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Estimates: Mental Health, PTSD & the needs of veterans' families

Foreign Affairs, Defence and Trade Legislation Committee
Wednesday 17 October 2012

Department of Veterans' Affairs

Senator WRIGHT: I have some questions in relation to mental health and also Vietnam nurses' entitlement and the Women's Land Army, if that helps you work out who is going to be needed. I am going to start off with some questions about mental health and PTSD, relating to veterans that served in current and ongoing conflicts and the changing nature of their mental health needs compared with veterans from previous conflicts. I am interested in what work the department has been doing in that area.

First of all, I am going to ask if you can provide details of research into PTSD or any other mental health effects of combat or military service that is currently being undertaken, conducted or commissioned by DVA or any other government body?

Ms Daniel: We run a number of research programs. We run what is called the Applied Research Program, which conducts a range of research programs. We also fund ACPMH, the Australian Centre for Posttraumatic Mental Health, and the Centre for Military and Veterans' Health. Through all of those channels, we have conducted a reasonably extensive program of research, program evaluation, investigative research and innovative development. We could take you through some of the details of the specifics of some of those research activities if you wished.

Senator WRIGHT: Yes; if you would not mind doing that briefly, I would appreciate that. Then, could you direct me to where else I could get further information.

Ms Daniel: I have just looked very quickly at applied research projects related to mental health and post-traumatic stress disorder. We funded ACPMH to do a project on gender differences in mental health among military personnel and veterans-a review of the literature. That is under contract negotiation. We have a current project with ACPMH on a meta-analysis of gender difference in post-traumatic stress disorder treatment outcomes. We have looked at depression in Australian Gulf War veterans; we have done that through Monash and the Murdoch Childrens Research Institute. We have done a systematic review of psychological disorder, multi- symptom disorder and chronic fatigue for the Gulf War, Iraq War and Afghanistan with Monash. We have a current project with CMVH around a comparison of DVA clients, ADF members and the general populations' responses to the 2007 National Survey of Mental Health and Wellbeing. We have done some research work with ACPMH on CBCS and the cognitive processing therapy. We have done a literature review of static load-and I am reading a full list here for you. We have done a literature review with CNVH around NTBI. We have done a project on the long term outcomes for CBCS centre based counselling; I think we mentioned this last time that CNVH evaluated our post-traumatic stress disorder group treatment program. We undertook a review of Operation Life workshops through Griffith University. We have done some work around dementia and PTSD with the University of Melbourne. We have a current project-another one-on Gulf war veterans; and, obviously, the study which we mentioned in response to your question on notice about suicide; a complete project-and I will not go right back-but-

Senator WRIGHT: So how far back have you gone at this stage, Ms Daniel? Have you gone back in chronological order? Is that pretty much how it has been?

Ms Daniel: My list started with our current projects.

Senator WRIGHT: And you have worked backwards then? Where did you get to in terms of time, chronology?

Ms Daniel: I do not have the dates on me.

Senator WRIGHT: That is fine.

Ms Daniel: If it was helpful to you, we can summarise that list for you on notice.

Senator WRIGHT: That would be very good. Thank you very much.

Ms Daniel: Just the names of the projects that are current and complete, back for a certain period.

Senator WRIGHT: That would be good, thank you very much. Perhaps for a period of 10 years would be good. How fare did you go? I am not sure.

Ms Daniel: Two or three years is more than is necessary.

Senator WRIGHT: Thank you. I am interested now in exploring, given the changing nature of warfare and the difference in the social context of current deployments, does the department have data on the anticipated mental health impacts of service personnel returning from recent conflict zones like Afghanistan or Iraq, including but not limited to the expected rate of mental illness and the differences in type and prevalence of mental ill health conditions compared with previous service or conflicts, and any other relevant matters. In a sense, someway of starting to have an overview of the prevalence of and differences in the conditions that current veterans might be experiencing?

Ms Daniel: I might make a couple of general comments and then, depending on your interest, ask Dr Stephanie Hodson to talk a little about the prevalence study. We have, and we did not have previously, obviously, the extensive study that Defence has undertaken on the prevalence of mental health conditions in the current forces. We are looking at that in terms of what it might mean for future demands for the department. Obviously, we have looked too at what has happened with historical patterns, for example, Vietnam. Stephanie was part of the research team for that prevalence study so, if it was of interest to you, she could talk you through some of the key findings that are relevant to us.

Senator WRIGHT: I am just conscious of the time that I have available. I would like to hear from you in person, Dr Hodson, but I think maybe it might be better to take that question on notice, if that would be all right, because I have a few things I need to get through. Following from that line of questioning, I suppose again, trying to get a sense of if and how conditions are changing because of changing circumstances and patterns of deployment. This is an issue that has been raised with me by veterans and also by partners and families of veterans, particularly-interestingly-by partners of Vietnam veterans who are looking on at the changing conditions for veterans of current conflicts and how it compares with what their partners experienced. I am interested in knowing the extent to which the department may be developing new types of mental health programs or strategies or, in fact, pre-exposure-to-conflict programs as a means of preparing veterans for what they may experience, in response to the different needs of veterans who have served in more recent conflicts. Is the department also developing any new programs to respond to the needs of veterans' families?

Ms Daniel: Preparing for the mental health issues that we anticipate we will face with the drawdown from Afghanistan is a very high priority for the department. Within my division, in the restructure that we undertook in March-and I may have mentioned this before-we established a mental and social health branch which gives us our capacity. That branch, in consultation with the broader department, is undertaking a number of activities. We are reviewing our mental health strategy. The last time a full mental health strategy was undertaken and completed was in 2001. That is important and high-level focused work.

At the same time, we have a range of activities that look at our particular programs and how our service response will deal better with what might be the differing needs of the contemporary cohort. Along the continuum, from awareness raising, population health activities to our PTSD program, which is an in-patient program for those needing that level of PTSD treatment, we are looking at our service offering in terms of where it may need to change or adapt for the contemporary cohort. The differing nature of family support, the need for availability of services more out of hours and recognising the growing importance of females in our treatment population are all issues that are on our agenda.

Senator WRIGHT: I am also interested in the mental health services being offered to former Army Reserve personnel and their families. Could you advise whether former Army Reserve personnel and their families have access to the same mental health programs offered through DVA to regular veterans, including but not limited to the VVCS, primary care and specialist services offered through general practitioners, private psychologists and consultants psychiatrists, and operation life?

Mr Carmody: Former members of the ADF and former reservists with operational service will have access to the Veterans and Veterans Families Counselling Service. Ms Daniel might add to this, but there are also other programs. If they have clinical diagnosis for an accepted mental health condition, they would obviously have access to treatment.

Senator WRIGHT: Do they have access to treatment through DVA? Does there have to be any kind of nexus or link between the diagnosis and their association with the Army Reserve?

Mr Carmody: My understanding-and my colleagues might confirm this for members of the Army Reserve-is that it is certainly for those who did regular service.

Senator WRIGHT: I am more interested now because I am pretty much aware of what is available for regular service personnel, but is there a differentiation between those and those in the Army Reserve?

Mr Carmody: I would have to take it on notice, unless my colleagues are aware.

Mr Campbell: If you mean 'a differentiation', as Mr Carmody said, the entitlement for a lot of services flows from deployment, as in the VVCS, to operational service or from an accepted condition. If there are two individuals, one who has served full-time and one who is a reservist but has had full-time deployment, then they are exactly the same. It really flows from deployment and eligibility for things like the VVCS and accepted conditions.

Senator WRIGHT: That helps clarify it. I was generally asking about whether there are any particular issues.

Mr Campbell: If I could add, though, because the number of questions you have asked also go to Defence. While a person is still in uniform Defence are to provide the service. I think an issue that is of great concern to ourselves, to Defence and to the individual concerned is that when reservists go back into the community. So they are reservists, they then go on to full-time duty, get deployed, then come back and go back into the community. That is certainly an issue that I think we all need to do quite a bit of work on, and I think that might have been underpinning a bit of your question.

Senator WRIGHT: It may well have. In fact, that was an issue that has been raised with the by reservists about the lack of buffer time between deployment and, for me, the unimaginable experiences that they have been having, and returning to civilian life with almost no buffer there. If you can provide any information about that issue, that would be helpful.

Mr Campbell: I think in those circumstances, I think that would be better from Defence. I know that they were on earlier today. Defence have been embarking on quite an extensive strategy for services to our reservists, and they are changing how they are doing it. The two-star who is in charge of that has got quite an extensive program of reform in front of him.

Senator WRIGHT: Thank you for that. I will look into that one in more detail.

Let me turn now to the Vietnam nurses entitlements. My questions related to Australian volunteer nursing staff who served on civilian surgical units under the banner of the South-East Asia Treaty Organisation-SEATO. Can you please advise what treatment or benefits and support these nurses are entitled to under the Veterans' Entitlements Act for physical and mental illnesses resulting from their service in the Vietnam War?

Mr Farrelly: The SEATO nurses are covered by the Safety, Rehabilitation and Compensation Act rather than the VEA.

Senator WRIGHT: Would that be encompassed under the Comcare system?

Mr Farrelly: Yes.

Senator WRIGHT: I understand there is a provision under the Veterans' Entitlements Act which allows the act to be applied to civilians. So I would be interested to know why it does not apply to the civilian volunteers who served through SEATO?

Mr Farrelly: The distinction is that the civilians need to be under military command, and the SEATO nurses were not under military command.

Senator WRIGHT: Would that preclude that discretion being applied at all or is that just a policy?

Mr Farrelly: No.

Senator WRIGHT: Is that a legal requirement under the act?

Mr Farrelly: Yes.

Senator WRIGHT: One of the issues I have had raised with me is that Comcare finishes at 65 and the VEA does not, so there is a discrepancy there. It is not as if there is an automatic covering that is similar.

Mr Farrelly: Notwithstanding that, while incapacity payments do cease at 65, there is access to age pension and so on for those that are in need.

Senator WRIGHT: Are the SEATO nurses, which I will call them to be brief, entitled to any other services or support through DVA?

Mr Farrelly: No.

Senator WRIGHT: I understand that the nurses were not eligible to receive the Australian Active Service Medal. Is that correct?

Mr Farrelly: They now have it.

Senator WRIGHT: They do now have it?

Mr Farrelly: Yes.

Senator WRIGHT: Do you know the date when that changed?

Mr Campbell: It was 1994 or 1996. If I say the mid-90s, I think that is close enough.

Senator WRIGHT: Okay, thank you. Has there been any other recognition of their service by the Australian government.

Mr Farrelly: No, I do not believe so.

Senator WRIGHT: Just for the sake of the record, these were nurses who volunteered for civilian surgical units under the South-East Asia Treaty Organisation in Vietnam, which was a program that was promoted by the Australian government.

Mr Campbell: During all conflicts, including the current conflicts, if a person is not under military command then they are not covered by the military compensation act. We do, for example, have police who are serving in deployed areas that are not covered by the military act. They are covered under SRCA and then their own act through the police. This is not unusual. The decision that has been taken for many years and many conflicts has been that if you are under military command then you are covered by military compensation.

Senator WRIGHT: I appreciate that. It has been raised with me whether it is unusual or not particularly if they were not employed-the police would be employed and covered under their own professional employment conditions, compensation arrangements or whatever-these were civilian volunteers. My understanding from what I have been advised is that some of these women are suffering conditions like post traumatic stress and increased levels of cancer, which are actually quite similar to what some of the veterans are, because they experienced conflict, trauma and so on.

Mr Campbell: In some circumstances police have been covered by the military act, but it depends upon the circumstances on the ground.

Senator WRIGHT: I am interested in exploring more closely what might be available to assist those women. I have questions in a similar vein relating to members of the Australian Women's Land Army who volunteered for service at the request and behest of the government during the Second World War. They are quite elderly women now of course. I understand that members of the Australian Women's Land Army who were recruited by the Australian government to assist the war effort are also not entitled to any medical treatment under the Veterans' Entitlements Act. Can you confirm that that is correct?

Mr Farrelly: That is correct. Again, they were a civilian formation and not part of the armed or defence forces.

Senator WRIGHT: Are they entitled to any other services or support through DVA?

Mr Farrelly: No.

Senator WRIGHT: And for the same reasons I guess you have given in relation to the previous issue I raised with you. Thank you very much.

Mr Farrelly: I believe that the Women's Land Army was recognised by the Prime Minister earlier this year. I do not know the details.

Mr Campbell: If you are interested in that, Ms Cosson can give you more details on that.

Senator WRIGHT: Yes, I would appreciate that.

Major Gen. Cosson: I am aware that Defence actually led a reception to recognise the women's service. The ladies from the Women's Land Army who attended were given a brooch in recognition of their service. DVA played a very minor role in actually supporting that activity and provided a commemorative booklet about the history of the Women's Land Army and contributions to the country.

Senator WRIGHT: Thank you for that.


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