Veterans and Veterans Families Counselling Service

National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

NAC Meeting Brisbane 21 & 22 Feb 2013

Minutes

Attendees: Dr Tony Austin AM (Chair) Mrs Mel Pyrah (Partner / families – member) Professor Malcolm Battersby (Psychiatrist – member) Dr David Cockram (Vietnam Veteran – member) Mr Brenton Russell DSM (Contemporary Veteran – member) Ms Tracey Negus (Daughters and Sons – member) Dr David Monash (General Practitioner – member) Mr Paul Copeland OAM JP (Peacekeeper/Peacemakers – member) Ms Heike Brown (Contemporary Veteran – member) Mr Ray Bromwich (Director General DCO – ex-officio) Professor David Forbes (ACPMH – ex-officio) Mr Wayne Penniall (National Manager VVCS – ex-officio) Ms Karen Campbell (Secretariat)

Apologies: MAJGEN Mark Kelly AO DSC (Commissioner) WO David Ashley OAM – RSM-A

Day 1: 21 February 2013 The Chair opened the meeting and welcomed the three new members, Mrs Pyrah, Mr Copeland and Ms Brown who gave a brief introduction to the committee.

Mr Dennis O’Brien, Director VVCS Southern Queensland gave a presentation on the services and activities conducted by VVCS in Southern Queensland. Main points discussed included:  Intakes are usually about 15-16 per day. This has increased following the floods which has led to increased stress and mental health issues.

 Less numbers of staff in Southport to reflect increased demand in Brisbane.

 Currently 134 Outreach Programs Counsellors (OPCs) registered giving a good regional coverage. About 80 OPCs regularly provide counselling.

 There are limited referrals to other OPCs due to reasons such as:

- Location in relation to other providers

- No demand in their area

- Skills don’t match presentation of clients.

 Ipswich outpost, near Amberley RAAF base, operating three days a week and booked out. Consideration is being given to increasing this to four days a week to meet increasing demand.

 Numbers of groups diminishing primarily as number of Heart Health groups have reduced.

Day 2: 22 February 2013 The Chair opened the meeting and acknowledged the traditional owners of the land on which the meeting is being held, and paid his respects to their elders, past and present. He also acknowledged the Vietnam veterans, the founders of the VVCS.

The Chair acknowledged the outstanding contribution of retiring members, Mr Martin Carr and Ms Bronwyn Fullick. The Chair will write letters of appreciation to Martin and Bronwyn.

1.1 Chair’s Report The Chair has been monitoring the proliferation of Facebook pages that have developed for recently separated members noting that several sites have VVCS badging on them to advise of where go to for support. He noted that VVCS was not managing to maximising its marketing to that group.

The Chair has been trying to contact MAJGEN John Cantwell to ask him to consider acting as a positive champion for VVCS.

1.2 Correspondence In: Nil Out: Minutes of the previous meeting.

1.3 Minutes of 8-9 November 2012. The Minutes of the previous meeting were agreed.

1.4 Actions arising from the Minutes of 8-9 November 2012 Action Who Outcome 1. National Manager to remind VVCS National Manager Actioned – Relevant VVCS offices to invite NAC members and Directors advised of new ensure contact details are provided to members contact details for Offices for invitations. RCF invites. 2. NAC Secretariat to provide copies of NAC Secretariat Ongoing. Secretariat doing the quarterly NSW e-newsletter to NAC an audit of provider e- members and to check re posting this newsletters from Centres newsletter on DVA website. and developing a process to ensure these are on the DVA website. 3. National Manager to provide update National Manager Detailed in Agenda Paper on the review of group programs at next 2.15 meeting. 4. VVCS to check on the status of NAC Secretariat VVCS confirmed that VVCS advertising in service advertisement is run newspapers and review use of local monthly in service newspapers. newspapers. More details are in Agenda Paper 2.4. 5. National Manager to provide specific National Manager Detailed in Agenda Paper report on progress on Agreement for 2.11 Service for next meeting. 6. Distribute presentation on genograms NAC Secretariat Copy distributed to NAC to NAC members. members with papers. 7. National Manager to update the table National Manager Detailed in Agenda Paper to NAC members on Service Mix 2.12 Review with initial proposed timeframe and revised timeframes. 8. National Manager, VVCS to provide National Manager Detailed in Agenda Paper information on VVCS client drug and 2.16 alcohol issues for the next meeting. 9. NAC members to provide feedback NAC members Discussed at Item 3.1 on the clinical governance paper to and Malcolm Malcolm Battersby who will refine the Battersby paper for the next NAC meeting. 1.5 Debrief from Consultation meetings The Committee reviewed the consultations meetings held with staff, clients, stakeholders, providers and the ADF.

2.0 National Manager Report The National Manager provided a statistical report on services provided by VVCS: Attachment A. Members noted that there had been an increase in services provided across the board particularly in southern and northern Queensland and in Darwin to a lesser degree.

Staffing Interviews have been held for Director Darwin, and the Assistant National Manger position closed on 14 February. The Director, Sydney to become vacant as occupant is transferring to a position with DVA. Recommendation: The NAC noted the update provided.

2.1 Strategic Promotions Update The National Manger provided an update on strategic promotions: Attachment B.

VVCS is currently advertising in set of key newspapers and magazines including every Vet Affairs issue, men’s peer health magazine and is looking at using local newspapers. Mr Penniall acknowledged that VVCS needs to be more proactive in marketing eg drafting a set of stories to provide to the broader media.

Approval has been given for a VVCS dedicated website which is to be developed in house. This was seen as a positive move by VVCS.

VVCS to consider having a Facebook page and noted that it would need to be closely moderated. The Chair raised the idea of using volunteers as moderators.

Recommendation: The NAC noted the update provided.

Action 1 - National Manager to provide NAC a copy of the VVCS marketing strategy.

2.2 Heart Health Update The National Manager provided an update on the Heart Health program: Attachment C.

Mr Penniall noted that VVCS and the Department are looking at the Heart Health and Stepping Out programs and examining ways to improve take up, as well as improvements to Heart Health to ensure the program is better targeted to contemporary clients.

2.3 Mental Health Accreditation Update The National Manager provided an update on mental health accreditation: Attachment D.

2.4 Delivery of VVCS Services to Serving Members Update The National Manager provided an update on Delivery of VVCS Services to Serving Members: Attachment E.

The revised AfS agreement is nearing completion. This is a discrete Schedule attached to overarching Agreement which sets out how Defence and DVA work together. The main changes proposed are to allow a larger range of health professionals to refer to VVCS, improved reporting, training and collaboration and financial arrangements. The Schedule will go to the Defence Links Steering committee in mid- March for ratification. Professor Forbes highlighted that Defence should be advised by VVCS that if they refer serving members for anger, the client will be treated using evidence based interventions around anger.

Action 2 - The Chair requested provision of trend data by Centre to see if any there is any impact of NAC visits. 2.5 F-111 Deseal-Reseal Update The National Manager provided an update on the F-111 Deseal-Reseal program: Attachment F.

Mr Penniall advised that the Australian National Audit Office was conducting an audit of DVA’s response to the F-111 study and that VVCS involved in this response though providing lifestyle courses and counselling.

2.6 Operation Life Update The National Manager provided an update on Operation Life suicide awareness workshops: Attachment G.

2.7 Complaints and Feedback Management Data The National Manager provided an update on complaints and compliments received by VVCS: Attachment H.

Action 3 - VVCS to include number of counselling sessions provided in same period to give context for the number of complaints.

2.8 Family Inclusive Practice Update The National Manager provided an update on family inclusive practice in VVCS: Attachment I.

2.9 Learning and Development Update The National Manager provided an update on learning and development activities in VVCS: Attachment J.

Action 4 - VVCS to provide NAC members with details of the formal orientation information used for centre based staff and outreach program counsellors.

2.10 Regional Consultative Forums (RCF) Update The National Manager provided an update on recent RCFs held: Attachment K.

It was noted that the issue of childcare is consistently raised at RCFs. VVCS pays for childcare for clients attending lifestyle courses only. Wayne Penniall advised that VVCS has scoped available childcare near our centres. Dr Monash suggested that VVCS acknowledge the need for childcare by meeting the cost. Recommendation: The NAC noted the update provided.

2.11 Property Update The National Manager provided an update on property issues: Attachment L.

The new Darwin office should be open in mid-June.

Recommendation: The NAC noted the update provided. 2.12 Service Mix Review Update The National Manager provided an update on the Service Mix Review: Attachment M and noted that a some recommendations have been completed and for some, implementation depends on the progress of other initiatives such as the recent environmental scan undertaken.

2.13 Management Information System Update The National Manager provided an update on the development of a new management information system for VVCS: Attachment N.

The new system will provide improved administrative processes, more consistent management of the intake process and for those clients who want it, access to the Personally Controlled Electronic Health Record (PECHR).

2.14 Stepping Out Review Update The National Manager provided an update on the review of Stepping Out: Attachment O.

2.15 Group Program Review Update The National Manager provided an update on the review of group programs: Attachment P.

2.16 Drug and Alcohol Paper The National Manager provided a paper on VVCS client drug and alcohol issues: Attachment Q.

Recommendation: The NAC to review the information provided.

Action 5 - VVCS to notify committee when the new app – On Track with the Right Mix is available.

3.0 Draft Mental Health Strategy – Discussion with Veronica Hancock and Jon Wauer, Mental and Social Health Branch, DVA (brought forward on agenda) Ms Veronica Hancock outlined the development of the draft Veteran Mental Health Strategy which sets the context for mental health services in the veteran community and is underpinned by a client focus. The strategy sets the high level strategic directions for mental health and a comprehensive action plan will sit under the strategy. DVA is currently analysing submissions and will then revise the strategy and it will go through the formal clearance processes.

Comments from NAC on Draft Strategy  The strategy would benefit from improved clarity regarding whether it is designed for the public, veterans, clinicians, or defined mental health providers. Ms Hancock noted the complexities with a document such as this and agreed that it would be useful to be specific about which part is for who e.g. families, providers etc.

 The graph on page 11 is not intuitive.

 The formatting around objectives hard to follow and it appears that some objectives also list actions.  The objective ‘Strengthening Partnerships’ excludes GPs who manage 80% of mental health issues in the community and a greater focus on GPs would be helpful.

 The report on sexual abuse in ADF is not covered in the strategy. Mr Jon Wauer noted that this has been raised by others and it will be included in next iteration. The strategy was aiming for a balance covering all of the emerging issues and range of cohorts.

 PTSD not a one fit category – veterans are also diagnosed with anxiety, adjustment disorder – not just PTSD. Mr Wauer noted that the strategy reflected a move from a medical model to biopsychosocial model.

 Ms Hancock highlighted that a social health strategy was being devoted and comments from the NAC would be welcome.

 Reduction in volunteers as Vietnam veterans numbers decline. ESOs are struggling to find volunteers. Ms Hancock acknowledged this issue and advised that a social health strategy to ensure mental health through social connectedness is also currently being developed.

 The work being done by ex-serving member, Mr Dane Christison in getting vets to the gym and giving mutual support was noted. Ms Hancock advised that this was exactly the sort of program that would be considered for the social health strategy.

 Families of veterans need to be considered in the strategy. The Vietnam Veterans’ Family Study highlights the importance of family support as a protective factor for mental health issues. It was suggested that the strategy be aligned with the outcomes of the family study. Mr Wauer advised that this would be included under ‘Strategic Objective 5 research’ as an evidence base and could be highlighted in the action plan..

Other mental health initiatives Ms Hancock outlined a number of recent mental health initiatives undertaken by the Mental and Social Branch. These include:  Revamp of At Ease Website including dividing it into sections for clients, families and clinicians, in order to guide people to the information which is important to them.

 Development of 9 mental health videos for viewing on You tube covering topics such as depression, mental health disorder, anxiety. The videos have a mix of actors and champions including General Hurley, Maj General Mark Kelly, Dr Rob Walters, The Hon Graham Edwards and current veterans who are clients of DVA (including

Mr Dane Christison). The key message is that there is help available, help can make a difference and to contact VVCS or the ADF helpline. The videos can be accessed through the At EASE website or at: http://www.youtube.com/user/DVAAus/videos  Mobile phone app – Australian version of PTSD coach which can be used as an adjunct to clinical treatment. Includes clinical guidelines and self-help tools such as deep breathing, guided imagery and mood assessment.

 DVA are keen to get feedback on the app including what works well and any suggested enhancements.

 On Track with the Right Mix App which was tested by cadets and soldiers at Soldier Recovery Centre at Enoggera. This app can track your drinking and how this effects your overall wellbeing and budget.  Work is also underway on an app to bring to life some of the tools on the Wellbeing toolbox.

Ms Hancock also provided an update on the environmental scan conducted by Mary Murnane which was looking at the size of demand for mental health services in the future. DVA is currently considering the report and assessing if current mental health programs and services will meet the needs of the contemporary cohort.

The Chair noted that the NAC were looking forward to seeing the recommendations of Ms Mary Murnane’s work.

Agenda Item 3.1 Clinical Governance Paper Professor Malcolm Battersby provided a background on the clinical governance paper. The Committee discussed the purpose of the paper and how it could link to Mary Murnane’s recommendations which included improving clinical governance and increasing capability to meet the needs of complex clients.

The Committee decided to proceed with their own clinical governance paper and then adapt and modify it to be congruent to DVA’s new directions. The paper will then be provided to DVA.

Agenda Item 4 Other Business The issue of home visits by VVCS was discussed and under what circumstances would VVCS consider a home visit. Mr Penniall outlined that the general policy is that VVCS does not do home or hospital visits. VVCS can link in DVA allied health arrangements Professor Forbes noted a conflict of interest in regards to services to assist with gambling but wished to highlight the issue of gambling problems and that gambling was to be listed as an addictive behaviour DSM V.

The Chair raised the issue of veterans in prison and that during intake it was not revealed if they were a veteran; it is only discovered when asked if on a pension. Dr Cockram raised case, NAC to formally flag this issue to VVCS to ascertain if veterans are over or under represented by those in prisons.

Wayne Penniall advised that VVCS does not provide counselling to prison inmates. VVCS is happy to meet with Justice psychologists to discuss military culture and the impact of military trauma. VVCS is also ready to provide services once discharged from prison but would not recommend that VVCS provide counselling to veterans in prison as the corrective services have programs and provide these services.

NAC Members to regularly monitor website and advise secretariat of any issues of changes required.

Training for advocates – accidental counselling. VVCS gets involved in TIP training and could use the modules from this training or advocates could visit VVCS centres for an orientation to VVCS.

Next Meeting The next meeting is to be held in Darwin in the last 2 weeks of June: either 19/20 June, or 26/27 June. The proposed base visit is to the Headquarters at Larrakeyah Barracks. Summary of Actions Action Who Outcome 1. National Manager to provide National Manager NAC a copy of the VVCS marketing strategy. 2. The Chair requested provision National Manager trend data by Centre to see if any there is any impact of NAC visit. 3. VVCS to include number of National Manager counselling sessions provided in same period to give context for the number of complaints. 4. VVCS to provide NAC National Manager members with details of the formal orientation information used for centre based staff and outreach program counsellors. 5. VVCS to notify committee NAC Secretariat when the new app – On Track with the Right Mix is available. 6. VVCS to invite local PTSD NAC Secretariat program providers to stakeholder consultations/RCF. Attachment A National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.0

2.0 National Manager Report and Updates - Overview of services

In total, 21,205 unique clients received VVCS services during 2011- 12, up 4% on the 20,457 clients in the preceding year. Of these, 12,486 clients received counselling and/or participated in group treatment or psycho-educational programs. Veterans line received 5497calls.

Data for the July - September 2012 period are below.

VVCS Regional Quarterly Report to NAC July - September 2012 NSW All Regions NT VIC SA FNQLD SQLD WA TAS ACT TOTAL CENTRE COUNSELLING Total number of centre based clients that had sessions 75 307 162 352 109 502 156 65 1728

Total number of Centre based services (sessions) 260 729 346 1048 331 1446 502 259 4921

Number of cases open during the quarter 87 229 198 392 128 504 217 64 1819 Percentage of 1st episodes 58.89 43.16 45.15 43.5 54.2 54.4 41.2 37.5 47.7

OUTREACH

Total number of outreach clients that had sessions 145 448 102 577 590 586 120 93 2661 Total number of Outreach 401 2089 450 3017 2576 2134 1335 538 12540 sessions Percentage of 1st episodes 62.44 56.9 50.47 49.2 50.6 51.2 38.4 31.9 47.35 INTAKES

Total number of intakes 159 672 277 647 603 991 248 192 3789 Total number (Not for further action) 32 286 113 182 186 137 48 107 1091 Total New allocations 64 223 88 288 257 455 83 30 1488 Total representing clients 63 158 65 246 157 373 114 54 1230 Percentage of Representing clients 39.62 23.51 23.47 38.0 26.0 37.6 46.0 28.1 32.46

GROUP PROGRAMS

Total number of unique group clients who has sessions 33 112 18 237 88 169 37 148 842 Total number of unique groups which had sessions 4 20 2 22 9 18 5 14 94

Total number invited to group programs 77 393 169 693 201 451 377 132 2493

COMMUNITY ACTIVITY

Total number of hours of community Activity 46 90 9 108 21 134 11 139 558 Total number of unique community activities 10 27 3 35 18 42 6 17 158

Number of attendees in community activities 241 576 416 2018 340 4257 141 250 8239

OTHER Total number or partners and sons and Daughters referred 0 8 0 9 1 6 2 0 26 to psychiatrist Number of Psychiatrist sessions 0 18 0 25 1 14 10 0 68

Total number AFS referrals 14 0 3 14 163 105 0 1 300 External

Veterans Line call types Veteran Partner Related Other Not Peace War Total Stated Keepers Widows Calls

353 32 365 116 392 5 96 1359 Attachment B National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item: 2.1 Strategic Promotions Update

Purpose To provide the NAC with an update on VVCS marketing and promotional activities.

Background Regular review of mechanisms to deliver this message is necessary to ensure that the organisation continues to appropriately promote its mental health counselling and support initiatives to existing clients, and also captures emerging client groups resulting from contemporary military operations. The core VVCS message to clients and stakeholders, is that ‘VVCS is a free, confidential, counselling service dedicated to supporting the mental health and wellbeing of the Australian veteran and ex-service community and their families’.

Update As part of its internal change management strategy VVCS has introduced a regular National Update to all staff as a way of keeping everyone informed of governance decisions, project activities and outcomes, events and as a way to share learnings. This increase in communication has been supplemented by greater use of the internal SharePoint website and has been well received by all staff.

VVCS has received internal permissions to progress the VVCS online presence with design and ICT work on a stand alone site (linked to the DVA and Ministerial sites) having commenced this month. Increasing the online presence of VVCS and more effectively embracing social media are also considered important tools for engaging with contemporary clients. In 2013 a project will commence to identify and assess the clinical veracity of online tools and develop an internal compendious of resources that can be provided to clients depending on their presentations.

In parallel to increasing use of social media, VVCS continues to utilise print media to reach its target audience, including regular promotional adverts in: ADF newspapers (Army, Navy and Airforce news); Defence Family Matters; PVA Journal; Australian Peacekeeper; Australian Reservist; and the AFP Journal. VVCS is also focusing on reaching military medical corps through the Paulatim annual (RAAMC) and will leveraging portfolio opportunities in 2013 with an increased presence in the Men’s Health Peer Education and VetAffairs publications. VVCS is also examining the targeted use of local newspapers where relevant and appropriate to promote to specific groups.

Ensuring communication remains targeted and appropriate to client demographics is a fundamental objective of VVCS communication moving forward. VVCS also continues to work collaboratively with DVA publications and media to assess opportunities to strengthen VVCS’ presence in the media, including input into media articles and briefings on VVCS for television programs.

Recommendation That the NAC note steps taken by VVCS to progress marketing and promotional activities since the last meeting.

Wayne Penniall National Manager VVCS February 2013 Attachment C National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item Number 2.2 Heart Health Update

Purpose: To provide an update on the status of the Heart Health Group and Outreach Heart Health Programs.

Background The Heart Health and Outreach Heart Health Programs are important and popular programs that provide physical and psycho-educational support to Veterans. Currently there are 11 groups running with a total of 136 participants and 143 Veterans enrolled in the Outreach Heart Health program which is an individual tailored program.

Activity Corporate Health Management (CHM) is continuing to provide Heart Health and Outreach Heart Health programs. In regions where there is insufficient numbers to run a traditional group (minimum 12), CHM has developed a flexible hybrid model for the delivery of the Heart Health program for Small Groups (7-11 participants) and Clusters of individual participants (2-6). In this model, groups of individuals who are enrolled in the Outreach Heart Health Program also receive regular facilitated or co-ordinated group sessions (e.g./ exercise classes, small group personal training sessions, walking groups, aquatic based activities).

 The quarterly monitoring meeting was held with CHM on 12 December 2012. The meeting discussed programs to date and ways to improve the participation rate in both group and outreach heart health programs.

Recommendation It is recommended that the NAC note the above program activities.

Wayne Penniall National Manager VVCS February 2013 Attachment D National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.3 Mental Health Accreditation Update Purpose: To update the NAC on VVCS accreditation through the Quality Improvement Council of Australia.

Background Accreditation, and the discipline of undertaking the accreditation process, increases VVCS accountability to our stakeholders, assists in facilitating an environment of continuous improvement, and ensures uniform ‘better practice’ behaviours are embedded across VVCS.

Activities VVCS completed phase two of the accreditation process, which involved the assessors visiting eight major VVCS centres to meet with staff and stakeholders in September 2012. This also included reviewing substantial documentary evidence against the accreditation criteria and receiving feedback via survey from outreach counsellors and clients.

As noted in the last NAC update on accreditation, steps to strengthen and improve VVCS governance and policy are already being implemented. Although not yet in a position to provide a definitive position on VVCS’s accreditation status, the review team has noted that VVCS has a genuine respect for clients, and provides high quality services that are highly regarded in the ex-service community and a commitment to ongoing quality improvement.

Recommendation It is recommended that the NAC note VVCS progress towards maintaining its accreditation as a national mental health service provider.

Wayne Penniall National Manager VVCS February 2013 Attachment E

Agenda Item 2.4

Delivery of VVCS services to serving members

Purpose: To provide an update on the provision of VVCS services to currently serving Australian Defence Force (ADF) personnel.

Background An agreement for access to VVCS services by current serving ADF members on a fee-for- service basis has been in place since 2000. In addition, any currently serving veteran may self-refer to VVCS for support at any time.

Issues Originally a schedule to the Memorandum of Understanding between the Department of Defence and the Department of Veterans’ Affairs for the Cooperative Delivery of Care and Support to Entitled Persons (MoU), since 2008 ADF access to VVCS services for otherwise non-eligible members has been facilitated through a stand alone agreement. To simplify and streamline the inter-departmental relationship, the agreement will again be subsumed into the MoU.

The agreement revision is near final, with significant work having been undertaken to update and refresh its terms, in particular in relation to administrative and reporting requirements and also to reflect changes in Defence’s definitions of and responses to members at risk. VVCS and Joint Health Command are on schedule to finalise arrangements in February 2013.

Quarterly AfS Statistics In 2011-12, 848 Defence referrals were made to VVCS, compared with 838 in 2010-11, and 544 in 2009–10. In the first quarter of the 2012-13 financial year 300 referrals have occurred, 268 of which have been in Queensland (refer Table 1). A national eight quarter trend for current serving members is also provided below.

VVCS Jurisdiction Total current serving Defence referral Self referral presentations Counselling Counselling North Queensland 382 163 219 South Queensland 255 105 150 New South Wales 150 13 137 Aust. Capital Territory 58 1 57 Victoria 63 0 63 Tasmania 22 1 21 South Australia 51 3 48 Western Australia 27 0 27 Northern Territory 88 14 74 Total 1096 300 796 Table 1: ADF members presenting at VVCS (from 1 July to 30 September 2012)

Of the 1096 currently serving members referred under the AfS or self referring to VVCS during the quarter, 726 clients received individual counselling. Of the remaining 370 clients, 250 participated in group programs following an assessment of needs at intake and the remaining 120 clients had issues dealt with during the intake process and no further support requirement was identified or sought.

The majority of the 300 personnel referred under the AfS participated in individual counselling, with 47 members (15.7 percent) participating in group programs and 31 members (10.3 percent) either choosing not to pursue support or following an assessment of needs at intake, their concerns were dealt with and no further support requirement was identified or sought.

Current Serving Member Presentations - 8 Quarter Trend

M Defence referred S C

Self referral r

b Linear (Defence referred) m

u Linear (Self referral) N 300

0 4Q10 1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 Quarter Presenting Issues1 Mental health issues continue to account for the majority of Defense referrals, whilst the majority of matters dealt with in self referrals centre around relationships and readjustment to family life.

Top Five Presenting Issues This Quarter and Last Quarter

Last Quarter Defence Referrals Rank Movement* 1 Anger 25.70% 1  2 Depression 22.70% 4  3 Health and Wellness 21.30% 3  4 Anxiety 21.00% 2  5 Post deployment 11.30% 8  Top 5 Percentage of Total Presentations 62.83%

1 VVCS records up to three presenting issues recorded for one episode of care. Last Quarter Self Referrals Rank Movement* 1 Relationships 27.70% 1  2 Anger 17.50% 2  3 Health and Wellness 15.90% 3  4 Military discharge/adjustment 15.30% 4  5 Information seeking 13.90% 5  Top 5 Percentage of Total Presentations 60.18% * Change in percentage representation since last Quarter

Recommendation It is recommended that NAC note the update on the provision of VVCS services to currently serving Australian Defence Force (ADF) personnel and the near completion of a revised AfS.

Wayne Penniall National Manager, VVCS February 2013 Attachment F National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item Number: 2.5

F-111 Deseal-Reseal Update

Purpose: To update the NAC on developments with the provision of VVCS services to F- 111 personnel and their families.

Background In line with Recommendation 12 of the Government’s response to the Parliamentary Inquiry report, Sealing a just outcome: Report from the Inquiry into the RAAF F-111 Deseal/Reseal workers and their families, mental health support services were extended to both Group 1 and Group 2 SHOAMP Health Care Scheme participants. Depending on the need of individuals, this support may include participation in the VVCS F-111 residential Lifestyle Management Program and access to counselling and other VVCS group programs.

Update Noting the unique characteristics of the F-111 cohort, VVCS works in collaboration with the DVA F-111 Implementation team to promote and deliver a specialised Lifestyle Management Program.

In 2012-13, five F-111 Lifestyle Management Programs have been conducted for 58 participants:  Queensland (Gold Coast, 31 July - 3 August, 14 – 17 August and 30 October – 2 November))  Victoria (Flowerdale, 11 – 14 September) also targeting participants from Tasmania and the ACT; and  New South Wales (Port Stephens, 9-12 October).

This is the first time that an F-111 Lifestyle Management Program has been conducted in Victoria. VVCS expects to schedule more F-111 Lifestyle Management Programs in 2013-14.

The up-take of VVCS services generally amongst F-111 eligible clients is encouraging. In 2012-13 to date, 30 F-111 clients attended VVCS individual or couple counselling and 16 F-111 clients attended a VVCS group program other than an F-111 Lifestyle Management Program.

Consideration of the need for a VVCS group program to support the partners of F-111 clients is ongoing. Discussion on this issue has occurred with the Partners of Veterans Association (PVA) and the Deseal-Reseal Support Group.

Recommendation It is recommended that the NAC note the update on the provision of VVCS services to F-111 personnel and their families.

Wayne Penniall National Manager VVCS February 2013 Attachment G National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.6 Operation Life Update

Purpose: To update the NAC on the implementation of Operation Life, suicide prevention awareness workshops for the veteran community.

Background Operation Life, the National Suicide Prevention Strategy for the Veteran Community was developed in 2007 as a framework for action to prevent suicide and promote mental health and resilience across the veteran community. The major components of the framework consist of a choice of suicide prevention workshops, as well as the provision of information on treatment services that are readily available to the veteran community.

There are three workshops which have been available to members of the veteran community since May 2009:  SafeTALK: suicide alertness for everyone – a four hour workshop  ASIST: applied suicide intervention skills training – a two day workshop  ASIST Tune Up – a half day refresher workshop that consolidates and refines the learning from ASIST

Veterans’ attendance at Operation Life workshops is coordinated by VVCS centres across Australia. Eligible veterans may receive assistance for travel costs to attend a workshop. The workshops’ emphasis is on suicide prevention with the aim of helping members of the veteran community to recognise someone who might be having thoughts of suicide and to link them in with appropriate help. The workshops are not treatment programs.

Workshop activity From November 2012 to end January 2013 the following workshops were conducted:  1 Safe Talk half-day introduction workshop in Sydney with 7 attendees; and  1 ASIST two-day skills training workshop in South Queensland with 9 attendees.

Note that in the Christmas period there are traditionally less workshops provided.

Forthcoming Workshops The following workshops are proposed for the period January to June 2013:

Suicide alertness for everyone: (safeTALK) 16th March 2013 - Sale 25 March 2013 Wodonga 30 April 2013 – Darwin 2 May 2013 - Katherine June/July 2013 - Ulladulla (tentative)

Applied Suicide Intervention Skills Training: (ASIST)

18 -19 March 2013 - Ulverstone Week of 18-22 March 2013 – Hervey Bay

Applied Suicide Intervention Skills Training (ASIST) Tune Up 13th May 2013 – Adelaide

Operation Life Contracting The contract with the current provider of Operation Life workshops concludes on 30 June 2013. Planning is underway for procurement of ongoing suicide prevention workshops for veterans. This process will take into account the recommendations of recent research into Operation Life workshops conducted by the Australian Institute for Suicide Prevention and Research which is soon to be released publicly. The RFT will also explore greater opportunities with Defence in the procurement of suicide prevention services.

Recommendation It is recommended that the CAC note the above Operation Life activities.

Wayne Penniall National Manager VVCS February 2013 Attachment H National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item: 2.7

Purpose: To provide you with an update on the VVCS Complaints and Feedback Management Data

Background VVCS staff are responsible for accepting, recording and dealing with complaints, compliments and suggestions for service improvement that are received.

Complaints and compliments, as defined in the DVA Complaints and Feedback Management Policy, are recorded in the upgraded Complaints and Feedback Management System (CFMS). The handling of feedback is also included in the department’s Service Charter.

VVCS complaints and compliments are recorded on a separate confidential data base that is accessible to VVCS staff only. VVCS has established a separate email address for client feedback ([email protected]). Feedback is handled in accordance with the DVA policy.

Activities The table below summarises VVCS feedback for the period 24 October 2012 – 31 January 2013 and will be made available on the VVCS website as part of the NAC update. Greater detail on this feedback, which is NAC-in-Confidence, is provided in Attachment A.

All States Compliments Complaints VVCS - Counsellors 4 0 VVCS - Group Programs 1 1 VVCS – Country Outreach Program 0 1 VVCS - Other 1 2 VVCS - Educational Activities 1 0 Total 7 4 Table: VVCS Feedback – all states 24 October 2012 – 31 January 2013 Note: this excludes compliments received by VVCS on Client feedback forms.

RECOMMENDATION That NAC note the update on VVCS Complaints and Compliments activities.

Wayne Penniall National Manager VVCS February 2013 Attachment I National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.8

Family inclusive Practice

Purpose: To update the NAC on Family Inclusive Practice (FIP) in VVCS

Background In 2010 VVCS introduced a family inclusive approach to working with clients and in overall service provision.

Family inclusion is viewed as a significant improvement in providing services to veterans and their families and has an evidence base in supporting the well being of children with parents with a mental illness.

Activities Given the breadth of activity needed to implement family inclusion in VVCS the work has been undertaken in two phases:

1. Phase one, from May 2010 to December 2011 saw the piloting of two specific family inclusive clinical interventions - family consultation and ‘Lets talk about children’ – following training from the Bouverie Centre.

2. Phase two, in 2012-13 is the period in which family inclusion is embedded across VVCS policy and service delivery.

 In November 2012 a ‘Train the trainer’ session was conducted by VVCS in collaboration with the Bouverie Centre. This session provided VVCS Deputy Directors and family inclusion ‘champions’ with a training package to be used with all clinical staff in centres to support consistent national implementation of family inclusive practices.  Intake questions regarding client family composition and caring responsibility for children commenced use on 1 October 2012 nationally.  The ‘Let’s talk about children’ questionnaire was adapted by VVCS for use with veteran families.  A draft family inclusion policy has been completed, along with work in more specific policy areas related to working with children and families.

Recommendation It is recommended that you note the above activities.

Wayne Penniall National Manager VVCS February 2013

24 Attachment J National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.9

Learning and Development Update

Purpose: To update the NAC on Learning and Development activities in VVCS

Background Learning and Development is a key component in ensuring VVCS continues to provide high quality services to clients.

Collaborative Learning and Development Seminar Series Local stakeholders are invited to attend all centres and share in seminar presentations via video conference with centre staff (for example DCO, local community mental health agency staff, ADF mental health staff, other DVA staff, contractors). The next collaborative seminar will be on lifestyle issues for younger veterans, in particular drug/alcohol use and misuse and is proposed for April. Jennifer Harland and Professor Robert Ali, from the DASSA-WHO Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems have been approached to present on drug/alcohol use and misuse in the veteran and current- serving community. Jennifer Harland’s previous role was as the National ATOD Coordinator with ADF and she has recently been working with the World Health Organisation in the development of a comprehensive alcohol and other drug assessment measure. Her substantive role is as the Assistant Director of Alcohol Policy with the Australian National Preventive Health Agency.

CPT Update VVCS staff have been participating in an ACPMH research project to assess the effectiveness of training clinical staff to provide CPT treatments within a community setting. 37 VVCS clinicians (including all Deputy Directors) across Australia were trained in early 2012. The assessment period for this research program finished on 31 January 2013. All trained counsellors will attend a follow up training session via video conference in February/ March 2013. ACPMH will collate the results and provide a report before the end of the financial year.

Family Inclusive Practice The FIP Reference Group prepared an in house training package and two FIP ’champions’ from each state and territory have been delivering this package to all clinical centres staff in the first quarter of 2013. All clinical staff will be able to provide family consultation sessions and also ’Lets talk’ sessions for clients who have parenting responsibilities.

Recommendation It is recommended that the NAC note the above activities.

Wayne Penniall National Manger VVCS February 2013

25 Attachment K

Agenda Item Number 2.10

Regional Consultative Forum (RCF) Updates-

Purpose: To update the NAC on VVCS Regional Consultative Forum Updates

Summary of RCF meetings:

Region Date of last RCF Date of Next RCF Adelaide 28 November 2012 May 2013 Southern 5 December 2012 March 2013 Queensland Northern Rivers 16 November 2012 17 May 2013 Northern Queensland 20 November 2012 14 February 2013 Canberra Regional 18 October 2012 9 April 2013 Darwin 17 August 2012 (QIC meeting) April 2013 Sydney 27 November 2012 7 May 2013 Tasmania 8 November 2012 7 March 2013 Victoria 22 November 2012 21 March 2013 Newcastle 14 August 2012 To be advised Perth 29 August 2012 (QIC meeting) 19 March 2013

Following is a summary of key recommendations and comments from RCF’s that have been held since the last NAC meeting

Canberra – 18 October 2012 Recommendations, Decisions and Action Who When It was recommended that child care Feedback to For NAC arrangement for Veterans and families NAC February accessing VVCS counselling and groups be meeting 2013 considered. Whilst the RCF acknowledges age care is not a Gerry Mapstone Next RCF VVCS issue, it was determined that Gerry VVFA Mapestone VVFA will table this issue at the upcoming Age Care Conference. It was recommended by the RCF that a grand RCF Next RCF parenting forum similar to the Penrith forum be undertaken in the ACT in 2013. The forum will be placed on the next RCF agenda for action.

Adelaide – 28 November 2012 Recommendations, Decisions and Action Who When Representative from Partners of Veterans SA Michael Burvill 2013 (Ann Stanton) recommended VVCS provide to follow-up workshop to new widows to aid in adjustment

26 to ‘new way of life’, both practically and psychologically.

Northern Rivers – 16 November 2012 Recommendations, Decisions and Action Who When  Palm Beach Currumbin Clinic service and VVCS Next NRCF referral information to be included in the VVCS report to the forum. Palm Beach Currumbin be invited to a meeting VVCS Within 2013 to provide a one off briefing. It is recommended the Northern Rivers NRCF Next NRCF Consultation Meeting Terms of Reference be Facilitator discussed and reviewed at the next Forum. Event Calender-All activities for inclusion in the Kylie Watson December 2013 Calender to be emailed to Kylie within two VVCS weeks.

Northern Queensland – 20 November 2012 Recommendations, Decisions and Action Who When The 3rd stage of Townsville’s strategic planning RCF Complete process with the regional stakeholders occurred. At this meeting, representatives from Meetings ADF, ESO and community organisations planned for attended. The group focussed on a vision 2013. statement and began the process of prioritising the work of the RCF, generated in the last 2 Work of the meetings. National Manager also attended and RCF identified responded to community concerns in relation to and prioritised. confidentiality.

Sydney - 27 November 2012 Recommendations, Decisions and Action Who When The RCF recommends that the TPI Committee RCF Next RCF consider including information on TBI in TIP 7 May 2013 welfare training. This recommendation to be communicated to the TIP committee by VVCS and VAN. It is recommended the RCF investigate the RCF Next RCF possibility of developing or locating a facts 7 May 2013 sheet on TBI that provides a user friendly overview on the subject.

Victoria – 27 November 2012 Recommendations, Decisions and Action Who When Discussion: Confidentiality and VVCS Ted Harrison to Prior to next Vic records respond to RCF meeting The issue of ‘confidentiality and VVCS records’ coronial inquiry 21 March 2013 was placed on the agenda by representatives question of VVAA, PVA and RSL following a VVCS

27 client’s case file being subpoenaed and Ann O’Kane presented at a Family Court hearing in circulated DP Townsville. response to RCF members Ted Harrison, Director of Litigation for the Department of Veterans Affairs, presented to NO to respond the VCF on ‘Confidentiality of VVCS records’. to any actions for the Mr Harrison advised that DVA have taken policewoman strong action in response to the incident in involved Townsville. He stated that the letter circulated by the client’s solicitor is highly inaccurate. However once the court rules that records are to be released then the Department is bound to do so.

Action: 1. Ted Harrison to respond on whether records can make their way into the public domain if they are released for a coronial inquiry. 2. Provide response by the Deputy President that addresses the issues raised. 3. Investigate what actions have been taken against the policewomen who subpoenaed the VVCS records.

Tasmania – 8 November 2012

Recommendations, Decisions and Action Who When RCF members endorsed the following meetings:

Meeting 1, 2013, all VVCS counsellors will be VVCS Next RCF invited to attend and present a brief 7 March 2013 presentation to the RCF group about their work.

Forum members endorsed the idea of seeking a video-link at a future RCF meeting with John Flanagan, RCF Facilitator for NSW and QLD.

Southern Queensland – 5 December 2012 – Minutes not yet available

28 Attachment L National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

VVCS Property Update

Purpose: To provide an update on the status of VVCS leases and accommodation.

Background VVCS has 15 Centres nationally. Eight VVCS Centres (Townsville, Brisbane, Sydney, Canberra, Melbourne, Launceston, Adelaide and Perth) are in separate locations from DVA premises. VVCS has three part-time out posted centres (Ipswich, Elizabeth and Noarlunga) in separate locations from DVA premises.

Six VVCS Centres are located at the same location as DVA premises (for example in the same building complex or as co-joined premises), but with separate signage, office entrances and waiting areas. These are in Maroochydore, Southport, Lismore, Newcastle, Albury/Wodonga and Hobart. One Centre (Darwin) shares an entrance and reception area, but has individual signage.

Activity Lismore A five year lease with a three year extension commenced 1 July 2012 incorporating an additional 134 m² space in the same building. This will also ensure separate street entrance and client reception.

Office designs are being finalised (the “ideal characteristics” design brief developed by the National Advisory Committee (NAC) have been used to assist in informing the design) and it is expected VVCS to be in the new office by March 2013.

Darwin The Department has identified alternate premises in Winnellie and on 9 May 2012 signed a 10 year lease for these premises, for the period 1 March 2012 – 28 February 2022. this will provide an increase in space of 145.8m2 (ie 27%) over the current property.

This property will have complete separation of client reception and access areas and separate street entrances for VVCS and DVA.

Floor plans are currently being drafted. The NAC design brief is informing work to be undertaken. It is expected that the new premises will be operational June/July 2013.

29 Attachment M National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.12

Service Mix Review Update

In 2010 VVCS commissioned an independent review, the Service Mix Review, to provide advice on the appropriate service delivery model for VVCS to meet the changing needs of the veteran and defence communities and their families. Independent consultants Sue Belsham and Associates conducted the review which included focus groups and submissions from ESOs, clients and staff.

The Service Mix Review was completed by the Consultants in late July 2010 and received by the Department in August 2010.

The Department and VVCS considered the SMR report’s 27 recommendations and developed a response to these recommendations. The National Advisory Committee (NAC) also provided advice to both the review and the response. The response accepted 22 recommendations, partially accepted four recommendations and did not accept one recommendation.

The Report and Response were released on the VVCS website in June 2011. The Service Mix Review report concluded that the VVCS is a highly regarded, successful and valued service. The recommendations will help position VVCS to continue to be responsive to the changing needs of the veteran community into the future.

As would be expected, some of the 27 recommendations are straightforward and are currently being implemented or are completed. Some recommendations have required a longer lead time due to complexity and the need for significant scoping. These include recommendation 8, relating to a review of client eligibility, recommendations 10 and 16, relating to case management and enhancement of the VMIS data management system, and recommendation 23, relating to a restructure of VVCS.

The one recommendation not accepted is recommendation 24, regarding converting temporary staff once in position for twelve months or more to permanent full time positions. The rationale for not accepting recommendation 24 is that this is a line management matter. While VVCS uses temporary staff as little as possible, the inadvertent use of a temporary staff member over 12 months would, if the recommendation were accepted, potentially increase the VVCS permanent staff establishment and have a budget impact.

30 Attachment N National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

VVCS Management Information System Project

Purpose: To provide an update on the status of the VVCS Management Information System project.

Background The VVCS Management Information System project MIS will incorporate the Government imitative of Personally Controlled Electronic Health Records PCEHR. The new system will replace VMIS and allow VVCS to participate in the PCEHR as a provider to the program for clients to have a summary of their interaction with VVCS uploaded to their own PCEHR. The system will also provide VVCS with a system which will ensure accountability, confidentiality and record keeping to be better managed.

This is an exciting development, and as well as ensuring VVCS has a Personally controlled Electronic Health Record (PECHR) compatible system, will improve VVCS clinical data management.

Activity

A tender to obtain a Commercial Off the Shelf (COTs) product has been finalised. The new vendor will shortly commence work on configuration of the COT’s product to meet VVCS specifications.

VVCS has a team of staff with IT support operating as an Expert Panel for the project. The Expert Panel has continued to its work on business rules and procedures for the configuration of the MIS.

MIS newsletters are being distributed internally to all staff monthly to keep them informed of the progress of the project.

A road show to all major centres is planned for May 2013. The road show presentation will be provided to staff and contracted service providers who are able to attend. Those providers who are unable to attend will be provided with webinar and other interactive tools.

Other training for staff and providers will be rolled out nearer to implementation of the MIS.

Wayne Penniall National Manager VVCS February 2013 Attachment O National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.14

Stepping Out Program Review

Purpose: To provide the NAC with an update on a multi-agency review of the Stepping Out transitional program.

Background The Stepping Out program is a two day, voluntary program for members separating from the Australian Defence Force (ADF). It aims to increase awareness of psycho-social skills and behaviours that may assist in the transition from military to civilian life. Program participation has stabilised at eight percent of separating members, below what was originally anticipated.

The recent review into the Administration of Mental Health Initiatives to Support Younger Veterans conducted by the Australian National Audit Office recommended that DVA review the Stepping Out program. The ANAO audit noted that VVCS had already planned a review of the program. A multi-agency committee, chaired by VVCS, was established to undertake the review.

Update The review included consideration of participant feedback collected after every program, associated documents, promotion and delivery processes, along with collection of feedback from front line stakeholders in the Department of Veterans’ Affairs (On Base Advisory Service (OBAS), Veterans Affairs Network (VAN) and other client related areas) and Defence (Joint Health Command, Transition Services and Defence Community Organisation).

It found that the program is highly effective and well regarded by those who attend. Participation rates could be considered to be in line with help seeking behaviour noted in other voluntary situations and as such initial estimates may have been in excess of what could reasonably be expected.

The Review, including draft recommendations in relation to improvements in program delivery and promotion will be submitted to the high level DVA-Defence LINKS committee for their consideration and direction on the program.

Recommendation That the NAC note the Review of the Stepping Out program and its next steps.

2 Attachment P National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.15

Group Program Review

Purpose: To update the NAC on progress towards completion of the VVCS group program review.

Background The group programs review provides recommendations for VVCS to re-orient its group program activity to better meet changing client needs and provide nationally consistent group programs. Contemporary veterans now represent a higher proportion of VVCS clients nationally than Vietnam-era veterans. They have different service needs and expectations which VVCS needs to respond to flexibly in order to provide effective group programs and encourage participation.

Review’s key recommendations The Recommendations Report’s key recommendations include:

 To provide national consistency, VVCS group programs should be consolidated around an expanded suite of national programs while maintaining capacity for centres to conduct short workshops in response to local service needs;

 The flexibility of group program delivery should be increased to better meet client needs. Program materials should be developed using online and social media resources and programs should be routinely provided out-of-hours;

 Utilising the stepped care principle of ‘shorter interventions first’, more programs of shorter duration which are strengths/wellbeing and skills-based should be provided to reduce barriers to participation. Longer and more intensive programs should be available to clients with greater clinical need;

 Nationally, VVCS should engage in strategic partnerships within DVA, and with other mental health agencies who have relevant subject area expertise, to assist in group program development and ensure coordinated and complementary service provision across the mental health environment;

 New protocols for evaluating group program outcomes should be developed to align VVCS with best practice in mental health program evaluation practices and with key DVA objectives.

3 Recommendation It is recommended that the NAC note VVCS progress towards reviewing its group program activity to meet changing client needs and to provide nationally consistent group programs.

4 Attachment Q National Advisory Committee Veterans and Veterans Families Counselling Service 1st Meeting Brisbane 21-22 February 2013

Agenda Item 2.16:

Management of VVCS Client Alcohol and Other Drug Issues in VVCS

Purpose: To provide the NAC with an information paper on VVCS client drug and alcohol issues in VVCS.

Background At the 8-9 November 2012 NAC meeting, the Chair requested information on how client alcohol and other drug issues are managed in VVCS.

Perspectives on alcohol and other drug service provision

 Alcohol and other drug (AOD) misuse is a significant, or potential, threat to psychological and physical well-being. The misuse of legal, prescription and illicit substances may cause far-reaching harm to individuals and their families. This is potentially exacerbated when significant psychological and lifestyle difficulties are present.

 AOD misuse is often comorbid with other psychological or physical disorders or conditions. It is common for people who misuse AOD to do so as part of ‘self-medicating’ for symptoms of, for example, PTSD, depression and anxiety or chronic pain. However, in the longer term such self medication often exacerbates psychological symptoms and in some situations can lead to substance dependency.

 In some cases AOD misuse may be a client’s primary presenting problem, while in others a mental health condition may be the main presenting concern, with a client having less awareness of the potential impact of their AOD misuse on their wellbeing. This is often despite concerns expressed by treating doctors, mental health clinicians and other people significant to the client.

Prevalence of AOD issues in the general community the Australian Defence Force (ADF) and VVCS clients

 Legal and illicit AOD usage has a significant prevalence in the general population. For example, a 2006 report identified that over 40% of Australians consume alcohol at least weekly and that 15% of Australians have used illicit drugs at least once in the last 12 months)..

 The ADF Mental Health Prevalence and Wellbeing Study (2010) found that for ‘alcohol disorders (dependence and harmful use)’: - alcohol disorder was significantly lower in the ADF than the general community, with most of the disorder being prevalent for males in the 18-27 age group; - younger ADF females (age 18–27) had much lower rates of alcohol disorder than their - non-ADF counterparts; - there were no significant differences in rates of alcohol dependence disorder between Navy, Army and Air Force; - Navy and Army were significantly more likely than Air Force to experience alcohol harmful use disorder; and - There was no significant difference between ranks in the rate of alcohol disorders.

5  The study concluded that, ‘the prevalence of alcohol disorders in the ADF is broadly in keeping with that in the general community. However, the reputational issues and scrutiny of ADF members’ health and behaviour demand active strategies to treat and manage alcohol disorders, which go beyond those available to the civilian community.’

 Regarding the AOD concerns of VVCS clients specifically:

- In 2012, there were 603 VVCS intakes (3.3% of all clients intakes for this period) in which ‘substance use’ was identified as a presenting problem.

- In the same year, 1,124 VVCS clients completed the Alcohol Use Disorders Identification Test (AUDIT) prior to participating in VVCS counselling or group programs. Of these, 337 completed both a T1 and T2 during the 12 months.

o 74.9% had AUDIT scores indicating that they over-consume alcohol o 10.9% were assessed as alcohol dependent o 26.4% had scores indicating that they were problem drinkers, and o 32.1% had a positive AUDIT screen indicating that some kind of intervention was required.

 This data indicates that although AOD issues were identified in only a small percentage (3.3%) of VVCS client intakes, the prevalence of problematic alcohol use for clients about to commence counselling or group programs, as identified in the AUDIT, was significant.

VVCS service provision for clients with AOD concerns

 VVCS uses a range of approaches to directly support clients with AOD concerns and to provide them with sources of information and referral if required.

- AOD use is routinely addressed during VVCS clinical intake and followed up if applicable during counselling.

- Regarding alcohol use specifically, VVCS undertakes routine screening of all new counselling and group program clients by administering the AUDIT prior to commencement of clinical services and undertakes to do so at service completion. VVCS uses a standardised form of the AUDIT to achieve national consistency and quality control.

- The rationale for use of the AUDIT includes:

o Ensuring early identification of alcohol-related issues to be used in planning for the counselling intervention. o Providing a brief intervention in its own right if the opportunity for follow-up does not occur. o The AUDIT has high sensitivity (detects alcohol problems when they exist on most occasions) o The AUDIT can be verbally or self administered o The AUDIT can be administered within 5 minutes

 VVCS clinicians utilise the printed The Right Mix materials with their clients. This includes use of the AUDIT contained with The Right Mix “Changing the Mix guide” for a brief (self-completion) intervention. The materials were revised in 2009 to reflect the Australian Guidelines to reduce health risks from drinking alcohol which were updated by the National Health & Medical Research Council. Following this, training was provided to VVCS staff nationally on use of the revised materials.

6  The Right Mix online material is currently being revised by DVA Mental Health Policy as part of a revamp of the DVA At Ease website.

 In collaboration with VVCS, DVA Mental Health Policy have recently developed the On Track with The Right Mix smartphone application as a new vehicle to reach veterans and serving personnel with mental health support. This app has two primary functions:

- Help users keep track of their drinking behaviour while providing education about healthy drinking habits; and - Bring The Right Mix message to the contemporary generation of veterans and serving personnel.

 The app has been developed following focus testing with current serving personnel and keys into the motivations indentified for them to better manage their drinking: money and fitness. The app will be available in android and Apple formats in coming months.

Recommendation That the NAC note the above information.