Understanding the veteran experience

1. Understand user needs

Understand user needs. Research to develop a deep knowledge of the users and their context for the service.

2. Have a multi-disciplinary team

Establish a sustainable multi-disciplinary team to design, build, operate and iterate the service, led by an experienced product manager with decision-making responsibility.

For many veterans, military service and operational deployment lead to a strong sense of identity and belonging. For clinicians working with veterans, demonstrating an understanding of the military experience can greatly enhance the therapeutic alliance and the delivery of effective treatment. Veterans are more likely to engage with health care practitioners whom they feel understand, or seek to understand their mental health problems within the context of their military service. This chapter provides a demographic overview of Australia’s veteran population, common mental health problems within the veteran community, and a summary of the military experience.

Australian veterans

Since federation, approximately 1.4 million Australian men and women have served with Australian military forces in wars and peacekeeping operations. Amongst those alive today, the majority are males aged 60 years and over. World War II veterans are the largest group (around 77,400), followed by Vietnam veterans (around 47,000) and approximately 14,700 veterans of the Korean War, Malayan Emergency, Indonesian Confrontation and other operations in Southeast Asia. The 1990s saw the Australian Defence Force (ADF) engaged in a new wave of overseas deployments, with approximately 1200 personnel serving in the First Gulf War and an estimated 5000 engaged in peacekeeping operations in places such as Cambodia, Somalia and Rwanda. Since 1999, it is estimated that a further 45,000 ADF personnel have served in peacekeeping operations and in areas of conflict, including East Timor, Afghanistan and Iraq (Department of Veterans’ Affairs, 2011).

Practitioners may see veterans or ex-service personnel, either men or women, ranging in age from as young as 18 to over 80, with increasing numbers of women joining the veteran ranks. As the composition of the veteran population changes, so too have their mental health needs. At one end of the spectrum are the World War II, Korean and Vietnam veterans, for whom issues of ageing and chronic disease can be an important consideration. At the other end are currently serving and recently discharged ADF personnel who have engaged in a range of warlike, peacekeeping and peacemaking deployments, as well as disaster response operations. These younger, or ‘contemporary’ veterans are more likely to have experienced multiple, high tempo deployments. Apart from deployment cycles, frequent relocations within Australia can result in a sense of dislocation for the veteran and their family, and combined with the often remote locations of ADF bases, this can limit consistent access to medical and mental health services. Currently serving veterans may also be concerned about career progression and limited opportunities for re-deployment when mental health issues are identified.

Recent conflicts and peacekeeping missions arguably involve fundamentally different types of conflict to previous engagements. For example, deployment to the Middle East may involve the ongoing threat of insurgent combatants, urban conflict amongst non-combatants, and increased prevalence of Improvised Explosive Devices. Many veterans describe the extraordinary demands of constantly facing the threat of death or serious injury. Additionally, complex rules of engagement and lines of command within multinational forces can increase the level of stress on Defence members on deployment, particularly in peacekeeping and peacemaking operations.

Veterans’ common mental health problems

The common mental health problems of veterans fall into five broad and overlapping clusters.

Common mental health problems amongst veterans

  • Depression problems:  major depressive disorder, dysthymia and complicated grief
  • Anxiety problems:  generalised anxiety disorder, panic disorder, agoraphobia and social anxiety
  • Substance use problems: problem drinking, alcohol dependence, medication misuse, and illicit drug use
  • Trauma and stressor-related disorders: posttraumatic stress disorder (PTSD)
  • Somatic problems: medically unexplained symptoms, e.g., psychogenic pain

While many of these presenting problems may be sufficiently significant to meet full diagnostic criteria, a large number of veterans are likely to present with partial syndromes of a disorder.

Comorbid mental health problems are common, particularly posttraumatic mental health problems, where substance use problems are present. For some veterans, many years may have elapsed between the time when mental health symptoms first appeared and when they were recognised and treated. This may have led to additional difficulties, as their relationships, their ability to participate in work and social activities, and their health may have been affected over long periods of time.

Many veterans present with more generic yet significant complaints such as sleep disturbance, problematic anger, vocational, parenting or relationship problems. Where practitioners identify such problems, they should investigate potential underlying mental health issues.