Mental Health – Treatment Benefits (POC 12) and Rehabilitation Services

This policy replaces the following: Mental Health (POC 12)

Purpose

1. This policy provides guidance on the range of mental health services that may be reimbursed under Program of Choice 12 (POC 12) of the Treatment Benefits Program or under the Rehabilitation Services and Vocational Assistance Program.
2. This policy is to be read in conjunction with the Related Health Services (POC 12) policy and the Rehabilitation Services and Vocational Assistance Plan: Assessments, Development and Implementation policy.

Policy

Veteran Eligibility

3. The following Veterans can be reimbursed for mental health services :
   1. Veterans entitled to receive treatment benefits under the Veteran Health Care Regulations (VHCR); and
   2. Veterans approved for rehabilitation services under Part 2 of the Veterans Well-being Act (VWA) as part of a rehabilitation plan (for more details, refer to the Rehabilitation Services and Vocational Assistance – Eligibility and Application Requirements (VWA) policy).

Mental Health Services

4. Mental health services that Veterans Affairs Canada (VAC) may fund under treatment benefits and rehabilitation services are professionally planned and structured interventions designed to reduce or eliminate symptoms associated with a mental health condition and to stabilize and restore psychological function. Mental health services are those services which are provided by health professionals approved by the Minister, such as, psychologists, psychotherapists, mental health occupational therapists, and social workers. In addition, mental health services may be funded when provided by other practitioners, such as addictions counsellors, who work under the direction of an approved health professional as part of a multi-disciplinary team (see the Health Professionals policy).
5. Some examples of mental health services include, counselling, psychotherapy, psycho-education, and pain management.
6. Mental health services may be delivered through one-on-one interventions, in small group settings, or with the family unit and can be delivered using modern technologies in certain instances, if required. See the Health Professionals policy for guidance on the delivery of telehealth services by health professionals.
7. A Veteran who requires treatment or rehabilitation for a mental health condition may also require treatment for other health issues, such as substance misuse, in order to successfully treat the mental health condition that is the primary focus of the treatment or rehabilitation plan.
8. The health condition that is the primary focus of the treatment or rehabilitation plan would be:
   1. in the case of a Veteran obtaining treatment benefits under the VHCR, the disability benefits entitled condition or other health problem for which the Veteran has treatment eligibility; or
   2. in the case of a Veteran participating in rehabilitation, the health problem resulting primarily from service (i.e., eligible under section 8 of the VWA) or the health problem which lead to a career ending medical release (i.e., eligible under section 9 of the VWA).
9. When considering the appropriateness of reimbursing for mental health services when other conditions are involved, please refer to:
   1. for treatment benefits, the direction provided in the Treatment for a Disability Benefits Entitled Condition.
   2. for rehabilitation, the direction provided in the Rehabilitation Services and Vocational Assistance Plan: Assessments, Development and Implementation.

Continuum of Mental Health Services

10. Examples of benefits which are available as part of VAC’s continuum of mental health services but which fall outside the scope of POC 12 benefits include:
    1. 1. treatment by a psychiatrist and/or family physician (POC 6);
       2. specialized in-patient/out-patient treatment programs (POC 5);
       3. specialized care through a network of Operational Stress Injury clinics;
       4. peer support through the Operational Stress Injury Social Support network;
       5. VAC Assistance Service (VWA) - through Health Canada;
       6. Mental Health First Aid; and
       7. access to the Public Service Health Care Plan.

    Note: Access to these programs and services depend on an individual’s eligibility and needs.

Involving Family in a Treatment Plan or a Rehabilitation Plan

11. As per the Treatment for a Disability Entitled Condition policy, treatment benefits may be reimbursed when they are expected to produce a positive treatment outcome for the Veteran for the entitled condition, or when there is a reasonable expectation to alleviate symptoms and/or effects that are caused in whole or in part by the entitled condition. Family members may be involved in the Veteran’s treatment to the extent required to help the Veteran achieve a positive treatment outcome for the Veteran’s entitled condition.
12. As per the Rehabilitation Services and Vocational Assistance Plan – Assessment, Development and Implementation policy, family members may be involved in the Veteran’s rehabilitation to the extent required to help the Veteran achieve the rehabilitation goal(s) identified under the Veteran’s rehabilitation plan. The rehabilitation plan must include a rationale based on professional assessments for why the family member’s involvement is necessary to achieve an identified rehabilitation goal of the Veteran.
13. A Veteran’s family member may be included in mental health services for the Veteran, such as psycho-education and family or couples counseling or therapy when a treatment or rehabilitation plan has established that doing so is required to address issues of family functioning that may be affecting the Veteran’s ability to achieve a positive treatment outcome(s) or rehabilitation goal(s).
14. A family member can be involved in a Veteran’s treatment or rehabilitation but must not be the main recipient or focus of the treatment. VAC has no authority to pay for individual counseling or therapy for a Veteran’s family member in his or her own right.
15. Provincial and territorial health authorities have the responsibility for addressing the health issues of a Veteran’s family members. Family members may need treatment for their own mental health conditions. Although this treatment will not be covered by VAC, VAC can provide information about local/provincial resources. Families may also be directed to other resources that may be available to them, such as the VAC Assistance Service or the Public Service Health Care Plan to address their own mental health needs.
16. There is no definition of the term "family" in VAC legislation. In situations where a Veteran’s treating health professional recommends that a member of the Veteran’s "family" participate in joint mental health services, an individual may be considered, even if they do not fall into the categories of "spouse", "common-law partner", "dependent child", "mother" or "father".
17. VAC has no authority to reimburse Veterans for travel and other costs related to a family member’s participation in treatment that is funded under the VHCR. Veterans may be reimbursed for certain expenses, such as travel costs, related to a family member’s participation in a Veteran’s rehabilitation plan. For details, please refer to the Rehabilitation Related Expenses - Other Than Training policy.

Spouse, Common-law Partner, and Survivor Eligibility (VWA only)

18. A Veteran’s survivor, spouse or common-law partner (collectively “spouse”), entitled to vocational assistance and rehabilitation services under Part 2 of the VWA as part of a vocational assistance plan, may also be authorized for mental health services for a mental health problem that is a barrier to engaging in the vocational assistance plan. For more details, refer to the Rehabilitation Services and Vocational Assistance Plan – Assessment, Development and Implementation policy.
19. Family members may be involved in the spouse’s rehabilitation to the extent required to help the spouse achieve the rehabilitation goal(s) identified under their rehabilitation plan. The rehabilitation plan must include a rationale based on professional assessments for why the family member’s involvement is necessary to achieve an identified rehabilitation goal for the spouse.
20. As in the case of a family member of a Veteran eligible for rehabilitation services, VAC has no authority to pay for individual counseling or therapy for a spouse’s family member in his or her own right. They can only be involved in mental health services, such as, psycho-education or couples or family counseling with the eligible spouse.

References

Veterans Well-being Act, Part II, sections 6-17; and

Veterans Well-being Regulations, Part II, sections 6-16.

Veterans Health Care Regulations Part I, sections 3-5. and Part IV

Health Professionals

Treatment for a Disability Benefits Entitled Condition

Rehabilitation Services and Vocational Assistance Plan: Assessments, Development and Implementation

Rehabilitation Related Expenses – Other Than Training