Mental health of ADF serving personnel
Submission 46
1. National Veteran Identity Card.
2. The Removal of Medical Officers from Regular Army Infantry
Battalions.
3. An Australian System to Provide The Opportunity for Further
Education for War Veterans
Introduction
The opportunity to make submissions to the above Senate Inquiry is appreciated. The three submissions that have been documented all have an influence on the identification, assessment and treatment of mental health issues affecting our veterans.
The centenary of ANZAC has provided the nation with an appropriate and significant program to celebrate the beginning of the ANZAC story and the mateship that emanates from this narrative.
In recent times the, media has highlighted the matter of veterans’ homelessness, the incidence of veterans being incarcerated and sadly self-harm and suicide .
These three issues raise the possibility that many of the homeless, veterans in the prison system and self-harm are invariably in this state due to mental health issues.
Too many veterans are falling through “the cracks” because we don’t who or where they are?
Many veterans leave the ADF without lodging any claims for disability but they develop problems later in life and many who are, or consider themselves healthy, may feel a little embarrassed about seeking help.
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Mental health of ADF serving personnel
Submission 46
DVA is the appropriate sponsor for embracing these people . They need timely access to their data base of all client veterans and if available a data base of all veterans who have served in the AMF (Australian Military Forces)/ADF. Other
AMF veteran non DVA clients have a Discharge Certificate in paper form that is most unlikely to be carried by them.
There needs to be a major conversation and paradigm shift in the mindset of the
Government and Parliament, Defence Department that includes DVA, veterans, and the broader community as to how we can best keep track of all our veterans well after their service and not just those who have become DVA clients.
Many veterans commit suicide, are homeless, abuse their families, are drug and alcohol dependant, live by choice or circumstance in isolation, and commit serious crimes. The condition which may be the cause of this behavior has been studied and researched by many clinicians in many countries over many years.
The treatments are varied; consume great slabs of resources for a relatively slow and small total recovery rate.
However, there is one basic principle which has been identified which can materially aid recovery. That is early identification and intervention . Once a behavior develops as a habit, treatment is longer, more expensive and problematic. Ask any psychologist or psychiatrist about treating individuals who have developed habits supported by neural pathways.
Although the ADF and DVA are better liaising and coordinating veterans’ health issues in the sharing of information in the best interests of the ADF member,
Defence, however, passes the responsibility for veterans post discharged to DVA.
The DVA Service Charter of 2014 states in its Mission Statement “To support those who serve or have served in the defense of our nation and commemorate their service and sacrifice” .
There is nothing in this Service Charter that states only for veterans that have made a claim and who are DVA clients. Currently DVA has no responsibility for veterans per se until they lodge a claim for rehabilitation.
DVA’s community of interest is therefore all veterans of the AMF: who are potential claimants for DVA support
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Mental health of ADF serving personnel
Submission 46
DVA should be encouraged to live up to their charter of looking after all veterans not just those who are successful in having their disability claim accepted.
Although DVA has come a long way in the last five years in its client service and claim processing, too many veterans still consider DVA an adversary they have to fight to have their claim accepted and this is unacceptable in particular when the veteran is already suffering from mental health issues.
The definition of a veteran (anyone who has served in AMF/ADF) the needs to be defined and it is obvious DVA responsibility not only covers warlike service but also peacekeepers and those injured in training for war. A recent DVA study identified that UN Peacekeepers are presenting with twice the incidence of health problems than veterans with war service. These all come under the DVA Charter.
All veterans must be recognized and receive the care they entitled to under the
DVA legislation
The Parliament and the Australian community recognize the uniqueness of military service and their need to provide special understanding care and support to the veterans and their families especially after service life. They are no longer soldiers, but different to civilians who have never served but more than capable of fulfilling a very worthwhile role in society and the community at large.
One of the principal requirements of support is being able to identify veterans .
Even the AMA has suggested that the medical profession and others need to have a clear and unambiguous identifier that identifies an individual as an AMF veteran whether they are a DVA client or have made a claim on DVA or not .
A National Veteran Identity Card could fulfill this need to be able to allow support agencies (medical, ambulance, police, government agencies etc) and identify and allocate veterans to the appropriate assistance . Additionally, it allows veterans to claim commercial retail and service discounts offered where proof of service is required.
National media in the last few months has exposed either factual or anecdotal information on the number of: homeless veterans; veteran’s suicide; and the veterans who are incarcerated in the prison system. Due to many of these cases not being DVA clients (support recipients) there is no accurate and indisputable way of knowing if the information that has been provided to the media is factual.
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Mental health of ADF serving personnel
Submission 46
Any criticism of the DVA not knowing the true facts related to all veterans is totally unfair because they can only help people who are either receiving benefits
(their clients) or in the process of a claim being processed.
AMF/ADF veterans are a unique segment of our society. A paradigm shift is required to a “whole of life care mindset” from the time that the individual enlists in the AMF/ADF to the time of their death. This recognizes and accepts responsibility that at future time there will be a claim of some sort by the individual or his/her widow/widower.
To support this paradigm a veterans’ national identity card is required to be issued at the time of the individual transitions out of the ADF. It fills the veteran’s identification time gap between end of service and making a DVA claim for support which could be some 15 to 20 years into the future.
This is the identification gap that desperately needs to be filled because the individual who has attempted suicide or the individual who has been imprisoned will not get better if PTSD or other mental health issues that has put the individual into his/her current predicament.
This card is not “Big Brother” and an infringement of one’s privacy but a “St.
Christopher” in the veterans’ wallet/purse as to help them all on their journey.
And it is a journey in some cases of extreme mental health suffering where the individual feels isolated and alone because of the perceived stigma of mental health issues or doesn’t know where or to whom to turn to for help.
The benefits of a Veterans National Identity Card for all AMF/ADF veterans (ex members of the ADF) that firstly identifies that an individual has served in the ADF and secondly confirms and reinforces the DVA Charter’s pledge and mission statement are worthwhile for the recognition of the veteran and their access to veterans support services.
British veterans are issued with a British Veterans Recognition Card which entitles the veterans with certain commercial benefits but also to assist in keeping track of veterans through the organizations data base. This is a not for profit organization but strongly supported by the British Government.
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Mental health of ADF serving personnel
Submission 46
Obviously any card of this nature is only as good as its longevity and has data that will not change, such as name details, service, enlistment date, discharge date and if possible a last known address. NOK is difficult as all are adults and circumstances change.
In the USA to assist in keeping track of all veterans many States have a Veteran
Identifier on the State issued driver’s license, which is an excellent way of keeping track and although the States in Australia have their differences, one would think in the best interests of veterans, in particular when it relates to homelessness, self-harm and incarceration, it would be in the interests of the State Agencies who need to deal with these unfortunate events, to be in the position to identify the individual as a veteran.
Sleeping rough is vagrancy, suicide and self-harm is reportable and being charged and convicted of a crime and jailed are all events and incidents that are all within
State Government jurisdictions.
All serving and ex serving members of the ADF must be made to feel that they are a unique segment of our society and that they have made a major contribution to the community and the nation and that they are:-
“Never Alone, Never Forgotten”
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Mental health of ADF serving personnel
Submission 46
From the formation of Australia’s Regular Army Infantry Battalions in 1947 until around 2011 each battalion had its own Regimental Medical Officer. These young doctors were generally products of the ADF medical scholarship scheme, and were fit enough to participate in all battalion training and operations. They quickly established themselves to be the friend of all the officers and soldiers, who consulted them without hesitation. They provided their Commanding
Officers with invaluable advice on the physical and mental health of the battalions, as well as assisting individuals experiencing problems with alcohol, drugs, injuries, illnesses and psychological problems. Whether or not they stayed on after their return of service was immaterial, as their tenure within the battalions was more than worth the cost of the scholarships.
In 2011 a decision was made by Army to remove these officers and to “brigade” medical support on the major Army bases where the battalions are now located.
This has meant that an infantry soldier reporting to an area medical centre is likely to be seen by a different doctor each time he reports. On deployment, a doctor who will not be familiar with the battalion will be attached. All
Commanding Officers were and still are opposed to this loss of capability, but their objections appear to be falling on deaf ears.
An enquiry from the Royal Australian Regiment Association about the future of this arrangement made to the Department of Defence Health Command led to the response that the arrangement was forced on Army because some years ago, recruiting of medical students for the scholarship scheme was reduced. It was advised that there was no intention to increase it in the future to cater for providing Regimental Medical Officers to the infantry battalions. Much was made of the “efficiency” of the new system, and the need for battalions to have their own doctors who were familiar in detail with the physical and mental health of those battalions, was not accepted.
This issue can be expanded to include the complete removal of medical platoons from the Infantry Battalions. Once was a time where Battalions were supported
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Mental health of ADF serving personnel
Submission 46 by a Platoon of 1 Officer RMO and 18 odd RAMC OR/ JNCO/SNCO, and now
Battalions need to bid six months in advance for allocation of centralized medics who invariably get cancelled or diverted elsewhere at the last minute. Some
Battalions ran training exercise that went in some cases for two months without proper and adequate medical support. In one case two medics were allocated and in another one, which is 1 x Medic for 500 troops. This is totally inadequate in providing sufficient medical treatment across the Battalion in the field.
The RMO and Company Medics traditionally bond and have an intimate knowledge of the Battalions members, and with the centralization of medical services and civilian doctors, word spreads quickly regarding who is free and easy with chits and there are troops who shirk their duties by 'doctor shopping' and malingering, which is far less likely with permanent RMO and their med platoons used to rapidly identify the malingerers, hypochondriacs and shirkers.
There is a strong suspicion that the Australian Army is the only Western Army whose Infantry Battalions have no permanent, organic medical capability which is an indictment on the system. The lack of an RMO who knows the soldiers of the
Battalion is a major impediment to identity mental health issues and early intervention for PTSD in particular in the members of the Battalion and with early intervention of PTSD being a key issue in the management and treating of the condition the lack of a permanent RMO is a major mistake which must be rectified.
This issue continue to be raised by the RARA at ESORT and other levels but the
ADF is simply not listening or at a loss as to how to address and rectify the situation.
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Mental health of ADF serving personnel
Submission 46
It has been well documented that many war veterans have difficulty in fitting back into society when they leave the Defence Force. They can isolate themselves, experience depression, suffer family break-up, turn to drugs and/or alcohol, become homeless and in extreme cases, commit suicide. Many of these issues are directly related to mental health problems such as Post Traumatic Stress Disorder, but not exclusively as those who have returned from active service are very different from the average civilians of similar ages and have difficulty relating to them.
A lot of work is under way within the Departments of Defence and Veterans’
Affairs to address these problems, but to date, as far as we are aware, there has been no mention of the role that a program offering subsidised further education to war veterans could play in reducing the post discharge problems being experienced.
With the average length of service now well below 10 years, the problems being experienced by veterans is not one of short term duration. Society owes these men and women maximum assistance to reassimilate and we contend that offering them financial support to undertake further education or training will provide an effective means of returning them to what may be described as a normal life.
The United States has operated a veterans’ readjustment program since 1944, commonly known as the “GI Bill”, and it contains many aspects which could be adopted in an Australian counterpart. It is much broader than just subsidising further education, including low cost mortgages, loans to start a business, one year’s unemployment compensation and payments for university, high school or vocational education courses. All those who have served for a minimum of 120 days on active duty and have not been dishonourably discharged are eligible.
Actual combat is not required. Canada operates a similar scheme.
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Mental health of ADF serving personnel
Submission 46
An updated education bill was passed post 9/11 which broadened the benefits available for education and training for veterans, reduced the eligibility to 90 days of aggregate active service after 10 September 2001 to those still serving or medically or honourably discharged. The program is widely regarded as being very successful in assisting veterans adjust to civilian life post war and reducing the incidence of the kind of problems referred to herein.
Currently, much of Army's generosity and flexibility is lavished on small groups of wounded soldiers (which is excellent and overdue, but it is not applied with equal enthusiasm across all cases). There are already the first signs of discontent from good soldiers who are to be medically discharged, as they wonder why they can't get access to the free tertiary studies that others are eligible for. The experts and others have all agreed that gainful employment and a place in society making a valuable contribution is of enormous benefit to anyone who is suffering from
PTSD and not transitioning into society as well as they would like. Study and focus on a better life are also major drivers to manage the condition and regaining selfworth.
T here is strong merit in supporting people post discharge so that individuals who are suffering mental health issues are able to manage their condition and establish a place in society.
Michael B. von Berg MC, OAM
Chairman and President
The Royal Australian Regiment Corporation
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