Video transcript – Supporting veterans’ mental health following withdrawal from Afghanistan

DVA partnered with Phoenix Australia – Centre for Posttraumatic Mental Health to present a live webinar entitled Supporting veterans’ mental health following withdrawal from Afghanistan. This webinar is designed to assist general practitioners and mental health clinicians to support veterans dealing with complex emotional and mental trauma issues raised by the withdrawal from Afghanistan.

Tim: Good luck.

Leonie Nowland: Ok, thank you.

Ok, welcome everyone. I would like to thank you all for attending. My name is Leonie Nowland. I am the Assistant Secretary for the Coordinated Client Support branch of the Department of Veterans’ Affairs and I’ll be chairing today’s webinar on supporting Veterans’ Mental Health following withdrawal from Afghanistan. Before we begin, I would like to acknowledge the traditional custodians of the many lands across which we are meeting today and to also pay my respects to their Elders past, present and emerging.

I would also like to acknowledge all who are currently serving and those who have served in our Australian Defence Force. I would also like to acknowledge the families who support them and thank them for their service. Thank you all in service.

I’d especially like to welcome people who are joining us from outside the department this morning and thank you very much for your interest in supporting our veterans.

The deteriorating situation in Afghanistan is challenging for the Australian community, especially for current and former service personnel.

Our message to veterans and their families who may be affected is simple. We are here for you and want to do everything that we can to support you. The department has a range of support services available, including mental health and medical support.

However, it’s also key that we support you in supporting these veterans. With this in mind, we’ve organised this webinar in partnership with Phoenix Australia, the Centre for Post-Traumatic Mental Health. We’re grateful to Phoenix Australia for this opportunity to learn more about supporting our veterans during this difficult and potentially traumatic time.

I would like to welcome our presenters Professor Andrea Phelps and Associate Professor Nicole Sadler, both of whom are experts in the field of veteran mental health.

Due to the format of the Teams Live Event, participants will not be able to interact directly with the presenters. However, we do encourage all participants to use the chat function for questions and discussion. The chat may be found on the right hand side of your screen. Relevant questions will be passed onto the presenters throughout the event and we will have time at the end of the session for those questions to be responded to. The session will also be recorded and made available to all participants after the event and will also be posted on the DVA website.

Phoenix will provide a link to a short user satisfaction survey that will be included in the chat text towards the end of the session, and we’d be very grateful if you could take a few minutes to complete that following the session.

And finally, a document detailing relevant DVA programs and online resources will be made available in the chat, and we will also collect all of the questions and answers, especially for those which were not able to attend during the session, for circulation after the event.

So I’d like to welcome Nicole, who is going to begin the seminar today and again, thank you all for your attendance and for your care for our veteran community.

Associate Professor Nicole Sadler: Thank you very much, Leonie, and thank you to DVA for the invitation to present to you today.

As Leonie has pointed out, the aim of this session is to explore ways that you may be able to support veterans and their families, and their mental health, following the withdrawal from Afghanistan. Look, obviously there’s been a lot of media coverage and commentary, but we are also aware that veterans are discussing these issues amongst themselves and on social media. I’ve been with Phoenix Australia for four years now, but prior to that I spent 23 years in the full-time Army as a psychologist, and supporting operations in Afghanistan with a large part of my last few years in the military, And I’ve certainly noted in my own peers that there’s a lot of discussion and reflection and re-framing of their own experiences. And we also know that clinicians are reporting issues being raised, not only by Afghanistan veterans, but also by veterans of other conflicts, and this is occurring not only in Australian veterans, but also in other nations.

So what we’re going to cover in this session is a brief overview of Australia’s role and mission in Afghanistan, primarily just to remind ourselves of the diversity of these roles for the Australian Defence Force and others who supported this mission. We’re gonna talk about some of the common reactions that you might note; what we’re seeing and hearing about nationally and internationally. And so that helps you to be prepared for what you might see in your health or mental health practices. We’ll provide some ideas and some thoughts around general mental health support that you might be able to provide regardless of your role, your discipline, and then to provide a bit more specific guidance about some evidence-based psychological therapies and maybe some perspectives or lenses that might be useful to think about in this context.

Next slide, thank you.

So first of all, as I said, this is a very quick and high level overview to remind ourselves of the nature of our involvement in Afghanistan. Over 40,000 Australian Defence Force personnel served in or directly supported operations in Afghanistan and Iraq since 2001. So the Middle East area of operations and I say both countries, because in the case of logistical support and other support, often they supported both of these areas of operations concurrently.

Unfortunately we saw 41 Australian Defence Force personnel killed in action and these were our first combat deaths since the Vietnam War and there were about 261 wounded and some of these were very seriously wounded with life-changing injuries. Our involvement commenced post the 9/11 terrorist attacks and the subsequent war on terror and establishment of the Coalition of the Willing, which was the setup of an international Security Assistance Force, which was all about conducting military operations in Afghanistan against al-Qaeda and the ruling Taliban regime. And then we saw several key phases of Australia’s involvement and the size of the force and the type of deployment varied.

And I wanna – what I want to highlight here is that all three arms of the ADF were involved, plus civilian elements. So the Navy, Army and Air Force and we had two major areas of operations. And Afghanistan itself but also the Persian Gulf.

So it kicked off with Operation Slipper in 2001. And for the first year or so it really was quite a limited mission involving our Special Operations, Task Force and Air Force elements.

Next slide, thank you.

And then from 2005 we saw a widening of the type of operations we got involved with – with lots of different elements of the Defence Force personnel getting involved. So doing things like helping with – and lots of this work and we were there for almost a decade in the Uruzgan Province – helping to secure and stabilise, helping to support the Afghan government and helping to establish the national security force, maintaining pressure on our terrorist networks. But then also increasingly reconstruction and then mentoring task force. So helping to rebuild the nation: schools, medical facilities, bridges, forward operating bases. Helping to train trades, train Afghan youth. And then also the mentoring of the Afghan forces themselves.

From 2014, we transitioned into Operation Highroad. Much less personnel there, but we have held an ongoing presence until early 2021. Of course, mainly they were advisors and trainers – more so in Kabul and Kandahar – with our last combat forces leaving at the end of 2013. We saw our last ADF personnel and diplomats departing in mid-June of this year. But of course most recently following the fall of Kabul in August 2021, we also saw some ADF personnel going back to assist the evacuation of Australians and some Afghans who assisted Australian forces.

Next slide, please.

So just some things I wanted to highlight about the nature of the sort of the stresses and strains that people may have experienced at the time to do with these operations. So as I’ve tried to highlight all different types of roles that people might have had. Don’t just think about the ways that some of our coalition forces were being used in Afghanistan. We were often used quite differently, so we saw different missions for different nations. Sometimes we had people who were posted into single or isolated roles in multinational headquarters. Sometimes they were there for up to a year. Some people who will have supported operations in Afghanistan never went to Afghanistan. They were working out of different bases. So, for example, Kuwait or in the UAE. So were deployed to Operation Slipper, but never actually went into Afghanistan. We also even saw some remote operations. So unmanned aerial vehicles being used to support operations.

Afghanistan is known for very harsh conditions. So these were difficult conditions to work in. Very hot to very cold and the thing of most concern in terms of risk was really the emergence and high use of improvised explosive devices. And in fact, these were the most deadly things for our forces. It was also unclear who the enemy was. Who in the populace may have been a threat? At times women, young children, sometimes it really was unclear who the enemy was and who you may have been at risk from. We also see different risks at different times of the year. There was what they called a killing season for those people who are deployed into the Afghan summer months.

Some of the local cultural and social norms could also be very confronting. The treatment of women. The treatment of young boys and sexual behaviour around young boys for example. And this was with people that they were – that the Australian Defence Force were working with, so the security forces, the police, the Afghan military trying to work with them and build up their security forces, but at the same time questioning and filling this divide or cultural tension between some of the values and the norms.

Of course we did also see some incidences of some, what we call, green on blue attacks where Afghan forces attacked and unfortunately sometimes killed some of the Australian forces within, what should have been, secure bases.

Lots of talk about the working relations with local Afghans – really had to rely upon them often as contractors or interpreters, and you will see some examples of some really strong relationships and trusting relationships which were developed.

As is always the case with operations, it’s not just the trauma and the direct combat and all those things that you think are going to be the biggest stresses for people. It’s all the other organisational and operational things which can be difficult for individuals. When you were being told to wear your uniform and were you getting the same treatment and conditions as other people? Were you getting the type of deployment that you thought you would be getting? All of those things may have been the stresses and strains for them.

It’s also important to know that this was an extremely busy time for the Australian Defence Force. We were deploying people into multiple areas of operation and many, if not most people were doing multiple deployments in and out of different places. And the number of times people deployed really often depended on the nature of their role. So smaller specialist units. If we think about, for example, special forces, but also things like intelligence, psychologists, health workers often would be deployed more often, but for shorter periods of time.

Just as a general observation, I think that the complexities of the mission, most people understood at the time – I think that most people are probably not terribly surprised – that, unfortunately this is where we’ve ended up, but had always been hopeful that broader change and more sustained and longer-term change would have been achievable.

Also worth noting that, of course, we’ve seen the impact of the ongoing investigations about alleged war crimes. They kicked off in 2016. So this has been an ongoing stressor for many years now for this population.

Thanks, next slide please.

Just wanted to highlight too for general awareness – we did see that there was lots of mental health support to this area of operation. If you are working with people, I can assure you that there was lots – that there was lots provided in terms of providing support before they deployed. There was lots of support in country including if people have been affected by critical incidents such as a death. There was also issues in terms of screening and supporters. People were coming out of country and also levels of support for their families as well.

Next slide, thank you.

So just around some of that context. When we – when we saw the fall of Kabul and all the commentary around this, we reached out to our international partners. Phoenix Co leads a five eyes collective of what we call the Mental Health Research and Innovation Collaborative into military and veteran mental health. So experts, the centres of excellence across – across these five eyes nations. So Canada, the US, New Zealand and the UK. And to get their read as well as to what we were saying. And probably not surprisingly, we were seeing some common themes. This is of course is not what we were seeing in everyone, but there were some themes that we’re starting to see. Of course there was a range of different experiences and emotions that people were reporting, veterans and their families are – all types of different emotions from sadness, frustration, anger, grief and a sense of demoralisation often.

Definitely this saturation of news coverage bringing back reminders of the conflict and maybe some things that people had – had not been thinking about so – so regularly were suddenly being stirred up again. But interestingly, seeing this not just in Afghan veterans, but also from other military conflicts. In particular that a lot of the parallels being made between the military withdrawal from Vietnam for the ADF. And for some, the coverage was triggering trauma reactions and maybe even exasperation of symptoms of PTSD, or indeed other mental health concerns. We are starting to see this idea around raising questions or perhaps reigniting questions. What was it all for? Was it worth it? Was the sacrifice worth it?

We see that in veterans but also in families and in the broader community. Next slide, please.

Certainly seeing evidence that people starting to perhaps re-evaluate their experience as you get new information in, as things change. Of course, it’s natural for people to be re-evaluating, but sometimes we’re seeing that perhaps is causing more distress than that, perhaps it has previously.

We do know that traumatic and morally distressing events are often better endured if it’s seen as there was a positive outcome. When there’s suddenly been a change in the outcome, it is – it is probably expected that people will start to re-evaluate or look through at this through a different lens and that there will be some, perhaps some distress when they think about the sacrifices others have made, either through our loss of life or injury. And also, we’ve seen this really strong theme particularly in Australia. Very fearful and angry about what might happen to translators and their families and other colleagues left behind in a sense of betrayal and a sense of not having – not doing the right thing by them.

Of course, all of this is moderated by people who – not everyone’s thinking about these things negatively, and I’ve certainly seen again in my colleagues and peers that some people are doing a good job of moderating themselves and still trying to really think about the positive experiences and gains that we were able to make as part of that operation.

I’m now going to hand over to Andrea. Thanks, Andrea.

Professor Andrea Phelps: Thank you very much, Nicole. And next slide. Thank you Tim.

So I think what’s really important in what Nicole’s been talking to us about is the range of experiences that people have had, and – and that is what I want to mirror as well when we start to look at the mental health impacts. But we’re not expecting to see a singular or uniform impact. It will affect different veterans and their family members in different ways. And so while it’s good to be alert to the potential for a negative impact. It’s also important that, as practitioners, we don’t assume that – we don’t assume that people are going to respond in the same way. We have to individualise our assessments and our responses.

But if we think about some of the broad ways that we might expect to see this response being played out amongst those who have been adversely impacted, we might see for some that it’s a general non-specific stressor. That there’s a lot of stress that we’re all experiencing at the moment with – with Covid and everything else that’s going on in our lives. And for some this is an additional stressor that adds to that, but for others it’s much more specific. It may be a trigger for traumatic memories that they have been exposed to that they may have put behind them or – or at least not been thinking about. But particularly for those who deployed to Afghanistan or, as Nicole said, too Vietnam where the withdrawal is – is a really strong reminder of what happened in Vietnam.

For some it may be that the impacts are – that we see are exacerbating pre-existing mental health problems. But for some it might also precipitate new problems.

And just picking up on the point that Nicole made about the way in which events can change our perception of an experience. If we feel that there has been – it’s been worthwhile and a positive impact. It allows us to think about some pretty distressing, potentially traumatic incidents in a way that is tolerable because of a positive outcome. If that changes over time, that can also change the impact of that experience on Earth.

The typical range of mental health problems that we see amongst veterans include depression, PTSD – although we often think first about PTSD, it’s not necessarily the most prevalent – but substance use issues and other anxiety disorders are also very common.

Next slide please Tim.

So when we’re providing mental health support, it is – it is useful to be – to anticipate that there may be issues, but as they say not to assume what those issues would be or to think that they will be the same for everyone. But to really take an individual approach to reviewing and assessing symptoms, diagnoses, risk factors and treatment needs. And, as we would for anyone presenting with a mental health concern, we have a fairly standard evidence-based approach which includes psychoeducation. So it can be really useful for some people just to help them to make the links.

So why is it that I’m feeling so unsettled at the moment?

For some people that would be really clear and obvious, but for others it might not. And so just some psychoeducation about the nature of stress and trauma reminders, and the impact that that can have. A reminder about stress reduction tools: relaxation, breathing – it may be yoga, meditation, whatever people normally use.

For some, there may be an opportunity to really start to get into more detail about the sorts of beliefs and cognitions that – that are causing distress, and I’ll go into a little bit more detail about that in a moment.

The importance of addressing avoidance that the – we know that across mental health disorders that avoidance can be a feature, but particularly for PTSD. So emphasising the need to maintain regular routines and normal function as much as possible. And, of course, to be considering the needs of veterans’ families as well as veterans themselves.

Thank you Tim.

In providing mental health support, reinforcing the basic health principles is always important. But particularly during times of excessive stress. So looking after yourself physically: sleep, diet, exercise, trying to stay away from substance use is very common when people are experiencing more distress to start – to have an over-reliance on substance use, remaining connected with supportive, significant others in your life, limiting exposure to news and to triggers and using positive coping strategies. Whatever that may be for the individual – whether it’s music, relaxation, spending time in nature. And also emphasising the importance of focusing on the present, engaging in activities that are actually meaningful and important.

So these are the sorts of things that we routinely suggest to our clients. But also for ourselves as well. For all of us it can be a stressful time and for people who are seeing a lot of veterans in this context. You know, we don’t underestimate the – the pressure and stress that that puts on the individual practitioner. So these sorts of things are really important to remember for ourselves as well as for the people that we’re working to support.

Thanks Tim.

I want to spend a few minutes now talking about more targeted psychological therapy for the sorts of issues that we might anticipate coming up around the withdrawal from Afghanistan. And what I wanted to talk about is some of the potentially useful lenses through which individuals’ reactions can be understood. And this is by no means an exhaustive list, but it’s just some of the things that have come up in our discussions between ourselves and with international counterparts as Nicole highlighted before.

The first one is around the trauma response, that for some it will be a – ah – a trauma trigger, a trauma reaction, and what we might see there is an increased sense of threat and hypervigilance. For example, to some people moral injury might be a useful lens to understand the reactions. For instance, if – if people are feeling betrayed by leaders or by government, if there’s been a perceived transgression, a moral transgression on the part of oneself or others.

Another lens that has come up is what’s known as mattering. The idea that – that you matter and that you add value and what you have done has mattered. The outcome means that my service amounted to nothing is something that we are aware of that – that might be the lens that some people are thinking about this through.

Another is survivor guilt. And in particular, in relation to people who have been left behind, that – that those who are safely back in Australia may feel guilty about leaving behind. For instance, translators or other colleagues and their families.

As they say, this is not exhaustive and it’s not going to apply to everyone. But just encouraging you to think about what’s the most useful lens, based on the person’s presenting issues and their cognitions, the way they’re thinking. And, rather than making assumptions based on their experience, we really need to understand for the individual, what does this mean for them.

Thanks Tim.

So what we – we try to do is to broaden the frame of reference to encourage different perspectives. We know that empathic listening is really important. Someone needs to be able to feel that you are listening to them and you are understanding where they’re coming from. But that in and of itself is not enough to actually shift the way someone thinks, and therefore to alleviate their emotional distress. So the last thing we want to do is to feel similarly overwhelmed and unable to change our own perspective about what people are seeing – what people are experiencing. So it’s important to work with the individual to identify the way they’re thinking and if there are particular stuck points in the way they’re thinking, that it’s creating emotional distress, and encouraging different perspectives through what we call Socratic questioning. And a lot of you will be familiar with that, but it’s really the idea of rather than just trying to say something reassuring like: ‘yes, of course, your service mattered’, we’re really working with the individual through a process of asking them a series of questions to help them to come to that conclusion.

I’ll explain that a little bit more. Thanks, Tim.

So a couple of examples. One is through the lens of mattering. And, as I say, mattering is this idea of feeling valued and that you’re adding value. A stuck point for someone might be – because the Taliban are back in control – my service and sacrifice count for nothing.

When we start digging into that, there might, it – there are a few assumptions that might underlie that – that we need to uncover. One of those is that my actions were of no value in their own right. Another is that there are no residual positive impacts. And the third is that the current situation that we find ourselves in the moment is the end state, rather than it being at a particular point in time.

Now each of those underlying assumptions might be present for a particular client. They might not be, but this is part of what we need to do to uncover. And I’m just going to use the example of the first one. But if I talk through that in a little bit more detail.

Thanks Tim. The next slide.

So looking through the lens of mattering: if someone will be experiencing a lot of distress – if they are saying to themselves my actions were of no value in their own right. And so what we’re trying to do is help them to challenge that thought. And in doing this we need to shift the focus from a global and overgeneralised lens to the specific deployment experience of the individual.

So, from a position of curiosity, we want to be enquiring about the specific deployment experiences of the individual. What was your role? Who did you work with? What was achieved? And how did that make a difference to a particular individual, group of individuals or a community? What would have happened to that individual or to those people if you hadn’t been there? What was the difference there? And, if that person or that group of people were sitting here with us now, what would they say?

So it’s really through this process of this Socratic questioning; asking people questions, really encouraging a reappraisal of whether their personal actions were of value, impact and importance in their own right. So we’re trying to break down the global overgeneralised lens to a specific reflection on the person’s own experience and really getting to: ‘what I did mattered.’ So it’s really challenging that their actions were of no right, no value.

The second example through the lens of moral injury. Moral injury is a – is a term that I imagine most of you are familiar with. It’s really gained a lot of currency in recent years. The idea that when people are exposed to events that transgress deeply held moral convictions or relate to betrayal in high stake situations. That there are a range of psychological, social and spiritual outcomes that go beyond our standard mental health disorders. And that the three sorts of events that come into the moral injury construct.

1. You did something or failed to do something yourself that went against your moral code or values.
2. You saw someone else doing something or failing to do something that went against your moral codes or values.
3. Or you felt betrayed or let down by someone you trusted in a position of authority.

Next slide, please Tim.

There’s a lot of debate at the moment about whether we need different treatments for moral injury or whether its evidence-based treatments for PTSD can address these sorts of issues, so we won’t go into that debate.

But what we do notice is that the movement in developing particular treatments for moral injury really do emphasise self or other forgiveness. They try to address guilt and shame. There’s a focus on acceptance. And, in some cases, a spiritual guidance as a as a way through. We are lacking high-quality research trials, but that’s the direction that things are going in.

Thanks, Tim.

So in working with someone who has experienced a moral transgression – moral transgression where they feel themselves that they have transgressed their own moral code, the sorts of feelings that we expect: our things like guilt and shame. And, what we do know is the importance of being able to share this story with someone who could be trusted to listen and not judge with – without judgement and what we’re aiming to do is to help the person to make meaning of the event and promote self-forgiveness.

We know that when people experience these sorts of events, if they can’t make meaning of them or come to think about them in a way that helps them to understand and make sense of their behaviour, it’s more likely they’re going to develop a moral injury.

So we’re working on emotional processing in which the moral transgression is fully acknowledged. We want to encourage the person to talk about it rather than just harbour – harbour their thoughts and feelings themselves. But also together with perhaps operation opportunities for reparation; for doing good deeds or making up in some way. And the role of chaplains can be really important to some people, particularly those who have particular spiritual or religious beliefs, but maybe for others as well.

Thanks Tim.

When the moral transgression has been on the part of someone else; the sorts of emotions and reactions that we’re more likely to see relate to a sense of injustice, betrayal and anger. And where an injustice has been done, it’s important to recognise the moral legitimacy of anger and, that in our society, anger can actually have a really productive and functional role in repairing the moral order. It can really motivate people to make things right; to put things right when there are opportunities for retributive justice. This can help people resolve their anger if someone is seen to be appropriately punished or held to account for their reactions; that can really help someone who is harbouring angry feelings. But that’s not always possible and sometimes restorative justice is an alternative where the victims of a particular situation or event have their story heard. That, at least, it’s acknowledged and heard and validated.

And the third element of this is around reparation, where people may – there may be no opportunity for justice to be done in the sense of retributive justice. But there may be opportunities to help family members or communities and that sense of reparation. And we know that this being able to put things right can be really important as a precursor to forgiveness. And we know that forgiveness is really important part of recovery from a moral injury.

When it comes to betrayal, particularly for people in leadership roles, that if there are opportunities for consideration of potential outcomes of alternative sources of action is what we commonly see in situations where people are judged or judge themselves or judge others on the basis of outcomes. Very often we’re in a situation where there is no good choice. And so a decision is made that has some negative outcomes, but it can also be important to consider what were the alternatives. This isn’t always going to be helpful because sometimes a wrong decision may have been made, but sometimes it can help to just shift that lens or that angle a little bit.

Next slide, please Tim.

So in summary, the experiences and the reactions will be wide and varied. It’s important that we anticipate the types of reactions that we might see, but that we base our response on the individual’s presenting issues, rather than going to a session or an interaction with someone. Assuming that we know what’s going to be going on for them – standard approaches to mental health assessment and treatment apply.

But for those who are stuck with some unhelpful thinking, it can be useful to consider a different lens that might help to make sense of the individual’s response to shift from a global to a specific lens. So rather than talking in generalities about what people are seeing in the media for instance – really trying to drill down to: let’s think about your experience. What your involvement was? What your actions were? What the outcomes of those actions were? And broadening the frame of reference to encourage different perspectives.

As some of those lenses that we talked about – the survivor guilt, trauma lens, mattering, moral injury – may or may not be useful. But it’s good to be thinking about those sorts of lenses, because it may help you to help your client to think about things in a way that helps them to understand their responses and to move through them.

Thank you Tim. I think that was the last slide. So yeah, very happy to take any questions.

Sorry, before we do that perhaps I will also – just – as Leonie said, if you wouldn’t mind, we’ve got three questions survey that I’m just going to put into the chat, even while we’re finishing before you get off. I know time gets away as soon as you leave the session, but even if you wouldn’t mind just taking a moment to respond to those questions. It’s important for us to get that feedback around how we can improve presentations over time. Thank you.

Leonie Nowland: So it doesn’t – doesn’t look as though we have any questions.

Associate Professor Nicole Sadler: Leonie, I can see a couple of questions if you like. I can – coming through on the chat so I can start off with answering those if you like. So one of them that came through which is a great observation described as the double whammy of what’s happening in lockdown where clients can’t do the normal things that constitute self-care providing meaning.

So other than looking at alternative activities that can they – that they can do. Are there any tips? So I’ll give a couple of ideas and then see if Andrea has got some others as well.

Look, my first observation is that I think that just naming it and being really upfront: that the Covid situation is a difficult one, in itself. It is a – it is a stressor within itself. And I think that we need to be careful that sometimes it’s not also used as an avoidance technique. So that there is a risk, I think, around some of this self-care. That it becomes too easy to say, oh no, it’s too difficult – the things that I’d normally do, I can’t do. And I think as clinicians it’s important for us to challenge and to explore that and to actually be willing to. Sometimes it can be difficult for people to think about or to generate or to be bothered to generate alternative. So I would still be encouraging that there has to be their discussion about around if they’re willing and interested in doing.

So could we look at some alternatives? Some things that we’re very mindful in terms of Covid in general is encouraging people not just to sit and watch the news feed and the social media feed which is coming in – that we all have the time to do that and really to be limiting that. To perhaps, putting some time limits around what the time that they spend thinking about experiences and that it can be good to dedicate some time to it. But to limit what you’re doing, I think also encouraging people to really think about who they are connecting with socially. And do I feel better at the end of that – after that interaction? Does it bring me any peace? Does it – does it make me more angry? So to be thinking about not just having social interactions, but the quality of those social interactions I think are really important – to be encouraging people to be doing, as I said, right at the beginning. I have seen some – I monitor the social media feeds. I’m part of several of those groups. And I am also seeing some great examples of veterans self-moderating; challenging each other and talking about it. You know it did matter. What we did – did make sense. And also some great examples of them coming together to do positive things: helping Afghan families, doing fundraising. So, some of that interaction can be positive. But it’s about encouraging them to look at ones that make them feel better and are also positive experiences

Ah, Andrea might have some other things to add to that.

Professor Andrea Phelps: Ah, not really Nicole. I think that I agree with you. I think that it – we need to be cautious about people dropping off normal activities and obviously there are restrictions on what people can do. But for all of us, I think we need to try and find ways around that and to still connect with people – to still have a routine, even if the routine is a different one, because it has to be through Covid. But to do the activities that we know are good for us. We can still continue with a lot of those things – recognising that there are restrictions.

Associate Professor Nicole Sadler: And then Andrea there was a second question about – so these sorts of questions – Socratic questioning with – I have trouble with that word – would it be useful when dealing with veterans of other theatres as well, particularly peacekeeping? So that question – that you could use it for other veterans?

Professor Andrea Phelps: Absolutely! It – it’s actually Socratic questioning is one of the sort of – I suppose – building blocks of cognitive therapies. So whenever you’re working with someone who is thinking about something in a way that feels stuck and that they can’t – they can’t shift the way they’re thinking.

It’s ruminative. It’s going around and around. And, you, it’s avoiding the tendency that, I think, we can all fall into where we try and just offer reassurance and say.

Oh, you know, you don’t – you don’t need to feel guilty about that. Or this is a – tried to offer reassurance which is not harmful, but it’s actually not likely to help the person to shift the way that they’re thinking. Whereas the idea of Socratic questioning is that you’re just asking questions that will help the person to answer their own question or to shift the way they’re thinking themselves.

So that once you get into and it’s also why exposure therapy is so important and so effective in the treatment of trauma-related mental health, because we’re really encouraging the person to get back into the detail of what they’ve experienced; so that they can think about it and process it in a way that’s different to their everyday memory of the event.

So it’s – it’s just those, really carefully targeted questions. They’re not clever questions. They don’t have to be – you don’t have to make up different questions all the time.

They really just basic questions about – interesting that you say that.

So – where, you know, it’s really asking people what’s the evidence for thinking in the way you’re thinking? How do you know that that’s right? What would someone else say if they were in the same situation?

A whole series of questions you don’t need to know the answers to yourself. But once you’re asking the questions and people start responding, you start to get a sense of where – where this is going. That’s going to be useful. And sometimes you’ll come up against a road block and it feels as though it’s not useful, so you might change your tack and ask a different sort of question.

But really the whole premise is that you’re not trying to just convince someone to think about something in a different way. You’re helping lead them to draw their own conclusions about that. So yes, it applies very broadly.

Associate Professor Nicole Sadler: And I’ve also seen in the chat someone has given another really good suggestion around the question we answered before, which is of course having some smaller goals given the layers of stress is around us with Covid and then dealing with things like the – the withdrawal out of Afghanistan. You know, it’s setting those expectations realistically. That’s a great suggestion and one we – we should have thought of. So that’s a really nice observation.

A couple of other things that I would just like to observe is that – and I know we spoke a lot about ADF personnel – there were a lot of Defence personnel and other public servants, diplomats, contractors: who weren’t defence personnel. Even AFP, for example, who are also involved in military deployments such as Afghanistan. So think about that also in terms of the clients that you might see.

And also the other thing I think that – is around self-care as clinicians. Many of us have been supporting veterans out of these deployments for a really long period of time. And we’ve seen the – the impact and terrible toll sometimes that it’s had upon them and their mates and their families. And I think that, you know, it’s important for us to also acknowledge for us that there can be a sense of frustration. And seeing the outcome of this and it can also impact upon us. So, sort of in a good trauma informed way, also being really mindful of the impact that it can also have on you and your own values and views as you’re going into this type of work.

I can see another question has come in: Afghanistan is an experience of unexpected transitioning with a range of impacts – identify seems to overlay the transitioning challenges out of the military. Veterans have a skill set to adjust and adapt to reframe and identify the challenges. What do you think about reframing the challenge, in the context of operational skill sets and training?

I think that, you know, more and more over the years, we have become really aware of the importance of transitions. People transition into the military. They transition into different roles and responsibilities. They transition in and out of deployments. They transition out of the military as well.

They do and their families do. And, at each time, we should be looking at training and support which – which makes sense in terms of the stage of their career, but also their ages and stages of where they’re up to as well. So I think that there are really important lessons that we can always be thinking about getting people to meet them where they are at that point in time. And they need to be thinking about the training and support they may have developed over the years. And what does that mean in terms of getting ready and preparing for the next point in their transition. So I think always being – curiosity that Andrea spoke about. Thinking about: where does this person come from? What are the skill set that they’ve learnt along the way? And helping them to identify: how can that help them to meet, to reframe, to look at something with a new lens, I think is always just good sort of practice as well.

I’m not sure there’s any other questions that have come through. I can’t see any other questions.

Leonie Nowland: No, I think that’s probably it, Nicole.

So I’d just like to say thank you so much to Nicole and Andrea for their very thought-provoking and considered presentation about the issues facing the veteran community at this point in time.

And I particularly was interested in the notion of mattering. I think that that is something which is important to all of us and certainly has quite the degree of resonance for how we work with the veteran community. And that includes the families as well who have also sacrificed some of their wellbeing and their time with their partners. So I think that notion of mattering, I thought, was particularly interesting as well as the distinction between retributive and restorative justice, and again quite a few things, I think for us to take away and consider in our work with the veteran community so that we can better support them through this quite challenging time.

So thank you very much, Andrea and Nicole. Excellent as always. And I would also like to draw people’s attention to the practitioner support service, which is run by Phoenix and that is specifically there to support practitioners in working with veterans around the range of mental health issues with which veterans present. As well as, of course, in the area of post-traumatic stress which is a key area of expertise for our colleagues in Phoenix.

So we will be sending around a link to the practitioner support service, as well as information about DVA supports available more generally. And we’ll also provide a written response to any further questions.

And please bear in mind that the role of DVA here is to support you in your work. We are not a provider of services for same with the exception of Open Arms. But we are here to support the work that you do to make sure that our veteran community is cared for appropriately, with the most current and evidence-based interventions. And we need to do that through supporting you in your work.

So thank you very much for your interest in attending the workshop today and look forward to further interaction. Thank you everyone.

** End of transcript **

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