Bill for veterans' mental health care reaches $241m with 20,000 in rehab

The Age

By Caitlin Fitzsimmons

January 3, 2021

The taxpayer bill for the mental health care of former defence personnel has ballooned 35 per cent in five years, with nearly 20,000 former service members checking into rehab clinics every year.

The problem of addiction and mental illnesses among former service members is so great that some treatment providers are starting to offer veterans-only programs, including The Buttery in northern NSW kicking off a pilot study this month.

Senator Jacqui Lambie says alcohol and substance abuse issues are rife among veterans and the system is failing them at every turn.

The Australian Defence Force has more than 89,000 service members and about 6000 leave each year, often with post-traumatic stress disorder (PTSD) alongside depression and addiction. 

They are then given unlimited access to mental health care, with clinics reporting some veterans are checking into rehab repeatedly to deal with deep-rooted problems.

The Department of Veteran Affairs (DVA) spent $241 million in 2018-2019 on mental health care for 55,500 veterans, including psychiatry, psychology and treatment in hospital or rehab clinics. The total figure also includes DVA-funded mental health treatment for war widows and dependants, plus the Open Arms counselling service for current and former service members and their families. In the 2020 financial year that rose to 58,500 veterans, while Open Arms experienced a 50 per cent increase in demand between March and June because of COVID-19. A DVA spokesman said about 15 per cent of the veterans accessing mental health services were under the age of 40.

Tasmanian Senator Jacqui Lambie, who served in the army for more than 10 years in the 1990s, said the system was failing veterans at every turn, starting from the drinking culture in the armed forces and worsening in civilian life because of inadequate support.

"There's a lot of drinking once they've hit rock bottom, then they get prescribed pills for PTSD and stuff like that and they just start taking them like they're peanuts," Senator Lambie said. "They're now starting to turn to ice [crystal methamphetamine] because they're not getting the treatment."

While some clinicians say the increased demand for treatment is because of successive governments making access easier, Senator Lambie blamed the aftermath of the wars in Afghanistan and Iraq.

"All the guys who served in the Middle East are just crashing," she said.

 The Australia Defence Association, a public-interest watchdog for national security, has backed calls for a royal commission into veteran suicide and the operations of the DVA.

ADA executive director Neil James said "the problem seems to be perpetual" and could lead to a problem with recruitment as well as retention.

"The mums and dads of Australia aren't going to let their children join the Defence Force if we don't start solving some of those problems and solving them in a coherent and integrated fashion," he said.

"I don't think that's getting enough long term thought because if we don't fix it, eventually we'll have a defence capability problem because there won't be enough people wanting to join the Defence Force.”

Veterans and clinicians say the psychological problems arise from the trauma of active service, including war, peacekeeping missions and border control, but also from the gruelling training regimen, traumatic events such as accidents or physical injuries, isolation from friends and family, bullying and sexual discrimination, a stubborn culture of not showing weakness, and worries about financial security when leaving the ADF.

Melbourne Clinic medical director Richard Bonwick said he treated a lot of veterans and the main reason for an increase in demand was the improved access to services; "a good thing rather than a bad thing".

Dr Bonwick said about one in 20 civilians had a mental health condition of some kind, while up to one in five veterans with combat experience had PTSD, usually alongside substance abuse or depression. Veterans often required repeat treatment because "most of the disorders they suffer are chronic", he said.

The October federal budget provided $101.7 million over four years to further bolster mental health support for ex-service personnel, plus $23.7 million to increase transition and employment support. In October the government also established the National Commissioner for Defence and Veteran Suicide Prevention.

Meanwhile, the NSW government has provided $300,000 for The Buttery to run a pilot program to treat a small group of veterans for PTSD and substance abuse using a treatment model developed in the United States.

Chief executive Leone Crayden said veterans already accounted for at least one in seven patients in The Buttery's four-week private residential programs and it made sense to treat them together given their shared experiences and problems.

"They need something really specific to their needs," she said.

The DVA funded 18,067 patients hospitalised for mental illness in 2018-2019, up nearly 3000 from two years earlier, Australian Institute of Health and Welfare figures show. Of those, 4329 were in public hospitals and 13,828 in private hospitals.

Minister for Veterans' Affairs and Defence Personnel Darren Chester said: "The mental health of our veterans and serving members is not an issue we take lightly". He said most service members had a positive experience in the ADF and took valuable skills and experience into civilian life but vowed: "If there is a need, it will be met."

Labor has called for a royal commission into veterans' mental health and suicides, but Mr James from the ADA said it should be into the DVA itself so the issues could be considered as a whole.

RSL NSW chief executive Jon Black welcomed the government's investment and said the next steps should be to fully implement existing recommendations from previous investigations, including the Productivity Commission report on mental health, rather than setting up a new inquiry.

Soldier On ambassador Jeff Shapiro, 36, who was in the navy for 10 years and developed PTSD, depression and anxiety while working on the patrol boats in northern Australia, said mental health was an "unavoidable issue" for veterans.

"It's something that all of us, all veterans, will have some form of experience with whether it's immediate or in the future," Mr Shapiro said.

Senator Lambie employed a staff member whose main role was organising rehab for veterans, trying to keep them out of general public psychiatric hospitals because veterans with PTSD "could not cope" with erratic behaviour from ice addicts.

Senator Lambie said an increasing number were going to private rehab clinics such as Byron Private Treatment Centre at Byron Bay, but this requires individual


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