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The aim of this research is to highlight significant elements of the ongoing debate around mental health and the Australian Defence Force (ADF). It examines in particular, the attitudes towards service provision and the support available to serving and ex-serving ADF personnel, highlighting areas where improvements can be made. To do so, a qualitative methodology was chosen to allow for the cataloguing of a range of views from working professionals and veterans. These include senior members of the Department of Defence (Defence), the ADF, the Department of Veterans’ Affairs (DVA), the medical profession (both clinicians and academics), members of Ex-Service Organisations (ESOs), politicians, allied health workers, journalists and veterans themselves. The aim was to highlight some of the most credible and trustworthy discourse on mental health and the ADF. The issue is currently attracting an unprecedented amount of attention from the media, the bureaucracy, the medical profession and parliament. There exist numerous ongoing challenges with regard to the health of military personnel and veterans, as evidenced by persistent and debilitating health concerns among these populations and by the open acknowledgement of a range of professionals working in the area.

A feature of debates about the mental health of serving and ex-serving ADF personnel is the apparent circular argument in the public discourse represented in the media which runs as follows: ‘the government sent these men and women to war, they have come back broken and it is now refusing to look after them’. These attacks make the government and the bureaucracy more defensive and reactive, and these running battles come to dominate discussion. The victimhood and entitlement mentality this has been seen to foster is not what veterans groups say their members ultimately want, nor is it compatible with long-term positive health outcomes post-military service. A circuit breaker is required to turn these circular debates (those that begin with personal narratives told through the media to parliament which engages experts and the bureaucracy, and back again) into a linear model of independent research leading to the development of evidence-based and best practice policy and service provision. The current system is failing a minority of veterans, and the manner in which this issue is being addressed in public debates is proving ultimately unhelpful, with some proposed solutions actually being counterproductive. Space must be made for a discussion on strategies not beholden to entrenched bureaucratic models that do not adequately consider what help these target groups need, nor how to get it to them.

A minority of veterans has been (psychologically) injured during their time in the military, experienced difficulties during their transition to the civilian workforce and encountered problems with their DVA claims. It is important to note that the system has not failed the majority of serving and ex-serving military personnel. The focus of this research is on ways in which the needs of a minority of disaffected serving and ex-serving ADF personnel can be better met. This is informed by both a case study approach with a small number of such disaffected veterans, while contextualising these case studies with the views of professionals with subject matter expertise working in military (mental) health and related fields. While the sample size is very small, and caution is required in interpreting the findings, the accounts of the veterans interviewed do complement the views of experts consulted.

An independently planned research strategy, with input from practitioners and academics is a vital but missing part of what is occurring at present (comment by an interviewee for this research who chose to remain anonymous). This needs to be made a priority for government (same source). This would include an ongoing commitment to both qualitative and quantitative research designed to assess the needs of veterans in a way that genuinely engages the unique aspects of the culture of this population, informing the design of strategies for prevention, early intervention and treatment. At present, an independent research agenda does not exist separate from bureaucratic control. This must be informed by subject matter experts, open to external scrutiny where experts are encouraged to be critical of poor practices when they are identified.

An umbrella framework is required to ensure the numerous diverse groups working in this environment can make a meaningful contribution to a whole, to ensure a commonality of effort, to foster collaboration, innovation and development, and eliminate redundancy.[1] A starting point for the development of end-user focused solutions is the experience of serving military personnel and veterans. An appreciation of the experience of these populations, combined with the application of a rigorous research methodology is useful to better understanding the needs of veterans and the best ways of implementing treatment models. Much of the current debate prominently features highly emotive accounts of disaffected veterans, but without a framework through which to understand these personal narratives, combative and reactive cultures flourish. What is required is to recognise and do justice to the experiences of veterans—constituting a form of unrefined truth is the application of a methodological framework to transform these experiences from personal tragedies to starting points for the development of meaningful solutions.[2]

A key feature of the service model as it currently exists is the range of Ex-Service Organisations (ESOs) that have grown to fill the (perceived) void between services and support provided by Defence and those provided by DVA. While committed and capable people are working for the benefit of veterans, some of the activities in this space feed into the above circular narrative of entitlement and victimhood where veterans find themselves in groups that see DVA as the enemy with whom they must battle for benefits. A system-wide approach to these groups that plays a coordinating function and offers guidance and support is an essential but missing element of the current system.

Both the respective leaderships of Defence and DVA recognise the complexity of the issue. Since the early 2000s, both departments have released a series of strategies, plans and reports and have been the subject of numerous inquiries. Likewise, the parliament has taken an interest in the health and wellbeing of serving military personnel and veterans. While much progress has been made, a disconnect continues to exist between some of the services available and the intended recipient communities. A consequence of the outsourcing and divestment of health assets and services by both Defence and DVA over the last decade is that there is a perceived lack of internal accountability regarding gaps in service provision. While the states and private sector are the providers of care, no systematic approach exists to understand and meet the complex needs of (particularly contemporary) veterans.

The gamut of issues around mental health and Defence is complex, poorly understood and easily misrepresented. It is not the aim of this research to review and summarise these issues but to highlight some of the recurring themes identified by a broad range of stakeholders, 76 of whom are acknowledged on the following pages. Unique features of the military include it being the only profession that requires its workforce to train for and carry out the killing of people and the destruction of property as part of its core business. This is thought to carry with it unique challenges to the non-physical elements of the wellbeing of the men and women who choose this profession.[3] Recurrent issues highlighted by those who agreed to participate in this research include the persistent issue of stigma that surrounds reduced mental fitness, and the challenges of the transition period between a career in Defence and one in the civilian workforce, and the corresponding impacts on (mental) fitness.

An encouraging note is the work being done by the 2nd Commando Regiment and the approach it has taken to the mental fitness of its workforce. There are elements of this that provide an example of what is possible, albeit with a small and highly specialised workforce of elite soldiers. This Regiment has been successful at substantially reducing the stigma around reduced mental fitness and offered meaningful support to transitioning members in a culturally relevant way. Among the strategies adopted by this group is the provision of services and support by beret-qualified members of their own unit who have had first-hand experience of service-related non-physical injuries. Following the example of this unit, an opportunity exists for the broader ADF to invest more resources and research into prevention including mental health first aid and mental health literacy.

The ideas presented in this monograph are suggestions and provocations, and as such, it seeks to make a useful contribution to this ongoing debate. It proposes a number of interventions to address the issues highlighted, as well as corresponding research and policy formulation. A space needs to exist that privileges the best ideas, where credible research can lead to the development of evidence-based policy and best practice solutions. The community’s appetite for sensational media reporting (leading to reactive institutional responses and back again), and the fragmented nature of the current state of responses to this issue is not serving the best interests of Australia’s military and veteran communities.