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I think there is a question in this for all those politicians who collectively sent those soldiers to war, particularly those who shared the spotlight with them when they went. What have you done since, what are you doing now to help them deal with the price they have paid? (Kerry O’Brien, Four Corners, 9 March 2015[1])

This program, Bringing the War Home, and the questions raised by the host, Kerry O’Brien, are a useful starting point for this monograph. In attempting to hold the politicians to account in this way, and with the health and wellbeing of our serving personnel in mind, perhaps more questions might be raised about foreign policy decisions that commit our military to war. However, the danger exists that this approach will prompt a defensive response and will continue to perpetuate the circular argument that pits veterans against the bureaucracy, and continues to parliament only to be repeated again without any progress having been made. One positive to come from the stance taken by the media is that this issue is now being discussed more than ever before. The mental wellbeing of military personnel and veterans now occupies a prominent place on the media and political landscape. Part of that is the way in which this program was the catalyst for the ongoing parliamentary inquiry. Once again however, the adversarial committee setting may not be the most effective vehicle to break the model of debate circularity described above.

This monograph employs qualitative methods as well as ethnographic and phenomenological methodologies in its analysis of the prevailing views of experts and personal truths of those who have experienced a military service-related psychological injury. As noted, a useful starting point for discussion on the health and wellbeing of Defence personnel and veterans is the lived experiences of these groups themselves. To provide this context, the stories of 12 veterans are included in an Appendix to this monograph. While these men and women represent the reason for the interest and action on this issue, the very small number of veterans interviewed means that interpreting the findings requires caution. While their stories can be most usefully seen as an important first step in the creation of evidence-based and best practice policy solutions to address the issue of the effects of military service on wellbeing, caution must be exercised when making generalisations based on the experiences of these case studies. While these stories give much needed context to discussions around mental health and the military, they do not, in and of themselves, necessarily lead directly to policy solutions or treatment models. Neither does having a career background in the military mean that an individual is uniquely qualified to speak on this issue.

Using these personal stories as a starting point to define the scope of this problem, this monograph considers the ways in which this issue has been treated within the bureaucracy. Both Defence and DVA have been actively considering the mental fitness of their respective client pools, as part of a larger picture of the wellbeing of these communities. The parliament has also taken an interest, evidenced by two recent parliamentary inquiries. While there is currently an unprecedented amount of interest in these issues, the veterans who agreed to be interviewed for this research described significant barriers to accessing care and support. They describe a system that treats them at times with suspicion, in which inadequate treatment options exist. They describe being frustrated with a process that effectively exacerbates their existing psychological injuries. If the debate is to move beyond the current circularity that pits the needs of veterans against the bureaucracy, the first step is recognising these problems.

While much of the available data used in the preparation of the following chapters relates to the Army, these issues are not solely an Army problem. Examples of the impacts of Navy and Air Force service have been used where available and it should be noted that the issue of mental fitness is not limited to any single service.

This monograph is divided into three parts. The first part places the issue of mental fitness and the military within a wider context of (mental) health and Australian society. It notes, however, aspects of this issue that are particular to military service. These include a growing appreciation of the fact that the military exposes its personnel to trauma and therefore experiences corresponding incidences of psychological injury; and that service in a totalising institution can significantly disrupt  individuals’ lives when that service comes to an end.

The second part maps the changing attitudes towards mental health and the ADF of a range of stakeholders. These include the federal parliament and the departments (both Defence and DVA). A growing awareness and increasingly sophisticated understanding of this issue is evident in the parliament, the military and the broader community. This corresponds with an increased level of services and support available to those who require it. Nevertheless, while the senior leadership of the ADF, Defence and DVA recognise the serious nature of the issue and are focused on helping those affected, these attitudes have not sufficiently permeated the low and mid-levels of their respective organisations. A disconnect has been noted between the attitudes of senior leadership and the services available, with better outcomes for those affected. Encouragingly, there exists a tangible appreciation amongst the ADF hierarchy that attitudinal and cultural change is not a found object, and there is commitment to continuous improvement and learning by doing evident from within this group. Another limitation is that while there is some consensus on what constitutes best practice psychological and medical care, there is no such thing as best practice macro-level policy models. While lessons can be learnt from the examples set by our partners in the US, UK, Canada and New Zealand, global policy settings are thought to be too context specific to allow for the adoption of an off-the-shelf product to address detailed policy requirements. 

The third part of the paper describes areas of significant progress and others where progress is required. The persistent issue of stigma acts as a reminder of the low starting point of knowledge and uninformed attitudes towards service-related psychological injuries. A hopeful note is struck by the 2nd Commando Regiment and its approach to dealing with the health and wellbeing of its workforce. Changing attitudes towards veterans has a shaping effect on broader attitudes towards service-related non-physical injuries. This monograph records examples of ESOs that provide an invaluable range of services and support to veterans. There is, however, a feeling that some advocacy and support groups appear to remain trapped in an entitlement mentality that sees DVA as the enemy with whom they must wage battles for compensation. Finally, the issue of preventative mental fitness will be introduced, investment in which is seen to have good prospects for improved outcomes.

The Government has not failed all veterans. The majority of ADF personnel go on to live productive and happy lives, having enjoyed their career in military service. Mirroring the attitudes of the broader community, attitudes in the ADF towards mental health have come a long way from a very low starting point. However, the results are not yet effective and without significant investment in this issue now, there is a risk that the mistakes of the Vietnam War will be replicated, creating another long legacy of psychological injury from recent and current deployments.