TOP brass of the Australian Defence Force (ADF) downplay the impact of the poorly understood mental health condition known as Post Traumatic Stress Disorder on contemporary war veterans, while those fighting for the rights of veterans take the opposite tack.
Defence argues that about 1.9 per cent of troops will be affected by the disorder while veteran groups put the figure at closer to 20 per cent.
The reality, according to the best research available, is that about 10 per cent of modern-day war veterans will suffer from some form of mental health injury as a result of their service. Not all of those will suffer from PTSD.
What is not in dispute is that society — and the Australian taxpayers who fork out $166 million a year on veterans mental health programs — have little understanding of the issues faced by men and women sent to war in Australia’s name who return home carrying deep mental scars or haunted by the black dog of depression.
Army Reservist and doctor Major Jon Lane, who is six years into his psychiatry training, says the biggest problem is that so-called “adjustment disorders’’ were being misdiagnosed as PTSD which he says has become a mental health “catch-all’’.
But what about those who want to keep working?
“Under our disability based system, adjustment disorder is unlikely to be compensated but PTSD will be compensated,” Major Lane said.
“Even those with genuine PTSD can be cured, but it needs to be treated and cured in the paradigm of a soldier.”
Major Lane rejects claims by Defence brass that PTSD rates are as low as 1.9 per cent.
He says the true figure is about 10 per cent or around 2600 of the 26,000 military personnel deployed to Afghanistan.
Even that is a huge number given that the total number of claims last year for mental trauma was 2351, up from 1901 in 2012.
Wrestling with the statistics and how to care for those affected by mental health injuries is the role of the Department of Veterans Affairs (DVA).
Once a soldier, sailor or air force person is discharged from the military, and that tends to be a speedy process for those who are hurt, he or she becomes a client of the DVA.
If they happen to have suffered mental health damage they will be cared for under a program that has an “uncapped” sum of government money attached to it and that currently costs taxpayers about $166 million a year.
That includes $32 million for private hospital fees, $30 million for pharmaceuticals, $29 million for public hospitals and $26 million for the Veterans and Veterans Families Counselling Service (VVCS).
It is also a drop in the bucket for the department’s $12.5 billion annual budget for 310,000 clients.
Many veterans either fear or despise the DVA, but that is changing and the department assures us that it not only understands the burden of mental illness, but it has developed a multi-pronged approach to care for those affected.
It is based on early intervention that starts at one of its 35 on-base advisory service centres around the country.
Serving soldiers can be treated under a DVA funded non-liability health care program for mental health issues and alcohol and substance disorders.
Other initiatives include numerous treatment programs as well as the At Ease website and the VVCS that was founded by Vietnam Vets as the Vietnam Veterans Counselling Service.
The services provide a comprehensive approach to the treatment of mental health issues.
As the At Ease site says: “It’s not unusual to experience sadness, distress or anger after deployment. At Ease can help veterans, ADF personnel, and family members identify the symptoms of not coping. When you need to reach out, seek treatment or identify effective ways to move forward, At Ease can provide tips, treatment options & resources. At Ease also has clinical resources for health professionals who may be treating members of the veteran & defence community.”
DVA Deputy Secretary Shane Carmody told News Corp Australia that dealing with mental health issues was nothing new for the department.
“We are investing a lot in what is a very complex series of problems,” Mr Carmody said.
He said that unlike Vietnam Veterans, contemporary veterans were presenting for treatment much sooner.
“The mantra of early intervention is having an effect, it is working.”
That intervention translates into the 70,000 counselling sessions a year provided by DVA to about 12,000 clients.
One of DVA’s leading mental health practitioners Dr Stephanie Hodson said the term PTSD was used much more widely than it should be.
She said post-deployment transition was a more accurate term.
“It only becomes PTSD when it stops you from being able to work,” Dr Hodson said.
“PTSD has a defined set of symptoms and they are different to depression and anxiety.
“Depression is a far bigger problem than PTSD. Soldiers are more depressed after a deployment.’’
Dr Hobson said getting people well and back into the workforce was the driving force behind the DVA’s mental health programs.
“It is a wicked problem,” she said.
That “wicked” problem has led to dozens of suicides, but due to poorly correlated statistics no one can define exactly how many serving and former defence personnel have actually taken their own lives.
The bottom line is that 80 per cent of veterans will adjust and 20 per cent will require ongoing treatment.
“Two-thirds of them will get better, but one-third will be hard core and will need long-term support,” Dr Hodson said.
Probably the biggest challenge faced by veterans returning home from a conflict zone is readjustment.
According to Major Lane the transition between a war zone and home is very difficult.
“Home is nowhere near as exciting and then there is the drudgery of daily life which can’t compare to working in a conflict zone,” he said.
“The biggest problem is that soldiers often carry too much s–t to explain to a civilian doctor,” Major Lane said.
The veterans’ charity Soldier On was formed in 2012 by John Bale and his wife Danielle following the death in Afghanistan of his mate Michael Fussell.
It is one of a number of new groups, including Mates 4 Mates in Queensland, to have sprung up to assist modern-day veterans with the aim of ensuring that wounded vets and their families were properly cared for and supported to lead successful lives.
“We want to make sure our wounded are able to overcome the obstacles caused by their injuries; enjoy happy, fulfilling lives; and feel proud for the sacrifices they have made,” he said.
Thanks to the generosity of many Australians Soldier On has raised $1.8 million in just 18 months and now employs eight full-time and two part-time staff, including wounded liaison officers, to support damaged veterans through a range of rehabilitation, adventure, community events and education, employment and empowerment programs.
It has reintegration and recovery centres in Canberra and Adelaide and will soon have one in Sydney and other capital cities.
Mr Bale, whose father was wounded during the Battle for Coral in Vietnam, said the key aim of ‘Soldier On’ was to successfully integrate as many wounded or damaged veterans as possible back into the community to lead full and fulfilling lives.
“We don’t want to have a lost generation,” he said.
“We need to help people before they get to the stage of being in care.”
He said war veterans had traditionally either feared or despised the Department of Veterans Affairs, but that was slowly changing.
The department was increasingly open to listening to the concerns of younger veterans and all players were singing from the same song sheet when it came to the importance of early intervention.
“We have lobbied hard for individuals with DVA trying to turn the big ship around,’’ he said.
“We will take on an even stronger lobbying role this year by asking veterans what they want and getting that through to the government and the DVA.”
Like Dr Hobson and the DVA, Soldier On seeks to avoid using PTSD as the “catch-all” phrase for mental health injuries preferring to see veterans back in the community before they become chronic sufferers of the disorder.
“Some will require deep intervention but many won’t,” Mr Bale said.
“We don’t want people on TPI pensions at 30 and not contributing to society for the rest of their lives.”
So far Soldier On has assisted 350 veterans of post 1991 conflicts and their families without a cent of government money.
“We are not against government funding, but it should be seen as an opportunity for them rather than a burden. I am sure that any money invested by government in Soldier On would save taxpayers a lot in the long-term.”
This article first appeared on ‘Herald Sun’ on 30 March 2014.