From Service to Sanctuary: Cultivating Wellbeing for Veterans in Transition

*Trigger Warning: This article discusses veteran suicide statistics - reader discretion advised

Something that has been on the radar of the Australian Veteran community for the last four decades at least, and that seems to be reflected within the veteran communities of other ‘Western’ Nations, is the known but, until recently, unrecognised issue of suicide among this community. Having dealt with my own mental health journey since leaving the Australian Army, and having either been directly, or one-part removed from, numerous veteran suicides or attempts, this matter strikes close to home for me. Only this year I attended the funeral of an American Serviceman who, after 20 years’ service with the USAF, transitioned and, like me, immediately moved to Singapore, losing his connection and community, identity and purpose. The result was a spiral of self-medication with alcohol, culminating in his completed suicide (this is one of three immediate or one-part removed veteran suicides that I have encountered this year alone).

The same week that we farewelled our mate, Dr Dan Pronk, a former deployed Medical Officer of the Australian Special Air Service Regiment and now a Veteran’s Mental Health commentator and advocate, released his article ‘Transition is probably going to suck!’ In this article, he quite eloquently points out that there are three primary, interrelated domains that, when one experiences losses among them, increases the psychological adjustment burden of the transitioning veteran. They are:

· Culture and community,

· Identity

· Purpose

As a result of my experience, and the Domains mentioned above, I propose that the Military, and the Department of Veteran’s Affairs (DVA), have a responsibility to slow down and manage the transition process. This would include:

· Analysis of the member’s risk factors

· Educating the member and their family of the effects of transition

· Mandated transition actions

· Connecting the member and their family to communities and medical and psychological supports at their Discharge Locality

I intend to articulate here how I would envision the process and will do so by firstly looking through the pertinent findings and outcomes of the Final Report of the  Australian Royal Commission into Defence and Veteran Suicide, then articulating a broad plan for the transition phase of a member’s career by looking at a risk analysis for transitioning members, suggesting potential actions that could be taken by Defence and DVA in at least attempting to soften the effects of this change in a service member’s, and their families, lives.

The Royal Commission and its Findings

The long-awaited release of the Final Report of the Royal Commission into Defence and Veterans Suicide clearly defined the scale of the problem of suicide among the ex-service community when compared to the employed Australian population statistics:

In Volume 5 of the Report, it was noted that senior Defence leaders ‘recognised that leaving the ADF is a key period of risk for members’, and goes on to describe that: ‘Latent harm experienced during service may re-emerge at a time when protective factors associated with service – such as social connection, sense of purpose, a strong and clear identity, mateship and loyalty to the unit – fall away’, echoing the domains that I quoted of Dr Pronk, above. While there are numerous factors that influence these risks, Defence and DVA have a moral obligation to attempt to find ways to mitigate them.

Defence and DVA have attempted to institute transition support programs that include questionnaires, advice, coaching, career guidance and other processes. Additionally, for those that are undergoing a medical separation, they are generally not discharged until such time as their DVA and Superannuation processing is complete, though this is not mandatory, nor has it been meaningfully encouraged for those that are voluntary or administratively separating from Defence. Since 2017, there have been additional measures put in place, but they are still mostly administrative and, while there are ‘case workers’ to support a member’s transition, the key limitation of these services is the honesty of the member with the service provider, their family, and themselves.

From experience, there are a few motivators to deny one’s deepest and darkest to themselves, their family and any supporting staff they engage with. The perceived stigma of accepting and discussing their mental health issues, the fear of having their grand plans being messed with through medical and administrative actions in response to those issues, and the fear of letting down one’s own family by coming across as weak, or for creating greater turmoil for their family. Additionally, while military personnel undertake suicide awareness training each year and are taught to look out for the signs and symptoms of those at risk, the effects of the Domains following transition, as mentioned above, have not been clearly articulated to them, nor does any member with a sound plan for transition suspect that they would succumb to such issues.

Analysing a member’s risk

So, if a member either doesn’t perceive their risk, or doesn’t admit to being at risk, how do we ensure that an honest risk assessment is done of the member prior to transition?

Well, firstly, a member needs to be educated on the risks. Providing educative material and briefings on the statistics, signs, symptoms, and the effects of loss among the three interrelated Domains upon transition. Echoing the comments of Defence’s senior leaders, I often liken the protection that still serving provides as ‘wearing body armour’ for pre-existing mental health concerns. While you serve, you have like-minded, similarly trained people around you, some of which you are extremely close with (Culture and Community Domain); you identify as a military person by Service, trade, rank, unit, etc (Identity Domain); and you do something that is greater than one’s self, for the better of your country (Purpose Domain). When you leave the services, those Domains are difficult to align to civilian life, especially when service personnel make the transition under the assumption that life will be better after leaving (like anyone who makes a bold career change such as this), they expect civilians to understand their service, they expect those around them to perform to standards and demonstrate mission-success orientated drive and determination, and they, given the trials of service, believe that they are ‘Ten feet tall and bullet-proof’. However, without the body armour of the uniform, these Domains are all inflicted loss and the effect on one’s mental health can be rapid, surprising and highly dangerous.

But, if the member doesn’t fully appreciate the risks, and they can’t be relied upon to be completely honest in transition questionnaire, how can the system appropriately analyse the risks to a transitioning member? 

Firstly, I’d propose that when a member first discusses transition with their chain of command, the immediate response should be referral to a service psychological practitioner. Before the member attends the appointment, that psychologist should conduct a full audit of the member’s psychological profile from the time of joining. This, with recommendations from the member’s chain of command should be the first step in the transition process. I make this point as, during my own transition, I was interviewed, however, if an audit of my psychological file had been conducted, then maybe it would have been noted, and possibly I would have been informed, that I was recorded as presenting with PTSD a full 13 years prior to my eventual discharge – I was not duly informed and transitioned without knowing the black dog was already present in my life.

Following the psychologist and chain of command recommendations, the member, supported by the psychologist, should be required to undertake a proper risk screening. While the Transition Preparedness Questionnaire exists in the ADF, it and other questionnaires seem to be predominately administrative or about trying to gain post-separation employment – both eminently important to the wellbeing of the member and their family; but they don’t cover off on the raw questions to be asked to analyse the risk. In Dr Pronk’s article, he offers a ‘tongue-in-cheek’ risk calculator called the Transition Suck Factor calculator:

Scoring:

TSF <12: You’re in good shape! Transition will still likely be stressful, but you’ve got a bunch of strong positive factors on your side to power on with life.

TSF 13-20: This is going to be a rocky road, but you’ve got some good protective factors on your side

TSF >21: There’s no sugar-coating the fact, transition is probably going to be a very difficult time. But don’t despair, with the right supports and mindset it can be successfully negotiated.

While this questionnaire is not the answer, I believe that had I, and a psychologist, gone through something similar prior to my own transition, I would have at least been a lot more aware of the risk of my transition ‘sucking’, as Dr Pronk bluntly puts it. Importantly though, the psychologist would have been more aware and, with the results of the questionnaire, and the psychologists audit of my files, they would have identified my risk and could have made recommendations to the chain of command about my individual transition process.

 Treating the member’s ‘suckiness’ risk

Once we identify the risk factors apparent to each individual’s circumstances, I believe that a ‘Gerden Leave’ style program could be appropriate. While Garden Leave is a corporate term usually enacted to prevent leaving employees from taking corporate knowledge to a competitor, I believe the process of giving paid leave, appropriate to the risk profile of the member, with concurrent transition supports, could be a great way to treat the risk profile and hopefully go some way to preventing veteran suicide. But how could this work?

Determining the timeframe. Firstly, following the risk assessment, the recommendation from the psychologist and the member’s chain of command should articulate what level of Garden Leave they assess a member would need. The member and their family then get buy-in to either fight for more or less of this entitlement as they perceive they require. Interconnecting factors such as education, already secured post-service employment, where the member is versus where they intend to reside post-separation, whether the member is married or not, how many children the member may have and any interconnecting concerns thereof (estrangement, special needs, etc). From this, a Commanding Officer, or appropriate delegate, then approves the member garden leave for three, six, nine, or twelve months. This could be scaled to include leave at half pay, or unpaid leave, should the member secure employment. The agreed period of Garden Leave would be mandated and the member, and Defence would both have connection requirements on mandated frequency (such as one physical meeting each month and one virtual meeting each week). This allows the member to know that they still have the Defence ‘armour’ around them and remain connected, but also ensure the ADF can track the member’s progress towards successful transition.

Education. As I alluded to, as a member myself, I knew a bit about mental health and had been exposed to others who had suffered from their own trauma. However, I was wearing my in-service ‘armour’ at the time and felt that I was going to transition like a boss. I erred with a bias for action to see through the current given mission, keeping my wife’s anxiety minimised through providing positive and encouraging teamwork and family leadership.

If I had of been made aware of the risk factors, my pre-existing conditions, and the importance of connection and culture, identity, and purpose, I may have given proper consideration and effort to these prior to and post separation, and maybe have been more cautious at the time. However, if my wife had of been educated about the risk factors, the need to ensure my Domains were prioritised, and the effects that my transition was likely to have on her the family, I could not have avoided identifying and addressing the risks associated with this milestone in my life.

What’s the key takeaway from here? Bring in the ‘Officer Commanding Homefront’ and give them the hard truths about this time in a veteran’s life, the risks, the effects on the veteran and the family, and ensure they are supported as much as the veteran in this process.

Support in settlement. While on Garden Leave, the member and their family would use the extant entitlements for separation removals and settle in their ‘Discharge Locality’. Upon arriving, the regional transition cell would then meet with the family (note that this is not just the member, but their spouse as well). In this interview, the representative would identify the needs of the family and then plan for connecting them to services, agencies and organisations within appropriate distance of the family’s new address. This should include:

1. A local, bulk-billing GP that is reported to be understanding of veteran’s needs.

2. Connection to schools for the member’s dependent children, according to their needs.

3. Connection to CV development and skills recognition agencies to transfer the member’s, and his spouse’s, skills into equivalents for civilian employment and then supporting their self-promotion to gain employment.

4. Appropriate community groups and sporting clubs for the member and their families in line with their needs and interests.

5. A reputable DVA Advocate to support the member through their DVA and ComSuper administration.

6. Local mental health practitioners that are trauma informed and understand the needs of veterans.

7. Connection to appropriate veterans Associations and the regional Returned and Servicemen’s League.

8. Regional, non-commission paid financial advisors.

9. Regional veterans’ employment groups and advocates.

10. Developing a transition mentor for the member.

11. Introduction to regional transitioning or recently transitioned families of similar make-up.While the list of helpful connections could be far greater with the right rigour applied, the above gives and indication of what the transition cell and the member should be working towards throughout the period of Garden Leave.

Remaining Connected. Every effort should be made to reinforce connection during the period of Garden Leave. This could include unit or base conducted physical training sessions, family days, invites to appropriate dining-in nights and events at units, and numerous other initiatives. Given the member is still serving at this stage, access to bases would not cause a security concern.

Monitoring. At each touch point with the transition cell, direct probing and passive observation needs to be made to assess the member’s, and their family’s, readiness to leave the security of Defence. This should be reinforced through formal interviews on regular frequency to understand any difficulties the member is experiencing, then actions taken to support the member in resolving those difficulties. Additionally, the member’s spouse should be regularly interviewed, away from the member, to understand their own transition progress, but also to cross-reference the member’s account of their own. Doing this would, at least, demonstrate the care that Defence has for the member and their family, while also support tracking of progress and any need for intervention. Intervention could look like provision of further support services, medical and psychological intervention or, if the need is assessed, recommendation for extension of the Garden Leave period.  

Ensuring participation in the program

It could likely be said that members and their families may be resistant to such a mandated transition program, and I would agree. However, given what we know about the potentially disastrous effects of transition upon this group, mandating such a program, over time, would be seen as just another administrative step in the transition process. Involvement in the program can be managed and tracked by the transition cell case officer and, with reference to transitioning psychological and medical practitioners, make recommendations for extension or reduction in the Garden Leave period, for approval by an appropriate, uniformed, delegate. This would ensure the member, and their spouse are encouraged to engage with the program, that best available oversite and support has been provided to their transition, and that the Chain of Command have exercised their due diligence and duty of care for their personnel.

Conclusion

In this newsletter, I have attempted to articulate a broad plan for the transition phase of a member’s career by looking at a risk analysis for transitioning members and suggesting potential actions that could be taken by Defence and DVA in the form of a Garden Leave-like system. I have hopefully offered a novel approach to this subject, and I believe that instituting this system would go some way to minimising the shock of transition for members and their families.

I have written this newsletter not to seek sympathy, but to hopefully add to the plethora of good ideas that are out there to attack the problem of veteran suicide. I have done this from my unique lived experience, and I acknowledge that one-size doesn’t fit all; however, I wholeheartedly believe a similar idea in this space would support Defence, and the Nation, in meeting their obligations of care for those that have served their nation.