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Estimates: questions relating to Veterans' mental health

Senate Foreign Affairs, Defence and Trade Legislation Committee 
Department of Veterans' Affairs 

20 November, 2013

Senator WRIGHT: I have some brief questions on veterans mental health. I understand the department runs eight veterans-only psychiatric facilities around the country. Is that correct?

Ms Daniel: I think the eight that you are referring to would be the hospitals where the department has contracts for PTSD programs. We have a range of contracts with mental health and hospitals, but eight specific PTSD programs. Dr Killer could tell you more about the history and what those programs do, if that was of interest.

Senator WRIGHT: It may be that it is relevant to hear from Dr Killer. First, I will explain my questioning about that particularly. I think you are right to identify that that is the particular issues in this case. I am interested in knowing the total number of beds in each of the facilities, the average occupation rate, the number of patients treated there each year and the cost of these services over the forward estimates, including the current financial year. Is it possible to give those statistics to me readily now, or is it better to have those taken on notice?

Ms Daniel: We would take that on notice. The PTSD programs are not necessarily an in-patient program, but we can provide you on notice a description of the eight programs and the number of clients who have gone through them in recent years.

Senator WRIGHT: Thank you. Is one of those programs in South Australia at the repat general hospital—ward 18 and 17?

Dr Killer: That is correct. These programs were established a number of years ago in the initial phase following the response to the problems with the Vietnam veterans. We set up the National Centre for Posttraumatic Mental Health, in Melbourne. Then we set up these programs in each of the states. There is one in South Australia, at Daw Park, and in Brisbane and Melbourne et cetera. These programs have been running since that time. Some are in-patient and some are out-patient. The nature of the programs has actually varied over the years. They have been very important in providing comprehensive rehabilitation in the psychiatric area for those veterans with the most difficult psychiatric problems.

These programs are still in place today. In fact they are accredited on a regular basis. We are currently looking at them now in terms of reviewing the content of their programs in view of some of the new innovations that are occurring, particularly coming from the United States, in better programs for looking at individuals with post-traumatic stress disorder.

So the programs are in place. They have been very useful. From memory—this is an approximate figure—we have put about 6,500 veterans through these programs since they were introduced.

Senator WRIGHT: Does the department expect demand for these services to increase as veterans return from deployment in Afghanistan?

Ms Daniel: It is reasonable to expect that we will see some modest increase in demand for programs. As Dr Killer said, we are in the process of looking at the programs to make sure they are truly contemporary.

Dr Killer: I think it is fair to say that we are responding to the mental health challenge in a number of ways. As the minister alluded to, the contemporary—if we call them that—veterans are different from the Vietnam veteran cohort. They communicate with one another differently. They tend to deal with issues online. There is also the important aspect of many of them being interested in self-help programs. So, in addition to the many programs we have in place, both in the community and in the treatment programs in hospitals, we have introduced a range of online self-help programs. There is a wide spectrum of programs now to deal with individuals, from very mild cases of post-traumatic stress disorder to the more difficult cases.

Senator WRIGHT: Your deputy commissioner in Tasmania, Jan Hyde, did a presentation recently that I was privy to. There is a variety of programs there.

Senator Ronaldson: I think we can all get tied up and try to pick numbers—I am not suggesting you are—which does not help the debate. I think the challenge for us is not to look at what the numbers might be but to look at what we can put in place to accommodate event, whatever the numbers might be, if that makes sense. That is why there is early intervention, the Stepping Out program and the joint research project between DVA and Defence at the moment to look at what the gaps might be post the exit from the defence force, or post that initial transition before people get to DVA. All our efforts have to be put into the early intervention. It is a lot harder when the issues become more complex. You minimise the chance of success with intervention at that stage.

Senator WRIGHT: Yes, I am very interested in that. I have met with the Centre for Posttraumatic Mental Health in Melbourne and talked about prophylactic and preventative measures as well, and what preparatory work can be done both with veterans and indeed with their families and partners. Again, that is a changing aspect from the previous veterans; I think the nature of relationships and the challenges to families—

Senator Ronaldson: The whole face of the department is changing, yes. They must respond.

Senator WRIGHT: And the other aspect of that that I am interested in inquiring about is that, while recent media coverage has indicated that these wards treat the symptoms of PTSD, they do not necessarily treat addictions specifically, and we are all aware that there is often a comorbidity between stress-related conditions and service-related conditions and reliance on alcohol and other substances. I am interested in whether you have records of the number of veterans suffering a substance abuse issue at present. Can you provide a breakdown of those figures?

Ms Daniel: I think we would take that on notice. We have information on accepted disabilities around alcohol disorders, but we would need to provide that on notice—and comorbidities.

Senator WRIGHT: Thank you. I am interested really in the thinking that is going on in terms of managing those aspects which can exacerbate—

Ms Daniel: Yes, certainly drug and alcohol issues are an important focus for us. You would have seen that the budget initiatives last year will extend from July 2014 our non-liability health provisions to include drug and alcohol disorders. The non-liability pathway is the one that allows eligible persons to have treatment funded by DVA without the need to have a compensation claim met, so it is a very good mechanism to get people into treatment early. Within the department, too, we have been doing some work to look at what we are doing in terms of drug and alcohol programs. We have had some external expertise to provide us with some advice, and we are doing some thinking about the range of drug and alcohol services that we have available. We currently have arrangements with hospitals for drug and alcohol services, but we are looking at what we might do more broadly. It is a very important area.

Senator WRIGHT: Thank you for that.

Senator Ronaldson: Because accepted liability data will not, of course, necessarily give you a true indication of what other addictions might be, and that is the difficulty, I assume, in accessing that sort of information.

Ms Daniel: Yes, it is limited.

Senator WRIGHT: And we know that in society, apart from veterans, there is extensive comorbidity now between mental health and those substance use problems, and of course we know that it is exacerbated sometimes.

Ms Daniel: Yes, certainly the mental health prevalence study that we have talked about in this committee on the Defence population gave some information about alcohol usage within the Defence Force. I do not have that information right here but—

Senator WRIGHT: Yes, I am aware of that.

Ms Daniel: We do not have that same information available from a survey source about our population. But it is an area where, as we move forward in our research program, one of our key pillars is longitudinal research. We will be looking at what we can have available.

Senator WRIGHT: Thank you. Chair, I just have a couple of other questions. Are you okay for me to finish these as well?

CHAIR: Yes, of course.

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