Healing invisible wounds: Navigating mental health in the Defence and ex-service community
It’s often said that the hardest wounds to heal are the ones we cannot see.
Australian Defence Force (ADF) members frequently face mental health challenges during active service, the transition to civilian life and beyond, and the military culture of stoicism and stigma can delay timely intervention.
While the journey to recovery looks different for everyone, mental health is dynamic and responds to our changing life circumstances.
There is no ‘set-and-forget’ mechanism, but experts and veterans agree that active management, early detection and appropriate and varying levels of support are crucial to achieving good mental health and wellbeing.
Common mental health challenges
It’s estimated that one in five serving ADF members has a mental disorder, and one in three veterans experience high levels of psychological distress.
Dr John Cooper, a Consultant Psychiatrist from Phoenix Australia, the national centre of excellence in posttraumatic mental health, has extensive expertise in veterans’ mental health.
Dr Cooper said the most commonly diagnosed mental health disorders among serving members and veterans are anxiety disorders (such as generalised anxiety, panic attacks and social anxiety), Post-Traumatic Stress Disorder (PTSD), followed by affective disorders such as depression and substance use disorders.
During service, individuals may develop mental health issues related to their deployment, or due to organisational or management problems.
“There are many reasons a mental health disorder may develop, and we know that the sooner a person gets help when they begin to feel unwell and their quality of life is affected, the better the outcomes are,” Dr Cooper said.
However, service and ex-servicepeople are often reluctant to seek mental health support, fearing it will be seen as a sign of weakness and impact their deployment or promotion opportunities.
Veteran Francine Dudfield, a former Army medic, said she has always been driven, competitive and independent, so she knows that it can be hard to seek help.
“Even though these traits can serve you well in life, being too hard on yourself isn’t really that helpful and I think we have to teach self-compassion,” she said.
“I have learned that showing vulnerability is being human and, in my opinion, asking for help is one of the most courageous things you can do.”
Prevention, detection and treatment
Dr Cooper describes mental health support as a tiered approach.
“On the first tier is the preventative aspect, the things we should all be doing for our mental health,” he said.
“This includes prioritising sleep, eating healthy foods, exercising, managing stress, and avoiding maladaptive coping strategies like drinking alcohol or taking drugs.
“We also know that positive relationships, social connections, and feeling supported, whether by family, friends, or within the workplace and community, have a protective positive impact on mental health.”
Francine, who is retraining as a clinical psychologist, said exercise is an important way she maintains her mental wellbeing, and she recently won a Gold Medal in the 2023 Invictus Games for her efforts.
She also practices self-care.
I try to take time to do things that make me happy, like going for a walk, spending time with friends and family and practicing positive self-talk. I also find journaling helpful.
FRANCINE DUDFIELD
Dr Cooper said veterans need a basic level of mental health literacy, so they can be aware of potential problems as they emerge, allowing early detection and treatment.
The second tier of support is for those who have early, mild symptoms that may follow a traumatic or severely stressful situation, requiring a health professional’s response, and this may be from a GP or counsellor.
“The third level is when you have a clear mental health disorder diagnosis such as depression or PTSD. There will be high levels of distress and active symptoms that impact on a person’s ability to work, their relationships and quality of life,” Dr Cooper explained.
“If these severe symptoms persist, they warrant a mental health intervention from a psychologist or psychiatrist.”
People with diagnosed mental health disorders such as PTSD often require a combination of robust and evidence-based psychological treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT) and cognitive processing therapy (CPT). Medication may also be needed.
Family is central to recovery
Dr Cooper noted that one of the common reasons veterans and military personnel seek help is because of the impact of their symptoms on their family and relationships.
Families are like sponges that can soak up a lot of stress and distress.
DR JOHN COOPER
“They are also incredibly important in providing support and having a positive influence on recovery and helping people get help and treatment.”
Part of staying on top of your mental health is feeling comfortable to share your feelings.
Leonie Nowland, the National Manager at Open Arms – Veterans and Families Counselling, said the counselling Open Arms provides to veterans and their families can involve supporting individuals to discuss their mental health with their families.
“People tend to bottle their feelings up and hide how they are feeling, but this can cause confusion for the family and they may misinterpret the behaviour,” Leonie says.
“Mental illness is often episodic in nature, meaning that while people do recover, they can relapse, which can create constant concern from the family.”
Open communication, patience and understanding are crucial.
Family members can also seek their own support from Open Arms to better equip them to support their loved ones.
Opportunity to reframe
Research shows that leaving the military and transitioning to civilian life can be a difficult and disruptive time for veterans and their families.
Veterans often describe a fracturing of their self-identity and they can experience the challenges of unemployment, financial insecurity, a lack of peer support, and new family responsibilities.
It is a period of increased mental health challenges and a higher risk of suicide.
Leonie says mental health issues linked to transition usually occur within two years, but Open Arms has also supported people up to ten years after.
Taking time to plan and prepare for transition can help make the process smoother, as well as understanding that new ways of thinking and behaving may be required.
When you leave the military, you often lose your career, connections, friendships, sense of belonging and purpose, and your pride.
FRANCINE DUDFIELD
“I think it’s important to recognise and validate when we have experienced loss, but then come back to a place of gratitude and acceptance and be gentle on yourself.
“It’s only then that you can move forward, transform, and take the next step in life.”
There are many avenues of support available to aid transition, but also practical steps that individuals can take. This can include pursuing a new hobby that could lead to creating new connections in the community, or staying in touch with the military through ex-service organisations to reduce isolation and loneliness.
Francine began volunteering. “It’s a great way to take a gentle step back into the workforce, make social connections, and establish a sense of purpose and belonging,” she says.
Today, she says she no longer feels defined by her career in service.
“I’m a mother, I’m just about to become a clinical psychologist, and I foster the other amazing parts of my identity, rather than being too focused on the past.”
