Suicide by Veterans and ex-service personnel 1 7 October 2016 Senator the Hon. Alex Gallacher ...

56 Pages·2016·0.82 MB·English

Suicide by veterans and ex-service personnel
Submission 160
Suicide by Veterans and ex-service personnel

Level 3, 192 Ann Street
Brisbane QLD 4000

Ph: [phone]
Fax: [phone]

www.slatergordon.com.au

Correspondence to:

7 October 2016 Brian Briggs
Practice Group Leader
Military Compensation

Senator the Hon. Alex Gallacher
GPO Box 2487
Chair of the Senate Foreign Affairs BRISBANE QLD 4001
Defence and Trade References Committee
DX 213 BRISBANE
C/- Parliament House
CANBERRA, ACT 2600

Dear Senator Gallacher

Re: Inquiry – Suicide by Veterans and ex-service personnel

Introduction
Thank you for your letter dated 8 September 2016 and the invitation to comment on the
issues of suicide by Veterans and ex-service personnel.
Relevant Legal Background
I am a legal practitioner admitted in 1987 and a Queensland Law Society Accredited
Specialist in Personal Injury Law. I have specialised exclusively in Military Compensation
claims under the three compensation schemes, including the Veterans’ Entitlements Act
1986 (Cth) (VEA), the Safety, Rehabilitation and Compensation Act 1988 (Cth) (SRCA), and
the Military Rehabilitation and Compensation Act 2004 (Cth) (MRCA) since 2008.
Military Compensation Matters
The Military Compensation Group at Slater and Gordon Lawyers (Slater and Gordon) is
acknowledged as the largest legal practice in Australia acting on behalf of Australian
Defence Force (ADF) personnel and Veterans. Slater and Gordon has assisted or
represented numerous individuals and organisations in reviews of military compensation,
Veterans’ entitlements and Comcare schemes, and in Senate Committee and Defence
inquiries. We have strongly advocated for the improvement of safety, benefits and services
to injured Veterans and other defence personnel.
Our success in Federal Court and High Court appeals is a testament to our commitment to
achieving the best possible outcomes for our clients. We are able to offer legal services to
Registered Members in relation to Australian Military Compensation Claims.
In my official role as National Military Compensation Expert and Practice Group Leader at
Slater and Gordon, I also have a variety of connections with the wider defence community
and am a close associate of many RSL Advocates and members of a variety of Ex-Service
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Organisations. I also have close ties with other stakeholders who share an interest in the
welfare of our defence personnel.
In making this submission to the current inquiry, I intend to draw on and refer to some of our
previous work in this area, including recent submissions to the Inquiry into Mental Health of
Australian Defence Force Members and Veterans (Mental Health Inquiry), the Veterans’
Affairs Legislation Amendment Bill and the Review of Military Compensation Arrangements
conducted in 2009. Due to our strong history of advocacy in this area, some of the following
submissions may strike the Committee as familiar; the fact is that many of the concerns we
have previously raised over a number of years remain issues today.
We are fortunate that the size of Slater and Gordon enables us to provide specialist
expertise in this area and provide legal services for vulnerable members of the community
who might not have otherwise had access to justice. My team represents Veterans,
members, ex-members and their families on a daily basis. We are at the coal face and have
witnessed the devastation of those left behind when our military personnel take their own
lives.
Many of our clients spend significant amounts of their time having to negotiate the minefield
of the various pieces of legislation and how each affects their claims. My team members are
also seriously affected when a client takes their own life. Given that there are no official
publicly available statistics, I cannot give exact numbers of how many Veterans and ex-
service personnel commit suicide each year – however even one life lost is one too many.
Many of our clients are simply worn down by the system.
One of the concerns we have had for a long time is that the process is overly complex and a
bureaucratic nightmare that results in huge delays. For legislation that is supposedly
beneficial, it, in my opinion, actually compounds the issues experienced by my clients who
suffer from serious mental health problems. Unfortunately, the whole process and the
system itself too frequently lead to suicides, marital and family breakdowns and self-harm.
My team must frequently deal with clients who are extremely psychologically disturbed and
crying out for assistance. Many feel guilty about simply making a claim or being a burden on
the country they have served.
It is well-known that there is a mentality in the military that you serve your country, you fight
for your mates and you do your utmost as a soldier without wanting to be seen as a whinger
or a malingerer. As a result, many injuries, conditions and diseases are not reported and
nothing appears in the military records. The reluctance of the Department of Veterans’
Affairs (DVA) to accept claims in the absence of contemporaneous records is of serious
concern.
For those of the Committee who are not familiar with the plight of our Veterans and ex-
service personnel, this submission will attempt to cast light on why our Veterans are
committing suicide at such high rates.
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Table of Contents
Introduction ........................................................................................................................... 1
Relevant Legal Background ............................................................................................... 1
Military Compensation Matters .......................................................................................... 1
Our Submissions ................................................................................................................... 6
(a) The reasons why Australian Veterans are committing suicide at such high rates ......... 6
Extent of the problem ..................................................................................................... 6
Causes .......................................................................................................................... 8
Problems with DVA Processing ...................................................................................... 9
The “Transition and Wellbeing Research Programme” ................................................. 10
Annual Screening ......................................................................................................... 11
Mental Health Evaluation and Counselling Services available ...................................... 12
Case studies from PTSD Inquiry .................................................................................. 12
USA and the UK........................................................................................................... 13
Australia ....................................................................................................................... 15
The adequacy of mental health and support services provided by DVA ....................... 16
Chaotic claims management by DVA ........................................................................... 17
The approach in the UK ............................................................................................... 19
Identification and disclosure policies of the ADF in relation to mental ill-health matters 20
The view of a Veteran .................................................................................................. 20
Encouraging reporting of mental health problems ........................................................ 20
(b) Previous reviews of military compensation arrangements and their failings ................ 21
Recommendation 8 ...................................................................................................... 21
Recommendation 9 ...................................................................................................... 21
Recommendation 10 .................................................................................................... 22
The 2003 Inquiry .......................................................................................................... 22
The 2013 APSC Capability Review .............................................................................. 23
(c) The Repatriation Medical Authority’s Statements of Principles, claims administration
time limits, claims for detriment caused by defective administration, authorised medical
treatment, level of compensation payments, including defence abuse, as contained in all
military compensation arrangements ............................................................................... 23
1. RMA’s Statement of Principles ................................................................................. 23
2. Claims Administration Time limits ............................................................................. 25
3. Examples of unreasonable delays and their consequences ..................................... 26
4. Claims for detriment caused by defective administration .......................................... 27
5. Authorised medical treatment ................................................................................... 27
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6. Level of compensation payments in all military compensation arrangements (including
defence abuse) ............................................................................................................ 27
(d) To investigate the progress of reforms within DVA ..................................................... 27
DVA Capability Review ................................................................................................ 28
Duplication of Services ................................................................................................. 29
DVA Client Survey 2014 .............................................................................................. 29
(e) The administration of claims by DVA and the legislative or other constraints on
effective rehabilitation and compensation for Veterans .................................................... 30
Administration of claims by DVA .................................................................................. 30
Delays in DVA decisions, compounding disadvantage for the injured Veteran ............. 31
Substance Abuse ......................................................................................................... 31
Inaccurate claim files and mismanagement of claims ................................................... 31
Examples ..................................................................................................................... 31
Complaint by Rod Thompson (Level Four Advocate) AAPVA ...................................... 32
Case of Sergeant Michael Lyddiard ............................................................................. 33
Other client experiences .............................................................................................. 33
Legislative constraints .................................................................................................. 34
(f) Any other related matters ............................................................................................ 39
Homelessness ............................................................................................................. 39
Support Available to Veterans ...................................................................................... 39
The role of Compensation Lawyers .............................................................................. 41
Summary of recommendations ........................................................................................... 42
Conclusion .......................................................................................................................... 43
Acknowledgements ............................................................................................................. 44
Glossary.............................................................................................................................. 45
References ......................................................................................................................... 46
References from this submission ..................................................................................... 46
Section A ..................................................................................................................... 46
Section B ..................................................................................................................... 47
Section C ..................................................................................................................... 47
Section D ..................................................................................................................... 48
Section E ..................................................................................................................... 48
Section F...................................................................................................................... 49
References from previous submission into Inquiry into Mental Health of ADF Members and
Veterans .......................................................................................................................... 50
Material on Treatment and Prevalence of Mental Illness in the UK Military .................. 50
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Material on Treatment and Prevalence of Mental Illness in the US Military .................. 51
Material on Treatment and Prevalence of Mental Illness in the Australian Military ........ 51
Other Research and Reports: ...................................................................................... 53
Recent media sample ...................................................................................................... 56

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Our Submissions
I make the following submissions in response to the Committee’s terms of reference. Please
find attached our submissions responding to the terms of reference (a) through (f). Annexed
to this Submission are a variety of media articles concerning issues surrounding the suicide
of Veterans and ex-service personnel.
(a) The reasons why Australian Veterans are committing suicide at such high rates
Suicide among our Australian Veterans seems to be increasing at an alarming rate. Current
press outlets are focussed on its apparent unabated rise. Despite the growth in programs, it
would appear that the assistance being publicised and offered is not being accepted. My
team and I have witnessed the devastation that is caused by military personnel taking their
own lives. Senator Jacqui Lambie reports that as at 15 September 2016, 48 Veterans and
military personnel have taken their lives this year alone. This is greater than the number of
ADF personnel killed over 13 years of engagement in Afghanistan. We cannot abide a
situation in which returning home proves more dangerous than deployment.
Extent of the problem
The prevalence and significance of mental health problems and PTSD among returned
service personnel cannot be denied. As a general estimate I would say that at least 10 per
cent of my current clients would be diagnosed as suffering from PTSD. I also have many
other clients suffering from other mental health problems, such as depression (ranging from
minor to severe), and anxiety or personality disorders that can be directly connected to their
military service.
Figures from the Military Compensation Group at Slater and Gordon Lawyers corroborate a
steady increase in the number of Veterans suffering from mental health issues over the past
five years. I expect this trend to continue into the future unless numbers of service personnel
on combat related deployments decrease. From past press reports I have observed that 8
per cent of the Defence personnel who had been on any deployment reported significant
PTSD symptoms. The rate of Navy personnel was 7.7 per cent.
The ADF and the DVA should be in a position to provide exact or at least adequate statistics.
However, one may dispute whether these statistics can be considered accurate as many
service personnel when discharged do not come under the auspices of the DVA and
therefore would fall ‘between the cracks’ of official reports. Instances of this occurring are
common knowledge amongst the Defence community.
Previous inquiries and studies by the Australian Bureau of Statistics (ABS), in a year-long
survey, found that 20 per cent (or 1 in 5) of personnel within the ADF population had
experienced mental health issues which was a similar figure to the rate of community sample
matched for age, gender and deployment. Of major concern is that the same studies found
that half of ADF personnel had experienced anxiety, affective (or mood) disorder or alcohol
disorder at some stage in their life, which was significantly higher than the matched
community rate.

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Although these numbers are shocking and have served as a call to action for many in the
Veteran support community, they may not reflect the true depths of the problem. I have
previously advocated, as have many others, for the introduction of a publicly maintained
register of suicide amongst ex-military personnel. Indeed, this was a central feature of a
number of submissions to last year’s Mental Health Inquiry. I was shocked to find that that
the Mental Health Inquiry Committee drew the conclusion that it was satisfied with the
measures currently in place and not in favour of the introduction of such a register. I cannot
fathom why the DVA does not at least want to know the extent of the problem.
Current pathways for scrutinising the death of ADF members, and (through civilian
pathways) Veterans, were considered to be adequate. The Committee noted that Defence
currently records the death of members during their service, including those suspected or
confirmed to have died as a result of suicide, but that “it is much more difficult, however, to
determine the number of Veterans who have died as a result of suicide”. It is staggering to
read that the Committee has placed an important measure for addressing the extent of such
a significant problem into the “too-hard basket”.
The underlying assumption of the difficulty of this task is also questionable. It is remarkable
that there is no such public record when it is widely known that the equivalent United States
Department can record the service history upon discharge of millions of ex-military
personnel. I query why DVA cannot keep track of the post-discharge health of mere
thousands of Australian Veterans. It appears that the problem in Australia is not a lack of
ability, but a lack of will. Australia expects more, and Veterans deserve more than this. It is
time that the necessary resources are dedicated to making this register a reality. With
accurate tracking of the prevalence of suicide among Veterans, DVA, the Department of
Defence (DoD) and the Australian Government (the Government) more broadly will be in a
far better position to understand this issue and use the insights gained to inform their
response to this crisis.
In the absence of official statistics, anecdotal reports are relied on to get a picture of the
problem. Media outlets have been performing a valuable public service in publishing
available figures and raising awareness of the issue, including thorough investigations such
as that carried out by the Herald Sun. The efforts of Veteran Aaron Gray in creating and
maintaining the Australian Veterans’ Suicide Register is another source of this incredibly
important information that is to be commended.
I note that DVA has commissioned the Australian Institute of Health and Welfare (AIHW) to
carry out a data matching exercise between military superannuants from ComSuper and the
National Death Index for reported incidents of suicide from 2001 onwards. DVA initially
advised the Mental Health Committee that results from this exercise were expected in late
2015, but later revised that commitment to late 2016. This is indeed a promising
development and will hopefully provide much needed clarity and lead to better mental health
diagnosis, treatment and support options. Although this is a positive development for
Veterans, the urgent need for consistent record keeping going forward remains.
The current process whereby DVA becomes aware of Veteran suicides when a dependant
lodges a claim is insensitive and manifestly inadequate of a Government organisation. This
process cannot continue in its current state. The type of data that the AIHW hopes to collect
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needs to be gathered on a regular basis and made publicly available in a de-identifiable
format. This is the only way that the extent of the issue can be properly quantified and
understood, and then steps toward a meaningful solution strategy taken.
Causes
While the lack of an official register means that we cannot be sure of the exact number of
Veteran suicides, any number is too high, and it is vital that we seek to understand and
combat the causes. The 2010 ADF Mental Health Prevalence and Wellbeing Study (the
2010 study) found that, in comparison with the general Australian community, ADF
personnel reported a significantly higher prevalence of suicide ideation and plans. This is
more than double that of the general population.
The reasons for Veterans’ suicide have been found to be multidimensional. A review of
research and literature undertaken by the Australian Institute for Suicide Research and
Prevention this year concluded that the studies suggest that these reasons include a range
of Veteran-specific risk factors such as:
 difficulty returning to civilian life;
 relationship problems;
 mental illness;
 alcohol and drug misuse;
 employment problems;
 bereavement;
 loss of the routine and structure that accompany military life; and
 veterans’ reluctance to seek help for their problems.
Many of these risk factors were identified as problems experienced by Veterans in last year’s
Mental Health Inquiry, and I would refer the current Committee to the statistics published in
Chapter two of that report where the extent and significance of mental health disorders in the
defence community is outlined in detail. My submissions to that inquiry gave graphic
examples of the experiences suffered by many Veterans on deployment and how those
traumatic events subsequently impacted upon their lives on returning to Australia and, if
medically discharged, to a civilian life.
It is clear that the issues in relation to mental health identified in that inquiry are contributing
to the incidence of Veteran suicide and that further action to address mental health concerns
will likewise assist in preventing further Veteran suicide. The worrying trend across all these
studies is that information about the prevalence of mental health is not being translated into
action being taken by the responsible Government departments.
Another important risk factor as outlined above is the reluctance of Veterans to seek help for
their problems. The root cause of this would appear to be a systemic problem within the
culture of the ADF where those who ask for help are seen as weak. The stigma associated
with a mental health condition and the fear of losing out on future deployment or career
progression opportunities underscore the reluctance of ADF members to report their
problems.
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I acknowledge the military’s acceptance of problems in this area and commend all efforts
towards remedying this, through both awareness-raising and initiatives to remove stigma.
Problems with DVA Processing
I refer to recent media from the Sydney Morning Herald and broadcaster Michael Smith
below.
Private Matthew Tonkin
Private Matthew Tonkin was diagnosed with depression and post-traumatic stress disorder
(PTSD) after returning from Afghanistan where he served with his best friend Robert Poate.
Poate was killed in action on 29 August 2012. Tonkin was said to have abused prescription
drugs since that night in order to cope with the loss. The reporter observes that “Poate died
in an instant whereas Tonkin died slowly on home soil, but both sacrificed their lives for their
country”. Poate’s father Hugh is frustrated that the DVA or DoD fail to publish the statistics
on suicide by Veterans returning to Australia. Mr Poate sees the DVA as an “obstructionist
institution with an insurance-industry mentality”. Tonkin’s father David says that his son’s
case worker from the DVA was “on holidays” three times in six months prior to his son
committing suicide; “They didn’t return calls. They wouldn’t put things in writing.” David
suggests that the DVA’s approach to processing his son’s claims greatly exaggerated his
son’s PTSD which led to his suicide. Ironically enough, DVA processed Tonkin’s claim 2
weeks after he committed suicide.
Rear Admiral Robyn Walker
Conversely, Rear Admiral Robyn Walker, Commander Joint Health and Surgeon General of
the ADF has said that PTSD (a condition that is believed to affect around 30 per cent of
military personnel worldwide), usually occurs after a ‘lifetime exposure to traumatic events’.
In light of the anecdotal reports that suggest a suicide rate three times higher than combat
mortality rates it is unfathomable for Walker to say that that there is “no link between
operational deployment and suicide”. Brisbane psychiatrist and clinical director at Brisbane’s
Toowong Private Hospital Dr Andrew Khoo says Walker’s comments are misleading: “If you
purely look at the diagnostic criteria ... you only need a one-off event,” says Dr Khoo. “I’ve
got innumerable patients who’ve just had a one-off, terrible trauma and they’ve got PTSD.”
Of the 85 claims DVA determined relating to death by suicide over 10 years up until 31
December 2014, 47 claims were accepted as service related.
Generally, DVA only becomes aware of the death of a Veteran by suicide through the
dependant lodging a compensation claim in respect of the death of that Veteran. To add
further to their grief, the cause of death must be investigated by the DVA in order to establish
a link to service.
A number of previous submissions to the Mental Health Inquiry highlighted the difficulty of
accurately estimating suicidality of Veterans and expressed concern about the lack of data
regarding this. When death from self-harm in association with existing mental health
difficulties occurs, the cause of death is often left open by the coroner unless it is very clear,
e.g. self-inflicted injury or overdose. This action produces inaccurately low figures with
regard to suicide, particularly when substance abuse, motor vehicle accidents and cliff falls
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are involved. In addition there may be no mention of a mental health history on the death
certificate at all.
Researcher Brian O’Toole identified in 2015 that Veterans were at far higher risk of the
effects of mental health issues. The research provided that Veterans are 7.9 times more
likely to have suicidal ideations, 9.7 times more likely to plan a suicide and 13.8 times more
likely to make attempts on their own life when compared with the general Australian
population.
Dr Kieran Tranter, in Griffith University’s submission to the Mental Health inquiry, stated that
PTSD, depression, alcohol disorders, phobia and agoraphobia were prominent predictors or
indicia of ideation, planning and attempts among Veterans. The Griffith University research
provides that according to the Veteran’s Line Statistics, 52 call-backs were made to
Veterans who presented as a risk in the year 2012-2013 compared with only 21 in 2011-
2012. In 2013/14, that number rose to more than double (122). See Figure 1.
Veterans' Calls
150
122
100
50 52
21
0
2011-2012 2012-2013 2013-2014
Veterans' Calls

Figure 1 – Graph of Veteran’s Line Call backs 2011 – 2014.
The “Transition and Wellbeing Research Programme”
We welcome the “Transition and Wellbeing Research Programme” survey previously
announced by Senator Michael Ronaldson. However, I would question why such a
comprehensive study has taken so long when the precedent had already been set by the
2010 study. The DVA seems to be continually reacting to pressures from the public and the
Defence community rather than being proactive in addressing the serious problems that face
the defence community. The equivalent UK and US Departments are much further advanced
in their response to these problems compared to Australia, despite having been involved in
many of the same conflicts as Australia over the past several decades.
I support the call from the Australian Defence Association for a Commonwealth funded
compulsory medical examination for Veterans. However, I anticipate that making the
examination compulsory will be met with resistance. After discharge, many of my clients only
wish to distance themselves from the bureaucracy of the ADF, the DoD and the DVA.
Forcing them to attend appointments may not be the right solution to plug the current gap in
reporting and is unlikely to improve their mental wellbeing.
What is obvious from the findings of the US experience is that any assessment of the
societal impact of a disorder must begin with a consideration of prevalence. Sadly Australia
seems to be playing catch up with the recording of mental disorders, PTSD and suicide in
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