Overview of roundtable discussions – May to December 2022
- Roundtable overview
The Commissioners engaged with a range of stakeholders during roundtables held between May and December 2022. These included senior public servants, representatives from ex-service and veteran support organisations, researchers and experts in the implementation science and policy fields, serving and ex-serving Australian Defence Force members, and clinicians and experts in the mental health field. The stakeholders have provided valuable insights to Commissioners to assist them with their inquiry.
The following is an overview of key themes raised in discussions at those roundtables, which inform the work of the Royal Commission; however, the views expressed in this overview do not represent the views or findings of the Commissioners.
It should also be noted that these summaries reflect the views of individual participants at the time roundtables were held. They should not be read as representing any official institutional positions, at the time, or since.
Department of Veterans’ Affairs
Role and purpose
Roundtable participants told Commissioners the core responsibility of the Department of Veterans’ Affairs (DVA) is managing compensation payments; however, they acknowledge there could be more emphasis on wellbeing and rehabilitation. It is possible the Department is impacted due to its ‘junior’ portfolio status and issues stemming from insufficient resourcing and staffing levels. Some also indicated the Department should divest itself of ‘non-core’ activities.
The Veteran Centric Reform program has assisted with data transfer, but participants recognise the enduring need to better establish and maintain lifetime contact with serving and ex-serving Australian Defence Force (ADF) members. Participants said contact needed to be ongoing because of the ‘long tail’ of claims – a claim relating to WW II received in 2019 was given as an example. They added DVA would ideally like to be in contact with all transitioning ADF members, contingent on ongoing resourcing.
Roundtable participants feel the current Non-Liability Health Care services trial should be continued, particularly for those who are waiting for claims. Under the program DVA may pay for a veteran’s treatment for all mental health and certain physical conditions without having to prove it was caused by their ADF service. It was suggested initial liability claims could be processed while members are still serving.
The transfer of information, especially medical records, between the ADF and DVA should be automatic, enabling better connectivity with individuals and medical professionals. Commissioners heard that DVA carries out actuarial modelling yearly to determine the likely number of claims under the Military Rehabilitation and Compensation Act (MRCA) and Safety, Rehabilitation and Compensation (Defence-related Claims) Act (DRCA).
Participants said approximately 6,500 personnel transitioned out of the ADF each year; however, they said that claims under the MRCA and DRCA were consistently increasing due to:
- multiple deployments over the last decade
- claims per person increasing, particularly under the MRCA
- better understanding, awareness and communication among the ex-serving community
- the Veteran Centric Reform program (described as a ‘catastrophic success’).
Commissioners were told DVA feels hindered by a lack of information sharing from Defence, but that this is improving.
Participants added DVA is working to improve the veteran experience by:
- granting immediate non-liability care to those with 20 most common medical conditions
- having more frequent communication with claimants
- prioritising those in greater need
- giving all staff mental health first aid training.
Participants stated they believe that about 80 per cent of claimants (generally those with two or three health conditions) have no trouble navigating the claims system.
Commissioners heard that recommendations from the McKinsey report, aimed at reducing the claims backlog, had been classified broadly as prioritised and non-prioritised. Prioritised recommendations are those focused on greater efficiency in the claims processing system and generally improving things for claimants – DVA has been and is implementing those it can through resource re-allocation.
Participants told Commissioners that the majority of legal disputes involving DVA are brought by claimants, and of these most relate to interpretation of the MRCA – as the legislation is relatively recent, the case law is not yet fully settled. Participants also said that legal disputes ‘seldom’ involved incidents of fraud, which are ‘low’. They stated DVA occasionally challenges the Veteran Review Board if it disagrees with a legislative interpretation.
Commissioners were told DVA’s average staffing level (ASL) varies from year to year due to short-term funding issues and the election cycle. Participants said they would prefer the Department had a demand-driven funding model to ensure certainty, particularly for staffing. They said DVA currently spends over half of its departmental funding on staffing.
Participants reported that DVA’s annual ASL cap varies from between approximately 1,600 to 2,000 people. They noted this was a small proportion of the public service total of approximately 150,000. It was also reported that 104 personnel, or about 5.5 per cent of DVA’s workforce, are ex-serving ADF members, with the Department aiming for 7 per cent. Programs towards this 7 per cent target across states and territories are picking up, and a pilot of pathways to public service employment for ex-serving members is soon due for evaluation before wider rollout.
Participants described transition as a ‘contested’ space between DVA and Defence, and one that needed early engagement with serving members. Participants suggested bolstering the capacity of the Joint Transition Authority and bringing together transition services of the three arms of the ADF.
Commissioners heard that the loss of income suffered by ex-serving members while waiting for claim determination is a serious issue. Despite the volume of people transitioning out of the ADF annually, participants believe transition services need to be tailored to the individual.
Participants said DVA analyses its own data to identify suicide trends and clusters; however, it is difficult for DVA to know about the welfare of ex-serving members in different jurisdictions due to data lag and lack of access to information.
Commissioners were told about a project in Queensland that is using data from triple zero phone calls to identify serving and ex-serving members – DVA is looking to expand this project.
Participants said the ex-service organisation (ESO) sector is ‘fractured and diverse’ with over 5,000 operating in this space. They feel it is dominated by those ‘with the loudest voice.’
The complexity of this issue was discussed. Participants suggested that the ADF’s style of military induction removes community connections that may act as protective factors. It was noted those under 30 years of age who are medically discharged from the ADF are at greatest risk of suicide and suicidality.
Participants discussed how some protective factors might be maintained post service life. It was agreed that ex-serving members’ access to their former clubs and messes, which was suspended after 9/11, could be reinstated and even broadened to include family and the community. Commissioners are aware of security and access issues pertaining to this suggestion.
Participants said they feel DVA’s engagement with, and support for, families is constrained by legislation and resourcing. Despite this, the Department is working to enhance its family support program. Support is delivered by contracted providers to families of those who are identified at risk of suicide or suicidality. People may be identified as being at risk by any external service provider or through DVA’s own welfare checks.
The Defence posting cycle was discussed in the context of potentially putting additional stress on families.
Participants told Commissioners that DVA would like early notification of the terminal illness of any serving or ex-serving members to be able to give timely support to them and their families. The Department would also like to be able to offer more support in domestic violence and relationship breakdown situations.
Participants said that DVA does not refer claimants directly to advocates, but will direct them to organisations that have accredited advocates. The Department provides grant funding to ex-service organisations (ESOs) to train advocates, but participants would like see more funding as not enough advocates are qualified. Information reported by Open Arms suggests that demand for advocates has increased by 25 per cent in the last year. Commissioners also heard that while advocates have been predominantly volunteers from ESOs in the past, there is a move to train and pay them. The
Commissioners were also told about a recent trend of advocates acting on a ‘fee for win’ basis, which participants said needs more oversight and control.
Roundtable participants said the majority of claims currently come under the MRCA and will continue to do so in future; however, they feel the Act is extremely detailed and complex. Some suggestions for improvement included a single simplified Act to make things easier for claimants and DVA staff, more focus on rehabilitation, and more flexibility and tailoring towards individual needs.
Participants also proposed legislating a compensation levy, much like workers’ compensation, to compensate serving ADF members for any non-warlike injuries suffered. It was thought this might promote more ‘care and diligence’ in training.
Numbers and funding
Roundtable participants said the number of ex-service organisations (ESOs) was increasing. One example was their proliferation in Townsville, which was described as potentially ‘overwhelming and confusing’ for veterans trying to navigate the system. While there is no feedback mechanism from ESOs to Department of Veterans’ Affairs (DVA), the organisations do collaborate among themselves.
Participants said some ESOs are funded by DVA and/or the RSL, while others rely on their own fundraising, or a mix of some or all of these. Some ESOs want increased funding to increase their service capacity.
The need for a peak body
Participants recognised the need for a national peak ESO body and better coordination of the sector, acknowledging this could address issues such as:
- over-servicing in some regions and lack of service in others
- organisations competing with each other for funding
- a need to go beyond just dealing with DVA matters
- better accountability.
They also said such a body might help with better representation for ‘contemporary veterans’, adding those who served in Vietnam and the younger cohort were reluctant to engage with the RSL; however, they cautioned a peak body was ‘never going to be a single voice’.
Roundtable participants agreed the transition experience has improved, but feel much more work needs to be done in this area. They stressed they receive ‘many inquiries’ from those transitioning for proper financial advice. Participants believe the Australian Defence Force (ADF) should be far more proactive in explaining the role of ESOs to its members and in making connections with them.
Commissioners heard that following the Productivity Commission’s recommendations in its 2019 report, A Better Way to Support Veterans, working groups were formed focusing on legislative reform; however, they ceased with the establishment of the Royal Commission. The lack of involvement of ex-serving ADF member representation in this area, and that of DVA reform, was noted.
Participants indicated they felt that there is a major gap in mainstream mental health services for ex serving members, particularly as most services do not understand ‘veteran specific’ issues. They discussed the need for the issue of mental health to become ‘normalised’ among serving ADF members to remove stigma and encourage help seeking.
Participants also noted many GPs are not adequately skilled in dealing with serving and ex-serving ADF members. Despite this, participants feel that ongoing subsidised health care for items not covered by Gold and White Cards would be beneficial for all ex serving members, even if capped.
All participants said that they refer people to specialist third parties for help in this area if requested, or if the need is identified.
Department of Veterans’ Affairs
Participants feel that the Department needs better communication, education and transparency to make it easier for people to navigate the claims system. They told of DVA’s hesitancy to work with ESOs, saying that better transparency and communication between the organisations would be beneficial to all in defining roles and responsibilities.
A collaboration between DVA and the Public Trustee was also suggested, as this could identify those with guardianship orders, or where mental health or substance abuse issues may present a risk, prior to lump sum compensation payouts. A controlled release of funds was proposed in the latter case.
Roundtable participants gave an overview of implementation science, which is the study of methods and strategies for implementing evidence-based research or programs. It is based on the principal of change at three levels: systems change, organisational change and individual change.
Participants outlined the preparatory work and ongoing steps required for successful implementation as including:
- concise problem articulation
- evidence-backed interventions
- sustained action
- change is not viewed through the traditional top down model, but with bottom-up initiatives and co-design (users or lived experience)
- the importance of leadership (involvement and accountability)
- an alignment of strategies at all levels of organisation
- a clear plan of who does what
- actual or implied surveillance
- audit and feedback
- the identification of barriers
- competence in government ranks.
The process of ‘de-commissioning’ existing systems was also discussed, with participants warning about money wasted on failed mental health interventions and ‘nice ideas’ in the past, hence the need for ongoing evaluation and accountability.
Participants said recommendations should explicitly state what needs to done by whom, and by what date. They also suggested establishing an independent body to ensure accountability and monitor implementation after the Royal Commission concluded. This body would need to address barriers to implementation.
Commissioners heard about the experience of Australian Defence Force (ADF) members, particularly First Nations members, in the context of NORFORCE (North-West Mobile Force), an infantry regiment of the Army Reserve established in 1981 with its origins from WW II. NORFORCE is one of three Regional Force Surveillance Units responsible for the security of approximately 50 per cent of Australia’s land mass.
This area covers some 250 nations that are covered by native title and more that are not, with about 800 First Nations dialects spoken. NORFORCE has approximately 560 members the majority of whom (about 500) are reserves. They are permitted to serve more days than other ADF reserves. The regiment focuses on reconnaissance and surveillance.
Roundtable participants said that NORFORCE’s recruitment approach is more holistic than the ADF’s in that it is partly based on applicants’ relationship to culture, community and family (as well as mental health and personal issues). Recruitment is sometimes targeted at particular First Nations communities to ensure a balanced cultural mix.
Commissioners were told NORFORCE’s Commanding Officer has authority to grant waivers for those who may not meet some ADF standards (such as educational, physical health, psychological and criminal checks); however, this prevents them from transitioning to the broader ADF.
Participants said some First Nations communities regarded NORFORCE membership as prestigious, with the influence and example of Elders being important. The regiment’s ability to recruit is enabled by embedded connections in communities.
NORFORCE’s unique ‘recruitment to retirement’ approach, which tries to make sure that members are supported all the way through their careers and beyond, was also discussed.
Participants said NORFORCE offers support to those who lapse during training, such as with disciplinary issues. This focus on support allows people to ‘fall safely’ then be ‘lifted up’. The training is also adapted for language and cultural needs.
Suicide and suicidality
NORFORCE’s strong familial and community networks were given as protective factors against suicide and suicidality. Participants feel that any instances of suicide and suicidality are likely to be connected with challenges in family and community, not service life. They added that NORFORCE members have access to the same health and support services as ADF members.
Regimental culture was described as one where everyone ‘looks after each other’. It was also noted that the supports and services with experience in First Nations communities would have a better understanding of the challenges faced by NORFORCE members (unlike ADF-contracted and mainstream services).
Participants said they were unaware of any incidents of suicide and suicidality of serving NORFORCE members, but were unsure about ex-serving members.
Commissioners heard that some of the biggest challenges for NORFORCE members include separation from family, maintaining cultural connection and practices and access to appropriate medical support and treatment, as required.
Cultural support is provided through the ‘wrap around’ of members facing challenges and support to return to Country if needed. Some other forms of support include:
- cultural competency, such as support in traditional practices and rituals
- the ability to live and serve on Country
- strong connection with Indigenous health providers and peak bodies in regions
- helping members to build personal qualities (such as confidence, leadership, operating in a team)
- that membership is seen as a ‘status symbol’
- support of Elders (some of who are NORFORCE members).
The trial of a new mental health first aid program was also discussed – there are hopes for expansion if it is successful.
Participants acknowledged there is some racism in the broader ADF, but the feel that the experience of First Nations members is improving. They said cultural curiosity and learning by non-Indigenous NORFORCE members was improving the experience of First Nations members. The positive role of Elders was noted, along with a cultural education program undertaken in 2018.
Commissioners heard that while members find transition difficult, ex-serving NORFORCE members remain part of the ‘family’, with this connection maintained through various activities and initiatives.
One participant commented that transition in the ADF generally had improved since their own experience 15 years ago, which they described as ‘the worst experience of my life’. They commended the ADF’s transition seminars and acknowledged efforts by certain ex-serving organisations (ESOs) in tailoring transition services for members (including for First Nations members); however, the challenge for ESOs and for NORFORCE in connecting with and providing support to transitioning and ex-serving members was acknowledged, primarily due to the ‘tyranny of distance’ and the remote locations where these transitioning and ex-serving members often live.
Participants reiterated the challenge ex-service organisations (ESO) face to reach those in remote locations. They said ESOs are aware of this issue but it remains unresolved. The disconnect between the culture of some ESOs and that of ex-serving First Nations and/or NORFORCE members was also noted, particularly for NORFORCE personnel who regard themselves as ‘different’ to the regular Army.
When asked about any services focused on First Nations and/or NORFORCE ex-serving members at a soon to be completed wellbeing centre in Darwin, participants said they were unaware of any, but suggested that a peer should be employed. They said they were aware of one NORFORCE ESO, but that it comprises mainly non-Indigenous members – greater engagement with serving and ex-serving First Nations members was suggested.
Participants noted a general lack of culturally competent support for serving and ex-serving First Nations people and their families among ESOs. They proposed that these organisations adopt an informal model of support like that provided by NORFORCE, where ex-serving members are embedded in communities which gives them the opportunity to keep serving these communities.
The need for greater transparency about services and accountability for outcomes in the ESO sector was suggested. It was suggested ESO funding be used largely for one-on one peer support, and that we could learn from other countries (particularly Canada and New Zealand) about how ESOs could better connect with First Nations people.
One participant went further, suggesting that the entire ESO framework in Australia needs an overhaul as there are ‘really no rules’ and some are even causing harm.
Participants said that health services are available to NORFORCE members in garrison towns across the Northern Territory, but things are difficult for those in remote regions. There is a strong relationship between NORFORCE and First Nations health providers in the Top End, which is important for delivering culturally appropriate services.
However, participants also said that there are challenges for some NORFORCE members in accessing healthcare services due to language barriers, a lack of necessary ‘paperwork’ (such as a Medicare card) or financial constraints. The lack of specialist health care across the Top End was also noted – members generally need to fly to cities to access this.
It was suggested that medical information might be shared with commanding officers in NORFORCE to facilitate support. The fact that different health and support services are ‘siloed’ was noted as a concern.
Participants said they feel that the Army needs a greater understanding of First Nations cultures, suggesting that those doing psychological testing and assessments should go out to country to gain better understanding of cultural nuances. The lack of psychiatric care was a serious issue in the Northern Territory, with ‘fly in’ psychiatrists leading to a lack of continuity of care for serving and ex-serving NORFORCE and ADF members.
Mentally healthy workplaces
Roundtable participants told Commissioners that when tackling mental health stigma in the workplace, there is a need to be mindful of audience, context and messaging or else there is potential for harm – some research has shown stigma can actually increase with the incorrect types of awareness raising. Similarly, the approach of ‘screening out’ of those with mental ill health in workplaces can lead to concealment, as this suggests individual workers, not systems, are the problem.
Participants all noted the importance of leaders and managers in promoting mentally health workplaces, adding that practical training is more likely to deliver positive outcomes than simply raising awareness. Role modelling and story telling were given as potential ‘bottom up’ approaches to overcome mistrust of hierarchy.
The Canadian military model where mental ill health is uncoupled from career progression and promotion potential was noted. One participant told of good evidence of successful treatment of mental ill health in first responders. Peer led programs being used in the UK and Canada were also discussed – one of these has been adopted by the NSW Fire and Rescue service.
Commissioners were informed of Safe Work Australia’s code of practice developed to minimise psychosocial hazards in the workplace. It was observed that while Comcare is generally responsible for Commonwealth enforcement of the code, the Australian Defence Force (ADF) has a ‘special arrangement’ with Comcare noting that Defence is exempt from WHS legislation in limited circumstances by virtue of the work performed.
Participants said a safe workplace culture can minimise the impact of psychosocial hazards and related stress and trauma. Participants added that research has shown it is critical to have a supportive supervisor and colleagues to mitigate the risks of exposure to trauma.
The issues of moral injury and organisational injustice were discussed. Safe Work Australia categorises these as ‘moral demands’ (resulting in shame, unfairness, shock and hurt) and considers them to be organisational risks.
Commissioners heard the main benefit of a more flexible approach to mental health in the ADF would be better workforce retention. The example of a cultural change in the aviation sector was given, where pilots with mental health issues who are given appropriate support are now allowed to fly.
The National Workplace Initiative and Thrive at Work framework were given as useful models for creating mentally healthy workplaces. Both are evidence-based frameworks being used to create mentally healthy workplaces by many organisations across Australia.
A participant stated introducing key performance indicators on improving workforce design and workplace health and safety may be helpful. Another said addressing false ‘efficiencies’ in the workplace and returning agency to employees can also help.
Participants encouraged Commissioners to look at how other occupations manage mental health in the workplace, and it was suggested that the concept of ‘industrial manslaughter’ is a good way to get people’s attention. They suggested this approach might be applied to the ADF.
The issue of burnout and its significant increase across all industries was discussed. One participant said it should be understood through an organisational (not individual) perspective, and its increasing prevalence makes a good case for creating mentally healthy workplaces.
Organisational culture was described by participants as ‘amorphous’, with leadership acknowledged as critical. They stated it is also important to consider other factors that reinforce, drive and sustain culture. The masculine culture in the ADF was noted as a particular challenge.
Participants told of attempts to change culture in the NSW Fire and Rescue service, where workers are given a realistic, strengths-based view of their likely career trajectory from commencement. This approach places the emphasis on developing future transferrable skills.
The culture of non-disclosure of mental ill health in the ADF, both before and after recruitment, was discussed. Research has confirmed people tend not to disclose during recruitment due to fear of rejection. Participants told of some GPs even offering ‘workarounds’ to avoid notifiable mental health plans for those aspiring to join the ADF or police.
One participant said research supports the need to establish a business case for creating a mentally healthy workplace before engaging leadership. They added first responder organisations frame this in the context of endurance and capability.
Related to this, participants said a cost/benefit analysis is critical. A 2022 research report commissioned by Safe Work Australia was quoted that estimated Australia’s economy would be $28.6 billion larger each year by eliminating all work health and safety incidents.
Participants also argued human resource personnel and leaders are not adequately trained in mental health and understanding psychological risks.
Commissioners heard that deployment could motivate soldiers to conceal mental health issues rather than seek help. One participant’s research found trauma related to deployment can be less severe than that caused by day-to-day stressors, and that having a supportive supervisor and colleagues was important whatever the context.
Participants also questioned the ADF’s policy on the non-deployment of those taking medication for mental health conditions.
Suicide and suicidality
There was a general consensus among participants that the workplace is important in nurturing a sense of identity, belonging and social connections. It is therefore seen as a having a positive influence on mental health and having a protective effect on suicide and suicidality.
Participants said the current data has limitations in comparing trends in the ADF to the general population, suggesting it would be better to compare cohorts with similar ages and gender in different workplaces.
It was acknowledged that the rate of suicidality in workplaces is something that is hard to quantify, as most people do not disclose this. Participants suggested that occupational workplace surveys are more likely to reveal issues with mental ill health and suicidality than general population surveys.
A study of suicidality in fly-in-fly-out (FIFO) workers was discussed. The study found that interaction with family was a key factor, with distress levels peaking just prior to commencing shift, then upon return home. The similarities to deployment were discussed, with participants questioning whether families should be involved in the ‘decompression’ process post deployment. It was noted that the support for, and support of, families is a gap in psychosocial risk identification and that the ‘whole family dynamic’ deserves more consideration.
One participant questioned the separate treatment of physical and mental health in ADF when they are often related, suggesting that occupational therapists may be useful here. Participants acknowledged the general lack of psychiatrists and psychologists, who in any event often lacked competency for effectively treating ex-serving members (such as familiarity with return to work programs, exposure therapies and military culture).
The UK ‘fit note’ initiative was put forward as an example of a program that focuses on ability and recovery instead of being unwell. Participants spoke of the ‘perverse incentives’ towards compensation that operate in Australia, such as older veterans trying to qualify for total and permanent incapacitation (TPI) or the Gold Card.