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A characteristic of debates around mental health and the ADF is the multitude of divergent groups with different and often contradictory views. This creates a set of political, social and administrative challenges for government. The task of integrating and co-ordinating the competing voices is significant. Leadership with authority and a capacity to bring together these disparate voices while forging a path forward that engages people, appears to be an essential element to optimising the potential of all those who seek to contribute. As noted, part of this puzzle is the relationship between the federal government’s coordination and state-based service provision. Another feature of the debate is the range of vested interests that are at play, each of whom are keen to ensure markets for their own products and services. One suggestion that arose during the research for this paper was to establish a forum run by professionals with subject matter expertise with a remit to address some of the identified issues around mental fitness. Currently, no forum exists through which the scope of the problem can be clearly defined and effective solutions planned. Such a forum would allow for the development of a new narrative focused on a professionally-set agenda.

The issue of the mental health of current serving ADF members and veterans is one that will always evoke a range of opinions and tensions between the organisations and individuals with a vested interest in this domain. One challenge arising for policymakers is how to encourage the development of high-quality research and audit arrangements to provide an objective analysis of emerging and current concerns. These findings would then require translation into legislation, policy and service implementation. This process depends on finding ways to facilitate collaborative dialogue between veterans, ESOs, federal government departments, state-based health departments, the medical profession and politicians. In part, this will require the development of a system of governance and independent oversight of the process. This role should also facilitate discourse between these parties. Another challenge is how to ensure that this kind of collaborative discourse and scrutiny feeds into a circle of continuous improvement of service delivery.

Further attention could usefully be paid to some systemic structural issues, such as the lack of clearly defined responsibility within the health system for addressing the divides and disjunctions between the responsible Commonwealth and state bodies that arise out of the structure of our Federation. This would ensure that an effective dialogue continues between the broader community health system and the veteran health system. The landscape of veterans’ mental health is constantly changing in terms of demographics, the numbers and duration of deployments, the types of wars being fought and the evolution of the health system. As such, these issues require ongoing monitoring to achieve optimised outcomes for both veterans themselves and the public at large.

Opportunity

The current reduction in operational tempo, and the significant interest and momentum in the issue of mental health combine to make the present a key opportunity to progress mental health care for Defence personnel and veterans.[1] The challenge is for Defence to capitalise on these factors and become a leader in the field, promoting and ensuring the psychological wellbeing of its workforce.

From the First World War veterans who were neglected by a medical system which misunderstood the link between military service and psychological injuries, to the woefully inadequate treatment of Vietnam War veterans, by comparison, the status of mental health in the Defence Force today is arguably in the best shape it has ever been. Encouragingly, there appears to exist from within its ranks, particularly in the senior leadership, a desire to continuously improve the way this issue is dealt with. While some activities around mental health and Defence appear chaotic, the challenge now is to harness the energy and direct the momentum in order to channel it into something of enduring benefit to serving members and veterans. With a small and captive audience as its workforce, the Australian Defence Force is well-placed to develop improved strategies for dealing with combat-related psychological trauma, reduced mental fitness and moral injury that other industries and nations will want to emulate. While we have come a long way from a very low starting point, the programs and services available are not yet effective and without significant investment in this issue now, there is the risk that the mistakes of the Vietnam War will be replicated, creating another long legacy of psychological injury from recent and current deployments.