In Australia, military service is held in high esteem with a recognition that it places high demands on those who serve, and can include exposure to extreme physical, psychological and mental stressors (Dobson et al., 2012; Forces in Mind Trust, 2013). Approximately 5,000 (9%) serving men and women transition out of the Regular Australian Defence Force (ADF) each year, either discharging completely (if involuntarily discharged, that is on medical or administrative grounds) or transferring into the Active or Inactive Reserves. This represents a significant number of Transitioned ADF members who are currently in the critical early stages of adjusting to civilian life and reintegrating into their community.
The period of transition from military to civilian life is quickly becoming recognised as one of the most significant and stressful transitions in the life course of military members world-wide owing to potential changes in identity, community and residence, social networks and status, family roles, occupation, finances, routines, responsibilities, supports and culture. Changes brought about by the transition process can lead to the development and/or exacerbation of existing service related mental and physical symptoms resulting in psycho-social adjustment issues ranging from employment difficulties and family/relationship conflict, to mental health and substance abuse problems.
Currently, there is very little systematic research about the mental health and wellbeing as well as the associated risk and protective factors and pathways to care in representative cohorts of transitioned military members. Most studies to date have focused on cohorts from specific deployments or those seeking treatment or compensation from the Department of Veterans’ Affairs (DVA) or the international equivalent, as these are the populations suggested to be most at risk. While international literature estimates 60–75% of transitioned military members report an easy adjustment to civilian life, it is likely others, particularly those who developed mental health symptoms or disorder prior to discharge, may struggle upon transition. The types of symptoms experienced by those who struggle and the factors that facilitate or inhibit these individuals from accessing care are essential to understand in order to ensure they receive appropriate mental health care in the civilian sector.
In Australia, only one in 10 ADF members who have recently transitioned out of the Defence Force choose to (or are able to) access veteran healthcare services therefore, administrative data alone cannot provide an accurate snapshot of the health of the population in the Australian context. Consequently, a population or cohort based approach is essential to establish accurate prevalence estimates of mental disorder in Transitioned ADF members. It is only through this understanding that targeted policy and programs can be developed that will meet the needs of individuals in this stage of the military career cycle.
This study builds on the findings of the 2010 Mental Health Prevalence and Wellbeing Study (McFarlane et al., 2011) which previously established the prevalence of mental disorder in the Regular ADF in 2010. It also examines the mental health and wellbeing and patterns of health service seeking and usage among ADF members in the first five years following transition from Regular ‘full-time’ ADF Service (January 2010-December 2014). The five-year window immediately post transition was chosen as this is a critical period to target for early intervention. Importantly, investigation of the differences in the mental health and wellbeing in current serving Regular ADF members, with Transitioned ADF members who are now in the Active and Inactive/Standby Reserves as well as Transitioned ADF members who have discharged completely into the community, provides critical information on the risk and protective factors throughout each stage of transition. Protective factors such as healthy worker or ‘healthy warrior’ effect have been seen for full-time regular serving ADF members but can lose strength as members transition out of the ADF.
Furthermore, a comparison of the self-reported psychological distress and alcohol consumption of the Transitioned ADF in 2015 with the contemporaneous data collected by the Australian Bureau of Statistics (ABS) in 2014–2015 as part of the National Health Survey was performed. This comparison situates the Transitioned ADF in the context of the civilian population using the most contemporary (and temporally equivalent) Australian data available. Mental health issues and disorder are not confined within the ADF. Nor are stigmas and barriers to care such as access, cost locality and stigmas. An understanding of how Transitioned ADF compare to the Australian community in this context provides a more thorough understanding of the role that military service plays in the amelioration or exacerbation of mental health symptoms as well as the factors that assist or limit access to care within these two populations.
The Transition and Wellbeing Research Programme is the most comprehensive study undertaken in Australia of the impact of military service on the mental, physical and social health of Transitioned and 2015 Regular Australian Defence Force (ADF) members and their families (the study populations). Utilising a robust two-phase design, the internationally acclaimed gold standard structured interview for assessing ICD-10 and DSM-IV mental disorder (Composite International Diagnostic Interview [CIDI]) (Kessler and Ustun, 2004)), and a two-stage statistical weighting methodology to correct for differential non-response and systematic response biases, this study provides the most thorough assessment of the mental health and wellbeing and patterns of help seeking in the Transitioned ADF compared to the current serving Regular ADF conducted to date.
This Report summarises the Mental Health and Wellbeing Transition Study methodology, describes the study populations and presents the key findings from the first two reports of the Transition and Wellbeing Research Programme: Mental Health Prevalence and Pathways to Care.