What we examined (see Focus of the audit)

Our audit objective was to determine whether Veterans Affairs Canada has facilitated timely access to services and benefits for veterans with mental illness. We examined the management of access to mental health services for veterans. While our audit primarily examined Veterans Affairs Canada, we also looked at two other areas:

• joint initiatives and the transfer of military records with the Department of National Defence/Canadian Armed Forces, and
• information on reviews and appeals by the Veterans Review and Appeal Board.

What we found

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 (see paragraph 3.19)

• Access to mental health support under the Rehabilitation Program is timely (see paragraphs 3.20-3.24)

• Eligibility decisions under the Disability Benefits Program are not timely (see paragraphs 3.25-3.29)

• There are longstanding barriers to timely access to disability benefits (see paragraphs 3.30-3.43)

  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 (see paragraphs 3.51-3.58)

  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 (see paragraphs 3.61-3.67)

  Recommendation. Veterans Affairs Canada should assess and report on the effectiveness of its Mental Health Strategy and develop performance measures for its strategy and outreach activities for veterans with mental health conditions.

Response

The audited entities agree with our recommendations, and have responded (see List of Recommendations).

Why we did this audit

As of March 31, 2014, about 15,000 War Service Veterans, Canadian Armed Forces Veterans, and still-serving personnel were eligible to receive mental health support from Veterans Affairs Canada through the Disability Benefits Program. An additional 1,000 veterans in the Department’s Rehabilitation Program self-identified as having a mental health condition.

According to Veterans Affairs Canada, veterans with mental health conditions represent an increasing proportion of its clients, up from less than 2 percent in 2002 to almost 12 percent in 2014. The number of veterans with identified mental health conditions is expected to continue to increase as those with service in Afghanistan return to civilian life, and as awareness and recognition of mental health conditions increase. In the 2012–13 fiscal year, the Department estimated its total mental health expenditures at $508 million for military veterans.

Details of the audit

Report of the	Auditor General of Canada
Type of product	Performance audit
Topics	Health National Defence
Audited entities	Department of National Defence Veteran Affairs Canada Veterans Review and Appeal Board
Completion date	31 August 2014
Tabling date	25 November 2014
Related audits	Chapter 4—Transition of Ill and Injured Military Personnel to Civilian Life, 2012 Fall Report of the Auditor General of Canada

For more information

Ghislain Desjardins
Manager, Media Relations
Tel.: 613 952 0213, extension 6292
E-mail: infomedia@oag-bvg.gc.ca

Twitter: OAG_BVG