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Estimates: Veteran Mental Health Services

Estimates & Committees
Penny Wright 7 Jun 2012

Senator WRIGHT: I have some questions regarding mental health programs and I believe they might be in outcome 2 or 3. Research indicates that veterans and partners of veterans experience higher levels of mental illness than the general population and this has significant implications for their children and extended family. Therefore, it is important that mental health services provide adequate support to current service personnel, veterans and their family members. My first set of questions relate to the level and adequacy of these mental health services. Firstly, what is the total amount that was allocated to veterans' mental health services and suicide prevention programs in this year's budget, please?

CHAIR: Perhaps while you are looking for that information, I will just let representatives of the War Memorial know that there is a consensus that we will not be asking any questions of you tonight, so sorry for dragging you up here but you are free to go. Thank you.

Ms Daniel: I do not have immediately a total of mental health expenditure that has been allocated in the 2012-13 budget. I can tell you that, in 2009-10 our expenditure on mental health was $159 million. That expenditure includes private hospitals, public hospitals, services from consultant psychiatrists, pharmaceuticals, private psychologists, social workers, general practitioners and our expenditure through the Australian Centre for Posttraumatic Mental Health. It does not include other activities related to mental health, such as disabilities, applied research funding and staffing costs or a small amount of funding through some specific budget measures. It does include the VVCS.

Senator WRIGHT: And that was 2009-10?

Ms Daniel: That was 2009-10, so it is actually quite a process for us to prepare that total.

Senator WRIGHT: Yes, I understand that. I might need to ask you take that particular question on notice then, for this year's budget.

Ms Daniel: Yes. To compile that number for mental health we actually extract from, for example, our gross expenditure on pharmaceuticals and, post the event, work out those that are in certain categories, and similarly those private hospital episodes. So our forward estimates are not produced at that level of disaggregation. But we should have a 2010-11 number available shortly.

Senator WRIGHT: I was going to ask you later anyway the annual amounts allocated to all veterans' mental health services and suicide prevention programs under budgets over the past five years, so as much as you are able to do that, I would appreciate that. I understand it is not going to be particularly easy with the forward estimates because it is based after the event-that is what I am understanding you to be saying-but I would still appreciate some estimation of what they would be so that we can get some sense of the global expenditure from the budget for mental health.

Ms Daniel: We can take that detail on notice and look at what we can do. Obviously we have this calculation historically, but we can look at what we could do in terms of our forward projections.

Senator WRIGHT: Thank you. Can you please describe for me some of the central programs that are funded under the budget allocation for mental health services and any suicide prevention programs?

Ms Daniel: Could you just repeat the question, Senator? I am trying to determine, in terms of our broad range of treatment and supplementary programs, what area you are most interested in me elaborating on.

Senator WRIGHT: Just the central programs that are funded under the budget allocation that you would be able to specify were for mental health and for wellbeing and suicide prevention.

Ms Daniel: Mental health, as I mentioned, is the whole range of treatment that we provide-so services through private hospitals and public hospitals where a veteran requires hospitalisation. We also provide a special post traumatic stress disorder group program, which is a tailored, specific program.

Senator WRIGHT: Does that program have a name or is it just the post traumatic stress disorder group program? I am just wondering if there are particularly nominated programs.

Ms Daniel: That is the name of the program-the post traumatic stress disorder group program.

Mr Penniall: As Ms Daniel specified, there are a range of mental health programs, ranging from pharmaceuticals, hospitals-in other words, services that are acute based and community based. Another range of those services available to veterans and their families is the Veterans and Veterans Families Counselling Service, which provides 24-hour services, including centre based and outreach counselling. It covers group programs. It has a 24-hour crisis support line and it also operates what is called Operation Life, which is suicide prevention awareness workshops for the veteran community. For those suicide prevention workshops there are three types of workshops: a half-day workshop, a two-day workshop and, in a sense, a refresher workshop. Those workshops are available for anyone in the veteran community who is interested in supporting veterans who may be at risk of suicide.

Senator WRIGHT: So they are devoted or designed for supporters and carers as opposed to the person who may be experiencing the troubled feelings or the suicidal intent themselves?

Mr Penniall: That is correct. They are not treatment programs as such but they are designed to help people support those people who may be at risk.

Senator WRIGHT: So I am presuming that in terms of the global figure that, Ms Daniel, you gave me in relation to 2009-10, that would have encompassed the VVCS as well as other aspects.

Ms Daniel: Yes, that is right.

Senator WRIGHT: So I understand that there are certainly treatment based and service based medical interventions and pharmaceuticals but as well as that there is the VVCS and then there are several programs that are overseen by the VVCS, it seems, if I am understanding correctly.

Mr Penniall: That is right.

Senator WRIGHT: So that is the full range of programs?

Ms Daniel: If I might just comment further, on top of the treatment programs within the department we do work on a range of online mental health resources to improve mental health literacy, also a range of initiatives to improve mental health care, awareness of military mental health issues with GPs and other allied health providers-so a range of initiatives that we have undertaken in that regard.

Senator WRIGHT: So that is in terms of training up service providers or professionals?

Ms Daniel: Raising awareness of issues with service providers, yes.

Mr Penniall: Just to clarify a bit more the Veterans and Veterans Families Counselling Service, in 2010-11 just over 20,000 clients received support from VVCS and that included almost 10,000 clients who received almost 60,000 counselling sessions. It included 354 group programs supporting almost 3,400 clients and our after-hours veterans line received over 5,300 calls.

Senator WRIGHT: Thank you. I was asking about the central programs and you have actually given me a sort of overview, I guess, of all the various aspects of what would come within the rubric of mental health funding. I would like to have an idea or a list of the mental health services and suicide prevention programs that are funded under this year's budget and the details of the amount of funding that would be allocated against each program or service. I understand that you will not necessarily be clear but presumably you have estimates of what each of those services is designed to or is expected to cost for this current financial year that is now ahead, the forward estimate for this year. I understand that will not be possible to do tonight but I ask you take that on notice.

Ms Daniel: As I said, we can have a look at what we can do. Many parts of our treatment are covered off within our general medical schedule and cover those services provided by psychiatrists or psychologists, but we can certainly give you the sort of list that shows you the comprehensive range of mental health services that are available through our treatment regime and through the supplementary programs that the department and VVCS provide.

Senator WRIGHT: I am presuming that there would be some ability to differentiate, as opposed to just general health costs, between those that would pertain to psychiatric services and those that would pertain to medical services.

Ms Daniel: Sure. Certainly we can look at what we can do historically. As I said earlier, projecting forward at that level of disaggregation we may not be able to give you that level of detail.

Senator WRIGHT: I understand that degree of certainty but I would like to know what the basis of your budget is.

Ms Daniel: Sure.

Senator WRIGHT: I would also like to know over the past year, how many veterans and members of veterans' families have accessed these various services and suicide prevention programs so we get a sense of how many people are actually accessing or benefiting from them. I would also like a breakdown of annual figures over the past five years of how many veterans and members of veterans' families have accessed these mental health services or suicide prevention programs so we can see the trend. I understand that would need to be on notice. I would also like, in relation to those things that I am asking for, to know which of the mental health programs and services are accessible to both veterans and family members, and existing service personnel.

Ms Daniel: That was a point I was about to clarify. Of course a lot of our treatment programs are for eligible veterans and their eligible family members but not necessarily the broader family, but support programs.

Senator WRIGHT: I guess what I am interested in is if you can give sufficient clarity about who is eligible to use and who has been accessing each of those programs. If I can now go to an article that was in the Sydney Morning Herald on 21 April this year which reported that four Afghanistan veterans had committed suicide while still serving. I understand and appreciate that this is a sensitive and complex issue, but obviously record keeping and monitoring of suicide is an important tool for suicide prevention and trying to ascertain the nature and scope of the problem that we are facing and then taking adequate measures to deal with it. I would like to have details of how the department keeps accurate records of suicide among service personnel and also among veterans who are now in the civilian community.

Ms Daniel: I cannot answer the question directly about what happens in Defence. I think we would have to take on notice, and Dr Killer may make some comments, because in some instances for the veteran community what we know and understand would need to rely on what comes through in terms of recording of those deaths through the system. I am not sure if Graeme has something to add there. It is obviously an issue that we take very seriously and are looking to improve the services and support that the department has available.

Mr Carmody: There are two points I would like to raise. One of them, for those members of the ADF who commit suicide, unfortunately I am not certain that we would have those details. Nor would we have details of former members of the Australian Defence Force who commit suicide unless they are clients of ours. If they have not become clients then we would have no record.

Senator WRIGHT: That is essentially my question, I suppose. To what degree is there follow-up or monitoring of persons in the civilian community now who have previously been veterans in terms of getting some sense of what the scope of the problem may be and the potential links between the service and what has happened since they have been living in civilian life. That was essentially one of the issues that was raised in this article.

Ms Daniel: Our research program does include a number of studies of a number of ex-military cohort which obviously looks at a number of health and health related issues. We have got a very extensive study for Vietnam veterans and their families, and for Timor Leste, and the Gulf War. I would have to take that on notice. That is a very comprehensive part of our research program, but to look at the specific issues around suicide ideation or suicide activity in those studies would be something that is beyond the level of detail I have got with me now.

Dr Killer: Some of the recent research done by the ADF, particularly the mental health prevalence study, has given us a fairly good idea of the psychiatric burden in the Australian Defence Force. I think the importance here now is that this is good baseline work, and the value will be in creating this into a longitudinal study so that we and the Department of Veterans' Affairs can follow this through and track these individuals from this baseline work over the next 10 or 20 years. This is what we are looking at now. This study conducted by the ADF is probably the best study in the world looking at the psychiatric burden in a defence force. It has set the base line, but to really get the value out of it we need to track it longitudinally, and this is something we are looking at now. It would be very valuable to understand what happens to individuals and their families when they leave the defence force, and this is something we are addressing.

Your point is quite correct: we will see numbers leave the ADF with the war winding down, and we really need to track these people because we know numbers in defence will have psychiatric problems. Defence is very good at providing health support for servicemen, but the barriers to putting your hand up to say you have a psychiatric problem are quite considerable in defence. When these individuals take off their uniform and become civilians we want to be able to track them, to identify them and to provide the care they need, and this is what we are looking at now.

Senator WRIGHT: That is certainly part of the genesis of my questioning. I have certainly had concerns raised with me by some medical professionals who have said that one of the difficulties is that when someone leaves service they are not necessarily evincing any particular symptoms at that point and that there is always the potential down the track for something to occur, but then perhaps they are lost to the follow-up. So it is important, obviously, that there is that tracking.

Dr Killer: Yes. This transition from defence to being a veteran is fundamental to providing care for them. If we lose them in the transition we might not pick them up until five or 10 years later, and then patterns of behaviour or illness are well ingrained. At that time it is much harder to look at rehabilitating people back to normal life, and also to include the family. We need to pick them up at transition when they leave defence or, if we do not pick them there, pick them up two, three or five years later. One way to put systemisation into this is to conduct some longitudinal research that will work hand in hand with these sorts of practical processes. I think that is what you have been alluding to.

Senator WRIGHT: It is, although I am interested in what systems are currently being implemented to be able to do that follow-up not just of a sample of former veterans but also of everybody who leaves the defence forces.

Dr Killer: We have been working with general practitioners and we have been trying to increase their understanding of military service so that when a serviceman or a veteran comes in an amber light should come on and that doctor should ask the veteran if he has served. This is very important. As we know, in men's health men are very loath to put their hand up and say, 'I've got a problem.' So we have to alert the provider community-particularly the general practitioner, because he is the entry point to the health service. We have to have the general practitioner vigilant and asking the right questions because unless they ask the questions the only way these people will be identified is when their wives come forward and say they have a problem.

This is what we have been doing in some of our educational programs. It is a big issue: there are only so many veterans out there and there a large number of general practitioners. Education for all the providers, particularly the GPs but also the psychologists and psychiatrists, is very important. We have just developed a new program that has not been launched yet called Vet Aware. This is where we are educating the community nurses who provide services for our veterans so that, when they go into the homes of people needing community care, they are able to recognise that there is a psychiatric need or a need for some intervention. So it is all about education-educating providers and working together with providers to make sure we can provide the services. We have a lot of services available. It is putting people in touch and getting the outcome.

Senator WRIGHT: Certainly, and that sounds helpful. It is becoming increasingly apparent in relation to the recording of suicide statistics throughout Australia, where there are real difficulties in terms of the definition and really knowing what data we are dealing with, that it is important to monitor and record as well so that we actually know the extent of the problem we are dealing with. I understand that the answer before was that information on suicides in relation to current serving members would not necessarily be available to DVA-that would be Defence, I understand.

Dr Killer: That is correct.

Senator WRIGHT: Is it possible for you to get that information for me or would I need to ask the right people in the defence department about that?

CHAIR: You can put that on notice.

Mr Carmody: Senator, can I clarify a point that I made earlier.

Senator WRIGHT: Yes.

Mr Carmody: I said that we would potentially only know if a veteran committed suicide if that veteran was a client. We also might find out if the family member put in a claim of suicide and related the claim to a death in service, but a coronial finding of suicide would have to lead us to that.

Senator WRIGHT: Right. But at this stage, if there were a coronial finding and it was evident to the coroner that the person was previously a veteran, there is no particular system of notification?

Mr Carmody: I do not believe so. I think only if it were referred to us would we know.

Senator WRIGHT: I was going to ask whether you could provide the number of deaths on an annual basis over the past five years of both service personnel and veterans in the civilian community for which the cause ofdeath was suicide. I understand now that you would not be able to give me that information, that it is with Defence, so I would have to ask that on notice. It also sounds to me as if you also would not, with any accuracy, be able to give me that information about veterans who are now in a civilian community. Am I right in thinking that is the case?

Mr Carmody: I would say that it would not be comprehensive, in that we would only know what we know. We would not necessarily have the entire picture.

Senator WRIGHT: Then we get into the known knowns and the known unknowns and the unknown unknowns, do we not?

Mr Carmody: We do.

Senator WRIGHT: Could you take that question on notice please and at least tell me what you do know, and then we will have to speculate about what you do not know. That is really where my questions are leading. I note that the article I mentioned suggested that a problem of recording is that the records of military personnel who have moved into civilian life are kept on paper, which takes time to access; however, a new electronic records system is apparently being introduced. That was certainly reported in that article. Is that the case and, if so, what is that system and when is that system likely to be introduced?

Mr Carmody: I presume that is a reference to Defence's joint e-health data initiative-the JeHDI program.

Senator WRIGHT: It was not mentioned in the article, so I cannot confirm that.

Mr Carmody: I presume that is what it is. I understand that is currently under development. Unfortunately, I do not know when it is due to be completed-that would be a matter for Defence-but I would have thought in the next couple of years. That is what they are working on-for all medical records to be electronically available.

Senator WRIGHT: I do have some further questions in relation to health, but I am happy to leave it there if you want to go to someone else. Thank you.


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