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Australia: Chief of Army launches PTSD DVD in Townsville

Chief of Army launches PTSD DVD in Townsville*


Wednesday 8 December 2010

*Check against delivery*

Good afternoon, and welcome to the launch of the new DVD,/“Dents in the Soul”./ This Mental Health initiative is a collaborative effort between the Army and Joint Health Command, and it is designed to raise awareness of; and to help de-stigmatise Post Traumatic Stress Disorder or PTSD. I’m delighted to be able to officially launch this DVD in conjunction with the opening of the Cassowary Soldier and Family Support precinct here at Lavarack Barracks. It is a fabulous facility and I congratulate all involved.

I hope you’ve been enjoying the family time and the refreshments that have been put on here today. I’d like to particularly acknowledge and thank the partners and children of our serving men and women for attending.

My thanks also go to Brigadier Smith, and the soldiers of the 3rd Brigade for opening up their base, and putting on this spread, and the events of today.

At this point could I also acknowledge Mr John Schumann, and his band – The Vagabond Crew for their enthusiastic support of our project. John shares with us his personal experience with PTSD in this new DVD and reminds us that this illness can affect civilians as well as those of us in uniform. Of course, it’s also fantastic to have the iconic song “I was Only 19” associated with Army’s newest mental health initiative in this production.

/“Dents in the Soul”/ arose from Army’s desire to better support our soldiers and their families’ in understanding PTSD. It is time for a robust discussion in Army and across Defence on how this illness develops, how it can be treated, and the considerable benefits of seeking help early to address the condition.

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I would like to start by acknowledging the families of our of 3 Brigade soldiers. You are an important part of Army’s family, and much of what we do and achieve is only possible through your ongoing support, your understanding and your patience.

Life as part of the Army family can be a challenge – we face prolonged absences through deployments and training, along with the disruptions associated with the mobility requirements of our profession. We simply could not meet these challenges as an organisation without the support of our wives, husbands, partners and families.

I feel it is particularly important that you are here on this occasion. Army is working hard to consolidate our direction in the management of PTSD, and I’m very pleased to be able to share some of this work with our soldiers and families today.

Time will prevent me from screening the entire DVD at this point. It will of course, be available for you to view later today. In order to provide some context to what I’m going to say, I’d like to, at this point, screen a trailer of /“Dents in the Soul”./

My key message is that me, my commanders and your Army is working hard to provide more effective resourcing and treatment solutions for our soldiers suffering from PTSD.

We are working towards raising awareness of PTSD; not trying to deny the illness which is indeed present in our ranks.

We are working towards encouraging those at risk to seek help, and, importantly, to seek help early. Critically, we are working towards making our soldiers aware, that a diagnosis of PTSD does not automatically mean the end of their Army career.

I believe our strategy is sound; and it takes into consideration and encourages active spouse and family engagement.

PTSD has long been under recognised, under reported, marginalised and pigeon holed as /“another” /mental illness. It is certainly not a new issue, nor is it a psychiatric fad. In fact, I would contend Post Traumatic Stress Disorder has probably been around as long as armies have gathered, and wars have been fought.

Our experience with PTSD dates back to the Australian Army’s initial involvement as an Infantry force on the world stage; where we’ve seen instances of personal trauma develop around an individual’s combat and combat-related experience. In the past, we’ve identified this condition by a number of names, some descriptive, some derogatory: Shell Shock, Shell Concussion, Combat Stress Reaction, Battle Fatigue, War Neurosis, and most recently, Post Traumatic Stress Disorder.

What we today call PTSD, first gained mainstream recognition in the aftermath of World War One. Reports from the British Army at that time attributed some 80,000 cases of shell shock to the horrors of trench warfare[1] .

One of the difficulties since; has been accurately identifying the markers of PTSD – those initial signs and signals that might first lead us to put our hand up and say “I need some help”. Or just as importantly, for our family or mates to say “you need some help”. We’ve also struggled to provide an appropriate framework for treatment and resolution of this illness. I believe these shortfalls could be due to the many misnomers that surround PTSD.

PTSD has made us nervous. In the past we’ve not been entirely sure on the best approach to address the signs and symptoms of this condition. This has been largely due to the mystery and stigma that surrounds it as an illness.

We would be badly mistaken to view those suffering from PTSD as being somewhat less robust, less masculine, less tough; less of a soldier than the rest of us.

PTSD is what I would describe as a “non-visible injury” – an illness that we cannot touch or feel. And accordingly, one that we tend to marginalise because of the absence of a magic pill or vaccination or universal cure. However, what I do know is; the symptoms of PTSD are different in each individual, and are often reflected in varied reactions to psychological stressors.

Defence currently has an active program for monitoring the mental health and psychological outcomes of deployment through a mental health screening continuum. Whilst not providing a diagnosis of PTSD, it does report the symptoms, identifying those who might be at risk of developing PTSD or other mental health conditions.

What we have learnt from this; is that at the 6 month mark post deployment, just under 1 in 10 of total ADF personnel deployed will exhibit some form of psychological distress.

Although the “at risk” group of ADF members runs at nearly 10%, in Army, we have not always been accepting of a soldier’s combat injuries, unless they were the kind that bled.

If we break an arm, it goes in a cast.

If we get shot, we get stitched up.

But if we are experiencing PTSD, what does that actually mean?

Where do we go for help? What treatment options are there?

How will PTSD affect our career in Army?

Who do our partners turn to if they are seeing the signs of PTSD in us?

What kind of mental/“cast” /exists in Army to fix it?

In short, we know there is no simple or straightforward “cure”.

In working out our approach to PTSD, we have had to stop and think about how to handle a problem which appears to have many more questions than answers.

Our current journey began in 2009, when Defence commissioned Professor David Dunt from the University of Melbourne to conduct a major review of our mental health services.

His findings indicated an urgent need for the broader Defence organisation to address the mental health issues of its personnel.

Subsequently, almost $90 Million has been allocated over four years to reform and enhance the Australian Defence Force Mental Health Strategy.

A feature of Army’s approach to tackling Mental Health Reform, and Critical Incident Mental Health Support, has included fully supporting the introduction of regional mental health networks. We have also introduced, or refined where appropriate, a number of mental health packages.

We’re focussing on Force Preservation with a program called /‘Keep Your Mates Safe - Peer Support’/; where we cover a number of topics including; suicide awareness and prevention, driver attitudes, alcohol misuse and a mental health ‘buddy system’.

We are making our Soldiers BattleSMART through a program of Self Management and Resilience Training; giving Soldiers practical skills for responding to stressful situations. Starting at Kapooka, these skills are being developed throughout a soldier’s career and reinforced during pre deployment training. These skills will allow soldiers to/“bounce back” /from adverse situations.

Here, at 3rd Brigade, this initiative also extends to Operation RESET, where a variety of critical topics are addressed in easing the transition from operational life, to home life. These include mental resilience, financial literacy and veteran entitlements.

Our broader mental health initiatives also target mental health literacy, awareness and resilience; and develops health promotion materials and up-skilling our mental health workforce.

It is now recognised that it is common for other conditions such as depression and alcohol abuse to co-exist with PTSD, making the management of this illness even more challenging. In May this year, a national mental health training program was held for over 100 of the ADF’s mental health providers. In addition to specific training in PTSD initiatives, our health providers received further training and development in the recognition, assessment and treatment of soldiers with PTSD complicated by other illnesses.

Another aspect in our push for mental health awareness in Army is today’s release of this DVD.

In launching this production, we are taking our focus on PTSD directly to our soldiers, asking them to engage in discussion, and become more aware of the symptoms of PTSD. We want them to seek help and seek it early. We want them to feel assured that PTSD does not necessarily mean the end of their Army career.

My gratitude and admiration is sincere in publicly recognising the contribution of the soldiers and officers who featured in this DVD. These men have courageously stood up to share their stories, and their respective journeys with PTSD. And, of equal importance, they have opened up the dialogue within Army on the illness.

I really believe this DVD will play an important role in bringing PTSD into the spotlight. My hope is that, as this DVD is more widely disseminated throughout Army, it will begin to de-mystify the stigma of PTSD within our organisation, whilst also addressing the mystery and suspicion that surrounds PTSD as the ‘invisible combat injury’.

Army’s values of courage, initiative and teamwork are built on the very real tenet of/“looking after our mates”/. We do this in training, in barracks, and on operations. Being a soldier is about the person next to you; it’s about the chain of command, it’s about an individual soldier’s willingness to invest his or her safety of life and limb in their mate - in the soldier standing next to them.

These values are also reflective of the manner in which we recognise and manage PTSD. To look after your mates, you need to look out for the signs.

Is he or she consuming more alcohol than normal?

Does he or she seem angry, tired or restless?

Are you picking up a sense that he or she might have problems at home? With their spouse? With their children?

Do they appear to be reliving their experiences on operations?

Are they avoiding activities, places, or people?

Spouses too – can look for some of these signs, and more, that may only be evident at home.

Is your partner having nightmares?

Do they seem moody or withdrawn?

Experience tells us that the symptoms of PTSD are most likely to present 4 to 6 weeks post deployment. This is the time when the invisible injury becomes visible, and provides us with a window of opportunity to address the symptoms and approach the remedy.

I would strongly encourage you to confront PTSD where you see these early signs, to call it out – and to seek help.

You must understand that help is available within the Army.

We have padres, psychologists and doctors – all of whom are trained to recognise the signs of PTSD, and all of whom can assist and guide - not judge, malign or disregard your concerns. Our Chain of Command, too, has an important role in recognising where problems exist, and offering assistance and guidance. This was a key theme I stressed at the recent Army Pre-Command course and on the RSM’s course.

Where a spouse of an Army member is tuning into these same concerns – I would like to reassure you that you will be listened to. Assistance is also available to you through our mental health support system of psychiatrists, medical officers, social workers, nursing officers, Chaplains, the Defence Community Organisation, as well as the “All Hours Support Line”, and the Veteran and Veteran Family Counselling Service.

Our Wounded Digger forum also provides an excellent avenue for exchange of information between Army and its broader family. This site also presents a synopsis of forward works, which I will continue to advance and implement during my time as the Chief.

Early recognition and intervention in PTSD is our first instance goal – seek help, and seek it early.

Our mental health specialists will establish a diagnosis through internationally accepted criteria, offering evidence based treatments for PTSD like cognitive behaviour therapy. In some instances, medication may be required, particularly where depression runs as a parallel condition to PTSD. And I reiterate, so too is family counselling available where required.

I am absolutely committed to the health, wellbeing and welfare of all of our soldiers and their families. My Army Commanders and I take very seriously our responsibility to ensure our people are prepared physically and mentally for the rigors of training and service on operations.

Where our soldiers are placed in harm’s way, our responsibility is to ensure, that upon their return, appropriate health care systems are available for their recovery, care and support.

This is encapsulated in our casualty management framework. The framework seeks to meet service member and family expectations, through the provision of timely and appropriate medical and psychological care.

PTSD sits firmly within this framework.

My feeling about PTSD is that it is not a life sentence – it is simply an illness that requires treatment.

I am aware of an underlying feeling within Army, that reporting PTSD or suspicion thereof, and/or out of character behaviour, might somehow be detrimental to a soldier’s career. Or that speaking up with concerns will taint a soldier’s reputation and standing within the Army community.

I am also aware of a misconception that a diagnosis of PTSD will almost certainly result in discharge from Army.

Please be assured, PTSD does not necessarily mark the end of your Army career. Once the illness is diagnosed, treated and managed, your career can pick up where it left off prior to diagnosis.

Within the framework of the Adaptive Army, termination of service on medical grounds is always the very last option. We are striving to make every effort to retain our soldiers; whether they are suffering from PTSD or recovering from serious physical injuries. We will exhaust all avenues of rehabilitation before discharge is a consideration.

You have only to ask the Commander of our Career Management Agency to have confirmed that I take a very active interest in this issue, and that I have directly intervened on a number of occasions when I’ve believed that all options other than discharge have not been explored before discharge options have been enacted.

I believe we are making real in-roads into PTSD and other mental health conditions. We can see from our recent history, and the initiatives I have discussed that we are making a difference.

Data from the Department of Veterans’ Affairs demonstrates a reduction in mental health claims across the ADF. Claims have decreased from 3.9% in East Timor in 1999, to a rate of 1.3% for personnel deployed to the Middle East Area of Operations since 2003. The ongoing challenge with the greater combat exposure seen in the last 3 to 4 years, will be bettering these relatively low incidences.

Our challenge, moving forward, is to keep PTSD awareness at a high level, remaining ever vigilant and proactive, and to keep the momentum of strategies, treatment and recovery ongoing.

We need to look after our mates – be aware of the markers of PTSD, and speak up when we see them.

Importantly, as individuals, we need to be cognisant of these symptoms in ourselves, and to accept the individual responsibility to take action, to seek help, and seek it early.

We need to draw on Army’s mental health support framework; and go to our padres, our psychs, our doctors, our mates and our Chain of Command for assistance.

We need to remain aware that PTSD is not a life sentence, nor is it a career stopper. There are options, and there are solutions available within Army for treatment and a meaningful recovery.

Ladies and Gentlemen,

I commend the DVD “Dents in the Soul” to you,

I am delighted to officially open the Cassowary Soldier and Family Support Precinct, and

I look forward to meeting as many of you as possible this afternoon.


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