Key Points for Serving and Ex-Serving ADF Members
Terminology
- Use ‘serving’ and ‘ex-serving’ for ADF members instead of ‘veteran’ to avoid misinterpretation.
Initial Consultation
- Build Relationship: Focus on developing a strong patient–doctor relationship.
- Trust and Disclosure: Understand that patients may initially withhold the extent of their conditions due to past traumas. They will disclose more as they feel safer within the relationship.
- Military Service Lifecycle: Incorporate knowledge of the stages of military service (recruitment, garrison, operations, return home, transfer to reserve forces, discharge) into patient assessment and management.
Cultural Considerations
- Recognize that the ADF is a significant employer of Aboriginal and Torres Strait Islander people.
- Ensure culturally appropriate services are available to support these members.
GP Role in Mental Health Management
- Multidisciplinary Team: GPs play a central role in managing mental health conditions within a multidisciplinary team.
- Encourage Civilian Healthcare Engagement: Empower ex-serving patients to re-engage with civilian healthcare and DVA services.
- Health Literacy: Understand that many serving members may have low health literacy and familiarity with the civilian health system.
- Advocate Support: Encourage ex-serving patients to use DVA-trained advocates to assist with claims and support.
Health Assessments and DVA Support
- Medicare-Funded Health Assessments: Use these to help ex-serving members identify potential health problems.
- Encourage DVA Applications: Promptly encourage applications for DVA support for comprehensive treatment systems.
- Referrals: Refer to psychiatry, psychology, mental health social work, and occupational therapy as needed. Family members may also be eligible for benefits.
Common Health Issues
- Primary Care Issues: Serving and ex-serving members may present with common primary care issues and conditions related to military service (e.g., musculoskeletal conditions, substance use disorders).
- Service-Related Health Conditions: Assess and identify any service-related health problems early, including mental health issues.
- Denial of Service Connection: Be aware that patients might not realize or may deny the connection between their health conditions and military service.
Professional Challenges for Clinicians
- Reconcile Needs: Clinicians may need to balance the health needs of the patient with the requirements of the ADF as their employer.
- Occupational Medicine: Similar challenges to those faced by occupational medical officers may arise.
Guiding topics
- Understand common presentations in serving and ex-serving Australian Defence Force (ADF) members and their possible aetiologies related to military service:
- environmental health conditions, including exposure to agents more likely to occur in a military setting. If suspected, these will require referral for specialist assessment. (For more information on environmental hazards see the Occupational and environmental medicine unit.)
- acute and chronic musculoskeletal conditions
- acute and chronic pain
- mental health conditions including depressive disorders and anxiety disorders, such as post-traumatic stress disorder (PTSD)
- substance use disorder
- comorbid medical conditions.
- Understand the experience and meaning of military culture in relation to health and mental health.
- Understand the role of the Australian Defence Force (ADF) and Department of Veterans’ Affairs (DVA) in caring for the health of serving and ex-serving military members, including the potential tensions between providing services for the patient and services for an external organisation.
- Understand eligibility requirements for DVA benefits and an overview of the application process.
- Be aware of the culturally appropriate services available to Aboriginal and Torres Strait Islander ADF members.
ADF doctors and registrars
Additional areas of content and focus include:
- Garrison Health – the provision of health services to entitled ADF personnel including training of ADF medical personnel and providing operational health support to the ADF. (See the RACGP Standards for Garrison Health Facilities in the Australian Defence Force .)
- conducting medical risk assessments and advising on mitigation; for example, fitness for operational duties
- working closely with international colleagues on joint operations and in joint health facilities, operating independently overseas in both developed and less developed nations
- provision of aviation and/or underwater medicine services in support of flying and diving operations
- provision of advice to Command regarding maintaining optimum workplace health and performance in demanding conditions.
Deployments to remote national and international locations during operations and exercises may require additional skills; for example, emergency medicine and trauma skills, retrieval medicine, tropical medicine and refugee health. This includes working in remote environments with restrained resources.