Chapter Two - Deployment Health
Deployment and health care planning
The United States and the United Kingdom have developed new health strategies relating
primarily to deployment and to identifying and addressing the problems that
occur in conflict.
military underwent substantial changes after the end of the Cold War, resulting
in a smaller, more flexible, lighterequipped and more lethal military force
with new health care needs. To meet and adapt to these changes, the Department of Defence developed an
innovative health care strategy to protect the health of its soldiers, sailors,
airmen and marines. This strategy, called Force Health Protection (FHP), uses
preventive health techniques and emerging technologies in environmental
surveillance and combat medicine to protect all service members before, during
and after deployment. FHP is designed to improve the health of service members,
prepare them for deployment, prevent casualties and promptly treat injuries or
illnesses that do occur.
The overarching goal of FHP is casualty
prevention, achieved through a physically and mentally fit force trained for
modern combat and supported by mobile, technologically advanced medical teams.
FHP has reengineered the military's approach to combat medicineexpanding
beyond acute care services and toward proactive, preventive services that
improve the health of service members and identify and address medical threats
before casualties can occur. Three interrelated pillars support the goal of
Casualty Care and Management.
The United Kingdoms Defence Health Programme 20032007 outlines similar
objectives, with an emphasis on linking preventive health strategies to the
availability of a competent deployment force:
From the outset it has been our
declared intention to work together with the wider military, the NHS and
independent healthcare providers to deliver the required Deployable Medical
Operational Capability and a health and healthcare system that maximises the number of Service
personnel fit for task.
The United States in particular has used the considerable research
resources of agencies such as the Institute of Medicine (IOM) and other
branches of the National Academies of Science to further pre deployment and
deployment health plans. The Institute of Medicine has produced several reports on military and veterans health, and
recommended that effective health strategies for deployments required stringent
data collection and recording. In its study,
Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces (2000) the Institute identified concerns about the
rate of implementation of such recommendations:
The overwhelming victory that [defence
forces] achieved in the Gulf War
has been shadowed by subsequent concerns about the longterm health status of
those who served. Various constituencies, including a significant number of
veterans, speculate that unidentified risk factors led to chronic, medically
unexplained illnesses, and these constituencies challenge the depth of the
militarys commitment to protect the health of deployed troops.
Recognising the seriousness of these
concerns, the US Department of Defense (DoD) has sought assistance over the
past decade from numerous expert panels to examine these issues. Although DoD
has generally concurred in the findings of these committees, few concrete
changes have been made at the field level. The most important recommendations
remain unimplemented, despite the compelling rationale for urgent action. A
Presidential Review Directive for the National Science and Technology Council
to develop an interagency plan to address health preparedness for future
deployments led to a 1998 report titled A
National Obligation. Like earlier reports, it outlines a comprehensive program that can be used to meet that
obligation, but there has been little progress toward implementation of the
The report, A National Obligation, identified many of the
administrative and planning issues that limited the capacity for immediate
follow up of troops from the first Gulf War:
Federal agencies discovered numerous
health related deficiencies in monitoring the health of deployed troops. For
example, our record keeping capabilities were not designed to track troop and
asset movements to the degree needed to determine who might have been exposed
to any given environmental or wartime health hazard. Seven years later, we just
now have a complete accounting of who was actually deployed to the Gulf.
In addition, we discovered major
deficiencies in the way we approach health risk communication. While the desire
is strong to disseminate all relevant health information to the affected groups
as soon as possible, we must ensure that information is delivered in a way that
is understandable and causes neither unwarranted
concern nor undue complacency. We must ensure that even during wartime
situations, the military leadership ensures accurate communication of risks
associated with countermeasures, such as vaccines, and maintenance of accurate
While noting that
the number of persons killed and injured in war was small, the report concluded
that unknown or unexplained illnesses or symptoms, and accidental injury were
some of the later consequences which had not been foreseen and therefore not
However, DoD and VA were not fully
prepared to recognise, respond promptly, and treat the type of health problems
reported by a large number of Gulf War veterans. The number of veterans wounded
or injured in the line of duty was small, but new challenges included:
of injury due to chemical and biological warfare agents;
chronic diseases due to infectious and toxic exposures;
illnesses with long latency periods following exposure;
illnesses that might affect family members, close contacts and children
conceived postdeployment; and
higher rates of
motor vehicle injury and death, and of other accidental injury, among war
suggest that attention must be paid not only to injury that occurs during
conflict, but also to the longer term effects of it. This may appear
contradictory, given that some of the difficulties experienced by past veterans
have been the lack of immediate services,
but it indicates more that some of the longer term outcomes do not always
appear obvious, however much they may be connected to conflicts.
ADF health service outsourcing
services have been subject to considerable review in recent years, with recommendations generally
suggesting greater centralisation and more effective utilisation of resources,
an emphasis on appropriate levels of staffing, and an awareness of good health
as a necessary part of an effective deployable force. This
has led to more outsourcing of medical services, although this also reflects
the employment market.
is true that Defence has experienced difficulty in recruiting and retaining
sufficient numbers of health professionals in a range of disciplines. This has
not been a matter of policy; it reflects the current extremely competitive
employment environment. This is currently being addressed through a number of
initiatives such as career and remuneration reviews.
suggested that with the reduction of qualified staff within the ADF, there had
been a reduction in corporate knowledge. This was linked to the outsourcing of
think that, if you are outsourcing, the pool of people that you have in the
uniformed health service that have daytoday knowledge of some of the
conditions that service people come across, particularly from some exotic
environmental threats, is diminished you do not gain the corporate knowledge.
And this was perhaps the experience at Amberley, with the conditions
experienced there. 
outsourcing of service provision is not in itself a problem, and may be a more
efficient way of meeting peaks and troughs in demand. It could create some
problems if it were seen that some services were not available, but service
provision is already limited to some degree to what is seen as necessary, not
what is available. There could
also be a belief that there is a rationing of a particular level of service,
and that those who do not have access to it are less valued. However, Defence
emphasised that cost was a secondary factor.
standard of health care provided to ADF members is determined by policies aimed
at maintaining a fit and healthy deployable force, and are in keeping with
usual community expectations of a good health care system.
efforts are made to provide health services cost effectively, standards of care
are not sacrificed to achieve cost reductions.
witnesses conceded there had been a reduction in service providers with
knowledge and experience in the type of diseases and injuries, and also of the
environmental hazards likely to be experienced by personnel, they stated that
this was only likely to be the case in areas where there was little deployment.
Appropriate staff, that is those who were within the ADF, were available for
personnel on deployments or who had been on deployments previously. Nonetheless, it is obvious that
efforts were also made to ensure that the contracted health practitioners
became aware of the nature of ADF work
and kept up with relevant courses.
raised in evidence was that outsourcing could signify a loss of expertise
within the forces which could have long term effects in several ways, such as a loss of status through being
dependent on other departments for information:
Early last year,
when the second Gulf War deployments commenced, there were statements in
service newspapers by the Commonwealth Chief Medical Officer to support views
about anthrax vaccinations. To me, that jarred a bit. I thought you would seek
the advice of a person like that about an outbreak of meningococcal infection
in a base camp, but when you are talking about weaponised systems involving
chemical or biological agents that core expertise should be in Defence and
recognised as such. That is an example of what, to us, appears to be a
run-down. Whether or not that rundown is substantiated, I do not know; it is
just an example.
While there is
some truth in this, it is likely that a greater danger to personnel is not loss
of status, but whether the expertise of qualified scientists and medical
practitioners is available and properly utilised and whether the overriding
culture is one which values health and safety at all times. Where a department is outsourcing,
or seeking expert input, it is sensible to use the expertise of specialist
agencies, and in effect the ADF does this through closely following key
documents such as the Australian Immunisation Handbook. 
substantial experience of the US and the UK in biological and chemical warfare issues, much of
the information available on various hazards, exposures and material that is
used, comes from research undertaken there. The only Australian input
required is approval of the information and of any substances such as vaccines.
The capacity to deal efficiently with queries about anthrax and other hazards,
including environmental exposures such as du,
does not invariably require that high level medically or scientifically
qualified persons be within the armed forces. It may be reassuring to have a
member of the ADF announce a particular medical program, but in reality this
is unlikely to have proceeded without some input from qualified external
agencies, including those from overseas.
suggestion in one submission that there was a clear link between guidelines on issues
such as informed consent and the availability of highly qualified medical
officers to advise the command in this area,
does raise some questions about the extent to which medical staff are involved
in decision-making at the higher levels. The discussion on the anthrax
immunisation issue indicates that there were problems with access to
informative material for medical staff on the Kanimbla, the timely availability of which might have limited the
concerns of personnel.
greater problem is likely to be whether the advice available at the planning
stages of deployments identifies medical and other issues such as not giving
anthrax vaccinations at the same time as others, or the practical effects of
not agreeing to receive a particular vaccination. In the particular instance of the
anthrax vaccinations, the combination of poor quality and sometimes
contradictory information and incomplete medical data resulted in an
unnecessarily chaotic situation. While the ADF has accepted that providing information
earlier would have been better, it also needs to ensure that its management
obtains clearer information itself.
the strategic, operational and tactical levels, headquarters staff includes
dedicated health planning staff. There are both single Service and tri-Service
courses which teach operational health planning to ensure that, as part of
their normal professional development, those who fill health planning
appointments have the appropriate skill sets.
Many of the
programs recently developed demonstrate that the ADF has moved increasingly
towards the approach set out by the US and the UK, a move which will be supported by the development of
the Centre for Military and Veterans Health. Following the reviews of Defence
health services, specific objectives were outlined as a part of the Defence
Provide a fit and healthy force which contributes
to ADF mission success;
minimise preventable injury and illness;
provide appropriate and timely treatment;
develop the capability of the Defence Health
Service to support ADF requirements; and
Provide a well managed adaptive and adequately
resourced quality health system.
Defence submission to this inquiry did not consider that there were problems in
providing adequate services as part of an holistic approach -routine health
care prior to deployment includes the monitoring of health and fitness
standards, and emphasis was
placed on members of the ADF having responsibility for their own readiness for
At the same time,
the ADF emphasises that, given rationalisation of resources, the allocation of
uniformed medical personnel will be to the areas likely to be deployed, and the
provision of health care is geared directly to operational requirements.
care delivery in the Australian Defence Organisation is made up of four
components: the active duty men and women of the ADF, the Reserve component, an
element of Australian Public Service people, and a pool of contractors. The
ratio of those four elements will depend on the base that you are looking at.
If you go to an operationally focused base then the preponderance of providers
will be uniformed people. It has been the thrust of the reorganisation of
Defence Health Services to concentrate a scarce resourcethat is, uniformed
health providersto our operational bases.
The reason for
this allocation is presumably that medical personnel within the ADF are seen as
having a greater understanding of the needs of the ADF, and are more likely to
have militaryspecific expertise. Where this experience is recent, this may
well be true. However, unless there is detailed information available on day to
day activities of individuals, many medical professionals may not be aware of
some of the factors affecting their patients healthotherwise many problems
would have been identified long ago. It should also be borne in mind that, just
as there may be problems with psychologists being used to try to get people to
change their minds, there is also
a need for doctors and nurses to remember that their main duty is to the
patient and not to the ADF. No detailed instances were given to this inquiry of
any case in which there was a conflict of roles, but the use of civilian
medical staff may provide a balance.
The provision of
health care, while linked to Medicare, is directed primarily at maintaining a
high level of fitness for operational duty:
with Medicare underpins the basic entitlement to the range of medical services
available. The provision of health care differs to that available to the
general public in that the range of, and ease of access to health care provided
to the ADF will exceed that available through the public health care system
because of the requirement to meet and maintain operational readiness.
Conversely, the DirectorGeneral Defence Health Service (DGDHS) may also issue
policy which precludes or limits the provision of certain medical and dental
treatment, despite its availability on Medicare, on the grounds that it is either
contraindicated or unnecessary for operational readiness.
overseas deployments includes the assessment of health threats and the
development of health support plans which operate across the pre deployment,
actual deployment and post deployment stages.
The rate at which such strategies are developed may vary:
The task of conducting health [threat]
assessments is research and analysis based, requiring the coordination of a
large amount of corporate knowledge to gather information and formulate
coherent policy before it is turned into strategic guidance.
There is an
ongoing requirement for the collection and analysis of data which will help
establish an information base about the deployment area, including endemic
diseases, water and electricity supplies, and availability of established
health services. While it is to be expected that many details of a deployment
area may need to be revised, there seems to be little reason why a substantial
amount of the information which is regularly collected would not have been
analysed and a coherent policy able to be put in place rapidly. More
information on the day to day role of staff involved in the collection and
analysis of information may indicate a need for a more efficient approach which
could limit the time required to provide a basic strategy when decisions are
made for deployment.
especially important given that the existing health and environmental threats
may determine personnel to be deployed (those already fully vaccinated) more
than the deployment waiting on personnel to be available.
seek advice from [health planning] staffs early in the planning process.
Frequently the time needed to complete vaccination schedules to protect against
a particular threat in an area of operations will have a direct influence on
how quickly troops can be deployed fully protected against that threat. The
environmental threat assessment, which is prepared by health intelligence
staff, has a direct effect on the make up of any deployment as health support
is configured, and predeployment preparation is tailored, to meet the
operational, occupational and environmental threats.
threat assessment is developed by two agencies, the Defence Health Service
Branch (DHSB) and the HQAST.
Without such plans, a deployment is likely to encounter substantial problems
which will affect its capacity to undertake the deployment effectively. No
problems were identified by Defence in its statements about current
arrangements, but some submissions and oral evidence indicated flaws which may
have arisen from these plans or from an inability to provide services as
required by plans. One example was the lack of adequate protection from malaria
experienced by personnel in East
Timor. Another referred to lack of
information about environmental hazards:
recent discussions by Federation staff with East Timor veterans
identified that many of them were unaware of many of the chemicals and
substances which were known by Defence to be present in the area of operations.
Although it is accepted that many of these hazards did not become apparent
until personnel were in-country, subsequent briefings and information have not
been forthcoming or adequately recorded for future reference.
It is not clear
what detail is provided to personnel on health threats, and to what extent they
are required to keep themselves up to date, and seek additional information in
the field, although some updates are provided:
they are deployed there is an ongoing education program, which is usually
conducted by the health providers, and that is either of a generic nature in
relation to the operation itself or it may be focused, depending on things that
have happened locally, such as an outbreak of gastroenteritis or that sort of
Nor is it clear
if all personnel are able to accurately assess their exposures or risk of
exposure to disease and environmental hazards. Information about certain aspects of
health plans are confidential, and personnel will only be allowed to know what
is deemed necessary. Even if they
are aware of all relevant issues, inadequate provision of required medication
or other services will limit the usefulness of this knowledge. Lack of
effective monitoring of individuals, to ensure that they have not exceeded
dosage of particular drugs, also appears to be lacking.
We are not 100 per cent sure of, and
have not been provided with, the long-term effects of taking doxycycline for,
say, seven to eight months. One particular case comes to mind of a member who
did a number of deployments in a row and ended up being on doxycycline for some
13 or 14 months.
that information is provided on drugs used in deployments, including
doxycycline, but because
doxycycline was common, not much information was given to personnel. There was no mention of any studies
on long term effects, although concern was expressed about the status of individuals for G6PD, a particular
enzyme we are worried about in relation to antimalarials.
It is possible
that a need to know policy also limits both collection of information and its
the quality of early advice may be
affected by the inability to consult with some supporting agencies. 
considers that the information it provides pre-deployment is detailed, and
includes data on potential operation, environmental and occupational hazards
that may be encountered. It is also the case that different forces may have different
health needs, because the nature of their work may vary considerably.
the ADF engages in an operation, operational health threat countermeasures are
not always universal across the three services because they may be operating in
different operational milieus. Historically, Navy personnel have not received
the suites of protective agents that, for instance, ground forces may receive
because the nature of their duties is quite different and their risk of
exposure is different. So, whilst a decision may be made for ground forces to
be protected against anthrax based on threat assessment, the issue of whether
Navy personnel should receive similar protection is not always clear cut. A lot
of that will get down to quite pragmatic issues of where the ships will
operate, the ports they will use, the probability of their personnel going
ashorethere is a whole range of issues that need to be consulted.
Examples of this
variation were seen in the first Gulf War, with the majority of forces being
naval, and consequently limited vaccination being required.
briefing is also given, emphasising operational stress training  and a pamphlet containing practical
information relevant to the Area of Operations with effective disease
minimisation and prevention advice as well as mental health information is
predeployment education provided to ADF members deploying on operations includes
a number of discrete modules that can be included when appropriate, including
body handling and the psychological issues involved in operations in an environment
where there is a threat of chemical or biological weapons.
is possible that some personnel already emotionally adversely affected by
previous deployments, or those especially vulnerable, may neither be picked up
through the assessment process nor assisted by this information. One submission
noted that there may be a lack of psychological screening pre deployment which
could have serious effects later.
That there was in fact little early psychological assessment was noted in other
At this stage we are not doing a
comprehensive mental health assessment of people at recruitment.
It is the goal of the mental health
team to develop comprehensive recruitment profiling which can then form the
baseline for further assessments.
development of the mental health teams is an important one, it is likely that
early identification of alcohol and substance abuse and of psychological
factors (including those contributing to harassment, intimidation etc) would be
highly beneficial, preferably at recruitment.
There seems little point in providing extensive military training for a person
who may be quite unsuited for deployment.
Psychological assessment at intake cannot identify those
more prone to break down in combat, although it can filter out the dull, the
illiterate and the severely disturbedsuch as those with schizophrenia. Normal
men and women can break down.
However, this is
to be distinguished from pre-deployment screening. Defences reasons for not
conducting predeployment psychological screening included:
ADF does not conduct routine predeployment screening but does conduct assessments
by request. There are a number of significant issues with the application of
predeployment screening, not least the possibility of disadvantaging an
individual who is incorrectly screened out from deployment. Another major issue
for predeployment screening is that, by the nature of predeployment activity,
individuals will be experiencing an elevated level of activity and some levels
of anxiety that diminish the accuracy of the screening methodology.
Another reason is
that, depending on the length of the campaign, many individuals will be subject
to stress, and this cannot be predicted:
Overall, it was the Second World War
that showed that it was not the case that breakdown could be avoided with
selection, training and moral fibre, as had been concluded at the end of the
First World War. The reality of industrialised warfare was inescapableeventually,
statistical inquiries showedmen would breakdown irrespective of training and
courage. After about 120 days of combat, most units became incapable of further
performance because of psychiatric injuries, which were also proportional to
the number of physical casualties.
The policy with
respect to predeployment psychological screening was criticised by one
submission which suggested the process was inadequate, as was the post
deployment screening. The main reason for this was that there were specific
differences in mental health issues depending on the nature of deployment, and
these were not considered:
Neither Defence nor DVA have a clear
picture of the state of the mental health of young veterans. Furthermore, they
have not conducted sufficient research to understand the specific differences
in the mental health problems associated with War Like Service and peacekeeping
opposed to Peace Making operations. There is a clear requirement for Defences
Centre for Military and Veterans Health to undertake extensive research into
the symptoms and signs of operational stress related injuries for each type of
stress injury to ensure the development of better rehabilitation and
A further relevant factor in problems of
identifying mental health is the stigma associated with mental health issues,
which Defence has sought to overcome:
has made significant efforts in a number of different campaigns in order to
address those but, at the base level, there is still that cultural problem.
however, that as part of the information obtained from the study of the first
Gulf War, psychological and substance abuse problems were addressed in the
planning stages of a deployment,
as a means of trying to deal with issues before rather than afterwards:
prior to deployment,
the members are given a deployment guide, which is quite a comprehensive
document that goes into all of the possible problems they may experience prior
to deployment, during deployment and on return to their families.The aim of that document is to
heighten the awareness of the families about what signs may be significant.
Through the Defence Community Organisation they can certainly access social workers and, through them, the
regional mental health support teams if the family is concerned about any aspect of
the behaviour of the partner who has returned from the deployment.
In due course, it
is assumed that the process that occurred prior to the return of personnel from
Iraq will be in place for all deploymentsthat is, that
there is some attempt to identify potentially traumatising events prior to
individuals returning home.
responsibility placed on unqualified family members to identify problems
appears excessive. The value of regional mental health support teams may be
undermined by the lack of professional input in identification of issues at an
support plan outlines the processes by which adequate health services will be
provided to personnel during the whole phase, including pre and post
deployment. This includes
undertaking health reviews of returned deployed staff, and helping to identify
any health issues that may arise in the short or longer term from such
deployments. Postdeployment information gathered from various sources
including medical reviews can help to determine patterns of injuries and
disease arising from conflicts and therefore has a role in the prevention or
moderation of such effects in future similar deployments. Updates on the basic plan are
provided throughout operations,although
these appear to be available to health staff only. This again raises the issue
of the extent to which any relevant new information is passed on to those more
directly involved, and how it is transmitted.
As a consequence
of the readiness for deployment approach, the ADF considered that it was
capable of responding rapidly. All three forces were subject to an annual
health review, regardless of need for deployment. When deployment was
determined, Army and RAAF personnel underwent an update interview to
determine if any injury or condition has occurred since their Annual Health
Assessment. While this interview
was undertaken by health staff, it had to be signed off by a medical
officer, a term which appears to mean doctor. The effectiveness and thoroughness
of this approach will obviously depend both on the qualifications and skills of
the health staff and the awareness of the individual, who may have some health
problem which has minimal symptoms, or has not been clearly identified. Naval personnel have a seagoing
medical, although they are
presumably also required to remain deploymentready.
readiness programs are unlikely to include standard inoculations which are part
of the readiness for deployment strategy,
and will rather comprise those required by the specific environment or
situation of the deployment. It is
in this area that many of the issues concerning improved standards arose, with
out of date vaccines, poor quality information, and apparent unwillingness to
accept the effect of symptoms all
seen as evidence of second rate services. Another submission stated that given
the extensive literature available on possible effects of exposures and of
vaccinations, an improved process
regarding information provision and informed consent was seen as necessary.
There was little
information provided on the capacity of the health services during deployments,
whether this had been assessed against performance indicators and the extent to
which involvement in joint operations resulted in ADF personnel receiving a
lesser level of care than they might have expected. Australia provides its own primary level care on deployment,
and believes that the standard of other care is appropriate.
only two countries under whose command ADF personnel have ever operated, or are
likely to operate in the near future, are the UK and the US. Both those countries, along with Australia and Canada, with New Zealand as an observer, are members of the Australia, Britain, Canada and America Standardisation Program. The Program
develops Quadripartite Standardisation Agreements (QSTAGs). QSTAG 470Documentation Relative to Medical
Evacuation, Treatment and Cause of Death of Patients sets documentation
standards which are agreed by all parties while QSTAG 2042Common Principles for Deployment Health Surveillance does the same
for health surveillance.
Material from a
2000 review of the health status of the ADF identified a range of disorders
from other deployments but no serious injuries.
Data from some recent deployments,
including Bougainville and East Timor,
indicated that almost half of medical attendances were due to skin diseases,
injuries, intestinal infections and other infections including dengue fever and
malaria. Measures have already been put in place to apply lessons learned to
current and future operations.
As far as the Iraq deployment was concerned, there were no physical
injuries of a serious nature. To General Cosgrove, it appeared that in respect of the 2nd
Gulf War a similar result emanated from the period of time that was spent
acclimatising in the combat zone prior to conflict:
I believe that the opportunity to
acclimatise, to learn of the operating environment and to assimilate or
integrate with coalition partners, was a major factor in our people being able
to show a professional performance without friction, misunderstanding or those
individual factors that exhausted and disoriented service men and women can
experience if they are pitchforked into a harsh, hazardous environment at short
statistics on medical discharge do not demonstrate if some claims might have
arisen subsequently, or if there were longer term injuries, including mental
health problems that might not be obvious or identified until later. Primary
health care in recent deployments has been provided by Australiawith in patient services being a UN
or Coalition responsibility.
The only issues
identified for the deployment period were that Australian forces may have been
required to meet standards of another force, and that medical records in
deployment areas may not be easily obtained
because a hospital was under the command of another organisation such as the
UN. These issues, especially the
latter, can have substantial consequences for people making claims for injury,
but the Repatriation Commission believes that many former difficulties are
being overcome by different means of obtaining information.
general policy with respect to postdeployment health care is in Health
Directive 222Health requirements for
deployed Australian Defence Force Personnel. This is available on the
Defence Intranet and is published on the Internet. For each operation a
specific Postdeployment Medical Insert Slip is developed. This document is
issued widely in Health Support Plans. It addresses the missionspecific health
threats, environmental hazards and prescribed eradication courses to be
undertaken. The Medical Insert Slip is placed in the members medical documents
for postdeployment action. Each individual also undergoes a health assessment
and a followup psychological screen approximately three months post
earlier Estimates hearings stated that a form of health assessment was given
prior to return from deployment, but
later informationin respect of the return of troops from Iraqcorrected this to advise that troops had rather been
provided with a health briefing prior to return which:
pharmaceuticals that might be required; and
information on the post deployment health check.
able to raise concerns with a doctor if they had any further queries. While the
process may have improved considerably since this time, a general briefingeven
one which raises an opportunity for further private discussiondoes not help to
identify all issues that individuals may have, since many people may not wish
to discuss these. It is not clear from this information what medicines were
dispensed and whether these were handed out with adequate information, or took
the needs of individuals into account. Defence notes that personnel are issued with
cards detailing diseases endemic in the Area of Operations, which are presumably linked to the
inserts referred to above and which will be used during later medical
Defence, there is a extensive health screening process in place on return from
deployment, although this does not occur for three months:
After returning from deployment,
individuals are subjected to comprehensive healthscreening processes. These
are designed to eradicate disease and to document and treat potential exposure
to operational, occupational and environmental hazards during deployment. These
processes include medical testing, psychological debriefing and ongoing health
assessment is an Annual Health Assessment,
a threemonth gap is surprising, given that numerous health issues may have
arisen and need to be tested for. One reason given for this three month period
was that certain infectious diseases may not in fact manifest themselves on
the testing until a period of at least six weeks after return and that other
symptoms or signs might emerge during that time.
presupposes that various diseases were all caught just prior to return. Given
that the average period of deployment in Iraq was 6 months,
it is more likely that at least a percentage of personnel would have been
infected during the deployment. Diseases, including malaria, HIV, and TB,can provide evidence of infection in
short time span and treatment should start then. TB is prevalent in Timor, Iraq and
Afghanistan, with the latter two having rates of infection of approximately 142
and 148.9 (1991) per 100,000 respectively
which is likely to have increased because of the effects of war, although ADF personnel may be less
prone to the disease because of higher levels of overall health, and the
relatively short period of time spent in affected areas.
provided with prophylaxis against malaria (found in Iraq, Afghanistan and Timor as well as other regions of the Pacific). This will
not necessarily guarantee protection, unless taken as prescribed. One of the
disadvantages of doxycycline was considered to be that, as it had to be taken
daily, adherence to guidelines might wane.
Another problem, as indicated above, is that it may have adverse effects and
its long term use should be monitored.
In addition, the
possibility of transmitting some diseases such as TB to others including family
members, is heightened through absence of early identification. Although
reference was made to prophylaxis for malaria, the ADF does not support BCG for
preventing TB: the ADF will seek to minimise the impact of TB infection
through targeted screening. It
does not appear from information provided that the post deployment period is
used to complete a vaccination program, including for anthrax, although this
may not be the case. However, other evidence suggests that there may not be a
standard process for providing immunisations by set dates, and that a catchup
process is used:
recommendation is that if there is a prolonged period between the vaccinations
then you basically carry on as though that time gap did not exist. Say that,
hypothetically, there are three vaccines in a suite of vaccines and that a
person has had the first two, there may be a one or twoyear gap, then you
would only give the person the third shot and consider the sequence to be
complete. You do not start from square one and start revaccinating.
While many of the
issues identified in submissions concern the difficulties experienced by individuals
post deployment, the causal factors of many of these problems could be
attributed in part to processes operating during the pre deployment stage and
during the deployment period itself. In particular these concern absence or
incompleteness of medical records; inadequate predeployment assessment;
absence of adequate information on environmental and other hazards, especially
those which are perceived as relating to slowly developing disorders; and some
lack of clarity about the status of individuals relative to occupationthat is,
that different activities may expose people to different risks.
environmental/chemical exposures may have been identified just prior to return
to Australia, it would be necessary for health examiners to be
aware of these and of potential implications for future health. In addition,
possibly inadequate levels of postdeployment health assessment may affect the
capacity of the individual to identify problems in the short and long term, or
to seek help for these.
we were exposed to a large number of chemicals that we are still not 100 per
cent sure about the long-term effects of. When I was over there I never knew
that was the case all the ones associated with mining copper and gold. We are
still not 100 per cent sure. We have a large list of chemicals that we were
The extent of
exposures to substances such as depleted uranium (du) and smoil (smoke and oil)
would be known to some degree, with land troops generally being more
vulnerable than those on ships.
Although current information suggests there is limited long term effect of du, this prediction is made only on the
basis of work undertaken on those who served in the first Gulf War: fourteen
years is not a particularly long period to assess effects which may not
manifest for two or three decades. It is the view of Defence witnesses that
Australian personnel were not exposed to significant levels of du,
although a survey of personnel from the 2nd Gulf War will also be
carried out. DVA's opinion on du is
similar to that of Defence, that there are likely to be limited effects.
There are no known health effects of
depleted uranium in humans. What is suspected is that it might result in renal
damage in the longer term. This is because in studies of laboratory animals,
uranium given in high doses results in renal damage. It is also envisaged that
there may be a risk for cancer, as DU is a weak emitter of alpha particles.
However, this risk of increased cancer has not been actually observed in any
population of humans that have been exposed to DU. Thus, we do not know if
there is any level of DU related disease. Moreover, at the exposure level that
we believe Australians experienced it would be difficult to envisage that there
would be any adverse effects.
testing was eventually introduced for persons who had been exposed to du in the first Gulf War, it apparently
was not made available to those who were not current members of the ADF. However, Defence advised that:
members of the ADF who are concerned about possible depleted uranium exposures
can approach DVA and, if they have not already done so, can lodge a claim. As
part of the investigation of the merits of their claim, DVA can undertake
urinary uranium testing.
that the levels of exposure are risk of either (a) increased cancer rates or
(b) kidney damage from the toxicology would at worst be twice that of the
This may be so, and also considered to be well under the amount necessary for
an effect on health, but as one of the concerns of 1st Gulf War
veterans appears to be the combined
effects of various exposures and vaccinations, such statements may not produce
Given the fact
that many concerns develop and grow out of proportion to actual riskas far as
such risk is knownit would be more appropriate for services such as du testing to be made readily available.
Even on a costeffective basis, the reduction of fear and the belief that ones
needs had been recognised is likely to reduce later claims. Some recognition of
the effects of confusion and anxiety that arose from the problems with the
anthrax vaccine is evident, and
this suggests that the way in which issues are handled, as well as the issue
itself, is acknowledged as important.
evidence, there is now available improved information on environmental
exposures during conflict, at least in those areas which were monitored by the US:
The US military has had a very robust
system of putting environmental people on the ground to conduct routine soil,
water and air sampling and they are linking that with geospatial data
information so they are able to identify where an individual is at any point in
time and what environmental threats were at play in that location, even down to
things like overlaying satellite imagery to show the presence or absence of oil
fire smoke plumes. We have access to that data for our deployed personnel
information provided about the existence of environmental threats can also be
used to avoid having personnel working in certain areas, thereby reducing
hazards. However, the information
available about areas where US troops were not present may be limited.
remarks made by various US reports
suggest that a number of important procedures were not undertaken in the
collection of data which could limit the availability of information on
exposures in conflicts, reports on which Australia may be dependent. The fact
that processes are available, therefore, does not mean that these have been
followed or that relevant data have been obtained.
problems in particular were identified as a sensitive area, in spite of
substantial advances made by both departments in the awareness of such problems
and in the development of research and programs. Psychological assessment following
deployment did not appear to be detailed, at least in respect of Iraq, where part of the abovementioned health briefing
included some assessment. Comments
from one submission in particular stated that in the past and even more
recently, the regime of debriefings is inconsistent, and the quality is
arbitrarily dependent upon resource availability. One detrimental aspect of former
debriefings was the process of asking groups if there were issues to be
discussed, which tended to restrict the volunteering of concerns in public. Nonetheless, post 199596, more
personal individual debriefings were thought to have been pursued, although
this might not be until six months after return from deployment.
Defence did not
agree with the assessment that the mental health of younger veterans was not
understood, nor that there were ongoing problems with the majority of persons
who had experienced some psychological problems:
those who are affected, most will find that the psychological symptoms are
transient and will result in no long-term adverse outcomes.
used after the Iraq conflict appeared to be a psychological screening tool which required identification by the
individual of exposure to what is potentially a traumatic event:
tool that we are using is a questionnaire. As I mentioned earlier, it looks at
two things. Firstly, it looks to see whether the individual has perceived that
they have been exposed to an event that is significantly outside their
expectation or their normal experiencein other words, something to which they
may adversely react. Secondly, it then looks at how they are responding to
that, because we all know there is enormous individual variationan event which
may be quite traumatic to one individual may in fact be deemed quite normal or
quite acceptable to another. So it is a broad-brush screening tool that works
in two ways. Firstly, it gathers data, which works as a base line for the
individual. Also, in a sense it is an education tool because it makes the
person aware of what the potential range of symptoms are. Following the
administration of that tool, they are then interviewed by a psychologist and
given an opportunity, in quite an unstructured way, to discuss any concerns
that they may have. That is an important part of the interaction. Firstly, it
may pick up those people who are not being entirely honest or forthright in
their questionnaire. Secondly, it also establishes a degree of personal rapport
between the member and a psychologist so that hopefully the door is seen to be
open if any problems develop later on.
Again, a certain
amount of onus appears to be on the individual to identify issues which they
may not always be in a position to do. Nor may the assessment be any more valid
through being completed prior to return when their thoughts are fresh, since a traumatic event may have
occurred long before. It was also noted that disorders such as PTSD must exist
as a set of symptoms 'for a period in excess of six months before you can use
that label' which indicates it
would be preferable to ascertain symptoms as soon as possible.
Returning from overseas deployment
without any counselling or intervention by a mental health professional can sow
the seeds of long term mental health problems in traumatised personnel. It has
been suggested that immediate treatment of combatinduced stress will reduce
the likelihood, or at least the severity, of posttraumatic stress disorder.
Early intervention is effectively a preventive strategy. Interventions before
or immediately after developing stress symptoms promote an adaptive response to
trauma and prevent maladaptive responses that lead to long term mental health
There are no
doubt benefits and disadvantages to the current approach, and to the provision
of information to the families of personnel so that they can check for changes
in behaviour etc on a return from deployment.
Nonetheless, it seems more efficient and professional for the ADF itself to do
this, and within a shorter period than three months after return.
This is not to
deny that families in the general community who have a member with serious
mental illness will necessarily become more involved in monitoring, once a
diagnosis has been made. However, it seems outside the current community
standard to place a responsibility on partners or parents (who may not see much
of their children) to make an assessment that is properly made at the least by
an experienced psychologist. Even though leaders and senior personnel are
also educated in the identification of symptoms of mental illness, they will need to have support from
other staff in this processleaders and senior personnel may not have the
ongoing contact which could help identify changes in behaviour.
It should be noted that stress is
additive and that post-deployment issues such as readjustment to civilian life,
relationship difficulties, financial hardship etc may contribute significantly
more to the veterans health than the original servicerelated stressor. While
stressors can be identified in postdeployment checks there is a need for
veterans to accurately report their health status. Sometimes this is not done,
especially if the serving member believes it may lead to an early end of their
career in the military.
That there have
been changes which have increased available information, and which are directed
to improving services generally, is apparent. Health service provision includes
regular collection of data on Key Performance Indicators (KPI) relating to
issues such as patient satisfaction, vaccination levels, and deployable status.
standards in the delivery of health services are expected to meet the
appropriate professional standards of good practice. Key performance indicators
are in place for ADF personnel and achievement is monitored centrally by the
Joint Health Support Agency. Performance indicators are tailored to ensure the
maintenance of individual fitness and a fit and healthy deployable
are set performance indicators that measure the quality of healthcare against
clinical benchmark standards. Clinical benchmark standards are based on a
comparison of key performance indicators (KPIs) across Defence health care
providers. KPIs used in health support for Defence address quality of care and
indicate individual readiness. The KPIs are mostly aligned to civilian
standards as determined by the Report on
Health Sector Performance Indicators 2001, Queensland Health, Brisbane.
of a Mental Health Strategy for the ADF indicates that there is a good
awareness of mental health issues: mental health issues are a
significant byproduct of involvement in both peacekeeping and warlike
activities, although some aspects of mental health services are
not yet meeting needs. There have
been some advances in data collection and plans for improved medical records,
although the electronic systems on which these will be based are not yet
The role of the individual
and the family in deployment health
whether a health service is home based or deployed, it has to meet both
individual and group needs. Some of the
evidence provided to the Committee indicated that there was quite a high level
of responsibility placed on individuals in the ADF to maintain their health
status and remain aware of potential problems in the future which might arise
from deployments. It could be argued that this level sometimes demands too much
of the individual, for, while responsibility for ones own health is a message
increasingly promulgated in the community, it is not always possible for those
within an institutional setting to be in control of health information and
Staff in the ADF
It is more
important for personnel on deployment to have confidence in the quality of
medical staff that are available. The role of doctors as opposed to other
health staff in medical work in the ADF is not clearly defined. While JHSA
staff undertake the assessments made prior to and after deployment, the
requirement for doctors in such assessments needs to be determined. The Defence
submission refers to medical officers having to sign off on predeployment
checks, although other evidence
states that this medical assessment involves a questionnaire and a focused
examination from a medical officer.
In the 1997 audit
of nondeployment health services, the ANAO noted problems experienced with
respect to the employment of medical staff.
The ADF relies, almost exclusively, on
Reserve members to provide specialist medical services during exercises and
deployments. In view of the operational requirement for specialists, there was
scope for employing specialists fulltime in the ADF. This could help alleviate
the ADFs difficulties in attracting and retaining medical officers. Defence
would need to compare the costs and benefits of engaging specialists under such
a proposal with the usual methods of engaging them. In common with most career
structures in the ADF, the higher ranks in the health services largely entailed
command and associated management responsibilities. As a consequence, promotion
to higher ranks in the health services largely resulted in health professionals
spending more time on management and less time on clinical duties. A Defence
review found that 45 per cent of doctors would prefer to confine their work to
By the 2001
followup audit, there had been some progress with respect to the recommendation
concerning a revised career structure and pay scale. The situation affects mostly nondeployment
services as higher level care during deployments is generally provided by other
the level of health staff available for level 1 care appeared not to be a
medical officer, which may contribute to limited information being available on
more complex issues:
health plan for Iraq was that each of the units deploying would have embedded what we call
level 1 health support, which is not always a medical officer. In the case of a
naval unit, that may be an advanced medical assistant, called a phase 4 medical
sailor. In the case of Army units, it could be an advanced medical assistant or
it could be a medical officer; it would depend on the size of the unit and
where it was operating. But the intention was that all ADF units would have
access to their own primary health care. Level 2 and level 3 health care
support was provided by coalition partners.
Primary health care was also addressed in the 1997
and 2001 reports by ANAO, which had originally recommended that there be
greater access to relevant work experience by ADF personnel:
Although the primary role of ADF health
services is to support operational forces in combat situations, health staff
had insufficient training and experience in treating trauma (wounds) and
emergency cases, which are the kind most likely to occur in such situations.
The greatest scope for obtaining this type of training and experience was in
civilian hospitals and ambulance services. Lack of civilian recognition of ADF
training of medical assistants posed a difficulty in arranging placements with
the civilian sector.
1997 Recommendation No.10*
The ANAO recommends that Defence make
determined efforts to reach agreement with the necessary civilian health
authorities for ADF personnel to work in areas where they will be exposed to
emergency treatment of wounds and injuries and that a uniform ADF policy be
In the 2001 follow-up audit, it was reported that
the situation had not changed substantially, for several reasons including the
number of deployments in which staff had been involved. However it is possible that
practical experience in the field may also have improved the skills of such
material distinguishes medical officers from contract doctors, and also uses
the terms health officer, health practitioner and practitioner, the last
three seemingly interchangeably.
All three terms appear to mean doctor. An alphabetical list of medical
staff included a medical
scientific officer and doctor, but no medical officer. There also appears
to be quite a high turnover rate of medical staff, and although data were not
readily available on the reasons for departure, it is assumed that the majority
of such staff were not dismissed but chose to leave.
Separation rates for ADF medical staff for 200102
While it is
likely that many persons will seek a rotation in the ADF for experience, it
seems unlikely that the majority of medical staff employed by the ADF will
have had considerable experience within their own profession and even less
likely to be at the head of it, unless they are a member of the reserve forces.
The question therefore needs to be asked if there are sufficient staff with
experience and qualifications available within the ADF, especially because of the increased
reference to mental health procedures, pre-deployment psychological assessment,
and post-deployment evaluation of psychological problems or potential problems.
It is also
important to ensure that those who are working in the ADF are able to remain
sufficiently independent of what might be seen as military objectives as
distinct from medical objectives. This is likely to be difficult when there
is a clash between the principles of one profession and the other. For example,
mention has been made of the alleged efforts of the medical officer and the
psychologist on board the Kanimbla to
persuade personnel to accept the anthrax vaccination. This can lead to situations where
the professional skills are being misused to meet other objectives. Once the
basic information is provided, any persuasion, if acceptable, should be
carried out by some other person outside the medical unit.
As the major role of providing support to the
injured and conducting post deployment screenings is carried out by JHSA its staff would be expected to be
aware of a range of factors relevant to immediate and longer term
rehabilitation. The skills and qualifications of such staff should therefore be
appropriate to this task. Psychologists are also provided on site prior to
return from deployments, and are involved in the administering of
questionnaires designed to elicit information about PTSD in particular. Given
that one of the reasons for the use of questionnaires was to build up a
relationship which may need to be utilised later, it is assumed these same
psychologists are involved in any further assessment or service provision,
although staff turnover may limit this.
Some problems may
also be difficult to identify, and require input from individual personnel, who
are issued with a card which lists diseases endemic in the area of deployment
which is to be used as a prompt in the post deployment review. How effective these cards are may
depend on the time available to JHSA staff and whether they are qualified to
ask appropriate questions that elicit information not readily forthcoming.
To some extent,
responsibility during the post deployment period of assessment and screening is
also placed on individual personnel. Defence states that individuals are given
the opportunity to discuss any concerns with health staff, but, as suggested above, the
usefulness of this process would need to be assessed. Some submissions said the
post deployment debriefing process was inadequate and would not encourage the
identification of problems, quite apart from the broader sensitivity to being
seen as vulnerable or unable to cope:
I think there is also a culture within
Defence and even within the general community, as can be seen by things like
the recent advertising and information campaigns on aspects like depression,
that means there is a stigma associated with mental health issues. A culture
such as that in Defence, or the uniformed element of Defence, makes it quite
difficult to discuss those sorts of issues. It makes it quite difficult to talk
about them in general.
from deployment may not be in the best position to ensure that all issues are
covered, and thus the effectiveness of information on mental health both pre
and post deployment will depend very much on the extent to which there is an
effective briefing and de-briefing. It has been suggested that many mental
health issues may be those which personnel are unwilling to discuss, even
though ADF members can have access to treatment and management
for any mental health problem irrespective of its cause.
There is little
evidence, overall, to demonstrate that placing a certain level of
responsibility on the individual will always be the most effective way of
ensuring issues are identified and able to be expressed. In theory, individual
responsibility is part of the community standard, in that the greater
availability of information and the provision of a wide range of health
programs advertised and supported by state and commonwealth governments has
made health a much more individual issue. Risk factors for disease, obesity,
smoking and other campaigns have made potential health problems much more
widely known. The capacity to act on these, however, will vary.
deployments are considered welcome, there is an incentive for ADF personnel to
remain fit, although it could also be said there is also an incentive to hide
or minimise problems that might limit access to deployment. Quite apart from
the identified issue of not having information on injuries or conditions for
which compensation may be being paid, the ADF culture may not encourage
identification of some problems and the individual may lack the skills to
identify these as matters which must be addressed. It is possible therefore
that greater availability of experienced doctors in some assessments is
required, regardless of the emphasis on choice, awareness and responsibility.
While much recent
effort has been placed on the fitness of personnel for deployment, the ADF has
also acknowledged that occupational health is a priority that is being
ADF is seeking to improve its knowledge and training in the area of
occupational health. As a response to the F111 Board of Inquiry, Defence
Health Services Branch has proposed the creation of a centre of excellence in
occupational health to provide a critical mass of expert knowledge, advice and
training. Improved education, awareness and regular review of workplace
practices should reduce unnecessary exposures in the workplace. This proposal
is currently being considered by the ADF Occupational Health and Safety project
reflects the previous high rate of injury and level of disability in the ADF,
an important factor in whether it is possible to provide fit personnel for
The discharge figures shown in the
table below were obtained from the Army Recruit Training Centre (ARTC). There
has been a significant reduction in the discharge rate since the mid 1990s.
This has been due to the implementation of a number of prevention strategies
over that time. The 5 per cent discharge rate in 199899 is artificially low
because it occurred during the introduction of common Reserve and Regular
recruit training. Injured reservists were sent home rather than being
discharged and urged to return when better. Subsequent Army Readiness requirements
have stopped this. The later rates of 1013 per cent better reflect the true
discharge situation. This represents a greater than 50 per cent reduction in
discharges over the last 10 years.
lessons learnt at ARTC have been packaged as the Defence Injury Prevention Program
which is in the process of being implemented across the ADF.
emphasis on healthy lifestyle is essential, a limited regard by the ADF to
occupational/employment stresses also leaves individuals in a work environment
where they are unable to control the factors which affect their career.
Problems with injury rates were identified in the 1997 ANAO report.
The original audit commended Defences
initiatives to reduce recruits injuries and wastage but found little evidence
of research on the incidence and cause of injuries more generally, especially
in Army where the major problems occurred. Full direct and indirect costs
associated with injuries in the ADF were not recorded or known, apart from
identified postdischarge costs (for example, lump sum compensation payments).
Individual ADF programs did not have to fund the premiums paid by Defence to
cover compensation costs, and therefore there was no incentive for program
managers to reduce injuries leading to compensation claims.
The 2001 followup
audit reported that there had been some progress in three key areas, including
Shortterm strategies aimed at reducing
injuries in the ADF since the original audit had been limited to reducing
injuries amongst recruits. The ANAO commends the work carried out in relation
to injuries among ADF recruits and notes that savings in both personnel and
costs that have been achieved. Nevertheless the ANAO considers that there is
scope for short-term strategies to be developed and implemented with
application to the wider ADF population, based on the findings of studies
completed at the time of the original audit. For example, it has been known,
from as early as 1991, that sport and physical training are the two main causes
of injuries in the ADF. Implementation of shortterm strategies in these areas
would have led to earlier personnel and monetary savings. 
In 2000, the
first ADF health status report made very similar comments, although these were
based on 1997 data.
Physical training is linked to the
highest number of working days lost, hospital admissions, sick and light duties
days. Sporting injuries are another significant factor.
The study shows that physical fitness
and military training injuries are higher within the parttime Reserve forces.
The new Injury Prevention Strategy will focus on initiatives aimed at
minimising these injuries across the ADF, including parttime forces.
Early reports on
the Defence Injury Prevention Program suggest that it has had an effect, at
least as far as recruits are concerned.
The program was developed at a number
of pilot sites covering 15 per cent of the fulltime ADF population. Within the
sample selected for pilot testing, the program has resulted in a 95 per cent
reduction in rates of pelvic stress fracture for female Army recruits,
elimination of serious knee injuries in recruits negotiating an obstacle course
and ten to 45 per cent reduction in rates of injury in other ADF groups.
referred to women, although not in great detail. The Australian Peacekeepers
& Peacemakers Association and
the Regular Defence Force Welfare Association Inc both mentioned the special needs of
women personnel. They would be mostly among the category of younger veterans
for whom the Australian Peacekeepers & Peacemakers Association would act,
and therefore include women subject to the different pressures of peacekeeping
as described by that organisation and others.
From the information provided on occupational injuries, women were also especially subject
to some of the injuries that occurred in training, although the development of
new processes had improved the injury rate, and possibly the retention rate.
There are obviously different injuries,
in some cases, but if you are talking about the compensation or TPI support
that we provide, we provide it equally. DVA are just as good to males and
femalesand Defence have an excellent equity programand, if they were not, we
would be the first ones to be supporting our members and putting in complaints.
I think there are some injuries that possibly are more prone to be suffered by
one sex than the otherwe do not have the facts on that.
It was also
suggested that there may be different responses to deployment issues, including
different stress reactions.
We are aware, as a general ruleif you
want to talk generalisationsthat the response to stress is different between
men and women. That is what we have been told. In our limited research, there
is a difference. But remember, of course, that now we are getting more and more
women in the Defence Force.
There is not a
great deal of information on women in Defence's Annual Report, although a
number of projects have been established which directly and indirectly will
have an impact on women, including a Gender Diversity Strategy, and an
assessment of 'physical characteristics and performance capacity' that could
'optimise an individual's likely success in each employment category'. As noted above, there has been some
work undertaken on reduction of injuries in recruitment processes, but
otherwise it is not readily apparent that special attention is paid to physical
harassment and bullying have also been addressed by the ADF, although a more detailed report
would be required to determine the extent to which women were subject to
harassment and bullying and if this, as well as deployment issues, contributed
to mental health problems and required specific services.
also a particular concern for organisations who believed they were at special
risk of not obtaining required services.
it seems that reservists are a class
of members of the ADF who, when they complete their period of service, go back
very quickly to the civilian health system. Particularly if they think they are
suffering from conditions that they are not quite sure about, their only access
to health treatment is through practitioners in the civilian sector who may or
may not be aware of the peculiar problems of that deployment.
A similar point
was made by another organisation which had been set up to assist younger
veteransincluding those who might undertake further deploymentsto obtain
holistic health treatment.
when our young veterans leave the Australian Defence Force they no longer
have access to Defences safety network. As soon as a young veteran leaves
Defence, they are alone, facing both medical and health issues without
Defences help. The young veteran views the Department of Veterans Affairs
with scepticism and fear if they have not actually worked for them on a regular
basis, and see them as only dealing with compensation.
If reservists are
not part of the post-deployment processes, including health checks, they are at
risk of obtaining limited appropriate health services for a number of reasons,
including not being fully aware of the risks experienced and not having the
skills to identify other issues including mental health problems. Some of these
issues may be picked up later if they go on further deployments, but even if
this is the case, the delay in identifying a problem may have contributed to
its becoming more entrenched.
instances, reservists will be eligible for DVA health care cards. DVA also advised that efforts were
made to provide required care and obtain specialist services where necessary.
DVA understands that there is a
shortage of specialist and expert medical skills in Australia
in many areas, but efforts are made to ensure that returning reservists have
all of their needs met. It is in the nature of reserve service that reservists
are often difficult to get in contact with professionals with the appropriate
skills. This has been a known problem for many years, both in Australia,
the United States
and the United Kingdom.
Each country uses a variety of strategies to try to ensure that the health
needs of reservists are met, and there is a regular exchange of information
about this problem.
reservists include people with peacekeeping experience, they may have a
particular need of services which understand the special pressures that can
occur in this type of work. Such services may not need to diverge markedly from
those available to others whose deployment has involved peacemaking and active
combat, although assessment of needs should be undertaken by experienced
researchers and staff.