The final report of the Royal Commission into Defence and Veteran Suicide features the following recommendations
Recommendation 1: Improve the capacity of future royal
commissions to undertake their inquiries
To enable the efficient operation of future royal commissions:
(a) the Australian Government should amend the Royal Commissions Act
1902 (Cth) so there are meaningful consequences for non-compliance with
a compulsory notice
(b) the Australian Government should undertake measures to ensure that
royal commissions benefit from more independent representation in
government, either by:
(i) setting up protocols that limit the engagement of the Royal
Commissions Branch of the Attorney-General’s Department with the
Australian Government Solicitor (AGS), or
(ii) moving the Royal Commissions Branch to a separate agency, for
example to the Department of Prime Minister and Cabinet, or:
(iii) setting up a liaison person or team in the Attorney-General’s
Department, whose role is to deal with royal commissions only
(c) the Australian Government should apply consistent and transparent
arrangements to allow royal commissions timely access to material
covered by public interest immunity, and consider legislative amendment
to facilitate royal commissions’ access to this material
(d) The Attorney-General’s Department should provide settled advice and
options on the operation of public interest immunity, Parliamentary
privilege and procedural fairness in the operation of royal commissions.
Recommendation 2: Improve outcomes and access to support for
recruits in ab initio training
Defence should improve support for all recruits in ab initio training to build resilience
and embed help-seeking behaviours. Developed in partnership with people with lived
experience of service, the model of support should:
(a) utilise mental health screening conducted during ab initio training
(Recommendation 65) to identify and provide support to proactively
meet recruits’ needs
(b) reduce barriers to accessing timely and appropriate care, including
physical health, mental health, spiritual health, pastoral care and
peer supports
(c) ensure that changes to ‘recruitment risk appetite’ do not jeopardise
members’ mental and physical health, including for those who enter under
reduced physical fitness standards, as waiver recipients or with higher
psychological risk, including by:
(i) longitudinal tracking of health, wellbeing and safety outcomes for
members from initial training and throughout their Australian Defence
Force career
(ii) with members’ consent, sharing insights about recruits’ support needs
obtained through recruitment processes to enable ab initio training
institutions to offer relevant supports proactively
(d) prioritise and promote postings at ab initio training institutions and
ensure that instructors have the resourcing, capabilities and personal
attributes necessary to lead and educate young people, including
vulnerable individuals.
Recommendation 3: Build the capability of career managers
Defence should build the capability of career managers to engage with and respond
to member needs and preferences when making posting decisions, including by:
(a) improving the ratio of career managers to members
(b) upskilling career managers to engage with vulnerable individuals through
training in trauma-informed approaches
(c) providing the training, resourcing, data and guidance for career managers
to identify and mitigate cumulative stressors experienced by members,
including psychosocial risk such as exposure to unacceptable behaviour,
when making posting decisions.
Recommendation 4: Mitigate the adverse impacts of the
posting cycle
Defence should take steps to mitigate the adverse impacts of the posting cycle
on members and their families, including:
(a) measures to reduce the frequency of relocation
(b) improved supports for members and their families moving to a new
location that target known stressors, such as housing, childcare and
children’s education, partner/spouse employment and community ties
(c) measures to implement greater mobility across the Australian Defence
Force and flexible working options
(d) working with state and territory governments to ensure that children
of Defence personnel can enrol in educational institutions without having
a fixed address as a result of Defence-required relocations of the family.
Recommendation 5: Support all serving members to decompress,
rest and reintegrate, especially after high-risk experiences
Defence should:
(a) implement a clear and consistent framework for post-deployment supports
for members and their families that addresses the psychosocial aspects of
reintegration. This should include:
(i) an evidence-based approach to decompression and reintegration that
allows for individual needs, informed by experience in comparable
industries such as emergency services
(ii) training that addresses common issues that arise on entering and
exiting operational activities, which may include grief, hypervigilance,
sleep issues, excess alcohol use and aggression
(iii) with members’ consent, a handover from their commanding officer
on deployment to their commanding officer at home that identifies
stressors experienced by the member on deployment
(b) implement a structured and comprehensive approach to respite across
the Australian Defence Force (ADF) that is not limited to ‘arduous
deployments’ and that addresses fatigue across the workforce
(c) analyse data collected on high-risk experiences, including deployments,
to derive lessons for improved risk and fatigue management across the
organisation and build a better understanding of the future physical and
mental health needs of ADF members and veterans.
Recommendation 6 : Improve the procedural fairness of the
military employment classification system
Defence should ensure members are treated fairly when making decisions about their
fitness to be employed or deployed by the Australian Defence Force. To achieve this,
Defence should:
(a) publish a guidance direction for decision-makers in the military
employment classification system on the requirements of procedural
fairness
(b) ensure members may review all relevant documents before a decision
is made about their military employment classification and have an
opportunity to make direct representations to the decision-maker, including
at Military Employment Classification Review Board meetings.
Recommendation 7: Increase employment opportunities within the
Australian Defence Force for members who cannot be deployed
Defence should implement measures to increase employment opportunities within the
Australian Defence Force (ADF) for members who are no longer able to be deployed
due to illness or injury. Measures should include:
(a) systematic identification, within Defence workforce planning and other
policies, of roles that may be suitable and should be considered for
members who cannot deploy
(b) a commitment to maximising opportunities for continuing employment of
ADF members who are no longer able to be deployed due to illness or
injury, including by minimising reliance on external service providers and
contractors
(c) processes to measure and monitor the number of members who can and
cannot be deployed, and how changes in this ratio impact on, and are
illustrative of, the wellbeing of members.
Recommendation 8: Maximise workforce retention by addressing
factors that contribute to voluntary separation
In the next iteration of the Defence Strategic Workforce Plan (or its equivalent),
Defence should specifically focus on outcomes-based retention initiatives. The
plan should:
(a) draw on service-specific workforce experience data, monthly workforce
reporting and analysis of factors driving voluntary separation
(b) address contributors to voluntary separation, including burnout, fatigue
and psychosocial stress
(c) establish targets, with accompanying performance measures, to enable
evaluation of the effectiveness of retention initiatives.
The plan should inform the evolution of Defence’s Employee Value Proposition and
be implemented in alignment with the Defence Work Health and Safety Strategy.
Recommendation 9: Improve organisational culture and leadership
accountability to increase member wellbeing and safety
The Chief of the Defence Force, Australian Defence Force (ADF) service chiefs and
the Chief of Personnel should agree on a suite of ADF culture targets, supported
by data-driven metrics. Targets should be outcomes-based and time-bound. At a
minimum, targets should be developed for the following cultural priorities:
(a) safety, health and wellbeing, with a focus on psychosocial safety
(b) unacceptable behaviour and sexual misconduct, with a focus on removing
barriers to reporting and improving complaints management
(c) senior leadership accountability.
The annual culture report should be publicly available and report on each service’s
progress against culture targets, as well as ADF-wide results.
Recommendation 10: Develop service-specific action plans to
implement the Defence Respect@Work Framework
The Australian Human Rights Commission should undertake an independent
assessment of the extent to which underlying drivers, risk and protective factors in the
Defence Respect@Work Framework are present in each service, and recommend
actions to address gaps and known risks.
Following these recommendations, Navy, Army and Air Force should develop
service-specific action plans for the Defence Respect@Work Framework, including
implementation timeframes, to be approved by the Minister for Defence and the
Minister for Defence Personnel.
Recommendation 11: Assess Australian Defence Force leaders
based on upward feedback and performance against culture,
health and wellbeing targets
Defence should amend the annual performance appraisals of Australian Defence
Force (ADF) leaders (from the rank of Colonel to the rank of General, and
equivalents) to include upward feedback from their direct reports, and assessment
against outcomes-based targets related to culture, health and wellbeing.
At a minimum, Defence should develop outcomes-based targets for leaders for the
following domains and metrics:
(a) safety, health and wellbeing
(i) psychological safety climate, based on the new Values and
Behaviours Survey metrics related to managers and commanders
(b) gender equality
(i) difference in cultural reporting between men and women (KPI 11
metrics, Women in the ADF Report)
(ii) women feel equally included (KPI 13 Metrics, Women in the
ADF Report)
(c) reporting and management of unacceptable behaviour
(i) level of under-reporting of unacceptable behaviour and sexual
misconduct (reported separately and disaggregated by gender)
(ii) satisfaction with management of unacceptable behaviour and sexual
misconduct (reported separately and disaggregated by gender).
Recommendation 12: Consider emotional intelligence and
performance against wellbeing targets in selecting leaders
to promote
The Australian Defence Force should strengthen its leadership selection and
promotion process by:
(a) assessing a candidate’s performance against culture, health and wellbeing
targets (see Recommendation 11) as part of the ‘fit and proper person’
check for leadership and command selection and promotion
(b) including psychometric testing, particularly emotional intelligence
measurement, as part of the command selection framework, based
on command-assessment programs in the United Kingdom and the
United States.
Recommendation 13: Co-design a new doctrine recognising that
operational readiness depends on a healthy workforce
Defence should convene a select panel to co-design a new doctrine on ‘people,
capability and service’ with Australian Defence Force (ADF) members.
The doctrine should make it clear that Australia’s military capability and operational
readiness depend on having a physically and mentally healthy workforce, where
prevention, early intervention and recovery are not in opposition to values of service
and sacrifice, but are essential for these values to be expressed in a sustainable way
that serves our nation’s interest.
The select panel should:
(a) consist of ex-serving members and represent experience at both the
commissioned and non-commissioned officer ranks, across Navy, Army
and Air Force
(b) undertake a co-design process including representation from a broad
range of age groups, ranks, bases and services, and maximise
involvement of members who have experienced physical and mental
health issues
(c) present the new doctrine on ‘people, capability and service’ to the Chief of
Personnel and the Chief of the Defence Force for endorsement by no later
than December 2026
(d) identify any other single-service or ADF cultural norms, symbols, systems,
policies or processes identified by members or commanding officers as
barriers to the prioritisation of member health and wellbeing, and suggest
changes in a report to the Minister for Defence and the Minister for
Defence Personnel.
Recommendation 14: Understand the prevalence and effects of
military sexual trauma and improve responses to support victims
The Australian Government should commission independent research on the
prevalence of military sexual trauma among serving and ex-serving Australian
Defence Force (ADF) members. This research should examine:
(a) the link between sexual misconduct and suicide and suicidality, other
impacts experienced during service, and specific needs of victims at the
time of transition, and benchmark the ADF response with best practice
approaches to inform recommendations for improvements
(b) the terminology ‘sexual misconduct’ used by the ADF, compared to
‘military sexual trauma and violence’, and the impact of terminology on
victims.
Recommendation 15: Clarify definitions and processes related to
sexual offences
Defence should amend its Complaints and Resolutions Manual to:
(a) include definitions of sexual offences aligned with the Crimes Act 1900
(ACT) sexual offence provisions, that clearly describe the types of
behaviours and actions that constitute each offence
(b) provide clear and explicit instructions that managers and commanders
who receive a report of sexual misconduct should consult with the Joint
Military Police Unit to determine whether the conduct constitutes an
offence, before taking any further action.
Recommendation 16: Evaluate training on managing sexual
misconduct and make it mandatory for all leaders
Defence should commission an independent evaluation of the Sexual Misconduct
Incident Management Workshop as a matter of priority. Following any required
improvements identified by this evaluation, sexual misconduct incident management
training should be mandatory for all commanders and managers.
Recommendation 17: Prioritise the prevention of sexual
misconduct in the Australian Defence Force
The Australian Defence Force should develop a comprehensive sexual misconduct
prevention strategy that includes primary prevention and early intervention, as well as
targeted behaviour change programs for perpetrators of sexual misconduct.
The strategy should be:
(a) developed in partnership with the Australian Human Rights Commission
and Our Watch, include specific actions for implementation, including
timeframes, and be tailored to the ADF context
(b) submitted to the Minister for Defence and the Minister for Defence
Personnel for endorsement, and published on the Defence website.
Recommendation 18: Strengthen workplace protections during
sexual misconduct investigations
The Australian Defence Force should develop a dedicated policy that applies when
sexual misconduct incident investigations are underway in the administrative,
disciplinary or civilian justice systems.
The policy should:
(a) provide that the commanding officer must immediately apply one of the
following interim actions to the alleged perpetrator, neither of which imply
any finding of guilt or wrongdoing:
(i) amend their work arrangements to ensure no contact between the
victim and the alleged perpetrator (depending on the nature of the
work, this may require re-assignment to a different location), noting
that the arrangement must not restrict the victim from accessing any
common areas
(ii) allow suspension with pay
(b) ensure that the commanding officer’s decision must be informed by a
comprehensive risk assessment of the safety, health and wellbeing of
the victim, the alleged perpetrator and the broader workplace, with the
reasons for the decision being recorded
(c) ensure that interim actions are reviewed on a regular basis until the
matter has been resolved through both the disciplinary (or criminal) and
administrative systems.
The policy should not preclude the commanding officer from:
(d) suspending an alleged perpetrator without pay (either in full or part), in
accordance with the Defence Force Discipline Act 1982 (Cth) and the
Defence Force Regulation 2016
(e) taking any additional interim actions as necessary.
Recommendation 19: Protect victims of sexual misconduct from
disadvantage over the course of their careers
To ensure there are no inadvertent career consequences for victims of sexual
misconduct and to support the safety of victims over the course of their careers,
Defence should:
(a) develop a neutral label to signify where a change in working hours, or a
short-notice or out-of-cycle posting, has occurred to protect a member’s
health and wellbeing, in a way that protects individual privacy and clearly
signals that no career penalty should apply. Similar amendments should
be made to the military employment classification system and in guidance
to promotions boards
(b) report to the Minister for Defence Personnel by no later than 30 June 2025
on whether career management, human resources and Defence housing
systems have been updated to ensure victims of sexual misconduct are
not posted with their perpetrator/s over the course of their career.
Recommendation 20: Amend the legislation related to sentencing
perpetrators of military sexual offences
The Australian Government should amend Section 70 of the Defence Force Discipline
Act 1982 (Cth) to:
(a) expressly require service tribunals to consider the impact of a sexual
offence on the victim as a factor during sentencing, including a victim
impact statement if one has been made, and allow the victim to read their
statement aloud if they choose to do so, in a closed or open court
(b) make it clear that if an offender is of higher rank than a victim, this should
be considered an aggravating factor for the purpose of sentencing.
The Australian Defence Force Chief Judge Advocate should amend Practice Note
6 – Part IV Sentencing to require the prosecution counsel to invite victims to make a
victim impact statement for consideration by the service tribunal during sentencing.
Recommendation 21: Implement a ‘presumption’ of discharge
for Australian Defence Force members found to have engaged in
certain forms of sexual misconduct
The Chief of the Defence Force should issue a directive providing for a presumption
that anyone in the Australian Defence Force (ADF) who is found to have engaged in
certain forms of sexual misconduct will be discharged.
(a) The directive should apply to specified forms of sexual misconduct
including, but not limited to, sexual harassment, sexual offences, related
offences including intimate image abuse, stalking, and any other offence
involving conduct of a sexual nature against an ADF member including
prejudicial conduct, assault and obscene conduct.
(b) The standard of proof is the balance of probabilities. For the directive to
apply, there needs to be a finding, either by a criminal/disciplinary tribunal
or administratively by command, substantiating that sexual misconduct
has occurred. Where a sexual offence allegation has been made but
has not proceeded to prosecution, or has been prosecuted but has not
resulted in a conviction, the behaviour must be assessed on the balance
of probabilities to determine whether the directive applies.
(c) Procedural fairness should be afforded to the member before a decision
on whether to retain or discharge them is made. The directive should
provide guidance on factors to be taken into account by the decision-
maker. The decision must be approved by the relevant service chief.
(d) Discharge statistics related to decisions made under the directive should
be provided annually to the Minister for Defence and the Minister for
Defence Personnel. Statistics should be disaggregated by service and
be accompanied by an analysis of common themes, lessons learnt, and
actions taken in response.
Recommendation 22: Adopt a policy of mandatory discharge for
Australian Defence Force members convicted of sexual and related
offences
Defence should adopt a policy of mandatory discharge for Australian Defence Force
members convicted of sexual and related offences (including stalking and intimate
image abuse) in the military and civilian criminal justice systems, subject to further
legal advice on the legislative barriers, if any.
Recommendation 23: Record convictions of sexual offences in
Australian Defence Force records and civilian criminal records
As a matter of urgency, the Australian Government should:
(a) ensure the Australian Defence Force has a complete and reliable record
of all serving members who have been convicted of sexual offences and
related offences (including stalking and intimate image abuse) in civilian
courts
(b) work with state and territory governments to ensure that civilian criminal
records include convictions of sexual offences and related offences
(including stalking and intimate image abuse) made under the Defence
Force Discipline Act 1982 (Cth).
(
Recommendation 24: Annually publish anonymised data on
outcomes of all incidents of sexual misconduct
Defence should publish data on administrative and disciplinary outcomes for all forms
of sexual misconduct incidents. At a minimum, this data should:
(a) be published on an annual basis, disaggregated by service
(b) identify the nature and type of all sexual misconduct incidents, including:
(i) the nature and type of sexual offences and related offences, including
intimate image abuse, stalking and relevant service offences that
include sexual misconduct as an element
(ii) other forms of sexual misconduct, including sexual harassment and
sex discrimination
(c) include demographic information of victims and perpetrators, including
age, rank and gender.
Recommendation 25: Conduct a formal inquiry into military sexual
violence in the Australian Defence Force
The Australian Government should commission an external, independent, expert
inquiry into military sexual violence in the Australian Defence Force (ADF), with
a report that includes recommendations provided to the Minister for Defence, the
Minister for Defence Personnel and the Attorney General, and made public.
The terms of reference for this inquiry should be developed in consultation with
victims of sexual violence in the ADF (serving and ex-serving), and at a minimum
should include:
(a) the effectiveness of the military justice system compared to the civilian
justice system in receiving, investigating and adjudicating on sexual and
related offences. This should include an examination of the Joint Military
Police Unit’s investigative powers and capability to conduct sexual offence
investigations; the referral of matters to civilian police; any barriers faced
by civilian police investigating sexual offences on ADF bases; sentencing
outcomes; recidivism rates; decisions not to prosecute and conviction
rates
(b) the underlying reasons for the reduction in actions (including making a
report, and agreeing to reported matters being investigated) taken by
victims of sexual violence, including the role of alcohol and other barriers,
and the adequacy of ADF policies in addressing these
(c) the effectiveness of anonymous reporting options including awareness,
uptake and impact compared to alternative approaches (including but not
limited to the approach taken in the United States).
The inquiry should have regard to all lived-experience testimony, statements, exhibits
and published submissions made to this Royal Commission that are related to sexual
violence in the ADF.
(
Recommendation 26: Foster a strong culture of reporting
unacceptable behaviour
Defence should foster a strong reporting culture to:
(a) proactively identify at-risk locations, cohorts, ranks or roles where toxic
subcultures are flourishing
(b) implement risk mitigation strategies to address unacceptable behaviour
directly in the locations, cohorts, ranks or roles identified
(c) report publicly on identified hot spots of unacceptable behaviour and what
actions have been taken to address unacceptable behaviour.
Recommendation 27: Evaluate outcomes to ensure that Defence
has addressed the intent behind recommendations
Defence should evaluate the outcomes of actions taken to implement the
recommendations made by the Commonwealth Ombudsman in its review Does
Defence handle unacceptable behaviour complaints effectively? Defending Fairness,
to ensure that the intent of the recommendations is achieved.
Recommendation 28: Coordinate governance, assurance and
policy functions of the military justice system
Defence should establish a home for military justice governance, assurance and
policy and provide sufficient resourcing to achieve the following functions:
(a) monitor qualitative and quantitative data and analyse trends across the
range of military justice processes and outcomes
(b) prioritising strategies to improve military justice record-keeping and data
input issues to remediate data quality and facilitate analysis
(c) monitoring the effectiveness of implementation of recommendations
from various military justice reviews (including Inspector-General of the
Australian Defence Force), including activity and impact evaluation
(d) continue to define military justice metrics and align them with health and
wellbeing metrics, and in so doing, to:
(i) identify and monitor risks of misuse and abuse of military justice
processes
(ii) track complaints and trends related to termination, offence type and
investigation outcomes
(iii) identify members who are repeatedly subject to military justice
processes
(iv) identify officers who apply disproportionately high numbers of
administrative sanctions
(e) establish and implement effectiveness measures for military justice
reforms / key actions on the Military Justice Steering Group action plan
(f) review current-status reporting on initiatives in line with good-practice
governance principles.
Recommendation 29: Establish a new role to improve training and
communication on conducting inquiries
Defence should establish the Joint Workforce Capability Employment Manager as a
priority, whose scope of work should include:
(a) reviewing the effectiveness of training in how to conduct ‘fact finds’ and
inquiries and ensuring that trauma-informed principles are embedded
throughout the training
(b) reviewing the effectiveness of policies and communication material related
to ‘fact finds’ and inquiries.
Recommendation 30: Prioritise the Inspector-General’s inquiry into
the weaponisation of the administrative system
The Inspector-General of the Australian Defence Force should initiate an own-initiative inquiry into the weaponisation of the military justice administrative system by
the end of 2024.
The inquiry should consider how to improve accountability of commanders who are
found to misuse and abuse military justice processes. Measures to identify misuse
and abuse may include monitoring trends in administrative sanctions and locations,
cohorts, roles or ranks found to be associated with disproportionately high rates of
sanctions.
Recommendation 31: Consider how mental health may contribute
to poor conduct before recommending administrative termination
That it be mandatory for Defence, when recommending administrative termination
of a member under Section 24 (1) (c) of the Defence Regulation 2016 (Cth)
‘retention-not-in-service-interest’, to consider the member’s current mental health
and/or the role that mental health may have played in the behaviour that attracted
administrative action.
Recommendation 32: When requested, conduct a merits
review when a member’s service is terminated for the reason
‘retention-not-in-service-interest’
Defence should implement a merits-review process for involuntary separation
under Section 24 (1) (c) of the Defence Regulation 2016 (Cth) ‘retention-not-in-
service-interest’ through consultation and collaboration with the Inspector-General
of the Australian Defence Force (ADF) and the Administrative Appeals Tribunal/
Administrative Review Tribunal.
(a) Defence should introduce an enhanced merits-review process in the
Redress of Grievance Directorate of the Inspector-General of the ADF.
(b) The Australian Government should consider giving jurisdiction to a
specialist division of the Administrative Appeals Tribunal/Administrative
Review Tribunal to manage a fast-track method for conducting external
merits reviews. It is proposed that an external merits review would only
be considered after the independent merits review process of the
Inspector-General of the ADF had been completed.
Recommendation 33: Seek to understand whether/how
involvement in military justice processes contributes to
adverse outcomes
Defence should undertake further research to better understand the stressors that
are both associated with, and lead to, involvement in administrative and disciplinary
processes, including:
(a) identifying prevalence rates of suicide and suicidality for serving and
ex-serving members who have been exposed to military justice
administrative and disciplinary processes
(b) exploring the connection between members’ use of alcohol and
other drugs as a numbing strategy to help them cope with trauma and
service-related stressors, and involvement in administrative or disciplinary
processes
(c) identifying opportunities to intervene when members are engaging
in maladaptive coping strategies before their behaviour leads to
administrative or disciplinary action.
Based on the outcomes of this research, Defence should implement policies to
support members involved with military justice processes and minimise the risk of
adverse outcomes, including suicide and suicidality.
(
Recommendation 34: Prioritise the review into the regulations
governing court martial panels
Defence should prioritise the review of current provisions relating to court martial
panels not being required to provide reasons for punishments being imposed.
Defence should document this in the 2024/25 Military Justice Steering Group
workplan.
Recommendation 35: Determine whether support mechanisms for
members involved with military justice processes are effective
Defence should evaluate the effectiveness of the key support mechanisms for those
involved in military justice proceedings, including but not limited to:
(a) support officers
(b) individual welfare boards.
In its evaluation, Defence should consider members’ experiences of the
supports provided.
Recommendation 36: Trial a model outside the chain of command
for supporting members involved in military justice processes
The Australian Defence Force (ADF) should fund and pilot a model for automatic,
opt-out referral to both legal and welfare support services for members engaged
in certain military justice processes that is separate from the chain of command
(for example, the Workplace Behaviour Adviser Network, the Sexual Misconduct
Prevention and Response Office, and the Employee Assistance Program).
In developing the pilot, the ADF should:
(a) consider the role of individual welfare boards in the process
(b) make it clear that once the referral is received, the relevant service would
be responsible for initiating contact
(c) consider thresholds for referral, and focus on increasing support for
members exposed to factors known to contribute to higher risk of
psychosocial harm, suicide and suicidality for example:
(i) those involved (both as victims and accused) in unacceptable behaviour
complaints, sexual misconduct incidents, and disciplinary proceedings
for offences under the Defence Force Discipline Act 1982 (Cth)
(ii) those who are being considered for administrative termination.
The ADF should evaluate the pilot at its conclusion to assess the demand impacts
and benefits in order to inform the decision for a broader roll-out.
Recommendation 37: Develop a charter of minimum standards
for all members involved in military justice processes
The Australian Defence Force (ADF) should develop a charter of minimum
standards for all members involved with or subject to disciplinary processes,
or involved in matters handled by the Inspector-General of the ADF. It should
include commitments to:
(a) treating members with courtesy, compassion, dignity and respect,
and consideration of their welfare needs
(b) providing members with information that is clear and understandable
about:
(i) the relevant military justice processes
(ii) the legal, welfare and victim-support services available to them
(c) referring members to relevant support services
(d) providing updates at key stages of the process, including explaining the
outcomes at its conclusion
(e) giving victims of unacceptable behaviour the opportunity to provide a
victim impact statement to inform sentencing, where the accused has
been found guilty.
The charter should also contain defined roles and responsibilities for meeting the
minimum standards.
The charter should be publicly available and members may refer to these minimum
standards via the existing appeals and complaints processes where they feel these
standards have not been upheld.
Recommendation 38: Improve governance processes related to
accountability and continuous improvement
To improve accountability and continuous improvement regarding mental health and
wellbeing outcomes, Defence should:
(a) continue to work towards including health, wellbeing and safety measures
in its Budget Paper performance measure, and ensure these measures
cascade into future corporate plans
(b) prioritise the development of the Monitoring and Evaluation Framework in
partnership with the Department of Veterans’ Affairs, for the joint Mental
Health and Wellbeing Strategy 2024‒2028, and set out what success
would look like for that strategy in terms of outcomes in the short, medium
and long term, against the wellbeing domains
(c) continue to develop a clear performance logic, including the translation
of performance measures from budget papers, the corporate plan, and
the joint strategy into clear accountability measures for senior leaders
in Defence
(d) once the Enterprise Reform Program has been implemented, assess
how improvements in the collection, sharing and use of data may better
support performance measurement, in line with the Defence performance
logic model.
Acknowledging the challenges in improving performance measurement, and the risk
of unintended consequences, the Australian Government should assist Defence to
build performance management experience and expertise at the unit, service and
enterprise level by:
(e) prioritising Defence in the broader Australian Public Service performance
management capability uplift
(f) prioritising Defence in the Australian Public Service Commission Capability
Review program
(g) supporting a coaching and mentoring program in areas (identified by
Defence) that have responsibility for developing and implementing reforms
in performance measurement.
Recommendation 39: Address risk factors for suicide and
suicidality and report on progress as part of enterprise-level risk
management
Defence should address in-service risk factors for suicide and suicidality as part of
the reporting processes related to enterprise risk management and the development
of mental health and wellbeing strategy by:
(a) identifying in-service risk factors to be reported (including, but not limited
to, the risk factors for suicide and suicidality related to Australian Defence
Force service identified in Chapter 1, Understanding suicide)
(b) developing outcomes-based measures against these risk factors
(c) developing risk controls and measures of control effectiveness.
Enterprise risk management must be informed by a contemporary assessment of
hazards related to the health and wellbeing of Defence personnel and should inform
delivery of the joint Mental Health and Wellbeing Strategy 2024‒2028.
Recommendation 40: Improve governance mechanisms from the
unit level to the enterprise level
In order to identify and address barriers to effective governance from the unit level to
the enterprise level, Defence should:
(a) review all internal and external governance reporting mechanisms
(b) identify root causes of non-compliance with required reporting
(c) identify duplicative reporting information and processes
(d) draw on process-improvement methodologies (for example, Lean
Thinking) to reduce the administrative burden of reporting and governance
compliance across Defence
(e) improve governance, performance-reporting and data literacy at the unit,
service and enterprise level via training and/or embedding coaching.
Recommendation 41: Build project-management capability so that
reform initiatives are successful
To build sustained capability to implement lasting policy changes, Defence should:
(a) engage independent expertise to undertake a project management
maturity assessment of the areas in Defence that will be responsible for
implementing the recommendations of this Royal Commission
(b) upon completion of the maturity assessment, develop a blueprint and
implementation plan to deliver the improvements to those areas of project
management capability that require an uplift
(c) monitor the implementation of the capability uplift through to completion
via a Tier 1 Committee.
Recommendation 42: Ensure that future Inspectors-General of the
Australian Defence Force will not have served in the ADF
The Australian Government should amend Part VIIIB Division 2, sections 110E
to 110P of the Defence Act 1903 so that:
(a) a person appointed as the Inspector-General of the ADF must not
have served in the ADF
(b) the Inspector-General should be supported by two Deputy
Inspectors-General with appropriate skills and experience, for
example, having served in the ADF or having experience and
understanding of the justice system, including military justice
(c) the Deputy Inspector-General positions are to be statutory appointments.
Recommendation 43: Allow the Inspector-General of the Australian
Defence Force to make recruitment decisions for the staffing of
their office
The Inspector-General of the Australian Defence Force (ADF) should have the
responsibility and authority for the selection of staff in their office, including as
to whether staff are drawn from the ADF, the Australian Public Service, or from
other sources.
The Inspector-General should have the power to select and recruit freely from the
ADF without being constrained by whom the Chief of the Defence Force, the service
chiefs or the Director of Military Legal Capability select or recommend.
Recommendation 44: Ensure that staff of the office of the
Inspector-General of the Australian Defence Force have the
necessary skills, expertise and qualifications
The Inspector-General of the Australian Defence Force (ADF) should develop a
workforce plan that includes:
(a) a review of the skills, expertise and professional qualifications required
to discharge effectively the Inspector-General’s complete functions
(b) an assessment of the current workforce in the office of the
Inspector-General in which any competency gaps are identified
(c) a strategic plan to attract and deliver the required capability profile
to the office of the Inspector-General.
Recommendation 45: Improve transparency and accountability
of the Inspector-General of the Australian Defence Force by
increasing their reporting requirements
The Inspector-General of the Australian Defence Force (ADF) should improve the
transparency and accountability of their office by:
(a) updating and publishing comprehensive guidance or other standard
operating procedures on its website, including quality-assurance
measures, related to the discharge of the Inspector-General’s functions in
each directorate of the office of the Inspector-General
(b) establishing and including in this guidance specific performance measures
related to timeliness in the completion of assessments and inquiries
and the consideration of redress of grievance complaints, and reporting
annually on performance against these measures.
Recommendation 46: Ensure staff of the Inspector-General of the
Australian Defence Force are trained in trauma-informed practice
The Inspector-General of the Australian Defence Force should ensure that all staff in
the office of the Inspector-General (including consultants) who engage with members’
next of kin and family members; are communicating with complainants, respondents
or witnesses for the purpose of an inquiry; or who are charged with considering a
redress-of-grievance complaint have completed the Compassionate Foundations
course or equivalent training in trauma-informed practice before doing so, and
complete refresher training every two years.
Recommendation 47: The Inspector-General to inquire into all
deaths of serving members unless suicide can be excluded as the
cause of death
The Inspector-General of the Australian Defence Force (ADF) should ensure that
where suicide cannot be categorically excluded as the cause of death of an ADF
member, a formal inquiry under written directions is conducted.
When undertaking such an inquiry, the Inspector-General should obtain input from a
qualified mental health expert, such as a psychologist, when determining:
(a) whether suicide may have been the cause of death
(b) where suicide cannot be excluded, what the contributing factors may have
been and whether there was a ‘service nexus’
(c) what recommendations should be made.
Recommendation 48: When a member dies by suicide, appoint a
legal officer to represent the interests of the deceased and support
the next of kin
When a serving member dies by suicide, or is suspected to have died by suicide, the
Inspector-General of the Australian Defence Force should ensure that a legal officer
from Defence Counsel Services has been appointed to represent the interests of the
deceased upon written directions for a formal inquiry being issued.
The Inspector-General should ensure that interviews with the member’s next of kin
are conducted after the legal officer has been appointed and made contact with them.
Recommendation 49: Minimise disclosure restrictions of
Inspector-General inquiry reports and ensure they are fair and
understood by the next of kin
In relation to non-disclosure directions made pursuant to section 21 of the Inspector
General of the Australian Defence Force Regulations 2016:
(a) staff from the office of the Inspector-General must explain the scope of the
directions to next of kin and family members before they are made
(b) the directions should not apply to information that next of kin themselves
provide to an inquiry, and which next of kin may know independently of
anything contained in a draft, unredacted or redacted report
(c) next of kin should be consulted directly about the persons that are to be
included in the carve-outs to the directions permitting disclosure, and
persons nominated by the next of kin should be included unless there is a
good reason not to include them
(d) restrictions on disclosure in respect of unredacted and redacted final
reports should only extend to those parts of the reports that need to have
disclosure restricted in the interests of the defence of the Commonwealth,
or for reasons of fairness to a person who the Inspector-General considers
may be affected by the inquiry
(e) the Inspector-General should establish a mechanism by which next of kin
may have the directions that are made reviewed by a legal officer of the
office of the Inspector-General who was not involved in the relevant inquiry
or in the decision to make the directions. The Inspector-General must
have regard to the issues or concerns raised by the legal officer
(f) there should be comprehensive guidance in relation to the making and
terms of Section 21 directions included in the updated comprehensive
guidance on the Inspector-General’s website.
Recommendation 50: Amend the scope of the Inspector-General’s
role to inquire into suicide deaths of former Australian Defence
Force members
The Inspector-General should be required and empowered to inquire into the death
of a former Australian Defence Force (ADF) member where the death may have been
by suicide, and where:
(a) the death occurs:
(i) after 30 September 2024; and
(ii) within two years of the former member ceasing to be an ADF
member; and
(b) the Inspector-General is notified or otherwise learns of the death within
three months of the date of death.
Recommendation 51: The Inspector-General to regularly review
inquiries into suicide deaths to determine common themes
The Inspector-General of the Australian Defence Force should conduct a review of all
inquiries and reports into suicide or suspected suicide every three years to determine
whether there are any common themes and contributing factors, and report the
findings to the Chief of the Defence Force, the Minister for Defence and the Minister
for Defence Personnel.
Recommendation 52: Conduct a merits review when a member’s
service is involuntarily terminated and they submit a redress of
grievance complaint
When a member makes a redress of grievance complaint concerning a decision to
terminate their service, the Inspector-General of the Australian Defence Force should:
(a) (in addition to Recommendation 32) conduct a review in the nature of a
merits review and determine, in their view, the correct or preferable decision
(b) conclude their consideration of the complaint within 60 days of referral
(c) give the member the opportunity to provide any further information or
submissions prior to concluding their consideration of the complaint, in
person, if practicable to do so, when the proposed outcome will not be
favourable to the member.
Recommendation 53: Give members 21 days to make a complaint
after being notified of a decision to terminate their service
Defence should amend Section 41(2) of the Defence Regulations 2016 to allow a
member to make a complaint up to 21 days after they are notified of a decision to
terminate their service.
Recommendation 54: Improve the frequency of military justice-
related audits conducted by the Inspector-General of the Australian
Defence Force
The Inspector-General of the Australian Defence Force (ADF) should:
(a) conduct a routine military justice performance audit of every major ADF
unit every three years, and of every ab initio training establishment every
two years
(b) conduct a longitudinal study of all audit reports every two years to
determine trends, themes and issues of concern, and provide the
outcomes of this analysis to the Chief of the Defence Force, the Minister
for Defence and the Minister for Defence Personnel
(c) audit at least three non-major units each year that are not part of the
Directorate of Military Justice Performance Audit routine audit cycle.
Recommendation 55: Conduct an audit into Defence workplace
health and safety risk management
The Defence Audit and Risk Committee should commission an audit into Defence
workplace health and safety (WHS) risk management within the next 12 months.
The audit should include, but not be limited to:
(a) reviewing WHS hazard trends with a focus on psychosocial health and
compliance with requirements of the Work Health and Safety Act 2011 (Cth)
(b) reviewing the accuracy of existing WHS enterprise risk reporting, including
the WHS dashboard
(c) assessing WHS risk-assessment methodology, and the accuracy of
categorisations of ‘likelihood’ and ‘impact’ of hazards within the ‘WHS’
enterprise risk category
(d) assessing the suitability and effectiveness of WHS hazard controls,
including their ability to be measured for impact.
The findings of the audit must be reflected in the delivery of the Defence WHS
Strategy and WHS risk reporting going forward.
Recommendation 56: Improve guidance and understanding of
Defence’s ‘if in doubt, notify’ policy
Comcare and Defence should work together to improve guidance and understanding
of the ‘if in doubt, notify’ policy in relation to determinations about when to report
notifiable incidents to Comcare.
Recommendation 57: Comcare to regularly review Australian
Defence Force determinations of ‘service nexus’ for suicide
attempts and suspected deaths by suicide
Comcare should improve its quality assurance of Australian Defence Force (ADF)
‘service nexus’ determinations made by the ADF by:
(a) undertaking a periodic review of service nexus determinations made
by the ADF for incidents of suicide, suspected suicide, attempted suicide,
and non-fatal self-harm by ADF members, where the ADF has concluded
that the incident did not arise out of the conduct of the ADF’s business
or undertaking, under section 38(1) of the Work Health and Safety
Act 2011 (Cth)
(b) evaluating the results of these periodic reviews after three years to
determine whether there is a continued need for them. The timeframe
of three years will enable Comcare to test a sufficient sample size to
inform a decision about whether to continue periodic reviews.
Defence should fund any additional resourcing required by Comcare to undertake
these periodic reviews over the three-year period and conduct its evaluation at the
end of that period.
Recommendation 58: Give Comcare access to the National
Veterans’ Data Asset
Comcare should have access to the National Veterans’ Data Asset (Recommendation
107), to inform Comcare’s regulatory approach to preventing psychosocial harm
including latent harm.
Recommendation 59: Defence to participate in Comcare’s
Psychosocial Proactive Inspection Program
Defence should participate in Comcare’s Psychosocial Proactive Inspection Program,
once the evaluation has established that it is effective.
Either:
(a) Defence should fund its participation in that program, or
(b) a Commonwealth appropriation should be made to Comcare for the
purpose of Defence’s participation in the program.
Recommendation 60: Improve strategies for harm prevention and
early intervention by sharing quality data with Comcare
To improve Comcare’s ability to inform prevention and early intervention strategies
for suicide and latent harm arising from Australian Defence Force service, Defence
should:
(a) share with Comcare on a quarterly basis through the Suicide and
Self-Harm Working Group meeting:
(i) data on psychosocial harm (including data related to notifiable
and non-notifiable incidents)
(ii) Defence’s analysis of this data to identify systemic issues related
to psychosocial harm
(b) share with Comcare through the Defence-Liaison Forum meeting what
actions it has taken to document and implement controls to address
systemic hazards, risks and issues relating to psychosocial harm.
Recommendation 61: Establish a brain injury program
Defence and the Department of Veterans’ Affairs should establish a brain injury
program that covers, at a minimum, relevant Army corps, special forces, Navy
clearance divers, Air Force combat controllers, and serving and ex-serving members
exposed to mefloquine and/or tafenoquine. The program should:
(a) aim to better understand, and mitigate, the impact of repetitive low-level
blast exposure on brain processes
(b) assess and treat neurocognitive issues affecting serving and ex-serving
members, whatever their cause.
To do this, it should:
(c) monitor and assess environmental exposure to blast overpressure
(d) record members’ exposure to traumatic brain injury and minor traumatic
brain injury, including in medical records
(e) establish a neurocognitive program suitable for serving and ex-serving
members experiencing a range of neurocognitive issues, whatever their
cause. This could be adapted from the former Mending Military Minds
program
(f) provide referral pathways for further medical assessment, when required.
Recommendation 62: Establish a research translation centre for
defence and veteran health care
The Australian Government should support the development of a research translation
centre for Defence and veteran health care, or a similar body with an explicit research
translation focus.
(a) Defence and the Department of Veterans’ Affairs (DVA) should work with
relevant stakeholders, including researchers and health providers with
expertise and experience in defence and veteran health care, to develop a
model for the establishment of the research translation centre and priority
initiatives for funding.
(b) The model should be informed by the National Health and Medical
Research Council criteria for accreditation of a research translation centre,
and include the following aims:
(i) promoting and increasing research on Defence and veteran health
care in Australia
(ii) translating research into improvements to the health system and
better outcomes for patients
(iii) facilitating collaboration among and between researchers and
clinicians
(iv) supporting research-infused education and training.
(c) Defence and DVA should jointly develop a business case for the research
translation centre for consideration by the Australian Government.
Recommendation 63: Reduce stigma and remove structural and
cultural barriers to help seeking
The Australian Defence Force (ADF) should identify and remove cultural and
structural barriers to help seeking and make a greater concerted effort to reduce
stigma. This should include:
(a) the Australian Government should remove reference to the word
‘malingering’ at Section 38 of the Defence Force Discipline Act 1982 (Cth)
(b) Defence should review all its policies and procedures and amend or
remove those that are stigmatising
(c) the ADF should develop a dedicated training program and a
communications campaign to reduce stigma and promote help seeking.
Recommendation 64: Establish an enterprise-wide program to
monitor and prevent physical and psychological injury
The Australian Defence Force should establish a comprehensive, enterprise-wide
injury surveillance and prevention program. The program should encompass physical
and psychosocial risks and hazards, and:
(a) be adequately resourced, including by engaging staff with appropriate
expertise in injury prevention, including physical and psychosocial injury
and illness
(b) identify the most common injury risks and hazards and implement
strategies for preventing or minimising them
(c) include functionality within the reporting system to identify root causes or
contributing factors including location, time, and activity being undertaken
at the time of injury
(d) actively monitor where injuries and psychological risks and hazards occur
and generate quarterly reports on injury rates and clusters with actionable
recommendations for commanding officers.
Recommendation 65: Improve access to, timeliness and quality of
mental health screening and use the data effectively
The Australian Defence Force should ensure that its mental health screening
continuum effectively identifies members who require additional support and/or who
are at heightened risk of suicide, and that these individuals receive support, by:
(a) ensuring that members have access to screening and are offered referrals
for further support at all known points of vulnerability, including: during
ab initio training, when their military employment classification is
downgraded, and accessing rehabilitation
(b) ensuring that a sufficient and appropriately trained workforce is available
to administer the mental health screening continuum and conduct the
required follow-ups, including:
(i) ensuring screening is done in such a way that encourages disclosure,
including face-to-face screening wherever possible
(ii) ensuring members receive timely and appropriate referrals following
screenings where required
(iii) monitoring the uptake of referrals and following up with members who
do not action these referrals
(iv) monitoring members who are overdue for screenings and following up
with them
(c) introducing tools that screen for known risk factors for suicide and
suicidality that are not currently screened for, including problematic anger,
sleeping difficulties and military sexual trauma
(d) using the data collected during screenings for longitudinal surveillance.
Recommendation 66: Where possible, support injured members to
be rehabilitated at work, within their home unit
The Australian Defence Force (ADF) should support and resource rehabilitation
services within the ADF to adopt a tailored approach, from members rehabilitating
within their home unit, either with or without the support of a specialist rehabilitation
service working in conjunction with the chain of command when required, to
coordination of rehabilitation and recovery through a specialist rehabilitation unit
only in exceptional circumstances and when necessary to optimise functioning and
return to work.
Consistent with this approach:
(a) Defence policies and procedures related to rehabilitation should adopt the
principle of recovering at work, where safe to do so. This principle should
be embedded in the Defence Health Manual, Military Personnel Manual,
ADF Rehabilitation Program Procedures Manual, and other relevant
policies and guidelines.
(b) rehabilitation at home or in a designated rehabilitation unit should be
reserved for exceptional circumstances, and even in these instances,
home units must maintain connection with the member undergoing
rehabilitation, whether that be at home or assigned to a designated
rehabilitation unit
(c) rehabilitation outcomes should be publicly reported on a regular basis.
Recommendation 67: Align Defence’s clinical governance
framework with the national model framework
Defence should work with relevant bodies, including the Australian Commission
on Safety and Quality in Health Care and the Royal Australian College of General
Practitioners, and in consultation with Bupa, the Department of Veterans’ Affairs
(DVA) and relevant civilian health services to review its clinical governance
framework, with a view to aligning it with the National Model Clinical Governance
Framework.
Defence should give particular attention to:
(a) strengthening its quality improvement systems to actively manage and
improve the safety and quality of its health care
(b) ensuring that performance monitoring systems are in place to monitor
clinical effectiveness
(c) establishing partnerships across DVA, civilian healthcare services and
specialist facilities for serving and ex-serving members, and leveraging
these partnerships to respond optimally to the unique needs of each
patient
(d) ensuring that serving members are a partner in the design, delivery and
evaluation of Australian Defence Force healthcare services.
Recommendation 68: Strike the right balance between upholding
confidentiality and disclosing information when a member is
in distress
Defence should ensure that members and commanding officers understand how
the Privacy Act 1988 (Cth) operates and the importance of members’ consenting
to their health information being shared with those able to facilitate appropriate
care and support, in the event members are distressed or experiencing mental
health challenges.
To this end, Defence should:
(a) continue its proactive approach to consent and provide regular training on
the Privacy Act
(b) regularly evaluate members’ understanding of the importance of consent
and how Defence will use their personal information
(c) by the end of 2025 and regularly thereafter (no less frequently than every
three years), review its privacy policy and amend it as appropriate to
ensure that it is clear, particularly with respect to:
(i) what it means to provide consent, and why consent is important,
particularly for ensuring that family members are equipped with relevant
information to support a members’ mental health and wellbeing
(ii) how members’ health information is reasonably necessary for, or
directly related to, the functions and activities of the Australian
Defence Force (ADF), including what ‘suitability for service from a
health perspective’ means
(iii) when a ‘general permitted situation’ (as defined in section 16A of the
Privacy Act 1988 (Cth)) exists in the context of the ADF, particularly
when a member is experiencing distress or mental health challenges
that puts them at risk of suicidality
(iv) when members’ mental health information will be disclosed to their
commander or manager to facilitate their wellbeing; when, in the
context of the ADF, disclosure is necessary to lessen or prevent
a serious threat to the life, health or safety of any individual or to
public health or safety, and to whom the information can be disclosed.
If barriers remain following review and amendment of the Defence privacy policy, then
consideration could be given to subsequent legislative change, as part of the process
set out in Recommendation 74.
Recommendation 69: Improve suicide-prevention training so
it is practical, tailored, informed by lived experience and delivered
in person
The Australian Defence Force should revise and improve its suicide-prevention
training so it:
(a) focuses on practical rather than theory-based learning, and ensures
members are familiar with what support is available
(b) is scaled, to emphasise different levels of responsibility, from junior ranks
to commanders. Specific training should be offered to senior leaders,
which sets out how they can support those under their command
(c) is informed by, and involves, members with lived experience of suicide,
suicidality or mental health
(d) delivers all suicide prevention training in-person by no later than
31 December 2025.
Recommendation 70: Revise protocols for responding to suicidal
crisis to be in line with clinical best practice
By no later than 31 December 2025, Defence should revise its protocols for
responding to suicidal crisis so they are applied consistently, in line with clinical best
practice.
(a) The protocols should, among other things, specify:
(i) the availability of, and arrangements for accessing, culturally
appropriate crisis care facilities
(ii) a minimum standard for aftercare
(iii) how monitoring and follow-up support should occur following a
suicide-related incident
(iv) approaches to reintegration following a suicidal crisis.
(b) The revised protocols should be developed in partnership with an external
body with expertise in managing suicidal crisis and aftercare.
(c) The revised protocols and their application across the three services
should be subject to independent evaluation after five years.
Recommendation 71: Increase the Department of Veterans’ Affairs
fee schedule so it is aligned with that of the National Disability
Insurance Scheme
The Australian Government should amend the Department of Veterans’ Affairs (DVA)
fee schedule to mitigate the challenges faced by veterans in accessing health care,
ensuring that:
(a) at a minimum, the revised fee schedule aligns with that of the National
Disability Insurance Scheme
(b) efforts to mitigate supply constraints are prioritised, such as
non-fee-for-service components, additional loading, and/or incentive
payments, including in areas with few health services for the populations
being served.
DVA should reduce the time taken to pay healthcare providers, and track and publicly
report on the time taken to provide these payments.
Recommendation 72: Expand and strengthen healthcare services
for veterans
The Australian Government and state and territory governments should prioritise
networks of care in the National Funding Agreement on Veterans’ Wellbeing
(Recommendation 88).
To enable this, the Department of Veterans’ Affairs (DVA) should develop a plan to
expand and strengthen specialised health care for veterans. It should set out how
to bring together the different components of the health system to meet the health
needs of veterans. DVA should complete the plan by September 2026 and submit it to
the Veterans’ Ministerial Council for endorsement as part of the funding agreement.
The plan must set out measures to improve the coverage of specialised veterans’
care, including by:
(a) providing support for primary and allied care providers whose services
focus on veterans’ health needs
(b) expanding veteran-specific secondary and tertiary health services
(c) developing additional partnership agreements between DVA and primary
health networks.
It must also support the integration of veterans’ health services at a local and national
level, including by:
(d) better informing veterans about available services
(e) using existing health infrastructure, such as primary health networks
(f) developing local exchanges to tighten relationships between medical and
allied health care practitioners.
The plan should be guided by current and future needs and informed by data on
Australia’s veteran population showing the size of veteran communities in different
areas, where specialised services currently exist or are lacking, and how and where
veterans access health services.
Recommendation 73: Improve military cultural competency in
health professions working with veterans
The Department of Veterans’ Affairs (DVA) should complement the work outlined in
Recommendation 72 by expanding its efforts to build cultural competency relating
to veterans among health workers who operate in mainstream health settings.
DVA should expand its training modules and enable health professionals working
with veterans to complete them. It should promote this work, including through
partnerships with professional bodies.
Recommendation 74: Clarify the application of the Privacy Act to
veterans to determine whether amendments are necessary
The Department of Veterans’ Affairs (DVA) should seek legal advice clarifying the
application of the Privacy Act 1988 (Cth) (and any other relevant legislation) to
veterans and their families in the context of sharing data and information related to
health, wellbeing and safety.
DVA should use this advice to inform consideration of whether legislative
amendments are required to optimise the management of the health and wellbeing
of veterans. Consideration may be given to extending the scope of any changes to
encompass serving members, if this is needed following the review of the Defence
privacy policy proposed at Recommendation 68.
Recommendation 75: Conduct an independent review of Open
Arms and publish the report
The Australian Government should commission an independent review of Open
Arms, to commence in 2027, following the implementation of the new Model of Care
and led by a qualified entity outside of the Defence portfolio.
The scope of the review should be wide-ranging and it should examine:
(a) how Open Arms is discharging its functions, including its compliance with
clinical standards and its management of at-risk clients
(b) issues that could affect Open Arms’ ability to discharge its functions,
including workforce, culture and funding
(c) what functions Open Arms should perform within the wider network of
services accessible to serving and ex-serving members
(d) the appropriateness of Open Arms’ delivery model, and whether another
model is preferable.
The Australian Government should make the review’s report public.
Recommendation 76: Develop a postvention framework with
experts and those with lived experience of suicide bereavement
The Australian Defence Force should develop a postvention framework that must be
implemented following a serving member’s death by suicide (or suspected suicide)
for the purposes of supporting the member’s family members and colleagues, as well
as first responders. It should involve:
(a) collaborating with and seeking input from peak postvention organisations
and those with lived experience of suicide bereavement
(b) developing communication materials and training modules for
commanders and key decision-makers about trauma-informed postvention
support for Defence personnel
(c) the use of a systematic process for identifying and referring those at
highest risk following a suicide death
(d) consideration of the unique circumstances of each posting or cultural
circumstances of the bereaved
(e) greater surveillance and evaluation of the broader impact of suicide
on personnel and their functioning for the purposes of improving
interventions.
Recommendation 77: Develop a suite of postvention resources in
collaboration with stakeholders
Defence and the Department of Veterans’ Affairs should fund and facilitate the
development of a postvention network of suicide-bereavement resources in
collaboration with ex-service organisations, states and territories, lived experience
peers, and civilian support organisations to augment current postvention offerings,
which can be inclusively accessed by and are tailored for the military community and
all those affected by veteran suicide.
Recommendation 78: Prevent, minimise and treat moral injury
Defence and the Department of Veterans’ Affairs should work collaboratively to
develop an agreed approach to minimising the negative impacts of moral injury,
including the risk of suicide and suicidality for serving and ex-serving members. The
approach should evolve in line with emerging research and best practice, and at a
minimum include:
(a) implementing education, training and support programs with the explicit
objectives of preventing, minimising and treating moral injury
(b) considering using the Moral Injury Outcome Scale or other tools, as the
evidence base evolves, to support the early identification and treatment of
moral injury
(c) conducting or commissioning further research to better understand moral
injury in the Australian military population.
Recommendation 79: Ensure that respect for and recognition of
service are embedded throughout Defence and the Department of
Veterans’ Affairs
Respect and recognition should be a key element of separation and transition
processes; they must also be the foundation for all interactions with members and
former members of the Australian Defence Force during service and civilian life.
Defence and the Department of Veterans’ Affairs should:
(a) examine their processes to identify ways in which respect in interactions
with serving and ex-serving members can be increased
(b) create a survey to benchmark the levels of respect shown to current and
ex-serving members prior to 30 June 2025
(c) conduct this survey every two years to identify areas for improvement,
and introduce improvements no later than the following year
(d) support the Joint Transition Authority to review its policy on recognition
and farewells on a regular basis (at least every three years) to identify
areas for improvement, and introduce these improvements by the
following year.
Recommendation 80: The Department of Veterans’ Affairs to take
responsibility for supporting members to transition out of the
Australian Defence Force
Defence should continue to be responsible for supporting members to prepare
for and complete separation from the Australian Defence Force (ADF). The new
executive agency to be established in the Department of Veterans’ Affairs (DVA)
(Recommendation 87) should take responsibility for supporting members to transition
into civilian life.
Through the new agency, DVA should:
(a) establish a meaningful relationship with serving members as soon as they
begin a pathway towards transition
(b) conduct a transition readiness review prior to separation, which includes
the member, their commanding officer and DVA support person
(c) lead transition screening and expand it to assess members’ psychosocial
readiness for transition, including purpose and connection, help-seeking,
beliefs about civilians, and regimentation and adaptability
(d) with the consent of the member, share transition screening results
(wholly or partially) with the member’s commanding officer and key
transition support people within Defence and DVA (with Defence and DVA
implementing a proactive process to obtain members’ consent to share
this information)
(e) proactively reach out to ex-serving members in the 12 months after
they leave the ADF to understand their experience of transition, how
they are adjusting to civilian life, and connect them with supports
delivered by Australian Government agencies, states and territories,
and ex-service organisations.
Recommendation 81: The Department of Veterans’ Affairs to fund
a program to support members’ wellbeing during transition to
civilian life
The Department of Veterans’ Affairs (DVA) should fund and commission a cultural
transition program to support members to build and maintain wellbeing during the
transition from military to civilian life. The purpose of the program should be to
empower members to develop the skills to adjust and integrate into civilian culture
successfully and sustain social connections.
The program should:
(a) be designed by an expert panel independent from DVA, including people
with lived experience of service and transition (both serving and ex-serving
Australian Defence Force members) and expertise in cultural adjustment
and trauma-informed approaches
(b) be delivered in two parts, the first prior to separation and the second within
six months of separation
(c) be evaluated three years after the commencement of the program
to assess its outcomes and effectiveness, with adjustments made
accordingly.
Recommendation 82: Establish a consistent, locally responsive
policy on ex-serving members’ access to bases
Defence should establish a consistent policy on access to military bases that
includes the objective of supporting ex-serving members and their families to
maintain social connections following separation from the Australian Defence
Force. The policy should allow for local decision-making that balances the benefits
of maintaining social connection with former colleagues in the 12 months following
separation, with the need to maintain base security.
Recommendation 83: Increase opportunities for members to gain
civilian qualifications from Defence training and education
Defence should expand the objective of its education and training policies and
programs from a sole focus on Defence capability requirements to include member
lifetime wellbeing. Specifically, Defence should:
(a) commencing 1 July 2025, issue all civilian accreditations for Defence
training at the point of completion of the requisite training, rather than at
the point of transition from service
(b) remove arbitrary limits on the number of civilian qualifications that may
be awarded to a member in recognition of Defence training they have
completed
(c) ‘fill the gap’ between Defence and civilian training (where an equivalent
civilian qualification exists), either by expanding the content of the
Defence training course or by funding bridging training for members prior
to separation.
Recommendation 84: Issue separating members with a reference
that states their skills, experience and capabilities
To support ex-serving members to promote their skills and experience in the civilian
job market, the Australian Defence Force should issue a reference to each member
at separation. The reference should reflect the individual skills and experience of the
member and include a personalised statement on the capabilities they demonstrated
in their most recent role/s. Contact details of the member’s commanding officer
approximate to, or at, the point of transition should be provided wherever possible.
Recommendation 85: Develop employment pathways for
ex-serving members in public sector agencies
The Australian Public Service Commission and its state and territory equivalents
should work with public sector agencies to develop and prioritise employment
pathways for ex-serving members. They should prioritise agencies in portfolios where
military capabilities and lived experience of service are especially relevant, including
health, justice, corrections, police, veterans’ affairs and defence.
Recommendation 86: Ongoing funding for Veterans’ and
Families’ Hubs
The Australian Government should develop a recurrent funding model for Veterans’
and Families’ Hubs to support their financial sustainability and ongoing operations.
In particular, the funding model should ensure that the operating costs of hubs can
be met (that is, separate from the costs associated with the services delivered by
various providers). The funding model should be developed in consultation with lead
organisations of Veterans’ and Families’ Hubs, as bespoke arrangements are likely to
be needed.
Funding agreements should include standardised, de-identified data collection and
reporting requirements to inform ongoing service delivery improvements and help to
identify service gaps. Data should be shared with state and territory governments.
Recommendation 87: Establish a new agency to focus on veteran
wellbeing
The Australian Government should establish a new executive agency focused
on veteran wellbeing. The new agency should have distinctive branding, but be
administratively nested within the Department of Veterans’ Affairs (DVA) to ensure
seamless information sharing and referrals.
The new veteran wellbeing agency should have the following functions:
(a) Transition – to play a key role in supporting veterans to transition from
military to civilian life (Recommendation 80), build relationships and
encourage veterans to access early interventions and supports
(b) System navigation and connection to wellbeing supports at the individual
level – to help veterans to navigate the wellbeing ecosystem by providing
clear information online about available services, and by working in
partnership with Veterans’ and Families’ Hubs and expanding engagement
with veterans through state and territory shopfronts
(c) Improve referral pathways and service integration at the systems level by:
(i) managing relationships between Veterans’ and Families’ Hubs,
ex-service organisations (ESOs), DVA, Australian and state and
territory government agencies and non-government service providers
(ii) ensuring referral pathways are in place and services are integrated
to the greatest extent possible
(iii) advising DVA and state and territory governments on service gaps
(d) Co-designing wellbeing supports – to work with veterans and ESOs to
co-design new prevention and early intervention wellbeing programs and
services at the local level, supported by a dedicated funding stream under
the redesigned grants program for ESOs.
The new veteran wellbeing agency should have an ongoing operating budget, and
the following capabilities and features:
(e) staff who have lived experience of military service
(f) offices established in area/s where large numbers of veterans live
(g) customer service expertise, including in digital-led solutions
(h) a trauma-informed communications and service-delivery approach
(i) led by a CEO who reports to the Secretary of DVA
(j) adhering to a service charter and associated key performance indicators,
supported by regular and transparent reporting requirements.
Recommendation 88: Develop a national funding agreement on
veterans’ wellbeing
A national funding agreement on veterans’ wellbeing should be developed, with
immediate focus on the following priorities:
(a) improving outcomes for veterans who are experiencing homelessness,
including a long-term investment framework that supports capital and
operational expenditure for veteran-specific housing and the provision
of wraparound services
(b) supporting veterans who are incarcerated, both during and after
their incarceration
(c) facilitating school enrolments for children of serving members, without
requiring a confirmed address
(d) developing networks of health care for veterans (see Recommendation 72)
(e) obtaining individual consent from veterans who separate involuntarily
for medical or other reasons (and other cohorts at higher risk of suicide
and suicidality) to provide their personal data to state and territory
governments to ensure they can receive tailored support and referrals to
veteran-specific services, including Veterans’ and Families’ Hubs.
Recommendation 89: Establish a national peak body for ex-service
organisations
The Australian Government, in consultation with ex-service organisations (ESOs),
should establish a national peak body for ESOs following a co-design process.
The role, functions, membership, governance and funding model of the peak body
should be informed by the outcomes of the business case, and agreed between the
Department of Veterans’ Affairs and the ESO sector. The funding model should not
exclude participation of any eligible ESOs, particularly those who operate on a not-
for-profit basis.
(
Recommendation 90: Remove the service differential for
permanent impairment compensation and expand mental
health support to all reserve personnel
The Australian Government should:
(a) remove the service differential as it relates to permanent impairment
compensation
(b) extend non-liability health care for mental health conditions to all reserve
personnel.
Recommendation 91: Implement combined benefits processing for
all initial liability and permanent impairment claims
The Department of Veterans’ Affairs (DVA) should implement combined benefits
processing for all initial liability and permanent impairment claims under the Military
Rehabilitation and Compensation Act 2004 (Cth) (the new single Act) for veterans’
entitlements, noting that some limited exceptions will apply.
The Australian Government should ensure that DVA has sufficient additional funding
to implement this new approach to claims processing.
Recommendation 92: Review claims to the Department of
Veterans’ Affairs associated with physical and sexual abuse
The Department of Veterans’ Affairs (DVA) should commission an independent review
of claims made between 2015 and 2024 that are associated with physical and sexual
abuse during service. The review should:
(a) determine if there is any material difference in the acceptance or
correctness rates for these claims compared to other claim types and,
if so, identify why and any required changes to veterans’ entitlements
legislation, DVA policy, and/or training and support provided to delegates
(b) recommend any necessary improvements that will ensure delegates
deliver services in a trauma-informed way and understand the dynamics
of military sexual violence and other forms of abuse during service
(c) examine the supports in place for victims who have submitted a claim of
this kind and recommend any necessary improvements to align with best
practice.
Recommendation 93: Fund the Transition Medical Assessment
Pilot Program on an ongoing and national basis
The Australian Government should provide funding to the Department of
Veterans’ Affairs and Defence to support:
(a) expanding the Transition Medical Assessment Pilot Program to
North Queensland in 2025–26
(b) rolling out the program nationally to serve all Australian Defence Force
members who are medically separating with complex needs from
2026–27 onwards.
Recommendation 94: Improve timeliness and reporting on
information-sharing between Defence and the Department of
Veterans’ Affairs for claims processing
To ensure timely information-sharing between the Department of Veterans’ Affairs
(DVA) and Defence for the purpose of claims processing:
(a) DVA and Defence should establish a key performance indicator for the
timeliness of information provided by Defence through the Single Access
Mechanism, and report on performance in annual reports
(b) Defence should report annually on the progress of records digitisation until
all records are fully digitised.
Recommendation 95: Support the expanded application of
‘presumptive liability’
The Department of Veterans’ Affairs (DVA) should:
(a) establish a dedicated ongoing workstream to support the expanded use
of presumptive liability as part of its research and evaluation model,
informed by the views of the expert committee on veteran health research
(Recommendation 117)
(b) follow developments in civilian workers’ compensation schemes, and
consider where they are relevant to Australian Defence Force (ADF)
contexts. As an immediate priority, DVA should consider whether a
presumption related to liability for post-traumatic stress disorder should
apply to certain roles within the ADF.
Recommendation 96: Ongoing funding for Provisional Access to
Medical Treatment
The Australian Government should fund Provisional Access to Medical Treatment
beyond June 2026 on an ongoing basis.
Recommendation 97: Consider giving the Veteran Payment to more
veterans with physical health conditions
The Department of Veterans’ Affairs (DVA), in conjunction with the Repatriation
Commission, should examine whether there are specific cohorts of veterans with
physical health conditions who are at higher risk of suicide and may therefore benefit
from receiving the Veteran Payment.
If such cohorts are identified, DVA should seek the appropriate authority from the
Australian Government to extend the Veteran Payment to those cohorts.
Recommendation 98: Strengthen Department of Veterans’ Affairs
performance targets for claims processing timeframes, and
improve transparency
Department of Veterans’ Affairs (DVA) performance targets for the timeliness of
liability and permanent impairment claims under the Military Rehabilitation and
Compensation Act 2004 (Cth) (the new single Act) should be reset so that:
(a) by 1 July 2026, at least 65% of claims are determined within 90 days
(b) by 1 July 2028, at least 80% of claims are determined within 90 days.
Starting in 2024–25, DVA should include in its annual reports:
(c) data-driven measures of DVA’s compliance with its customer service
standards
(d) the percentage of claims for which DVA requested an independent medical
examination
(e) the number of additional conditions and sequelae covered by presumptive
liability compared with the previous year, as well as the number and
percentage of initial liability determinations that were made pursuant to
presumptive liability provisions.
Recommendation 99: Improve compensation advocacy by funding
professional, paid advocates
The Australian Government should replace the Building Excellence in Support and
Training (BEST) grant program with an ongoing, demand-driven funding program for
professional, paid veteran compensation advocates. At a minimum, the amount of
funding should be increased to provide compensation advocacy for:
(a) all veterans who need support to submit a liability and/or compensation
claim with the Department of Veterans’ Affairs
(b) all veterans seeking an internal or external review of a claims decision.
Funding allocations should be for a minimum of three years to provide employment
stability. They should be designed to ensure equitable geographic service coverage
and meet the diverse demographic needs of the veteran population, including female
veterans and LGBTIQ+ veterans.
Recommendation 100: Improve the transparency, accountability
and effectiveness of the Department of Veterans’ Affairs
rehabilitation program
The Department of Veterans’ Affairs (DVA) should improve the transparency of the
DVA Rehabilitation Program and how its effectiveness is measured. At a minimum,
this should include:
(a) reinstating the program performance indicator that measures the
percentage of clients for whom rehabilitation goals were met or exceeded,
with a target of 75%, and including this measure in annual public reporting
(b) expanding key performance indicators for rehabilitation program
providers to measure the percentage of clients who meet or exceed their
rehabilitation goals, disaggregated by goal type (for example, medical
management, vocational and psychosocial). This information should be
shared with DVA rehabilitation clients so they can make an informed
choice of provider (as related to Recommendation 101 on choice and
autonomy).
Recommendation 101: Give Department of Veterans’ Affairs clients
more choice and autonomy
Veterans supported by the Department of Veterans’ Affairs should be afforded similar
levels of choice and autonomy to National Disability Insurance Scheme (NDIS)
participants, to the greatest extent possible. At a minimum, this should include:
(a) enabling veterans to:
(i) choose their rehabilitation provider, supported by clear information
about provider quality and service characteristics (including
information specified in Recommendation 100)
(ii) self-manage their budget for approved household assistance on
an opt-in basis, to align with the autonomy and payment conditions
afforded to NDIS clients and providers
(b) reimbursing veterans for travel costs to see their preferred healthcare
providers (noting that some constraints will apply), supported by legislative
reform developed in consultation with veterans.
Recommendation 102: Implement and improve upon the
Defence Strategy for Preventing and Responding to Family
and Domestic Violence
In addition to, and as part of the implementation of the Defence Strategy for Preventing
and Responding to Family and Domestic Violence 2023–2028, Defence should:
(a) recognise the nexus between family violence and suicide, including the
inclusion of family violence indicators within approaches to suicide prevention,
and consideration of suicide risk within responses to family violence
(b) implement all recommendations made by Defence Families of Australia
(DFA) in its issues paper on Australian Defence Force families and
domestic violence and work collaboratively in an enduring fashion with the
DFA to deliver ongoing reforms to prevent family and domestic violence
and support victims of family and domestic violence
(c) establish and communicate a set of minimum standards to guide its
approach to family and domestic violence that are publicly available and:
(i) clearly articulate victim safety (including that of children) as the
primary consideration in decision-making
(ii) define how Defence will ensure that any protection orders that may
be in place can be upheld in the workplace, including how it will
ensure that postings and workplace arrangements prioritise the safety
of the victim
(iii) include clear expectations regarding disclosure by Defence members
who are the respondent on a protection order relating to family
violence
(d) take steps to ensure that Defence property, equipment and resources
are not used to perpetrate family and domestic violence, including that
Defence housing stability is not used as a means to exercise coercive
control or to create barriers to safe separation
(e) ensure that there are no impediments to Defence personnel accessing
emergency services responses while on base, in relation to family and
domestic violence. All materials regarding family and domestic violence
should include emergency services response information and be regularly
reviewed for currency.
Recommendation 103: Improve the support, communication and
services provided to Defence families
In recognition of the critical role that Defence families play in Defence capability,
and the stressors that service life places on the member and their family unit,
Defence should:
(a) increase and enhance the suite of family support programs and initiatives
available to Defence families, informed by co-design with members,
families and Advocates. This should include:
(i) systematically analysing data from the Defence Member and
Family Helpline to better understand issues and trends, and create
opportunities to better assist members and their families
(ii) removing barriers to families directly accessing information and
services provided by Defence Member and Family Support (DMFS)
(iii) providing an evidence-based suite of information and resources to
support families, especially at times of peak stress including postings,
return from deployment and member transition
(iv) facilitating greater access to or provision of family therapy, and
services that support partners and children of Defence members
(v) an enhanced DMFS communications strategy
(b) ensure that systems are in place to communicate directly with families
on an ‘opt out’ basis to provide information on available services and
supports, assisted by a refreshed DMFS communications strategy and
greater efforts to publicise the supports available
(c) develop and implement a framework to evaluate outcomes, including the
efficiency and effectiveness of all current and future DMFS initiatives,
with this material to be made public to demonstrate transparency and
accountability for the performance of DMFS
(d) work with the Australian, state and territory governments to investigate
and improve arrangements for facilitating employment opportunities for
partners of Defence members as well as opportunities for remote working,
or preferential employment of this cohort in appropriate roles
(e) work with the Australian Government, following the completion of the
Defence Childcare Review and the Productivity Commission Review into
Early Childhood Education and Care, to identify and realise opportunities
to improve the provision of child care services to Defence members.
(
Recommendation 104: Improve the profile, resourcing and impact
of the Defence Family Advocate
To achieve the best possible representation of serving and ex-serving members and
their families, the Australian Government should:
(a) improve the profile, resourcing and impact of the Defence Family
Advocate, by:
(i) providing the Defence Family Advocate with appropriate staffing,
budget and remuneration, with a salary and employment conditions
at an equivalent rate to comparable executive positions, supported
by full-time staff with the same employment conditions as their
counterparts in Defence and the public service
(ii) formalising the relationship between the Defence Family Advocate
and the Veteran Family Advocate Commissioner
(iii) working with the new Defence Family Advocate to implement
the recommendations made in the ‘Our Community’ and the
PricewaterhouseCoopers reviews to refine and improve the
governance and outcomes of the Defence Family Advocate
(b) appropriately staff and resource the Veteran Family Advocate
Commissioner and their office to improve outcomes and ensure that
veteran families are represented in policy design, decision-making and
advocacy
(c) investigate whether shared administrative support for both office holders
may further assist collaboration and support the efficiency of their
operations.
Recommendation 105: Improve coordination with coroners and
the National Coronial Information System
The Australian Government Attorney-General’s Department should work with its
state and territory counterparts to establish mechanisms that improve coordination
between coroners, the Department of Veterans’ Affairs (DVA), the Australian Bureau
of Statistics and the National Coronial Information System and work towards:
(a) aligning coronial practices related to making determinations of intentional
self-harm to improve the consistency and timeliness of national suicide
reporting
(b) implementing communication strategies between Defence, the
Inspector-General of the Australian Defence Force, DVA and coroners
to support the streamlined provision of information and reduce the risk
of stress on families
(c) sharing good-practice support regarding trauma-informed care.
Recommendation 106: Establish a suicide database of serving
and ex-serving members
Defence should design and develop a new suicide database that is appropriate for
the purpose of suicide monitoring and reporting of all relevant data of permanent,
reserve and ex-serving members. The design and development of the database
should:
(a) leverage data collected throughout the service journey from recruitment
to discharge and beyond
(b) capture a broader range of risk and protective factors, including but not
limited to recording incidents of unacceptable behaviour and injuries,
which is necessary to improve understanding of suicide, suicidality and
self-harm
(c) be informed by best-practice approaches from other countries, including
the United States.
Recommendation 107: Establish the National Veterans’ Data Asset
To improve understanding of deaths by suicide and provide better support to veterans
and their families, the Australian Government should:
(a) provide appropriation funding to the Australian Institute of Health and
Welfare and the National Suicide Prevention Office (or any subsequent
body assuming its functions) to establish and maintain a National
Veterans’ Data Asset that brings together data from Defence, the
Department of Veterans’ Affairs, and states and territories, to enable
timely monitoring and surveillance of suicide and suicidality of serving
and ex-serving Australian Defence Force (ADF) members
(b) provide appropriation funding to the Australian Institute of Health and
Welfare and the National Suicide Prevention Office to:
(i) use the National Veterans’ Data Asset to produce discrete
annual public reports and other research to monitor and improve
understanding of suicidality and deaths by suicide, and the associated
risk factors for serving and ex-serving ADF members and their families
(ii) commission an independent program of evaluation of the
implementation and functioning of the National Veterans’ Data Asset,
including an interim evaluation and a post-implementation evaluation.
The Australian Government and state and territory governments, through their
relevant agencies, should use the National Veterans’ Data Asset for the purposes of:
(c) furthering their understanding of suicide, suicidality, and health and
wellbeing among serving and ex-serving members and their families; and
(d) preventing deaths by suicide and improving postvention for serving and
ex-serving members and their families.
Recommendation 108: Ensure that all relevant jurisdictions and
entities regularly provide data to the National Veterans’ Data Asset
So that all jurisdictions provide data regularly to the National Veterans’ Data Asset:
(a) the Australian Government, and state and territory governments, through
their relevant agencies, should provide relevant data at quarterly intervals
to the National Veterans’ Data Asset (Recommendation 107)
(b) Defence and the Department of Veterans’ Affairs should prioritise data
governance arrangements in order to provide data for the National
Veterans’ Data Asset to support its development and ongoing use.
Recommendation 109: Defence to report annually on its progress
towards data maturity
Defence should report on its progress to improve data maturity, each year, to the
Minister for Defence, using the 2021 Defence Enterprise Data Maturity Assessment
as a baseline. Reports should be supported by surveys of Defence staff every three
years in addition to the data capability maturity assessment tool.
(
Recommendation 110: Review Defence’s data assets and address
issues with their quality, management, integration and use
The Defence Chief Data Integration Officer (CDIO) and Defence Data and Analytics
Board should establish a program of review of Defence’s data assets. As part of
this program:
(a) the reviews should be conducted by Defence’s Data Division and focus
on the quality, awareness, management, access, integration and use of
the dataset
(b) the CDIO should designate actions required of data custodians to address
any issues identified by each review and be provided with follow-up
reports from Enterprise Data Custodians on the progress of actions
following completion of Data Division reviews.
Recommendation 111: Achieve a ‘gold standard’ rating for Defence
datasets related to suicidality and suicide
The Defence Chief Data Integration Officer should direct data custodians to improve
the data quality of datasets related to suicide, self-harm and suicidality so they
achieve a ‘gold standard’ rating. This will ensure the data is reliable and supports
accurate decision-making. The remediation should focus on addressing issues of
duplicated, missing, incomplete and non-standardised data, and ensuring datasets
can be integrated.
Recommendation 112: Include data on suicide and suicidality in
the enterprise-wide Defence data catalogue
Defence should prioritise the inclusion of datasets related to suicide and suicidality
in its enterprise-wide data catalogue. Defence should also make its data catalogue
publicly available and include the quality rating of each dataset.
Recommendation 113: Ensure commanding officers access and
use quality data for continuous improvement of wellbeing metrics
To better support Defence commanders and personnel, Defence should:
(a) use data from the following sources to provide Australian Defence Force
commanders with data for their units and teams, as well as relevant
comparison points:
(i) the new Defence suicide database (Recommendation 106)
(ii) the National Veterans’ Data Asset (Recommendation 107)
(iii) internal surveys
(iv) unacceptable behaviour reporting and injury reporting.
(b) ensure the data is provided in a timely manner, in an accessible
format and with necessary context, and provide training that supports
commanders to use the data to inform decision-making.
Commanders should use this data for continuous improvement and to better
understand the wellbeing of the members under their command.
Recommendation 114: Defence and the Department of Veterans’
Affairs to prioritise research into veteran health and wellbeing,
and publish their workplans
Defence and the Department of Veterans’ Affairs should publish research workplans
showing research priorities on issues affecting the health and wellbeing of current
and ex-serving members. These workplans should be updated annually and include
information on planned research and the progress of research that is underway.
Recommendation 115: Defence and the Department of Veterans’
Affairs to publish their research into veteran health and wellbeing
Defence and the Department of Veterans’ Affairs should conduct and, as a matter
of course, publish research that includes information on the health and wellbeing of
serving and ex-serving members.
Prior to publication, research outputs should be subject to review from independent
researchers, including from the new expert committee on veteran health research
(see Recommendation 117).
Recommendation 116: Improve the quality, evaluation, translation
and sharing of research findings
Defence and the Department of Veterans’ Affairs (DVA) should create evaluation
and research teams in a central area of their respective departments to improve the
quality and coordination of research and evaluation practices. These central research
and evaluation teams should be given the following responsibilities:
(a) take the lead on improving the research and evaluation culture
(b) manage the evaluation of programs and policies within their respective
departments, and ensure evaluations are appropriate and effective
(c) develop and maintain the evaluation schedule of all mental health and
suicide prevention programs
(d) develop and maintain a central library of program evaluations and relevant
research, ensuring that evaluation findings are used and incorporated into
future programs and policies
(e) monitor the integration of research outputs into policy, programs and
practices, thus ensuring that research outputs are translated effectively
(f) use data and research to provide timely, targeted and effective advice to
improve suicide prevention, intervention and postvention support
(g) implement the continuing joint Defence and DVA research agenda
(h) in the case of the Defence evaluation and research team, develop a
revised survey research program with surveys that:
(i) collect information that can be used to evaluate Defence programs
and policies effectively
(ii) capture data on the health and wellbeing of Australian Defence Force
members
(iii) capture data not otherwise included in Defence administrative
datasets and the National Veterans’ Data Asset.
Recommendation 117: Establish an expert committee on veteran
research
Defence and the Department of Veterans’ Affairs (DVA) should establish an expert
committee on veteran research, comprising experts from government, academia and
the private sector who have skills and experience in military and veterans’ affairs,
health care, rehabilitation and family support.
The committee should:
(a) be informed by international examples of success from Five Eyes partners
and other nations
(b) include representatives with lived experience of service life, suicidality and
mental health
(c) fulfil the functions described in Chapter 29, Use of data and research by
Defence and DVA, and provide advice to Defence and DVA on research
and evaluation matters relevant to improving the wellbeing of serving and
ex-serving members.
Recommendation 118: Use the Census to collect information on
ex-serving members as a population
To ensure there is ongoing collection of reliable statistics and information on
ex-serving Australian Defence Force (ADF) members in the Australian community,
the Australian Government should:
(a) direct the Australian Bureau of Statistics (ABS) to continue the existing
Census question on ADF service in 2026 and in future censuses
(b) direct the ABS to include an additional question on year of separation
for ex-serving members in the 2026 Census and in future censuses,
with the ABS undertaking any testing required to include this question
on the 2026 Census.
Recommendation 119: Improve understanding of veteran health by
adding questions to Australian Bureau of Statistics surveys
The Australian Government should fund the Australian Bureau of Statistics to:
(a) include additional questions on Australian Defence Force (ADF) service
in any future iterations of the National Health Study, the National Study
of Mental Health and Wellbeing, the General Social Survey and the
Personal Safety Survey, prompting respondents to state whether they
are a current or ex-serving ADF member and if so, whether they served
in the permanent forces or solely in the reserve forces
(b) increase the sample of serving and ex-serving members in any future
iterations of these surveys to allow for robust reporting on serving and
ex-serving members.
Recommendation 120: Increase funding for research into veteran
health and wellbeing
The Australian Government should provide increased funding for research into the
health and wellbeing of serving and ex-serving Australian Defence Force members by:
(a) providing $10 million through the National Health and Medical Research
Council to support a Special Initiative research grant program focused on
veteran health and wellbeing
(b) considering opportunities to fund veteran health and wellbeing research
through the Medical Research Future Fund and Million Minds Mental
Health Research Mission.
Recommendation 121: Enable research into the health and
wellbeing of Defence families
The Australian Government should enable research on the health and wellbeing
of families of current and ex-serving members through:
(a) expanded National Health and Medical Research Council funding for
veteran health and wellbeing research
(b) Defence and the Department of Veterans’ Affairs leading research in
conjunction with lived experience individuals (see Recommendation 117)
(c) the Australian Institute of Health and Welfare, the Australian Bureau of
Statistics and the Australian Institute of Family Studies being funded to
collaborate and leverage existing datasets and the National Veterans’
Data Asset (see Recommendation 107), to develop a better understanding
of veteran families through research on wellbeing and risk and protective
factors.
Recommendation 122: Establish a new statutory entity to oversee
system reform across the whole Defence ecosystem
The Australian Government should establish a new statutory entity with the purpose
of providing independent oversight and evidence-based advice in order to drive
system reform to improve suicide prevention and wellbeing outcomes for serving
and ex-serving Australian Defence Force members.