Stuart Robert (Fadden, Liberal Party, Assistant Minister for Defence) Share this | Link to this | Hansard source

I ask leave of the House to make a ministerial statement relating to mental health in the Australian Defence Force.

Leave granted.

I rise with a great sense of responsibility to deliver this ministerial statement on the floor of the House. I do so having just returned from Townsville, where I, like the entire community, honoured the 34,500 personnel who deployed to Afghanistan and the Middle East as part of Operation Slipper.

In my address to ADF personnel, their families and friends in Townsville I said the following:

Operation Slipper was a conflict that involved so many, yet not without cost. 41 of our nation's sons were killed in action; 262 suffered serious physical wounds; and we acknowledge the unseen wounds of so many more. Your mission is over, but our mission to stand with, and support you continues.

This government, like those before it, takes these words seriously. We do acknowledge the unseen psychological wounds from conflict and training and we are committed to assist those carrying physical or psychological scars as a result of that service.

The government and senior Defence leadership are absolutely committed to ensuring our ADF personnel are prepared for the unique occupational risks of military service and are as resilient as possible. Likewise we are committed to promoting good mental health for all of our members and their families and, importantly, caring for those with a mental health condition.

Accordingly, today I will outline what the government is doing in terms of mental health research to more fully understand the challenges some of our service men and women face. I will also take stock of the many and varied programs and actions currently used to support ADF personnel and their families. And finally, so that everyone is aware of the journey we will take, I will address what comes next in terms of mental health policy in the ADF.

Mental health research

Mental health research forms the basis of our understanding of the mental health issues affecting ADF personnel, and the use of the best evidence ensures we make the right decisions to best support our service men and women. To provide the best support, we need to fully understand the type and range of mental health needs of ADF personnel. To know this, we have undertaken, and continue to undertake, the research to help us be informed. But let us be clear: while we are informed by research and empirical evidence, we will always remain focused on achieving outcomes for individuals and their support networks.

In 2010 the publication of the ADF Mental Health and Wellbeing Strategy and the supporting action plan set the direction on mental health through to the end of 2015, whilst also ensuring the recommendations of the Dunt review were actioned. The initial 2010 study revealed a number of facets to the mental health challenges facing the modern ADF. Some of those findings are:

On the surface this seems counterintuitive, and at times at odds with the experience of some of our service men and women. It may be explained by variations in demographics, life experience and the relative resilience of the two groups in the study. Clearly, though, more work and research is required, which is why the next study the government has announced will explore this critical subject in greater detail.

I am determined to ensure we fully understand the needs of our ADF personnel and it is clear to the government that additional research would be beneficial; indeed it is required. The fact is we are interested in the mental health and wellbeing of our people throughout their entire career—from recruitment, through their service life and during transition out of the ADF and into civilian life.

Transition and Wellbeing Research Program

To meet this ongoing research requirement, in June of 2014 the government launched the Transition and Wellbeing Research Program. This multimillion-dollar program is the largest and most comprehensive program of study undertaken in Australia to examine the impact of military service on the mental, physical and social health of serving and ex-serving personnel, and their families, who have deployed to contemporary conflicts.

The Transition and Wellbeing Research Program will consist of three components: firstly, the Mental Health and Wellbeing Transition Study; secondly, the Impact of Combat Study; and, thirdly, the Family Wellbeing Study. The program will, for the first time, provide a comprehensive picture of the mental health and wellbeing status of members transitioning from full-time service. It will specifically investigate how individuals previously diagnosed with a psychological disorder access care, how mental health issues change over time, the mental health status of our reservists, as well as examining the experiences and needs of families of serving and ex-serving members.

Up to 50,000 serving and ex-serving ADF members, including reservists, and up to 35,000 family members will be invited to participate in different components of this research. Defence and DVA have now commenced the recruitment phase of this very important project and are utilising the Military and Veteran Research Study Roll, another extremely worthwhile initiative, to this end.

Suicide

Defence is also acutely aware of the association between mental health conditions and suicide risk, particularly depression and PTSD. Any death of a defence member or veteran is a tragedy and the factors that lead a person to die by suicide are often complex. It is important to note, however, that suicide of serving ADF personnel is lower than the national average and does not compare to the high rates reported in other military forces such as those of the United States.

The facts are that since 1 January 2000 there have been 106 full-time serving defence members who are suspected or confirmed to have died by suicide (as at 19 March 2015). Of the 106 serving defence members, 61 had not deployed and of the 45 defence members who had deployed, only 17 had one or more deployments to the Middle East Area of Operations. And while Defence has no ongoing visibility of ex-serving defence members, DVA and others are seeking to confirm these numbers. More work needs to be done on this. We all agree that one death by suicide is too many.

Stigma

It is also important to make a statement about the stigma that some people attach to a mental health condition. This is known worldwide as a significant obstacle to seeking treatment. Just as there is within the broader Australian community, there is still reluctance from some ADF members to seek help for mental health issues. My strong message to defence members, veterans and their families is that whatever the cause of an individual's mental health challenge or illness, whether deployment related or not, this does not prevent you from having access to the full range of mental health care available. We will support you and your family. There will not be a detriment to your career by putting your hand up to say 'I'm struggling.' Defence members continue to be employed during their treatment and rehabilitation and are given support and the opportunity to recover and return to their previous work, or undertake new work within the ADF.

I can only repeat that one of the most important factors in treating mental disorders, including PTSD, is for members and/or their families to seek support and treatment as soon as possible. The earlier someone seeks treatment, the more likely the condition can be successfully treated. The longer it is before treatment is received, the greater the likelihood the treatment will not be effective and that a medical discharge may occur. We know there is more to be done and this government will do all that it can to seek to normalise mental health in the ADF so that it is seen in the same light as a physical injury.

Programs and Actions

There is an ongoing need for research into the mental health of ADF personnel, of that there can be no argument. Yet the outcomes of this research are what translate into better mental health for individual ADF members. To this end, it is important to highlight some of the key programs government and Defence are delivering in support of ADF personnel.

In terms of strict numbers, since 2009 Defence has invested more than $140 million in mental health services and support, while the Department of Veterans' Affairs spends over $179 million annually. An extra 91 positions have also been created in the mental health workforce over the last six years. But the numbers alone do not tell the whole story. Defence continues efforts to reduce stigmas and barriers to care, improve access to treatment and encourage defence members and their families to seek help as early as possible. If an ADF member does experience mental health problems they have access to a comprehensive range of mental health programs, services and support and they receive treatment and rehabilitation whilst still in service.

Some of the programs and initiatives developed to support ADF personnel include:

It is important that this information is kept up to date.

The Long Way Home

The ADF Separation Health Examination is a key component of this screening process and a member's transition from military to civilian life. It baselines the defence member's health status at the time of separation and ensures that all illnesses or injuries sustained during service are recorded. In addition, it provides the member with a clinical summary that assists their new civilian health care providers to understand and address their ongoing healthcare needs.

What has been introduced includes:

These are just a number of the specific programs available to ADF members.

Throughout their careers, ADF members receive a wide range of training in mental health from annual training, deployment-specific training and targeted programs regarding suicide awareness and prevention, alcohol management and early recognition and treatment of emerging mental health issues.

DVA and transition

I must stress the government's commitment to meeting the mental health needs of our people does not end when they separate from the ADF. Minister Ronaldson, the Minister for Veterans' Affairs, and I are committed to working together to ensure transition out of the ADF is as seamless as possible, and our service men and women receive the health care they need and benefits to which they are entitled when they leave the ADF.

The Department of Veterans' Affairs spends almost $179 million per year on comprehensive mental health service systems for clients, which include online mental health information and support, GP services, psychiatric, psychological and social work services, trauma recovery programs, and in-patient hospital treatment for those who need it. The Veterans and Veterans Families Counselling Service, or VVCS, is also available to provide support for war and service-related mental health conditions. It is important to note that this spending is demand driven. It is not capped. If a veteran needs a mental health service, they can access it.

On 1 July 2014, new initiatives, in addition to those I have mentioned, also started providing greater access to mental health support. These include:

Minister Ronaldson and I share the view that the more seamless a transition, the better the mental health outcomes for service and ex-service personnel, and we are committed to continue to work together to make improvements in this area. Defence is committed to ensuring a coordinated and integrated approach across welfare, rehabilitation, compensation and transition programs to improve outcomes for ADF members and their families and better support commanders in meeting their responsibilities. A lot has been done but we recognise more is needed.

What are the next steps ?

The Chief of the Defence Force and I both agree that more can be done and that we must continue to destigmatise mental health disorders so our ADF personnel are as comfortable seeking help for a mental injury as they are for a physical injury. We will continue to identify those leaving the service who may be developing mental health challenges, monitor and improve the transition of those leaving the service and try and keep in contact with those who have left.

In striving for best-practice mental health management within the ADF, Defence has now fully rolled out its ADF electronic health record system, the first of its kind of any agency or group in the country. This will allow for real-time detailed reporting and data analysis in a way not possible with paper records. It will also facilitate the seamless transfer of health information to an ADF member's civilian practitioner once they separate from the ADF, as Defence's electronic health record is compatible with the national Personally Controlled Electronic Health Record system. Where required, Veterans' Affairs will also be automatically sent a member's electronic record on discharge.

With regard to continuing and future initiatives, the government is committed to expediting the $22 million development and roll out of ForceNet, one of the key communication tools for ADF personnel, their families and soon the ex-service community. ForceNet will help the senior leadership to communicate with all members and their families in a secure, trusted manner and help veterans who have left the service to stay connected.

The Chief of the Defence Force and I have also agreed to rapidly expand the current mental health screening process for ADF personnel. It will soon apply to all personnel, including those who leave the ADF, not just those who have deployed on operational service. Work is also being done to ensure that the Defence Community Organisation information packs reach every single family that deploys. There will be no excuse for this information not reaching families.

The government is also committed to supporting new, innovative and proven ways to help our personnel, such as the emerging Arts for Recovery, Resilience Teamwork and Skills Program. Further collaboration with non-Defence service providers are being and will be considered if they can meet current needs.

Importantly, the ongoing research program for the next five years covering the Mental Health and Wellbeing Transition Study, the Impact of Combat Study and the Family and Wellbeing Study will further guide and shape Defence and Veterans' Affairs responses to the challenges in dealing with mental health. We will respond to any and all research outcomes that make a difference in the lives of our service men and women.

Finally, more needs to be done to destigmatise mental health so that our ADF personnel and families are comfortable seeking help. I do not think anyone has all the answers on the best approach to make this happen; however, it is a priority action to explore ways to expedite this outcome. Likewise, once Defence personnel seeking mental health treatment have finished this treatment, all haste must be pursued in medically upgrading personnel back to their original status so they can continue with their careers.

Conclusion

In conclusion, we are absolutely committed to the care of ADF personnel and to the continual promotion of developing and living lives of good mental health.

Defence has excellent programs in place to assist our service men and women and we will continue to work closely with the DVA to provide a smoother transition for those leaving the ADF. We are particularly focused on improving our understanding of mental health conditions, particularly PTSD, as well as preventing and treating such conditions. We are consistently engaged in the development and refinement of the continuum of care to ensure the seamless transition and support of our service personnel from Defence to the DVA. We do this in full and open collaboration with all stakeholders.

Mental health conditions such as PTSD can be successfully treated. Early identification, diagnosis and intervention by trained mental health professionals provide the best outcome for those affected. We continually strive to learn from past experiences and use the best scientific evidence to support our ADF, their families and friends.

We as a government are fully committed to providing the best possible care to our service men and women, whatever their injury or ailment. Yes there is more to do, and we will do it, for our personnel are our most important capability and their health and wellbeing is my number one priority.

I ask leave of the House to move a motion to enable the member for Canberra to speak for 21 minutes.

Leave granted.

I move:

That so much of the standing orders be suspended as would prevent the honourable member for Canberra for speaking for a period not exceeding 21 minutes.

Question agreed to.

Gai Brodtmann (Canberra, Australian Labor Party, Shadow Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

I am pleased to have the opportunity to make a statement on this critical issue and I thank, welcome and commend the assistant minister on his statement this afternoon. Like the assistant minister, over the weekend I too commemorated the end of Operation Slipper. It was an honour to welcome home the 34,500 personnel who served in Afghanistan and the Middle East. It was a time to remember the dedication, courage and sacrifice of those who served. It was also a time to honour those who made the ultimate sacrifice—those 41 Australians—and to provide support to their families and friends. It was also a time to pledge our support to the wounded and to all those who have come back to Australia forever changed by what they have experienced. That is why I am standing here today, pledging our support once again.

The mental health of our serving and ex-serving Defence Force members must be a top priority for both government and the ADF. It is impossible to exaggerate what we owe to our service personnel and their families. In thanking them for their sacrifices and showing our gratitude for the work they do in securing our nation and preserving our precious democracy, we must ensure that we provide the highest standard of care for them upon their return. We must do all we can to achieve the best mental health management within the ADF to reduce the risk of anxiety, depression, post-traumatic stress disorder and, ultimately, suicide.

As the assistant minister has said, since January 2000 there have been 106 full-time serving Defence members who are suspected or confirmed to have died by suicide. While there are no accurate statistics about how many former members have committed suicide, recent reports claim that almost 200 Afghanistan war veterans have taken their own lives, and another 2,600 have been confirmed as suffering from PTSD. More needs to be done to address this lack of information. As the assistant minister said, one death by suicide is too many.

PTSD is one of the most common psychiatric disorders in Australia. The Australian Centre for the Posttraumatic Mental Health says that five to 10 per cent of Australians are likely to experience PTSD in their lives, while up to 12 per cent of serving and ex-serving members will be affected by PTSD in any given year. The Department of Veterans' Affairs says that 1,713 veterans of recent conflicts are suffering from PTSD. Of those, 955 are veterans of either Afghanistan or Iraq. However, in reality, this number is likely to be much higher. Many sufferers often develop symptoms years after their service, and many more remain undetected because they never seek the help they need to treat their PTSD. Major General John Cantwell, the former commander of the Australian forces in the Middle East says of Australia's withdrawal from Afghanistan:

There is a wave of sadness coming away, and the system—DVA and Defence—needs to be ready for it.

As the problem grows, so must our response. That is why I welcomed the assistant minister's strong commitment to providing the best possible care to our servicemen and women, and I commend him again for that. His commitment builds on the work Labor did in government to reform mental health services for current and former members of the ADF and their families. Our 2013-14 budget contained a record $12.5 billion investment in the veterans affairs portfolio. Part of this record investment was $26.4 million for new mental health initiatives, which have been outlined in our 2013 white paper. These initiatives included extending non-liability health cover for certain conditions to former members of the ADF, and expanding access to the Veterans and Veterans Families Counselling Service to veterans involved in high risk peacetime service and their families, as well as to families of veterans killed in operational service.

In 2009, we also commissioned Professor David Dunt to conduct an independent review to benchmark current ADF mental health support services against best practice, including the transition process to the Department of Veterans' Affairs, and to determine the extent to which mental health services met the needs of serving and transitioning ADF members. Professor Dunt made 52 recommendations to reform and improve ADF mental health programs, as well as the transition services of both Defence and the Department of Veterans' Affairs.

The Department of Defence states that as of 18 March this year, nearly half of the recommendations have been implemented, including completion of the 2010 Mental Health Prevalence and Wellbeing Study, and the development of the 2011 ADF Mental Health and Wellbeing Strategy.

As you can see, positive steps have been taken to understand and support those with mental health issues. In particular, progress has been made in terms of streamlining the DVA and Defence processes, and streamlining the information on injured soldiers. I was involved in the Joint Standing Committee on Foreign Affairs and Trade Defence Subcommittee review into wounded soldiers. One of the major issues that came from that inquiry, and the hearings that we had, was the lack of seamlessness between DVA and Defence, so it is great to hear that progress is being made in that area, but more needs to be done. As policy makers, we have to do more, and we have to do better.

I would like to take this opportunity to acknowledge and commend the government on its $5 million Transition and Wellbeing Research Program, which was launched in June last year. A vital part of improving mental health services for our serving and ex-serving personnel is understanding their mental health needs. The program will, for the first time, provide a comprehensive picture of the mental health and wellbeing status of members transitioning from full-time service.

I woul d also like to acknowledge the m inister 's and the Chief of the Defence Force ' s efforts to rapidly expand the current mental health screening process to include all personnel , including those leaving and not just those who have been deployed. It is pleas ing to see the m inister and assistant minister have acknowledged the important role that families play in recognising the early signs of mental illness . We commend the work of the Defence Community Organisation, because I know that they have been playing a very important role in this in addition to Defence Families Association.

Labor also supports the government ' s work in supporting new initiatives like the ADF Arts for Recovery, Resilience , Teamwork and Skills Program. While it is important to acknowledge government-run programs and commend government-run programs aimed at improving the mental health of our personnel, it is also important to recognise the non-government organisations working in this space. Last week , I was honoured to attend Soldier On's official reopening of the Robert Poate Reintegration and Recovery Centre. Soldier On is a Canberra based organisation that supports our physically and psychologically wounded soldiers. The new facilit ies in Crace, unfortunately not in my electorate, allow Soldier On to continue its vitally important work, particul arly in helping our wounded sol d i ers transition from the ADF and into the next stage of their career.

Another community organisation doing great work in this space is Young Diggers. Young Diggers is working to change the culture of stigma and sha me that still exists in the ADF and that sadly results in returning soldiers ignoring the signs of mental health issues and other injuries. This stigma is a significant cultural problem within the ADF, and it is pleasing to see the assistant minister listing this as a top priority. There must be clear direction from government, the m inister , the assistant minister, the Chief of the Defence Force and all th e way down the chain of command that there will be no detrimental impact on your career if you are seeking m ental health treatment . W e know that early identification, diagnosis and intervention by trained professionals provide the best outcome for those dealing with mental illness. The ADF needs to shift the stigma around mental health, as does the Australian population more broadly .

As I said, on the weekend I attended the Operation Slipper parade and the memorial service at the War Memorial. It was a wonderful event. It was wonderful to see so many—I think it was 2,000 plus—of our service personnel from the Navy, Army and Air Force, and members of the AFP. What was particularly touching for me was to see the civilians, those from a range of government agencies who served in a range of capacities over many years, marching as well in the parade. It just underscored the fact that operations like Defence have integrated workforces. Civilian Defence staff are critical to the frontline operations of the ADF. They provide high-level technical skills. Those who served also need mental health to be a priority for them as well and a support and assista nce to them.

The government plays a vital role in maintain ing and enhancing the wellbeing —phys ical, financial and emotional— of current and former ADF members and their families. It is pleasing that in recent years there has been an increased awareness of the effects of depression, anxiety disorders, substance abuse and PTSD, and an increased awareness of issues surrounding suicide rates amongst current and former servicemen and women. It is also pleasing to see the ADF has put an enormous amount of effort into improving the understanding of and screening for mental health conditions, particularly PTSD, as well as in preventing and treating such conditions. It has been particularly over the last six years. But as the assistant minister has said, and as I say, there is more work to be done. There is much more work to be done.

We must ensure that the Department of Veterans' Affairs and the Department of Defence are adequately funded to provide the rollout of their many excellent programs. And, as we have both discussed today, we must ensure that the systems that they have are talking to each other, are working together and are working seamlessly. We must also acknowledge and support the great work of community organisations like the RSLs, Soldier On, Young Diggers, the Vietnam Veterans Federation of Australia, the Vietnam Veterans Association and Mates4Mates, as well as the DCI and the DFA. We must constantly work to reduce the stigma and normalise mental health issues within our Defence Force, because it is a shared national mission to provide our serving and ex-serving personnel, and those who have served our nation in a military and a civilian capacity with the best possible care. Again, I commend the assistant minister for his statement this afternoon.