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Record of Discussion – Mental Health Advisory Group Teleconference

Thursday, June 29, 2017
1330 – 1500 (EDT)

In Attendance

  • Michel Blais, Canadian Veterans Advocacy
  • Dr. Karen Cohen, Canadian Psychological Association
  • Sgt Brian Harding
  • Glynne Hines, Royal Canadian Legion (Co-chair)
  • Robert Thibeau, Aboriginal Veterans Autochtones
  • Dr. Don Richardson, Canadian Psychiatric Association
  • Dr. Patrick Smith, Canadian Mental Health Association

Regrets

  • Ed Mantler, Mental Health Commission of Canada
  • Dave Gallson, Mood Disorders Society of Canada
  • Sapper (Retired) Aaron Bedard
  • Col Colleen Forestier, Director of Mental Health, Canadian Armed Forces
  • Dr. Ruth Lanius, University of Western Ontario
  • WO (Retired) Brian McKenna
  • Kerry Mould, Canadian Association of Veterans in United Nations Peacekeeping

Office of the Minister of Veterans Affairs

  • Ben Charland, Stakeholder Relations

Veterans Affairs Canada Officials

  • Dr. Cyd Courchesne, Director General Health Professionals
  • Joel Fillion, Director, Mental Health (VAC Co-chair)
  • Michelle Morrison, Senior Analyst, Stakeholder Engagement and Outreach
  • Sheila Bolger, Analyst, Stakeholder Engagement and Outreach

Guest Presenter

  • BGen H.C. MacKay, Surgeon General, Canadian Armed Forces

Observer

  • Cory Micalef for Amanda Jane, Office of the Veterans Ombudsman

Opening Remarks

The co-chairs welcomed members of the group, and introduced Brigadier-General H.C. MacKay, the Surgeon General of the Canadian Armed Forces.

Presentation: Mefloquine Use in the Canadian Armed Forces

Brigadier-General MacKay presented to the Advisory Group on the use of mefloquine in the Canadian Armed Forces (CAF). The presentation can be viewed here.

Highlights of the presentation and discussion include:

  • The CAF deploys members to some areas of the world where malaria is a health and potential operational threat. They follow the advice of the Public Health Agency of Canada on malaria prevention, which includes the use of the medicine mefloquine.
  • In response to concerns raised by the Military and Veteran community, the Surgeon General completed a report (Surgeon General Task Force Report on Mefloquine), it is available at the following link.
  • The report notes several key findings:
    • The use of mefloquine has decreased substantially over time, while atovaquone-proguanil (AP) has increased in use.
    • Although the CAF’s malaria policy is generally followed (i.e. personnel receiving prescriptions have a face to face meeting with a clinician), there was insufficient documentation of screening for contraindication (where a symptom or condition could make a particular treatment or procedure inadvisable), and in some cases personnel received a prescription for mefloquine despite evidence of potential contraindications or precautions in their medical records.
    • The CAF approach to using mefloquine is consistent with international and national guidelines. It was noted that there are usually non-scientific factors putting mefloquine into a status of not being preferred as a medication, such as political and operational considerations.
    • The Surgeon General Task Force reviewed over 100 studies involving approximately 400,000 military personnel. They concluded that mefloquine was not associated with an overall excess risk of adverse effects, nor was it linked to not being able to perform occupational duties. However, it was noted that the majority of studies reviewed were not of the “gold standard” type (i.e. randomized trial), so evidence is potentially less reliable.
  • One United States study was referred to as being of potential interest to the group, and was subsequently forwarded to members. This study can be found at here (this study is only available in English).
  • Overall, the Surgeon General Task Force found that the science is not definitive about the risks of mefloquine, and that there are aspects of the military operational context which merit taking a precautionary approach (for example, deployment of large numbers of personnel within a short period of time can pose challenges for adequately screening individuals).
  • The policy recommendations to the Chief of the Defence Staff are to move mefloquine to the second line, but not to remove it totally from use in the CAF. Specifically, it can be considered for use as an alternative to other medications such as AP or doxycycline, if those are not sufficiently tolerated by the member, or if a member has previously taken it, has no contraindications to its use, and specifically requests it.

Following the presentation, members asked about the impacts of differing lengths of time taking the prescription. The Surgeon General referred the group to the findings in the US study noted above, that looked more specifically at those impacts. Additionally, members reinforced the importance in general of ensuring patients are appropriately informed about the medications they are being prescribed, and the risks.

The Mental Health Advisory Group expressed its thanks to the Surgeon General for making the presentation to them.

Other Discussion Points

  • Mental Health Advisory Group members were told that the Canadian Armed Forces/Veterans Affairs Canada Joint Suicide Prevention Strategy should be completed in the early fall, and that Veterans Affairs Canada (VAC) and the CAF each will have an action plan that focuses on transition.
  • There is no date set for a stakeholder summit.
  • Advisory Group members are interested in the on-going development of the Centre of Excellence on PTSD and Related Mental Health Conditions. Members were told that VAC is currently defining/clarifying the concept with the Treasury Board of Canada Secretariat, and is continuing consultation on the Centre of Excellence. The Group decided the member co-chair could be the point of contact with the VAC lead for this initiative, on behalf of the Advisory Group.
  • A question was posed about the Veteran and Family Well-Being Fund, in terms of eligibility and types of initiatives it will support. It was noted that the details are still being worked on, and the fund will be available in April 2018.
  • A face-to-face meeting of the Mental Health Advisory Group is proposed for October 2017.
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