Veterans Affairs Committee on May 4th, 2023

[The Vice-Chair, Conservative, Blake Richards]

Good evening. Welcome to meeting number 50 of the Standing Committee on Veterans Affairs.

This evening, we are resuming our study on the experience of women veterans.

We have a number of witnesses, but before we welcome them, I have a reminder.

During this study we have occasionally heard testimony that has been difficult for some to hear and that may have brought back memories for others, and so it can be difficult on our mental health. I just want to remind everyone that this committee does have resources in place for anyone who needs them. If testimony brings something to light that you need to address, please see our clerk to avail yourself of those resources if needed.

With that, we will turn to our witnesses. We have a number of witnesses here with us this evening, some in person and others who are online with us tonight.

Here in person, from the Atlas Institute, we have MaryAnn Notarianni and Dr. Sara Rodrigues. We also have with us tonight, as an individual, Dr. Mary Beth MacLean, who is a consulting research associate, and then from the Department of Veterans Affairs we have Dr. Cyd Courchesne, chief medical officer, and Trudie MacKinnon, who's the acting director general, centralized operations division.

We will get right into hearing from our witnesses. Each individual or organization will have five minutes for opening remarks, and then of course we will turn to our questions from members for the remainder of the meeting.

We'll start with Dr. Mary Beth MacLean.

Dr. MacLean, the floor is yours for the next five minutes to make your opening remarks.

[Dr. Mary Beth MacLean, Consulting Research Associate, As an Individual]

Thank you very much for the opportunity to speak with you today about this important topic.

I appeared before this committee on January 30, and then I spoke about the veteran population and their employment experience in general. Most of my talk was on studies related to life after service. These are surveys with an income-record linkage, which are conducted every three years by Statistics Canada.

Today I'll be using that same data to talk about the employment experience particularly of female veterans.

Female veterans in Canada have been found to experience relatively large reductions in post-release income, and much of this is due to a decline in their employment earnings. That is as a result, in part, of their lower labour force participation and higher rates of part-time work compared to male veterans. In the year after release, 39% of women reported that their main activity was working, compared to 59% of men.

Women are more likely to attend school, be providing care to others and report being on disability as their main activities. This explains a lot of their lower rates of labour force participation.

Females are also twice as likely as male veterans to work part time post release. The largest employer for both female and male veterans is the public service. However, women are more likely to work in health care, while men are more likely to work in construction and manufacturing.

As I mentioned earlier, women veterans earn less than men. This is true across industries, except for mining and agriculture. Though occupation may also play a role in women's lower earnings, we do not know what occupations veterans are working in post release.

Paradoxically, although female veterans are more likely to be in a comparable civilian occupation, such as administrative work, at release than their male veteran counterparts, they are less likely to agree that the knowledge and skills used in their civilian jobs are the same as those used during their military service. However, in terms of satisfaction with employment, women and men have been found to be similar.

What does all this mean? For women, work disability is more of an issue than for men. Fortunately, there are evidence-based approaches to the prevention of work disability, such as work accommodations, case management and multidisciplinary health care. However, this necessitates that case managers, both at VAC and CAF, work closely with employers. From what I understand, that is not often the case.

Women who have caregiving responsibilities also require accommodations. It appears that many women veterans may be taking part-time work, or not working at all, to allow time to care for others. This puts them in a more precarious situation in terms of low income.

Qualitative research could help us understand the unique barriers to the labour market that women experience. We also need more quantitative research that includes larger samples of female veterans. Current data limits our detection of similarities and differences between male and female veterans, since female veterans make up only around 13% of the population. It's hard to see what differences there are between them, given those small numbers.

Also, on the record linkage of tax data to survey data—which currently exists.... The record linkages between those two datasets have not been done. This could help us to understand the lower labour force participation rates among women, and their lower earnings as well.

That concludes my preamble. I welcome your questions.

[The Vice-Chair, Conservative, Blake Richards]

You must have practised that one a few times. You almost hit five minutes on the head just about perfectly, so you were well prepared. Thank you very much for that and for some very useful information.

We will turn next to the witnesses who are here with us in person from the Atlas Institute for Veterans and Families. I'm not sure which of you will deliver the opening remarks.

I will just note that many of us in this committee were at the Sam Sharpe breakfast on the Hill this week. I had the pleasure of sitting at a table for breakfast with some members of your institute, including your CEO. I'm very interested in hearing your contributions today, based on some of the conversations I had that morning.

We will turn it to you. I'm not sure which of you is making the opening remarks, but whichever of you would like to...is it Ms. Notarianni?

[MaryAnn Notarianni, Deputy Chief Executive Officer and Executive Vice President, Knowledge Mobilization, Atlas Institute for Veterans and Families]

I will be kicking things off, and then I will turn to Sara. We're splitting our time.

[Blake Richards, Conservative, Banff—Airdrie, AB]

We will start with you then. Between the two of you, however you would like to use it, you have the next five minutes.

[MaryAnn Notarianni]

Hello, everyone, and thank you for the opportunity to speak here today.

As our name suggests, at the Atlas Institute we work with military and RCMP veterans and their families, along with service providers and researchers, to identify and close research gaps and mobilize evidence widely to improve mental health care and supports for those who have given so much to Canada.

Key to our approach has been how we engage with veterans and families and those who work with them. We continuously strive to ensure that the voices of lived experience are embedded in our work.

On our staff, we currently have two strategic advisers for veterans and two strategic advisers for families. We're adding a new position soon of a strategic adviser for women veterans, to ensure a clear lens on women veterans' issues through all we do.

We have four community-based reference groups composed of veterans, veteran families, service providers and researchers, respectively, from across Canada. We have endeavoured to have a makeup that ensures diversity, including gender diversity, as well as service, family structures and geography, among others. Their influence is key to how we operate organizationally. We invite input from these groups to influence our strategic planning and work planning processes.

We also bring lived experience to the fore through our board, our many project advisory committees and our cadre of lived experience volunteers, which is a 33-member group and growing. It's representative of different veteran and family perspectives from across Canada. Of them, currently, about one-third are CAF women veterans.

We also apply an IDEA lens to our work—that's inclusivity, diversity, equity and accessibility. We recognize the importance of bringing together people with different voices, experiences, expertise and identities, including gender identities, to better understand, respond to and serve veteran and family mental health needs, including those of women veterans.

The topic of women veterans is of significant interest to our stakeholders, and we at the Atlas Institute recognize that this warrants special attention. One in six veterans is a woman. There are 75,000 women veterans in Canada. Despite the number of women who serve, the system supporting both the CAF and the RCMP was initially designed for men.

We know there are issues that have impacted the experience of women and that continue to impact their life after service as well. For example, women veterans face different mental health issues from men veterans. Research has shown that women CAF veterans are more likely to report a difficult transition out of the military than men CAF veterans.

There is clearly a significant need for immediate action in multiple areas, such as care, research and access. There's a need, through research and advocacy, to better understand women veterans' mental health needs and experiences with service systems, so that tangible change in both policy and legislation, if needed, can be made, and so that women veterans' well-being can improve. As such, we commend this committee for this intensive study, which prioritizes understanding the unique needs of women veterans.

I will turn this over now to my colleague, Dr. Sara Rodrigues, Atlas's director of applied research, to speak to some of the work we have undertaken to understand the needs of women veterans, and to some of the exciting work we're set to embark on as we make this an organizational priority.

[Dr. Sara Rodrigues, Director, Applied Research, Atlas Institute for Veterans and Families]

Thank you for the invitation to speak to you today.

Over the past few weeks, the committee has heard about critical gaps in data collection and research on women veterans' health across many areas. Researchers at the Atlas Institute have observed this as well through a recent research gap analysis that we conducted, which also prompted a need for us to identify specific areas for further investigation. Accordingly, we are prioritizing research on women veterans’ well-being and engaging women veterans in the process.

To identify a relevant topic for study, we hosted a consultation series with a group of women veterans between September 2022 and January 2023. The objective was to understand their perspective on what areas are important to study. We know that for research to be relevant to and resonate with women veterans, it needs to be guided by their insights.

Twelve women veterans from across Canada shared their experiences, prudent recommendations and timely ideas. We synthesized their input into a study topic and held a follow-up meeting with some of them to verify and validate that topic.

Through this engagement, we determined that our new study will explore how women’s experiences in service might relate to mental health outcomes as a woman veteran, something that has been emphasized in these meetings. Informed by the principles of community-based research, our study—the Athena project—will involve women veterans in all aspects and stages.

At present, we are forming a working group of CAF and RCMP veterans who will collaborate with us on the design and execution of this study. The call for members received 78 responses, including 10 from women veterans of the RCMP. This extraordinary response underscores the significance of this topic and the eagerness of women veterans to help shape and contribute to research.

In addition to our engagement with women veterans, we asked our research counterparts in government and academia for help in developing the consultation series. We value collaboration and information sharing across organizations and departments, and we are fortunate to have relationships with researchers and leaders at VAC and OVO and in academic institutions.

As the Atlas Institute is committed to publicly sharing information about our research, the details of this new study, including the approach we are taking, are already available on our website. We ensure that our research findings are accessible to veterans and their families by publishing our work in open access journals and prioritizing knowledge mobilization through the co-development of resources and by hosting events about new findings.

While it's still in the early stages, it is our hope that our study will contribute new evidence to improve mental health outcomes for women veterans and identify opportunities to enhance post-service quality of life. Because it will inquire about women’s experiences during service, the findings may be able to inform upstream approaches.

Women veterans of the CAF and RCMP deserve mental health care and support that is responsive to their sex- and gender-specific needs. To get there, decision-makers and service providers need accessible, current and relevant research, which the Atlas Institute is striving to provide.

Thank you for your time. We look forward to your questions.

[The Vice-Chair, Conservative, Blake Richards]

Thank you very much. I appreciate those remarks as well.

For our final opening comments, we'll turn to our witnesses from the Department of Veterans Affairs.

I'm not sure who is going to begin, but I'll turn it over to you, and you can jump in as needed.

[Dr. Cyd Courchesne, Chief Medical Officer, Department of Veterans Affairs]

Good evening. Thank you, Mr. Chair and committee members, for inviting us to appear before you today.

I am Dr. Cyd Courchesne, the chief medical officer and director general of health professionals for Veterans Affairs Canada. I'm also a 30-year veteran of the Canadian Armed Forces, having served from 1984 to 2014 and retired at the rank of Captain (Navy). I'm joined today by my colleague Trudie MacKinnon, director general of centralized operations, also a veteran, who served six years with the reserves.

As both veterans and leaders at Veterans Affairs Canada, we are pleased to appear today for this study on the experience of women veterans.

My career started in Cold Lake, Alberta, providing care to service members and their families. I looked after fighter pilots and ground crew—both male and female—and delivered their babies. I can tell you that it was the most exciting and rewarding posting of my career and is probably the reason I stayed in the forces for 30 years.

I worked in flight safety. I worked as wing surgeon in Trenton and at the Canadian Forces Environmental Medicine Establishment in Toronto. I served as the Royal Canadian Air Force surgeon and eventually as a senior leader with the CF health services headquarters. I deployed to Djibouti, Africa on a mission with the UN High Commission for Refugees. I accompanied many fighter squadrons on exercises to the Arctic and the U.S. and participated in the domestic Operation Assistance during the Manitoba floods of 1997.

After eight years at Veterans Affairs Canada, or VAC, I can say that the department is committed to ensuring that women veterans have access to supports, programs and services that meet their unique needs.

According to the 2021 census, nearly one in six veterans is a woman. We know that women veterans have distinct experiences in the military and have unique needs after their service. Female veterans are more likely to experience challenges in all seven domains of well-being, including difficulties in transitioning to civilian life, different reproductive and sexual health challenges and needs, barriers to accessing services, and reluctance to identify as a veteran.

The Office of Women and LGBTQ2 Veterans was created in July 2019 to work horizontally within the department, and with partners and veteran stakeholder groups, to help identify systemic barriers impacting women veterans and contributing to inequitable outcomes.

The office is also the departmental functional lead for GBA+. We now have a GBA+ strategy that identifies key actions and a GBA+ policy that sets clear roles and responsibilities within the department.

We have also strengthened our data collection, leveraging national survey data and qualitative storytelling of lived experiences like military sexual trauma, the LGBT purge, women's health issues and so on.

Following the first Women Veterans Forum in 2019, the minister committed to regular conversations with women veterans, resulting in a virtual series in 2020 and the recent 2SLGBTQI+ Women and Veterans Forum, held in February 2023.

Veterans Affairs Canada is committed to taking action and developing a departmental action plan to achieve equity and inclusion goals for women veterans and other under-represented or marginalized groups, to create a culture of equity and inclusion with measurable goals and outcomes.

The minister created six advisory groups on families, policy, mental health, service excellence and transition, care and support, and commemoration. These groups are made up of stakeholders, and 40% of those are women.

That's not to mention the establishment of the Atlas Institute for Veterans and Families, which is doing a lot of excellent work in this field. We've already heard from them. I will let them speak to their successes and their work, as they mentioned in their opening remarks.

In addition to enhanced awareness and understanding of the specific needs of subpopulations, targeted engagement with women and 2SLGBTQI+ veterans, and concerted efforts to integrate the use of disaggregated data, we've made advancements in the following areas: a veteran identifier in the 2021 census, in addition to a gender identity marker; a VAC women veterans research plan; the veteran family well-being fund, with targeted funding to support women and other marginalized groups; the implementation of sex and gender equity research principles in VAC-sponsored research; fairness in disability benefit adjudication, with a dedicated unit focused on women veterans' claims; improvements to the table of disabilities and the entitlement eligibility guidelines; and inclusive commemorative activities and products.

Also, in partnership with the sexual misconduct support resource centre, we're developing a military sexual trauma peer support program, and more recently—

[The Vice-Chair, Conservative, Blake Richards]

Dr. Courchesne, I'm sorry to interrupt you.

We are a fair bit over time. I don't mind if you just need 30 seconds or so to wrap up. That would be great.

[Dr. Cyd Courchesne]

Yes.

I just want to finish on this. Recently, we launched a community health needs assessment to better understand population health needs across diverse subpopulations like women veterans.

Thank you very much for your time. We'll be happy to take your questions.

[The Vice-Chair, Conservative, Blake Richards]

It looks like I just needed to give you a few more seconds of patience. My apologies. It's sometimes hard to know when someone's arriving to a conclusion.

I appreciate your remarks. We, as a committee, certainly appreciate them.

Thank you to both of you for your service to our country during your time in the forces and for continuing to serve your fellow veterans in Veterans Affairs. It's great to see two members of Veterans Affairs who are veterans themselves here with us tonight. It's something we hope to see even more of in the future. Thank you for being here with us.

We'll now turn to our questioning rounds.

With our first round of questions, there are six minutes allotted to each of the four recognized political parties in the House of Commons.

The first round goes to the Conservative Party. Mr. Fraser Tolmie will have the next six minutes for questions.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

Thank you, Chair, and thank you to our guests this evening.

To those who have served, thank you very much for your service, and thank you for joining us by Zoom.

A lot of information has been shared with us today. I apologize—I know we'll have quite a few questions for you.

I'd like to start off with Ms. MacLean.

One of the questions I have for you is.... Last year, you co-authored an article published in the Frontiers in Public Health journal, entitled “Lessons Learned From Presumptive Condition Lists in Veteran Compensation Systems”. In this article, you discuss presumptive condition lists used by the U.S., the U.K., New Zealand and Australia in their departments of veterans affairs. What has stood out for us is that all these countries have presumptive condition lists, yet Veterans Affairs Canada does not.

Can you speak to your findings on this, and elaborate a bit for this committee?

[Dr. Mary Beth MacLean]

I suppose I could, though I haven't looked at that paper for a little while. Also, I was the second author on that paper.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

Make it your own.

[Dr. Mary Beth MacLean]

Dr. Amy Hall is the first author on that paper. If you want to know more.... I prepared myself to speak on the women veteran employment area, not the area of presumptive rulings. I can get back to the committee on that paper if you like.

I think the presumptive rulings, overall, are not the panacea. They're very difficult to implement....

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

Okay. Here's what I'll do. I'll switch bait, and make it a bit easier for you. How's that?

If you prepared in equity, I have a few questions concerning that as well. Why don't we go down that pathway?

You talked about equity after the military and the challenges facing women once they've been released from the military. You talked about part time work and how women will become caregivers.

Who are they becoming caregivers for? Is there a link here? Is that something we should be looking at?

[Dr. Mary Beth MacLean]

It's probably, given their age.... It's not asked. It's just caregiving in general. We don't know exactly what caregiving they're doing, but given their average age at release, it's likely to be children. It could be parents as well, but it's much more likely to be children. They may potentially be releasing to start to have children.

As I said, what I'm speaking to mostly is from quantitative data. Actually, it's exclusively quantitative data, but I also suggested we needed more qualitative data from female veterans.

There was a study done following veterans pre and post release. It was 80 veterans, and women were overrepresented in that study. However, they didn't specifically look much at employment, although it was one area. They didn't look at barriers to participation in employment.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

Okay. Thank you.

One of the numbers you threw out—not threw out. I apologize. That sounds derogatory. One of the numbers you used, and it was difficult to get in your research, was that 13% of the population is female veterans releasing from the military. Is that from the military?

Earlier on, Atlas talked about the Athena project and using 10 RCMP veterans. Do your numbers include that?

[Dr. Mary Beth MacLean]

Those are regular force veterans.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

Have you included female veterans from the RCMP? Have any of your studies or research done any of that?

[Dr. Mary Beth MacLean]

No. Veterans Affairs is not responsible for doing that research. The research I did was as an employee of Veterans Affairs. It would be the Solicitor General who would do that type of research.

[Fraser Tolmie, Conservative, Moose Jaw—Lake Centre—Lanigan, SK]

As a quick summary, do you see a difference in equity between officers and NCMs who have released?

[The Vice-Chair, Conservative, Blake Richards]

We have only a few seconds, but you can give a brief answer.

[Dr. Mary Beth MacLean]

Yes, rank makes a huge difference. In terms of satisfaction with employment and employment rates, it is much higher among officers than among non-commissioned members.