Summary of round tables with community groups

The need to think about transition at the start of, or early in, a person’s ADF career, including:

• That the transition process can be a significant shock, especially when transitioning unexpectedly – for example, as a result of medical discharge.
• Other organisations, such as the National Rugby League, police and elite sporting organisations, start planning and putting supports in place for their employees’ transition early in their employment, and check-in with employees during their career to assist them to consider their future.

• There are a range of reasons why people leave the ADF, and for many it also may not be a choice.
• It was suggested that a key reason for leaving the ADF may include members feeling that they don’t have a voice with the leadership, with one participant noting the ADF is ‘the only place you fight for a democracy but live under a dictatorship’.
• Experiences of bullying and other types of inappropriate behaviour may contribute to some members’ decisions to leave the ADF—particularly in cases where the person accused of the inappropriate behaviour is in a position to be significantly influential with regards to the member’s next posting or deployment. The effects of bullying and inappropriate behaviour continue to be felt after the member leaves the ADF, and may contribute to veteran deaths by suicide.
• The corporatisation of former ADF roles, contracting out and turning ADF positions into Australian Public Service roles has meant there are limited opportunities to rotate members into other roles when they come back from deployment. Participants discussed how uniformed positons that allow people to recover, rehabilitate and normalise could help people continue to stay in the ‘family’ and feel as though they are contributing.

• There is a need to understand the reasons why a person joins the ADF to identify ways to help with transition. For example, some people join the ADF due to home or family difficulties and the ADF becomes their ‘family’. This may mean that they will not have family or other support networks outside of the ADF when they transition.
• The importance of preparing for transition, including:
  • the need for financial management training to be incorporated in the transition process to aid the transition to civilian life, especially given that some veterans receive lump sum payments that they need to manage. It was noted that some ADF members, especially those who joined the ADF straight from school, have not necessarily had the opportunity to develop financial management skills;
  • suggestions that the normal training schedule for ADF members should include preparation for civilian life and transition, with some suggesting up to a 6 week course, which includes training on the Department of Veterans’ Affairs (DVA) claims process;
  • the administrative discharge process can mean there is a limited time for DVA and Open Arms to provide support;
  • the importance of providing transitioning members with training and information on likely mental health issues that may affect them during and after the transition period;
  • a suggestion to identify job opportunities for current serving members who are medically discharging to facilitate their transition into a career where they can use their military skills, especially when the discharge is unexpected;
  • the importance of a process to ensure that skills and qualifications obtained during ADF service are captured as Recognised Prior Learning when a member is transitioning to ensure skills are transferrable to civilian employment. It was suggested that the Recognition of Prior Learning process has been wound back and can be difficult to navigate;
  • it was noted that some members do not realise they have mental ill-health until they have transitioned into the community and may come to regret their decision to leave the ADF. Some participants suggested that the ADF should ensure that ADF members are fit for civilian life prior to discharging, including potentially providing employment in non-deployable units or public service roles in the Department of Defence; and
  • other members may have known or suspected mental health concerns, but due to the desire to leave the ADF quickly, they may mask these concerns. Similarly, those who have experienced some trauma or significant events may desire to leave the ADF quickly. This can mean they do not receive support from Defence.
• The tempo of life in the ADF, which does not allow much time for a person to think about transitioning.  This includes insufficient downtime after or between deployments to allow for decompression, recovery or leave, which can exacerbate issues when a person transitions.
• Early intervention programs should occur prior to discharge to enable development of a skill set to cope with transition.  For example, learning self-soothing and distress tolerance. An example of a beneficial intervention was the cognitive training provided to Israeli soldiers who are deploying.  

• Individuals experience a lack of empathy from the ADF and DVA during the transition process, as this process tends to focus on process and the collective rather than the people who are transitioning. It was noted some changes are being made to improve the transition process – for example, the establishment of the Joint Transition Agency and the introduction of transition programs and seminars for separating personnel. However, it was observed that there is still a lot of angst among serving and ex‑serving members about their future, which requires an empathic approach.
• The chain of command in the ADF does not have the capacity to oversee the transition processes – for example, ensuring that ADF members attend all transition seminars and apply for DVA entitlements.
• A suggestion was made that it could be beneficial to have a mentoring program for ADF members before, during and after they transition, or have veterans at ADF offices around the country to talk to people about to transition. 
• The transition process is voluntary and not all members will participate. The process for some appeared to be a ‘box-ticking exercise’ with some members deliberately avoiding raising issues because they know that doing so would keep them in the system. Some members who have employment on discharge do not have the time or inclination to go through programs to support the transition process and may not recognise their value.
  • Transition coaches are mandatory but members have varying experiences of their value.
• Transition seminars and expos could be moved online. This may help those who cannot attend in person, or if a person’s circumstances change over time. This would allow information to be tailored to specific circumstances.
• There is a lack of cohesion between different parts of the ADF, including medical, recruitment and transition.
• One participant noted the need for some level of recognition of the agency of those who choose to transition out of the ADF as adults who decided to both work for the ADF and subsequently leave.
• The sense of collective identity experienced by ADF members during service can contribute to a sense of alienation in a more individualised civilian context. In addition, a reliance on Defence to provide transitioning members with support can lead to fundamental knowledge gaps – and resultant embarrassment and frustration – when it comes to completing basic functions within the civilian world, such as renting a home or accessing health care.
• It is important for ADF members to be supported to think about future civilian life well before the point of transition, as Defence has the best opportunity to prepare them for their post-military career whilst they remain in service. 
• Information to support transition needs to be provided at an appropriate pace. Providing an ADF member with too much information close to the point of transition can lead to the individual feeling overwhelmed during an already stressful period.
• Courses provided by the Human Performance Centre were discussed by participants as a positive example of a discharge course.  One participant noted that a member may need several months in civilian life before they are ready to engage fully in a transition process.
• The impact of the ADF induction and indoctrination process on a person’s beliefs and the importance of programs which have a similar process on the way out, including helping people transitioning to understand the impacts indoctrination and services had on their beliefs.
• The process of cultural integration, which also has a significant role in the transition process. Ex-serving members shift from the collectivist culture of the military, characterised by shared understanding and comradery, into the highly individualistic culture of the civilian world.
• Although Defence and DVA have improved their information sharing in recent years, a lack of shared ownership and coordination between Defence and DVA continues to impede effective transition, despite successive recommendations that have raised this as an issue. Poor service continuity can leave veterans feeling frustrated, abandoned and disillusioned.

• Higher ranking ex-service personnel often have a different transition experience than those of lower ranks. Senior officers may have a smoother transition from service to civilian life and therefore their experiences are not representative of the broader veteran community.
• Isolation and disconnection can be major issues for veterans transitioning, particularly those who are medically discharged and unable to move into the Reserves, and those who discharge to a separate location from their family and friends.
• The loss of identity and resilience ex-serving members can feel when they transition to civilian life. A collective identity and ‘service before self’ is strongly embedded while in the ADF and transitioning members do not always have a strong individual identity to fall back on after transitioning.
• Transitioning members will typically experience a dip in wellbeing post-transition, due to the loss of camaraderie or ‘tribe’, mission and purpose. It was noted that removing these factors may be one of the worst things you could do to someone experiencing mental ill-health.
  • This can be particularly difficult for female veterans, who are more likely to feel like they do not belong in the ADF and can be ostracised further when they do not fit in as veterans.
  • This dip can occur both when transitioning from the regular forces to the Reserve forces, and when transferring from the Reserve forces to civilian life.
  • The impact of loss of identity and tribe can mean that some veterans question the meaning of their service.
• Veterans face the following losses when they leave the ADF, with those able to mitigate losses in these spheres likely to transition better:
  • the loss of identity;
  • the lack of structure and wider community; and
  • the loss of support and services.
• The need to acknowledge ex-serving members after transition. For example, American airports have signage welcoming veterans. Other suggestions were the local Member of Parliament could write a letter to veterans welcoming them to the community, Defence could hold a parade or morning tea to acknowledge a person’s service, and there could be opportunities to acknowledge local veterans at ANZAC Day and Remembrance Day events. One participant discussed the prospect of launching a National Communications strategy to congratulate and recognise people for their ADF service.  However, it was also noted that not all veterans want to identify as such. 
• Research examining the re-integration challenges associated with the transition period has found that transitioning members experience both practical challenges (i.e. adjustment to new environments/schooling systems, moving house) and psychological adjustment. This adjustment process is largely overlooked within the ADF.
• It can be difficult for ADF members to re-adjust after the operational tempo of multiple deployments. Some people try to replicate the stimulation from deployment in unhealthy ways.
• Due to the high tempo of service, some may not realise their mental health concerns until they transition and are no longer as busy as they were.
• Transition can have a particular impact for those leaving the ADF when they are still young. For those who transition without an opportunity to plan another career path fully, such as following a medical discharge, transition can be particularly difficult.
• It is important to recognise that a high proportion of people transition well.

The importance of families in the transition process, and that families should be even more involved than they currently are. Although the ADF currently considers families as part of the transition process, some participants highlighted that families should be involved in the transition process together with the ADF member, otherwise they do not always receive all of the information they need before, during and after the transition process. The National Welfare Coordination Centre was cited as an example of a service for families that the ADF member needs to opt into.

• Fulfilling and rewarding employment, where skills are acknowledged and used, can facilitate smoother transition into civilian life and alleviate financial stressors.
• The impact of the current job market on veterans who are transitioning, noting that it has been more challenging for ex-members to find work for the last 20 years.
• The validation of transferrable skills that civilian employers understand and value is critical to improve the employment prospects of transitioning ADF members. Recognition of Prior Learning processes within Defence do not always effectively support this.

• The process to change type of discharge retrospectively is difficult and has an administrative burden with a large volume of paperwork.
• Despite this burden, a large number of individuals do make this change, particularly with respect to a retrospective medical discharge to qualify for DVA support.

• It is important for Defence, DVA, ESOs and VSOs to come together collectively, without an agenda, to focus on how they each play a role in a person’s life.
• The relationship with VSOs and ESOs needs to commence from the day a person joins the ADF, not post-transition, to ensure there is a support network when they leave.
• Awareness of support services leading up to and during transition. ADF members can become institutionalised whilst in the ADF and come to rely on the structure of support services available to them in the military.
• Community veteran support organisations should be allowed to present at transition seminars, stating that the seminars currently provide generic information, which does not assist people to know how to find support or what supports are available to them. 
• The importance of empowering organisations at the grass roots level and the suggestion that achieving change at a national level alone will be ineffective. One participant highlighted that this principle is outlined in the US President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide” (PREVENTS).
• A large number of community veteran support organisations do a large amount of good but that there are challenges with coordination. The community veteran support system in Australia can be fragmented, with many veterans unaware of the supports available to them or how to use these supports.
• ESOs and VSOs may have an understanding of where homeless or at-risk of homelessness veterans are. Privacy issues are preventing DVA from more closely engaging on this. 

• The transition process needs to focus on a ‘wellness approach’, rather than an ‘illness approach’. For example it was suggested there could be a greater focus on wellbeing when accessing services and transitioning, rather than needing to be ill or injured to access most services.
  • This approach is also evident in Defence discharging a person if they are not fit for service.
• Similarly, there needs to be a greater focus on “reablement” rather than rehabilitation. Reablement recognises that people may not return to peak functioning, but instead strive for a new level of functioning to maximise participation in the community. It was suggested that the Gold Card does not promote the idea of reablement, but instead focuses on impairment or disability. It was also noted that the ambition and drive that leads people join the ADF should be a focus for those who are leaving the ADF.
• The need to encourage self-worth throughout the transition period, specifically in ex-serving personnel aged between 20 and 30 years. Ex-serving personnel often experience a significant reduction in self-worth whilst transitioning, especially those who have been medically discharged.

• Difficulties accessing mental health supports when they are needed, including:
  • Being unable to access support as soon as a person needs help. While there are positive experiences in accessing support through Open Arms, the waiting list for support is long and not enough practitioners are available to provide the support. An example was provided of a widow having to get a second job to afford to pay for private counselling sessions. It was also suggested that the support provided by Open Arms should be increased at times of heightened risk, such as periods of likely increases in alcohol and drug consumption on Friday and Saturday evenings.
  • Lack of local mental health and wellbeing supports and services, particularly in smaller jurisdictions or regional areas. Many people have to travel to access mental health services including, for some, travelling interstate. This can remove people from their support networks or be prohibitively expensive.
  • The person themselves may be a barrier due to a reluctance to ask for help.
  • Those who join the ADF from a young age may lack the necessary skills and knowledge to locate supports and services once they transition from the ADF, which can be amplified if a person is involuntarily discharged and has not planned for their transition.
  • Veterans may also hold rigid beliefs around mental health and medication, which may prompt some distrust of practitioners.
• DVA now issues a White Card and creates a file for all serving members when they commence in the ADF. However, while all White Card holders can access free treatment for any mental health conditions, there are difficulties finding practitioners to provide the free mental health support available through the White Card.  The majority of veteran needs are addressed by the private system as public system has a very limited capacity to deal with veterans and service-related conditions. This lack of skilled practitioners has been attributed to the significantly lower rates of remuneration provided by DVA compared to amounts received by practitioners seeing community clients in private practice.  This dis-incentivises engagement with the veteran community. As a result, practitioners in this space are usually young, inexperienced and/or under skilled.  It was noted that DVA is about to increase their rates.
  • Although the public system is effective at dealing with crisis patients, it is under-resourced to address the psychosocial stressors or complex PTSD often experienced by veterans.
• Other concerns raised with the White Card include it being specific to particular conditions. This is problematic, particularly for veterans in chronic pain who, for example, may not be able to get an x-ray if it’s not for their specific recognised condition.
• The need to provide support to all veterans, and not just those who have an injury or illness that is covered by a compensation payment. There should be follow up care or check-ins for veterans who discharge without seeking assistance through DVA, as issues may emerge later or not be initially disclosed.
• The need for veteran specific services, similar to those that used to exist after the Vietnam War. The privatisation of these services has resulted in minimal facilities available specifically for veterans. Civilian providers may also not have an understanding of deployment or the experiences of veterans.
• Care provided by Defence when medically discharging is of good quality, including the use of holistic multi-disciplinary teams. This care is often better than what is accessed through the civilian public health system.
• The COVID-19 pandemic meant that supports have been often moved online. Many individuals have adapted to this online environment and further online service provision could be considered. This may be particularly beneficial to reach remote clients with lower access to face-to-face supports.
  • However, online services should not replace in-person support, as it is more difficult to develop virtual clinical relationships.

• The importance of early intervention – not relying on an individual recognising they need help and then seeking it, but instead intervening early to prevent mental health problems arising. Individuals often do not recognise that they need help, but rather their families or friends identify that they are having difficulties and encourage them to access support.
• An emphasis on mental health and proactive support should begin during the recruitment process, including emotional intelligence training incorporated into both recruitment and general ADF training. Efforts should be made to ensure people are equipped with the skills they need to cope before commencing in the ADF. Similarly, perhaps ADF psychologists should be required to have experience of military service, to ensure they understand what ADF employment involves.
• There can be considerable variations in the diagnostic and screening thresholds for ADF mental health services compared to those in the general population, including mental health providers funded by the ADF. For example, different mental health screening tools in use and some practitioners categorising risk differently (for example, classifying a person as being at low risk of suicide when they are actually high risk).

• There is persistent fear among serving ADF members about asking for mental health support due to perceived stigma associated with mental ill health and mental illness, as they are concerned it will have a negative impact on their career. This is also particularly relevant for those who hope to move into the reserve forces.  Participants indicated that this stigma is prominent throughout the ADF chain of command. The ADF needs to proactively ensure that serving members are provided with the support they need throughout their ADF career and into transition.
• There are further disincentives to report mental health issues as it may be seen that officers cannot appropriately manage their soldiers. In addition, older ADF members may find it difficult to raise issues (especially family issues) with young officers, who may be recent university graduates without much life experience.
• There can be a disconnect between officers and soldiers. This is a change from the team environment of decades past. Off-base, separate living may contribute to this.
• Stigma associated with mental ill health may be reduced when accessing telehealth services, which are increasingly supported through Medicare.
• Some participants suggested that injured and unwell personnel can be placed in ‘holding units’, with the leaders of such units sometimes assigned to these roles due to under-performance. These units often don’t provide an appropriate environment for recovery and can lead to members feeling ostracised.
• Some individuals’ experience of the public healthcare system is that it is only willing to treat patients who are passive and accepting of help. This is not always conducive towards assisting veterans experiencing a mental health crisis, who may act aggressively or refuse help.

• The need for continuity of care when a person discharges from the ADF.
  • There may be a correlation between deaths by suicide and ‘doctor-shopping’.
  • Suggestions to address this included that Defence develop a care plan for the transitioning member that would be available on My Health Record; providing medical care through the same practitioners for both Defence and DVA-funded services; and producing a manual for physicians to support treatment of veterans (based on the Canadian model).

• Many Defence Force families experience stress and dysfunction.
• When ADF families are not co-located, they miss out on support of the ADF community, particularly from other ADF families. 
• Following the death of a serving member, families may also experience isolation from the ADF community and often struggle to access immediate care in crisis situations.
• Partners of members who have died in duty may not be aware of the payments and services they are eligible for or can access. There needs to be a greater focus on informing and supporting war widows throughout this process.

• Presence of various different ESOs and lack of coordination between ESOs can make it difficult for veterans to navigate these services. Participants emphasised the need for ESOs to work together and not duplicate services, with a suggestion this could be achieved through a peak body. Veteran-specific support services also need to be integrated with mainstream services. Additionally, funding mechanisms for ESOs need to be reformed to ensure longer term planning and sustainability in their advocacy and wellbeing supports.
  • There is a large number of ESOs, and sometimes agencies such as the Defence Community Organisation and Joint Transition Authority may not be aware of them all.
• Some participants discussed and supported the idea of a Charter governing ESOs. The Charter would outline the services that community organisations can provide, while also providing visibility of the support that the organisations provide to veterans.
  • ESOs are poorly regulated. Any issues with organisational governance may therefore be unchecked.
• Current serving members and families are not necessarily aware that ESOs do not only support veterans. In addition, some people may not be aware that ESOs will assist any veteran, not just those who are a member or part of that ESO. It was suggested this could be addressed through clearer, more inclusive language.

• There are a number of innovative and holistic veteran programs emerging, including those incorporating, for example; live in elements, treks, engagement with veterans in other countries and equine or k9 therapies, however, DVA funding does not support these types of approaches.  The DVA funding model is not able to respond adequately to emerging evidence-based approached.

• The complexity of various compensation legislation, including varying levels of support and entitlements depending on which legislation covers their claim. There is a need to reduce the complexity of the system so people do not require advocates and additional supports to assist them to making a claim. Additionally, participants noted the complexity and challenges reservists face when making a claim – for example, because of paucity of records.
• The steps DVA has taken to streamline their claims processes, with participants noting many claim applications can now be completed online. However, some claim application processes are still complex. The uptake of the online application process means that there is a need for additional delegates in DVA to process the claims, and pushing veterans to use an online system without an advocate may also be problematic.
  • The improved ease of making a claim, and the increase in awareness of DVA compensation has increased the backlog of DVA claims.
• The online My Service portal experience could be improved as it is currently not intuitive and there is a lack of information to guide individuals when putting in a claim.
• ESOs may be contributing to difficulties in attempts to streamline or simplify the compensation schemes, as ESOs fight over keeping every benefit across every Act. As these entitlements vary greatly, it may be too hard or too expensive for DVA or the Government to simplify the legislation and keep every entitlement.
• Some participants feel that DVA pays lip service to advice provided to them by ESOs.
• The experience under Veterans’ Entitlements Act 1986 (VEA) was relatively simple compared to contemporary veterans that may be looked after by 4 different areas in DVA which do not talk to each other. An example was provided of a veteran being required to undergo 3 ‘whole of body’ assessments in a short timeframe as the different areas were using slightly different forms.
• General practitioners and other doctors can be intimidated by the complexity of DVA forms. Some participants highlighted the need to educate medical practitioners on how they can make money from DVA by providing services to veterans and others indicated that once they know the system it’s not that difficult.
• The claims system could be improved by linking it with health records so that individuals do not need to repeatedly prove their condition. Individuals would have to consent to this sharing of information.
• Not many veterans complete their service without some sort of injury, and this needs to be reflected in simplified processing where possible.

• The current backlog of DVA claims yet to be processed has a negative effect on veterans.  Many participants raised the impact of delays in having claims processed or even being assigned a delegate. Participants also noted that there was no follow up to ensure veteran’s welfare during delays. It was suggested that claims could be fast-tracked for approval once they meet particular thresholds, some claims could be automatically accepted by DVA, or veterans could automatically receive a basic income while waiting for claims to be processed. Participants noted that DVA needs to accept that in order to accelerate the payment of claims, there will be a risk that some payments may be made where there is no entitlement.  Some participants also noted that delay is not always the case and some claims are processed quickly.
• Advocates require trust to efficiently support a veteran, however delays by DVA in processing a claim can strain the relationship between the advocate and the veteran and their family.
• Claimants acting on their own, without an advocate, are often rejected because they do not know how to complete the application correctly, despite otherwise having a legitimate claim.
• The current prioritisation system for DVA claims is not adequate and there is a need to develop an evidence-based triage system for claims that takes account of those at high risk of suicidal behaviours. Advocates effectively manage the triage process by calling DVA and pushing for a claim to be prioritised.
• The suggestion of providing a gold card to all ex-serving members when they discharge to avoid veterans having to ‘fight’ to get one. Alternatively, Defence could continue to provide housing to people while their DVA claim is processed.   
• Minimal information is provided to claimants and obtaining access to DVA can be extremely challenging.
• Claimants should receive their ongoing pay, or a proportion of it, while progressing through their claims process.
• Families bereaved by suicide have to wait for the coronial process to be resolved before they can access support from DVA and apply for probate.
• DVA are understaffed and due to the time it takes to train staff there is not capacity to deal with sudden influx of personnel, such as the return of personnel from Timor, Iraq or Afghanistan.

• The need for DVA to provide assistance and support to veterans in accessing their entitlements in the same way an advocate does, rather than just processing claims. This could be done by assigning case managers to support veterans through their claims process.
• The importance of DVA communicating with veterans in a sensitive manner, rather than just sending letters. It was noted that letters from DVA are generic, insensitive, overly complex and do not offer support to veterans. One participant noted work is being done to review DVA’s letters to make them more compassionate.
  • One suggestion was to write to people waiting for their claims to be progressed to advise that their matter is still progressing and to alert them to other supports that are available.
  • Another suggestion was DVA’s approach of asking for their identification number at the outset may be dehumanising, and asking for their name may be a more sensitive approach. This would also be inclusive for families who may not know a veteran’s identification number.
  • People with claims that are likely to have adverse findings should be provided with advice and guidance for what additional information would be needed for a successful claim, prior to a final decision being made.
• It was also suggested that DVA should employ veterans to conduct face to face engagement with veterans.
• Some participants indicated the experiences for some people receiving the widow pension have been positive.
• Interactions with DVA can create trigger points for suicide, including:
  • feelings of not being recognised;
  • not being believed and having to repeatedly re-tell what has happened, even when a veteran has been medically discharged from DVA; and
  • not being supported by the government body established to help.
• Often ex-service personnel are experiencing significant change and emotional turmoil throughout the transition period, making it challenging to navigate the complexities of DVA’s processes and systems.
• There are not enough staff to deal with claims, and the job that some DVA staff do can be stressful. Training for DVA case coordinators takes time.
• There is mixed feedback about on-base veteran support officers. Some experiences have been that they are collaborative and work well with clients. Others indicate they have not been helpful.
• Defence’s process prior to 2017 was disproportionately focused on administration and process, provided limited support to anyone serving less than 12 years, focused almost exclusively on the date of transition and largely excluded families. This left some ADF members without crucial supports during their transition, which contributed to feelings of abandonment and betrayal.

• There should be changes to improve advocacy for veterans. The Veterans’ Review Board does not allow legally trained representatives to advocate for veterans.  
• Advocates are often not adequately trained and there is limited training available in different parts of Australia. Further, as much of the advocacy work relies heavily on volunteers, it was suggested that advocates should be professionalised and funded by an agency that is also able to provide oversight to support quality and consistency, in a way similar to legal aid. Advocates should also be paid.
• The Advocacy Training and Development Program is too rigid. There is a reliance on organisations providing mentorship and training but it is not possible to have an un-paid advocate and a paid advocate who do the same role in an organisation. Training advocates requires a financial investment and it is difficult to access grants for this.
• There should be an increase in the number of on-base advocacy services to assist individuals in putting in claims at the time of an injury.

• Negative perceptions of DVA can dissuade people from making claims. Barriers include:
  • perceived backlog of claims acting as a deterrent for people engaging with DVA;
  • the complexity of DVA and the various legislation surrounding DVA;
  • DVA being seen as a service for older people;
  • lack of trust towards DVA;
  • having a claim rejected by DVA; and
  • the impact a DVA claim may have on a person’s Reserve service.

• All DVA claims should be finalised before a person discharges. Participants noted that while ADF members are still serving, they can access supports and are surrounded by friends and family who can help them, whereas there can be uncertainty and other stressors once a person discharges, which can be exacerbated by an unresolved DVA claim, especially if you are already struggling with mental health issues.
• Many mental health disorders acquired in the ADF are not being recognised – including major depressive disorder, anxiety and even bi-polar.  When people are being medically discharged their mental health conditions are not always being correctly diagnosed. This pushes a person towards needing to satisfy the DVA points system for them to receive a Gold Card.

• The need to extend the timeframe to appeal a DVA claim decision, as the claimant is often required to obtain further medical evidence and attend medical appointments to substantiate the appeal.
• Veterans are regularly receiving notifications indicating that they owe money due to recalculations under the Military Rehabilitation and Compensation Act 2004 (MRCA) people are regularly receiving notification about recalculations, which can exacerbate stress.

• DVA have made changes in the last few years to improve their systems. Some participants commented that these changes have had a positive effect.
• There has been improvements made to the conditions that can be fast tracked by DVA for processing. This has been informed by research that has modelled typical impairments experienced at different career stages.  However, Defence Standing Operating Procedures should be better aligned with this research.

• Veteran’s receiving lump sum compensation payments should be offered financial services to assist with using funds sustainably and managing money effectively.
• Participants noted that there can also be significant deductions in veteran compensation payments due to the provision of child support.
• Some suicide deaths do not involve mental health issues. Issues can arise from a lack of financial security. Issues can often be addressed through immediate support at the time of crisis.
• The DVA process can incentivise an ‘illness’ over ‘wellness’ approach and can penalise people for trying to move forward. The Gold Card becomes the goal, rather than wellness. Individuals choose not to do volunteer work or paid employment because it affects their invalidity pensions. There is personal risk associated with making these decisions due to effects on housing, loans and other financial matters.
• The Commonwealth Superannuation Corporation has an important role in providing financial security to veterans, particularly over the long-term.
• Participants raised the different treatment of compensation following a 2007 High Court decision as an issue for some veterans.

• Rebranding to Open Arms from the previous Vietnam Veterans Counselling Service was a positive achievement.
• Open Arms should be independent from DVA – for example, it could be established as an independent body like the Australian War Memorial.

• A large number of recommendations have been made over the last decade which have not been implemented. It was suggested that conducting further inquiries would be a waste of time and money.

• Suicide of ADF members and veterans is not purely a mental health problem, but rather a complex array of issues across mental health, physical health, identity, and many other factors.  There is a significant increase in suicide risk of young male veterans, however other cohorts such as Vietnam veterans also need to be considered.
• A high proportion of veterans (almost 1 in 2) that meet the criteria for a mental health condition in the year following discharge.
• In NSW, only 15% of those who died by suicide had been admitted with a mental health condition in the previous 3 years.
• Some participants noted that veteran suicide deaths may be due to acute life challenges, not just mental health conditions. Other participants noted many mental health concerns may be undiagnosed and not fully managed.
• There has been an improvement in the level of mental health awareness in Defence.
• It was noted that the suicide rate for those in Defence is 50% lower than the general community, so the question is why or how Defence is a protective factor, and why this is not translated when a person leaves service.
• A realistic goal for veteran suicide is for it to be similar to the national average. Zero suicides is an unrealistic goal. Changes will take time and will require patience and financial commitment.
• The need to correctly identify the cause of mental health problems - for example, distinguishing between symptoms of a mental health condition from those induced by a physical injury (for example, post-concussive syndrome or musculoskeletal injuries leading to that PTSD). Noting that not all mental health issues relate to traumatic events.  It was also noted that PTSD has a strong biological component. Some people, irrespective of whether they are in the ADF, police or other situation, will be more prone to PTSD.
• Veterans struggling with mental ill-health often need an incentive to integrate into society, however, can find this difficult if they are having financial problems. For example, they may be unable to join a gym/sporting venue due to financial concerns.
• Suicide prevention efforts should encompass a spectrum of approaches, but the focus should be on what can be done early on. It will always be the case that it will be difficult to reach some people.
• The importance of understanding ‘moral injury’, with research showing a correlation between moral injury and suicidality. Some participants suggested the correlation between moral injury and suicide is significantly higher than PTSD and suicide.
• Veterans, families and partners need to be educated in the identification of PTSD and related mental health symptoms to enable better support, particularly the difference between adaptive or normal responses and abnormal or pathological responses to traumatic events. It was reported ex-service personnel often don’t identify when they are experiencing symptom of PTSD or other psychopathologies. This may also be attributed to a lack of understanding about what is considered a ‘normal’ response to trauma. Training in this area could be highly beneficial for both the veteran and broader community.
• Relevant research including:
  • Findings around the proportion of ADF members and veterans developing bipolar disorder, and an increased risk of suicidality. It was noted that research on early intervention and treatment of bipolar disorder with lithium has been shown to decrease suicide rates.
  • US research which suggests that countries with higher rates of antidepressant prescriptions have lower suicide rates.
• Substance abuse and alcohol culture in the ADF were raised as significant issues, which can result in people who are experiencing distress or physical pain, self-medicating with large amounts of alcohol, ultimately exacerbating the problem.
• One participant noted the impact of societal changes over time on the resilience of all members of our communities, suggesting rates of mental health issues have progressively increased, while another noted there is not necessarily a greater prevalence of mental health issues now than in the past. Modern society is characterised by greater mental health literacy, allowing for better identification, recognition and treatment of mental health conditions.
• There is a long way to go in improving the efficacy of mental health treatment. Even for ‘gold-standard’ treatments such as exposure therapy there is a substantial proportion of individuals who do not improve or get worse.
• Several participants noted religious beliefs and spirituality are protective factors against suicide. This is attributed to beliefs in a higher power and also the social network and connectivity provided by membership of religious group. However, one participant noted there are also negative emotions associated with a strong religious support focus, including potential for increased shame and guilt.
  • The ADF padres are an example of religious support that can have a positive impact on wellbeing. Padres engage with members and sit outside of their chain of command. Padres have a role to play in mental health and suicide prevention, but it may take some time for any effects of emphasising the role of padres to be observed.
• Participants raised suicide risks arising from a history of childhood abuse and trauma.

• The Australian Institute of Health and Welfare record of deaths by suicide is incomplete and does not capture all deaths, for example deaths by suicide of Vietnam veterans and single car accidents are not captured. There was also discussion about whether the suicide rate is changing and a suggestion that there is a broader suicide pandemic.
• NSW Health holds relevant data indicators but information on veteran status is lacking.
• One positive development is that veteran status will be included as a Census question in the future.
• Commonwealth Superannuation Corporation payment data provide insight into the number of veterans retrospectively medically discharging.
• The Australian Institute for Suicide Research and Prevention (AISRAP) holds a suicide register which includes 270 variables, allowing for comparison of risk factors in both the Australian population to veterans. From 1990-2019, there was a total of 283 Defence and veteran suicides:
• life events which most commonly occur prior to death by suicide include relationship separation and conflict, work related problems and mental health diagnosis;
• involuntary, primarily medical discharge, is associated with significantly higher rate of suicide in the ex-service demographic; and
• A large percentage of both serving and ex-serving members who have died by suicide have a diagnosis of depression, anxiety or PTSD prior to their death.
• According to this research, substance abuse disorder was not a large risk factor for current serving, but was for ex-serving personnel.

• The ADF provides integrated support – chaplains, doctors and nurses, however, DVA has not been willing to adopt this model.  This was contrasted with the US Department of Veterans Affairs, which has thousands of veteran chaplains.
• Government initiatives to manage medical discharge need to be closely considered to ensure an appropriate response.

• The experience of reservists is important.  Many reservists are very active, including participation in overseas deployments and civil operations. Reservists are also exposed to trauma, but are typically less well versed in DVA processes and may not understand that they could qualify for support.

• Participants suggested there is consideration given to deployments, and its impact on suicide rates. The deployments were described by the participant as often 3 months in length and served concurrently or in quick succession. It was also noted that more should be done to support a serving member coming back from deployment to re-adjust to life at home.

Language used in relation to veteran suicide can further perpetuate stigmatisation with ‘battlefield-like’ terminology inhibiting recovery. There is a need to instead recognise struggles and mental illness for what it is.   

• One participant suggested the Office of the National Commissioner has the opportunity to enhance public understanding of the terminology around mental health and suicide to address both positive and negative manifestations of stigma. It is important to define ‘mental health’ and ‘mental illness’ and communicate that these are not mutually exclusive, as you can be ‘mentally healthy’ despite having a diagnosed mental illness.

• Veterans are using social media to seek advice, which can be problematic if the answers are incorrect.  It was also noted that encouraging a sense of entitlement among veterans was not helpful.
• Some social media pages established for people to discuss DVA have become toxic and negative platforms, which can contribute to mental ill-health.

• Since serving and ex-serving members’ experiences differ greatly, they should be treated differently – for example, recognising that people who served in Vietnam may have different needs than those who served in Afghanistan. Similarly, there needs to be a greater understanding of younger veterans’ needs compared to older veterans.

• There appears to be a correlation between transition out of the ADF and an increased likelihood of relationship breakdown and the need for data to be obtained in relation to this.
• Some participants discussed whether the inclusion of gambling machines within Returned Services Leagues clubs contributes to unhealthy gambling among veterans.
• Issues with how the justice system interacts with veterans, including:
  • female veterans are disproportionately represented in the Victorian prison system;
  • often veterans within the prison system suffer from traumatic brain injuries; and
  • police are often uneducated on how to interact with veterans, which can lead to escalated encounters if veterans perceive police as a threat.
• A study is currently being undertaken to understand how many veterans are currently incarcerated and the reasons for their imprisonment (for example, if their service contributed to criminal behaviour). Better support should be provided to veterans who are incarcerated.
• Key drivers of veteran homelessness and suicide include financial pressures, substance abuse, marriage or family unit breakdown and mental health issues. Homelessness is also a predictor of suicide.

• The issues that exist in the veteran health and wellbeing service space also exist in general services, including fragmented systems, delays in access, lack of clinicians, and siloed or isolated services.
• Limitations and pressures on medical infrastructure are not unique to veterans with ongoing pressures on the public health system across all spectrums. It was noted there is a time in suicidal crisis when acute containment of risk is required, beds for which are limited.
• The need to identify ex-serving members who are receiving care within civilian hospitals and other medical services to deliver more tailored support.
  • Veteran liaison officers within the hospital system could assist by informing vulnerable individuals about how to access the services available.
  • One idea is to have a number of key hospitals that are able to take in veterans in-crisis immediately. Certain clinicians in key hospitals could be specifically trained in veteran issues.
• Veterans often receive a different response to suicide than community patients. Police and emergency response staff have pre-conceived notions about the term veteran and the risk associated with this population. Subsequently, responses are often more risk averse toward those in veteran community relative to the general population. 
  • One participant recommended training for emergency response personnel (i.e., police and ambulance) to support veterans. There is an opportunity to provide direct links to suicide crisis support services which deal with psychosocial stress as opposed to adopting a more ‘blunt’ approach such as conducting a welfare check or taking patients to the emergency room. 
• The public health system is ill-equipped to deal with veterans and service-related conditions. An example provided was that the health system is only willing to treat people who are passive and accepting of help, whereas sometimes veterans requiring health act aggressively and are refused treatment.

• Privacy protections under the Privacy Act 1988 negatively impact certain information sharing processes. For example, privacy restrictions were cited as an impediment to ex-service organisations (ESOs) being able to assist veterans to access their entitlements. Examples were also provided of privacy restrictions impeding the ability of the ADF to communicate with families directly, despite many families welcoming the opportunity to be contacted and kept apprised of key information. Another example was state health systems (e.g. hospitals) not applying privacy laws appropriately and refusing to provide information to advocates trying to support their veteran clients.

Issues were raised in relation to the handling of the ‘Brereton Report’ (the Inspector-General of the ADF Afghanistan Inquiry), including:

• short timeframes provided to ADF members when responding to administrative inquiries;
• inadequate legal representation for ADF members;
• loss of entitlements for those who leave the ADF as a result of the administrative inquiry;
• whether an administrative inquiry is needed when there are alleged criminal processes underway;
• difficulty in people responding to a notice to show cause when responding could expose a person to matters subject to criminal inquiry;
• ostracism and negative public sentiment towards ADF members and their families; and
• the risk of increased deaths by suicide due to the handling of the Brereton Report.

Some participants made suggestions for the operation of the Office of the National Commissioner for Defence and Veteran Suicide Prevention, including:

• the need to have a mental health practitioner on staff to guide supports and review the evidence provided
• the need to gather solid data, particularly noting the difficulties in identifying a person who died by suicide as a veteran to include them within the National Commissioner’s inquiries
• the importance of the National Commissioner providing statistical data regarding suicides
• importance of engaging academics, including those voices who may be considered more controversial
• the need to provide multiple avenues for people to give evidence, which should be driven by the needs of families and the bereaved. However, also need to allow for the open and transparent investigation of organisations
• engaging with younger or contemporary veterans. Some participants raised concern that younger veterans have established new organisations to address issues relevant to their demographic. This may change the ESO make-up over time with existing organisations unable to maintain their memberships.

• Australian War Widows
• Council for Women and Families United by Defence Service
• Defence Families of Australia
• Defence Force Welfare Association
• RSL, Australian Capital Territory Branch

• Australian Veteran Alliance
• Council for Women and Families United by Defence Service
• Defence Force Welfare Association
• Gallipoli Medical Research Foundation
• Mates4Mates
• Vietnam Veterans Association of Australia, Queensland Branch
• Solider On
• The Warrior’s Return
• RSL, Queensland Branch

• Air Force Association
• Carry On Victoria
• Hawthorn RSL
• RSL, Victorian Branch
• The Australian Federation of Totally and Permanently Incapacitated Ex-Servicemen and Women West Australian Branch
• Victoria Vietnam Veterans Association of Australia
• Victorian Defence Reserves Association

• Australian Special Air Service Association
• Defence Force Welfare Association, Western Australia Branch
• Legacy WA
• RSL, Western Australia Branch
• Vietnam Veterans Association of Australia
• Vietnam Veterans Association of Australia, Western Australia Branch

• Australian Peacekeeper & Peacemaker Veterans’ Association
• Australian War Widows NSW
• Council for Women and Families United by Defence Service
• Defence Reserves Association
• Disaster Relief Australia
• Legacy Australia
• Vietnam Veterans Association of Australia, New South Wales Branch
• Voice of a Veteran

• Vietnam Veterans Association of Australia
• Townsville RSL
• The Oasis Townsville
• RSL, Queensland Branch
• Totally and Permanently Disabled Ex Servicepersons Association
• Women’s Veterans Network Australia
• Hounds 4 Healing

• Australian War Widows, Queensland and Townsville Sub-Branch
• Royal Australian Air Force (RAAF) Association Queensland Division, Townsville Branch
• The Oasis Townsville
• Townsville Suicide Prevention Network
• National Servicemen’s Association of Australia QLD Inc.
• Legacy
• Mates4Mates
• 2RAR Association
• Veterans Support Centre North Queensland Inc.

• Defence Force Welfare Association
• 4 Aussie Heroes Foundation Ltd
• Survive to Thrive Nation
• Veterans Care
• 6RAR Association
• Timor Awakening
• Veterans and Emergency Services Personnel Mental Health Network Committee, RANZCP

• Australian War Widows
• Stand Tall for PTS
• Red Shield Defence Services
• Trojans Trek Foundation
• Veterans and Emergency Services Personnel Mental Health Network Committee, RANZCP
• Gallipoli Medical Research Foundation
• Toowong Private Hospital
• REDSIX
• Bravery Trust
• Wounded Heroes

• RSL National
• RSL, Tasmanian Branch
• The Partners of Veterans Association of Australian Inc.
• University of Tasmania
• Australian Federation of Totally and Permanently Incapacitated Ex Servicemen and Women Ltd.
• Vietnam Veterans Association, Tasmanian Branch
• Naval Association of Australia
• Tasmanian Regional Support Chaplains

• Ex-Military Rehabilitation Centre Inc
• Flinders University
• Legacy – South Australia and Broken Hill
• Military chaplains
• Military and Emergency Services Health Australia
• University of Adelaide
• Veterans' Advisory Council South Australia
• Vietnam Veterans Association of Australia, South Australia Branch

• Flinders University
• Defence Force Welfare Association
• Partners of Veterans Association of Australia Inc
• Phoenix Australia
• Royal Australian Army Regiment Association
• RSL South Australia and Northern Territory

• Military Historian
• University of Sydney
• Modern Soldier
• Wounded Heroes
• RSL Life Care

• Reeling Veterans
• Veterans Australia NT
• Council of Australian Veterans
• Soldier On
• Mates4Mates, Northern Territory