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.
“There is an obligation to
care for those who care for
the community.”
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.
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 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.
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.”
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.
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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.”
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