Australian Institute of Health and Welfare (2021) Final report to the Independent Review of Past Defence and Veteran Suicides., AIHW, Australian Government, accessed 30 November 2021
Australian Institute of Health and Welfare. (2021). Final report to the Independent Review of Past Defence and Veteran Suicides. Retrieved from https://www.aihw.gov.au/reports/veterans/independent-review-past-defence-veterans-suicides
Final report to the Independent Review of Past Defence and Veteran Suicides. Australian Institute of Health and Welfare, 29 September 2021, https://www.aihw.gov.au/reports/veterans/independent-review-past-defence-veterans-suicides
Australian Institute of Health and Welfare. Final report to the Independent Review of Past Defence and Veteran Suicides [Internet]. Canberra: Australian Institute of Health and Welfare, 2021 [cited 2021 Nov. 30]. Available from: https://www.aihw.gov.au/reports/veterans/independent-review-past-defence-veterans-suicides
Australian Institute of Health and Welfare (AIHW) 2021, Final report to the Independent Review of Past Defence and Veteran Suicides, viewed 30 November 2021, https://www.aihw.gov.au/reports/veterans/independent-review-past-defence-veterans-suicides
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Health services accessed by veterans who died by suicide
Mental health-related services
Medicare-subsidised and DVA-funded health services
Use of hospital-based services funded by DVA
Defence Health Hotline
ADF members are able to access a variety of different health services, engaging with different systems over their lifetime. This chapter examines access to health services by the study cohort: ADF members who have died by suicide with at least 1 day of service since 1 January 2001.
The analysis covers:
Broadly, serving personnel primarily access Defence funded health services although they may access Medicare-subsidised and DVA-funded health services. Ex-serving and reserve ADF members can access both Medicare-subsidised and DVA funded health services for approved claims (Table 15).
All current and ex-serving ADF members may also access public hospitals, emergency departments and specialised non-admitted services (not funded by DVA), ancillary private health services (‘extras’), or pay for services entirely out-of-pocket. Data on these health services are not available for this report.
Defence-funded health services
Serving and reserve ADF members can access health services through Health Service Contracts (HSC) off-base (data available for 2013 – 2018), Health Hotline (data available for 2012 – 2018) and Defence Electronic Health Systems (data not presented in this report).
DVA-funded health services
Data available for 2000 – 2018 (Emergency data for 2015 – 2018)
DVA clients can access general practitioner (GP), specialist, allied health, hospital and emergency department services.
Medicare-subsidised health services
Data available for 2000 – 2018
Australia’s universal health insurance scheme, Medicare, subsidises access to a range of treatments and diagnostic tests for Australians (and some overseas visitors). These services include general GP and medical specialist services, hospital treatments for private patients, selected diagnostic imaging and pathology services, and some allied health services.
Between 2001 and 2018, the proportion of ex-serving (88%) and reserve males (85%) who used Medicare-subsidised or DVA-funded health services in the year before death was similar to Australian males who died by suicide (85%). A similar proportion of ex-serving females used a Medicare-subsidised or DVA‑funded health service in the year before death (96%), compared with Australian females who died by suicide (94%). While the primary source of health services for serving ADF members is Defence funded health services, nearly 1 in 4 of those who died by suicide (23%) used a Medicare-subsidised or DVA-funded health service in the year prior to death.
Between 2014 and 2018, 198 ADF members died by suicide. Of these, 57 (29%) had a Medicare-subsidised, DVA-funded or Defence-funded Health Service Contracts (HSC) off-base health service provided in the week before death, and 109 (55%) had a service in the 30 days before death. Most serving members (97%) used at least one health service in the year before death, particularly in the 60 days before death with 84% having used a health service compared with 62% of ex-serving and 57% of reserve members (Figure 14).
Source: AIHW analysis of PMKeyS-NDI-MBS-DVA-HSC off-base, 2014-2018
Over half (53%) of ex-serving males who died by suicide between 2014 and 2018 had a mental health-related service in the year before death. In comparison, over a third (38%) of Australian males who died by suicide in the same period received a Medicare‑subsidised mental health-related service in the year before death (Figure 15). Among serving and reserve male and female ADF members who died by suicide, around 2 in 5 (40%) had a mental health-related service in the year before death.
Of those ADF members who died by suicide between 2014 and 2018, 21% of ex‑serving males and 47% of ex-serving females used a mental health-related service in the 30 days before death compared with 15% of Australian males and 26% of Australian females, respectively.
n.p. – not published due to small numbers.
Sources: AIHW analysis of linked PMKeyS–NDI–MBS–DVA–HSC off-base data 2014–2018.
This section looks at use of Medicare-subsidised and DVA-funded health services by those ex-serving ADF members who accessed services at least once a year in the period from 2001 to 2018.
Overall, the proportion of ex-serving ADF members who used Medicare-subsidised and DVA-funded health services increased from 59% in 2001 to 84% in 2018 for males, and 77% to 92% for females. From 2001 to 2018, a lower proportion of ex-serving males (from 59% to 84%) and ex-serving females (from 77% to 92%) used Medicare-subsidised services and DVA‑funded services compared with the Australian male (from 83% to 87%) and female population (from 94% to 95%) (Figure 16 and Figure 17). While the Australian male and female population groups are restricted to the age range of the male and female ex-serving study group respectively, there are differences in the age structure within these ranges that may account for differences in service use.
Of ex-serving members who used health services, almost all accessed a Medicare‑subsidised service at least once in the year, especially females (around 99%). The proportion of ex‑serving ADF members who used at least one DVA-funded health service increased steadily between 2001 and 2018, ranging from 7% to 20% for males, and 2% to 15% for females (Figure 16 and Figure 17).
Source: AIHW analysis of PMKeyS-NDI-MBS, 2001-2018; Department of Health MBS claims data, 2001-2018; Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) 2001-2018.
Source: AIHW analysis of PMKeyS-NDI-MBS, 2001-2018; Department of Health MBS claims data, 2001-2018; ABS ERP 2001-2018.
Mental health‑related services subsidised through Medicare and DVA may be provided by psychiatrists, general practitioners (GPs), psychologists and other allied health professionals.
The proportion of all ex-serving members who used a Medicare-subsidised or DVA-funded mental health-related service increased steadily between 2001 and 2018 for both males (3% to 16%) and females (3% to 22%) (Figure 18). This pattern is broadly reflective of the increase in use of Medicare-subsidised services by the Australian population, which can be largely attributed to the introduction of the Better Access program for all Australians (Box 1).
In recent years, the use of Medicare-subsidised mental health-related service were similar between ex-serving ADF members (9% for males and 17% for females in 2018) and the Australian population (9% for males and 15% for females in 2018). However, the higher overall use by ex-serving members was largely attributable to additional members who used DVA-funded services, adding 6.5 percentage points for ex-serving males and 5.2 percentage points for ex-serving females in 2018.
Box 1: Changes to mental health-related services subsidised by Medicare and DVA
The services that Medicare subsidises, and how similar services are coded has changed over time, particularly for mental health services provided by GPs and allied health professionals. A significant change occurred in November 2006 with the introduction of the Better Access program. As a result, key findings for mental health-related service use are mainly reported for the periods 2007 to 2018 and from 2008 to 2018 for services used 1 year prior to death.
DVA-funded healthcare includes identical Medicare items, however during this period, DVA clients were entitled to ‘uncapped’ services. DVA has also increased access to mental health services through various policy changes since 2001, most significantly in 2016 when eligibility was expanded to include all current and former ADF members with at least one day of continuous full-time service.
See Appendix A5 for information about these initatives and details about how mental health-related Medicare subsidised and DVA-funded services are grouped.
The proportion of ex-serving members using psychiatry services (Medicare or DVA) has almost doubled from 3.9% in 2011 to 7.4% in 2018 for males and 3.5% to 7.1% for females. This is mainly an increase in the number of ex-serving members who used DVA‑funded psychiatry services. Most mental health care received by ex-serving members eligible for DVA-funded services was provided by psychiatrists. In 2018, 80% of all ex-serving males and 69% of females had their psychiatry services funded by DVA (Figure 19).
The use of mental health related GP services and mental health related allied health services has steadily increased since 2006 for male and female ex-serving members and the general Australian population. The majority of ex-serving patients who used GP and allied mental health services claimed their services through Medicare (Figure 20 and Figure 21).
Source: AIHW analysis of PMKeyS-NDI-MBS, 2001-2018; and Department of Health MBS claims data, 2001-2018.
A higher proportion of ex-serving members who separated for involuntary medical reasons used Medicare-subsidised and DVA-funded mental health related services and in particular psychiatry services, compared to those who separated for other involuntary reasons or voluntarily (Figure 22).
Sources: AIHW analysis of linked PMKeyS–NDI–MBS–DVA data 2018.
This section examines admitted patient and emergency department services used by ADF members (serving, reserve and ex-serving) eligible for healthcare funding by DVA (‘DVA clients’ The analysis uses administrative data from the DVA National Treatment Account, which has limited analysis to DVA clients. Future analysis could investigate the use of Australian hospital-based services by all ADF members, including those who died by suicide, and Australians who died by suicide.
ADF members are eligible for the provision of DVA-funded healthcare according to various criteria (DVA 2021). However, DVA clients can continue to access all public Medicare services and hospital-based care and may use these services, private health insurance-funded or self‑funded services independently of the DVA.
A total of 11,140 (26%) ex-serving DVA clients received overnight or day-only admitted patient care from 2001 to 2018. Most were males (90%). The care provided to these DVA clients included acute care1 (85%), rehabilitation care2 (4%) and mental health care3 (1%) (mental health care was included with acute care until 1 July 2015).
In terms of the number of patients, the most frequent reasons (principal diagnoses) for DVA clients to receive admitted patient care were diseases of musculoskeletal and connective tissue (50%), mental and behavioural disorders (25%), diseases of the digestive system (24%) and neoplasms (20%) (Table 16).
Diseases of musculoskeletal and connective tissue (M00-M99)
Mental and behavioural disorders (F00-F99)
Diseases of the digestive system (K00-K93)
Neoplasms (C00-C96, D00-D09, D37-D48)
Diseases of the nervous system (G00-G99)
Injury, poisoning and certain other consequences of external causes (S00-T98)
Diseases of the circulatory system (I00-I99)
Source: AIHW analysis of PMKeyS-NDI-DVA, 2001-2018
Between 2001 and 2018, the greatest number of all episodes of care4 (33%) were provided to ex‑serving DVA clients with a mental and behavioural disorder as their principal diagnosis. During this period, the average number of episodes of care for mental and behavioural disorders for ex-serving DVA clients was 11.4 per patient.
When including principal and all secondary diagnoses in the analysis, 3,326 (30%) ex‑serving DVA clients receiving admitted patient care had at least one diagnosis related to mental health; most had multiple mental health diagnoses. The most prevalent mental health diagnosis groups (ICD 10AM) for ex-serving DVA clients receiving admitted patient care are included in Table 17.
Note: 4. An episode of care can be a total hospital stay or a portion of a hospital stay when there is a change of care type e.g. from acute care to rehabilitation care.
Diagnosis group (ICD 10AM )
No. (%(e)) patients
No. (%(f)) episodes
Stress-related disorders (F43)
Depressive disorders (excluding bipolar) (F32)
Drug and alcohol disorders (F10-F19, Z502-3, Z714-5)
Anxiety disorders (F40-2, F44-8)
Bipolar and mixed-mood disorders (F30-1, F33-9)
Dementia (F00-3, F051, G30)
Schizophrenia and related disorders ((F20-9)
The most common mental health diagnostic groups among ex-serving DVA clients receiving admitted patient care were:
While the proportion of all ex-serving DVA clients receiving admitted patient care for mental health disorders is between 0.5 – 3.3%, there has been a steady increase particularly since 2010 (Figure 23).
Source: AIHW analysis of PMKeyS-NDI-DVA, 2001-2018.
A total of 2,543 (6%) ex-serving DVA clients presented to a public emergency department (ED) between 2015 and 2018; 93% were men. During this period, the mean number of ED presentations by a DVA client was two.
The most common reasons for presentation (principal diagnosis) were injury, poisoning and other consequences of external causes (31%) followed by diseases of the circulatory system (10%), diseases of musculoskeletal and connective tissue (9%) and mental and behavioural disorders (9%).
The 1800 IMSICK service is a national, 24 hour, nurse triage and health support line for use by ADF Entitled Personnel if they become ill or injured after hours or are not in close proximity to a Defence health facility.
Between 2012 and 2018, Defence Health Hotline received 68,053 calls from 31,826 ADF members. Half of the callers made more than one call; thirty-five calls were received from 16 ADF members who died by suicide. During the period, the hotline received 503 mental health‑related calls from 444 ADF members, including from a small number of those who died by suicide. These calls include:
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