General News Sector News — 13 December 2013
Army brass say PTSD is minimal among veterans; try telling that to Liam Haven

LIAM Haven scans the tarmac with his cane as he strides along the old highway to Canberra, recalling his childhood in Western Australia.

His old man, Craig, now a prosecutor, was a policeman who was posted to stations around the state. His mum, Debbie, is Burmese; she’d emigrated as a child. “Growing up in rural WA with a father as a cop I got picked on a lot. My dad had locked up some of my classmates; you can imagine how that went down. Mum’s Aussie as, but looks Asian, and so I copped it for that too.” His early teenage years were “best forgot” – he was a gangly, pimply kid who couldn’t wait to leave school and he did, not long after he turned 15.

Haven moved to Broome, where his dad was posted, and started work as a cement renderer. It was an OK job but the tropical lethargy of the place – work in the morning and then fishing, surfing and the pub every afternoon – started to get to him. And so he joined the army. It wasn’t out of any great sense of patriotism; that came later. He wanted adventure.Troops face mental health risks

He loved army life the moment he laced up his desert boots. It gave him a sense of purpose. He slotted in and no one gave a rat’s about what his old man did and where his mum came from. “When you first join the army everyone’s a piece of shit, but you’re all equal pieces of shit.” He celebrated his 18th at basic training. The skinny teenager hit the weights and bulked up to 120kg. He was big and strong and they turned him into an infantryman, a machine gunner in the Brisbane-based 6th Battalion of the Royal Australian Regiment, 6RAR, famous for its gallantry at the Battle of Long Tan.

His unit went off to East Timor, his first time overseas, and the experience made a better soldier of him. He grew up. And then he was off to Iraq. It was what he’d dreamed of, a proper deployment. His unit departed on November 30, 2007 and, on top of his infantry duties, he was trained in combat first aid. The politics of the war in Iraq didn’t concern him. “Our job was to do anti-rocket patrols, anti-IED patrols, not to be an aggressive presence but an assertive presence. It was pretty frustrating at times – I wouldn’t say we were wrapped in cotton wool but there was a caution that prevented us from doing our job at times.”

On the morning of May 15, 2008, two weeks before he was due to come home, he went out on a routine patrol. It was an uneventful shift and at 4am the following day, the soldiers walked a few kilometres back to their armoured Bushmaster. Haven stood exposed at the back of the vehicle, scanning for trouble. “We pushed off, got maybe 100m down the road, and then BOOM!” A bomb designed to cripple a tank – 40kg of explosives and 100kg of shrapnel – was hidden in sand beside the road. It exploded three metres in front of the Bushmaster.

Haven was bent over backwards by the force of the explosion – he saw the flash, then nothing – and instinctively ducked into the vehicle and closed the hatch. He had an intense pain in his shoulder but gave the thumbs-up to indicate he was OK. He couldn’t see, but figured it was temporary, a result of the flash. He felt his face and thought it was sweat – it was blood. A piece of shrapnel had penetrated his blast goggles and sliced through his left eyeball; part of his eye was hanging out. There was blood gushing from his neck and shrapnel peppered his face. As the first-aid guy, he had to talk his mates through the procedures. “I said, ‘Don’t f. k around, tell me how bad it is.’?”

“Your left eye is screwed,” he was told.

They loaded him onto a stretcher. Someone put a cigarette in his mouth and he took a couple of deep, heavy drags. “F. k me, Havo, you’re heavy,” one of his mates said as they carried him to a helicopter they’d summoned. They kept telling him he’d be OK, that he’d be back with them soon. The truth is they were petrified. They had no idea if he’d live or die. They too were kids, most of them barely out of school. At some point Haven passed out. He woke up to darkness in a military hospital in Germany. He was 19.

Haven, now 25, has one glass eye and two per cent vision in his other eye and, as we trundle along the road to Canberra, he tells me he can sometimes make out the white lines against the bitumen. “That, and occasionally a nipple on a breast,” he adds, with a grin. Memories from when he could see are precious, but they’re “like videotapes – if I rewind them too often they wear out”.

He’s lost his sight, but his physical wounds have healed. In many respects that has been the easy part, both for him and the army. Surgeons patched up his face and shoulder; they did what they could for his eyes. They got him a guide dog. He was taught to live as a blind man. But his unseen wounds – the terror of the dreams, taking him back to that day in the Bushmaster, the sleeplessness, the insatiable appetite for booze and its fleeting comfort, the disconnection from his family, the failed relationships – were harder to deal with.

He’s walking 350km along the back roads from Sydney to Canberra to raise money for the veterans’ charity Soldier On, and for Guide Dogs Victoria. But there’s more to it than that. He wants to send a message to our military leaders, to the government and to the people of Australia. “These guys fought for this country and now they are hurting.” I ask him, are we doing enough? “I don’t think so. I think we are facing a pandemic of mental illness. There is still this great stigma. Guys don’t want to get treatment or go on medication because they fear it will end their career. Defence needs to do more to help these guys and they need to work harder to get rid of this stigma.”

The extent of post-traumatic stress disorder (PTSD) among Australian veterans is a contentious issue. By year’s end the Australian base in Tarin Kowt will close and 1000 troops will come home – leaving 400 Australian soldiers in the country in non-combat roles. More than 26,000 Australian men and women have served in Afghanistan; 261 have been wounded and 40 killed. Some 17,500 served in Iraq, where two soldiers died in accidents and 27 were wounded. Studies from the US suggest that 20-30 per cent of its veterans from Iraq and Afghanistan have returned with either PTSD or traumatic brain injury, a form of concussion injury caused by roadside bomb attacks.

Retired general John Cantwell, who commanded Australia’s troops in Afghanistan and the Middle East in 2010, predicted there was likely to be a great surge of mental anguish among Australian veterans as our service men and women return home. “I think it will be a tidal wave,” said Cantwell, who retired in 2012, after years of battling PTSD himself – a result of fighting in three wars.

However, some controversial studies commissioned by the ADF suggest the rate of PTSD is drastically lower among Australian veterans than among their US counterparts. The ADF-commissioned research estimates the rate of PTSD at less than two per cent – although it is significantly higher for soldiers who have experienced combat. Chief of the Defence Force, General David Hurley, has dismissed his former colleague’s “tidal wave” claim as being “provocative and emotive” and says it “points to a simplistic view of military mental health”. Hurley made the bold claim on ABC TV’s 7.30 that “we actually don’t have a difference in the rates of mental health illness between the people who have deployed and people who haven’t deployed”. He stressed that this conclusion was based on world-class research. Being deployed to a war zone, our most senior military officer suggested, did not increase the chances of defence personnel getting PTSD.

“That is just ridiculous,” counters retired US general Peter Chiarelli, a former senior military adviser to the US Secretary of Defense, when I put Hurley’s statement to him. “Absolutely ridiculous. There has to be recognition that this is a problem. It has been a problem forever. There’s this crap about this being something about this generation – it isn’t anything about this generation. This has been a problem forever, for as long as we have had war.”

Chiarelli was the commander of the Coalition’s combat forces in Iraq in 2006. After his return to the US he looked at ways of reducing the alarming suicide rates among veterans and investigated programs to deal with PTSD. (He personally penned a letter to the family of every US soldier killed under his command in Iraq, posting 606 letters in a year.) He now works for a research organisation called One Mind, investigating better treatments for PTSD and traumatic brain injuries.

Chiarelli predicts Australian troops who served in Afghanistan and Iraq will return with rates of mental illness similar to those who served in Vietnam. “Probably higher,” he adds, on reflection. “While Vietnam was a guerilla war, there were front lines and there were places you could disappear and not worry. There is no road you can drive down in Afghanistan or Iraq and say, ‘The bad guys are not down here, there are no IEDs’ – the threat is constant.” The Department of Veterans’ Affairs eventually compensated 29 per cent of Australian veterans who served in Vietnam, accepting they’d suffered PTSD. It’s a long way from two per cent.

That’s not to say the issue is being swept under the carpet. There appears to be genuine concern among senior military leaders to avoid a repeat of the disgraceful abandonment of Vietnam veterans. Soldiers are being screened following their deployments for signs of mental distress. There are services available for veterans with PTSD who come forward, but are they adequate? Is PTSD getting the attention and resources it deserves?

John Bale, CEO of Soldier On, says Defence needs to do more to ensure the message filters down through the ranks that mental wounds are as valid as physical wounds and require treatment. “The most difficult thing is getting soldiers to come forward and seek help,” Bale says. “Servicemen and women have a great fear it will hamper their career within the military and so they avoid treatment.”

There is a great disparity between the Defence research and what Bale’s organisation is hearing from veterans about the extent of mental anguish. “Some of the company commanders from Afghanistan have told us that up to half of their troops are doing it tough,” he says. Defence says that 780 veterans have been diagnosed with PTSD; Soldier On is working on an estimated number of 3500. If its estimate is correct, there are now several thousand veterans who are suffering, untreated.

If the Defence attitude to PTSD is that it is not particularly widespread, as Hurley insists, then that dictates the resources it is allocated. But a senior psychiatrist, who has done work with Defence on PTSD, says there are serious shortfalls in the ADF’s strategy. It needs to take a “much more proactive approach”, he says, in dealing with soldiers who are at the greatest risk of developing PTSD in the future.

The psychiatrist, who wouldn’t be named, says that while tens of thousands of troops have served overseas, it’s those in units such as the special forces, infantry and sappers – soldiers at the sharp end of combat – who are most likely to suffer. “Many of these soldiers are already suffering sub-syndromal symptoms of PTSD. There is a real opportunity here that is being wasted. You know who is at risk and you know what to do. There should be a much more active strategy targeting these people.” Once they leave the army it becomes more difficult to reach them, he adds.

What was not widely reported with the release of the Defence studies into mental health is that 16.3 per cent of soldiers from Iraq who had combat exposure were experiencing PTSD compared to only 7.6 per cent from Afghanistan. What this indicates is that there is a significant rise over time – the bulk of Iraq veterans having deployed earlier. The prevalence of PTSD among ex-service personnel who completed the survey two to three years after their most recent deployment was almost 30 per cent.

On a blustery Thursday afternoon General David Morrison, the Chief of Army, joins Liam Haven on his trek. After an hour or so of chatting with Haven, Morrison drops back and we fall into step. He tells me the army is on a steep learning curve when it comes to dealing with its wounded and mentally traumatised soldiers. “I admit that it has been less than elegant at times,” he says as we stride along behind Haven. “I can’t give them back their sight or their mobility or ease their mental stress, but we are embarking on programs to help them wherever we can.” The army is changing, Morrison insists, to accommodate wounded soldiers and those with PTSD to allow them a rewarding military career or help them transition into civilian life.

The army has recently set up three Soldier Recovery Centres in Townsville, Darwin and Brisbane. Morrison invites me to visit one, which I do, a few days later. It’s in an old gym at Brisbane’s Enoggera base and opened late in 2012. Major Roger Briggs, the base’s officer in charge of health and wellbeing, says the centre has a capacity for 20 soldiers – some wounded and injured, most with mental health problems – who have been referred by their commanding officers in consultation with their doctors. These soldiers are unfit to serve in their regular units, but wish to remain in the army; they come here until they are well enough to return to their unit, or are discharged. Briggs admits there are not enough places to fill demand. “I personally think we are a few years too late,” he says. “I think there are a lot of people who have left the army who fit into that ‘bitter’ category.”

Briggs says the idea of the recovery centre is to give the soldiers a sense of purpose during their recovery. “I like to see it as a long-term period of decompression where they can adjust to the world,” he says. Soldiers may be assigned to the centre for several months to a year.

The program was designed by a physical fitness instructor. The soldiers spend the morning exercising and in the afternoon they may visit a homeless shelter or do leatherwork or play lawn bowls. “We try to engage them in a social network and keep them active so they don’t get into that damaging self-talk and ruminate,” Briggs says. There are no psychiatrists, psychologists or counsellors – no one who is qualified to deal with PTSD – attached to the centre, but Briggs says a padre was recently assigned, which had been helpful. There is no requirement for the soldiers to receive psychiatric care, but if they do, they go elsewhere for this treatment. “I think we are creating a group of soldiers who are not bitter, not pissed off with the world,” he says. But the recovery centre doesn’t work for everyone.

In the support vehicles for Haven’s walk are two men who are both suffering from their war service. In the lead vehicle, waving down approaching traffic, is Daniel Excell, a laconic infantryman from 6RAR – who has just been discharged, against his will, as medically unfit. Excell joined the army at the age of 19 in 2007 and was deployed to Afghanistan early in 2010, where he was posted to one of the forward operating bases. He and 15 other Australians lived and worked in the base with their Afghan National Army counterparts. It was from these bases that they took the fight to the Taliban.

They’d been there about two months when, during a routine patrol, an improvised bomb exploded next to them. He and another Australian were blown into the air. Excell, the radio operator, had blood coming from his ears as he called in a US helicopter. For days afterwards he suffered terrible headaches, but kept working. He didn’t want to let his mates down.

A couple of months later he was out on patrol again, training Afghan soldiers. “We’d set up a defensive perimeter and I sat down against this wall of earth to take off my load and collect my thoughts,” he says. “I was just about to take my helmet off when BOOM, the IED went off just 30cm above my head. I was completely covered in dirt – it felt like I’d been buried.” No one who was there can quite believe how he survived. But again, he continued with his deployment. His mates would tell him each morning how he’d woken them, yelling and screaming in his sleep. He wasn’t the only one.

“The minute I stepped out of Afghanistan and landed back in Australia I had this overwhelming feeling I’d be killed,” he says. “I was waiting at the airport and had this sense that the bus would mount the footpath and hit me. It was like I was always on patrol, as if I was being stalked by death.”

He went weeks without sleeping. He hit the booze. After a couple of months he was placed on heavy medication – his weight blew out from 98kg to 130kg. Being on the drugs meant he couldn’t work and so he wallowed. He has been through therapy and was, for a time, enrolled in the Brisbane Soldier Recovery Centre – that was until he lost his temper with a PT instructor who’d ordered him to change into his uniform and he held him down on a table by the scruff of the neck. (“Daniel Excell is a lovely bloke,” says Briggs when I ask about him, “but unfortunately he is one of those guys who fell between the cracks.”)

“I desperately wanted to stay in the army,” Excell tells me. “I loved it – it was my life. I was willing to do anything to stay, to get better.” The army wasn’t prepared to wait. He’s now 26, lost and terribly damaged. “The army had no faith in me. There’s all this talk about them accommodating guys like me with PTSD but when it comes down to it they’re full of shit. Guys see what happened to me and there’s no way they’d come forward and admit they have a problem, not if they want a career.” And how many guys are there like him? “Heaps.”

Not long after returning to Australia, Excell started a relationship with a young law student. “She was the girl of my dreams,” he tells me. They got engaged but the relationship could not survive his demons. “We’re still mates,” he says, lighting another cigarette. “We were due to get married this weekend.”

“Prevention is better than cure,” he adds. “Soldiers need to be constantly trained for mental resilience – just as we work on our fitness – so that when we encounter terrible situations in war we are better able to cope.”

The other Australian soldier supporting Haven’s walk did three tours of Afghanistan and he too is suffering. He asked not to be identified; we’ll call him John. “I really liked being in the army and serving my country,” John tells me of his 13-year career. “I got a lot out of feeling part of something bigger and helping out. But in the end the stress and the grief from losing so many of my friends on a regular basis started affecting me psychologically and physically, and I just couldn’t work in that environment anymore. I just started to break down in public. Something small would happen and I just couldn’t control my emotions. I was broken by grief.”

John says the army gave him all the support, medical and emotional, he needed. “I’ve got no complaints, they did their best to look after me,” he says. “They gave me time to come to the conclusion myself that I couldn’t continue in this line of work. So now I am leaving into the big unknown and that is very, very frightening.”

After a long day of walking – 36km over seven hours – a visit to the Goulburn war memorial and afternoon tea with old diggers from the local RSL, Liam Haven and I settle down in his motel room with a beer. He says that when he first returned to Australia he threw himself into learning how to live life as a blind man. “I was pretty good for a fair while actually,” he says. “I had no idea what post-traumatic stress was, until it hit me.”

It was in 2011, after starting a relationship, that things began to turn sour. He lost interest in sex, he became withdrawn and he was having trouble sleeping. He started drinking very heavily, “a bottle of bourbon every night”. He ended up in a rehabilitation clinic and then went off for treatment for his psychological traumas, which, he says, has helped. “It is not as if the army ignores this sort of stuff altogether,” he says. “They are trying. I just reckon they could do better, much better. And I think these guys deserve something better.”

Australia was a bit player in the wars in Afghanistan and Iraq. We had no real influence over the outcome of either conflict – both of which are still being played out. The current military leadership will not be judged on those wars but on how the men and women who fought on our behalf fare in the years to come.

This article first appeared on ‘The Australian’ on 7 December 2013.

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