Chapter 21
Post-deployment welfare
21.1
The committee has noted the potential for Australian personnel involved
in overseas deployments to be exposed to a range of operational, environmental
and occupational hazards. In this chapter, the committee considers the
post-deployment care of, and support available to, Australian peacekeepers, and
related matters including:
- debriefing and reintegration procedures;
- care and services available to those suffering adversely from
service as a peacekeeper;
- post-traumatic stress disorder;
Debriefing and medical clearance
21.2
The following section considers the steps taken to ensure that the
reintegration of Australian peacekeepers back into Australian working and
family life is as smooth as possible and that those requiring special post-deployment
support or care receive it.
ADF
21.3
Defence informed the committee that personnel have both a Return to
Australia (RTA) medical screen and Return to Australia psychological screen
(RtAPs). They are usually conducted in the area of operations in the week prior
to returning to Australia. For personnel returning urgently, or for smaller
operations, the screening is done in Australia as soon as possible after
return. These checks are compulsory.
21.4
RTA medical screening involves a standardised health questionnaire and
physical examination, documentation of hospital admissions and of exposure to
hazards during deployment. Health countermeasure medications (such as malaria
eradication treatment) are also prescribed as appropriate for the operation. The
RtAPs covers a series of standard psychological screening instruments:
- Deployment Experience Questionnaire, Kessler 10 Questionnaire;
- Traumatic Stress Exposure Scale—Revised;
- Post-Traumatic Stress Disorder Check list—Civilian;
- Major Stressors Inventory, and Alcohol Use Disorder
Identification Test for those deployments where alcohol consumption is
permitted; and
- a structured interview by a psychologist or a psychological
examiner.[1]
21.5
According to Defence, these health screens are followed up with a
post-deployment medical check and a post-operational psychological screen. The
post-deployment medical check covers an annual health assessment,
post-deployment screening for HIV and Hepatitis C and, if indicated,
tuberculosis. The post-deployment medical check and psychological screen are
usually conducted three months after return to Australia. These checks are also
compulsory.[2]
Reservists
21.6
The Regular Defence Force Welfare Association (RDFWA) stated that reservists
deployed on operations are often discharged immediately after their return and
are then no longer covered by ADF medical services. It stated:
This group may not seek medical advice for a condition that to
them may appear benign but may be related to service in a particular area. Our
recommendation is that any member returning from a peacekeeping operation in
which environmental health problems have been identified should have access to
comprehensive medical care for a period of six months. We understand that the
US Veterans Administration has such a scheme for their reservists. A similar
scheme could be administered by either the ADF or DVA.[3]
21.7
In light of the often delayed onset of signs and symptoms from
conditions such as PTSD or health complications due to exposure to environmental
hazards including certain chemicals, the committee notes the importance of
continuing access to ADF medical services. It agrees with the RDFWA that
reservists should not be disadvantaged because they may leave the ADF soon
after returning from deployment. It draws the concerns expressed by the RDFWA
to the attention of the ADF.
AFP
21.8
The AFP's Reintegration Coordination Team (RCT) is responsible for
supporting deployed officers throughout their deployment, from the moment an
officer applies to serve offshore. It considers the destination and duration of
deployment and its impacts on the officer's career. The RCT has 'a full-time
career development officer who will help people offshore to continue their own
development'. This approach is taken because the AFP wants 'people to realise
that serving offshore may actually enhance, rather than be a detriment, to his
or her career' Indeed, Assistant Commissioner Jevtovic said in an interview
that the RCT is 'an integral part of the way we support our people into the
future'.[4]
21.9
RCT provides a post-deployment program for officers who have been on an
overseas deployment for 40 weeks or longer. The program consists of six
components:
- member recognition function (voluntary);
- operational/mission debrief and member feedback process
(mandatory);
- career planning and development service (voluntary);
- member re-induction course—organisational information (e.g.
legislation and policy changes) (mandatory);
- psychological clearance and welfare briefing (mandatory); and
- medical clearance and briefing (mandatory).
21.10
Members deployed between 16 and 40 weeks and state and territory police in
IDG missions participate in the same program except for the career coaching
and re-induction which 'are not seen as necessary reintegration components' for
this group.[5]
Committee view
21.11
The committee notes the package of post-deployment re-integration and
health screening programs conducted by the ADF and the AFP. These programs
indicate that both the ADF and the AFP are aware of the importance of the
post-deployment care of their personnel. Evidence before the committee
suggested that in general, the level of care and attention provided to
Australian personnel was appropriate. There were, however, a number of
significant matters that warrant closer examination. They relate to post-traumatic
stress disorder, medical record keeping, the availability of statistics on the
health and welfare of veterans and health studies of veterans. The concerns
were raised in relation to the ADF.
Post-Traumatic Stress Disorder
ADF
21.12
A number of submitters referred to the incidence of Post-Traumatic
Stress Disorder (PTSD) in ADF personnel who have served in some very difficult
peacekeeping operations.[6]
21.13
When asked about the number of claims due to PTSD, the Department of
Veterans' Affairs (DVA) was not able to provide concrete statistics. Instead, Mr
Mark Johnson, National Manager, Compensation Policy, referred to the number of
people who had had a mental condition accepted under the Safety
Rehabilitation and Compensation Act (SRCA).[7]
For example, 183 claims had been accepted for mental disorders relating to
service in East Timor.[8]
In answer to a question on notice taken during a 2007 estimates hearing, DVA
provided the following statistics on the claims for disability pensions
relating to mental health issues that it had received as at June 2007.[9]
|
Veterans' Entitlements Act
(VEA)
|
Iraq
|
Afghanistan
|
East Timor
|
Solomon Islands
|
|
Number of mental health
disabilities claims
|
105
|
163
|
1,469
|
128
|
|
Number of mental health
disabilities claims accepted
|
71
|
120
|
1,101
|
89
|
21.14
It should be noted that medical experts in mental health tend to agree
that mental health problems associated with PTSD may become apparent sometime
after the initial trauma.[10]
21.15
In contrast to the lack of accurate statistics on PTSD in ADF personnel,
the AFP produced clear figures for the committee.
AFP
21.16
The AFP informed the committee that 16 claims had been lodged with
COMCARE that relate to PTSD. Of these, 13 claims were accepted and 3 claims
were rejected. The table below shows number of claims and costs associated with
East Timor and Solomon Islands.[11]
Cost Centre Name
|
Claims lodged
|
Claims Accepted
|
Claims Rejected
|
Costs to Date
|
Likely Future Cost
|
Estimated Cost*
|
|
East Timor
|
12
|
9
|
3
|
$1,355,936.36
|
$1,244,995.00
|
$2,600,931.3
|
|
Solomon Islands
|
4
|
4
|
0
|
$269,820.10
|
$335,147.00
|
$604,967.10
|
*Includes 'Costs to Date' and 'Likely Future Cost'
Committee view
21.17
The committee finds the inability of the ADF or DVA to provide the committee
with full and complete details on the incidence of PTSD in ADF peacekeepers
highly unsatisfactory. The committee continues its consideration of statistics
later in the chapter but first considers the approach taken with regard to promoting
the mental health of ADF peacekeepers.
ADF preventative measures
21.18
The committee previously touched on mental health in the context of
prevention through the mission's mandate which, the committee argued, should
match the 'conditions on the ground' and not unnecessarily jeopardise the
wellbeing of Australian peacekeepers. It especially noted instances where an
inadequate mandate placed peacekeepers in a situation where they were unable to
intervene to protect innocent civilians from attack.
21.19
It is clear that while a peacekeeping operation may expose peacekeepers
to circumstances that pose a risk to their mental health, there are measures
that can be taken to reduce risk, especially during pre-deployment training.
21.20
The committee notes that a number of studies have observed that the
mental preparation for a combat mission differs from that of a peacekeeping
operation. Such studies identify the requirement to exercise restraint in the
face of provocation as a major stressor for peacekeepers.[12]
For example, writing in ADF Health in 2003, Major Karl Haas noted that
peacekeeping missions that 'bring soldiers into warzones as non-combatants
present 'a wide variety of stresses that have short- and long-term effects on
mental health':
Soldiers are trained to win the day by the application of
tactics and up to date weaponry, yet peacekeeping and humanitarian missions
generally restrict tactical freedom and the use of force, exposing soldiers to
stresses for which they are not prepared or trained.[13]
21.21
Professor Mark Creamer, Australian Centre for Post-Traumatic Mental
Health, stated in October 2006 that peacekeeping 'generally requires a whole
different and complex set of skills, often...for which people are not necessarily
terribly well trained'.[14]
Indeed, the UN recognises that 'stress management training has become an
increasingly important factor in the adequate preparation and training of
United Nations peace-keepers'.[15]
Earlier in this report, the committee supported the comments by Lt Gen Gillespie
that training for peacekeeping operations is to take a 'more prominent place'
in ADF training. In so doing, the committee advises that mental health training
and support must be given priority.
21.22
The importance of elevating mental health education and training in ADF
pre-deployment preparation is evident when considering mental health literacy. During
an estimates hearing, Dr Graeme Killer, Principal Medical Officer, DVA,
highlighted concerns about health education. He stated:
...when we looked at the younger peacekeepers and peacemakers in
this study, which was called Pathways to Care, we found that they had very low
levels of health literacy. They did not really understand what the trauma had
done to them in the way they were feeling and they were dealing with their
families. So many of them, because the consultation and medication had not worked,
would often then self-medicate with alcohol.[16]
21.23
In response to this statement, Defence informed the committee that
mental health literacy was recognised in the ADF Mental Health Strategy
that was launched in 2002. Defence also asserted that all problems relating to
mental health are 'thoroughly assessed and managed'. In addition, it noted that
eighteen fact sheets had been developed on various topics, including
depression, alcohol, drug use and PTSD. Defence said:
A major focus of the strategy is aimed at breaking down barriers
to care, including the concept that mental ill health is a sign of weakness.
Defence members are encouraged to maintain a sense of personal well-being and
to develop a healthy and physically fit lifestyle.[17]
21.24
Even so, Mr Paul Copeland, National President of APPVA, was more
circumspect about the adequacy of the strategy. He observed that from the association's
experience, mental health was 'significant in policy; marginal in reality'.[18]
21.25
This view emphasises the importance of the ADF ensuring that its policy
on mental health translates into changes in organisational culture, attitude
and practice which should start in the training establishments. All personnel
about to be deployed to a peacekeeping operation should, as part of their preparation,
participate in a comprehensive education program on PTSD and other mental
health issues. The effectiveness of this program should be subject to
continuing evaluation and review.
21.26
The committee now looks at the assistance and support network provided
for ADF personnel with regard to mental health.
Services available for PTSD in the
ADF
21.27
Training alone will not prevent the occurrence of mental health
problems. The committee accepts that the risks to mental health cannot be
entirely eliminated and that some Australian peacekeepers in the course of
their duties in an overseas mission will experience circumstances that may
cause psychological harm. Mr Copeland stated:
You can go through all the preparation in the world but, when
you go over there and come up against these situations, different people act
differently. Unfortunately, there has been a large number of cases of
post-traumatic stress disorder, depression, anxiety and generalised anxiety
disorder: probably 25 per cent of the force that went to Rwanda; a large number
that went to Somalia in the first push with the battalion group and the UNOSOM
Australian contingent thereafter; and also a large number who went to Cambodia.
It is interesting to note the large number of people reporting from East Timor
as well. We know that you can be trained up as much as you can but, when it
comes to these situations, nothing will prepare you. It is about your reaction
and your resilience. You will find that the adrenaline will kick in for
soldiers and their training will come into being. Once that has finished and
the adrenaline has calmed down, then you will find the effect of that actual
incident may be severe. Therefore, peer support or counselling may be needed or
critical incident stress management would be needed as well.[19]
21.28
According to the ADF, it has a comprehensive program to assist with the
diagnosis and treatment of mental health problems, including PTSD. The then Minister
for Veterans' Affairs informed Parliament in March 2006 that the ADF had 'one
of the largest workplace mental health support systems in Australia that
provides a wide range of mental health and counselling services'. He explained:
The ADF provides mental health support across the deployment
cycle inclusive of pre-deployment screening and psychological briefings, the
provision of embedded (Australian or coalition) and/or 'fly-in' mental health
support and the conduct of post operational psychological screening and
programs to assist re-integration after returning from the operational environment.
Additionally, veterans of deployments are also able to access the services of
the Vietnam Veterans' Counselling Service.[20]
21.29
The services include:
- a wide range of mental health services through public and private
hospitals, psychiatrists, psychologists, general practitioners; and
- the development of strong working relationships with experts in
the field of mental health notably the Australian Centre for Posttraumatic
Mental Health.
21.30
With the support of DVA and relevant government ministers, this centre
has for many years been conducting research, providing policy and service
development advice on the mental heath issues in veteran and military
populations.[21]
21.31
The ADF has also:
- produced the policy document 'Towards Better Mental Health for
the Veteran Community';
- undertaken the Pathways to Care study; and
- established the National Veterans Mental Health and Wellbeing
Forum.[22]
21.32
Despite assurances provided by the ADF and DVA about the adequacy of the
services they provide in the area of mental health, evidence suggests that
there are shortcomings.
21.33
In its pre-election policy document, the current government made a
commitment to 'ensuring the very best mental health support' would be available
for ADF personnel and the ex-service community. It announced that it would 'implement
an ADF Mental Health Lifecycle Package of mental health research and innovative
interventions, in partnership with the Australian Centre for Posttraumatic
Mental Health'.[23]
As noted earlier, this centre has been working on the mental health of veterans
and military personnel for some time. This commitment is now reflected in the
government's May 2008 Budget. It has allocated $3.8 million over four years to
introduce a package of nine strategic mental health initiatives to improve
access to mental health services for current and former ADF members and active
reserve personnel. According to the budget statement:
This initiative will be integrated across the four stages of an
Australian Defence Force member's career lifecycle: recruitment, service, transition
or discharge, and rehabilitation and resettlement into civilian life. The
package aims to enhance psychological resilience among serving members, ensure
successful transition into civilian life and provide effective rehabilitation
and support.[24]
21.34
The committee supports the government's initiative but notes that PTSD
and other mental health conditions have been a source of concern for many
decades.
Care for personnel with PTSD or
related illness
21.35
Concerns with the detection, diagnosis and treatment of mental health
problems in ADF personnel are not new and have been the subject of much
parliamentary and media discussion.[25]
Mr Paul Copeland referred to the ADF Mental Health Strategy launched in 2004
and explained that the rehabilitation program provides 'the soldier with the
maximum time and ability to rehabilitate'. He then noted:
Unfortunately, we are still having people reporting that, once
they have been diagnosed with post-traumatic stress disorder, for example, they
are being given a notice of termination and they are out the door medically. It
is a heartbreaking moment; I can say that from my own personal situation. You
feel that you have done 120 per cent for the Australian Defence Force and the
country and, when you come back you become ill and all the ADF seem to be doing
to you is wanting to get rid of you. So it is quite a significant impact on
that veteran and his family.[26]
21.36
Two members from ATST-EM were also critical of the post-deployment care
provided for mental health problems. Captain Wayne McInnes stated:
Lip service was paid to the needs of ATSTEM personnel rotating
out of country many failed to be correctly screened for Psych procedures and
still carry the scars of their deployment today.[27]
21.37
While submission 7 stated:
Three months after I returned to Australia I was post deployment
debriefed, I expressed concerns about some difficulties I was having adjusting
and was told it will settle down you will be fine if you have any further
issues call this number, four years later I am still waiting for it to 'settle
down'.[28]
21.38
Mr Mark Johnson, DVA, explained that people
can get treatment for PTSD even if DVA has not accepted the condition as
related to service. He stated:
That is treatment that we will pay for. There is a range of
treatments available, from both hospital-type care to non-residential-type
care. So people can come to the department and ask us to pay for treatment as
long as they have a diagnosed condition...If they consider it is due to their
service and we accept the condition then we will pay for all care. It is the
same with any condition. If the Commonwealth has accepted liability for the
condition due to service then all treatment is paid for...There is no time
cut-off. In fact, under SRCA most of our claims are some years after the date of
injury.[29]
21.39
The committee notes the importance of ensuring that all ADF peacekeepers
are appropriately screened for mental health concerns and receive the
appropriate care when needed. It is firmly of the view, however, that compensation
in the form of payment for treatment does not adequately address the problem.
The committee believes that the ADF has a duty of care to ensure that mental
illness is managed properly. In this regard, it notes Mr Paul Copeland's
observation that 'all the ADF seem to be doing...is wanting to get rid of you'.[30]
The committee would like to see indications that the ADF is committed to the
long-term care and rehabilitation of members even where, because of their
mental health, they are no longer serving members.
Stigma of PTSD
21.40
There is no doubt that the ADF has programs in place designed for the
early diagnosis and treatment of mental problems but one of the most
significant impediments to promoting mental health, particularly in the ADF, is
the reluctance to seek help. This hesitancy to report or seek help for a mental
health problem is a well-recognised problem. In 2003, Major Karl Haas wrote in ADF
Health:
More of the 2002 group were aware of the availability of
counselling services than the 1999 group, but no survey participants actually
used counselling services. Most of the 1999 group and half of the 2002 group
indicated that they would not use counselling services to cope with stress,
even if they were available. This is of concern, as the survey respondents were
health personnel who should have had an understanding of the value of mental
health interventions.[31]
21.41
He concluded:
The reluctance to use mental health services may be attributable
to a perception that using such services is an admission of inability to cope
and meet the obligations of a soldier.[32]
21.42
More recently, Professor Alexander McFarlane and Professor Mark Creamer observed
in ADF Health that one of the most critical problems with mental health is
'the failure to diagnose these conditions early and ensure early treatment'. In
their opinion:
The natural hardiness of individuals and a willingness to deny
suffering means that many struggle with their symptoms over a long period. This
leads to secondary disabilities and adverse social consequences. Marital
relationships are likely to suffer, as is work performance.[33]
21.43
They highlighted 'the importance of ongoing research into human
adaptations to traumatic stress'.[34]
21.44
The committee received similar evidence during this inquiry. For
example, Mr Paul Copeland was of the view that:
The stigmatisation issue is still there within the Defence
Force. I think, until that stigmatisation evaporates within commanders and
local commanders on the ground, at the coalface, you will find people who will
be reluctant to report such illnesses, and they will try to hold the chain as
long as they can until they are at breaking point. There is a debriefing system
in place. RTAPS is one; there is Return to Australia Psychological Screening in
country and the psychological screening when they are at home some three months
afterwards. Some people have slipped through the gaps. I am not saying that it
is a perfect model, but there are some gaps in there that people are slipping
through.[35]
21.45
In its 2005 report on Australia's military justice system, the committee
recognised that one of the major health challenges facing the ADF was to
counter the attitude that seeking help is an admission of weakness.[36]
It urged the ADF to acknowledge that the military culture makes it difficult
for members to ask for help, and to put in place services that take account of,
and compensate for, this failing. Today, the committee again notes that one of
the most difficult challenges for the ADF is to remove many of the existing
prejudices associated with psychological disorders.
Committee view
21.46
The committee understands that service in a peacekeeping operation
brings with it psychological challenges. It recognises the measures implemented
by the ADF regarding the prevention, detection and remediation of mental
illness. The committee notes, however, that the stigma attached to mental
health remains a critical barrier both to reporting mental health problems and
to receiving treatment for mental health conditions.
Statistics
21.47
There is no doubt that the mental health of Australian peacekeepers
remains an area that needs close attention. Australia is not the only country
grappling with how to prevent and manage the problem. A clear and precise
understanding of the extent and nature of mental health concerns among
returning peacekeepers is required to both design an effective preventative education
program and to make available the most appropriate services for those who need
care. The data available on the incidence of PTSD in Australian peacekeepers,
however, does not present a clear picture. The committee now looks more
generally at the statistics available on the health concerns of ADF
peacekeepers.
21.48
One of the primary indicators of the health and safety problems
encountered by ADF personnel comes from the claims they have submitted. Australian
peacekeepers may claim assistance for medical services or compensation for
disability under three main pieces of legislation—Veterans' Entitlements Act
1986 (VEA), the Safety, Rehabilitation and Compensation Act 1988
(SRCA) and the Military Rehabilitation and Compensation Act 2004 (MRCA).
This legislation is discussed in greater detail in the following chapter.
21.49
DVA informed the committee that under the VEA approximately 1,600
veterans with eligible peacekeeping service have submitted claims for disabilities.
Mr Johnson, DVA, stated that this figure represented those captured on the
department's system since the early 1980s, which would 'be pretty much for all
our peacekeeping operations'.[37]
Under the SRCA, 1,300 claims for service in East Timor have been lodged.
Mr Johnson pointed out, however, that some of those would be people who had
dual entitlements and may have claimed under both the VEA and the SRCA.
21.50
DVA could not provide a breakdown of the causes for the claims under the
VEA but could do so for those under the SRCA. Mr Johnson stated:
...for East Timor out of approximately 1,300 claims 1,047 have
been accepted and, of those, 440 are for what is classified as injury and
poisoning, 183 for mental disorders, 122 for infectious and parasitic diseases—these
are accepted—100 for diseases of the musculoskeletal system and then the others
come into other categories.[38]
21.51
For RAMSI, DVA had received 45 claims, and 94 claims for Bougainville. Mr
Johnson explained that he did not have figures for others because they had
been difficult to retrieve from the system.[39]
21.52
Information provided to the committee in response to a question on
notice taken during Estimates in May 2007
produced a different set of statistics.
21.53
As at June 2007, DVA had received the following claims for disability[40]:
|
Veterans' Entitlements Act (VEA)
|
Iraq
|
Afghanistan
|
East Timor
|
Solomon Islands
|
|
Number of claims received
|
1,585
|
2,345
|
13,846
|
1,119
|
21.54
It should be noted that the number of claims approximately equals the
number of conditions, but not number of persons.[41]
Thus, these figures may well align with those provided by Mr Johnson to the
committee.
21.55
The committee is concerned that DVA could not produce comprehensive and
detailed statistics on the number of peacekeepers who have made a claim for
disability due to peacekeeping service, the nature of the disability and the
relevant operation.
21.56
DVA also provided information on compensation claims, other than those for
the disability pension, that had been made under the MRCA and SRCA,
Income Support and 'treatment only' health care benefits. The number of those
claims, determined under the different Acts for the four conflicts to June 2007
were:
|
VEA
|
MRCA
|
SRCA
|
|
931
|
885
|
1,579
|
21.57
The most common claims under the VEA were for invalidity, qualifying
service, malignant neoplasm, PTSD and depressive disorders. Under the MRCA and
SRCA, the most common claims were for injury and poisoning, mental disorders,
diseases of the musculoskeletal and nervous systems, and parasitic and other
infections.[42]
Committee view
21.58
The committee is concerned about the vagueness of the statistics
produced by DVA, particularly its inability to provide precise information on
the number of claimants and nature of claims as they relate to specific
deployments.
21.59
Despite the absence of full and complete figures, the committee is in no
doubt that many of those who deploy to a peacekeeping operation encounter an
environment or situations that heighten the risk to their physical or mental
health. The committee is interested in the health studies that have been
undertaken that would provide an insight into the problems encountered by
peacekeepers.
Health studies
21.60
DVA informed the committee that it had not conducted a study of the
effects of service in peacekeeping operations on the personnel who have taken
part in peacekeeping operations. Mr Johnson stated:
...Defence are doing various studies with pre- and post-deployment
in some of their more recent deployments. We have done lots of health studies,
but not one on peacekeeping that I can recall.[43]
21.61
He explained that one of the major challenges in conducting health
studies is establishing a roll of ADF persons who participated in a particular
operation and establishing a comparison group. He stated:
If you are going to do a health study, you need to have a reasonable
number in the health study to get scientific power in the study to reach some
reasonable conclusions from any results that come out of the study. Some
deployments that are very small are difficult because of that. Different
deployments may have different factors—for example, environmental factors...I
would have thought that lumping them together would also be difficult. You
would have such a jumbled group and to come to any conclusions about the health
impacts, or otherwise, of the aggregate group would be very difficult.[44]
In the past when the department has done studies, one of the
first things that it has tried to do has been to establish some sort of nominal
roll of people that participated in, for instance, the conflict in Vietnam or
in the British nuclear tests. That is very time consuming. It is difficult to
get current names and addresses and to seek the permission of those people to
participate.[45]
21.62
Defence agreed that issues concerning the health of veterans of past
deployments have been difficult to resolve because insufficient data was
collected at the time of those deployments. The absence today of reliable data
on the health of peacekeeping veterans, as noted earlier by the committee,
highlights the pressing need for the ADF to have a comprehensive database on
ADF members, their service and related health problems.
21.63
It should be noted, however, in 1999 the then Minister for Veterans'
Affairs announced a new health strategy for overseas deployments that inter
alia would include the compilation of the nominal rolls for all significant
overseas deployments over the past decade and health reviews for all future
overseas deployment.[46]
As foreshadowed in this announcement, Defence, assisted by DVA, have
established a program of post-deployment health surveillance. This program, the
Deployment Health Surveillance Program (DHSP), is conducting retrospective
studies on East Timor, Bougainville and Solomon Islands veterans. The Centre
for Military and Veterans' Health, established in April 2004, is undertaking this
longitudinal health surveillance on ADF deployed personnel, including
peacekeepers. The health effects of specific deployments currently being
investigated include Solomon Islands, Bougainville and East Timor.[47]
21.64
The program is a joint venture involving Defence, DVA and a consortium
consisting of the University of Queensland, University of Adelaide and Charles Darwin
University. According to Defence, the studies are similar to those being
conducted by allies such as the US and the UK. It anticipates that the studies 'will
inform a continuing, comprehensive health surveillance program for the ADF,
concentrating on the health effects of operational deployments'.[48]
The short-term benefits identified during a presentation on the program include:
- improved documentation and measurement of occupational and
environmental exposure;
- contribution to improving Defence health record systems;
- early identification of deployment health issues; and
- systematic review of literature about specific deployments.
21.65
The anticipated longer term benefits are:
- better quality information to guide interventions to prevent
chronic disability; and
- scientific evidence on health effects of deployment.[49]
21.66
In addition, through its applied research program, DVA is funding
smaller studies of other peacekeeper deployments.[50]
21.67
In March 2008, the Minister for Defence Science and Personnel called on current
or former ADF personnel to take part in the Timor-Leste and Bougainville Health
Study by the Centre for Military and Veterans' Health. In May 2008, he
announced a review of mental health care in the ADF and the transition to
non-military life. This review will examine existing mental health programs and
support across the ADF and DVA and 'advise on their effectiveness, gaps in
services, and challenges in delivery. It will also examine and advise on the
transition process between the ADF and DVA'.[51]
Committee view
21.68
The committee is unaware of any reliable data that has been collected or
analysed on the clinical profiles of Australian peacekeepers. The lack of clear
detail regarding the health and welfare of peacekeeping veterans leaves a
significant void in Australia's understanding of the effects that a peacekeeping
operation may have on those who serve in such operations. This gap means that
those responsible for preparing peacekeepers for service are at a disadvantage
in devising programs and training that might address and help prevent potential
health and safety issues. The committee sees a definite need for more effective
means of gathering, collating and analysing information on all aspects of the
health and welfare of those who have participated in a peacekeeping operation.
21.69
The committee also recognises the need to improve public discussion and
understanding of the health aspects of peacekeeping. Health studies should be an
integral and continuing part of a preventive policy to minimise dangerous
exposure to disease, unsafe work practices or environments. Although only in
its early phase, the ADF Deployed Health Surveillance Program appears to address
many of the committee's concerns about the absence of data. Even so, to
underline the importance of conducting comprehensive studies and continuing
surveillance of the health problems and needs of those who serve in peacekeeping
operations, the committee asserts that a more effective military medical
surveillance system is required. It makes the following recommendations.
Recommendation 26
21.70
The committee recommends that the ADF develop a comprehensive and
reliable database on Australian peacekeepers that would provide accurate
statistics on where and when ADF members were deployed. The database would also
enable correlations to be made between particular deployments and associated
health problems.
21.71
The committee notes the importance of ensuring that all ADF peacekeepers
are appropriately screened for mental health concerns and receive the
appropriate care when needed. It is firmly of the view, however, that
compensation in the form of payment for treatment does not adequately address
the problem. The committee believes that the ADF has a duty of care to ensure
that mental illness is managed properly. In this regard, it notes a witness's
observation that 'all the ADF seem to be doing...is wanting to get rid of you'.[52]
The committee would like to see indications that the ADF is committed to the
long-term care and rehabilitation of members, even where, because of their
mental health, they are no longer serving members.
Recommendation 27
21.72
The committee recommends that the ADF broaden the scope of the research
and studies being done on veterans' mental health by the Australian Centre for
Posttraumatic Mental Health and the Centre for Military and Veterans' Health to
include the rehabilitation of veterans with mental health problems; the
retraining opportunities or career transition services provided to them; the
quality of, and access to, appropriate and continuing care; and the stigma
attached to mental health problems in the ADF.
21.73
The committee notes that while some government and university sector research
has been undertaken into the health of Australian peacekeepers, as yet, it has
not been brought together to inform Australian peacekeeping practice. The
national peacekeeping institute, outlined in Chapter 25, would provide a
mechanism for drawing together the existing research capacity, whilst also
providing a critical link between government and non-government sectors.
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