Defence’s newly released mental health plan for the military is a welcome step towards dealing with the hidden wounds of war — especially the scourge of post-traumatic stress disorder, or PTSD.
The ADF is still moving slowly and fails to recognise fully the extent of a problem one former general describes as "rampant", but, taken with previous studies and strategy proposals dating to 2009, the Health and Wellbeing Plan 2012-2015 (pdf) amounts to a serious attempt to make progress on mental health issues.
The report recognises the impact of mental health issues on the capability of Australia’s defence forces.
"Understanding the key role that mental fitness has in the ADF’s ability to meet current challenges, the MH&WB Plan aims to build and maintain the resilience and mental fitness of ADF members…", head of the Joint Health Command chief, Rear-Admiral Robyn Walker, writes in the report.
It calls for earlier screening and destigmatisation of mental health problems, improved education of personnel and healthcare professionals and more help for families.
Families often pay a high price for the impact of combat and overseas employment on service men and women. At the same time, they play a critical role in their treatment. This is also recognised.
"The Plan also recognises that, due to the extraordinary demands of military service, the ADF must increasingly acknowledge the importance of families, and continue to support members and their families after the transition to civilian life," the report says.
It also recommends a mental health website and downloadable apps for smartphones and tablets — important measures for helping defence personnel access professional face-to-face help.
The report, the latest since the 2009 Dunt Review by Melbourne-based public health specialist Professor David Dunt, is 12 months late. The ADF’s 2011 strategy document — which found half of military personnel experienced mental health issues in their lifetime and one in five in the previous 12 months — called for it to be delivered early last year.
This is a significant drawback, considering the urgency of the ADF’s mental health crisis. In addition, the plan appears to underestimate how long significant conditions like PTSD last.
Vietnam veterans are still being treated, sometimes hospitalised, and face daily problems almost four decades after that war ended.
PTSD increases the risk of suicide, or harm to close family members. And, ironically, most medicines used to treat the condition list an increased risk of suicide as a possible side-effect.
It also manifests as alcohol or drug abuse, depression, nightmares, sleeplessness, flashbacks and an inability to hold down a steady job. Many sufferers of PTSD will be on medication for the rest of their lives.
Earlier official studies estimate rates of PTSD at 8 per cent of personnel who have been deployed.
But that is almost certainly a drastic underestimate; some mental health experts used by Defence say it is more like 40 per cent of personnel deployed across Afghanistan, Iraq East Timor and the Pacific in conflicts and disaster relief since 1999.
While the official reports and studies detail the plight of soldiers suffering PTSD, Major-General John Cantwell’s recently published autobiography, Exit Wounds, has painted a vivider picture than statistics ever could.
After serving as commander of Middle East forces, including in Afghanistan, Cantwell, a veteran of both Gulf wars, returned to Australia with a chance of being appointed chief of the Army.
Instead, he ended up in a psychiatric ward with PTSD after hiding it for two decades.
Cantwell, the most senior ADF officer to openly and candidly talk about his PTSD — it’s more prevalent among other ranks than officers — said in a recent interview:
"I think it’s everywhere. If the size of my inbox on my email and my Facebook page and text messages is any indication … it’s a rampant problem … I think that Australia underestimates the scale of it.
"Part of the problem is that for people like me, I didn’t even ask for help. I just tried to keep it a secret, tried to mask it because I wanted to have a career and get on … If you’ve got a problem, do something about it."
Taken together, the various reports since 2009 and the praise Cantwell’s book has garnered from military leaders, it’s evident that the ADF is making real attempts to address a neglected crisis in its ranks.
But it’s a long, slow road. The government’s responsibility to its soldiers does not end when their deployment ends. For many, that’s just the beginning.
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