ࡱ> y|xg >bjbjVV @Tr<r<5RR%+%+%+%+%+9+9+9+8q+,+,9++a+L,"7,7,7,&-Z--```````$ehV`!%+-&-&---`%+%+7,7,`,/,/,/-@%+7,%+7,`,/-`,/,/jZ]7,s-[*``0+a\h /"hT]h%+],/---``,/---+a----h---------R ): Chapter 8: Adequacy and Accessibility of Support Mechanisms Contents  TOC \o "1-2" Appendix O: Chapter 8: Adequacy and Accessibility of Support Mechanisms  PAGEREF _Toc206829994 \h 1 Appendix O.1: Health and fitness monitoring, support and services  PAGEREF _Toc206829995 \h 2 Appendix O.2: Mental health research and initiatives  PAGEREF _Toc206829996 \h 4  Health and fitness monitoring, support and services Health and fitness is monitored by the Medical Employment Classification (MEC) system, a consistent tri-service approach that determines the employability, deployability and rehabilitation of a member. The MEC system involves regular physical examinations and patient questionnaires that assess individual fitness for service. Members are assigned a classification which then impacts upon employment, postings, trainings, occupational rehabilitation, transfers between employment categories, payment of specialist allowances and retention in the ADF.281 The MEC system comprises five broad categories: MEC1: Fully Employable and Deployable MEC2: Employable and Deployable with Restrictions MEC3: Rehabilitation MEC4: Employment Transition MEC5: Separation.282 The MEC system is a personnel management system, not a patient management tool, and defers to other bodies in the ADF (including Joint Health Command, Regional Health Directors, a members chain of command, Medical Employment Classification Review Board, Career Management Agencies/Personnel Management Agencies and the member themselves) to administer to the needs associated with the classifications assigned.283 Among these is Joint Health Command, which is responsible for the provision of health care to non-deployed members of the ADF, and for the operational preparedness of the force from a health perspective.284 It conducts strategic health research, develops strategic health policies, provides strategic level health advice, and exercises technical and financial control of ADF health units.285 Joint Operations Command and the single Services are responsible for health support on operations.286 Joint Health Command provides facilities located at ADF workplaces and Defence health units around Australia, including primary health care, theatre capability, in-patient capability, dental, physiotherapy, radiology, mental health, rehabilitation and pharmacy services.287 ADF members can be referred to one of these, or an appropriate civilian service, through an after-hours advice and triage style phone service.288 Permanent ADF members do not require Medicare cards to access these services, but are invoiced or billed and then reimbursed. Families of ADF personnel are not currently entitled to health subsidies as a matter of course, however, the Australian Defence Force Family Health Trial is providing ADF families residing in regional areas with benefits including reimbursing Medicare gap charges and an allied health allowance of $330 per dependent per year.289 Regular publications keep ADF personnel updated about health and support news. Defence family matters is a tri-annual magazine sent to all permanent ADF members and those on continuous full-time service who have one or more dependents, and any other personnel who have requested a free subscription.290 Joint Health Command has also produced a series of concise fact sheets, available online and in places of work, to inform members about issues, policy and services in areas including depression, grief, alcohol and drug issues.291 Beyond Joint Health Command there are two primary organisations that provide assistance and information to ADF members and their families: the Defence Community Organisation and Defence Families of Australia. The Defence Community Organisation is run by ADF personnel, and provides services and information to Defence families. The services provided include support from social workers, education and employment, childcare and transition assistance.292 The Defence Community Organisation also has a website and administers the Defence Family Helpline, which ADF members can access 24 hours a day.293 Defence Families of Australia is a Ministerial appointed group that represents the views of Defence families by reporting, making recommendations and influencing policy that directly affects families.294 Defence Families of Australia receives its funding from Defence and external sponsorship, and currently has a civilian executive and a number of ADF members as delegates.295 In addition to offering input at the policy level, Defence Families of Australia maintains an accessible and informative website offering advice for families and partners in a series of areas including health, money and education. Mental health research and initiatives The ADF has undertaken a number of studies and initiatives over the previous decade. In 2002, the ADF Mental Health Strategy developed an agenda for the planning and provision of mental health care.296 In 2009, Professor David Dunts Review of Mental Health Care in the ADF and Transition through Discharge was submitted to the ADF.297 The 2010 ADF Mental Health Prevalence and Wellbeing Study established baseline data to enable Defence to better inform and prioritise initiatives in the ADF Mental Health Reform Program.298 This led to the 2011 ADF Mental Health and Wellbeing Strategy which provides a blueprint for the development of the 2012-2015 Mental Health and Wellbeing Action Plan.299 The Plan seeks to finalise Dunt Review recommendations, align of Defence with the national mental health reform agenda, and put in place a system that is self-monitoring and continuously improving.300 The Review of Mental Health Care in the ADF and Transition through Discharge (Dunt Report) was submitted on 4 February 2009. Its major recommendations were: 1. Expanding the mental health workforce 2. Improving mental health training 3. Making prevention strategies (including stress management and positive coping strategies) a core component of military training 4. Improving mental health governance (including with e-health data management) 5. Improving mental health policy, with a focus on rehabilitation 6. Enhancing research and surveillance, and mental health screening 7. Enhancing rehabilitation and return to work programs 8. Enhancing military to civilian transition services 9. Including and informing families about mental health issues 10. Developing new and improved facilities.301 The ADF then set about collecting baseline data to inform the implementation of these recommendations and policy changes through the 2010 ADF Mental Health Prevalence and Wellbeing Study. This was the first comprehensive investigation of the mental health of an ADF serving population, and has been described by Professor Ian Hickie of the Brain and Mind Research Institute as a worlds best practice study.302 Nearly 49% of ADF current serving members participated between April 2010 and January 2011.303 The study found that 22% of the ADF population experienced a mental disorder in the past 12 months, a prevalence rate similar to the Australian community. ADF lifetime prevalence rates, however, are higher than the wider communitys.304 It also found that anxiety disorders are the most common type of medical disorder in the ADF. There was a higher prevalence of anxiety disorders among women compared to men, and among other ranks compared to officers.305 ADF males experience higher rates of mood disorders than the wider community, mostly accounted for by depressive episodes. Officers were as likely to experience affective disorders as other ranks.306 According to the study, there were high levels of alcohol use, but alcohol disorder was significantly lower in the ADF than in the wider community. Most disorder was in males in the 18-27 age group. ADF Females 18-27 had lower rates than their community counterparts. There were no significant differences between the Services with regards to alcohol dependence disorder, but members of Navy and Army were significantly more likely than Air Force to experience alcohol harmful use disorder.307 ADF personnel reported thinking about and planning suicide at a higher rate than the community. The number of suicide attempts is not significantly greater than in the general community, and the number of reported deaths by suicide is lower.308 43% of ADF members reported multiple deployments, 19% had one and 39% had never been deployed. Deployed personnel did not report greater levels of mental disorder, but were 10% more likely to seek care for mental health or family problems.309 In the previous year 17.9% of ADF members sought help for stress, emotional, mental health or family problems. Two main factors contribute to the low uptake of mental health services: the fear of stigma, and perceived barriers.310 The most cited barrier was a concern that seeking help would reduce their deployability (39.6% of respondents). The most cited stigmas were a fear of being treated differently (27.6%) and of harm to career (26.9%).311 Based on these findings, the 2012-2015 Mental Health and Wellbeing Action Plan is currently being finalised. Defence senior leadership has identified the following seven priority areas for immediate action: a communications strategy to address stigma and barriers to care enhanced service delivery development of e-mental health approaches up-skilling health providers improving pathways to care strengthening the mental health screening continuum and developing a comprehensive peer support network.312 This plan will aim to align Defence with the national mental health reform agenda, and put in place a system that is self-monitoring and continuously improving.313 Department of Defence, HLTHMAN, volume 3, chapter 1, 1.2, provided to the Review. Guidelines for the administration of the MEC system are laid out in HLTHMAN and Department of Defence, Defence Instruction (Army) PERS 16-15, Australian Defence Forces Medical Employment Classification System, 1 July 2011 (DI(A) PERS 16-15). DI(A) PERS 16-15, above. Department of Defence, HLTHMAN, volume 3, chapter 1, 1.12. Joint Health Command, 鱨վ, http://www.defence.gov.au/health/about/i-organisation.htm (viewed 26 March 2012). Joint Health Command, Strategic Plan 2010-12 (2010), p56. Australian National Audit Office, Defences Management of Health Services to Australian Defence Force Personnel in Australia (2010), p16. Australian Defence Force, JHC Facilities provided to the Review by CMDR Alison Westwood, 18 January 2012. Joint Health Command, 1800 IMSICK (1800 467 425). At http://www.defence.gov.au/health/contacts/i-imsick.htm (viewed 4June 2012). Joint Health Command, Australian Defence Force Family Health (ADFFH) Trial. At http://www.defence.gov.au/health/Dependant_Healthcare/i-healthcare.htm (viewed 4 June 2012). Defence Community Organisation, Defence Family Matters, http://www.defence.gov.au/dco/dfm.htm (viewed 5 June 2012). See factsheets at Joint Health Command, Fact sheets, http://www.defence.gov.au/health/DMH/i-dmh_factsheets.htm (viewed 26March 2012); Department of Defence, Health Care Related Complaints and Compliments in the ADF, 28 August 2009. See Defence Community Organisation, Defence Family Forum, http://www.defence.gov.au/dco/Forum.html (viewed 5 June 2012). Defence Community Organisation, Welcome to the Defence Community Organisation, http://www.defence.gov.au/dco/ (viewed 5June 2012); Defence Community Organisation, Defence Family Helpline now open for business, http://www.defence.gov.au/dco/national_family_helpline.htm (viewed 5 June 2012). Defence Families of Australia, 鱨վ Us, http://dfa.org.au/about-us-0 (viewed 5 June 2012). Meeting with Defence Families of Australia. Department of Defence, Capability through mental fitness: 2011 Australian Defence Force Mental Health and Wellbeing Strategy (2011), p1. At http://www.defence.gov.au/health/DMH/docs/2011%20ADF%20Mental%20Health%20and%20Wellbeing%20Strategy%20.pdf (viewed 30 March 2012). LTCOL S Hodson, L Moore and MAJ J McGrogan, The Mental Health Reform Health Process (Dunt Report): A Support System for ADF Personnel (2009) 10(1) ADF Health 21-22. S Hodson, A C McFarlane, M Van Hooff and C Davies, Mental Health in the Australian Defence Force 2010 ADF Mental Health Prevalence and Wellbeing Study: Executive Report (2011), p1. Department of Defence, Capability through mental fitness: 2011 Australian Defence Force Mental Health and Wellbeing Strategy (2011). At http://www.defence.gov.au/health/DMH/docs/2011%20ADF%20Mental%20Health%20and%20Wellbeing%20Strategy%20.pdf (viewed 30 March 2012). Joint Health Command, Mental Health Strategy. At http://www.defence.gov.au/health/DMH/i-dmhs.htm (viewed 30 March 2012). Hodson, Moore and McGrogan, note 297. Department of Defence, Defence leads the way on mental health research, 24 October 2011. At http://www.defence.gov.au/defencenews/stories/2011/oct/1024.htm(viewed 6 June 2012). Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Hodson, McFarlane, Van Hooff,Davies, note 298, p17. Hodson, McFarlane, Van Hooff,Davies, note 298, Key Findings. Broderick Review Phase 2 Task 97 Mental Health provided to the Review by CMDR A Westwood, 12 November 2011. Joint Health Command, ADF Mental Health Strategy. At http://www.defence.gov.au/health/DMH/i-dmhs.htm (viewed 6 June 2012).     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