Final report to the Independent Review of Past Defence and Veteran Suicides

This chapter reports on administrative client data collected by DVA, which records information about ADF members making a DVA claim, receiving income or a payment, using a DVA-funded health service or support service and whether they are a health card holder. The analysis covers access to DVA services by veterans in the study cohort with at least 1 day of service in the ADF between 1 January 2001 and 31 December 2018.

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Characteristics of DVA clients who were ex-serving ADF members

Trends in the number of DVA clients between 2001 and 2018

Between 2001 and 2018, there were 42,798 (36%) ex-serving ADF members who were DVA clients; comprising 37,023 (37%) males and 5,775 (32%) females. The proportion for ex-serving ADF members who were DVA clients increased from 29% in 2001 to 36% in 2018; (Figure 13). This increase is mostly due to the introduction of new programs or policy change over time including changes to the Non-Liability Health Care arrangement in July 2017 and White Card on Transition project in mid- 2018 (DVA, 2020).

Figure 13: Percentage of ex-serving males and females who were a DVA client, 2001 to 2018

Notes

1. 22 December 2004 - Treatment for anxiety and depressive disorders added.
2. 1 July 2014 - Treatment for alcohol use disorder and substance use disorder added. Eligibility extended for peacetime service post-1994.
3. 1 July 2016 - Eligibility for five mental health conditions expands to include all current and ex-serving members of the Australian Defence Force (ADF) with at least one day of continuous full-time service. Claiming made easier by allowing email and phone call to be accepted as a claim and a diagnosis of one of the five mental health conditions to be provided within 6 months.
4. 1 July 2017 - Treatment for five mental health conditions expanded to all mental health conditions. Policy changed so that no diagnosis is required to access mental health treatment.

5. Mid-2018 - Eligibility for the treatment of any mental health condition expanded to include reservists that have rendered Reserve Service Days with:

   • Disaster Relief Service;
   • Border Protection Service; or
   • Involvement in a serious service-related training incident.

   Mid-2018 - The White Card on Transition project commenced, with DVA issuing White Cards to transitioning members as they separate from the ADF. The White Card can be used to access Non-Liability Health Care (NLHC) treatment for any mental health condition, at any point in the person's life. The 'claim' for NLHC is taken to be when the person first uses the White Card to access treatment, at which time they also become eligible to receive Veterans Supplement.

   See DVA – Non-Liability Health Care (NLHC) for more information.

Source: AIHW analysis of PMKeyS–NDI–DVA, 2001−2018.

Mental health condition related claims

Over one third (37% or 15,995) of ex-serving ADF DVA clients had at least 1 mental health condition related claim¹ processed between 1 January 2001 and 31 December 2018. Among those who had a processed mental health condition related claim, three-quarters (74% or 11,894 ex-serving ADF DVA clients) had their listed conditions processed under the non-liability health care arrangement².

The largest proportion of ex-serving ADF members had mental health condition related claims processed under mood (affective) disorders followed by post-traumatic stress disorder, acute stress reaction and adjustment disorders (Table 12).

Notes

1. See Technical notes: What is a processed claim for more information.
2. Non-Liability Health Care (NLHC) allows for former and current ADF members, depending on eligibility, to receive treatment for a range of conditions, including mental health. ADF members do not need to establish that such conditions were caused by service.

Table 12: Numbers and proportions of ex-serving ADF members who were a DVA client who had a processed mental health claim, by mental health conditions type, 2001 to 2018

Mental health condition type(a)	Number	Proportion (%)
Mood (affective) disorders	7,997	50.0
Post-traumatic stress disorder, acute stress reaction, adjustment disorders	6,097	38.1
Neurotic, stress-related and somatoform disorders	4,232	26.5
Psychoactive substance use	3,287	20.6

Note: (a) Groupings of mental health claims based on ICD-10 classifications. See Technical notes for a full list of mental health groupings.

Sources: AIHW analysis of linked PMKeyS–NDI–DVA data, 2001–2018.

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Characteristics of DVA clients who died by suicide

Number and proportion of DVA clients who died by suicide

Between 2001 and 2018, 154³ ADF members who died by suicide were DVA clients at the time of death. This comprised 146 males (99 (68%) were ex-serving; 22 (15%) were serving; 25 (17%) were reserves) and 8 females (all ex-serving) (Table 13).

The rate of ex-serving male non-DVA clients who died by suicide (25 per 100,000) was lower than ex-serving male DVA clients who died by suicide (36 per 100,000).

Note: 3. 37 ADF members who died by suicide had either been issued a White card, had a DVA or MBS service claim processed, or received a payment after their death. For the purposes of this study and the limitations of the data-driven definition, these ADF members are not defined as DVA clients at time of death.

DVA health card holders who died by suicide

Between 2001 and 2018, 90 male ADF members who died by suicide were either a White or Gold card holder (66 White card and 24 Gold card). Over 1 in 4 ex-serving (26%), 6% of serving and 24% of reserve males who died by suicide were a White card holder.

Table 13: Numbers and proportions of ex-serving males who were DVA clients^(a), who died by suicide between 2001 to 2018 and total ex-serving males in 2018^(b), by service-related characteristics

	Number of ex-serving male DVA clients who died by suicide between 2001–2018	%(c)	Total ex-serving males who died by suicide	Number of DVA clients in 2018	%(d)	Total ex-serving males in 2018(b)
Age group(e)(f)
Less than 35 years	30	26.1	115	6,824	24.3	28,086
35–44	35	46.1	76	8,898	29.8	24,763
45–54	28	70.0	40	8,464	42.2	29,871
55 years and over	6	54.5	11	12,179	57.3	21,239
Service
Army	68	41.7	163	23,301	35.2	66,242
Navy	19	39.6	48	6,792	38.9	17,462
Air Force	12	38.7	31	6,272	40.3	15,571
Entry type
Officer	8	40.0	20	6,719	36.0	18,675
General enlistee	91	41.0	222	29,645	36.8	80,599
Operational experience(f)
Any operational experience	15	53.6	28	6,716	45.3	14,822
No operational experience	25	22.1	113	7,044	18.4	38,333
Separation reason(g)
Medical separation	46	79.3	58	10,806	90.2	11,974
Other Involuntary	17	22.7	75	7,769	27.3	28,506
Voluntary	29	29.6	98	14,408	29.0	49,608
Length of service(e)
Less than 1 year	10	18.9	53	1,239	10.2	12,148
1 to less than 5 years	15	24.2	62	4,867	24.0	20,242
5 to less than 10 years	17	42.5	40	5,442	34.3	15,858
10 or more years	57	65.5	87	24,817	48.6	51,027
Time since separation(e)
Less than 1 year	9	30.0	30	3,394	50.8	6,686
1 to less than 5 years	47	49.5	95	11,181	39.5	28,286
5 to less than 10 years	29	38.2	76	8,167	34.4	23,755
10 or more years	14	34.1	41	13,623	33.6	40,548
Total	99	40.9	242	36,365	36.6	99,275

Notes:

1. Includes ex-serving males who met one of the following conditions: had a White or Gold card or received a health service or support service or received an income payment or had at least one processed claim.
2. Includes those who were alive or deceased in 2018.
3. Numerator is ex-serving males who died by suicide and were a DVA client and denominator is ex-serving males who died by suicide between 2001 and 2018.
4. Numerator is all ex-serving males who were a DVA client and denominator is all ex-serving males who were alive or deceased in 2018.
5. Age, time since service, and length of service characteristics are calculated as at 31 December 2018, or at death, if this occurred prior to 31 December 2018.
6. Operational service falls into four broad categories: warlike, non-warlike, overseas and domestic. Individuals with at least one type of operational service are counted in ‘Any’, and those with no operational service are counted in ‘None’. Only operational service since 1 January 1999 has been consistently identified across the four operational service categories. To ensure comparability, analysis of operational service includes only personnel hired on or after 1 January 1999. Individuals hired before 1999 are not included in percentage calculations for operational experience.
7. 64% (7) of ex-serving males, who were discharged due to contractual/administrative reasons and died by suicide, were DVA clients. 37% of ex-serving males, who were discharged due to contractual/administrative reasons in 2018, were a DVA client. Appendix A: Technical Note for discharge reason groupings.

Sources: AIHW analysis of linked PMKeyS–NDI–DVA data, 2001–2018.

DVA clients who died by suicide

Among 146 male DVA clients who died by suicide, 75 male ADF members had a processed claim relating to mental health any time prior to death (Table 14). There were 14 ADF members who died by suicide and had only rejected mental health condition related claims, noting, these ADF members’ death and their claims were processed prior to the policy changes of non-liability health care arrangement (DVA, 2021).

Table 14: Proportions of mental health conditions by claim type for male DVA clients who died by suicide, 2001 to 2018

Mental Health Condition by Type(a)	Count	Proportion (%)
Mood (affective) disorders	47	62.7
Post-traumatic stress disorder, acute stress reaction, adjustment disorders	38	50.7
Psychoactive substance use	22	29.3
Neurotic, stress-related and somatoform disorders	18	24.0

Note: (a) Groupings of mental health claims based on ICD10-AM classifications. See Technical notes for a full list of mental health groupings.

Sources: AIHW analysis of linked PMKeyS–NDI–DVA data, 2001–2018.