Lighting the way: Lessons from the Royal Commission into Defence and Veteran Suicide
The following interview contains information relating to mental health and suicidal ideation. If you require any urgent support or assistance around this topic, please reach out to Open Arms via 1800 011 046 or call 000.
Photography: Supplied
In what makes for a sobering read, the Royal Commission into Defence and Veteran Suicide’s lived experience report was tabled in Parliament earlier this year, with the publication of the Final Report on 9 September.
Shining a Light: Stories of Trauma & Tragedy, Hope & Healing by Patrick Lindsay AM is based on the almost 6,000 submissions the Royal Commission received, most of which were from serving and ex-serving Australian Defence Force (ADF) personnel, their families and friends.
There were five common themes identified in those submissions, including: suicide and suicidal behaviour; ADF culture, governance and accountability; mental illness; Department of Veterans’ Affairs claims and compensation and ADF mental health support and responses.
It is hoped that, together with the Royal Commission’s final report, Shining a Light will help to drive real and lasting change of the complex cultural and systemic issues that affect the entire Defence community.
Dr Peggy Brown AO is one of three Commissioners appointed to the Royal Commission. She spoke with RSL Victoria journalist Aileen Phillips.
Mental health battles related to military service are often misunderstood. Who are the people affected?
Without a doubt, the issue of suicidality and suicide is not just confined to those who have seen service in active war zones.
That can be an issue for people who have been in combat zones and theatres of war, but many of the people from whom we received submissions had experiences across defence and in their post-service life that were very much related to their suicidality or, in some cases, their loved one’s experience of suicide, that was nothing to do with being in a theatre of war.
Shining a Light uses the terms suicidality and suicide. What is the difference between the two terms?
The key point to make is that some people experience suicidality. So, for example, they might think life is not worth living, but not necessarily have suicidal thoughts. Then, they might progress to having thoughts of suicide, to having a plan or taking an action and making an attempt on their life.
The statistics tell us that a lot of people will experience thoughts of suicide but never actually go further down that pathway or make an attempt or indeed end their own life. So, there is a distinction between suicidality and then the ultimate act of suicide.
How does post-traumatic stress disorder (PTSD) specifically contribute to veteran suicidality and suicide?
In terms of understanding where it sits in that pathway to suicide (if I can call it that), as a risk factor it is undoubtedly associated with an increased risk of suicidality and suicide. But it’s also important to note that PTSD co-occurs with many other things, for example, depression, anxiety, moral injury.
There are lots of crossovers between moral injury and PTSD, and a lot of people have both. PTSD is often associated with using alcohol or drugs as a coping mechanism. It’s often associated with relationship breakdowns. So, all those factors can increase the risk, in addition to the PTSD itself.
What has changed about understanding PTSD and how to treat it?
We’re starting to understand that PTSD is not just a mental illness.
PTSD affects the whole body and impacts biological functioning, immune functioning, and is associated with a whole host of other physiological issues as well.
In terms of treatments, that means that treatments are starting to broaden out as well in terms of what should be potentially offered to veterans.
We didn’t go in depth in the Royal Commission into specific treatments, but certainly understand that there is a place for new and emerging treatments and that the systems that provide care and support – whether in Defence, the Department of Veterans’ Affairs (DVA) or in mainstream health – need to also be embracing opportunities to engage with new and emerging treatments.
In which areas are policy changes needed to improve the mental health and wellbeing of veterans?
Probably too many to describe.
We looked at recruitment – what the issues are there and specifically around the support for new recruits, particularly during their basic training and their initial employment training.
We looked at postings, and it’s no secret that postings have an impact on service members and their families. And of course, when families are affected, it impacts them, so there’s a host of issues there.
There are issues around work health and safety and servicemembers’ wellbeing and how well Defence does injury prevention and minimises harm.
Then we looked at health promotion and early intervention and their approach to that and thinking about whether there is more they can do in that space.
The delivery of healthcare services in Defence, how they manage suicidal crisis, their policies around aftercare and in the event of a death postvention [interventions focused on supporting individuals, families and communities affected by a suicide death].
We looked at deployment, we looked at their promotions and career management processes and perhaps ways that they could better support that process.
We had a strong focus on governance and accountability, and that includes how they manage their projects and programs to have good governance and accountability.
We looked at military justice. Unacceptable behaviour is a really significant issue in terms of the harm that potentially can do. We also heard a lot of accounts about weaponisation of administrative and justice processes.
Transition is a big one, and we also looked at how Defence collect and use their data and how they could perhaps use it better.
It’s a really broad range of areas that we looked at and we’ve made a number of recommendations around those kinds of issues.
Defence have been making changes to policies during the Royal Commission. They’ve also been changing some of their structures during the course of the Royal Commission.
That’s a good thing, because it means they’re not just sitting back and waiting; they’re trying to get on with things and do things that they think are going to be helpful.
The book recounts problems faced when the military “moulds the identities of serving members” and “the challenges of adapting back into civilian society”. How should the process of preparing for transition out of service change?
I do think there are things that could be done while people are in Defence.
One is, for example, that sense of elitism or exceptionalism, that military personnel are better than civilians. There really shouldn’t be that distinction.
So, maintaining connections with the civilian world, encouraging interaction with the civilian world, encouraging them to be in civilian sporting groups and all sorts of other interactions that can occur, I think is a positive thing.
Then there are things like the skills and qualifications they develop in the military. Defence should be assisting people by ensuring they have a good understanding of what those skills and attributes are that they’ve acquired in the military.
I’ve heard many people completely ignoring what they’ve gained by being in the military, whether it’s their problem-solving skills, discipline, loyalty, commitment, hard work.
Then, when someone has made the decision to transition, I think there could be a lot more that could be done in terms of assessing people’s preparedness and then when there are potential gaps in their readiness, to tackle those in a meaningful way.
Adapting to civilian life can be a protracted process for some. Who is responsible during that ongoing transition period?
Some people said it never ends, but certainly for many people it’s the first 12 to 24 months that are particularly crucial.
There need to be ways to check in on people and see how they’re travelling and what assistance they might need during that period.
Is that Defence? Is it DVA? What role do the ESOs [Ex-Service Organisations] play? Personally, I think everybody has a role to play.
Issues with ESOs were raised in the report. What are some areas ESOs can improve on?
ESOs play quite a critical role in the space of supporting veterans.
There’s a large number of ESOs that provide a diverse range of services, and I think that’s really good because it’s not a one-size-fits-all type of situation.
There is quite a bit of duplication but there are also gaps, and some better collaboration and planning across the ESO sector to try and minimise the duplication and address the gaps would be terrific.
We also have to recognise that that our ex-serving veteran cohort is a very broad demographic. They range in age from 20 to 100, so there does have to be that sense of how the ESOs can cater for the different cohorts.
The challenge for the ESOs is to work out what their place is and to whom they are addressing their services and their service offerings, and how the needs of those that don’t fit within that particular service offerings are best met; whether they then need to change their service offering to make it more desirable for a broader cohort, or whether there’s a different ESO that they could work collaboratively with.
Shining a Light, as its full name suggests, also contains inspirational stories of hope and healing. How significant were these stories in driving the Royal Commission forward? peppered throughout with positive stories and experiences that highlight resilience, recovery and growth. How significant are these?
I think it’s one of the things that’s helped sustain us.
People ask, ‘How have you done this for three years and heard all these tragic stories – it must have impacted you?’ Of course it does.
But on the other side, you also have opportunity to hear from people who’ve been through difficult times, but who nevertheless get through and continue to care about others and want to make things better for others, not just themselves.
So that sense of commitment, the courage, the resilience, just the fact that out of adversity can come personal growth. They are very uplifting – they certainly were for us. It’s a really important message.
I talked about the attributes of service personnel and their families. Quite frankly the families are often undersold in terms of what they go through and the role they play in supporting our military capability. But they do demonstrate these enormous strengths, abilities, resilience, courage and commitment.
It’s not all doom and gloom. Yes, we want to tackle the problem of suicide and suicidality, but even when people are in a tough space, many come through it if they’re able to get the appropriate support.
