In 2002, the Department of Defence, in line with the national mental health reform agenda, identified the need to develop a mental health strategy to address service planning for, and provision of, mental health care. The ADF Mental Health Strategy 2002 integrated the National Mental Health Strategy 1992, as well as the first and second national mental health plans; but also recognised the unique challenges of the Defence environment resulting from the demands of military service.
In 2009, the Government commissioned Professor David Dunt to conduct an independent review in order to benchmark current ADF mental health support services against best practice, including the transition process to the Department of Veterans’ Affairs, and to determine the extent to which mental health services met the needs of serving and transitioning ADF members.
In his report, Review of Mental Health Care in the ADF and Transition through Discharge, Professor Dunt stated that the introduction of the ADF Mental Health Strategy in 2002 was far-sighted, and that some of the programs surpassed similar initiatives in other Australian workplaces, and international military forces. Nevertheless, the review highlighted gaps in the delivery of mental health services in Defence. He made 52 recommendations to reform and enhance ADF mental health programs, as well as the transition services of both Defence and the Department of Veterans Affairs.
Defence is implementing the recommendations of the Dunt Review through a comprehensive four-year ADF Mental Health Reform Program, which started in July 2009. Already, nearly half of the recommendations have been implemented, including completion of the 2010 Mental Health Prevalence and Wellbeing Study and the development of the 2011 ADF Mental Health and Wellbeing Strategy.
The goals of the ADF Mental Health Reform Program have been refined and aligned with the Fourth National Mental Health Plan (2009–2014), to form the 2011 ADF Mental Health and Wellbeing Strategy. The strategy’s focus is similar to that of the Fourth National Mental Health Plan in that it takes a whole-of-government approach, with a particular emphasis on partnering with the Department of Veterans’ Affairs to ensure more effective transition for ADF personnel.
The 2010 ADF Mental Health Prevalence and Wellbeing Study is the first comprehensive investigation of the mental health of an ADF serving population. It is world leading research that has been conducted by Defence in collaboration with the University of Adelaide. The Mental Health of the Australian Defence Force – 2010 ADF Mental Health Prevalence and Wellbeing Study Executive Report of key findings and a detailed technical version (Mental Health of the Australian Defence Force – 2010 ADF Mental Health Prevalence and Wellbeing Study Report) are available.
The goals of the study were to establish a base-line prevalence of mental disorder, to refine current mental health detection methods, and to investigate the specific occupational stressors that influence mental illness.
Joint Health Command determined that the most efficient way to achieve the goals of the study was to combine it with the existing Deployment Health Surveillance Program. The 2010 Mental Health Prevalence and Wellbeing Study data collection was a collaboration between the Directorate of Strategic and Operational Mental Health and the Centre for Traumatic Stress Studies, while the Military Health Outcome Program surveys were conducted by the Centre of Military and Veterans Health.
The study was conducted in two phases. In the first phase, ADF personnel used a self-report screening questionnaire. In the second phase a subset of these respondents were telephone interviewed, with priority given to ADF personnel who were identified as being more likely to have mental illness based on their screening questionnaire. The study did not include reservists or ex-serving personnel.
Almost half of the ADF participated in the study. A weighting process was used to allow estimates to be calculated for the ADF population.
In order to interpret the rate of mental disorder reported in the ADF, mental health data on the Australian community was obtained from the Australian Bureau of Statistics (ABS). This community data was matched to the demographic characteristics of the ADF population. This allowed a direct comparison to be made between the estimated prevalence of mental disorder in the ADF and the Australian community.
The study focussed on the three most common types of mental disorders, including affective (mood) disorders; anxiety disorders; and alcohol disorders; as well as suicidality; impact on ability to work; barriers to seeking care; and a number of occupational risk and protective factors.
The findings of the study have allowed prioritisation of the goals of the ADF Mental Health Reform Program and assisted in the development of the 2011 ADF Mental Health and Wellbeing Strategy.
The estimated prevalence of mental disorders in the ADF over a 12-month period is of the same magnitude as that of the community, and therefore has the potential to have a substantial impact on individual wellbeing and operational capability.
Results from the 2010 Mental Health Prevalence and Wellbeing Study indicate that one in five of the ADF population had experienced a mental disorder in the previous 12 months, which is a similar rate to that in a community sample, matched for age, gender and employment; from the 2007 National Survey of Mental Health and Wellbeing conducted by the ABS.
More than half of the ADF has experienced an anxiety, affective or alcohol disorder at some stage in their lifetime, which is significantly higher than the matched community rate. The largest difference from the community was among males in the ADF, who had a significantly greater prevalence of affective disorders, and a significantly lower prevalence of alcohol disorders. The mental health of ADF females did not differ significantly from that of females in the community, except that ADF females had a lower prevalence of alcohol disorders.
A challenge for the community is the rate of mental disorders among youth. An examination of the inter-relationship between age and each of the mental disorder groups revealed that, as in the community, mental disorders in the ADF were most common in the 18 to 37 age range.
11,016 ADF members met diagnostic criteria for a mental disorder in the last 12 months. Of those, 7,420 had an anxiety disorder, 4,757 had an affective disorder, and 2,590 had an alcohol disorder. While the overall 12-month mental disorder rates in the ADF were similar to those in the community, there is a significant difference in the profile of mental disorders.
The report shows that the 12-month prevalence of mental disorder in the ADF is the same as that of the community, however the ADF has a different profile of mental disorder. This is consistent with the occupational stressors to which ADF personnel are exposed (such as deployment experiences and absence from family and support networks).
The most common mental disorders in the ADF are anxiety disorders; the prevalence rate is not significantly different to that of the community. The most prevalent of the anxiety disorders in the ADF is post-traumatic stress disorder, which was significantly more prevalent than in the community. This was not unexpected considering the types of occupational risks in the military.
ADF members, particularly males, reported a significantly higher rate of affective disorders when compared with the community. Of the affective disorders, the most prevalent was depressive episodes, where the rate was significantly higher than in the community, especially in the younger age groups. Within the community, depressive episodes are typically more prevalent in middle age. It may be that the occupational stressors of military service result in earlier onset of these disorders.
The self-report data from the study showed high levels of alcohol use, consistent with community rates, but this is not as readily translating to disorder in the ADF. Alcohol disorders were significantly lower in the ADF than in the community, with most of the disorder in males in the 18–27 age group. There was no difference between the Services on alcohol dependence disorder. Personnel in the Navy and Army, however, were significantly more likely than Air Force members to have alcohol harmful use disorder.
The prevalence of suicidal ideation and making a suicide plan was significantly higher in the ADF compared to the community. However, whilst ADF personnel are more symptomatic and more likely to express suicidal ideation than people in the general community, they are only equally likely to attempt suicide and less likely to complete the act. These findings suggest that the comprehensive initiatives on mental health literacy and suicide prevention currently being implemented in Defence may be having a positive impact. That is, although ADF members are more likely to express suicidal ideation than people in the community, they are only as likely to attempt suicide, and less likely to complete the act. The current evaluation of the ADF Suicide Prevention Program will provide insight into the effectiveness of the program.
An estimated 43% of ADF members reported having been deployed multiple times, 19% reported having been deployed only once, and the remaining 39% have never been deployed. Army has the highest incidence of multiple deployments at 46%, followed by Navy with 41%. Air Force has the lowest frequency of multiple deployments at 36%. Navy, at 11%, has the highest proportion of personnel reporting six or more deployments.
There was very little difference for mental disorders in the previous 12 months between personnel who have been on deployment and those who have never been deployed. This result suggests that the significant resources invested by the ADF in a comprehensive operational mental health support system may be effective in prevention of, and early intervention, for mental disorders resulting from exposure to operational stressors. This is supported by the fact that personnel who have been deployed are more likely to seek care than personnel who have never been deployed.
Analysis of the data has not revealed a relationship between the number of deployments and mental health symptoms. There is a trend; however, that indicates greater levels of traumatic symptomatology with each trauma or combat exposure on deployments. The data show a strong relationship between lifetime trauma exposure and mental health symptoms. While more detailed analysis will be needed, it is likely that – consistent with international literature – the number of deployments is not as predictive of mental health outcomes as the level of trauma or combat exposure.
Almost one in five personnel (17.9%) reported that they had sought help for a stress-related, emotional, mental health or family problem in the previous 12 months. However, only half the sample with post-traumatic stress disorder or depressive episodes reported receiving treatment in the previous 12 months and only 15% of those with alcohol dependence disorder.
The highest rated barrier to seeking help was concern that it would reduce deployability (36.9%). The most frequently perceived stigma for ADF members was that people would treat them differently if they sought care (27.6%), and that seeking care would harm their career (26.9%).
ADF personnel reported significantly more partial, rather than total, days out of role due to psychological distress than the community. The data indicate that mental disorders have an impact on the ability of personnel to work, not only in terms of absenteeism, but also in the number of days where they are unable to perform at work. Individuals with affective disorders, for example, report an average of 23 days off per year due to the disorder. This loss not only reduces the member’s wellbeing but creates a significant drain on the capability and resources of the ADF.
The total days out of role in the previous four weeks in the ADF were equally accounted for by depressive (41.1%) and anxiety (42.9%) disorders and were higher than the burden for any alcohol disorder (7.1%). The highest ranked disorders were panic attack (32.7%); depressive episodes (32.4%); specific phobia (28.4%); and post-traumatic stress disorder (24%).
When any mental disorder is considered, 61.8% of the total days ADF members were unable to work due to psychological distress, are attributable to a definable disorder. Significantly, the remaining figure (38.2%) represents days out of role for non-specific symptomatology. This proportion highlights the importance of psychological distress in the absence of a diagnosis as a source of disability as well as diagnosable disorders. Further work will also be done to determine the economic cost to Defence, and the impact on readiness and capability of mental disorders.
The 2011 ADF Mental Health and Wellbeing Strategy provides a blueprint for the development of the 2012-2015 Mental Health and Wellbeing Action Plan; which will allow the finalisation of Dunt review recommendations, align Defence with the national mental health reform agenda, and put in place a system that is self monitoring and continuously improving.
The strategy articulates Defence’s vision of achieving capability through mental fitness through a commitment to:
This commitment will be achieved by meeting six strategic objectives, including:
As a follow-on to the ADF Mental Health and Wellbeing Strategy, Joint Health Command released the ADF Mental Health Wellbeing Plan (2012-2015) in October 2012 to coincide with the inaugural ADF Mental Health Day. The ADF Mental Health and Wellbeing Plan is guiding the implementation of the six Strategic Objectives and seven Priority Actions outlined in the Strategy.
Click on the following link to view the ADF Mental Health and Wellbeing Action Plan 2012-2015.
While the action plan is being finalised, Defence senior leadership has identified seven priority actions for immediate attention, including:
Mental Health Advisory Group—Terms of Reference
This document is one complete report, however, it has been separated into various sections to enable ease of download.