Veterans Affairs Committee on Nov. 15th, 2016

[Col Andrew Downes]

I'll answer that one: Absolutely.

What's important to understand about suicide is that the suicide rate changes over time and varies according to people's age. When you compare people of the same age, which is the analysis that we've done, that's where we get this observation that the rate is higher in the army than in age-matched males in the civilian sector.

Within the air force and the navy, the rate is slightly lower than in the civilian sector, but it's not a statistically significant difference. It is numerically a little lower.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Do the American numbers sound shocking at 13 per 100,000 versus 30 per 100,000?

[Col Andrew Downes]

Just remember that the 13 per 100,000 I think includes even children. I'm not sure what age it starts at, but as people move into middle age, that's when the suicide rate is actually the highest. That captures our serving population.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

I think I'm getting what you're saying. If you're talking about people from 20 to 70, it would be a higher number obviously. I see.

What about the deployments themselves? I'm hearing that around 2006 we were seeing numbers that were disturbing. You can relate back to the Afghan deployment. You also began tracking in 1995, which would put you in the Bosnian, former Yugoslavia, deployment. In the Afghan one, has there been an evaluation of the operation and of how those stresses may have been manifested in extreme mental health incidents and suicide?

[Col Andrew Downes]

I'll go ahead first. We investigate each individual suicide to better understand what factors are at play, and we find that the majority of people do have mental illness or some mental distress. That is overlaid with what we call an acute trigger, so a stressor like a relationship issue, for example. We know that a mission like Afghanistan, in which there was a lot of psychological trauma, did end up causing a lot of mental illness. We think the mental illness that occurred during the operation is one of the factors behind the increase in rates in army personnel. It was primarily the army personnel who were exposed most to the combat-related stressors.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

It's interesting to me, because in Kandahar our involvement was in the provincial reconstruction unit. We had people from Hamilton there, and I met a lot of these young veterans when they came back, and so on. It's certainly a lot different from a World War II battle, if you will. I wonder if the military needs to really investigate how troops are used, how they're deployed, and how they interact with the people around them, because something happened differently in these deployments than I think in what we traditionally saw in the past. Is it fair to say that there could be more to discover in this?

[The Chair, Liberal, Neil Ellis]

Could we have a very short answer, please?

[Col Andrew Downes]

I would say that every mission has its risks. I think when we look at wars like World War I and World War II, there were significant mental illnesses that came from that. I think the Canadian Forces has looked at ways to interact as effectively as possible with the local population, but bearing in mind that there are still going to be circumstances in which soldiers are exposed to psychological trauma.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall.

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

Thank you very much. I'm pleased to have both of you here.

Brigadier-General, I wasn't here last week so I've just been reading your notes from last week's statements.

I just want to quote:

As you are likely aware, mefloquine remains an option for malaria prevention for many militaries around the world. We do, however, remain vigilant and open to assessing any new evidence related to mefloquine and other antimalarial medications.

Then you go on to say:

We will, accordingly, update our approach to malaria prevention in a scientifically sound manner and with an emphasis on critical appraisal of the evidence.

I did some research, and of course, this would be in relation to our allies. That would be where we would go to see what else was being done with those other militaries around the world.

I have a statement here from September 15 of this year from the Minister of Veterans Affairs for Australia addressing mefloquine concerns:

The Department of Veterans' Affairs has established a dedicated mefloquine support team for our serving and ex-serving community.... [and] additional support for current and former...members who have been administered mefloquine. The Government will: establish a formal community consultation mechanism to provide an open dialogue on issues concerning mefloquine between the Defence Links Committee and serving and ex-serving...; develop a more comprehensive online resource that will provide information on anti-malarial medications; establish a dedicated...mefloquine support team to assist...with...related claims, which will provide a specialised point of contact...and direct the inter-departmental [c]ommittee to examine the issues raised, consider existing relevant medical evidence and provide advice.... Any former member who was administered Mefloquine...and is concerned about possible side effects...can lodge a claim for a condition that they think was caused by Mefloquine.... Current and former...personnel can also access free mental health treatment....

They go on to list all the different areas of mental health that need treatment, and they indicate that those services are there.

In Britain also—this is from July 2016—the former head of the army has admitted that he would not take a controversial antimalarial drug as he revealed his son had suffered severe depression while prescribed Lariam. Lord Dannatt said that the side effects of the drug could be “pretty catastrophic” and he apologized to troops who had taken it while he was chief of the general staff.

He urged the Minister of Defence to show generosity when reaching compensation settlements with hundreds of personnel alleged to have suffered mental health problems after being given the drug during deployment to malaria hot spots.

He says here:

We see no reason to disbelieve the very strong anecdotal evidence that such conditions have been ignored in dispensing it to large numbers of troops about to be deployed.... It is our firm conclusion that there is neither the need nor any justification for continuing to issue this medication to Service personnel except when the three conditions listed above have been met.

The conditions were as a last resort when they weren't able to tolerate the other alternatives.

Then of course, the U.S. has had witnesses here. Dr. Nevin has said it's been blackboxed in the States.

With this type of evidence from our strong allies, would it not be time for Canada, especially with the new definitions that Health Canada has come out with on side effects, to see that this is a mental health issue that we could deal with right now? These are people who think they have PTSD because that's what they were told, when it's clearly possible they have a brain injury. Is it not time for us to set up the same type of services for them whereby we can get this information from our veterans directly?

[BGen Hugh MacKay]

Mefloquine has been used in tens of millions of people over several decades. World experts and bodies like the World Health Organization, the Centers for Disease Control in the United States of America, the Committee to Advise on Tropical Medicine and Travel continue to look at all the evidence that is available with respect to mefloquine and recommend it as a first-line medication to prevent malaria.

Our conclusion from the statements, the assessment of what our allies have done, is that we should continue to offer mefloquine as an antimalaria medication, particularly to those who have used it in the past and were satisfied with the medication.

It's important to make sure that we consider all the available evidence and not rely on small bits of information, small groups of scientists who have opinions and theories, or jump to conclusions that might remove what has been recommended by the world experts as a useful antimalaria medication.

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

While these other options have side effects, but not to the same degree as it would appear mefloquine has, why would we not make that choice to use what is less dangerous to our soldiers? It would appear that other countries have come to the conclusion to give them that other option. Why is it that in Canada this is still seen as a priority rather than a last resort?

[BGen Hugh MacKay]

It's important to remember that all antimalarial medications have side effects.

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

Yes.

[BGen Hugh MacKay]

Some of those other medications have significant side effects.

When we discuss with patients what their choice will be with respect to their antimalaria use, we talk about all of the potential side effects, and we help them to come to a decision. We also screen them for any of the contraindications that are listed for any of the options for antimalarials, and we give them the opportunity to make a choice about which antimalarial they would like to use.

Malaria continues to be a dangerous disease that we need to be able to protect our soldiers, sailors, and air persons from. We think that it's important to be able to offer the options that are available and recommended by the world bodies.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you both for coming.

Colonel Downes, it's good to see you again.

Colonel Downes and I went to medical school together about 25 years ago.

A couple of people have asked about the data on suicide rates. To the greater question of mental health in the armed forces, what data is collected overall on mental health, which diagnoses, and what rates of mental illnesses?

[Col Andrew Downes]

We gather information from different sources. Perhaps the most important study we've done is the 2013 Canadian Forces mental health survey. The data was collected on our behalf by Stats Canada, and that actually showed a lot of important information, including the rates of several of the more prevalent mental illnesses like depression, PTSD, and so on.

That has really given us a very strong foundation for understanding what types of illnesses we have. There has been a fairly significant body of work going on to analyze this data in all sorts of ways, for example, understanding the rates of adverse childhood experiences in Canadian Forces members if we're looking at thoughts of suicide, suicidal ideation, etc.

We have published a number of papers and are working on more from that particular data set. We've also done chart reviews from which we have a good understanding of the impact of mental illness on people who have deployed in Afghanistan. We also examine the data from our enhanced post-deployment screening.

Those give some examples of some of the research we've done to understand this issue in our population.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Certainly, through all our work with veterans, we talk about the role of families and how, when someone enlists in the Armed Forces, their family enlists too. Does the Canadian Armed Forces offer mental health services to the family members of serving members?

[BGen Hugh MacKay]

The Canadian Forces health services don't offer mental health services to family members. Family members, though, may have access to some mental health services through the military family resource centres.

What we do recognize, though, is the importance of families as we're treating military members who have mental illness, and where we can and where the patient agrees, we'll try to involve the family members in the care of the military member.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Hypothetically, if you had a family member of an armed forces member living with the member in a reasonably isolated area, an outpost where there were very few resources other than what was available on base, if mental health issues were developing in that family member, what would be their resource, or where could they go?

[Col Andrew Downes]

In some of the very isolated communities, like Goose Bay, for example, military families are entitled to care by the Canadian Forces, but those are rather the exception. Otherwise, family members are provided health care through the provincial health systems.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

[BGen Hugh MacKay]

I would just add, if I may, that there is a mechanism to help fund transportation for some if they need to travel to a different location to access health care.