MENTAL HEALTH REFORM IN THE AUSTRALIAN DEFENCE FORCE

Resilience and Recovery

JOINT HEALTH COMMAND

David Morton

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

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

OBJECTIVES AREAS OF ACTION

STRONG FOUNDATIONADF Members have a strong foundation to deal with the challenges of military service

Selection and TrainingPreventionCommand and LeadershipFamilies and social support

OPERATIONAL RISKSMitigate the risks of operational deployment with a focus on prevention & early intervention

Research & SurveillanceResilience BuildingEducation and awarenessScreeningEarly Intervention

RECOVERYMental health care and rehabilitation system that delivers evidence-based practice in a multi-disciplinary environment

WorkforcePolicy to PracticeAssessment and treatment RehabilitationTransitionFacilities

RELATIONSHIP and PARTNERSHIPS Cultivate partnerships that inform and support contemporary practice / interventions

Member/family and providerMember/ Command/ Health ProviderNational EngagementInternational Engagement

Area Health ServiceMO, Allied Health, MH & Rehab

Regional MHT

Single ServiceMH Assets

DCOInpatientFacilities Chaplaincy

MHP&R(Policy Reform and Governance)

CMVH ACPMH

ADF CMH

Transition

Contracted HealthProviders

Command

Garrison Health Operations(Service delivery)

Regional Health Director

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

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

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.

Enhanced WorkforceMHP&R

ADF Centre for Mental HealthOutpatient Residential Treatment

Tele-psychiatry, Training Health Professionals

Regional Mental Health TeamsCoordinate Local Networks, Outpatient Treatment Programs

Coordinate Critical Incident Support, Complex Case ManagementCoordinate Prevention Strategies

Local Multi-disciplinary Teams

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

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

BattleSMART Self Regulation and Resilience Training

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

Research & SurveillanceResearch & Surveillance

RESILIENCERESILIENCE

ADF Resilience Study

• Prospective Longitudinal Study

• Being conducted in collaboration with ACPMH

• Help us unpackage resilience

Project LASER

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 Mental Critical Incident Mental Health SupportHealth Support

Suicide PreventionSuicide Prevention•• Annual Awareness ProgramAnnual Awareness Program•• Peer Training Peer 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)

Alcohol Tobacco & other Alcohol Tobacco & other Drugs (Drugs (AToDSAToDS) )

•• Annual Awareness ProgramsAnnual Awareness Programs•• Peer Training Peer Training -- Keep Your Mate Safe (KYMS)Keep Your Mate Safe (KYMS)•• Provider Up skilling Provider Up skilling •• Policy and doctrinePolicy and doctrine•• Treatment Programs Treatment Programs –– Outpatients treatment Outpatients treatment

programs (OATP)programs (OATP)

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

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

• 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

ADF Rehabilitation Program

Purpose:Reduce the impact of injury or illness on the ADF

JOINT HEALTH COMMAND

Biopsychosocial Model for Rehabilitation

MemberMember PCMCommand

Psychosocial

Risk Factors

•Injury, pain, mobility •Treatment & Rehabilitation • Personal characteristics•Job, work setting, •Organisation & Industry•Family & friends attitudes•Expectations of others

Return to work outcome

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

TransitionTransition 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

Transition InitiativesSIIP 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

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

Questions?

Contact details:

David.Morton3@defence.gov.au

(02) 6266 3897

JOINT HEALTH COMMAND

JOINT HEALTH COMMAND