National Defence Committee on Feb. 23rd, 2017

[Col Andrew Downes]

If I may just add to that, our road to mental readiness program does have a module for family members through which they receive similar education and language around the mental health care that we provide to the service member.

[Sherry Romanado, Liberal, Longueuil—Charles-LeMoyne, QC]

My colleagues actually touched on this.

My son lost two classmates at RMC last year. Do you have statistics in terms of when, during their service, members are more likely to decide to take their own life? We're seeing it at the beginning of their service when they're transitioning from civilian. We see it after combat, according to your details. Are we seeing it after they've been ill or diagnosed as ill and injured? When is it happening in the career? Is it happening in theatre? Is it happening all over the place? We're just not sure when it's happening in the career so that we can identify some potential stressors there or make adjustments and make sure the supports are there. Do you have that information?

[BGen Hugh MacKay]

What we've seen from our medical professional technical suicide reviews doesn't really reveal that it happens in any particular place in a career. We're seeing that it happens broadly across the career timelines.

[The Chair, Liberal, Stephen Fuhr]

I'll let us circle back on that, because we're out of time.

I'm going to have to yield the floor to Mr. Paul-Hus.

Go ahead, Mr. Paul-Hus.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you, Mr. Chair.

My thanks to the brigadier general and the colonel for their remarks.

I would like to go back to the primary causes of suicide. In your presentation, you mentioned various causes. You said that the main cause is a breakup with an intimate partner.

Having served during two operational deployments, I know that we sometimes wondered who would be the first to be left by their spouse. Between 50% and 60% of the members of the battalion went through breakups during the mission. During missions, the pressure is enormous because of those domestic partnership issues.

It is easy to think that the deployment produces combat-related post-traumatic stress, but can the pressure that comes from one's personal life also have a devastating effect on forces during deployment?

Can the family centres on military bases really provide effective assistance in preventing suicides with support to spouses, so as to prevent, or help to prevent, breakup situations?

[BGen Hugh MacKay]

One of the results of the reports we've put together has led to a project within the Canadian Armed Forces called the journey. In the journey, we're trying to look at how we can address all of these items that we see as potential triggers. We do believe that if we can engage with the partners early on, we can help them to address the issues that are creating the stress in that relationship, help them to either stay together and work together or to find a way to separate in a way that is not so stressful and might otherwise cause one to undertake such a thing as committing suicide.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

As Surgeon General of the Canadian Armed Forces, do you work with the family centres or are they completely independent entities? I am not talking about your chain of command. Do you have a direct involvement with family centres?

[BGen Hugh MacKay]

The military family resource centres are independent entities, but they report to my commander, Lieutenant-General Whitecross, commander of military personnel command, and they report to a colleague of mine, Commodore Sean Cantelon. We get together on a weekly basis. We talk about what's going on in the centres and we are able to collaborate and work together.

One of the perfect examples has been with the family violence prevention program. We have a very close relationship with them with respect to family violence.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you.

My second question goes to you, Mr. MacKay, as Surgeon General of the Canadian Armed Forces.

Knowing that there are drug use problems in the Canadian Forces—it's a management problem involving various cases—what is your opinion about legalizing marijuana?

How do you see that?

[BGen Hugh MacKay]

We have done some studies—not us in the medical side, but the chain of command—to look at the use of marijuana in the Canadian Armed Forces. It is being used as a recreational medication, but it's a small percentage of military members who are using marijuana recreationally.

If you're asking me for my opinion with respect to it as a medication, at the present time I do not believe that there is enough clinical evidence to support us using marijuana to treat most of the types of illnesses that we are addressing in our military population. We do not prescribe marijuana in treatment. We look for alternative treatment methodologies.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

In terms of potential legalization, which would allow members of the military to obtain marijuana, do you see that positively or do you believe that it is really not appropriate?

[BGen Hugh MacKay]

Once again, it's not a question for me. That's a question for the chief of the defence staff and the chain of command, because it really will be something that the chain of command is going to have to tackle. I think the use of any substance is something that you need to consider very carefully.

[Pierre Paul-Hus, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Thank you.

[The Chair, Liberal, Stephen Fuhr]

Mr. Fisher, you have the floor.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair, and thank you, gentlemen, for being here today with us to share your expertise.

I want to talk a little bit about mefloquine again. Ms. Gallant had some of the same questions I have.

You had talked about a decrease in use. Can you describe that decrease? Is that a minor decrease, or is it a massive decrease in use?

[BGen Hugh MacKay]

Yes, it's a very large decrease in use. In 2003, the medication called malarone became licensed. Starting in 2003, we started to see a decrease in mefloquine use. It had been sitting around 85% of prescriptions for anti-malarial medications, and it has decreased down to less than 5% today. Malarone use, which was maybe 5% or 10% at that time, has now increased to between 80% and 85% of the anti-malarial medication that we are prescribing.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you.

Do soldiers know what they're taking? You touched on it with a couple of other questions. If they're still on mefloquine or if they're on a new drug, are they told about some of the potential side effects very clearly? Has that always been the case or is that something new, since they've seen what mefloquine can do?

[BGen Hugh MacKay]

I'm sorry, but I don't remember the date when we actually formalized the process. However, for many years now, before a member is given an anti-malarial medication and if there are a large number going out, they may receive a briefing on each of the anti-malarial medications, informing them about the potential side effects and the potential contraindications to using those medications.

They fill in a questionnaire that would help the clinician to identify whether they may have contraindications to the use of mefloquine and then they have a discussion with the clinician regarding which is the best anti-malarial medication for them.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

You're doing a review on mefloquine right now, right? Are you finished it?

[BGen Hugh MacKay]

That's correct.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Will that report become public soon? Are you suggesting that it be banned?

[BGen Hugh MacKay]

I haven't made a formal policy recommendation yet. The report from the task force is under study right now. I anticipate that before the end of March I will be able to formulate a policy recommendation with respect to our anti-malarial use.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

The one that's being used by 85% now, is it called malarone?

[BGen Hugh MacKay]

Yes, that's correct.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Do you foresee any future side effects? Has that been tested more extensively than mefloquine was? Are there any early signs of side effects?

I'm sure there's probably no chance of having a drug that has no side effects at all that would also take care of malaria.