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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.
[1]. Evidenced
most recently by the Turnbull Government’s response to the 2014 National Mental
Health Commission’s review of mental health programs and services.