National Defence Committee on Feb. 23rd, 2017

[The Chair, Liberal, Stephen Fuhr]

That's the will of the committee.

You have about a minute left. If you can get a question and an answer in within one minute, I'd happy to give you the floor. Otherwise, I'd like to give the floor to Mr. Garrison. It's up to you.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

I'll give it to Mr. Bezan.

[The Chair, Liberal, Stephen Fuhr]

Okay. Go quickly, please.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Thank you, Mr. Chair. I'll be very quick.

We talked earlier about the stigma of mental health within the Canadian Armed Forces, and of course, there's the culture. If you're experiencing depression or anxiety, quite often you're called weak. Has the road to mental readiness suite of programs started to change that culture, especially with middle managers?

[BGen Hugh MacKay]

We believe that we are seeing the change in culture that's necessary. Part of the evidence to that is what we found in the recent survey with respect to the willingness of our members to come forward and ask for assistance. It wasn't just to the health system; it was to their bosses and supervisors. I think from 2002 to 2013 there has been a significant increase in the willingness of members to come forward and talk with family members, their bosses and supervisors, and the health system with respect to their issues with mental health. That's a very positive change.

[The Chair, Liberal, Stephen Fuhr]

Thank you.

Go ahead, Mr. Garrison.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thanks very much, Mr. Chair.

In your presentation you mentioned that the suicide rate had been largely unchanged, and then there was a spike or an increase in the rate—I won't call it a spike. Does that correspond with the ending of the mission in Afghanistan?

[BGen Hugh MacKay]

The start of the increase in the suicide rate in the Canadian army started in 2006. That's when we started to see it. Since the end of the mission, we've started to see it stabilize again.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

It has stabilized.

[BGen Hugh MacKay]

Yes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

It went up during the mission. I'm not trying to say it's a cause, but it's of particular interest to me since I was in Afghanistan working for an international agency at the time. I think other international agencies didn't recognize this problem. Again, I'll give credit to the Canadian military: other agencies also had suicides and didn't recognize it at all. There seems to be some connection between that operation and the increase.

[BGen Hugh MacKay]

If you look at our study as well, what hadn't been present before was a potential linkage between risk of suicide and deployment. Although it's still not statistically significant, it's close enough to statistical significance that we believe we need to take a look at it. I think that this deployment is now starting to show as a risk factor for suicide.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

That was going to be my question, then. Is there an investigation of that specific deployment? I know you said deployment is a factor, but is there an investigation of the circumstances of that specific deployment and a link to suicide?

[BGen Hugh MacKay]

We have not undertaken a specific investigation with respect to that. That certainly is the greatest deployment we had that is contributing to it.

Andrew, would you comment?

[Col Andrew Downes]

I was just going to add that it's not so much the deployment that counts; it's what happens. There are many people who went to Afghanistan and were not exposed to any significant psychological trauma, and there were some, obviously, who were. Even so, the majority of those who were did not sustain mental illness as a result.

Nonetheless, it's truly the exposure that counts, not the deployment per se.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

That maybe explains your reference to the adverse childhood experiences. In other words, you're looking for underlying things that wouldn't be shared by all those on the deployment that might be the underlying causes.

[BGen Hugh MacKay]

It would be things that may contribute to the risk of developing mental illness with subsequent traumas in life.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

If you can establish those kinds of correlations, might you be able to do better at predicting who would have problems and get more assistance to them earlier?

[Col Andrew Downes]

That's right, yes. Ideally, there would be a blood test or something that we could use to identify people at high risk, and then know exactly how we were going to manage that. Mental health conditions generally around the world are not that well understood to that level of sophistication.

In the future, we hope to get there. Perhaps things like machine learning are going to be able to help us identify some of these risk factors that we're not currently able to identify. I think the future is very bright in this area, but for now we still are very much limited by our knowledge and understanding of mental illness and suicide.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I have no more questions. Thank you very much.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Chair, could I share time with Mr. Kitchen? I have one question.

[The Chair, Liberal, Stephen Fuhr]

Who else would like to ask another question?

Go ahead, Mr. Bezan.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Yes, and I'll share with Mr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair. General and Colonel, it's nice to see you again.

I want to go back to your chart, in which you talk about suicides increasing and mefloquine dropping. That's a beautiful pictorial, but the reality is that you're making the assumption that if you take mefloquine, you're going to have suicide. That's a one on one.

When we're talking about mental illness and the potential of mefloquine being possibly toxic, the potential for long-term.... We actually see the increase, the spike of suicide later, and it might be a cause as we factor in all the other aspects, such as debt, family relationships, etc.

I don't see that same analogy that you might, where one going down and one going up is a reason to say it's not an issue. From a statistical point of view or a research point of view, you're sitting there saying that.... Is there not a potential that we should be looking at this and asking if there is a potential for that to happen, and can we rule it out?

[BGen Hugh MacKay]

As I said, it's a crude analysis. The difficulty is that the evidence to support the other side, to show that this is causing other long-term neuropsychiatric illnesses and suicide, is just not there for us to even be able to do an analysis about when you might expect to see an effect from the mefloquine. Therefore, to suggest that we need to wait for five years, 10 years, 20 years to see such an effect is not something that I can speculate on, because there is not good science to support that position to start with.