Saving those who serve

The medical profession has known for over a century that war can damage people’s minds – when the battles stop, for many that’s when the real struggle begins.

Australians have understood the psychological consequences of combat since World War I.

In the late 1930s, 20% of the Commonwealth budget went towards pensions for widows of veterans and veterans who were physically and mentally damaged by war service.

A century on, we still need to know more about how ongoing service affects military personnel, particularly when they return to civilian life. This is the aim of a new federally funded $5 million study of nearly 60,000 recently discharged plus still serving Australian Defence Force (ADF) personnel, led by the University’s Dr Miranda Van Hooff.

“The majority of veterans get through with remarkable resilience,” says Professor Sandy McFarlane, head of the University’s Centre for Traumatic Stress Studies, where the research project is based.

However, there is a real challenge in making sure services reach those who need them. To begin, veterans often have a stoic attitude and also the psychological impact of exposure to horrific events can take years emerge. A previous survey of still-serving personnel found 24% of officers and 27% of other ranks would not seek help for memories they struggle to deal with, lest they be seen as “weak”.

“The challenge is to get care early before a person’s social relationships fragment and secondary problems such as alcohol abuse emerge,” Professor McFarlane says. He points to studies of Australian deployments overseas in the last 25 years to demonstrate that the absence of combat does not mean someone is not a risk.

“The similarities of traumatic exposures during modern peacekeeping operations are often greater than the differences experienced during deployment in a declared combat zone; the rates of psychiatric disorder in veterans following the two types of deployment are therefore quite similar,” he wrote in an August editorial for the Medical Journal of Australia.

This makes recognising and reducing what Professor McFarlane calls “barriers to care” a core problem in helping veterans. They are barriers that must be better understood to be changed: “Younger ADF personnel have higher depression rates than the general community. If they leave service without getting assistance, they’re the ones who are at risk and likely to benefit from treatment. The study will look at rates of suicide and suicide attempts; this is one focal point,” he says.

The aftershocks of traumatic stress extend well beyond the military. Professor McFarlane has worked for decades with survivors of bushfire disasters and his centre has a long established interest on the consequences of traffic accidents for victims. But in this new project, the focus is on creating a benchmark study to establish needs and service delivery among, and for, veterans. This is especially important now that it is understood that post-traumatic stress disorder (PTSD) can take years to appear.

A widely published and internationally recognised expert on PTSD, Professor McFarlane has worked with the Australian Department of Veterans Affairs, consulted to the United Nations, and been involved in litigation against the UK government by veterans of the Falklands and Gulf wars and those deployed to Northern Ireland.

The problems many veterans face are now known to extend far beyond the need to deal with the memory of appalling events. Certainly post-traumatic stress activates fear mechanisms and disrupts parts of the brain which modulate behaviour but it also affects people’s basic biology. Professor McFarlane also warns PTSD sufferers therefore have heightened risks of cardiovascular and autoimmune diseases. “This is a disease that affects the body not just the mind.”

The survey, now underway, has six core objectives which will make it one of the largest studies of military personnel ever undertaken. Professor McFarlane and Dr Van Hooff and their colleagues want to know about the physical and mental health of veterans who transitioned out of full-time service between 2010–2014 and they’re interested in the trajectory of mental health symptoms and disorders. Thus the survey will ask about physical problems, such as recurrent pain and difficulties sleeping, and health risk behaviours, including alcohol, tobacco and drug use, and put everything in context by relating people’s conditions to their experiences while serving, and when they returned home.

The challenge is getting veterans to respond. “Some leave Defence and just want to forget. They do not always want to engage with surveys about their welfare,” Professor McFarlane says. It’s also essential that they understand that while federally funded, the survey is independent of government. “Many vets just don’t trust bureaucracy,” he adds.

Veterans are often the last to admit they may be struggling, hence families are crucial both in encouraging participation, and reporting behaviour. There is also a separate study on the impact of service on families.

The findings of such work have broad relevance going beyond those who have served in the military, particularly emergency services staff. “The people most at risk of PTSD are willing to walk into danger,” he says. “There is an obligation to care for those who care for the community.”