The tragedy of veteran suicide: How Australia has failed its finest’ Address by Commissioner Nick Kaldas APM (Chair) to the National Press Club

Address by Commissioner Nick Kaldas APM (Chair)

National Press Club, Canberra

Good afternoon, ladies and gentleman.

It’s an honour to be here today, during Suicide Prevention Week, to speak about what is a national tragedy: the unacceptably high rates of suicide and suicidality among serving and ex-serving members of the Australian Defence Force – and the failure by successive Governments, the ADF, and the Departments of Defence and Veterans’ Affairs to adequately protect the mental health and wellbeing of those who serve our country.

I would like to begin by acknowledging the Traditional owners of the land on which we meet today: the Ngunnawal (nunna-wol) People.

We pay our respects to their elders past and present, and extend that respect to any other First Nations people who are here today or watching across Australia.

On behalf of my fellow Commissioners, Dr Peggy Brown AO and the Honourable James Douglas KC, I would also like to acknowledge and thank current and former members of the Australian Defence Force, and their families, for the unique and important sacrifices they have made on behalf of our country.

I would also like to acknowledge senior leadership from the ADF and other Commonwealth agencies for joining us here today.

This Royal Commission recognises that every death by suicide is a tragic event – and that there is an over-representation of Defence and veteran deaths by suicide in this country.

We acknowledge all of those who have a lived experience of suicide.

We acknowledge the lives lost.

We acknowledge those who have made an attempt on their life and those who are vulnerable to suicide.

And we acknowledge those bereaved by suicide – the families, friends, colleagues and supporters of those who’ve died.

I want to start today by taking you back to Australia’s very first Royal Commission.

The S.S. Drayton Grange was a British merchant vessel chartered to transport 1,500 Australian soldiers returning home from the Boer (Bore) War in South Africa in July 1902.

Considerable overcrowding and unsanitary conditions, compounded by a lack of adequate medical supplies and poor weather, led to outbreaks of measles and influenza, as well as lice infestation.

By the time the troopship had docked in Melbourne at the end of its month-long voyage, five soldiers were dead – and another 12 died in the weeks that followed.

Public outrage led to the Royal Commissions Act being enacted in August 1902 – and within days Australia’s first Royal Commission into the Drayton Grange was underway.

It ultimately found the Officer Commanding Troops wanted to do the best in a trying position.

But ‘the best’ seemed to be accepting things as they were, rather than making strenuous efforts to improve them – to endure rather than to overcome.

One might draw parallels between this dark chapter in our military history, and the current tragedy at the core of this Royal Commission.

The Royal Commission into Defence and Veteran Suicide was established in 2021 after then-Prime Minister Morrison bowed to political pressure from cross-party MPs and Senators.

That followed a hard-fought and sustained campaign by the brave families of Australian veterans who had taken their own lives, as well as former ADF members who were traumatised in various ways.

The numbers are heartbreaking.

There were at least 1,600 deaths by suicide between 1997 and 2020 of veterans who served on or after 1 January 1985.

That’s more than 20-times the number killed in active duty over roughly the same period.

It’s important to stress that these numbers do not include serving and ex-serving members whose deaths were not officially recorded as suicide – such as incidents where intent could not be determined.

Nor do they include those who had served before 1985 – including our Vietnam Veterans who died by suicide.

Tragically, the senseless loss of life continues today.

Rarely a week goes by that this Royal Commission isn’t alerted to the untimely death of another serving or ex-serving member.

It is unquestionably a national crisis.

For every life lost there are family, friends, colleagues and whole communities flooded by grief and anger. Researchers at the University of Kentucky have even put a number on it – finding that for every suicide, 135 other people are impacted.

This Royal Commission’s Terms of Reference are deliberately broad, requiring us to look into the risk and protective factors in relation to all aspects of military life.

This wide-ranging inquiry has now been running for about 26 months.

During that time, we’ve been provided about 250,000 documents in response to more than 1,000 compulsory notices we’ve issued.

We’ve received approximately 4,200 public submissions.

We’ve heard from more than 300 witnesses during 11 public hearing blocks in capital cities and garrison towns across Australia.

We Commissioners have held 535 private sessions – sitting one-on-one with people with lived experience of suicide, suicidality or military service and hearing their deeply personal stories.

And there are some 400 private sessions still to be undertaken throughout the rest of 2023 and into 2024.

The Commission has also visited close to two dozen Defence bases across the country – hearing directly from current servicemen and women about the challenges and opportunities of life in our Navy, Army and Air Force.

And we’ve worked closely with the academic and research community, veterans’ groups and charitable organisations – commissioning research and conducting workshops and roundtables on a diverse range of issues.

High rates of suicide and suicidality among serving and ex-serving military personnel are not a problem exclusive to Australia.

That’s why, in line with our terms of reference, we Commissioners have looked at how Australia’s ‘Five Eyes’ partners – Canada, New Zealand, the United Kingdom and United States – are responding to similar challenges in their military communities.

We have looked at what has and hasn’t worked for our closest allies – and what might work if applied in the Australian context.

So, with all this information – what have we learned so far?

First and foremost, I want to take a moment to correct a common misconception that all veterans are broken. We know that is most definitely not the case!

The vast majority of those who serve in the ADF have rewarding careers and go on to successfully transition to civilian life.

The extensive range of skills, abilities and attributes developed during their military service mean veterans are well regarded by private sector employers across a diverse range of industries, particularly in a tight labour market – and many make a valuable contribution to their communities, and broader society, in their post-service life.

Notably, this includes many who have suffered physical or mental health impacts during their service.

Sadly, though, this is not the case for all who serve.

Some veterans struggle to find their post-service identity in the civilian world or to secure gainful employment.

Some find it difficult to make meaningful connections in their new community, while no longer enjoying the ease of contact with their former Defence colleagues.

And some suffer due to the permanent physical and mental health impacts from their service.

All of the above can lead them to dark places in their mind – including to suicide and suicidal behaviour.

We know that suicide in the military context is an extremely complex and multifaceted phenomenon.

It’s not just about mental health – although mental health issues often do play a role.

Nor, as is often assumed, is it always related to trauma experienced in the theatre of war – although this, too, can clearly play a role.

It is not a reflection of the character of the individual or indicative of some inherent deficit in their psyche or their moral framework.

And lastly, while suicide may not be predictable in every individual, it must be viewed as preventable.

Individuals who suicide are quite often in contact with an agency or organisation prior to their death.

We know the way in which agencies and organisations interact with veterans can, and does, impact their mental health and wellbeing.

They, therefore, have a responsibility to act in ways that are alert to the risks and that reflect appropriate support and compassion for individuals who may have experienced trauma and are vulnerable.

As we have peeled back the layers of complexity – there’s been much more to find that has been illuminating. Let me share some of that with you.

We already know from existing Australian Institute of Health and Welfare data that:

the suicide rate for ex-serving males who served after 1985 and died between 1997 and 2020 was 27 per cent higher when compared with the general Australian population, and

the suicide rate for ex-serving females was 107 percent higher.

Further analysis conducted by the AIHW at the request of the Royal Commission has been more telling.

It found the suicide rate for ex-serving men who only served in the reserve forces is similar to the general Australian male population.

But the suicide rate for ex-serving men who served in the permanent forces is actually 44 per cent higher than the general Australian male population.

This differential is not seen in the suicide rates for ex-serving females.

Significantly, whether women served in the reserves or permanent forces, their suicide rate is about twice that of the general Australian female population.

Defence tells us its selection process delivers a ‘healthy worker’ effect because it excludes individuals who don’t meet the necessary physical and mental health requirements.

We also hear from Defence that its members have easy access – at least in theory – to free and ongoing healthcare (including mental health support), and to the ADF’s suicide prevention program.

We are charged with inquiring into the link between high rates of suicidality and permanent service in the Defence Force – and evaluating the effectiveness of the healthcare and support provided to members by the ADF.

The fact that suicide rates for those who’ve served in the permanent forces are higher than the Australian population is worrying.

To address this, Defence must FIRST acknowledge its role and actively and urgently embrace the changes needed.

The first step to fixing a problem, is to acknowledge a problem exists.

Before moving on, I’d like to make an important point.

To date, the analysis of suicide data in relation to serving ADF members has been limited.

It has compared suicide rates amongst people in service to a limited metric: the general Australian population.

Significantly, this metric includes employed and non-employed people.

So, we are currently examining a new methodology whereby we compare suicide rates for serving ADF members with only the employed population of Australia.

This is a new way of looking at this data – and we hope this will yield greater insights about whether or not service is actually a protective factor at all.

Historically, there appears to have been a reluctance by Defence to accept suicide, suicidality and mental ill-health as a consequence of military service.

Such issues were instead put down to a weakness in the individual’s character or resilience, rather than something for which the military organisation must take some responsibility.

Fifty years on from the end of Australia’s involvement in the Vietnam War, I acknowledge the lasting legacy of our Vietnam veterans in being the first to raise awareness about mental health and PTSD.

Their experiences have helped shape modern society’s understanding of these incredibly complex issues, which allows this Royal Commission to examine in depth the ongoing tragedy that is defence and veteran suicide.

So, what is going on? What is contributing to this increased suicide risk – particularly for those who’ve served in the permanent forces?

We’ve looked at all aspects of service life in our quest for answers.

We’ve examined Defence’s recruitment practices, including whether its marketing campaigns create unrealistic expectations for new recruits.

We’ve looked at training processes. We understand and accept their importance for building strength, resilience and ADF preparedness – but do they result in preventable, career-ending injuries?

We’ve explored the effect of postings and how the lives of partners and children are regularly uprooted with work, schooling, friendships and support systems cut off before they’ve been properly established – and have to be established anew in their next location.

We know some ADF members are required to deploy for months at a time, often at short notice, meaning long periods away from loved ones – and sometimes they can’t even tell their family where they’re going or for how long, causing immense stress.

We know families play a vital role in members’ wellbeing. Research shows ADF personnel perform better and serve longer when their families are happy, well and stable.

During our Adelaide hearing, Commissioner Brown expressed her frustration at the amount of work Defence still needs to do in this vital area – particularly around childcare, domestic and family violence, improved communication, and the need for better data collection.

The Supporting Service Families Report, written by Sue Hamilton in 1986, identified many of these same issues – and here we are, 37 years later, and we continue to hear how many Defence families are still doing it tough.

On 15 May this year, during National Families Week, the Minister for Veterans’ Affairs and Defence Personnel, issued a media release in which he stated – and I quote:

“People are Defence’s most important capability and we recognise the importance of supporting the families that support those who serve (…)

Having the support of their family is essential for ADF members to undertake their work in service of our nation, while families are often on the front line when a veteran needs some extra support.”

End quote.

Gwen Cherne, the Veteran Family Advocate Commissioner, told us families are being let down by a lack of investment from Defence and DVA.

We certainly heard Ms Cherne’s frustration as she told us – and I quote:

“Until every part of this eco-system of support that is supposed to exist for families starts recognising them, talking to them, and actually investing in programs and support services for them (…) then it’s just rhetoric and we will continue to suffer and we will continue to fray the fabric of Australian society.”

End quote.

Families that are under stress can break down.

We know family breakdown can be – and tragically has been -associated with suicide.

That is why it’s vital that Defence and DVA step up to the plate when it comes to providing appropriate support for military families.

When it comes to protecting the mental health and wellbeing of servicemen and women, the evidence this Royal Commission has uncovered to date suggests there’s been far too much talk and not enough action.

We know the Chief of Defence Force appointed a brigadier (or one-star officer) to head up a new Mental Health and Wellbeing Branch within Defence.

We note that this initiative commenced two years after the establishment of the Royal Commission.

From the evidence we heard in Perth, it seems that senior officer has not been provided the information, staff and resources required to appropriately address mental health and suicide prevention at an organisational level.

We’ve been told there will be no “mature”, fully-resourced and functioning Branch until at least January 2025.

To quote Brigadier Caitlin Langford – they are “building the plane as they’re flying it”.

Given that we’ve known these issues have existed since at least the Vietnam War, it seems extraordinary to hear that Defence is only now “building the plane”.

I note that Defence was able to stand up – without delay – a very well-resourced taskforce – led by a two-star officer – to ‘assist’ this Royal Commission.

Yet Defence’s approach to investigating and reporting on suicides has progressed at a snail’s pace; and we are yet to find sufficient evidence of urgency in responding to these complex issues holistically – even with this Royal Commission on foot!

We’ve heard about attempts by the Navy Clearance Divers Trust to offer data, expertise and advice on issues of mental health, safety and wellbeing.

In evidence, the Trust told this Royal Commission that despite three suicides within their ranks over a two-year period, there was no response from Navy.

We also heard about a key initiative shown to significantly reduce injury rates among military personnel and improve the reporting of injuries having its funding withdrawn.

All of this raises serious questions as to whether Defence is committed to making change in the best interests of its members – or whether they’re just going through the motions.

We’ve heard contemporary lived experience accounts of abuse, assault, bastardisation, bullying, harassment, discrimination, misogyny – and physical and sexual violence within the ADF.

We’ve been told of perpetrators being protected by a code of silence and opaque military justice process.

The Defence Abuse Response Taskforce, which ran from November 2012 to June 2016, shone a bright light in dark places within the ADF.

It examined 2,439 complaints of abuse, bullying and harassment within Defence prior to April 2011 – 1,751 (about 72%) of those complaints were found to be credible, and most received some compensation.

The DART report should have been a wake-up call, a pivotal moment. That did not happen.

It’s troubling to imagine that such behaviour persists in any modern-day workplace.

What is even more alarming is that an employer could neglect or mishandle a complaint of misconduct or target the complainant, leaving them re-traumatised.

Yet that is exactly what we are hearing.

Former Air Force chaplain, Reverend Dr Nikki Coleman, told us how reluctant she felt the Defence hierarchy had been to act against a male colleague whom she had accused of abusing her in 2019.

We heard that Dr Coleman felt the institution protected her alleged abuser to the detriment of her own career, reputation and mental health.

In concluding her testimony, Dr Coleman sent a strong message to the Defence leadership – and I quote:

“You lack the moral courage to stand up to the bullies, the abusers and the sexual perverts who prey on the men and women who’ve signed up to protect their country and serve under you.

You lie when you say you take unacceptable behaviour and more serious abuse seriously. You lie when you say that people are your most important assets.”

End quote.

We’ve also heard how those who serve in the military can experience what’s known as ‘moral injury’ – after witnessing something that goes against their moral or ethical values or when they feel betrayed by those whom they’ve served.

Witness ‘BR2’, who appeared at our Brisbane hearing, spoke of recovering the bodies of asylum seekers as part of his role in the Navy – and the guilt he felt after those they managed to rescue ended up in offshore detention.

We’ve heard evidence about the link between physical injury and poor mental health outcomes – including countless stories of sick and injured service personnel being labelled ‘malingerers’ and ostracised by their peers for declaring their injuries and seeking help.

Seeking help early and engaging in effective treatments can lead to improved outcomes and prevent future problems.

Unfortunately, putting your hand up for help in the ADF is all too often seen as a weakness, in a male-dominated culture that reveres strength.

We continue to hear evidence of the deep-rooted cultural and systemwide issues within the Department of Veterans’ Affairs that are impeding timely access to the support and services veterans, and their families, so desperately need.

We’ve heard many stories of veterans and their families being driven to the brink – and in some tragic cases, beyond – while waiting years for their claims to be even looked at.

One frustrated veteran described the situation in a submission to the Royal Commission – and I quote:

“There is a common saying that the paperwork hoops and hurdles you must climb over is deliberately designed to be that hard; veterans will either just give up or do themselves in.

Either way the problem goes away.”

End quote.

We note the positive impact of the recommendations contained in our interim report handed down in August last year.

Government has moved to harmonise complex legislation governing veterans’ entitlements; and DVA has been provided additional resources to clear the backlog of unprocessed claims.

At last count, there are still just over 30,000 claims yet to be processed – down from around 43,000 a year ago.

We are not convinced, based on the evidence that the level of fraud in claims justifies the often strongly adversarial approach taken by DVA in approving claims. That has to change.

While it’s good to see some progress being made, we’re very much aware there is still a lot of work for DVA to do to improve its ICT and data systems, its customer service – and that adversarial culture, which has left many veterans retraumatised when forced to justify their claims for compensation.

Victorian Premier Daniel Andrews told our Melbourne hearing that our servicemen and women are “second guessed” by DVA when lodging claims – and I quote:

“For many veterans, there is a sense that they are not believed… that agencies that ought to be working for them are operating more like an insurance company – and not an especially good insurance company.

There are many ways that system can be improved – and it starts with believing veterans

And that when they make claims that they are supported not second guessed – and not treated as if they were trying to cheat the system.”

End quote.

During our Adelaide hearing, the Secretary of DVA, Alison Frame, acknowledged she could not take away the hurt and distress that “suboptimal practices” within DVA had caused many veterans, but said – and I quote:

“Going forward we are committed to continuing to try and improve wherever we can.”

End quote.

We will watch this space closely as we frame up our recommendations to be included in our Final Report.

I want to remind you that this Royal Commission is not just looking at the ADF, Defence and DVA.

The scope of our inquiries covers a broad and complex landscape, including Commonwealth, state and territory governments, oversight bodies, as well as health, ex-service and other support organisations, amongst others.

We recognise there are roles and responsibilities for State and Territory governments in providing health services, housing, education and other services.

We are heartened to see a ministerial group for state and territory veteran affairs ministers which – although in its infancy – will examine ways to better coordinate and collaborate. This is crucial.

We have also recognised the role of ex-service organisations.

And while there has not been effective collaboration, I’d like to acknowledge the initiative taken by ex-service organisations towards establishing a national peak body to represent and advocate the needs of ESOs – both large and small – as well as veterans, and their families.

It’s a good example of a sector not waiting for the outcome of this Royal Commission – instead listening and learning from our inquiries to date to make change, which will have positive impacts on the mental health and wellbeing of our serving and ex-serving members.

Australia’s defence capability, primarily, comes from the brave men and women who pull on the uniform of our Navy, Army and Air Force and go to work each day to protect us.

Serving and ex-serving ADF members must be treated fairly, with dignity and respect, with access to high-quality and timely health care and strong prospects for meaningful employment once they transition out of active service.

It’s not hard to see that fixing the entrenched cultural and systemic issues that are impacting the mental health and wellbeing of members would also go a long way to solving the ADF’s recruitment and retention crisis – at a time when Australia is trying to bolster its uniformed stocks by 30% to close to 80,000 by 2040.

Let’s be clear: This Royal Commission does not seek to undermine our Defence capability.

We seek to help build a more resilient, stronger and better ADF, with a psychologically-safe workplace to meet Australia’s future Defence challenges.

Operationally, when we first commenced this inquiry, we did not expect to be stymied and stonewalled along the way.

We have faced significant delays in the provision of vital data and information sought from Defence, as well as other challenges such as cabinet-in-confidence, public interest immunity and parliamentary privilege – and the need to sensitively gather evidence without impacting issues of national security.

This Royal Commission is responding to a national crisis, decades in the making.

Despite the Government establishing a Royal Commission – and the legislature wanting certain issues investigated – obtaining critical information from Commonwealth bodies in a timely manner has been difficult.

Our success will require Government and its agencies – including the ADF, Defence and DVA – to, once and for all, get on board and act.

The stark reality is that despite 57 previous inquiries over the last 20 to 30 years examining the risk factors for suicide in our military community – and almost 770 recommendations arising from those inquiries – very little has changed.

People are still dying to this day!

We urge the Prime Minister, relevant ministers and the leadership of Defence and DVA to see this Royal Commission as an opportunity to drive the long overdue change that is required to ensure our brave men and women in uniform – and their families – have the support they need and deserve.

It’s important to recognise that there will be no quick fix to these issues – and real, long-lasting and meaningful reforms will take some time.

And the focus on these issues must not end with the work of this Royal Commission.

Accordingly, we Commissioners believe an enduring, powerful, independent body is necessary to hold Government, the ADF, Defence, DVA and other relevant agencies, as well as State and Territory governments, to account – to make sure that they prioritise the major, long-term, complex reforms that are needed.

This body must not only be independent, it must have the confidence of serving and ex-serving ADF members, and seek direct and significant input from them.

It must be an ‘oversight’ body: but not one that usurps the leadership of the DVA or ADF, nor one that absolves that leadership of its primary responsibility for veterans’ wellbeing.

And it must have sufficient powers to deal with the issues it faces.

We will release a report on this entity in the coming months and consult further with key stakeholders before finalising a recommendation to Government.

Bipartisan commitment will be required to ensure mistakes from the past do not continue.

We expect strong, decisive leadership from both sides of politics, as well as crossbench MPs and senators, to ensure the final recommendations of this Royal Commission are implemented – and that the ADF, Defence and DVA are forevermore held to account, so that the wellbeing of past and present members, and their families, remains the focus going forward.

It is not enough to support and reflect on the sacrifice of our veterans only on days of commemoration and remembrance.

The theme of Suicide Prevention Week this year is ‘We all have a role to play’. And nothing could be truer in relation to Defence and veteran suicide.

We all have a role to play in holding Government to account when it comes to ensuring the mental health and wellbeing of those who risk their lives each day in the service of our country.

Voters and the media must maintain interest and demand action. That has been lacking.

Every one of us has an important role to play in protecting those who protect us.

Australia has let down its veterans for far too long.

This Royal Commission must be a call to action – no longer can we allow the preventable deaths of our finest to be ignored.

Thank you.

/Public Release. View in full here.