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Veteran and military mental health

ACPMH undertakes a range of research exploring posttraumatic mental health with veteran and military populations, including studies on conceptual and methodological issues. The results of this research may have broader applicability to posttraumatic mental health in other populations.

Promoting veteran and military mental health

Barriers to Rehabilitation - Phase 1

Phase 1 of the Barriers to Rehabilitation project was to determine whether there are systematic barriers (particularly those that DVA may be able to address) to successful rehabilitation for DVA clients. ACPMH conducted interviews with DVA clients, staff, and stakeholders, and surveyed rehabilitation service providers to explore how rehabilitation outcomes were being measured and identify perceived barriers to rehabilitation. A key finding of the project was that defining "success" in rehabilitation is a complex and subjective task, which depends on a number of factors including the client's initial goals, age, injuries, geographic location, and the legislation they fall under.

Barriers to Rehabilitation - Phase 2

Consensus among participants of Phase 1 of this project indicated that measuring success in rehabilitation is an important and necessary requirement, but that there is a need for a useful measure of "successful outcomes" beyond return to work. Phase 2 of the study was designed as a trial of the Goal Attainment Scaling (GAS) approach, in which targeted goals with well-defined outcomes to be achieved within a specific timeframe are determined for each individual. The achievement of the intended outcome is recorded and a standardised score can be calculated for all goals and clients. The GAS approach was seen by service providers to support a client-focused approach to rehabilitation.

Evaluation of DVA mental health initiatives

DVA's mental health initiative, from the 2006/7 Budget Measure, identified a range of activities which aimed to improve access to preventative and community-oriented mental health care for the veteran community, particularly younger veterans. In consultation with DVA Mental Health Policy, ACPMH designed an overarching framework for an evaluation that represented the logical links between the proposed activities to be implemented under the initiative and their intended effects for DVA staff, service providers, and DVA clients and the broader veteran community. The framework is a representation of the strategic foundations of the overarching mental health policy of DVA. It represents a working tool for policy development, implementation, evaluation and review.

Family studies/ family functioning in veterans and partners

Poor family functioning is consistently found to be associated with PTSD symptoms in veterans, however the relationship between family functioning and response to treatment has not been as widely investigated. This longitudinal study evaluated the relations between PTSD symptoms and poor family functioning in a large sample of veterans and their partners. We found that veterans who reported more difficult family relationships at intake to a treatment program also reported a relative increase in PTSD symptoms at 3 months post-treatment. Similarly, poor family functioning at 3 months post-treatment was a good predictor of subsequent increases in avoidance and hyperarousal symptoms. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance. These findings suggest that an increased focus on improving family functioning may play a role in providing more effective treatment for veterans.

Anger/ measurement of anger in combat-related PTSD

Anger is the problem most frequently reported by veterans with combat-related PTSD, their spouses, and assessing clinicians, and is associated with ongoing psychological disturbance well after traumatic exposure. Along with generalised irritability, anger has also been implicated in the development of PTSD. Therefore, there is a need for a brief specific measure of anger for use in the assessment of posttraumatic mental health problems. This research was the first to formally assess the psychometric properties of the 7-item Dimensions of Anger Reactions (DAR) scale. Our results suggest that the scale is a reliable and unidimensional measure of anger disposition directed towards others. The DAR also appears to be sensitive to change associated with therapeutic intervention for PTSD, which indicates it has potential value for measuring treatment outcomes in a clinical setting, or as a short measure for use in research.

Program evaluation

Quality assurance and PTSD program monitoring

Just as important as providing treatment to people with PTSD is ensuring that treatment is effective. The aim of this ongoing project is to accredit, manage and report on the outcomes of DVA-contracted PTSD programs across Australia. ACPMH monitors clinical outcomes for veterans participating in the programs by collecting data from veterans and clinicians at key points during program delivery. Feedback is provided to DVA and the service providers to help ensure that the programs evolve to meet the changing needs of veterans and their families. This is particularly important given the new wave of veterans engaging with DVA services.

Monitoring outcomes of Veterans and Veterans Families Counselling Service (VVCS) group programs

ACPMH supports the work of VVCS by monitoring participant outcomes from broader mental health focussed group programs conducted by or on behalf of VVCS. The programs that are part of this external data collection and analysis process include Lifestyle, Health and Wellbeing, and Stepping Out programs. This standardised monitoring program allows ACPMH to provide timely information for the group facilitators and to support VVCS in providing high quality treatment group programs. This information also further supports the policy advice we provide to DVA and ADF. Data is collected from participants in the group programs at or prior to commencement, and six months after completion. Program facilitators consider this analysis of intake data and feedback about the participants when tailoring program content and/or delivery to each specific group.

VVCS Heart Health Program evaluation

The Heart Health Program (HHP) was designed to address the significant health issues of Vietnam veterans. It consists of two physical exercise sessions per week for 52 weeks, and 12 health seminars during that time. An evaluation conducted by ACPMH aimed to identify whether participation in the program resulted in significant physical and mental health improvements, and whether these improvements were maintained over time. We undertook two studies to achieve these aims, utilising routine data collected at intake and completion of the program, and follow-up data collected by ACPMH.

Long term outcomes for VVCS Counselling

While immediate improvements in mental health are a desired outcome of therapy, it is also important that those early changes are maintained in the long term. This research aims to examine the effects of centre-based VVCS counselling for veterans and veterans' family members from pre- to post-intervention, and identify whether improvements in mental health are maintained long-term. Results may inform future delivery of services to VVCS clients, and may identify particular groups of veterans or veterans' family members who do not respond as well to treatment.