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Auditor General of Canada Fall 2014 "Mental Health Services for Veterans"

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In a nutshell, from the Auditor General's video about the programming:
In our audit of mental health services for veterans, we found that Veterans Affairs Canada has put in place important mental health supports.

However, in many cases, the Department is not doing enough to facilitate veterans’ timely access to mental health services and benefits.

Veterans Affairs Canada needs to do more to overcome the barriers that slow veterans’ access to services and benefits. These barriers are a complex application process, delays in obtaining medical and service records from National Defence and the Canadian Armed Forces, and long wait times for getting access to qualified health care professionals in government-funded operational stress injury clinics.

This means that, from the time they first contact Veterans Affairs Canada, about 20 percent of veterans have to wait more than 8 months before the Department gives them a green light to access specialized mental health services.

We also looked at what Veterans Affairs Canada is doing to increase awareness among various stakeholder groups of the supports it makes available to veterans.

We found that the Department delivers a variety of outreach activities that target its existing clients and soldiers being released from military service. However, it could do more to reach other groups who can encourage veterans to seek help, including in particular family doctors and families of veterans.

Highlights:
....Facilitating access to mental health services

Overall, we found that Veterans Affairs is not adequately facilitating timely access to mental health services. Veterans Affairs Canada has put in place important health supports for veterans, and the Department is providing timely access to the Rehabilitation Program. However, access to the Disability Benefits Program—the program through which most veterans access mental health services—is slow, and the application process is complex. We found that Veterans Affairs Canada has not analyzed the time it takes, from a veteran’s perspective, to receive a Disability Benefits eligibility decision. This finding is important because Veterans Affairs Canada has a legislative responsibility to facilitate access to the specialized care required by veterans with mental health conditions.

Veterans Affairs Canada has put in place important mental health supports

Access to mental health support under the Rehabilitation Program is timely

Eligibility decisions under the Disability Benefits Program are not timely

There are longstanding barriers to timely access to disability benefits

Recommendation (note: this recommendation applies to findings presented in paragraphs 3.25 to 3.43). Veterans Affairs Canada should analyze the Disability Benefits application process, quantify and document barriers to timeliness, and take corrective action. In particular, Veterans Affairs Canada should help those veterans who may require additional assistance with the application process.

Recommendation. National Defence and the Canadian Armed Forces should take further steps to accelerate the transfer of service and medical records to Veterans Affairs Canada.

Recommendation. Veterans Affairs Canada should work with the operational stress injury clinics to implement solutions to provide timely access for psychological and psychiatric assessments.

Recommendation. National Defence and the Canadian Armed Forces should work with the Operational and Trauma Stress Support Centres to implement solutions to provide timely access for psychological and psychiatric assessments.

Veterans Affairs Canada does not analyze appeal and review decisions to identify systemic problems in its application process (see paragraphs 3.44-3.47)

Recommendation. Veterans Affairs Canada should work with the Veterans Review and Appeal Board to identify whether reasons for successful reviews and appeals indicate a need to modify the application process.

Providing mental health outreach
Overall, we found that Veterans Affairs Canada’s mental health outreach strategy is not comprehensive enough. The strategy focuses on existing veteran clients and military members who are about to be released. We noted more could be done to reach family doctors and families of veterans.

Veterans Affairs Canada outreach activities are not comprehensive enough

Recommendation. Veterans Affairs Canada should update its outreach strategy to include family physicians. The Department should also carry out an outreach strategy that meets the needs of all target audiences.

Managing the Mental Health Strategy
Overall, we found that while Veterans Affairs Canada has developed a mental health strategy, it does not collect information or report on its effectiveness of it. This finding is important because the information would help Veterans Affairs Canada focus its resources to achieve its strategic objectives, determine whether it is achieving these objectives, and adjust its strategy as required to ensure that veterans receive the mental health services they need.

The Department has developed a Mental Health Strategy, but has not assessed and reported on how well this strategy is working ....

Full list of recommendations + VAC's responses here, full report here.
 
One reporter put it this way:
Veterans deserve more than government spin
Michael Den Tandt, Postmedia News
Edmonton Journal
26 Nov 2014

The Conservative party has made patriotism and support for the military central to its brand. That makes its ramshackle, shoddy and unacceptable treatment of Canadian veterans, revealed in auditor general Michael Ferguson's fall report, all the more egregious. It is simply not good enough. And the customary official excuses and genuflections and blathering, in ample evidence Tuesday, only add insult to injury.

It is not good enough to declare, as Defence Minister Rob Nicholson did while fending off questions that should rightly have been fielded by Veterans Affairs Minister Julian Fantino, that Ferguson found slivers of light amid the darkness. To hear Nicholson tell it, both in an early afternoon news conference and in question period, veterans are getting most of the help they need, though improvements are of course always welcome. That's not true. Ferguson's report says so.

"Overall, we found that Veterans Affairs Canada is not adequately facilitating timely access to mental health services," the audit's preamble states. "Canada has put in place important health supports for veterans, and the Department is providing timely access to the Rehabilitation Program. However, access to the Disability Benefits Program - the program through which most veterans access mental health services, is slow, and the application process is complex. We found that Veterans Affairs Canada has not analyzed the time it takes, from a veteran's perspective, to receive a Disability Benefits eligibility decision."

Elsewhere, the audit states: "Delays in obtaining assessments, whether through Veterans Affairs Canada or National Defence clinics, contribute to delays in the veteran's application for disability benefits. These delays may jeopardize a veteran's stabilization and/or recovery." Now, connect the dots. The Defence Department's own data show that more Canadian soldiers have now died of suicide than were killed in

combat in Afghanistan. The government has had those statistics for months. Yet it was just Sunday - with this audit pending - that the government announced $200 million in new funding for mental health in the military.

Why did it take an auditor general's report to prompt this action? One does not require analytical genius to link untreated operational stress injuries, which run the gamut from hyper-awareness to fullblown post-traumatic stress disorder, with the suicide rate. Where was the ministerial fist pounding on the ministerial table one or two or three years ago demanding that no stone be left unturned in speeding access to mental health services for veterans?

And where was Prime Minister Stephen Harper? A week ago, Canadian Press reporter Murray Brewster reported that $1.13 billion in unspent money has been returned by Veterans Affairs to the federal Treasury since 2006. Consider that: When the Afghan war was at its height, even as veterans' groups sounded the alarm about their plight, the full budget allocated for them was not spent.

There are two elements emerging from this audit: The first is the incompetence and lack of care revealed. The second is the communications bungle, which may be the politically more damaging. For where was the veterans affairs minister when this emerged? Off in Europe, attending a commemoration of the Italian campaign in the Second World War.

This is not to denigrate, in any way, the importance of that conflict in Canadian military history; indeed the Italian campaign is the first modern instance in which Canadian soldiers faced urban combat conditions similar to those they would later encounter in Kandahar.

But history, important though it is, should absolutely not have trumped the problems facing Canadian veterans today. The responsible minister needed to be in Ottawa, front and centre. This post-audit ritual, whereby relevant ministers stand up and take their public caning and pledge fealty to the AG's recommendations, already has lost much currency. Nicholson, who is not among the cabinet's strongest performers, was like a deer in the headlights. The news conference was more of a mauling than a QA. Perhaps strangest of all, the Harper government does not seem capable any longer of seeing an issue through the eyes of the average, reasonable, fair-minded citizen. For obvious reasons, veterans are respected and admired by Canadians generally, whereas politicians are not. In a contest of public trust between the two groups, consequently, veterans will always win.

Even if only for the sheer political optics, there needed to be contrition expressed Tuesday; a sense that, based on the simple findings of the audit - the wait times of eight months or more before many veterans become eligible to seek treatment for chronic mental health injuries sustained in the service of this country - the government has failed them, and is sorry for having done so.

But contrition and humility were nowhere to be found. The spin was all selective and misleading quotations, deflection, dodging, hedging and excuses. Here we are, supposedly, on an election footing: Yet this could scarcely have been botched more thoroughly.

It's a far cry indeed from the calculating, annoying but efficient Conservative message manipulation of yesteryear. It does not bode well for the government as it gears up for a campaign.
 
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