GOVERNMENT RESPONSE TO AUSTRALIAN GULF WAR VETERANS’ HEALTH STUDY 2003
AND
REPORT ON PROGRESS IN IMPLEMENTING THE STUDY’S RECOMMENDATIONS
Introduction
The Australian Gulf War Veterans’ Health Study Report was released to the public in March 2003. The Hon Danna Vale MP, as both Minister for Veterans’ Affairs and Minister Assisting the Minister for Defence, accepted all the study’s findings. While noting that a comprehensive range of treatment and support programs was already available to Gulf War veterans, the Minister asked the Repatriation Medical Authority to consider the report. In accepting the recommendations of the Report, the Minister also committed the Departments of Defence and Veterans’ Affairs to take action as required.
The following information is provided about the most significant achievements to date in response to the Study. A number of other initiatives to address ADF mental health issues, implemented during the same period, have been included. It should be noted, however, that not all actions of a process nature, that support and supplement these achievements, have been included.
- Introduction
- Report Recommendations and Action Taken:
Report recommendations and action taken
Recommendation 1.
There should be wide promotion of the study findings to the veteran and service communities, the Departments of Defence and Veterans’ Affairs, the Repatriation Commission, ADF Medical Officers, the broader Australian community and the scientific community.
Minister Vale issued a media release about the Study on 25 March 2003 when the report was posted on the Department of Veterans’ Affairs main website. Information sessions on the research have been presented in the larger Australian States, especially to offices of the VVCS - Veterans and Veterans Families Counselling Service (VVCS).
The researchers who conducted the Study have submitted papers for publication in peer-reviewed journals and continue to write up their findings. They have presented papers at scientific conferences, including the 13th World Congress on Disaster and Emergency Medicine in Melbourne, and the annual conferences of the Australian Military Medicine Association in Adelaide and the International Society for Traumatic Stress Studies in Chicago.
The outcomes of the Study relevant to deployments and mental health and also generally have been drawn to the attention of ADF Medical Officers through the Defence Health Service’s Health Bulletins and other services.
Recommendation 2.
Consideration should be given to measures to reduce adverse psychological impacts of military service or deployment related activities on Defence Force personnel, especially in relation to better psychological preparation for the possibility of chemical or biological weapons attack.
Defence has established a Memorandum of Understanding with the Australian Centre for Posttraumatic Mental Health (ACPMH) under which they work together in the development of world-class strategies for minimising and treating PTSD.
At the present time, personnel proceeding overseas on operations are provided with pre-deployment briefings. The content of these briefings includes (but is not restricted to) the following:
- Cultural aspects of, and issues related to, the area they are about to enter;
- Issues related to the Rules of Engagement;
- Deployment phases and the differing issues that can arise at the varying stages of the deployment, and how to respond to those issues;
- Hostage negotiation;
- How to deal with refugees and other displaced persons
- How to deal with handling human remains; and
- Stress reactions and adaptation problems.
Advice and information on nuclear, biological and chemical warfare are now also an integral part of pre-deployment briefings provided by the ADF.
Debriefings are also provided two to three weeks before returning to Australia, or within 48 hours of return to Australia. Army personnel participate in a mandatory Return to Australia Psychological Screen with a three-month follow-up. The Screen process involves both a group education process and a one-on-one psychological screen with an appropriately trained mental health professional.
Personnel also have access to a 24 hours, 7 days a week confidential triage support telephone line which aims to provide personnel and their families with support as needed. The All-hours Support Line (ASL) was launched on 20 October 2003 for a 12-month trial and calls can be made from within and outside of Australia.
There is a far greater understanding and acceptance within the ADF that conflict results in adverse psychological outcomes and that deliberate effort is required to prevent and minimise this. In August 2003, ADF Health Bulletins were issued detailing the ADF policy for mental health support to operationally deployed forces and for the management of personnel involved in 'critical incidents’ or ‘potentially traumatising events’.
Regional Mental Health Teams (RMHT) were formed in 2003 to facilitate the delivery and integration of mental health services for ADF personnel. Whilst delivery of such services is primarily provided through the chain of command, RMHT provide commanders with additional tools to assist in the effective management of personnel.
The Defence Health Service held the ADF National Mental Health Conference in May 2004 to inform Defence and key stakeholders about developments and changes in two important areas of mental health practice. The conference theme was Alcohol, Drug and Suicide Prevention Management in the ADF – The Way Forward. It gave commanders and mental health providers an opportunity to hear international speakers discuss current research and practice as well as to learn about the programs that are being established to enhance current policy and services in the ADF.
The Department of Veterans’ Affairs has established programs that are available to Gulf War veterans. These include private psychiatric and allied health services, intensive treatment programs for PTSD and a range of individual and group services provided through the VVCS. These services are promoted among veterans of the Gulf War and other deployments using techniques that assist in increasing ADF members’ association with the issues and challenges addressed by the programs.
Defence fact sheets for serving personnel provide contact details for mental health services. The sheets cover topics such as:
- separation issues whilst deployed;
- return to Australia post deployment (“Coming Home”); and
- PTSD, anxiety and depression.
The service providers include VVCS, Lifeline, the Family Information Network for Defence, the Defence Community Organisation and the Psychology Support Sections of the ADF.
Recommendation 3.
Consideration should be given to developing a minimum health dataset collected routinely in a standardised manner on all individuals before active deployments.
The Health Service Branch of the ADF, Monash University, Veterans’ Affairs and other interested parties met in June 2003 to discuss strategies for establishing base line health and exposure data for future deployments.
The ADF is taking the lead on the resulting work, following agreement by the Defence Health Standing Committee to the establishment of an overarching database for health monitoring and health study purposes. The database will accommodate analyses on both an individual and multiple deployment basis. A Request for Tender to analyse what data needed to be contained within the database was sent out on 25 November 2003 and consultants were engaged in December 2003 to identify datasets suitable for collection both pre- and post deployment.
This exercise is progressing well with the assistance, as required, of Veterans’ Affairs and the Centre for Military and Veterans’ Health (CMVH). However, it is important to note that this is a long-term exercise that may take some time to accumulate sufficient data to provide meaningful results.
Recommendation 4.
Consideration should be given to developing procedures for more accurately documenting exposures during active deployments.
The Defence Force Personnel Executive continues to examine ways and means to better document exposures that occur during deployments.
It is intended to include exposure-related information in the database that is being developed for health monitoring and health studies (see Recommendation 3). “Exposures” will include operational, occupational and environmental.
Documentation of exposures is a requirement of the new Occupational Health and Safety (OHS) Management Framework in Defence that is being implemented under the guidance of the new Defence OHS Committee (operating as a sub-committee of the Defence Committee). In March 2004, the Defence Committee endorsed a new Strategic OHS Plan and a new Defence OHS Branch has been established to undertake the work.
The Plan includes the development and implementation of a Defence OHS Management System (OHSMS) that will assist Defence decision-makers in reducing the physical and psychological impact of illness and injury on ADF personnel particularly but also all members of Defence.
Formal discussions are also underway between the ADF and the United States authorities to explore opportunities for the sharing of health surveillance information.
Recommendation 5.
Consideration should be given to the further development, including validation, of the Military Service Experience (MSE) questionnaire for use in practice to assess the effect of deployments and in future studies.
The Traumatic Stress Exposures Scale (TSES) has been used for some time now in the ADF. It serves a very similar purpose to the MSE and is Defence’s preferred instrument of choice for measuring exposures to stressors. However, this policy will be reviewed in the light of any further development of the MSE (see Recommendation 6).
Recommendation 6.
Consideration should be given to undertaking further analyses of the dataset and/or collecting further data to address other questions raised about the impact of Gulf War service, or other aspects of military service, on health.
The Repatriation Commission has recently agreed to provide funding under its research grants program to a team comprised of departmental experts and Monash University. Their work, to be undertaken in the next 12 months or so, will include:
- identification of the characteristics of the first psychological disorder(s) to appear after return from deployment, an assessment of whether there is a period of greatest risk of developing psychological disorders after deployment, and the sequential development of multiple disorders;
- identification and analysis of any differences in the characteristics of those who deployed to the Gulf in 1990-91 and were still in the ADF at the time the Australian Gulf War Veterans’ Health Study 2003 was undertaken, and those who deployed to the Gulf but had left the ADF when the Study was done;
- identification and analysis of any interrelationships between physical and psychological health; and
- further development of the Military Service Experience (MSE) questionnaire.
In addition to this research, the veterans administrations of Australia, New Zealand, the USA, Canada and the United Kingdom have been discussing the feasibility of co-operative research efforts. The international Gulf War deployments are a significant feature of these discussions.
Recommendation 7.
Consideration should be given to undertaking follow-up studies, especially in relation to the cohort mortality and cancer study, but also in relation to some of the health outcomes found in excess in Gulf War veterans, such as posttraumatic stress disorder.
When sufficient time has elapsed for meaningful data to have accumulated, which will probably be at least seven to ten years from now, it would be appropriate to repeat the cancer incidence and mortality study.
The Repatriation Medical Authority (RMA) reviewed the Study report and advised in August 2003 that it would not make a Statement of Principles (SoPs) for Gulf War Syndrome as it was not a disease or injury within the meaning of section 5D of the Veterans’ Entitlements Act 1986.
Recommendation 8.
A Board of Trustees should be appointed by the Repatriation Commission for the purpose of governing future access to the serum held in long-term storage.
Informal discussions have been held with certain ex-service organisations about appropriate representatives to serve on the Board. Formalising the establishment of the Board is yet to be finalised.