SUBMISSION TO THE ROYAL COMMISSION INTO DEFENCE AND VETERAN SUICIDE

Preamble

1. The Trojan’s Trek Foundation has been invited to comment in accord with the TOR subject listing. The list is comprehensive and includes several topics or areas in which the Foundation has very little experience recorded, and therefore no comments are offered.  However, those areas which, through the delivery of the intervention programs over 13 years in SA and QLD have provided a wealth of hands-on experience, the Foundation submits comments in two of the listings as follows:
2. Existing services. The availability, accessibility, timeliness, and quality of health, wellbeing, and support services (including mental health support services) to the defence member or veteran, and the effectiveness of such services; and
3. Role of NGO. The role of non-government organisations, including ex-service organisations, in providing relevant services and support for defence members, veterans, their families and others.

Background

2. Trojan’s Trek Foundation (www.trojanstrek.com) commenced operations in SA in 2009 and was incorporated in 2013 in response to an identified shortfall in effective hands-on support to veterans suffering from stress illness.  The program expanded into QLD in 2015.  It is a recognised not-for-profit charity, has gift deductible status and is run by a board of six directors. The program was established to assist younger military veterans and first responders suffering from stress illness by taking part in treks. Although first responders have always attended, they were added as a target group was a result of the recent fires and other disasters over the 2019-2020 period which saw many first responders many of whom were ex-military, deeply impacted.  The experience termed a circuit breaker, provides a valuable adjunct to clinical and other alternates over a six-day, remote live-in program.
3. The program was independently evaluated by ACPMH (now Phoenix) and UniSA in 2009, and in 2012 and 2013 by way of masters’ theses. The results were presented at the Australasian Military Medicine Conference (AMMA) in Adelaide in November 2014 and 2019.  The outcomes established new benchmarks for peer support.  This approach to stress illness is a valuable adjunct to other methods of treatment.  Several longitudinal studies looking at longer-term impacts on individuals have also been completed over time.  They have established that the positive impact of the experience was present after 12 months.  The Primary Health Network (PHN) a federally funded body, has also completed a 12-month evaluation which was completed in Oct 2019.  In 2020, the Gallipoli Medical Research Foundation (GMRF) was commissioned by RSL Qld to write and publish a paper to determine the efficacy of the program. Having been peer-reviewed and published, it provides empirical, research-based evidence that the program is most effective.

4. The results of these evaluations indicate that the Trojan’s Trek program promotes sustained improvements in depression, anxiety, stress, self-efficacy, and life satisfaction.  Each trek continues to be independently evaluated both qualitatively and quantitatively in QLD by GMRF and in SA by Flinders University Staff.  A simplified quantitative result before and after a 6-day trek is enclosed as an example.  It shows improvement in depression, anxiety, and stress, in 87% of participants with the others remaining at no change.  Other methods of gauging outcomes are being trialled.

Existing Services 

5. Current Practice.  The mental health services which currently are devoted to well-being and support are based on the time-honoured practice of one-on-one counselling and pharmacology.   This is the gold standard, which is adopted in most developed western countries, of which Australia is one.  One of the contradictions in medical practice terms is that most one-on-one counselling rarely if ever, uses the term recovery.  And despite the occasional dropping of the letter D in PTSD, the practice has not changed, presumably based on the definition of the condition as a permanent “disorder”.  This often results in what our clients term the “revolving door syndrome”, which refers to the ongoing referrals experienced in the clinical approach.  This is generally non-productive and frustrating for individuals.
6. Access to Services. One of the difficulties faced by individuals and GPs is the long waiting periods faced when attempting to access psychiatric services. In some cases, waiting periods of more than nine months are common.  Clearly, this is not acceptable, and these long stressful periods can result in triggers.

Trek Design 

7. Because the staff of Trojan’s Trek has shared the same frustrations of our clients, they understand the difficulties faced by endless consultations with no endpoint in sight or referred to. To that end, the trek program which is delivered over a six-day live-in experience in the remote bush, includes a transition from victim to gentle warrior.  The trek, sometimes described as the start of a new journey in life, is the primary business of the Foundation. Women attend as a separate group, their preference.
8. The treks are more cranial than physical and provide the setting and conditions under which participants will experience a lasting positive shift in personal values and interpersonal relationships designed to improve their lifestyle and community involvement. The thrust of the program, which is centred on 15 formal sessions, is improved condition self-management to result in a better more productive life.  It is designed to improve social interaction and contribute to a healthy lifestyle, resulting in better family and community members by equipping our clients with “tools” to assist in their recovery.
9. Trojan’s trek is a circuit breaker; the Foundation does not have the resources nor intent to maintain contact which can be successfully carried out by existing organizations. Most individuals will benefit from some form of follow-up treatment on completion.  The differences between this program and conventional treatment may be summarized as follows:

• It is culture-specific.
• It encourages group identity and results in the formation of support groups.
• It involves veteran to veteran, responder to responder delivery.
• It utilizes the remoteness and isolation of the bush as part of a “live in” experience.
• The program focus is on individuals transferring from “victim to gentle warrior”, and
• The process includes partners understanding the illness.

10. The impact of the trek on individuals can be gauged by reading the testimonials enclosed which are taken from daily journals completed during the treks. Longer term outcomes are referred to in paragraph 3 and all the studies completed confirm that the trek impact is present after periods of 12 months and more.

Cost-Benefit 

11. Attendance at a trek is free ex Brisbane and Adelaide. The amortised cost of taking one individual on a trek is approximately $2,500.  Groups of 12 to 16, all of whom self-nominate, make up the normal participant group.  Depending on the level of financial assistance offered to supplement travel expenses, each trek costs approximately $35,000 to run.  A total of five treks per year are conducted in SA and QLD.
12. These are significant costs for a small charity that receives very little Government support. However, when compared with patient costs for clinical care at approximately $1,500 per day, they pale into insignificance given the benefits.

Role of NGO

13. Mental health is certainly impacting many more individuals than even 5 years ago and the suffers are now more prepared to seek assistance. Combined with COVID 19, the mental health support system is close to overwhelmed.   This has placed a strain on alternate support systems and some NGO have attempted to assist, some unsuccessfully.  However, there is a role for NGO to become involved in providing even simple MH first aid to supplement the system and this should be encouraged.
14. Currently, it is understood that more than 3,000 organisation list that they provide support to the veteran community. The Foundation is aware of the work of some, but little independent evidence is available to indicate the value of the service provided.  RSL QLD appears to be the only organisation that has attempted to grade or measure the impact of various NGOs.
15. NGO’s play a key role in supporting government-based services in three specific ways: additional resources, alternative approaches, and broader geographic availability. The sheer volume of Ex-Service Organisations (ESO’s), most of which are NGO’s, speak to the demand for additional and alternative resources.
16. Many of our participants report having tried the numerous currently accepted therapies including, but not limited to, regular and long stints in mental health facilities at up to $1500/day, pharmacology, one-on-one counselling with a clinician, EMDR, ECT, etc. They will universally say that the experience provided by Trojan’s Trek is the best and most effective treatment they have had.
17. The ability to utilise alternate therapies such as Neuro-Linguistic Programming (NLP) and Cognitive Behaviour Therapy (CBT) as part of our approach has been a key to our success. While our clients are encouraged to listen and discuss, they take away from the experience what they consider useful for their recovery, nothing more.   Whilst some of these therapies are making their way into current clinical practice but they are still largely considered fringe, and not supported by clinicians.  Our most recent peer-reviewed and published results prove that the Trojan’s Trek programs are three times more effective than the ‘Gold Standard’ treatment of pharmacology and one-on-one counselling and are sustained after two months.
18. Finally, the ability of NGOs to be nimble and responsive (without the bureaucratic restraints of a large organisation) means that organisations like Trojan’s trek are typically the first port of call for people who need an acute response. The fact that most government services are city-based also creates opportunities for regionally located NGOs to take up the cudgel. It is in these ways that NGOs provide a valuable adjunct to the current government-provided services.

Conclusion

19.   The workings of the brain and the impact which experiences have on behaviour, is an area about which new information is continually presented and investigated.

There is no doubt that traumatic exposures have an adverse impact on behaviour.  Almost all who suffer from stress illness exhibit unacceptable behaviour or periods of poor anger management.  This in turn results in failed relationships, which further enhance depression and anxiety. If behaviour can be changed to conform with what is termed “normal,” recovery by reversion to the norm can be commenced.

The way in which the individual decides or is persuaded to commence that journey is of no consequence as the program “does no harm.” That is to say, the decision to make positive change is up to the individual which results from the experience of the trek.  And if that attitudinal change is supported by simple tools and individuals who have experienced similar events and are supportive, there is a significant opportunity to implement positive gains to the benefit of the community, children, loved ones, friends, and those in other relationships.

Trojan’s Trek has achieved those outcomes over 13 years with more than 400 male and female clients benefitting from the intervention.

Moose Dunlop OAM

Operations Director

Please see the attached submissions:
Submission by Jake Sparrow
Submission by Dean Saddler
Submission by Lee Bailey
Combined comments