Review into the Suicide and Self Harm Prevention …

1 DRAFT Review into the Suicide and self - harm Prevention services available to current and former serving ADF members and their families final report : Findings and Recommendations National Mental Health Commission 28 March 2017 DRAFT Acknowledgement We acknowledge people with a lived experience of Suicide and mental health issues, their families, friends and supporters. We acknowledge all who provided input into this Review process, including current and former serving members of the Australian Defence Force and their families, service providers and professional organisations, the Australian Advisory Group on Suicide Prevention , and the Expert Reference Group convened for the purposes of this Review . We also acknowledge the input received from Commonwealth agencies, including representatives from the Commonwealth Department of Health, Department of Defence and Department of Veterans Affairs, the Australian Institute of Health and Welfare, and the Australian Bureau of Statistics.

2 We also acknowledge the team at ConNetica who was engaged by the National Mental Health Commission to undertake the fieldwork and data collection for this Review . 28 March 2017 Minister for Veterans Affairs and Defence Personnel Minister for Health Dear Ministers On behalf of the National Mental Health Commission, I present to you the final report on the Review into the Suicide and self - harm Prevention services available to current and former serving ADF members and their families (the Review ). This report presents the key findings against the Review s terms of reference and recommendations regarding areas for improvement and/or further investigation by Government. Separate summaries of information gathered for the Review are also available to support our findings. I trust the findings and recommendations of this Review will contribute to the ongoing efforts by the Government and others, and ultimately lead to improvements in the lives and outcomes of current and former service men and women and their families.

3 Yours sincerely Dr Peggy Brown CEO National Mental Health Commission 2 Table of Contents Executive Summary ..4 Abbreviations and Definitions ..9 Key Definitions .. 9 Terms of Reference (as at August 2016) .. 11 Introduction .. 12 About the National Mental Health Commission .. 12 Context for this Review .. 13 Review methodology .. 14 Qualifiers and Limitations .. 15 Structure of this report .. 18 Overview of findings .. 19 About Suicide and self - harm .. 19 What distinguishes military service from other experiences? .. 20 The transition from the ADF .. 21 Families of current and former ADF members .. 22 1. The range of services available .. 24 services for current serving ADF members .. 24 services for former-serving ADF members .. 26 services for families .. 26 DVA health cards and non-liability health care .. 27 2. The effectiveness of services .

4 29 Assessing effectiveness .. 29 Issues identified relating to perceptions of service effectiveness .. 31 3. Duplication or gaps in current services .. 37 Gaps in a stepped care framework .. 38 Ex-Service Organisations (ESOs) .. 40 4. Barriers to accessing services .. 42 ADF culture and career consequences of seeking help .. 43 Stigma .. 44 Attitudes regarding access to off-base services .. 44 Lack of awareness of services available .. 45 3 Cost of services .. 45 High demand and waiting times .. 46 Geographic location and distribution of services .. 46 Barriers for families in providing support .. 46 5. The extent to which former serving members use other services .. 48 6. The reporting and incidence of Suicide and self - harm .. 49 Reporting and incidence in the community .. 49 Comparing Suicide and self - harm in serving and former ADF members and the general Australian community.

5 49 Recommendations .. 52 Appendix A: Recommendations of the Independent study into Suicide in the ex-service community by Professor David Dunt, January 2009 .. 56 Appendix B: Recommendations of the Review of Mental Health Care in the ADF and Transition through Discharge by Professor David Dunt, January 2009 .. 60 Appendix C: Members of the Review Reference Group .. 66 Appendix D: Members of the Australian Advisory Group on Suicide 67 Appendix E: List of services related to the Prevention of Suicide and self - harm funded through Defence .. 68 Appendix F: List of services related to the Prevention of Suicide and self - harm funded through DVA .. 83 References .. 92 4 Executive Summary What we heard As with all the National Mental Health Commission s work, the approach of this Review was to place current and former serving members of the Australian Defence Force (ADF), and their families, at the centre of our considerations.

6 Through our survey, submissions, group discussions and individual interviews, we heard directly from more than 3,200 people. While some stories pointed out instances of good practice and positive outcomes, there were many strong views presented by current and former ADF members and their families that identified areas for improvements to systems, services , beliefs and culture. People who reported they had recently accessed mental health treatment rated their experience of services very highly. A survey conducted for the Review found that experiences were described as fair, good, very good or excellent by 80% of current ADF members and by 90% of former ADF members using health care cards to access services . However, qualitatively, we also heard a broad range of poor experiences of services and general feelings of cynicism, distrust, frustration, abandonment and loss.

7 For many, these are the realities of what being in the military brings and the sacrifice that is asked of them and their families in service of their country. It is not known however whether these experiences relate to recent or past experiences of the service systems. Nor is it known the extent to which these sentiments are felt across the broader estimated population of more than 700,000 current and former ADF members1 and an even higher number of their family members. Nevertheless, these stories and experiences are real and deserve to be heard and responded to. We also heard about the wide range of groups and individuals, within the government, the ADF and in the community, who are committed to driving ongoing change and improvement. These efforts will be critical to achieving improvements across a wide range of areas that are relevant to Suicide , self - harm and general wellbeing, including culture, workforce, health services , training, transition and rehabilitation services .

8 Concerted and continued attention is needed to ensure efforts are effective in preventing Suicide and self - harm amongst Australia s current and former serving personnel and their families. The Government s action in commissioning this Review forms part of that effort and the National Mental Health Commission commends the Australian Government for taking the step to seek an independent Review that can inform their ongoing efforts. We would like to take this opportunity to sincerely thank everyone who provided information to this Review for your valuable contributions. We acknowledge and value your personal efforts and experiences, and support you in your resilience and commitment to recovery. About our report Throughout the Review , the Commission has been mindful of the unique nature of military service. We have specifically endeavoured to understand and draw on the experiences and insights of current and former members of the ADF, their families, the Departments of Defence (Defence) and Veterans Affairs (DVA) and other stakeholders with expertise in this area.

9 This document faithfully reflects the insights and input we received as well as other materials that were available to the Commission at the time of the Review . 5 It should be noted that very little information was identified to inform our considerations regarding self - harm in each of the groups of interest to this Review . The findings of the Review therefore focus on Suicide and the factors known to increase the risk of Suicide and self - harm , including poor mental health and wellbeing. We also found relatively little information about families of current and former serving members their rates and risks of Suicide and self - harm and their experience of services . Where possible, this report makes some observations in this regard, with an overarching finding that there is a general lack of emphasis on the critical role that families play in the lives of current and former serving members, including in relation to helping to manage risk factors for Suicide and self - harm , and generally limited engagement with families by both the ADF and DVA.

10 While there have been many actions taken by the ADF and DVA to improve services and outcomes in relation to Suicide and mental health amongst current and former serving ADF members, the context for the Review indicates that key issues persist. This is particularly reflected by two recent Senate inquiries in this space into the Mental Health of ADF Serving Personnel (which tabled its report in March 2016) and more recently into Suicide by Veterans and Ex-service Personnel (which is expected to report by 30 March 2017). The issues raised in these inquiries should be taken into account when considering the findings and recommendations of this report . Finally, this report should also be considered in light of two important studies being undertaken separately to this Review : the findings of the Transition and Wellbeing Research Programme jointly commissioned by the Departments of Defence and Veterans Affairs, and the Australian Institute of Health and Welfare (AIHW) study Estimation of incidence of Suicide in ex-serving Australian Defence Force personnel.