Veterans Affairs Committee on Nov. 15th, 2016

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Mr. Chair.

In reference to our previous conversation, I want to make note that you indicated that we can't rely on these studies and things unless they're significant. I think it's important to note that the one in the U.S. was done by the FDA, and a significant portion of the U.S. military participated. The other two were done by the British House of Commons and by the Australian Department of Veterans' Affairs. These would be very credible studies that I think would be important for Canada to take a look at in discussing mefloquine.

I have three very quick questions for very short answers.

In 1999, Brigadier-General Claude Auger, surgeon general and commander of the Canadian Forces Medical Group of the Department of National Defence, was asked some questions by the Standing Committee on Public Accounts. He was answering the question on what we have done since Somalia to better control distribution of unlicensed drugs, and he said, “We are also in the process of developing an adverse effect monitoring and reporting database”.

Are you aware of whether that database exists? Is that something this committee could have some feedback from or access to?

[BGen Hugh MacKay]

Since General Auger presented, we did create a medical regulatory affairs group within the Directorate of Health Services Operations. For unlicensed medications, they do track anybody who has been provided those unlicensed medications—this is since they've been put in place—and whether or not there were any reported adverse events as a result of the use of those medications.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

That would apply to mefloquine as well, then?

[BGen Hugh MacKay]

Mefloquine is not an unlicensed medication in Canada. It became licensed in 1993, I believe.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

This was after, so there was no going back and studying the effects of the unlicensed drug mefloquine?

[BGen Hugh MacKay]

To my knowledge, there was no study looking at the use of the unlicensed drug.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Okay. Can you tell me how many options are given to our soldiers when they go into an area where they need to use an antimalarial drug? How many options do they have as far as the drug they could choose is concerned?

[BGen Hugh MacKay]

In chloroquine-resistant areas, we would usually offer three medications. The first one is Malarone; the second one is doxycycline; and the third one is mefloquine.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Can you tell me, or could you find for us, the cost per soldier for each of those three?

[BGen Hugh MacKay]

We could find that for you. Malarone is our most-used medication at this point in time, and I believe it's the most expensive. For doxycycline, I'm sorry, I'll have to get you the data.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

That would be great. Thank you. I would appreciate that.

That's all I have.

[The Chair, Liberal, Neil Ellis]

You have one minute and 40 seconds.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Thank you, Mr. Chair.

Mr. Downes, you spoke about the incidence of mental health in the lesser ranks. Quite often within the military, pay and benefits are tied to rank, so you may find in fact that some of those in higher command positions may not necessarily come forward with issues of mental health because doing so could potentially impact their pay and benefits, or more importantly it could impact their potential for promotion. Are you suggesting that it's just in the lower ranks that we're seeing those issues of mental health? A lot of these commanders who are in positions of command were deployed at some point, perhaps in Afghanistan, and perhaps they're masking or not coming forward with any mental health issues because of that fear of a lack of promotion.

I'd like your comments on that, because it's something I picked up on when you said it earlier.

[Col Andrew Downes]

I think you've touched on a few important facts, including the fact that mental illness is more common in people of lower socio-economic status and lower levels of education. That is typically what we see in younger members of the Canadian Forces. Many of them are still studying at school. They're maybe not earning much income.

As people get promoted, they get more education, and they get more insight. They have more tools to develop for the stresses and strains of the job as well.

We have people of all ranks of the Canadian Forces, from privates to generals, coming forward for care in our clinics. Each one of them makes an individual decision to come forward, certainly, and we encourage them to do so because we know that the best option for continuing their career is to come forward for care early, because they have the best chance of recovery if they come forward early.

But another interesting point is that currently there is a rule in place such that people have to be medically fit to be promoted, and this rule is a barrier to care. People often, when they know they're potentially getting close to promotion, may decide to wait until afterward. This particular policy is one that is under review as well.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you.

One of the things we haven't discussed is addiction, and we know that it's quite often tied to suicide rates. What services are we offering for addiction?

[BGen Hugh MacKay]

Addiction or substance-use disorders are a concern of mine, certainly. One of the things we do see is that mental illness combined with substance-use disorder makes it very complicated to treat patients. We have in-house treatment available. We have addictions counsellors available and all of our mental-health providers can deal with addictions. But when we have really complicated, difficult cases, and sometimes when there's the co-morbidity of mental illness, we refer people out to civilian medical treatment facilities that can do in-patient care.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Do you feel that referring them to outside civilian services is optimal, or is it a reflection of resources?

[BGen Hugh MacKay]

I believe that when we refer them to those civilian in-patient facilities it's because there's a need for that kind of intense substance-use-disorder care. That is a valuable resource available to us to provide the care to our service members.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I just find it curious that we're referring people to outside civilian services given that we talk an awful lot about the value of camaraderie when we're talking about treatment. Again, is it ideal that we're referring outside? Are in-house services something we should be working towards? Are they something we had in the past and lost?

[BGen Hugh MacKay]

We did have in-house services in the past, and I think we closed them down in the nineties. It's important to remember that they go away for a period of time when they're in-patients to get that intense care, and then they come back to us. There's a next phase of care where they're at home and they're working with our health care providers. They have an opportunity to have that camaraderie but also to work on issues that may have arisen at home as a result of the substance-use issues. I think we have a very good mix of services to meet the needs of the members.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I appreciate that the success stories happen when they do come back. I guess I'm concerned with those who are, for lack of a better term, falling between the cracks, and who aren't successful. We're looking for ways to improve this and lower suicide rates. Can either one of you give us some insight on things that we can improve upon to try to broaden the net?

[Col Andrew Downes]

Specifically related to addictions, we have recently convened a working group to look at the addictions issues with an addictions treatment process within the Canadian Forces. We have just recently hired an addictions specialist to help give us some advice on all of this. We're aiming to personalize the care to match the needs of the individual with the services that we can offer them. There will always be a need for the intensive in-patient care in one of these private centres to which we can send people, but we do want to have access to intensive out-patient treatments closer to people's homes.

There are factors to keep in mind, including where people live. Is it reasonable for us to have our own intensive out-patient centre at a small base where we would not have the clientele to justify having such a program? Perhaps at a larger base.... We're looking at different options, but I would just like to reassure you that this is something we are actively looking at.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you very much.