This was a very large and complex inquiry with terms of reference which could easily have taken multiple reports to cover. Rather than produce a number of reports, the committee has sought to table this report as soon as possible. The clear message to the committee was that immediate as well as longer term action is required to address suicide by veterans.
The committee appreciates that not everyone has the time to read this report cover to cover and provides this executive summary to give an overview of the key issues from the evidence and highlight key recommendations. Recommendations are categorised into short, medium and long term.
The need to streamline the administrative practices of DVA was the overwhelming concern of the majority of submissions to the inquiry. The importance of improvements in this area is also recognised in the committee's longer term recommendations. Recent improvements through DVA's 'Veteran Centric Reform' program have highlighted the potential for further reform of administrative processes which can be rapidly achieved. The committee has recommended that the government continue to support and fund the 'Veteran Centric Reform' program in DVA (see Chapter 5).
At the same time as pursuing the 'Veteran Centric Reform' program, the committee has recommended the government continue to fund measures to reduce the backlog of claims and increase case coordination staff to assist clients with complex needs. To facilitate further assessment and improvement of administrative practices, the committee has recommended that the Australian National Audit Office commence a performance audit of the 'Efficiency of veterans' service delivery by the Department of Veterans' Affairs' as soon as possible (see Chapter 5).
The committee was concerned to hear that some clients felt they had not been treated with respect by DVA officers. The committee acknowledges the difficulties of interacting with clients who are very frustrated with the processes and may be experiencing mental health issues. The committee would therefore like to ensure that relevant DVA staff interacting with clients have appropriate and up-to-date training. To this end the committee has recommended that DVA review its training to ensure that staff have an understanding of: military service; the health issues of veterans; have appropriate skills to deal with mental health conditions; and training regarding interpreting medical assessment reports (see Chapter 5).
The committee appreciates the diverse nature of the veteran community and that it provides a challenge for DVA to ensure appropriate engagement. Older veterans are generally not reliant on online resources but contemporary veterans expect them. The committee believes there is scope for DVA to enhance its digital communication through social media to reach younger veterans. This would assist with referring clients to the most appropriate resources. The committee has recommended DVA expand its online engagement through social media (see Chapter 5).
Targeted programs based on new research
The committee commends recent research in this area, such as the AIHW findings concerning veterans at-risk of suicide, and believes more can be done to respond to new research findings. The committee considers better use of this research identifying 'at-risk' cohorts in the ADF and veteran community to target proactive support programs is needed. Research findings such as those by the AIHW should be used to develop new targeted suicide prevention and veteran support programs. The committee has recommended that the government develop and implement targeted suicide prevention programs based on the new research. The committee also recommended that the government expand the DVA Reconnects project to proactively contact veterans in at-risk groups (see Chapter 3).
Increasing access to the mental health community
The committee heard about a lack of experience in treating veteran specific issues within the wider mental health community. The committee considers that enhancements to online resources and training programs could assist with this issue. The committee has recommended that the government enhance the provision of veteran-specific online training programs (See Chapter 3). Further, mental health professionals highlighted discrepancies between the fees paid by Defence and DVA as a barrier to veterans accessing support. The committee has recommended that Defence and DVA align their arrangements for the provision of professional mental health care (see Chapter 3).
Addressing issues in transition
Appropriate support is essential to assist ADF members transition to civilian life. Significant reform in this area is occurring. The committee has recommended the Transition Taskforce examine and address gaps in support to veterans, barriers to employment and any disincentives for veterans undertaking work and study. Vulnerable ADF personnel can fall through the cracks of support in the transition process. The committee has recommended a two-track transition process be established with intensive support for veterans who will need it. Furthermore, the committee has recommended all transitioning ADF members should be provided with a DVA White Card to facilitate access to non-liability health care, serve as veteran identification and as a platform for data collection (see Chapter 6).
Accessing the benefits of alternative therapies
The committee heard from veterans with mental health conditions who felt alternative therapies had significantly improve their conditions. The committee accepts that the evidence base is developing in relation to many alternative therapies but several are being provided through ESOs and other groups. The committee believes there is scope to expand the reshape the existing programs to take account of the benefits of these therapies. The committee has recommended that the government expand the Veterans and Community Grants program to support the provision of alternative therapies to veterans with mental health conditions. The committee also recommended that DVA consult ex-service organisations and the veteran community about ways to reform the Veterans and Community Grants program to support the provision of alternative therapies.
In particular, the committee perceived value in developing an evidence base in Australia for supporting the use of complementary treatments, such as the effectiveness of companion and assistance animals. The committee has recommended funding for a trial program that would provide assistance animals for veterans with Post Traumatic Stress Disorder (PTSD) stemming from their military service in order to gather research (see Chapter 7).
National suicide register
A clear message from the evidence was the wish for an on-going register of veteran suicide. The committee agrees that there should be a national register. The committee has recommended that the government establish a national veteran suicide register to be maintained by the Australian Institute of Health and Welfare (see Chapter 3).
The committee was very concerned by accounts of negative interactions with DVA. It is logical that veterans who were satisfied with their experiences were less likely to be interested in the inquiry. Nonetheless, the committee believes a key contention by many witnesses, that the claims process is a key stressor and contributing factor to suicide by some veterans should be looked at closely. The committee has recommended that the government commission an independent study into the mental health impacts of the claims processes. Results from this study would feed into medium and longer term recommendations to address administrative issues described below (see Chapter 3).
Many veterans told the committee that they were unhappy with their experiences in medico-legal firms and being required to attend multiple appointments. The committee supports efforts by DVA, Defence and CSC to implement a single medical assessment process. However the committee has recommended that DVA reassess its use of medico-legal firms to ensure the assessments are appropriate for conditions of veterans, particularly mental health conditions (see Chapter 5).
Further supporting veteran employment
Gaining meaningful employment one of the most important components of success for veterans in their post service lives. However, those transitioning from the ADF can struggle to connect with employers and employers can be unsure about transferrable skills. The committee has recommended the Career Transition Assistance Scheme include an option for veterans to undertake a period of work experience with an outside employer. The valued skills and experience of ADF members means they are often well suited to other public sector careers. The committee has recommended that the Australian Public Service Commission conduct a review into mechanisms to further support veteran employment in the Australian Public Service and the public sector (see Chapter 6).
Support for partners
A supportive and inclusive approach to the families of veterans in the transition process is vital to ensuring the long-term well-being of veterans. However, a consistent theme from the evidence received was that there was a lack of support for the partners of veterans who have mental health conditions or have acquired severe disabilities arising from their service. The committee has recommended that the Department of Veterans' Affairs review the support for partners of veterans to identify further avenues to support. This review should include services such as information and advice, counselling, peer support and options for family respite care to support partners (see Chapter 6).
There are a complex range of services available for veterans and the committee heard that people struggle to navigate them. The committee was attracted to the idea of a single point of information that can operate to link veterans with local services and support. The committee believes that the Veterans and Veterans Families Counselling Service is the most appropriate organisation to take on this role as it is trusted in the defence community and received praise for the services it offers. The committee recommended that the government provide funding to support the Veterans and Veterans Families Counselling Service to create and maintain a public database of services available to veterans and to provide an information service to assist veterans and families connect appropriate services (see Chapter 7).
Veteran's Review Board
The committee was concerned that the practice of preventing veterans bringing their lawyer to the VRB is appropriate in all cases. A number of examples were provided where vulnerable veterans felt underrepresented or were unable to fairly engage with VRB proceedings. The committee accepts that this practice has been maintained in order to allow the VRB to be an open and non-adversarial forum for veterans to seek review of decisions. The committee also acknowledges the genuine efforts that the VRB makes to support veterans in its proceedings.
However, given the long-term future of veterans is in the balance, and the structural barriers involved in making an appeal to the AAT, veterans should be able to achieve the fairest hearing possible. The committee has recommended an independent review of the representation of veterans before the VRB (see Chapter 7). This review should assess whether the rights of vulnerable veterans are being adequately protected and whether further support mechanisms for veterans appearing before the Veterans' Review Board are required.
Addressing legal and administrative complexity
The burden of legislative complexity and administrative hurdles impacts veterans when they are seeking support at a vulnerable period in their lives. The complexity of the legislative framework was a key theme from the evidence received. While arguably the most important issue during the inquiry, the committee recognises there is no quick fix.
Some previous reviews have examined at this issue but ultimately recommended that a single piece of legislation not be pursued. This assumption that a single piece of legislation cannot easily be achieved, has resulted in ad hoc measures intended to simplify the system. While any simplification is welcome, the fundamental complexity in the system has remained.
The committee agrees with witnesses that the current framework is complex and confusing and contributes to the frustration felt by veterans and ex-service personnel in dealing with DVA. There are two aspects: the legal complexity which has resulted in administrative complexity.
Other jurisdictions have simpler legislative frameworks for veterans. While the committee acknowledges steps being taken by DVA to streamline some aspects of their processes the committee anticipates that simplifying the legislative framework would result in efficiencies for all, including flowing through to the time taken to process claims. The committee has recommended that the government ask the Productivity Commission to review the legislative framework and administrative processes with the objective of simplifying the system. In particular, this review should examine the utilisation of Statements of Principle in the determination of compensation claims. The review should be completed within 18 months and be tabled in the Parliament (see Chapters 4 and 5)
The committee recognises the ICT issues with multiple systems adding to the complexity and the lack of investment in efficient ICT. The committee reaffirmed its recommendation from the inquiry into the mental health of ADF serving personnel that DVA be adequately funded to achieve full digitisation of its records and modernisation of its systems by 2020, including the introduction of a single coherent system to process and manage claims.
The committee commends the excellent work of advocates in assisting veterans make claims. Volunteer and ESO supported advocates will continue to be required to assist the vast majority of veterans to make claims. However, the decreasing numbers of advocates will put pressure on the current system. The committee is also concerned about DVA being responsible for the training of advocates who will then argue against the decisions of DVA officers on behalf of veterans. The committee is recommending the establishment of a Bureau of Veterans' Advocates (BVA) institutionally modelled on the Bureau of Pensions Advocates in Canada. This would consist of a section of legally trained public servants with a mission to independently assist and advocate for veterans in making claims. The BVA will supplement and support the current system of volunteer advocates. Where necessary, the BVA will be allocated a budget to commission legal aid to assist veterans make appeals. The BVA will also take over responsibility for grants to ESOs regarding advocacy, training and accreditation of volunteer advocates and insurance issues (see Chapter 7).
Finally, the committee acknowledges that there is substantial support being committed by the Australian Government and considerable work being undertaken by DVA to transform the client experience for veterans. It is encouraging that DVA's reform agenda appears to be moving in the same direction as the recommendations suggested by many submitters. The areas highlighted in the Budget 2017-18 for the ADF and DVA also respond to several of the concerns raised during the inquiry. Nevertheless the pace of reform has been slow and needs to be increased. The committee hopes that the recommendations in this report will contribution to this reform.