The Australian Psychological Society (APS) welcomes the opportunity to provide a response to the Royal Commission into Defence and Veteran Suicide. We are deeply concerned about the enduring mental health issues and suicides within the Australian Defence Force (ADF) and veteran community, and the wide-reaching impact on families, friends, colleagues and society at large.
Informed by the Royal Commission’s Terms of Reference, the APS submission is organised thematically and makes a range of recommendations for reform and action in key areas. The recommendations throughout our submission included:
Recommendation 1: Provide adequate resources and support to urgently implement the recommendations set out in the Interim Report with the potential to impact the mental health, wellbeing and self-harm of veterans including: simplification of legislation, addressing the backlog of DVA claims and embedding a trauma-informed approach into all ADF and DVA information and support services.
Recommendation 2: Deeply embed a comprehensive approach to mental health care and suicide prevention and response within the ADF, DVA and other support agencies. This should include strengthening of protective factors, mitigation of risks and the provision of integrated non-clinical and clinical care focused on prevention through to recovery and postvention from the point of recruitment, throughout military service and during separation, transition and beyond.
Recommendation 3: Incorporate trauma-informed care principles as part of organisational and operational decision-making in the ADF, DVA and other agencies.
Recommendation 4: Ensure the availability of timely psychological expertise to address the complex emotional responses, for example, to trauma and moral injury in affected veterans.
Recommendation 5: Support increased longitudinal research into predisposing risks as well as protective factors in suicidality in current and former military personnel.
Recommendation 6: Establish dedicated support to assist veterans (and their families) to navigate and stay engaged with quality, mainstream healthcare services that provide evidence-based treatment.
Recommendation 7: Address mental health and suicide stigma in military culture to remove barriers to help-seeking behaviour, and further, to promote a culture that encourages help-seeking behaviour.
Recommendation 8: Identify veterans as a vulnerable group requiring targeted policies and initiatives that support their access to mainstream services, for example, housing support.
Recommendation 9: Invest in more research and implementation of evidence-based initiatives to prevent and respond to veteran contact with the criminal justice system.
Recommendation 10: Dedicate a ‘stream’ of appropriate psychological support for those who experience military sexual trauma.
Recommendation 11: Encourage and strengthen current efforts to investigate and address all types of abuse, discrimination and bullying in the military, in particular while considering a diversity of characteristics and attributes including gender status, cultural background, preference and identity, beliefs, attitudes, skills, vulnerabilities and perceived weaknesses and attitudes.
Recommendation 12: Ensure veterans, their families and kin have timely access to evidenced based mental health and suicide care that operates within a non-stigmatising, person-centred stepped care model that aligns with an individual's needs and enables flexibility to transition seamlessly between different levels of support, ranging from low to high intensity, as those needs evolve.
Recommendation 13: The ADF and DVA partner with the APS, psychological scientists and field experts to build and implement systems that support the delivery of evidence-based mental health and suicide prevention and response practices for veterans, their families and kin, including:
· Develop clear statements of expectations or standards of mental health and suicide care commensurate with contemporary evidence-based practice.
· Implement mental health workforce incentives that drive best practice mental health and suicide care.
· Increase the availability of expert mental health advisors/panels to provide support and practice guidance for mental health practitioners.
· Coproduce training programs with those who have lived experience for early career mental health practitioners to develop military ‘cultural competence’ and support the continuing development of clinical skill requirements for evidence-based treatments for high-prevalence disorders in veterans.
· Provide funding for professional organisations (e.g., the APS) to develop and lead psychology intern and registrar programs with appropriate supervision focused on evidenced-based mental health and suicide care for veterans, their families and kin which will help to meet the demands now and into the future for highly skilled mental health practitioners available to work with this population.
Recommendation 14: Codesign and implement a robust system of clinical governance and quality assurance across the ADF and DVA for mental health and suicide prevention care for veterans, their families and kin, including:
· Resource the development and implementation of a robust case management system for complex veteran care cases.
· Create clinical panels to review mental health cases for quality compliance as required.
· Ensure mental health practitioners have qualifications and training appropriate to treating mental health concerns for veterans and their families.
· Implement robust outcomes measurement and evaluation of mental health and suicide prevention care provided to veterans, their families and kin.
Recommendation 15: The DVA to urgently review and increase the scheduled fee for all registered psychologists who participate in their Non-Liability Health Care Scheme.
Recommendation 16: Include, as part of a comprehensive suicide reduction strategy, a focus on known contextual factors and groups and subgroups identified as higher risk when transitioning out of military service.
Recommendation 17: Review the adequacy of the duration, intensity and nature of transition support provided by the DVA and other agencies to ensure it effectively addresses critically important practical and psychological considerations in a proactive manner.
Recommendation 18: Ensure ongoing assessment and monitoring for early identification and engagement in evidence-based care and connecting to services for transitioned ADF members and their families.
Recommendation 19: Strengthen efforts to develop alternative workplace injury and rehabilitation models for individuals with service-related injuries that aim to support the return of defence members to the same or alternative ADF roles.
Recommendation 20: Adopt a preventative, cross-department, whole-of-government approach to support families and kin, particularly to assist them when veterans transition out of the military.
View Submission