND must encourage the lead government department, Health Canada, to finalize a National Suicide Prevention Strategy that will be relevant to all Canadians, including Veterans.
- Expedite the release of the VAC Mental Health Strategy.
Clearly, more detailed advice could be provided at a later date or as further information becomes available.
Next Steps
The MHAG will continue to refine the vision for the CoE and will finalize the Mental Wellness Framework/Model as an adjunct to the CoE. The MHAG will also continue to improve the advice relevant to the other two priorities (education, counseling and training, and suicide prevention).
Additionally, the MHAG is considering what else can be done to de-stigmatize mental health issues and remove barriers to care within the Veteran community. This includes more robust preventive measures, increased public awareness, closer ties with health care organizations, and increased outreach to remote and under-serviced areas and above all, closer work with the CAF to enable smooth transition and minimize triggers.