Australia — Chief of Army launches PTSD DVD “DENTS IN THE SOUL” in Townsville

Good after­noon, and wel­come to the launch of the new DVD, “Dents in the Soul”. This Men­tal Health ini­tia­tive is a col­lab­o­ra­tive effort between the Army and Joint Health Com­mand, and it is designed to raise aware­ness of; and to help de-stig­ma­tise Post Trau­mat­ic Stress Dis­or­der or PTSD. I’m delight­ed to be able to offi­cial­ly launch this DVD in con­junc­tion with the open­ing of the Cas­sowary Sol­dier and Fam­i­ly Sup­port precinct here at Lavarack Bar­racks. It is a fab­u­lous facil­i­ty and I con­grat­u­late all involved.

I hope you’ve been enjoy­ing the fam­i­ly time and the refresh­ments that have been put on here today. I’d like to par­tic­u­lar­ly acknowl­edge and thank the part­ners and chil­dren of our serv­ing men and women for attending. 

My thanks also go to Brigadier Smith, and the sol­diers of the 3rd Brigade for open­ing up their base, and putting on this spread, and the events of today. 

At this point could I also acknowl­edge Mr John Schu­mann, and his band – The Vagabond Crew for their enthu­si­as­tic sup­port of our project. John shares with us his per­son­al expe­ri­ence with PTSD in this new DVD and reminds us that this ill­ness can affect civil­ians as well as those of us in uni­form. Of course, it’s also fan­tas­tic to have the icon­ic song “I was Only 19” asso­ci­at­ed with Army’s newest men­tal health ini­tia­tive in this production. 

“Dents in the Soul” arose from Army’s desire to bet­ter sup­port our sol­diers and their fam­i­lies’ in under­stand­ing PTSD. It is time for a robust dis­cus­sion in Army and across Defence on how this ill­ness devel­ops, how it can be treat­ed, and the con­sid­er­able ben­e­fits of seek­ing help ear­ly to address the con­di­tion. I would like to start by acknowl­edg­ing the fam­i­lies of our of 3 Brigade sol­diers. You are an impor­tant part of Army’s fam­i­ly, and much of what we do and achieve is only pos­si­ble through your ongo­ing sup­port, your under­stand­ing and your patience. 

Life as part of the Army fam­i­ly can be a chal­lenge – we face pro­longed absences through deploy­ments and train­ing, along with the dis­rup­tions asso­ci­at­ed with the mobil­i­ty require­ments of our pro­fes­sion. We sim­ply could not meet these chal­lenges as an organ­i­sa­tion with­out the sup­port of our wives, hus­bands, part­ners and fam­i­lies. I feel it is par­tic­u­lar­ly impor­tant that you are here on this occa­sion. Army is work­ing hard to con­sol­i­date our direc­tion in the man­age­ment of PTSD, and I’m very pleased to be able to share some of this work with our sol­diers and fam­i­lies today. 

Time will pre­vent me from screen­ing the entire DVD at this point. It will of course, be avail­able for you to view lat­er today. In order to pro­vide some con­text to what I’m going to say, I’d like to, at this point, screen a trail­er of “Dents in the Soul”.

My key mes­sage is that me, my com­man­ders and your Army is work­ing hard to pro­vide more effec­tive resourc­ing and treat­ment solu­tions for our sol­diers suf­fer­ing from PTSD. We are work­ing towards rais­ing aware­ness of PTSD; not try­ing to deny the ill­ness which is indeed present in our ranks.

We are work­ing towards encour­ag­ing those at risk to seek help, and, impor­tant­ly, to seek help ear­ly. Crit­i­cal­ly, we are work­ing towards mak­ing our sol­diers aware, that a diag­no­sis of PTSD does not auto­mat­i­cal­ly mean the end of their Army career.

I believe our strat­e­gy is sound; and it takes into con­sid­er­a­tion and encour­ages active spouse and fam­i­ly engagement. 

PTSD has long been under recog­nised, under report­ed, mar­gin­alised and pigeon holed as “anoth­er” men­tal ill­ness. It is cer­tain­ly not a new issue, nor is it a psy­chi­atric fad. In fact, I would con­tend Post Trau­mat­ic Stress Dis­or­der has prob­a­bly been around as long as armies have gath­ered, and wars have been fought. 

Our expe­ri­ence with PTSD dates back to the Aus­tralian Army’s ini­tial involve­ment as an Infantry force on the world stage; where we’ve seen instances of per­son­al trau­ma devel­op around an individual’s com­bat and com­bat-relat­ed expe­ri­ence. In the past, we’ve iden­ti­fied this con­di­tion by a num­ber of names, some descrip­tive, some deroga­to­ry: Shell Shock, Shell Con­cus­sion, Com­bat Stress Reac­tion, Bat­tle Fatigue, War Neu­ro­sis, and most recent­ly, Post Trau­mat­ic Stress Disorder. 

What we today call PTSD, first gained main­stream recog­ni­tion in the after­math of World War One. Reports from the British Army at that time attrib­uted some 80,000 cas­es of shell shock to the hor­rors of trench war­fare[¹].

One of the dif­fi­cul­ties since; has been accu­rate­ly iden­ti­fy­ing the mark­ers of PTSD – those ini­tial signs and sig­nals that might first lead us to put our hand up and say “I need some help”. Or just as impor­tant­ly, for our fam­i­ly or mates to say “you need some help”. We’ve also strug­gled to pro­vide an appro­pri­ate frame­work for treat­ment and res­o­lu­tion of this ill­ness. I believe these short­falls could be due to the many mis­nomers that sur­round PTSD.

PTSD has made us ner­vous. In the past we’ve not been entire­ly sure on the best approach to address the signs and symp­toms of this con­di­tion. This has been large­ly due to the mys­tery and stig­ma that sur­rounds it as an illness. 

We would be bad­ly mis­tak­en to view those suf­fer­ing from PTSD as being some­what less robust, less mas­cu­line, less tough; less of a sol­dier than the rest of us.

PTSD is what I would describe as a “non-vis­i­ble injury” – an ill­ness that we can­not touch or feel. And accord­ing­ly, one that we tend to mar­gin­alise because of the absence of a mag­ic pill or vac­ci­na­tion or uni­ver­sal cure. How­ev­er, what I do know is; the symp­toms of PTSD are dif­fer­ent in each indi­vid­ual, and are often reflect­ed in var­ied reac­tions to psy­cho­log­i­cal stressors.

Defence cur­rent­ly has an active pro­gram for mon­i­tor­ing the men­tal health and psy­cho­log­i­cal out­comes of deploy­ment through a men­tal health screen­ing con­tin­u­um. Whilst not pro­vid­ing a diag­no­sis of PTSD, it does report the symp­toms, iden­ti­fy­ing those who might be at risk of devel­op­ing PTSD or oth­er men­tal health conditions. 

What we have learnt from this; is that at the 6 month mark post deploy­ment, just under 1 in 10 of total ADF per­son­nel deployed will exhib­it some form of psy­cho­log­i­cal dis­tress. Although the “at risk” group of ADF mem­bers runs at near­ly 10%, in Army, we have not always been accept­ing of a soldier’s com­bat injuries, unless they were the kind that bled. If we break an arm, it goes in a cast.

If we get shot, we get stitched up.

But if we are expe­ri­enc­ing PTSD, what does that actu­al­ly mean?

Where do we go for help? What treat­ment options are there?

How will PTSD affect our career in Army? 

Who do our part­ners turn to if they are see­ing the signs of PTSD in us?

What kind of men­tal “cast” exists in Army to fix it? 

In short, we know there is no sim­ple or straight­for­ward “cure”.

In work­ing out our approach to PTSD, we have had to stop and think about how to han­dle a prob­lem which appears to have many more ques­tions than answers. 

Our cur­rent jour­ney began in 2009, when Defence com­mis­sioned Pro­fes­sor David Dunt from the Uni­ver­si­ty of Mel­bourne to con­duct a major review of our men­tal health ser­vices. His find­ings indi­cat­ed an urgent need for the broad­er Defence organ­i­sa­tion to address the men­tal health issues of its personnel. 

Sub­se­quent­ly, almost $90 Mil­lion has been allo­cat­ed over four years to reform and enhance the Aus­tralian Defence Force Men­tal Health Strategy. 

A fea­ture of Army’s approach to tack­ling Men­tal Health Reform, and Crit­i­cal Inci­dent Men­tal Health Sup­port, has includ­ed ful­ly sup­port­ing the intro­duc­tion of region­al men­tal health net­works. We have also intro­duced, or refined where appro­pri­ate, a num­ber of men­tal health packages. 

We’re focussing on Force Preser­va­tion with a pro­gram called ‘Keep Your Mates Safe — Peer Sup­port’; where we cov­er a num­ber of top­ics includ­ing; sui­cide aware­ness and pre­ven­tion, dri­ver atti­tudes, alco­hol mis­use and a men­tal health ‘bud­dy system’.

We are mak­ing our Sol­diers Bat­tleS­MART through a pro­gram of Self Man­age­ment and Resilience Train­ing; giv­ing Sol­diers prac­ti­cal skills for respond­ing to stress­ful sit­u­a­tions. Start­ing at Kapooka, these skills are being devel­oped through­out a soldier’s career and rein­forced dur­ing pre deploy­ment train­ing. These skills will allow sol­diers to “bounce back” from adverse situations.

Here, at 3rd Brigade, this ini­tia­tive also extends to Oper­a­tion RESET, where a vari­ety of crit­i­cal top­ics are addressed in eas­ing the tran­si­tion from oper­a­tional life, to home life. These include men­tal resilience, finan­cial lit­er­a­cy and vet­er­an entitlements. 

Our broad­er men­tal health ini­tia­tives also tar­get men­tal health lit­er­a­cy, aware­ness and resilience; and devel­ops health pro­mo­tion mate­ri­als and up-skilling our men­tal health workforce. 

It is now recog­nised that it is com­mon for oth­er con­di­tions such as depres­sion and alco­hol abuse to co-exist with PTSD, mak­ing the man­age­ment of this ill­ness even more chal­leng­ing. In May this year, a nation­al men­tal health train­ing pro­gram was held for over 100 of the ADF’s men­tal health providers. In addi­tion to spe­cif­ic train­ing in PTSD ini­tia­tives, our health providers received fur­ther train­ing and devel­op­ment in the recog­ni­tion, assess­ment and treat­ment of sol­diers with PTSD com­pli­cat­ed by oth­er illnesses.

Anoth­er aspect in our push for men­tal health aware­ness in Army is today’s release of this DVD. 

In launch­ing this pro­duc­tion, we are tak­ing our focus on PTSD direct­ly to our sol­diers, ask­ing them to engage in dis­cus­sion, and become more aware of the symp­toms of PTSD. We want them to seek help and seek it ear­ly. We want them to feel assured that PTSD does not nec­es­sar­i­ly mean the end of their Army career.

My grat­i­tude and admi­ra­tion is sin­cere in pub­licly recog­nis­ing the con­tri­bu­tion of the sol­diers and offi­cers who fea­tured in this DVD. These men have coura­geous­ly stood up to share their sto­ries, and their respec­tive jour­neys with PTSD. And, of equal impor­tance, they have opened up the dia­logue with­in Army on the illness. 

I real­ly believe this DVD will play an impor­tant role in bring­ing PTSD into the spot­light. My hope is that, as this DVD is more wide­ly dis­sem­i­nat­ed through­out Army, it will begin to de-mys­ti­fy the stig­ma of PTSD with­in our organ­i­sa­tion, whilst also address­ing the mys­tery and sus­pi­cion that sur­rounds PTSD as the ‘invis­i­ble com­bat injury’. 

Army’s val­ues of courage, ini­tia­tive and team­work are built on the very real tenet of “look­ing after our mates”. We do this in train­ing, in bar­racks, and on oper­a­tions. Being a sol­dier is about the per­son next to you; it’s about the chain of com­mand, it’s about an indi­vid­ual soldier’s will­ing­ness to invest his or her safe­ty of life and limb in their mate — in the sol­dier stand­ing next to them.

These val­ues are also reflec­tive of the man­ner in which we recog­nise and man­age PTSD. To look after your mates, you need to look out for the signs.

Is he or she con­sum­ing more alco­hol than normal?

Does he or she seem angry, tired or restless?

Are you pick­ing up a sense that he or she might have prob­lems at home? With their spouse? With their children?

Do they appear to be reliv­ing their expe­ri­ences on operations?

Are they avoid­ing activ­i­ties, places, or people?

Spous­es too – can look for some of these signs, and more, that may only be evi­dent at home.

Is your part­ner hav­ing nightmares? 

Do they seem moody or withdrawn?

Expe­ri­ence tells us that the symp­toms of PTSD are most like­ly to present 4 to 6 weeks post deploy­ment. This is the time when the invis­i­ble injury becomes vis­i­ble, and pro­vides us with a win­dow of oppor­tu­ni­ty to address the symp­toms and approach the remedy. 

I would strong­ly encour­age you to con­front PTSD where you see these ear­ly signs, to call it out – and to seek help.

You must under­stand that help is avail­able with­in the Army. 

We have padres, psy­chol­o­gists and doc­tors – all of whom are trained to recog­nise the signs of PTSD, and all of whom can assist and guide — not judge, malign or dis­re­gard your con­cerns. Our Chain of Com­mand, too, has an impor­tant role in recog­nis­ing where prob­lems exist, and offer­ing assis­tance and guid­ance. This was a key theme I stressed at the recent Army Pre-Com­mand course and on the RSM’s course. 

Where a spouse of an Army mem­ber is tun­ing into these same con­cerns – I would like to reas­sure you that you will be lis­tened to. Assis­tance is also avail­able to you through our men­tal health sup­port sys­tem of psy­chi­a­trists, med­ical offi­cers, social work­ers, nurs­ing offi­cers, Chap­lains, the Defence Com­mu­ni­ty Organ­i­sa­tion, as well as the “All Hours Sup­port Line”, and the Vet­er­an and Vet­er­an Fam­i­ly Coun­selling Service.

Our Wound­ed Dig­ger forum also pro­vides an excel­lent avenue for exchange of infor­ma­tion between Army and its broad­er fam­i­ly. This site also presents a syn­op­sis of for­ward works, which I will con­tin­ue to advance and imple­ment dur­ing my time as the Chief.

Ear­ly recog­ni­tion and inter­ven­tion in PTSD is our first instance goal – seek help, and seek it early. 

Our men­tal health spe­cial­ists will estab­lish a diag­no­sis through inter­na­tion­al­ly accept­ed cri­te­ria, offer­ing evi­dence based treat­ments for PTSD like cog­ni­tive behav­iour ther­a­py. In some instances, med­ica­tion may be required, par­tic­u­lar­ly where depres­sion runs as a par­al­lel con­di­tion to PTSD. And I reit­er­ate, so too is fam­i­ly coun­selling avail­able where required.

I am absolute­ly com­mit­ted to the health, well­be­ing and wel­fare of all of our sol­diers and their fam­i­lies. My Army Com­man­ders and I take very seri­ous­ly our respon­si­bil­i­ty to ensure our peo­ple are pre­pared phys­i­cal­ly and men­tal­ly for the rig­ors of train­ing and ser­vice on operations.

Where our sol­diers are placed in harm’s way, our respon­si­bil­i­ty is to ensure, that upon their return, appro­pri­ate health care sys­tems are avail­able for their recov­ery, care and support. 

This is encap­su­lat­ed in our casu­al­ty man­age­ment frame­work. The frame­work seeks to meet ser­vice mem­ber and fam­i­ly expec­ta­tions, through the pro­vi­sion of time­ly and appro­pri­ate med­ical and psy­cho­log­i­cal care.

PTSD sits firm­ly with­in this framework.

My feel­ing about PTSD is that it is not a life sen­tence – it is sim­ply an ill­ness that requires treatment.

I am aware of an under­ly­ing feel­ing with­in Army, that report­ing PTSD or sus­pi­cion there­of, and/or out of char­ac­ter behav­iour, might some­how be detri­men­tal to a soldier’s career. Or that speak­ing up with con­cerns will taint a soldier’s rep­u­ta­tion and stand­ing with­in the Army community. 

I am also aware of a mis­con­cep­tion that a diag­no­sis of PTSD will almost cer­tain­ly result in dis­charge from Army.

Please be assured, PTSD does not nec­es­sar­i­ly mark the end of your Army career. Once the ill­ness is diag­nosed, treat­ed and man­aged, your career can pick up where it left off pri­or to diagnosis. 

With­in the frame­work of the Adap­tive Army, ter­mi­na­tion of ser­vice on med­ical grounds is always the very last option. We are striv­ing to make every effort to retain our sol­diers; whether they are suf­fer­ing from PTSD or recov­er­ing from seri­ous phys­i­cal injuries. We will exhaust all avenues of reha­bil­i­ta­tion before dis­charge is a consideration. 

You have only to ask the Com­man­der of our Career Man­age­ment Agency to have con­firmed that I take a very active inter­est in this issue, and that I have direct­ly inter­vened on a num­ber of occa­sions when I’ve believed that all options oth­er than dis­charge have not been explored before dis­charge options have been enacted.

I believe we are mak­ing real in-roads into PTSD and oth­er men­tal health con­di­tions. We can see from our recent his­to­ry, and the ini­tia­tives I have dis­cussed that we are mak­ing a difference. 

Data from the Depart­ment of Vet­er­ans’ Affairs demon­strates a reduc­tion in men­tal health claims across the ADF. Claims have decreased from 3.9% in East Tim­or in 1999, to a rate of 1.3% for per­son­nel deployed to the Mid­dle East Area of Oper­a­tions since 2003. The ongo­ing chal­lenge with the greater com­bat expo­sure seen in the last 3 to 4 years, will be bet­ter­ing these rel­a­tive­ly low incidences.

Our chal­lenge, mov­ing for­ward, is to keep PTSD aware­ness at a high lev­el, remain­ing ever vig­i­lant and proac­tive, and to keep the momen­tum of strate­gies, treat­ment and recov­ery ongoing.

We need to look after our mates – be aware of the mark­ers of PTSD, and speak up when we see them. 

Impor­tant­ly, as indi­vid­u­als, we need to be cog­nisant of these symp­toms in our­selves, and to accept the indi­vid­ual respon­si­bil­i­ty to take action, to seek help, and seek it ear­ly. We need to draw on Army’s men­tal health sup­port frame­work; and go to our padres, our psychs, our doc­tors, our mates and our Chain of Com­mand for assistance.

We need to remain aware that PTSD is not a life sen­tence, nor is it a career stop­per. There are options, and there are solu­tions avail­able with­in Army for treat­ment and a mean­ing­ful recovery.

Ladies and Gentlemen, 

I com­mend the DVD “Dents in the Soul” to you,
I am delight­ed to offi­cial­ly open the Cas­sowary Sol­dier and Fam­i­ly Sup­port Precinct, and I look for­ward to meet­ing as many of you as pos­si­ble this afternoon. 

________________________________________
[¹] Bourke, Joan­na 2010; Shell Shock Dur­ing World War One; ww.bbc.co.uk/history/worldwars/wwone

Press release
Min­is­te­r­i­al Sup­port and Pub­lic Affairs,
Depart­ment of Defence,
Can­ber­ra, Australia 

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