Veterans Affairs Canada - Main issues

• Private Member's Motion M-225, Neil Ellis (Liberal, Bay of Quinte), was passed with all-party support in June 2019. It reads:
• the government should set a goal to prevent and end veteran homelessness in Canada by 2025;
• a plan to achieve this aim should be developed by the government and be presented to the House by June 2020, led by the Minister of Families, Children and Social Development and supported by the Minister of Veterans Affairs; and
• this plan should include consideration of whether a National Veterans Housing Benefit similar to the highly successful U.S. Housing and Urban Development – Veterans Administration Supportive Housing (HUD VASH) Program would fit the Canadian context, complementing the National Housing Strategy.

• ACVA Report on Veteran Homelessness
  • On May 1, 2019, the House of Commons Standing Committee on Veterans Affairs (ACVA) released a report entitled, Moving Towards Ending Homelessness Among Veterans. The report notes that Veterans Affairs Canada has begun to develop an approach to prevent and end veteran homelessness, but reported that stakeholders criticized the amount of time it is taking to launch the strategy, which has been under development for three years.

  Version 1; 2019-11-19
  Source: VAC QP Note on Homeless Veterans 2019-11-19

  Mefloquine

  • Veterans Affairs Hey Canada is committed to the health and well-being of Veterans, the Royal Canadian Mounted Police and their families.
  • Veterans are reminded that they may claim any condition related to taking mefloquine with supporting medical information from their treating physician.
  • A link between the medical condition and mefloquine must be present.
  • Veterans who believe they have a disability related to their military service are encouraged to contact Veterans Affairs Canada for assistance.
  • Every situation is unique and we work with Veterans on a case-bycase basis.

  Details

  Background – Mefloquine

  Q1) Since 2001, how many medical claims have been filed related to mefloquine?

  Q2) What have been the outcome of these claims? (Approved/Denied)

  • Any Veteran or member who believes they have a disability related to their military service is encouraged to contact Veterans Affairs Canada for assistance. It is important to note that Veterans Affairs Canada does not diagnose medical conditions. The Veteran's health care practitioner is responsible for providing a diagnosis. Veterans may apply for any condition they believe related to mefloquine with supporting medical information from their treating physician.
  • However, while a Veteran may claim any condition related to the ingestion of mefloquine with supporting medical information, Veterans Affairs Canada tracks medical claims by health condition and program, not by the cause of the claimed condition. That is to say, we track Disability Benefits, but we do not capture the specific cause of the mental or physical health condition associated with that Benefit. As this is the case, we are unable to provide the requested statistics.

  Q3) How many were awarded based on service in a Special Duty Area?

  • As mentioned above, Veterans Affairs Canada tracks medical claims by health condition and program, not by the cause of the claimed condition. As this is the case, we are unable to provide the requested statistics.

  General Background

  • Malaria is a potentially life-threatening parasitic disease that occurs in many tropical and sub-tropical areas of the world. It presents a risk to Canadian Armed Forces personnel who travel to endemic areas, whether for operational or leisure purposes. Prevention of malaria relies on multiple tactics, including avoiding mosquito bites, and using malaria medication (called malaria chemoprophylaxis) to eliminate parasites that are inoculated through mosquito bites.
  • Mefloquine is an approved anti-malarial drug that is structurally related to quinine and quinidine. It is indicated for the prevention of infection with the malarial parasites P. falciparum and P. vivax, including chloroquine –resistant strains of P. falciparum.
  • Veterans Affairs Canada thanks Health Canada for their Safety Review on Mefloquine and also the Surgeon General for his report released June 1, 2017.
  • The Surgeon General released his report on 1 June 2017 on the review of use of mefloquine in the Canadian Armed Forces.
  • The Surgeon General's review found that compared to currently recommended alternatives (doxycycline and Atovaquone-Proguanil), the body of evidence suggests mefloquine is not consistently associated with an excess overall risk of adverse effects, nor is it associated with an excess risk of not being able to perform occupational duties (low to very low quality evidence). In summary:
    • The Surgeon General concluded that mefloquine will now be considered a second-line treatment for the prevention of malaria among Canadian Armed Forces personnel because there are good alternatives available. It will only be recommended for use in people who cannot use other treatments for any reason (such as drug allergies), or for people who have used it in the past and experienced no side effects.
    • The Surgeon General stated that: Mefloquine is extremely effective at preventing malaria, and because it requires weekly doses instead of daily ones, is more effective in an operational theatre where there are fewer chances to miss a dose.
    • He also stated that while the side effects of mefloquine can vary, even the most minor ones – nausea and dizziness – can limit operational performance. More serious side effects such as anxiety, nervousness, and depression are rare, but can pose risks to a member's long-term health.
    • In spite of the potential side effects of mefloquine, they are less serious than complications from malaria. Canadian Armed Forces members will not be deployed into operational theatres where malaria is present, without sufficient protection to prevent malaria.
    • Although some cases have been reported, there is no conclusive evidence that mefloquine can cause long-lasting and permanent neurological and psychiatric adverse events;
    • some individuals were prescribed mefloquine even though they had contraindications against its use such as past or ongoing neurological or psychiatric conditions; and
    • there were a small number of reported cases of permanent damage to the vestibular system in the inner ear, which controls balance.

    Claims at Veterans Affairs Canada

    • Veterans or members who believe they have a disability related to their military service are encouraged to apply to Veterans Affairs Canada for assistance and can contact the department through our toll free line (1-866-522-2122), or our Web site.
    • A Veteran or member may claim any condition related to the ingestion of mefloquine with supporting medical information from their treating physician. Claims linked to mefloquine are adjudicated on a case-by-case basis by Veterans Affairs Canada's Medical Advisory unit. Veterans Affairs Canada's Medical Advisory Unit would then do the research required (to link the medical condition to mefloquine). Historically, the most common claims have been for psychiatric conditions.

    Version 1; 2019-11-12
    Source: VAC QP Note on Mefloquine 2019-11-12

    Mental Health

    • Veterans Affairs Canada is committed to ensuring eligible Veterans, retired Royal Canadian Mounted Police members and their families have access to the mental health support they need, when they need it.
    • Veterans Affairs Canada funds a network of 11 operational stress injury (OSI) clinics across the country and additional OSI Clinic satellite service sites closer to where Veterans live.
    • In addition, the department funds a national network of approximately 4,000 mental health professionals and a Veterans Affairs Canada Assistance Service which offers a 24-hour toll-free help line, face-to-face psychological counselling, bereavement support and referral services, to Veterans, former Royal Canadian Mounted Police members and their family members or caregivers experiencing mental health or personal difficulties.

    Details Operational Stress Injury Clinics

    • Veterans Affairs Canada funds a network of 11 operational stress injury clinics across the country (10 outpatient and 1 inpatient) as well as additional operational stress injury clinic satellite service sites closer to where Veterans live. More operational stress injury clinic satellite service sites will open across the country based on need.
    • Operational Stress Injury Clinics offer access (through referral) to an interdisciplinary team of mental health professionals who provide specialized assessment and treatment services to Veterans, Canadian Armed Forces and Royal Canadian Mounted Police members and understand their experience and unique needs.
    • Veterans Affairs Canada also funds a well-established national network of approximately 4,000 mental health professionals in the community who deliver mental health treatments to eligible Veterans across Canada

    Assistance Service

    • The Veterans Affairs Canada Assistance Service (1-800-268-7708) or TDD (1-800567-5803) offers a 24-hour toll-free help line, face-to-face psychological counselling, bereavement support and referral services, to Veterans, former RCMP members, family members, or caregivers experiencing mental health or personal difficulties. Also available as of September 1st, 2018 is LifeSpeak, a free online, anonymous and confidential, mental and physical health information and support resource for Veterans and their families.

    The Operational Stress Injury Social Support Service

    • The Operational Stress Injury Social Support Service offers confidential peer support to Canadian Armed Forces members, Veterans and their families impacted by an operational stress injury. The support is provided by trained peer support and family peer support coordinators, who typically have first-hand experience with these injuries.
    • A Canadian Veteran-specific version of Mental Health First Aid, launched in partnership with the Mental Health Commission of Canada, provides mental health literacy training to the Veterans community located across the country.
    • The Mood Disorder Society of Canada has received Government of Canada funding to provide skills development training and support services to assist unemployed Veterans with a mental health condition with the establishment of a new career.
    • Veterans Affairs Canada has collaborated with a number of partners to develop a series of free online and mobile applications for Veterans and their families including PTSD Coach Canada, the Operational Stress Injury Resource for Caregivers, Veterans and Mental Health tutorial and an Online Caregiver Training Program.
    • An updated version of PTSD Coach Canada mobile application has been made available in April 2019 on IOS and Androids app stores. It includes reliable information on PTSD and treatments that work, tools for screening and tracking one's symptoms, convenient, easy-to-use tools to help handle stress symptoms and information on crisis support.
    • On May 7, 2018, Veterans Affairs Canada announced a partnership with the Royal Ottawa Health Care Group for the establishment of a Centre of Excellence on Post Traumatic Stress Disorder and Related Mental Health Conditions. The Centre of Excellence will expand existing Canadian mental health clinical and research networks to increase creation and dissemination of new Canadian expertise on military and Veteran mental health, suicide prevention and substance-use disorder issues. The new Centre of Excellence opened in June 2019.
    • The Government is committing $147 million over the next six years in order to expand access, as of April 1, 2018, to the Veteran Family Program for families of medically released Veterans across all 32 Military Family Resource Centers, the Family Information Line and CAFconnection.ca.
    • Additionally, the Department of National Defence and Veterans Affairs Canada have developed a Joint Suicide Prevention Strategy. The Strategy was released on October 5th, 2017 and includes comprehensive Canadian Armed Forces and Veterans Affairs Canada Action Plans. The Veterans Affairs Canada Suicide Prevention Strategy Action Plan identifies 63 Action items.

    Version 1 : 2019-11-08
    Source : VAC QP Note on Mental Health, 2019-11-08

    Ste. Anne's Hospital

    • On April 1, 2016, the Ste. Anne's Hospital was the last of the former Veterans' hospitals to be transferred from federal to provincial jurisdiction.
    • It is now one of over 1,200 provincially and privately owned and operated facilities where Veterans Affairs Canada supports the long term care needs of Veterans.
    • Veterans Affairs Canada continues to work closely with the Government of Quebec, as we do with other provinces, health authorities, and facilities, to find solutions that ensure the health and well-being of Veterans.

    Details

    Ste. Anne's Hospital

    • Veterans Affairs Canada's priority is to preserve priority access to beds and the high quality of care for eligible war Veterans at Ste. Anne's Hospital in the official language of their choice. The Ste. Anne's Hospital transfer agreement is the official commitment to the negotiated positions agreed upon between both levels of government in the transfer of the hospital.
    • Veterans Affairs Canada supports Veterans in long term care at the Ste. Anne's Hospital in two ways. First, through its funding, the Department subsidizes the accommodation and meal costs of eligible Veterans such that the maximum amount any Veteran needs to contribute toward their monthly resident fees is $1058/month. Second, per diem funding is provided to support an enhanced level of services and specialized programs for War Veteran residents. Financial support is also provided for the operation of the Day Centre that offers social activities, exercise programs, and access to health care including foot care and occupational therapy.
    • Since April 2017, a Veterans Affairs Canada employee (VAC Liaison Officer) is onsite at Ste. Anne's Hospital. A working group with representatives from Veterans Affairs Canada, the Integrated Health and Social Services Centre, and the Quebec Ministry of Health and Social Services continue to work together to identify solutions to current issues.
    • Veterans Affairs Canada continues to pursue a provincial agreement to designate 10 beds for "preferred admission" of other Veterans.
    • On October 1, 2019, there were 119 Veteran residents at Ste. Anne's Hospital.

    Operational Stress Injury Clinics

    • The two Operational Stress Injury clinics located at Ste. Anne's Hospital - the Ste. Anne's Operational Stress Injury Clinic and the Residential Treatment Clinic for Operational Stress Injuries - now fall under provincial jurisdiction, as do the other Operational Stress Injury clinics across the country. The Department continues to provide the funding for the clinics and Veterans and their families continue to have access to the clinical services for which they are eligible.

    Version 1: 2019-11-07
    Source: VAC QP Note on Ste. Anne’s Hospital 2019-11-07

    Lapsed Funding

    • Our benefits are demand-driven; so no matter how many Veterans come forward, when eligible, they will receive their benefits. These are based on estimates and the process guarantees that whenever a Veteran comes forward—this year, next year, or beyond—they will receive benefits.
    • Our priority is to help Veterans. In fact, almost all (93%) of the department's budget goes to funding Veterans' programs and benefits. Last year alone, that amounted to $4.4 billion spent directly on benefits and services for Veterans, their families and other eligible recipients – a billion more than at the peak of funding by the previous government.
    • Since 2016, our government has invested $10.3 billion for Veterans.
    • It is no surprise that the number of Veterans coming forward with disability benefit applications has increased by a third (32%) over the past three years, since the previous government left office.
    • Whether ten Veterans, or 10,000 come forward, they will receive the benefits they need. To deal with that increase, we invested $42.8 million in Budget 2018 to eliminate the backlog of applications over 16 weeks.
    • To keep up with the rise in demand and ensure that Veterans get services and benefits when they need them, we invested $42.8 million in Budget 2018 to increase service delivery capacity.
    • Changing how the government accounts for lapsed money for Veterans programs does not preclude investment in Veterans since those resources are always there for us to draw on.

    Details

    Lapsed Funding

    • On 5 November 2018, the following motion by MP Gord Johns (Courtenay – Alberni) was discussed for Opposition Day:

    Veterans Affairs Canada Supported This Motion And The Rationale Was As Follows

    • The Government already does this. Money returned to the consolidated revenue fund (lapsed) for quasi-statutory programming is accessible the next year to fund Veterans programming based on demand. This is how "quasi-statutory" program authority works. Veteran programs/services are funded based on need regardless of when the Veterans come forward to receive the benefit.
    • This motion alone would have minimal impact on back logged applications as the department typically has not lapsed more than the currently authorized maximum operating budget carry forward amount. This is funding used to deliver Veteran programs/services. However, if the department were to lapse more than the maximum allowable carry forward, this motion would support retaining all lapsed funding.
    • We do not need to change how the government does budgetary accounting to invest more money in Veterans and invest in decreasing the wait time for applications to be seen.
    • Our priority as a department and a government is to help Veterans access the supports and services they need. We do this through the delivery of programs such as disability benefits, education, training and financial benefits. In fact, 93 per cent of the department's budget goes to funding these programs and benefits. Last year alone, that amounted to $4.4 billion spent directly on Veterans and their families – a billion more than at the peak of funding by the previous government.
    • Since 2016, our government has invested $10-billion in new resources improving benefits for Veterans and their families and introducing new programs to help return to the life the men and women of the Canadian Armed Forces want to live after their military career is over.
    • It is no surprise that the number of Veterans coming forward with disability benefit applications has increased by 32 per cent over the past three years, since the previous government left office. Whether ten Veterans, or 10,000 come forward, they will receive the benefits they need. To keep up with the rise in demand and ensure that Veterans get services and benefits when they need them, we invested 42.8 million in Budget 2018 to increase service delivery capacity. Changing how the government accounts for lapsed money for Veterans programs does not preclude investment in Veterans since those resources are always there for us to draw on.

    Background Information on Lapsed Funding

    • Veterans Affairs Canada manages two main budgets – the first budget represents over 93% of the department's entire funding and is what is required annually for Programs and Benefits for Veterans, their families and other clients. The other, much smaller budget, is provided to run the operations of the department, itself.
    • Regarding the Operating Budget, Veterans Affairs Canada is able to carry forward up to 5% of unused funds annually into the next fiscal year. In the past several years, the department did not lapse more than its maximum allowable carry forward.
    • Regarding the much larger budget – the funding for Programs and Benefits, each year Veterans Affairs Canada estimates how many Veterans will come forward and receive program benefits, and how much funding will be required to meet that forecasted demand. This budget is very different from the Operating Budget, in that it is based entirely on demand for authorized programs and benefits, hence is "quasi-statutory" in nature.
    • If fewer Veterans than forecasted use Veterans Affairs Canada's programs, or if there is less uptake of benefits in a certain fiscal year, then the unused funding is returned to the fiscal framework, but never at the expense of an eligible Veteran.
    • At the beginning of the next annual budget cycle, the process repeats itself - a new Program and Benefit budget is provided based on another evaluation of forecasted demand.
    • Veterans Affairs builds its annual budgets so that the Department can fully respond to demand from Veterans for benefits and services. The Department's forecasting models ensure there is sufficient funding for all eligible Veterans who are likely to need help.
    • Veterans Affairs' planned spending each year is established through the Main Estimates and Supplementary Estimates.

    Version 1; 2019-10-07
    Source: VAC QP Note on Lapsed Funding 2019-10-07

    Accounting Error From 2003 Owing Money To Upwards Of 270,000 Veterans

    • Our Government is committed to supporting Canada's Veterans and their families, and values the significant contributions that Veterans have made protecting Canadians.
    • When the government learned about this error, we took action and corrected the calculation.
    • After a detailed review of all records between 2003-2010, we found that upwards of 270,000 Veterans, survivors, RCMP members and Veterans still required compensation for this adjustment. In some cases the payments will need to be made to estates.
    • The Department has secured a source of funds of up to $165 million for retroactive payments.
    • Most individuals will receive a few hundred dollars, while the maximum amount to be paid would be several thousand dollars.
    • The Department has begun issuing payments to living Veterans, however more complex cases will take longer to process and pay. Individuals representing estates will be able to apply for corrective payments beginning in 2020.
    • We are committed to ensuring that Veterans receive the respect, support, care, and economic opportunities they deserve.

    Class-Action Lawsuit

    • With respect to the class-action lawsuit filed against the Government, the matter is before the courts, and it would be inappropriate for me to comment further.

    Details – Veterans Affairs Canada accounting error from 2003 owing money to upwards of 270,000 veterans - compensation for corrective adjustments to Annual Disability Pension calculations between 2003 and 2010

    • Under the Pension Act, Veterans Affairs Canada's Disability Pension program provides a monthly tax-free payment to eligible War Service Veterans, or their survivors, and the Department also administers Disability Pensions on behalf of the Royal Canadian Mounted Police.
    • Section 75 of the Pension Act prescribes two methods of calculating the annual escalation adjustment: using either the Consumer Price Index or the Annual Wage Calculation, with the method applied being the one that provides a greater benefit to the Veteran/survivor.
    • In the early 2000's, the Government of Canada introduced a change to the personal tax exemptions under the Income Tax Act. Unfortunately, this change was not incorporated in Veterans Affairs Canada's annual adjustment calculations until January 2011 and on a go forward basis only.
    • Approximately 270,000 Veterans, survivors and members of the RCMP who received Veterans Affairs Canada's Disability Pension payments from 2003 to 2010 are impacted and will receive a retroactive payment. The estimated value of the error is approximately $165 million.

    Class Action Lawsuits

    • With respect to the five class-action lawsuits filed against the Government, the matter is before the courts.

    Veterans Affairs Canada's Action

    • The Government agrees and has committed to provide corrective payments to impacted individuals.
    • It is expected that approximately 90% of payments to living eligible Veterans and RCMP will be made automatically using existing systems. The remaining cases may require more manual intervention due to their complexity.
    • Estates of deceased Veterans will have the opportunity to apply for a retroactive payment. This application process is required because the Department does not maintain contact information for estates.
    • Payments to estates are more complex and will require more time to process.

    Additional Benefits Impacted

    • During the implementation of retroactive adjustments for Disability Pension, it was identified that three additional program benefits were impacted:
      • Treatment Allowance
      • Health Related Travel Escort Fees
      • Children of Deceased Veterans Education Assistance
      • Treatment Allowance is not escalated directly; it is a manual calculation performed by staff in field offices based on the pension rate.
      • Overall, 3,200 VAC clients were impacted a total value of $99K.
      • There were also 380 RCMP clients impacted at a total value of $2K.
      • Most impacted clients are entitled to corrective adjustments of less than $25.
      • This benefit is not directly escalated; it is an automated calculation based on rates prescribed in the regulations.
      • Overall, 7,178 VAC clients were impacted at a total value of $60K.
      • Most impacted clients are entitled to corrective adjustments of less than $10, with 50% of impacted clients entitled to less than $2.
      • Both the monthly allowance and costs of education/instruction are to be annually escalated in accordance with the Consumer Price Index.
      • This resulted in an overpayment of $431K and impacted 450 clients.
      • Given the view that the overpayment is the result of administrative error, the Department is perusing the option to remit any historical overpayments.

      Version 1; 2019-11-28
      Source: VAC QP Note on Accounting Error, 2019-11-28

      Service Dogs

      • The Government recognized that there was great interest in using service dogs to assist Veterans with mental health conditions.
      • As research in this area was limited, Veterans Affairs Canada funded a small pilot study in 2018 to evaluate the safety and effectiveness of using service dogs to assist Veterans with PostTraumatic Stress Disorder. The study was completed in 2018 with limited results.
      • In 2019, Wounded Warriors Canada received funding for a project through the Veteran and Family Well-Being Fund to expand its Post Traumatic Stress Disorder (PTSD) Service Dog Program and ensure that PTSD Service Dogs meet or exceed the published standards available in Canada.
      • Veterans Affairs Canada continues to monitor additional studies related to service dogs currently being conducted by our allies. As a result of a Budget 2018 initiative, individuals who rely on a specially trained service animal to assist in coping with their mental health condition may qualify for Canada Revenue Agency's Medical Expense Tax Credit effective January 2018.

      If questioned on Canadian Human Rights Complaint

      • As the issue you raise is part of an active complaint before the Canadian Human Rights Commission, it would be inappropriate for me to comment at this time.

      Details

      2018 Expansion of The Medical Expense Tax Credit for Psychiatric Service Dogs

      • Through Budget 2018, the Government expanded the Medical Expense Tax Credit to recognize costs for these animals for the 2018 and future tax years. This measure directly benefits Veterans and others in the disability community who rely on mental health service dogs.

      Standards

      • Veterans Affairs Canada previously had a contract with the Canadian General Standards Board to establish a set of national standards to provide assurance that the service dogs being provided to Veterans are properly trained and meet standardized behavior requirements. On April 17, 2018, the Canadian General Standards Board notified members of the technical committee that it had withdrawn its intent to produce a National Standard of Canada for Service Dogs, as there was no consensus among the committee members that the standard could be achieved. As a result, the initiative to develop a national standard was discontinued.

      Pilot Study

      • As research in this area was limited, Veterans Affairs Canada funded a pilot study to evaluate the effectiveness of service dogs for Veterans with Post-Traumatic Stress Disorder. While 31 Veterans were recruited, only 18 Veteran participants completed the pilot study over the course of an 18-month period.
      • The pilot study is complete and the final report was received on July 31, 2018. Results of the study revealed that Veterans with Post-Traumatic Stress Disorder who had a service dog for 12 months:
        • had slightly increased their physical activity and reported fewer nightmares and improved sleep quality;
        • had a reduction in Post-Traumatic Stress Disorder symptoms and a moderate, long-lasting reduction in depressive symptoms;
        • reported significant increases in the quality of life domains, in venturing into their communities and feeling more comfortable in public places;
        • had no reduced medication use or reliance on a family member/other caregiver.

        Human Rights Complaint

        • A Veteran has filed a human rights complaint with the Canadian Human Rights Commission alleging that VAC is discriminating against the Veteran by denying him an allowance for the care and upkeep of a service dog. This Veteran claims that VAC fails to recognize the requirement of a service dog for PTSD the same way that it recognizes the requirement of a guide dog for vision loss. Veterans Affairs Canada agreed to meet for mediation.

        Version 1: 2019-12-05
        Source: VAC QP Note on Service Dogs 2019-12-05

        Mental Health Support for Family Members – Garnier Case

        • Our hearts go out to the family of Constable Campbell.
        • The focus of providing mental health support to a family member is always based on the best interest and the well-being of the Veteran.
        • Ensuring the health and well-being of a Veteran remains our top priority.
        • For privacy reasons, I cannot comment on the specifics of any case. [Garnier]
        • Requests for mental health services for family members are being reviewed by Veterans Affairs Canada* before making a decision in extenuating circumstances. [when a family member is incarcerated.]
        • In no instance will Veterans Affairs Canada treatment benefits be provided to a Veteran's family member who is incarcerated in a federal facility. These facilities are responsible for the treatment of persons in their care.

        (*an Area Director or above)

        Details

        Background – Mental Health Support for Family Members – Garnier Case:

        • On October 23, 2018, a media story on Global News describes a meeting on this same day between the parents (Susan Campbell and her husband, Dwight) of deceased Constable Catherine Campbell and Conservative Leader Andrew Scheer, MPs and Veterans, as part of an effort to get the Veterans benefits going to Mrs.Campbell's daughter's murderer revoked.
        • Christopher Garnier was sentenced for the murder of Const. Catherine Campbell in Halifax in 2015. Mr. Garnier appealed both the conviction decision and the sentencing decision rendered in 2018. The Nova Scotia Court of Appeal heard his case on December 3, 2019, and reserved judgment. Case in Media Specific Background
        • Veterans Affairs Canada has extended its mental health services to include family members; however, it is always done in the best interest and well-being of the Veteran.
        • Care is provided to family members and spouses when Veterans Affairs Canada knows it is to the benefit of the well-being of the Veteran.
        • In situations where there are unusual circumstances, decisions are made on a case by case basis.
        • Achieving a positive outcome can be compromised if the Veteran is treated in isolation without addressing the effects that the mental health condition has on the family, or the effects that the family dynamic has on the patient's own mental health condition.

        General Background

        • When a man or woman serves in the Canadian armed forces or the Royal Canadian Mounted Police, their whole family serves with them. Veterans Affairs Canada acknowledges that a Veteran may only be able to restore his or her ability to function with the support of their family. In all cases, VAC approved services are intended to address the Veteran's mental health condition. A Veteran's family may be included in mental health services when doing so is required to achieve positive outcomes for the Veteran as established in the Veteran's rehabilitation plan.
        • Family members may have mental health needs that are unrelated to the mental health problem for which the Veteran client is receiving rehabilitation services or treatment. These needs will not be covered by Veterans Affairs Canada; however information about local/provincial resources is provided to them.
        • Other ways Veterans Affairs Canada can provide support and care for family members:
          • Veterans Affairs Canada Assistance Service, a 24/7 toll free number that any veteran or family member can call to speak with a mental health professional, who will work to match them up with a counsellor in the local community. In such a case, the decision to provide services is made by the mental health professional.
          • The Department funds a network of 11 Operational Stress Injury clinics which provide mental health support and services to Veterans and their families when the Veteran has an operational stress injury. If it looks like treating family member(s) would help progress the treatment of the Veteran, a decision would then be made to do so. Services are based on current best practices and are customized to meet the individual's needs. The team also works closely with health care providers or organizations in the community to help ensure follow-up is available when needed. Family members may also receive or participate in some of the services provided through the clinic. A total of 238 family members received treatment/mental health support.

          Direction of Former Minister (S. O'Regan) of Veterans Affairs

          • Ensure the services received by a family member of a Veteran are related to the Veteran's service and where they are not, that the case be reviewed by a senior official.
          • That Veterans Affairs Canada address its policy in relation to providing treatment to family members under extenuating circumstances, such as conviction of a serious crime.
          • The former Minister of Veterans Affairs, Seamus O'Regan, stated on September 25, 2018: "Treatment benefits are not to be provided to a Veteran's family member who is incarcerated in a federal facility. . Those facilities would be responsible for the treatment of persons in their institutions."
          • Since then, Mr. O'Regan reinforced the point that where services are provided by another jurisdiction, Veterans Affairs Canada will not duplicate those services and Mr. O'Regan defended the prerogative to provide Veterans with the mental health care they need, and when and where they need it.

          Review of Mental Health Policy

          • The Department is reviewing its Mental Health Policy, and is working with the Department of Justice to determine the extent to which family members can participate in a Veteran's rehabilitation and treatment plan.

          Version 2: 2019-12-08
          Source: VAC QP Note on Mental Health Support for Family Members – Garnier Case 2019-12-08

          Lionel Desmond Inquiry

          • Our hearts go out to the families involved in this tragedy.
          • The Government of Canada is committed to supporting the Desmond Fatality Inquiry by providing the Inquiry with relevant information within its jurisdiction about Lionel Desmond and his family.
          • As details of the Inquiry unfold, the Government of Canada will respond to requests for information within its jurisdiction and in accordance with the Privacy Act.
          • Information has been shared with the Inquiry, but at this time we cannot provide further comment in order to respect the integrity of the Inquiry process.

          Details – Background – Lionel Desmond Inquiry

          Nova Scotia Inquiry into the deaths of Lionel Desmond and his family

          • On January 3, 2017, the bodies of Lionel Desmond, a veteran of the war in Afghanistan, his wife Shanna, their 10-year old daughter Aaliyah, and Mr. Desmond's mother Brenda, were found in a home in Upper Big Tracadie, Guysborough County. It is believed that Mr. Desmond took the lives of his family members, before he took his own life.
          • On 28 December 2017, the Nova Scotia Chief Medical Examiner recommended to the Nova Scotia Minister of Justice that an inquiry be held into the deaths of Lionel Desmond and his family under the Nova Scotia Fatality Investigations Act.
          • On 24 May 2018, the Order establishing the Inquiry and setting out the Terms of Reference was released. The Attorney General of Canada was granted standing to participate. Hearings are expected to begin on January 27, 2020 in Guysborough, Nova Scotia, before Provincial Court Judge Warren Zimmer.

          Version 1: 2019-11-21
          Source: VAC QP Note on Lionel Desmond Inquiry 2019-11-21

          Suicide Prevention – Canada/Department of National Defence) Suicide Prevention Strategy

          • Our Government is committed to suicide prevention.
          • That is why, on October 5, 2017, our government proudly released a Joint Suicide Prevention Strategy that is holistic and is based on the latest scientific evidence in the area of suicide prevention.
          • The new strategy builds on the strong foundation of Government of Canada programs, services and supports currently available to those who serve or who have served.
          • It provides the way forward to continue to improve assistance to Veterans and their families, including during the transition from military to civilian life.

          Details

          • Ongoing for Veterans Affairs: Work with National Defence to develop a Joint Suicide Prevention Strategy for Canadian Armed Forces personnel and Veterans.
          • On October 5, 2017, the Minister of National Defence, the former Minister of Veterans Affairs and Chief of the Defence Staff announced a Joint Suicide Prevention Strategy that seeks to understand, address and mitigate risks of suicide across the entire military and Veteran community.
          • The Strategy represents a new, holistic, pan-Canadian Armed Forces and Veterans Affairs Canada approach to suicide prevention. The approach combines efforts in education, communications, support initiatives, mental health and health care. While it might be impossible to prevent every suicide, meaningful action can be taken to reduce risk factors and augment protective factors in the area of Veteran suicides.
          • To this end, the Joint Suicide Prevention Strategy identifies seven Lines of Effort and more than 158 action items between the two departments, including a jointly managed Seamless Transition Task Force to ensure a coordinated approach during the transition from military to civilian life.
          • The Strategy is aligned with the Federal Framework for Suicide Prevention, builds on the recent Canadian Armed Forces Expert Panel Report on Suicide Prevention, and draws from the latest research on this topic.
          • Finally, the Strategy addresses the different domains of well-being (social, financial, vocational, health and housing). This approach is important given that the 2017 Report of Suicide Mortality in the Canadian Armed Forces (1995 to 2016) reports that 85% of Regular Force males who died by suicide had at least one work or family-life stressor. These stressors included failing relationships, a friend or family member's suicide or death, a family member's or personal illness, debt, professional or legal problems.
          • Meanwhile, the recently released 2017 Veteran Suicide Mortality Study, which reports on suicides in Canadian Veterans over a 37-year period (1976 to 2012), reveals that male Veterans had an overall 1.4 times higher risk of dying by suicide compared to males in the Canadian general population, with the youngest males being at highest risk. Female Veterans had an overall 1.8 times higher risk of dying by suicide compared to females in the Canadian general population. More analysis of this data is underway. Meanwhile, Veteran Affairs Canada's Suicide Prevention Strategy Action Plan has been adjusted to ensure that attention is placed on addressing the problem of suicide in female Veterans, and further action to address the new information from this study will follow.
          • The department is highly committed to doing all that can be done to prevent suicides of Canadian Veterans who have sacrificed so much to serve their country.
          • The Veterans Affairs Canada Suicide Prevention Strategy Action Plan identifies 63 Action items, 17 of which have been fully completed.

          Version 1: 2019-11-0
          Source: VAC QP Note on Suicide Prevention, 2019-11-07

          Indigenous Veterans

          • Our Government is committed to supporting and recognizing our Indigenous Veterans.
          • Our commitment is demonstrated through involvement with the established permanent bilateral mechanisms with First Nations, Inuit and Métis leaders to identify joint priorities, co-develop policy and monitor progress.
          • Making sure that Indigenous Veterans are getting the services they need is a priority as we continue on our path of reconciliation.
          • On February 8, 2019, the Standing Committee on Veterans Affairs tabled its report, "Indigenous Veterans: From Memories of Injustice to Lasting Recognition" which presented 12 recommendations.
          • Our Government's response agreed with the spirit and intent of the Report's 12 recommendations and we continue to advance work toward better recognition of Indigenous Veterans while ensuring they get the services they need.
          • We are firmly committed to increasing awareness of our programs and services among Indigenous Veterans and to recognizing their military achievements.
          • The contribution and sacrifice of all Indigenous Veterans will not be forgotten.

          Details

          • Canada's Indigenous Peoples - First Nations, Métis and Inuit - have a proud tradition of military service. While exact numbers are difficult to determine, the rate of Indigenous participation in Canada's military has been significant. It is estimated that as many as 12,000 Indigenous people from Canada served in the two world wars, with at least 500 of them sadly losing their lives.
          • On December 15, 2016, the Prime Minister announced the establishment of permanent bilateral mechanisms (PBM) with the Assembly of First Nations, the Inuit Tapiriit Kanatami and the four Inuit Nunangat Regions, and the Métis National Council in order to establish joint priorities and monitor progress.
          • Recently on September 10, 2019, federal Minister of Veterans Affairs, Ministe MacAulay issued a statement to recognize the pre-and post Second World War experiences of Metis Veterans.
          • "We regret that our country has taken three-quarters of a century to address the concerns of Métis Veterans who joined Canada's call to arms to enter the Second World War. They left this country not knowing the enemy they would face, nor the countries and people they were to defend. They were, nonetheless, instrumental in Canada's action to protect basic rights and freedoms around the globe."
          • "Addressing these longstanding concerns is a significant step forward in the process of reconciliation with the Métis people. When the Government of Canada and the Métis Nation signed the Canada-Métis Nation Accord in April 2017, we agreed that Métis Veterans were a priority area that needed to be addressed."
          • "To this end, I am pleased that the Government of Canada has allocated $30 million to recognize Métis Veterans of the Second World War for their pre- and post-war experiences and to support commemorative initiatives that promote awareness and appreciation of Métis Veterans' sacrifices and contributions among the Métis People as well as the general Canadian public."

          Honouring Service

          • Commemoration of Indigenous Veterans is achieved through various components of Veterans Affairs Canada's Canada Remembers Program, including memorials, Heroes Remember, the Canadian Virtual War Memorial and learning opportunities. The Canada Remembers Program promotes remembrance of Canada's Indigenous Veterans' achievements and sacrifices and seeks appropriate opportunities to create awareness of their military contributions.
          • The Books of Remembrance, which are kept on Parliament Hill, commemorate the lives of more than 118,000 Canadians including Indigenous servicemen and women who, since Confederation, have made the ultimate sacrifice while serving our country in uniform. Other ways in which Veterans Affairs Canada recognizes the contributions and sacrifices of Indigenous Veterans include an Indigenous Veterans web feature, which highlights their impressive contributions to Canadian military efforts over the years, historical fact sheets and booklets, and articles in Veterans Affairs Canada's Veterans' Week learning material.
          • Interviews with Indigenous Veterans can be found on Veterans Affairs Canada's Heroes Remember web feature, which offers a unique opportunity for Canadians of all ages to experience history through the eyes of those who lived it. Veterans Affairs Canada's social media channels also include entries that touch on Indigenous Veterans' military accomplishments. In addition, the Department periodically organizes commemorative events in Canada and overseas to mark significant military anniversaries. Indigenous Veterans have been part of these special tributes. For example, Indigenous Veterans have been part of the official Government of Canada delegations that traveled overseas for the 100th anniversaries of the Battle of Passchendaele and the Battle of Vimy Ridge, as well as the 75th anniversary of the Dieppe Raid and, most recently, the 75th anniversary of D-Day and the Battle of Normandy.
          • In Canada, Indigenous Veterans participate in commemorative ceremonies held throughout the year, and Indigenous youth also participate to demonstrate their commitment to carry the torch of remembrance for future generations.
          • Through its funding programs, the Department has supported many commemorative projects and memorials dedicated to our Indigenous Veterans and fallen heroes.
          • Indigenous peoples from every region of Canada have a strong tradition of service, and their courage and contributions are a source of pride to their families, communities and all Canadians.

          Serving Indigenous Veterans

          • The Government of Canada is committed to meeting the needs of Indigenous Veterans, regardless of where they live. Veterans Affairs Canada remains committed to offering high quality services to all Veterans regardless of where they live in Canada, including those living in remote and northern communities. Through its ongoing Case Management service offering, Veterans Affairs Canada service teams provide services to all parts of Canada including rural and remote communities. Veterans living in those communities or on reserve can also receive in person home visits on an as needed basis.
          • Veterans and their families can contact the Veterans Affairs Canada call centre as well as the 24 hour assistance service line. Information on all of Veterans Affairs Canada's programs and services is available on Veterans Affairs Canada's website through which Veterans can access the Benefits Navigator. Veterans who prefer interacting online can use My Veterans Affairs Canada Account to send front-line staff secure messages or to apply for benefits and track the processing of their applications.
          • When visiting communities, Veterans Affairs Canada service teams work with community partners, service providers, the Canadian Armed Forces (including Canadian Rangers) and Service Canada to raise awareness of Veterans Affairs Canada's programs and benefits while ensuring they are delivered in a culturallyappropriate manner.

          Eleventh Report of the Standing Committee on Veterans Affairs entitled: Indigenous Veterans: From Memories of Injustice to Lasting Recognition"

          • On February 8, 2019, the Standing Committee on Veterans Affairs tabled its report, "Indigenous Veterans: From Memories of Injustice to Lasting Recognition". A formal Government Response was required within 120 days. The Government response was tabled in Parliament on May 30, 2019.
          • The Report presents 12 recommendations. The majority of the recommendations (7 of 12) are directed solely at Veterans Affairs Canada with 5 implicating other Government Departments (Canadian Armed Forces/Department of National Defence; Service Canada; Territorial governments; United States Department of Veterans Affairs, and Indigenous Services Canada).
          • In its report, several topics were explored: 1) support offered to Indigenous Veterans during the transition process, 2) services offered to Indigenous Veterans by Veterans Affairs Canada (VAC) and partners, 3) response to the specific needs of Indigenous Veterans living in remote areas, 4) the treatment of Indigenous Veterans who served in the First World War, the Second World War and the Korean War, 5) support for Veterans who served with the Canadian Rangers, 6) engagement of Indigenous Veterans organizations and 7) commemoration.
          • In its response, the Government agreed with the spirit and intent of all recommendations and is now working to understand and better address the needs of Indigenous Veterans.

          Version 1; 2019-11-28
          Source: VAC QP Note on Indigenous Veterans, 2019-11-28

          Long Term Care

          • We place the highest priority on making sure Veterans have the support they need, when they need it - and that includes access to long-term care.
          • We support Veterans and their long term care needs in over 1,200 provincially and privately owned and operated facilities across the country.
          • Veterans Affairs Canada works closely with provinces, health authorities and facilities to find solutions that ensure the well-being of Veterans.
          • Our Government is and continues to be committed to supporting Canada's Veterans and their families and to ensuring that Veterans receive the respect, support, and care they deserve.

          Details

          • The support that Veterans Affairs provides for Veterans who need long-term care is governed by the Veterans Health Care Regulations. Veteran eligibility for long-term care support, as well as the type of long-term care setting, depends on the type and location of military service, income, health care need, and whether the need for longterm care is related to a disability from military service.
          • Support is provided in provincially licensed, regulated or operated health care facilities, most of which provide care to other provincial residents as well as Veterans, including:
            • facilities such as nursing homes and other long-term care facilities with beds that are open to Veterans as well as other provincial residents (community beds); and
            • facilities with beds designated through contractual arrangements with the province, health authority and/or facility for priority access for Second World War and Korean War Veterans (contract beds).
            • 2,989 are in community beds, in 1,226 facilities; and
            • 1,532 are in contract beds, in 91 facilities.

            Version 1: 2019-10-07
            Source: VAC QP Note on Long Term Care, 2019-10-07