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Outcome 2: Health

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Maintain and enhance the physical wellbeing and quality of life of eligible persons and their dependants through heath and other care services that promote early intervention, prevention and treatment, including advice and information about health service entitlements.

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DVA works with public and private providers to ensure that clients have access to high-quality health and other care services, with an emphasis on early intervention, prevention and treatment. DVA's approach is informed by targeted research on the health and wellbeing of members and their families.

In 2016–17:

  • 53,038 veterans were living with a mental health condition.
  • $5.3 billion was spent on health services, including $1.4 billion on hospital services and around $0.2 billion on mental health support.
  • 193,968 DVA Health Cards were current including 135,263 Gold Cards and 58,705 White Cards.
  • 25,621 Veterans and Veterans Families Counselling Service (VVCS) counselling sessions were conducted.

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Mental health

DVA spends approximately $191 million a year on a range of services and treatments to provide mental health support. This includes online information and support tools; GP services; psychology and social work services, including the Veterans and Veterans Families Counselling Service (VVCS); psychiatric services; pharmaceuticals; and hospital services, including trauma recovery programs for posttraumatic stress disorder (PTSD). Funding for mental health treatment is demand driven and not capped.


Table 16 shows the numbers of veterans living with accepted mental health conditions, under service-related compensation arrangements (by different cohorts) and under non-liability arrangements. The table also shows how the numbers in each group changed over the five years from 2012 to 2017.

Table 16—Veterans with accepted mental health conditions, June 2012 and June 2017
Category June 2012 June 2017 Change (%)
Service-related disabilities
Pre-Vietnam conflicts1 13,166 6,119 -53.5
Vietnam War2 26,352 25,075 -4.8
1972–99 conflicts3 1,105 1,480 33.9
Post-1999 conflicts4 1,794 4,614 157.2
Peacetime service only5 6,331 9,672 52.8
Total service-related disabilities 47,139 45,068 -4.4
Non-liability conditions6 13,436 22,762 69.4
Net total veterans 50,056 53,038 6.0
  1. Includes Second World War veterans and mariners, Korea, Malaya, Far East Strategic Reserve and all peacekeeping operations prior to 1975.
  2. May include some Special Overseas Service veterans who did not serve in Vietnam.
  3. Includes Cambodia, the Gulf War, Iran/Iraq, Namibia, Rwanda, Somalia, Zimbabwe and other operations between 1975 and 1999.
  4. Includes East Timor, Afghanistan, Iraq, Solomon Islands and all other operations since 1999.
  5. Veterans with service-related disabilities that have not been attributed to operational service.
  6. Veterans with disabilities not attributed to service.

Note: 'Veterans' includes anyone with service in the Australian Defence Force. Some veterans have both service-related disabilities and non-liability conditions. 'Net total veterans' includes veterans in both categories. Veterans with disabilities attributed to multiple conflicts across groups (e.g. Korea and Vietnam) have been counted in each relevant group. Similarly, veterans with more than one mental health condition are counted under each relevant condition.

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The net total number of members and former members of the ADF with mental health disabilities increased over the five years, from 50,056 to 53,038.

While the Vietnam War cohort continues to have the highest number of mental health disabilities, there have been large increases among those who served in post-1999 conflicts and those who have peacetime service only. DVA expects that this type of growth will continue over the next five years.

The increase in the number of people covered by non-liability mental health arrangements, from 13,436 to 22,762, is mainly due to the expansions of eligibility that occurred in 2014 and from 1 July 2016.

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In 2016–17, DVA pursued a number of initiatives to facilitate early access to mental health treatment to offer the best chance for recovery, to support families who may be affected by mental health issues arising from military service, and to increase the capability of mental health providers to deliver quality evidence-based care to their veteran patients. DVA has continued to focus on gathering evidence to inform policy and programs, including commissioning or partnering on research into transition, homelessness, suicide and new treatment.

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Review of suicide prevention services

In 2016, the Prime Minister commissioned the National Mental Health Commission (NMHC) to review the suicide prevention services provided to current and ex-serving ADF members and their families. The review focused on the type and efficacy of the self-harm and suicide prevention services that are available, and looked at prevalence rates and potential barriers to accessing services.

The NMHC found that suicide prevention is a complex issue that requires a multifaceted service response to ensure that current and ex-serving members have access to the support they need, at the right time.

The Government considered the NMHC report and released its response on 30 June 2017. The Government's response outlines work already underway within DVA, Defence and the Department of Health, and sets out the Government's commitment to continue to improve the support available to current and ex-serving ADF members and their families.

In the response, the Government committed to continued action in four key areas to ensure that efforts are effective in preventing suicide among Australia's current and former serving personnel and their families. These areas are:

  • improving suicide prevention and mental health support for current serving ADF members, veterans and their families
  • improving the transition process for ADF members moving from military life into post-service civilian life and providing targeted support to families
  • improving family support through engagement of families and family-sensitive practice
  • transforming DVA systems, processes and organisational culture to better respond to the needs of Australia's veterans and their families.

The NMHC review and government response are available on the DVA website (

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Non-liability health care

As outlined in Outcome 1, in addition to making compensation arrangements for service-related conditions, DVA can pay for mental health treatment whatever the cause. From July 2016, eligibility for these arrangements was extended to all current and ex-serving members of the ADF with at least one day of full-time service. From July 2017, this non-liability health care will extend to treatment for any diagnosed mental health condition, and will include access to VVCS for the member and their family.

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Community mental health counselling

The VVCS has been the cornerstone of the Australian Government's veteran mental health support response for 35 years. A nationally accredited mental health service, VVCS provides free and confidential counselling and mental health support to current and former ADF members who have served at least one day. Recognising that military trauma rarely impacts on an individual in isolation, VVCS is also accessible to the families of ADF members.

VVCS client numbers continued to increase in 2016–17, following expansions to client eligibility as a result of a number of election commitments and budget announcements. Services have an increasing focus on coordinated care for at-risk clients, especially those at risk of suicide. In Townsville, VVCS is trialling a community coordination team, comprising a skilled VVCS clinician and former serving ADF members with experience of mental illness, which will work collaboratively within the community to enhance the clinical service experience of clients with complex needs.

VVCS continued to harness enabling technologies to improve the client experience, including an upgrade to its secure online client information system, and the design of a trial of a new e-health platform designed to help clients and their families more effectively manage their mental health.

A full report of VVCS performance is provided in Program 2.5.

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Kookaburra Kids

To provide assistance to family members, DVA has provided funding for a pilot program run by the Australian Kookaburra Kids Foundation for children of current and former serving ADF members who have been affected by mental illness. This pilot was launched in March 2017 and delivers recreational and educational camps and activities with a focus on mental health education and developing coping skills and resilience. Evaluation of the pilot will start in 2018.

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Mefloquine outreach

In 2016–17, Defence and DVA provided significant information, support and resources to address veteran and community concerns relating to use of the antimalarial drug mefloquine in the ADF.

Mefloquine is approved by the Therapeutic Goods Administration and is widely available for travellers in the broader community. It is only prescribed in the ADF as a 'third line agent', when other antimalarial medications are unsuitable.

DVA conducted an outreach program targeting serving and ex-serving members and their families in Townsville in December 2016.

There are dedicated points of contact within DVA and Defence to assist anyone with concerns about the use of mefloquine in the ADF.

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Support for alcohol and other drug use disorders

To facilitate easier referral to clinically appropriate treatment for alcohol and other drug use disorders, in 2016 DVA established a panel of community-based providers to broaden the range of treatment services available to DVA clients. The panel comprises providers that have demonstrated that they have met quality standards. It offers varying degrees of support, including early intervention and an evidence-based, staged approach that ranges from counselling and group day programs to case management and follow-up after-care, allowing support to be tailored to an individual's needs.

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Centenary of Anzac Centre

In 2016–17, DVA progressed arrangements to fund Phoenix Australia—Centre for Posttraumatic Mental Health to establish the Centenary of Anzac Centre, to work collaboratively in support of practitioners and ESOs who work closely with veterans with mental health concerns.

The practitioner support service will provide expert advice, consultation and supervision through a network of national specialists to guide practitioners who are supporting veterans with complex mental health problems. The treatment research centre will be Australia's leading centre for research in veteran and military mental health. It will undertake pioneering research into PTSD and other complex mental health problems, and test innovative treatment and early intervention models.

The centre is expected to commence operations in 2017–18.

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Prime Ministerial Advisory Council on Veterans' Mental Health

The Prime Ministerial Advisory Council on Veterans' Mental Health, established in March 2014, continued its work in 2016–17. The council advises the Prime Minister, the Minister for Veterans' Affairs and the Government on high-level strategic and complex matters relating to the mental health of veterans and their families. In 2016–17, the council focused on the following priorities:

  • transition, including consultation with various professionals in the private sector, Government and DVA to inform the Council's views on how to better assist ADF members at all stages of transition
  • vocational rehabilitation, including support for the Prime Minister's Veterans' Employment Program (launched in November 2016) and the direct linkages between employment opportunities for veterans and an effective transition by them into civilian life
  • increasing community recognition and support for members of the ADF and their families affected by mental health issues.

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In 2016–17, DVA continued to invest strategically in research to inform and improve the effectiveness of the healthcare and related services available to DVA clients.

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In 2016–17, DVA worked with the Australian Institute of Health and Welfare (AIHW) and Defence on a study to improve the understanding of the incidence of suicide in the serving and ex-serving ADF community, and to investigate whether there is a difference in suicide mortality compared with the general Australian population.

This research is the most statistically robust data ever compiled on the incidence of suicide among current and former members of the ADF. It used data from the ADF Personnel Management Key System, which contains information on all people who serve or have served in the ADF, from 1 January 2001, and the National Death Index, which contains certified suicide deaths.

Preliminary results from this study were released in November 2016. On 30 June 2017, the Government released updated findings and a summary of the analysis to date on service-related characteristics, such as length of service, time since service, operational service, reason for discharge, and rank at discharge.

The updated findings released in June 2017 reaffirmed preliminary results from November 2016, and indicated that protective factors put in place by Defence are working to reduce the risk of suicide among current serving ADF members, but ex-serving members appear to be more vulnerable to risk factors.

The AIHW's detailed analysis showed that ex-serving men are at greater risk of suicide when compared to their peers if they share one or more of the following service-related characteristics:

  • aged 18–29 years
  • discharged involuntarily (particularly if discharged for medical reasons)
  • left the ADF with less than one year of service
  • held a rank other than commissioned officer at discharge.

These findings provide the Government with a strong evidence base to target efforts to those most at risk. For example, it is clear from these results that support as serving members transition out of the ADF is vital, and that the level of support not only needs to adapt to the complexity of the individual but also needs to target at-risk populations. These results are being used to inform the design and development of improvements to the transition process.

DVA, Defence and the AIHW will work together to periodically update the study. This ongoing data collection will continue to improve the Government's understanding of suicide and help to better target efforts to those most at risk. The report is available on the AIHW website.

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Transition and Wellbeing Research Programme

DVA and Defence have invested in the Transition and Wellbeing Research Programme, launched in June 2014, to examine the impact of military service on the mental, physical and social health of serving and ex-serving ADF members who have deployed to contemporary conflicts. The research is also investigating the impact of military service on the health and wellbeing of families. The program comprises three major studies: the Mental Health and Wellbeing Transition Study, the Impact of Combat Study, and the Family Wellbeing Study.

In 2016–17, data collection for the program was completed, and analysis and preparation of the report commenced. The program expects to deliver eight reports progressively from late 2017.

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In 2015–16, DVA commissioned the Australian Housing and Urban Research Institute to conduct research that will lead to a clearer understanding of homelessness among Australian veterans and better inform whole-of-government policy and programs. The institute will develop estimates of the number of veterans accessing homelessness services and examine the experiences of homeless veterans and the factors that cause homelessness. The research will be completed during the first half of 2018.

The research will complement work undertaken by DVA and the AIHW to include veteran identifiers in the data collected about the use of specialist homelessness services in the Australian community. Data collection will commence on 1 July 2017.

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RESTORE research partnership

In 2016–17, DVA and VVCS continued to collaborate with Defence and the University of Melbourne on the Rapid Exposure Supporting Trauma Recovery (RESTORE) trial. The trial, which is being conducted by Phoenix Australia and funded by the National Health and Medical Research Council, is investigating whether an intensive delivery of prolonged exposure therapy, involving 10 sessions over a two-week period, will deliver outcomes which are comparable to the gold standard prolonged exposure treatment protocol.

The trial commenced in December 2015 and continued to recruit new participants, provide treatment and undertake assessments in 2016–17. The final report of the trial will be delivered in 2019.

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MRCA Rehabilitation Long-Term Study

The MRCA Rehabilitation Long-Term Study is a joint DVA–Defence project to examine the long-term effectiveness of rehabilitation offered under the MRCA.

In 2016–17, a consortium led by the Sax Institute developed the study design framework. DVA and Defence are now putting in place arrangements to begin the study.

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Government response to the Vietnam Veterans Family Study

The Vietnam Veterans Family Study was the most significant research program ever undertaken by the Australian Government into the health of the families of Australia's Vietnam veterans.

The government response to the Vietnam Veterans Family Study was released on 20 December 2016. Findings from the study have played a significant role in informing DVA's transformation agenda. The government response also addressed mental health measures, Defence–DVA collaboration and future research.

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Dental and allied health review

DVA has continued to review its arrangements for dental and allied health services, to ensure that they continue to support appropriate, high-quality and effective services for DVA clients. The review progressed over 2016–17 with further meetings of clinical working groups to develop options for broader consultation with the ex-service community and peak bodies representing healthcare providers.

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Strategic procurement

In 2016–17, DVA continued to improve the way it contracts with service providers, consistent with the direction in past years.

DVA built on the success of the simplified procurement model, first introduced in September 2015, by applying it to the procurement of day procedure centres. Around 250 centres deliver day hospital services to DVA clients across Australia. The simplified application process aims to encourage a high volume of applications, thus facilitating DVA clients' access to local providers.

DVA managed several major procurements in 2016–17 using the traditional request for tender approach, which is suited to a competitive environment. This included tenders for taxi, hire car and home care services. DVA used the request for expressions of interest procurement method to engage the home modification industry and seek innovative proposals that challenge traditional processing methods.

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Priorities for 2017–18

In the coming year, DVA will respond to the various reviews, inquiries and new evidence arising in 2016–17, including the AIHW's suicide data study and the results of the inquiry into suicide by veterans and ex-service personnel by the Senate Foreign Affairs, Defence and Trade References Committee, which is expected to report to government in August 2017. Priorities include:

  • implementing 2017–18 Budget measures, including:
    • expanding non-liability health care to include free treatment for any mental health condition
    • piloting new approaches to suicide prevention and support for veterans
    • expanding eligibility for VVCS
  • continuing to implement government election commitments, including the establishment of the Centenary of Anzac Centre and continuing homelessness research and mefloquine support
  • releasing reports under the Transition and Wellbeing Research Programme, and analysing their implications for policy and programs
  • continuing to strengthen and enhance the VVCS community mental health counselling service by:
    • harnessing enabling technologies with ongoing upgrades to VVCS's secure online client information system and a trial of e-health technology
    • continuing to build the evidence base for the most effective treatment of military trauma through a comprehensive research agenda
    • modernising the range of group programs to be more responsive to the needs of contemporary clients
  • providing treatment for any condition (Gold Card) to Australian participants in the British nuclear tests and Australian members of the British Commonwealth Occupation Force in Japan at the at the end of the second World War.

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