Record of Discussion – 12 April 2018

Thursday, April 12, 2018
13:30 – 15:00 (EDT)

Mental Health Advisory Group Members

  • Sapper (Retired) Aaron Bedard
  • Michael Blais, Canadian Veterans Advocacy
  • Colonel Colleen Forestier, Director of Mental Health, Canadian Armed Forces
  • Dave Gallson, Mood Disorders Society of Canada
  • Sergeant Brian Harding
  • Glynne Hines, Royal Canadian Legion (Co-chair)
  • Sapna Mahajan, for Ed Mantler, Mental Health Commission of Canada
  • Warrant Officer (Retired) Brian McKenna
  • Kerry Mould, Canadian Association of Veterans in United Nations Peacekeeping
  • Robert Thibeau, Aboriginal Veterans Autochtones

Regrets

  • Joel Fillion, Director, Mental Health (VAC Co-chair)
  • Dr. Karen Cohen, Canadian Psychological Association
  • Dr. Ruth Lanius, Western University
  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Patrick Smith, Canadian Mental Health Association
  • Amanda Jane, Observer, Office of the Veterans Ombudsman

Office of the Minister of Veterans Affairs

  • Laurel Chester, Stakeholder Relations
  • Bernard O’Meara, Stakeholder Relations

Veterans Affairs Canada Presenters and Officials

  • Dr. Alexandra Heber, Chief of Psychiatry, Veterans Affairs Canada
  • Dr. Linda Van Til, Epidemiologist, Veterans Affairs Canada
  • Raymond Lalonde, Senior Project Officer, Veterans Affairs Canada
  • Michelle Morrison, Senior Analyst, Stakeholder Engagement and Outreach

Opening Remarks

The member co-chair welcomed the group, and noted the regrets of the Veterans Affairs Canada (VAC) co-chair. He introduced the first speaker, an epidemiologist with the Research Directorate of VAC to present on the Veteran Suicide Mortality Study.

Briefing on Veteran Suicide Mortality Study

An overview was provided using the VAC Research Directorate Infobrief as a guide to the overall 2017 Veteran Suicide Mortality Study (Report published in November 2017). This report is based on the results of a collaborative study between VAC, the Department of National Defence (DND), and Statistics Canada. This study compared risk of suicide mortality in the Canadian Veteran population to the general Canadian population. Administrative data from DND was linked to 37 years of Canadian mortality data from Statistics Canada, covering Veterans who released from the CAF between 1976 and 2012. Data included Regular Force Veterans and Reserve Force Class C Veterans. It was noted that this report is the first step in developing a picture of suicide mortality within the Veteran population, and will help shape the actions for the Canadian Armed Forces (CAF)-VAC Joint Suicide Prevention Strategy, discussed later in the meeting. The key findings from the report:

  • The rate of suicide deaths over this period of time was 37 per 100,000 for male Veterans and 11 per 100,000 for female Veterans.
  • The risk of death by suicide among male Veterans was 1.4 times higher than their counterparts in the Canadian general population.
  • The risk was highest among males under age 25, at 2.4 times higher risk than their counterparts in the Canadian general population. Veteran males over 55 years old were at lower risk than the Canadian general population.
  • The risk of suicide among female Veterans was 1.8 times higher than their counterparts in the Canadian general population, with similar risks for older and younger female Veterans.
  • The risk of suicide for both male and female Veterans has remained relatively unchanged over the past four decades and has been consistently higher than the Canadian general population.

The discussion about the Veteran Suicide Mortality Study findings that followed included:

  • A question was raised about how the Reserve Forces Class C personnel data was identified to be included in the study. The presenter noted that the data was obtained from payment history, so if someone had Reserve Force Class C service at any point of their career, they were captured in the study.
  • In response to a question regarding what is being done to capture data related to other Reserve Force personnel (Class A and B), the presenter noted from other research undertaken related to Reservists, that until 2003, Reserve Force Class A and B information systems have been largely maintained in paper records in locations all across Canada, and thus are difficult to obtain. Given the limited number of years of available data for Reserve Force A and B personnel, they were not included in the mortality study data at this point.
  • It was asked how frequently the study will be updated to provide new data from 2012 onwards. The presenter noted that there will be a report produced by VAC every year; however, there will not be new data available from Statistics Canada until 2019 at the earliest.
  • A question was raised by a group member about connections to comparable research happening in other countries, referencing Australia, where a study was reportedly produced in a short period of time, with numbers of Australian Veteran suicides. The member suggested this may have been an internal audit of clients of the Australian Department of Veteran Affairs, and wondered why a similar process could not be done in Canada, which would involve asking current and former case managers to report on numbers of deaths by suicide from their caseload information. The presenter indicated that this type of information-gathering would be a different type of research, and specific to only VAC clients, who represent 12 to 15 % of estimated number of Veterans in Canada. The Veteran Suicide Mortality Study is able to have results from a broader Veteran population in Canada, using existing data to determine risk of suicide compared to the Canadian general population.

CAF-VAC Joint Suicide Prevention Strategy Action Plan

The Chief of Psychiatry at VAC provided a review and update on the CAF-VAC Joint Suicide Prevention Strategy Action Plan, released in October 2017, to address the risks of suicide among the still-serving military and Veteran populations. The contributions of the Mental Health Advisory Group towards the development of the strategy were noted and members thanked. To guide the discussion with the group, a presentation was provided. The highlights of the presentation included the following points:

  • CAF and VAC will organize their efforts along the Suicide Prevention Continuum, as described in the Federal Framework for Suicide Prevention, through prevention, intervention, and postvention.
  • All the determinants of well-being must be considered to ensure the broadest impact.
  • There is a list of 160 actions planned, or already under-way between the two Departments. These are organized under seven ‘Lines of Effort’:
    • Communicating, Engaging, and Educating
    • Building and Supporting Resilient CAF Members and Veterans
    • Connecting and Strengthening CAF Members and Veterans through Families and Community
    • Providing Timely Access to Effective Health Care and Support
    • Promoting well-being of CAF members through their Transition to Civilian Life
    • Protocols, Policies, and Processes, to Better Manage Risk and Stress
    • Continuously Improve Through Research, Analysis and Incorporation of Lessons Learned and Best Practices
  • There are separate action plans for VAC and CAF, with overlap between the action items.

The presenter acknowledged the challenge of developing a joint strategy between two Departments , noting the differing and separate systems of mental health services; unique needs of the different populations served by each Department; as well as different legislative mandates and regulations. However, there are common guiding principles, and both Departments recognize the vulnerability that can be part of the transition process, a shared responsibility of both Departments.

The presenter noted that VAC is focused on emerging areas of interest, for example exploring the possibilities of increased use of technology in mental health services, such as increased use of telemental health, further research and work on women Veterans and suicide, and exploring emerging treatments to target suicidality.

Progress on the Strategy action items include:

  • The mental health section on VAC’s website has been updated and reformatted.
  • A webpage is now available for information on military sexual trauma. As well, the NCCN (National Call Centre) staff were provided Questions and Answers in case of calls received about military sexual trauma.
  • A scientific literature review was undertaken about the “caring contacts protocol”. This is a concept developed in the United States, where postcards, letters and/or messages are sent as follow-up to individuals who had been hospitalized for suicide attempts and suicidal ideation. VAC is looking at setting up something similar to this.
  • A review of existing VAC family postvention protocols is underway.
  • Collaboration has been established with Crises Services Canada, a national call centre for suicide prevention in Canada.
  • The Quebec City Operational Stress Injury Clinic has expanded, and the Kingston Satellite Service Site was officially opened on April 5, 2018.

Following the presentation, the discussion included the following questions and comments:

  • A point was made that in the CAF, suicide prevention training and awareness needs to also happen at the leadership level, as well as lower ranks, as suicide is an issue affecting all ranks.
  • A suggestion was made that the action items be accompanied with the name of the responsible staff area to ensure accountability. It was noted that each item is being tracked and has a responsible lead and target dates.
  • A suggestion was made for increased use options for remote therapy using technology, where people can receive treatment at home via computer.
  • It was suggested that VAC consider biofeedback apps to assist with self-monitoring mental health concerns. The presenter emphasized that all technological options are being explored. The group member offered to assist with any further considerations of this idea.
  • A group member offered an opinion that there is not a need for a centralized in-patient facility, as Veterans tend to want to receive services at home in their own communities. He also noted that northern communities and rural communities may not have access to online technology, but still require services, cautioning against focusing too much on this solution. The presenter agreed that this is an issue that will have to be taken into account.

Centre of Excellence on Post-Traumatic Stress Disorder (PTSD) and related Mental Health Conditions.

The group was briefed on developments for the new Centre of Excellence on Post-Traumatic Stress Disorder (PTSD) and related Mental Health Conditions, with the aid of a presentation to guide the discussion:

  • The Centre of Excellence will be funded as a not-for-profit organization.
  • The planning and staffing will take place in 2018 - 2019, with an opening scheduled for April 2019. The funding will grow from $500,000 this fiscal year, to $9.4 million in the fourth year when the Centre will be fully operational, and receive on-going funding after that.
  • The purpose of the Centre of Excellence is to improve the capability of individuals, organizations and the healthcare community in understanding, preventing and/or treating PTSD and related mental health conditions in Canadian Veterans by:
    • increasing Canadian expertise and knowledge creation;
    • transferring knowledge on the subject of mental health, suicide, prevention and substance use disorders;
    • translating mental health science into clinical practice;
  • Additionally, the Centre will develop training tools and guidelines for healthcare providers across Canada, as well as for Veterans, families, and the general public.
  • The impacts of the Centre will be broader than the Veteran population, and provide value for first responders, Royal Canadian Mounted Police, and the general public.
  • There will not be a treatment mandate. The Centre will work closely with the network of Operational Stress Injury Clinics, and other key partners through which research initiatives, training, and programs will seek to improve knowledge and treatment for Veterans in Canada.

The discussion points following the presentation included the following:

  • A group member expressed concern that a centrally located Centre of Excellence does not ensure reach across the country and leverage of already existing local innovative mental health programs. He noted his concern that the money will not result in clinical improvements for Veterans, but rather will go towards more administration processes.
  • A member expressed concern at the length of time it will take for the Centre to become fully operational, and questioned the delay, given that it has been talked about for over a year. The presenter noted the significant time required to confirm funding and obtain legislated approval before beginning the implementation phase.
  • A comment was raised about the purpose and direction of the Centre and how much VAC will be able to influence the direction of its efforts, given it will be operated by a third party. It was noted that VAC will encourage the third party organization to continue consultation with stakeholders.
  • A member asked how the Centre of Excellence differs from the Canadian Institute of Military and Veteran Health Research. The presenter noted that the Institute does research in all levels of health, where the Centre will have a specific focus on mental health and Post Traumatic Stress Disorder (PTSD). Both organizations will be working closely together.
  • (Note: Since the meeting, the Minister of Veterans Affairs made a formal announcement about the Centre of Excellence on May 7, 2018 via a news release.

Final Roundtable comments included:

  • A concern was expressed by one member that the advice provided by the Mental Health Advisory Group was not being fully recognized in the outcomes of the design of the Centre of Excellence.
  • Regarding the future of the Advisory Groups, the member co-chair noted that the work of the group will continue for the time being.
  • Additionally, a member noted that the Mental Health Advisory Group’s terms of reference of the group were not being adhered to, regarding the number of face-to-face meetings.

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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