Veterans Affairs Committee on Nov. 15th, 2016

[Jean Rioux, Liberal, Saint-Jean, QC]

I'm talking about the medical record.

[Col Andrew Downes]

Certain documents from the medical record can very easily be provided to an individual, but to provide the complete medical record requires us, under the Privacy Act, to go through each page and remove information that's considered third party information. That takes some time to do as you can imagine. Nonetheless, as General MacKay has mentioned, we have a higher number of additional people to complete this task, and the time it takes is significantly shorter now than it was in the past.

[Jean Rioux, Liberal, Saint-Jean, QC]

Unless I'm mistaken, this is in line with the ombudsman's recommendation.

[Col Andrew Downes]

Yes.

[Jean Rioux, Liberal, Saint-Jean, QC]

In addition, General Roméo Dallaire said that National Defence should be more involved in suicide prevention.

Have any improvements or efforts been made toward prevention?

[Col Andrew Downes]

We have done many things to improve suicide prevention within the Canadian Forces. As I mentioned earlier, mental illness is one of the key elements of suicide, so we have done a lot to improve the programs and services that we offer clinically to decrease the impact of mental illness. For example, in the past 10 years or so, we've doubled the number of mental health clinicians working in our clinics. We have increased the number of operational stress support centres. We have brought on line a resiliency program that helps people to better manage their own levels of stress, as well as to identify when they themselves need to come forward for care. Outside of health services, the army, for example, knowing that its suicide rate is higher, has recently implemented what it calls the “sentinels program”, which is a peer-based program in which certain members of a unit get special training so that they can more easily identify their colleagues who are having difficulties and encourage them to come forward for care.

The army has also implemented a program that they call CAIPS. I can't remember what the acronym stands for right now, but basically it is another form of resiliency program that deals with different aspects of people's lives, from family to spiritual, to medical, to physical fitness, and so on. A lot of things have been put in place to tackle the problem of mental illness, and therefore, suicide as well.

[Jean Rioux, Liberal, Saint-Jean, QC]

In the Saint-Jean riding, which I represent, some people who attended the two military colleges took their own lives. There seems to have been an increase in these cases recently. You would be more familiar with the statistics than I would be.

Have any additional steps been taken with this group?

[Col Andrew Downes]

Regarding the road to mental readiness program that we spoke of earlier, one of the new modules we've recently developed is specifically intended for military colleges. We've just implemented this for the first years at the Royal Military College. Depending on how that goes, we might roll it out to other places as well. Road to mental readiness training is also provided to new recruits when they go to Saint-Jean Garrison and start their basic training for the military. All members, once they've joined the forces, have access to the full suite of programs that we offer to our members, including the clinic-based care and mental health, education, and training programs, as well as our CFMAP. It's a member assistance program. There's a 1-800 number people can phone if they're having stresses or issues going on in their lives, to get some advice and assistance over the phone and potentially some additional counselling as well.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Mr. Chair.

I want to go back to earlier questions from Ms. Wagantall and get a better sense of the concerns that I'm sure the medical personnel of DND have with regard to the current concern about antimalarials.

In light of the reports of side effects of long-term concern, are you doing any follow-up with personnel who have taken antimalarials once they return home or are released?

[Col Andrew Downes]

Everybody who returns home from a mission undergoes enhanced post-deployment screening three to six months afterwards. At that time, their mental health conditions in particular are reviewed, but they also have a chance to bring up physical health conditions. These could include side effects of medications or other concerns that individuals might have. That gives an opportunity to review those things. In addition, at any other time afterwards when they're having medical appointments and follow-up, people can bring up their concerns as well.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

That's three to six months.

Has there been any thought about going beyond that? The discussion that's been out there in the last little while is that these side effects go on for many years.

[Col Andrew Downes]

Typically, though, if people are having side effects, they would have them early on either in the course of taking the medication or shortly after. You'd expect the person to have experienced them by the three-month to six-month window.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

You said that at the time of deployment, or just before deployment, troops are advised about the potential side effects, and they are given a choice about which antimalarial drug they want to take. What if they weren't willing to take anything at all? What if they were so concerned about being one of those people profoundly adversely affected that they didn't want to even try the drugs? What happens then?

[BGen Hugh MacKay]

If we are going to be sending troops into areas where malaria is a significant risk and an individual chooses not to take an antimalarial medication, then we would make a recommendation that the individual not deploy into that particular area or mission. Malaria is a very significant disease, and we would not want them to have that risk.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Would there be any negative consequences of that decision for the individual?

[BGen Hugh MacKay]

A decision not to take the antimalarial medications and therefore not deploy may result in an administrative review process, where they would look at whether or not the individual would be able to continue to serve.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

It could have very negative consequences on a career.

[BGen Hugh MacKay]

The administrative review process could result in significant consequences, yes.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

In the theatre, in the field, you said that if someone is experiencing a mental difficulty, then the primary care physician gets involved. I wonder if they are mental health specialists or if they are general practitioners. What kind of skill set do they bring to that diagnosis? It's a significant decision in terms of what happens to the individual CF member.

[BGen Hugh MacKay]

The primary care clinicians who would normally deploy would usually be physician assistants, general practitioners, or family physicians who have experience and knowledge to be able to assess an individual's medical condition and to make a decision as to whether they should have employment limitations applied or stay in a mission.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

That would include the mental health piece of it. I know that there are specialties in medicine, and I wondered about that particular area of expertise.

[BGen Hugh MacKay]

There is a broad spectrum of symptoms that somebody might present with, and a physician assistant or family physician might seek assistance from a medical health professional to help them make the decision, if that was necessary.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Eyolfson.

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

Thank you.

You talked about someone having a mental health issue coming up when they are serving in theatre, whether it turns out they're diagnosed with depression or PTSD, and then a determination being made as to whether it's suitable for them to remain in theatre or to be removed from the theatre to another sort of deployment. Does this have implications for their universality of service?