1. MENTAL HEALTH REFORM IN THE
AUSTRALIAN DEFENCE FORCE
Resilience and Recovery
JOINT HEALTH COMMAND
David Morton
2.
3. JOINT HEALTH COMMAND
Professor David Dunt – Public Health Physician
Report submitted 4 Feb 09, released to the public on 1
May 09
Report included 52 recommendations
49 recommendations were accepted unconditionally
three partially accepted
Government committed $83M over the next four years
Mental Health Reform
4. Mental health service delivery
Post traumatic mental health
Suicide prevention and depression
initiative
Resilience and prevention
Operational mental health
Alcohol, tobacco and other drugs
DMH clinical program
E-Health
Research
Facilities
Transition
Families
Rehabilitation
Enablers
Reform Goals
•Improving mental health
governance
•Improving mental health policy
•Enhancing the mental health
workforce
•Improving mental health training
•Prevention strategies
•Enhanced research and
surveillance
•Rehabilitation and return to work
programs
•Transition services
•Families
•Facilities
Vision: To optimise mental health and wellbeing in the
ADF
5. OBJECTIVES AREAS OF ACTION
STRONG FOUNDATION
ADF Members have a strong foundation to
deal with the challenges of military service
Selection and Training
Prevention
Command and Leadership
Families and social support
OPERATIONAL RISKS
Mitigate the risks of operational deployment
with a focus on prevention & early intervention
Research & Surveillance
Resilience Building
Education and awareness
Screening
Early Intervention
RECOVERY
Mental health care and rehabilitation system
that delivers evidence-based practice in a
multi-disciplinary environment
Workforce
Policy to Practice
Assessment and treatment
Rehabilitation
Transition
Facilities
RELATIONSHIP and PARTNERSHIPS
Cultivate partnerships that inform and support
contemporary practice / interventions
Member/family and provider
Member/ Command/ Health Provider
National Engagement
International Engagement
6. Area Health Service
MO, Allied Health, MH & Rehab
Regional MHT
Single Service
MH Assets
DCO
Inpatient
Facilities
Chaplaincy
MHP&R
(Policy Reform and Governance)
CMVH ACPMH
ADF CMH
Transition
Contracted Health
Providers
Command
Garrison Health Operations
(Service delivery)
Regional Health Director
7. Military Occupational Mental Health Model -
Strengthen Resilience and Enable Recovery
Unit-Focused Healthcare-Focused
• Selection
• Skills
• Knowledge
• Cohesion
• Leader
Behaviors
• Basic
Resilience
Training
Foundation
• Peer Programs
• Surveillance
• Targeted
Resilience Training
Occupational
Risk Individual
Reactions
• Psychological
Screening
• MH First-Aid
• Mental health
training
• Ceremonies
Early Intervention
• Assessment
• Treatment
• Family
Engagement
• Clinical and
Occupational
rehabilitation
• Psycho-
education
Treatment/
Recovery
Behaviors Emotions
Thoughts
Physical
Reactions
Shared
Responsibility
Context: Culture, Environment, Social Support, Families
Service
Member and Command
8. Menal Health Review Goals
Improving mental health governance.
Second generation of the Mental Health Strategy including
a robust evaluation system.
Improving mental health policy.
Breaking down stigma, by demonstrating that Defence’s
goal is to treat and rehabilitate wherever possible, and that
discharge on health grounds is the last resort.
Mental Health Reform Goals
9.
10. Mental Health Reform Goals
Enhancing the mental health workforce.
The first priority has been enhancing the mental health
workforce with Joint Health Command increasing the
dedicated mental health workforce by 50% across the
country over the next three years. This will significantly
increase the personnel to deliver both primary health care
but also develop mental health programs especially in the
areas of health promotion and prevention.
11. Enhanced Workforce
MHP&R
ADF Centre for Mental Health
Outpatient Residential Treatment
Tele-psychiatry, Training Health Professionals
Regional Mental Health Teams
Coordinate Local Networks, Outpatient Treatment Programs
Coordinate Critical Incident Support, Complex Case Management
Coordinate Prevention Strategies
Local Multi-disciplinary Teams
12. Prevention strategies.
A program has been developed and is being implemented
that will strengthen the psychological resilience of serving
personnel allowing them to cope more effectively with life,
deployment and military stressors. The ADF’s
“BattleSMART”, Self Management and Resilience Training
program has been developed to teach Commanders and
individuals, effective stress management and positive
coping strategies.
Mental Health Reform Goals
13. ADF Life Cycle Projects
• Government initiated to improve the
health and wellbeing of ADF members and
veterans
• Three key ADF Mental Health Projects
– Longitudinal Resilience Study
– Development of ADF Resilience Training
– Mental Health Screening
15. Menal Health Review Goals
Enhanced research and surveillance.
The pre, during and post deployment psychological support
currently offered by the ADF is currently being reviewed.
All personnel undergo psychological on return to Australia
and at three to six months. However, the ADF believe these
processes would be more effective with greater family
engagement and environments which reflect a positive
attitude to seeking mental health assistance.
Mental Health Reform Goals
20. Developed in
conjunction with the
Australian Centre for
Posttraumatic Mental
Health
Framework to mitigate
and alleviate possible
psychological injuries
following a critical
incident
Critical Incident MentalCritical Incident Mental
Health SupportHealth Support
21. Suicide PreventionSuicide Prevention
•• Annual Awareness ProgramAnnual Awareness Program
•• Peer TrainingPeer Training –– ASIST &ASIST &
Keep Your Mate Safe (KYMS)Keep Your Mate Safe (KYMS)
•• Provider Up skilling (Risk Assess)Provider Up skilling (Risk Assess)
•• Policy and doctrinePolicy and doctrine
•• All Hours Support Line (ASL)All Hours Support Line (ASL)
22. Alcohol Tobacco & otherAlcohol Tobacco & other
Drugs (Drugs (AToDSAToDS))
•• Annual Awareness ProgramsAnnual Awareness Programs
•• Peer TrainingPeer Training -- Keep Your Mate Safe (KYMS)Keep Your Mate Safe (KYMS)
•• Provider Up skillingProvider Up skilling
•• Policy and doctrinePolicy and doctrine
•• Treatment ProgramsTreatment Programs –– Outpatients treatmentOutpatients treatment
programs (OATP)programs (OATP)
23. Improving mental health training.
By increasing the mental health workforce the ADF will
now have the mechanism to ensure that a broad and
comprehensive mental health literacy program can be
delivered to serving personnel. Mental health literacy will
ensure that service personnel know when, where and how to
seek care. Furthermore, Defence is establishing an ADF
Centre of Mental Health which will become a centre of
excellence in the area of military mental health programs
and training of mental health professionals and providers.
Mental Health Reform Goals
24. Menal Health Review Goals
• Families.
A member’s family is often the first to see changes in the
serving member therefore Joint Health Command have
embarked on a major project to inform families on mental
health issues and to train health care providers in family
friendly practice.
•Facilities.
New and improved facilities to co-locate services.
Mental Health Reform Goals
25. • Rehabilitation and return to work programs.
Enhancing the ADF Rehabilitation Program through better
case management by medical officers and improving the
training of caseworkers.
• Transition services.
Ensuring the transition service arrangements adequately
provide seamless transition from military to civilian life for
individuals with mental health.
Mental Health Reform Goals
27. Biopsychosocial Model for Rehabilitation
MemberMember
PCMCommand
Psychosocial
RiskFactors
•Injury, pain, mobility
•Treatment & Rehabilitation
• Personal characteristics
•Job, work setting,
•Organisation & Industry
•Family & friends attitudes
•Expectations of others
Return to work outcome
28. ADF Paralympic Sports
Program
Assist ADF members to regain functional
independence, physical fitness & an active & healthy
lifestyle through adaptive sport
•Improve amputee care
•Advance personal fitness goals
•Coaching & mentoring
•Equity & empowerment
•Mateship & teamwork
JOINT HEALTH COMMAND
29. Transition
Transition support is provided to ADF members by
Transition Support Services.
Regional ADF Transition Centres assist all separating
ADF members to access information relevant to their
needs as well as with transition administration.
Transition Centres
These centres provide information on, and link
members into, Defence and government support
services, such as ADF Rehabilitation Program,
Defence Community Organisation, Department of
Veterans’ Affairs, ComSuper and Centrelink.
JOINT HEALTH COMMAND
30. Transition Initiatives
SIIP Review - a gap analysis to support evidence
based practice to delivering integrated and streamlined
welfare, treatment, rehabilitation and compensation
LifeSMART (an adaptation of BattleSMART) for ADF
members who are transitioning from Defence to civilian
life.
Stepping Out Program run by Veterans and Veterans
Families Counselling Service (VVCS) This program is
a free, 2-day program developed for ADF members
and their partners, who are about to, or have recently
separated from the military.
JOINT HEALTH COMMAND
31. Next Steps and Challenges
• ADF Mental Health Strategy and implementation plan
• Shape response to individual need and ADF capability
• Model of service delivery- Operations to Garrison continuum
• Building integrated and multidisciplinary teams
–Broaden beyond psychologists and GP’s
–Confidentiality, Record keeping & Sharing
–Mental health awareness and training
–Co-location of services and resources
–Moving to internal rehab provider model
• Stigma – Language, relevance, recovery focus
• Impact of multiple deployments
• Emerging PTS, Alcohol, depression, sleep, anger, relationships
• Engaging in family sensitive and inclusive practice
JOINT HEALTH COMMAND
