Welcome members of the Military, Veterans’ and Emergency Services Personnel Mental Health Network

Thank you all for taking the time to read our first newsletter in some time.

Firstly, as the Chair of this Network, it is my pleasure to introduce myself. I took over this position from Dr Andrew Khoo in 2023.

I’m an Army veteran of some 35 years, including service as a soldier, Regimental Medical Officer, and psychiatrist, with operational service in Afghanistan in 2013. I work full time as the inaugural Chief Psychiatrist of the Department of Veterans’ Affairs but also have a small part-time private practice and lead the Psychiatry curriculum for the University of Tasmania Medical School.

My clinical and research interests are in culturally specific, peer led, transdiagnostic programs for stress and trauma for military, veterans, and emergency services personnel.

With regards,

A/Prof Jonathan Lane
Chair, Military, Veterans’ and Emergency Services Personnel Mental Health Network Committee

Announcements

The following items are available on the Network's webpage:

Educational and other resources - 

1. Two RANZCP Psych Matters podcast episodes "A day in the life of a Department of Veterans' Affairs psychiatrist" and "A day in the life of a military and veteran psychiatry trainee".
2. Network member research and opportunities to share your relevant research with the Network.
3. External resources relevant to those working with Military, Veterans’ and Emergency Services Personnel.
4. Consumer resources (Black Dog Institute, Mesothelioma & Veterans, and Australian Institute of Health and Welfare - Veterans).

Military and Veterans Psychiatry Training Program resource book - 

The MVPTP resource book (previously referred to as the resource hub) contains information for Trainees in MVPTP funded posts about the program, as well as reading lists and links to podcast episodes. All sources within the booklet have been sourced from Fellows and members of the Military and Veterans Emergency Services Personnel Mental Health Network Committee.

Please see the article later in this newsletter for more information on this program and on the College website.

Pharmacological management of PTSD Survey:

Study Title: Understanding Clinicians’ Perspectives on Pharmacological Management of PTSD: A Questionnaire-based Study.

This survey is designed to explore clinicians' perspectives on the pharmacological management and polypharmacy in the treatment of PTSD and their opinions on strategies to manage polypharmacy.

The survey will take approximately 15-20 minutes.

Summary of network’s progress over the recent past

In 2023, the Network delivered three symposia at Congress and met face-to-face for the first time in September 2023 to plan our further activities. We contributed to multiple state and federal inquiries, RANZCP position statements, and were actively engaged with the ongoing Royal Commission into Defence and Veteran Suicide, including two funded research projects. This also included participation by A/Prof Lane and Dr Khoo at the Ministerial Round Table working group on the development of the combined Defence and DVA Mental Health Strategy, amongst other events. A/Prof Lane also presented a personal submission to the Parliamentary Enquiry into ADF Adaptive Sports and spoke to the hearing committee on behalf of himself and the RANZCP submission. He was also heavily involved with the Royal Commission, including a written submission and two hours of oral testimony in the Hobart hearing session in 2022, and being appointed as a member of the Reference Group for the report.

In 2024, the Network continued its presence at a range of different events, including Congress with symposia and individual presentations. The International Military Medical Association held its annual conference in Brisbane in September, and again a large number of Network Committee members presented new research and other topics. The Network Committee members continued to represent our professional interests at the DVA Mental Health Expert Advisory Group and the Defence Mental Health and Wellbeing Advisory Group. We also produced a number of podcasts including stories for Psych Matters and the MVPTP. We are therefore in a strong position to continue this work going forward in the remainder of 2025 and the years ahead.

Royal Commission into Defence and Veteran Suicide

As most of our readers would be aware, the Royal Commission report was handed down in September 2024. This report was an enormous undertaking, led by Nick Kaldas APM, AM, with both James Douglas KC and our own Dr Peggy Brown AO. The final report is a substantial body of work, with 122 recommendations, and can be seen here:

The majority of recommendations have been accepted by the Government. Michael Manthorpe PSM has recently been appointed as the interim Head of Defence and Veterans’ Service Commission and will lead this as it comes into being. Furthermore, the Royal Commission itself, not just the recommendations, have already stimulated significant changes in both Defence and DVA. The appointment of A/Prof Lane as the inaugural Chief Psychiatrist of DVA is evidence of the importance that Secretary Alison Frame has given these issues. The Royal Commission has also stimulated wider research into the problems in these populations, and indeed a recent article in Australasian Psychiatry has identified that knowledge of sub-populations’ risks of suicide is important to our clinical work https://journals.sagepub.com/doi/full/10.1177/10398562241299336

It is heartening to see further research and publications that were stimulated through the work of the Royal Commission as this can only help to improve the outcomes our Service personnel have faced. In recognition of this, the Network has advocated for, and successfully gained, a keynote address from Dr Brown AO at this year’s Congress which was well received.

Retirement of Dr Duncan Wallace

We have somewhat bittersweet feelings around the recent retirement of Dr Wallace, MB BS, MA, FRANZCP, Commodore, RAN (Rtd).

Dr Wallace was the instigator of our Network, including providing the drive and effort behind our establishment in 2018 as the inaugural Chair and now ongoing operations. As such it is sad to see him go, although we wish him the best going forward now, he doesn’t have such extensive responsibilities.

Duncan served in the Navy for over 40 years, attaining the final rank of Commodore. He served in a wide range of positions, including operational deployments to Border Force operations, Timor Leste, Iraq, Afghanistan and the wider pacific, amongst other local operations. He was effectively the sole internal psychiatric voice to Defence for some decades, and a key player in keeping psychiatry and mental health matters central to training, employment, deployment, and policy matters central to Defence from the 1990’s until late last year.

He was central to the establishment of the ADF Centre for Mental Health and used his wealth of service experience and knowledge of military culture to provide excellent clinical care for serving members and veterans through his emphasis on using evidence-based treatments plus close joint management with psychologists to achieve the best possible clinical outcomes.

His wry sense of humour, dedication, knowledge, and expertise have been appreciated by all of us who have had the privilege of working with him, and on behalf of the Network Committee we raise the salute of ‘Bravo Zulu’ to you Sir.

Military and Veterans Psychiatry Training Program (MVPTP)

MVPTP trainee-to-fellow retention success story/s

Since the start of the program in 2020, we have had 46 trainees who have completed rotations in Military and Veterans’ mental health, with some completing more than one rotation. The team have been advised from three former MVPTP trainees, who have now attained Fellowship and are dedicating their career to military and veterans’ mental health. The MVPTP, funded through the Department of Veterans’ Affairs, continues to be a successful program enhancing trainees’ knowledge in military and veterans’ mental health. The RANZCP provides trainees with support through access to the RANZCP’s mentoring program and a resource booklet to benefit them whilst in an MVPTP funded post.”

Current and future projects in the MVP Training Program –

The MVPTP podcasts have been developed for listeners to gain an understanding of what working in Military and Veterans’ mental health is like. The podcasts include members from the Military and Veterans’ Emergency Services Personnel Mental Health Network Committee. The podcasts are available to list to via PsychMatters:

·         Day in the Life of a DVA Psychiatrist

·         Day in the Life of an MVPTP Trainee

The next podcast due for release soon will be ‘What makes Military and Veterans’ and Emergency Services different?’. Another podcast on the findings from the Royal Commission is due for release later this year.

Updates from MVESPMHN Committee Members

Duncan Wallace

While assisting in the preparation of the College’s submission to the Royal Commission on Defence and Veteran Suicide in 2022, I reconnected with a colleague, Ms Sue Cripps, with whom I had previously worked at St Vincent’s Hospital, Sydney, Mental Health Service in outreach services to homeless mentally ill persons. She informed me of her work with the Community Housing Industry Association in the field of veteran homelessness. This prompted my interest and concern about the problem, noting the association between veteran homelessness, mental illness and suicide. It led to including a significant section on veteran homelessness in the College’s submission to the Royal Commission and the development of an article that was published in Australasian Psychiatry to promote awareness of the problem. I also had the opportunity to present on the issue at the College Congress in May 2023. Here is a link to my paper: Veteran homelessness in Australia: What do we know? What has been done? What do we need to do? - Duncan Wallace, Kat Hoggett, Sue Cripps, Wendy Hayhurst, Nathan Klinge, 2023 (sagepub.com)

Ed Heffernan

ONE VETERAN HAS SUICIDE-RELATED CONTACT WITH POLICE, PARAMEDICS EVERY FOUR HOURS: How military and veteran research can make a difference.

The Queensland Centre for Mental Health Research’s (QCMHR) Military and Veteran Mental Health Research stream enables clinicians, researchers, serving members and veterans to collaborate on research initiatives. It also has a research partnership with the Gallipoli Medical Research Foundation (GMRF). The stream, led by committee member Professor Ed Heffernan, has established several large data linkage and qualitative research projects that have translated into training resources and evidence to inform health planning for entities including the Royal Commission, Department of Defence and Department of Veterans Affairs. The research unit includes seven committee members who are co-investigators and affiliated with the unit: Dr’s Duncan Wallace, Jon Lane, Andrew Khoo, Diana McKay, Andrew Ramage, Carolyn Nas-Jones and Ed Heffernan. The research unit also has PhD students, 3 of these are serving members (including a psychiatrist and psychiatry registrar) and supports an RANZCP scholarly project.

Recent research conducted by this stream, funded by the Royal Commission into Defence and Veteran Suicide has been the subject of significant media attention and is published on the Royal Commission website (Understanding and enhancing responses to suicide crises involving current serving and ex-serving members of the ADF: A data linkage study | Royal Commission into Defence and Veteran Suicide). The study, led by Professor Ed Heffernan and Associate Professor Carla Meurk from QCMHR used linked data about Queensland veterans, and findings included one serving or ex-serving Australian Defence Force member has suicide-related contact with emergency services every four hours across Australia. The study also revealed that past and present ADF members had 1.24 times the odds of having a suicide-related contact with police or paramedics compared to the general adult population. Further, current serving permanent ADF members are 5.84 times more likely to have suicide-related contact with police or paramedics compared to current serving reserve and ex-serving ADF members. In addition, the report has identified crucial information about health service contacts, polypharmacy and multimorbidity associated with suicidality and suicide death.

This study is an example of the importance of research in establishing an evidence base to enhance the understanding of the mental health needs of our military and veteran community and to inform health policy and service development. If you are interested in military and veteran mental health research you can read more here (Military and Veterans' Mental Health Research Stream - Queensland Centre for Mental Health Research (QCMHR)  or you can contact Prof Ed Heffernan via

memberhelp@ranzcp.org

Subject line – MVESPMHN Committee – Prof Ed Heffernan – MVMHRS

Megan Gilbert

In the last 12 months I have engaged with a network of people who are collaborating to further the recognition, identification and management of Veterans with mTBI.

Traumatic brain injury (TBI) is a general term used to represent a wide range of brain injuries when the brain is harmed by an unexpected external physical attack. It can result in diffuse or localized damage and can range in severity from a minor concussion to a serious injury that puts the victim in a coma or even kills them and is among the leading causes of adult disability and mortality. Regarding the military domain, it was first recognized during WW1, being described as ‘shellshock’. When the trauma is big and obvious, such as a penetrating ballistic injury or severe head impact it can be easily recognized and managed. However, in the military context, it is much more commonly seen from less apparent sources, such as explosion exposure from improvised explosive devices and even training. This is then referred to as mild Traumatic Brain Injury (mTBI).

The clinical presentation of mTBI is clearly identical to any concussive presentation including problems with memory, balance, sleep and concentration, headache, tinnitus, sensitivity to light or other visual disturbances, fatigue and irritability. Symptoms are typically temporary; however, a small proportion of individuals will have persistent symptoms with estimates between 5-20%. Furthermore, repetitive trauma has been demonstrated to have cumulative detrimental neurological consequences. The diagnosis and treatment of mTBI is limited not only by assessment tools, which in the past has relied on self-reporting, but also by the overlap of symptoms with psychiatric conditions that often coexist, including PTSD, depression, and chronic pain.

Our group hopes to highlight this condition with the aim of promoting early detection/prevention through more research and monitoring of biomarkers and blast exposure.

Diana McKay, Carolyn Nas Jones, and Carmel Cash

Since 2019 there has been a steady increase in uniformed psychiatrist in the Defence Force. There are currently five fulltime psychiatrists, three in the Army, one in the Navy and one in the Air Force. The role of the uniformed psychiatrist is varied and includes clinical work, policy development, liaison with Command as well as a role in teaching and research. There is also currently one psychiatry registrar who are undertaking psychiatry training whilst remaining in fulltime service, the second one has now Fellowed.  We are located in Canberra, Darwin, Sydney, Brisbane and Townsville. There is a growing number of Reserve psychiatrists in all three services and making effective use of their time and specialist knowledge is a priority. 

Whilst the psychiatry capability within Defence is expanding, the vast majority of psychiatry clinical care for Defence members is provided by our civilian peers in private practice.  It is important work providing mental health support to those who serve our country, and it is exciting to see the opportunities for psychiatry registrars to build expertise in military and veteran psychiatry through Military and Veteran Psychiatry Training Program posts.

In terms of activities outside direct clinical care, we are involved in education inside and outside of the ADF. For example, recently CMDR Nas Jones along with Dr Anna Colwell, Deputy Chief Health Officer from DVA, has engaged with the Central and Eastern Primary Health Care Network in Sydney to provide information and support to GPs, as well as liaising with UNSW to see Military and Veteran Health included in the curriculum.   There is an active group of fulltime and reserve psychiatrists involved in research across various sites and areas of interest. 

If any members of the Network would like further information about psychiatry in the ADF we are happy to be contacted via email –

memberhelp@ranzcp.org

Subject line – MVESPMHN Committee request for information about psychiatry in the ADF

Next Edition

If you wish to submit an article for the next MVESPMHN Newsletter please forward it to: memberhelp@ranzcp.org

Subject line – MVESPMHN Committee proposed Newsletter article.