Veterans Affairs Committee on June 1st, 2023

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

Thank you, Chair.

We heard from past witnesses about women veterans' issues, such as the lack of gender-specific health care facilities, the lack of mental health support and the military trauma. It makes it difficult for women vets to have access to health support.

Earlier, in your opening, you mentioned your focus on improving health care. Can you share what adaptations you've made to help vets in this space?

[LGen Lise Bourgon]

Thank you very much, Mr. Chair.

Again, we're looking at measures to help serving members. That's the CAF mandate. From a health perspective, I guess I'll give the floor to Marc, who can talk specifically about what we're doing.

[MGen Marc Bilodeau]

There is a lot to do, and we don't have all the data yet to determine what needs to be done because we lack research. It's not unique to the military. There's a lack of research about women's health in society overall. Most of the research in medicine has been designed for male populations, and, obviously, it's not always possible to extrapolate the impact to women. We have a great example of that with cardiac disease. It's definitely not designed for women.

We need to start there. We need to have a better database to monitor research. We are partnering with many organizations in order to do that research, including the Canadian Institute for Military and Veteran Health Research. Forty-three Canadian universities that are part of that group are helping us to figure out what needs to be done from a research perspective. That will subsequently inform prevention, what we need to do for prevention to reduce injuries and reduce illness for our military women, but also what we need to do better from a care perspective.

We're following the Canadian guidelines for treatment of women, so I think we're aligned from that perspective, but what is unique to uniformed women, we don't know that for sure. We have a bit of research from international partners on that, and we're trying to import, I guess, the expertise that is out there, but there is definitely more to do in order to better inform the progress.

Our women's health program is just starting. It started last year. We're now staffing a team. We're hiring people. Then, subsequently, we're going to start investing more in research and health care and then, hopefully, improve health outcomes for military women.

[LGen Lise Bourgon]

I'm just going to add, in case anyone is interested, that there is an incredible book out there. It's by Caroline Pérez, and it's called Invisible Women. It's about the world that was designed by men for men, and now women are invisible in society. The CAF and the military are the same. It's a very interesting book, in case you're looking for summer reading at the beach.

[Rechie Valdez, Liberal, Mississauga—Streetsville, ON]

I just so happen to be looking for a book, so I appreciate the referral. I don't have much time, so I'll just say thank you again for your service.

I just want to say a shout-out to the witnesses who are witnessing the witnesses who have joined and who have also served. Thank you so much.

[The Vice-Chair, Conservative, Blake Richards]

Thank you.

I think we have time for two more rounds, just like the second round.

We were supposed to start this third round with Mr. Tolmie.

He is not in the room, so we will pass that to Ms. Wagantall for the next five minutes.

I'm sure we would have lots of volunteers, but Ms. Wagantall had her hand up first, so we'll go to her for five minutes.

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

All right. Now I've lost what I had up on my phone here, but...

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Do you want my question?

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

No. I'll go another route. Thank you very much.

General Bilodeau, this is for you. Somalia came up in conversation tonight, and this committee did meet with individuals who experienced the challenges of being administered mefloquine while they were there. We did another major study on that issue.

I was thinking about it. We've had no feedback from women in the military, and this drug has been used right up through Afghanistan and is now a drug of last resort. However, it was made clear in the report that this did not impact civilian use. I lost a friend who was a considerable and amazing veterans' advocate, who had taken it with her husband on a trip to Thailand. She eventually did take her own life.

Every other country—U.K., Germany, Ireland, Australia and the U.S.—has identified this as a concern, as a brain stem injury, and is treating specifically for that, yet we do not have that in Canada. There is no recognition of the results of that particular drug. I know part of the inquiry was to do with a number of other things, but then the inquiry was shut down before mefloquine was approached.

Are you aware of women who were administered mefloquine when serving, and is there any feedback at all as to its impact on them?

[MGen Marc Bilodeau]

Thank you for the question.

Yes, there are women who took mefloquine during their careers, for sure. I don't have the data on women specifically. Many of our men in uniform obviously took mefloquine as well.

A significant large study was done for our military members about mefloquine several years ago, informing what needed to be done from that perspective. It was reported to my predecessor, the surgeon general. Obviously that study was aligned with evidence in the research community—both Canadian evidence and international evidence. There have been many research activities all around the world on mefloquine.

Based on that evidence, a recommendation was made to basically put mefloquine as a last-resort choice, as you mentioned, because of some potential impacts of mefloquine on the brain. This hasn't been officially proven. There is still a lot of debate in the scientific community about that, but to be prudent, we have decided to basically make it a last resort.

Why is it still in the formulary? It is because for some people it's well tolerated and they have done well with it. The beauty of mefloquine is that you take it once a week instead of every day, so compliance is much better. Having said that, we keep monitoring the corps of members who have taken mefloquine over their careers and we're—

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

Are you aware of everyone who would be on that list of individuals who were administered mefloquine during their service?

[MGen Marc Bilodeau]

I'm sorry. What is your question?

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

Are you aware of everyone who was administered mefloquine during their service? Do you have that list of individuals you're monitoring?

[MGen Marc Bilodeau]

It is in their health records. It was prescribed to them and we monitor everything we do in health care, obviously.

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

Okay.

I am just a little confused because I do follow Dr. Nevin and the Quinism Foundation in the States and the research that has been done in these other countries. We don't seem to be in line with them on that issue.

It's come to my heart and mind today because we have studied this before any of.... Were you there? It was very significant. I appreciate the feedback. I do hope that those who need assistance will eventually get that identified as a need within our Veterans Affairs community.

The other thing I would like to refer to is that gender-based analysis. It was specific to one area. I don't have it on my phone. I don't know what I did with it.

What I would like to do is provide it to you and then you could follow up. It was a motion that was brought to the floor here. We want to get the information that was found out in that analysis, so that we can assist those who have struggled with a clear picture of what has been determined through the study. It doesn't seem to be available to those who have served, to see what the results were of that particular analysis.

[The Vice-Chair, Conservative, Blake Richards]

Mrs. Wagantall, we'll maybe have to just pass that to one of your colleagues when you find it. Your round is up. You can ask them to share the information and check with the witnesses, if you'd like.

We'll move now to Sean Casey for the five-minute round.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you very much, Mr. Chair.

I'd like to bring Lieutenant-Colonel Tuka into the conversation.

You're the national practice leader for psychiatry for the Canadian Armed Forces. Is that the correct title?

[Lieutenant-Colonel Andrea Tuka, National Practice Leader (Psychiatry), Canadian Armed Forces, Department of National Defence]

Yes.

[Sean Casey, Liberal, Charlottetown, PE]

We have heard an awful lot of very powerful testimony during the course of this study from people who, after having served, had a long course of PTSD, depression and many other psychiatric and psychological conditions. We heard today about Seamless Canada, which facilitates the transition from the military medical system to the civilian one. I am particularly interested in your area of expertise and in anything you can tell us about what women veterans need, specifically in your field of expertise, to be able to continue to have a reasonable standard of care.

I expect you're going to tell me that the standard of care in the military is top-notch. Why don't we start with that?

Let's talk about the level of care in the military, the level of care in civilian society and that in-between step, from your perspective.

[LCol Andrea Tuka]

Thank you.

First, I would like to acknowledge that I am situated in Vancouver on the unceded traditional territories of the Musqueam, Squamish and Tsleil-Waututh nations.

To answer your question, thank you, and yes, as you stated, in the Canadian Armed Forces we do have robust mental health care, services and programs available to everyone. I can go into detail, but what I would like to emphasize is that, yes, we follow evidence-based care for every mental health condition, every psychiatric and psychological condition, including PTSD.

Also, I would like to mention that we have studied this, and people with PTSD very frequently have comorbid conditions. That means they have not just PTSD but anxiety disorders or depression, and some of them, unfortunately, have substance-use disorders as well. We are usually dealing with complex clinical pictures for those individuals who unfortunately cannot continue their military service and are released from the military, so we encourage people—including women—to seek help as early as possible, because research shows that early intervention has a way better outcome.

We treat people with evidence-based treatment modalities in multidisciplinary care. We have a multidisciplinary team with psychiatrists, psychologists, social workers and addiction counsellors in our mental health care plans, so our outpatients or members get comprehensive care when they are ill.

When the realization comes up that unfortunately the member cannot continue their service and will be released on a medical basis, quite early we start the transition process that you've heard about. As soon as members get permanent employment limitations that are not compatible with continued military service, at that point they are connected with a nurse case manager. We work with them through the transition process.

As clinicians, our responsibility is to work closely with the primary care clinician and the nurse case manager to establish follow-up care for those members by the time they release from the military. We try to do it as early as possible. We see how comfortable our members are with their new providers in the community and we try to ensure that by the day they leave they already have the appointments set up with the psychiatrist, psychologist, social worker or whoever they need. This is what we can do. Many of the psychologists who are treating our members in the community are not just Blue Cross providers and not just providers for the Canadian Armed Forces. They are providers for Veteran Affairs Canada as well, so this transition is quite smooth.

Probably you've heard about the operational—

[The Vice-Chair, Conservative, Blake Richards]

I'm sorry to interrupt you, Lieutenant-Colonel.

Can you try to wrap up your response? We're quite a bit over time with this round.

Finish up your thought quickly.

[LCol Andrea Tuka]

Thank you, Mr. Chair.

Also, I just wanted to mention the operational stress injury network, a similar multidisciplinary team that we have in the Canadian Armed Forces.

[The Vice-Chair, Conservative, Blake Richards]

Thank you.

Mr. Desilets, you have the floor for two and a half minutes.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

I realize that we are hearing from three senior Quebec officers here in Ottawa this evening, and that impresses me. It's nice to see.

Ms. Tuka, I really like you, but my question is not for you.

Mr. Bouchard, you are a transition expert. In this study, we've seen all the difficulties related to the transition from military to civilian status, which means medical services are cut off when the records are not transferred. I've been hoping for three years that some kind of connection will be made, and in my wildest dreams, a military member's physician will continue to see them during the first year of their transition in order to facilitate the transition. How do you feel about that?

Ms. Bourgon, please don't answer for him.

[Cmdre Daniel Bouchard]

Thank you for your question, but I think Mr. Bilodeau would be in a better position to answer it.