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Foreign Affairs, Defence and Trade References Committee
Mental health of returned Australian Defence Force personnel

HEMMINGS, Mr Ciaran, Private capacity

McKEEVER, Mr Matthew, Private capacity

McLAREN, Dr Nial, Private capacity


CHAIR: Welcome, would you like to make a brief opening statement before we go to questions, Dr McLaren?

Dr McLaren : I was not aware of the format for this, so I have actually—

CHAIR: A brief opening statement is fine. If you would prefer to go straight to questions that is also fine.

Dr McLaren : I will give you some information that I do not think you will get anywhere else.

My background is that I graduated in medicine in Perth in 1971 and completed my psychiatry training in 1977. Over the next 10 years I worked for nine years with Veterans' Affairs, including six years full-time, most of that as head of department at Hollywood Hospital in Perth. I then went north and worked as the Kimberly psychiatrist for six years, establishing a service there—there were no facilities whatsoever. Then I went to Darwin and for three years I was chief psychiatrist for the Top End of the NT. I then went into private practice. In that time in private practice I was doing the great bulk of the military work in Darwin. I moved to Brisbane a few years ago and very quickly took a large part of the military work in Brisbane.

In the last 19 years I suppose that I have seen well over 1,000 serving members. I have seen several thousand veterans. The earliest were from the Battle of Frommel—I imagine you know of that. I have seen hundreds and hundreds of World War II veterans in Perth, including from 2nd Commando Battalion on Timor and survivors of the terrible fighting in Aitape and Wewak in northern New Guinea and every combat arena that we have been in. I also have extensive experience in civilian post-traumatic states—crime et cetera. So I would like you to understand that I am not an amateur and I am not an academic.

While I was working in Perth I started a PhD in the philosophy of science as applied to psychiatry, I have published extensively in that—I meant to bring one of my books in but I forgot. Very few psychiatrists in the world work in this area, so I claim I am sufficiently qualified and experienced to give evidence to this inquiry as an expert. My particular fields are the philosophy of science and psychiatry, military and post-traumatic psychiatry, and isolated services.

I want to comment on psychiatry in general and psychiatry as it applies to the ADF. I have two patients I know very well. I mentioned this to them and they said they would like to come, so I have to give some of my time to that. On the status of modern psychiatry, this is the important material that you need to know, because you will not get it anywhere else, I can promise you. I will go straight to a quote which you have probably heard from a very urbane psychiatrist in his Armani suit. This quote is direct: 'Psychiatry is making very rapid advances on a broad number of fronts. Today we stand on the cusp of major developments in our understanding of the science of mental disorder. We have powerful new tools of diagnosis, investigation and treatment, giving us dramatic new insights into the causes and management of mental disorder. After so long as the neglected Cinderella of medicine, psychiatry is ready to take its place as a fully developed scientific specialty making major contributions to the wellbeing of our fellow humans.' I am sure you have heard something like that. That actually comes from the first introductory lecture I did in my training in 1974. So psychiatry, as they say, has always had a great future, and always will. I will not go into what that amounts to in philosophy of science. The Greek term is 'skata taurou'; we will leave that out. The truth of the matter is that modern psychiatry is most emphatically not a science. At the best it is a proto-science, a field from which a science could emerge, and at worst it is a crude technology driven by a variety of conflicting ambitions: political, financial and the drives of the psychiatry guild.

I picked this stuff up in the tearoom of our practice yesterday. These are 'Understanding depression' and mental health resources brought to you by the nice caring people at Pfizer. Pfizer, I should point out, paid a $2.3 billion fine in the US in 2009 for falsely misleading the government on sales of drugs. So anything to do with the drug companies is immediately suspect. This is what they have here: they have nice pictures of neurotransmitters. This is all fanciful. It is the crudest theory and has absolutely no substance of support in the literature. It is just an ideology.

The question for all psychiatrists is: what is the name of the model of mental disorder you use in your daily practice, your teaching and your research? Give the name of the originator and three seminal references showing how it can improve our understanding and management of mental disorder. You will never get an answer to that question. I have asked hundreds of psychiatrists; all I ever get is a stony stare and then they look at their watches and disappear. My conclusion is resisted with very bitter antagonism by the psychiatric establishment.

I will rush through some quick examples showing how all of this comes about. This is all research from the point of view of the philosopher of science looking abstractly at the phenomenon of modern orthodox psychiatry. The first one is that there is a total lack of justification of biological approach, so all of this stuff here has absolutely no justification in the scientific literature. I published an extensive survey two years ago looking at the 13 major English-language psychiatric journals over 11 years—200,000 pages and 25,000 papers, editorials, seminars, contributions et cetera. Not one justified the biological approach in psychiatry—not one.

CHAIR: Dr McLaren, you are going to bring this home to the terms of reference of the inquiry?

Dr McLaren : Yes, the terms of reference are −

Senator WHISH-WILSON: Sorry, Dr McLaren, could I just interrupt you? Could you explain what the biological approach is, exactly?

Dr McLaren : The biological approach is this—

Senator WHISH-WILSON: So it is drug pharmaceuticals?

Dr McLaren : Drug pharmaceuticals, yes. The same is true all across the board. You are getting a particular point of view hammered home: institutional psychiatry built around hospitals, built around drugs, built around major services. Everything is there. How do we build up these places? The facts of the matter are that this has absolutely no justification in the literature. I am sorry to have to tell you that, but nobody else will. That is critically important. Look at this stuff, which comes from the US veterans administration. This is their flow chart on how to manage PTSD. It is based on the idea that it is all biological. So there are drugs, there are teams, there are questionnaires, there are studies—there is all of this sort of stuff—but there is no humanity, and that is what these chaps will talk about. ECT is used in post-traumatic stress disorder. I have not used ECT in 40 years. Anybody who says, as the Royal Australian and New Zealand College of Psychiatrists does, that it is an essential tool of treatment—their position statement No. 74—is saying something that is absolutely false, but you will not be told that, and Veterans' Affairs are paying for ECT for veterans.

CHAIR: What is ECT?

Dr McLaren : Electroconvulsive therapy. There is an explosive growth in certain disorders, in particular bipolar disorder. When I trained, this was considered extremely rare—0.1 to 0.2 of the population. In 1984 that had gone to one per cent, in 1999 it was 6.4 per cent and in 2004 Philip Mitchell, a professor in Sydney, said that it was 11 per cent of the population and that all of these people should be on drugs. Genetic disorders do not increase by a factor of 10,000 per cent in one generation. You are not being told this.

Regarding hospital beds, the vast majority of people in hospital do not need to be there. Of the 1,000-plus serving members I have seen in the last 20 years, only three of four were admitted to hospital, and yet they are routinely admitted to hospital here at huge cost—$1,000 to $1,500 a day. My experience working in the Kimberley is that this is completely unnecessary. It is driven by institutional needs, not by the needs of the veteran. I will not go into any more on that.

People sometimes say I am an anti-psychiatrist. This is completely false. I do firmly believe that mental disorder is a reality. It is not a fantasy. People like Thomas Szasz specifically said there is no such thing as mental disorder in soldiers; it is just a gigantic fraud; they are simply trying to avoid their duty. That is absolutely false. There is no truth to that at all. Regarding psychiatry in the ADF—and my experience is with well over 1,000 serving members over the past 19 years and with several thousand veterans—there is a widely held impression that military psychiatry consists of post-traumatic states only, but this is false. That is only a small part of the work. There are poor recruitment procedures. Nobody seems to be interested in this. I said to one chap last year, 'How on earth did you get through recruitment?' And he said, 'I lied through my teeth.' It is very simple. There are the effects of injuries. There are sports injuries, training injuries and injuries on service. We are now seeing an epidemic of young men with wrecked backs—25-year-old men with spinal fusions—which was completely unheard of after World War II, and this is going to get worse. It comes from carrying 65 kilo packs. This has a shattering effect on people's lives. There are marital and family problems, of course. There are work related problems such as bullying in various forms. There are alcohol and drug problems. There are post-traumatic states, including difficulties adjusting to civilian life—and among veterans, of course, post-traumatic states are much more significant. Serving members are subject to practically the same range of problems as the civilian population; it is just that the incidence changes across that population.

Compounded in all of this is the intense stigma directed against people with mental problems in the Defence forces, and this stems from the myth of the 'real man'. The myth of the 'real man' is that there is no such thing as pain, sickness or mental disorder, only weakness of will. Anybody who shows pain, sickness or mental symptoms—and this is continuing with the myth—is weak and must be treated harshly until he gets tough 'like us'. That myth is absolutely rife. It is everywhere. It is in the air that people breathe in the Defence forces. Of course, it is fantasy.

Senator WHISH-WILSON: Is that what is mostly responsible for the stigma that soldiers do not want to—

CHAIR: We will let Dr McLaren finish his opening statement, and then we will go to questions.

Dr McLaren : I will finish this in just a moment. This is across the board, but you have to remember that the people who are expounding this point of view are extremely lucky in that they have never been injured, they have never suffered pain—a lot of them have never had a cold. When they get hurt it is a totally different story, of course. It leads to people being called malingerers, which is possibly the most brutal thing that you can say to a male.

The management in the defence forces: what does the ADF Joint Health Command to do standardise and supervise management of mental disorders among members? My experience is: absolutely nothing. I have had no contact from them in 20 years. I spoke to one reserve psychiatrist in August 2001, in Darwin. I was just down the road from the base. I spoke to him for few minutes. I had chased him, I had run him to ground, and nothing came of it. I was on the email list for the Australian Centre for Posttraumatic Mental Health for a few years, but it was of no value whatsoever, and that has somehow fizzled out.

Until two months ago I did not even know there was a thing called the Australian Defence Forces Centre for Mental Health. I did not know it existed. I had actually forgotten that there was a position called Chief Psychiatrist of ADF, because he had never contacted me and I had never been invited to any of their talks or presentations or to give my experience to any of them. What do all these people do? I have no idea, but it does not impact on the people doing the work, because the great bulk of the work of treating mental disorder in veterans is in the private sector.

Those four patients who were shown on the ABC program a few months ago are absolutely routine to me. They are the ones I do, but I deal with them as outpatients—a minimum of drugs, never ECT. And my results are at least as good as if not better than the standard results. The ADF does not audit private psychiatrists who manage the great bulk of veterans. There is no comparison of outcomes, no comparison of costs, no attempt to ask people to present their results or methods, no effort to explore options. The ADF absorbs massive costs without demur—$100,000 at hospital admission, which in my experience is a complete waste of money. The actual costs are a closely held secret. Truly outrageous cost claims are submitted and paid with no questions asked. There are a lot of private psychiatrists making a great deal of money from ADF members and veterans, but the prevailing attitude seems to be that as long as something is being seen to be done everybody is off the hook. CYA—cover your arse—seems to be the prevailing ethos: heavily sedated unemployable patients who are in and out of hospital and rarely complain too much, but when something goes wrong, like a suicide, everybody can stand around and say: 'Well, we did our best. Look how much we spent.'

Just for the record, my contract to provide services to ADF members was abruptly terminated on 10 June with no warning. None of the medical officers who referred to me here and who were very happy to do so were questioned. None of my patients were asked. My figures were never checked. It was simply a decision made in Canberra with no explanation and no apology. I will ask Mr McKeever and Mr Hemmings to speak, because they are the blokes on the spot; they are the blokes at the receiving end of all of this.

Mr McKeever : I was 16 years and three days in the military—a highly decorated soldier deployed five times with all ranks. I was first diagnosed with PTSD in 2011 after returning from my third deployment, which was my first deployment to Afghanistan in 2010. I am on two documentaries, if you want to get a wider view of what I actually did in Afghanistan during that period. I was refused counselling. I was then redeployed to Afghanistan again, in 2012. There may be a few things I bring up that might be disturbing to people in the room and to you people out the front. You are probably not aware of what a front-line soldier does in Afghanistan, particularly in the Mirabad Valley.

I killed my first person on 30 August 2010—retrieved the body; you are required to fingerprint it and required to iris scan. I was offered no mental support after that. I then had dealings with other dead Taliban who were killed by other people where I was required to physically examine them for bullet holes. On occasion when I would lift their arms up my fingers would go through their wrists from the bullet holes. Because of that, I have no sexual function. I have to inject myself with a needle; I can show you it. If I try to have sexual intercourse with my partner, I get flashbacks from my fingers going into dead people. So I have to inject my penis with a needle of the size I am showing you—it is quite large—which is not nice. So I have no sexual life, and I have not slept with my wife for over 12 months due to severe nightmares.

My second deployment to Afghanistan was totally different. My first one was high activity with numerous contacts, numerous IED explosions and handling numerous dead bodies. My second one was quite different. I knew I had a problem, but then I was exposed to the handling of dead children. In one instance with one child, I had to pick the little boy up by his ankles and shake him to prove to his parents that he was deceased. Then when I returned from Afghanistan I tried to commit suicide because I saw my child and that brought back a lot of memories.

I suffer from multiple—every joint in my body is wrecked. When you are injured in the Army and you come back and you have a problem and want to address it, in your POPS you tell them everything you have seen, everything you have done and they still do not address it. As soon as they find out that you have a mental illness or any kind of illness, regardless of whether it is a knee, back or whatever, you are treated as a malingerer and you are treated quite badly. They do not want to acknowledge you; they want to kick you out as soon as possible. Fortunately I have been looked after by DVA because I have everything in black and white recorded in my medical documents and I made sure, before I discharged from the Army, that all my claims were accepted before discharge. And I am not sure if that is a new thing that they have done, because I have only been out of the Army a year in two days time. But I guess the main point is that there is a mental illness in the military that the people do not want to reflect upon or, if you do come out, it is like being gay. Coming out and telling someone you are gay is quite difficult. Coming out and telling somebody you have got PTSD is difficult. The only reason it was found out that I had PTSD was that I tried to commit suicide. If you want to ask me questions, I am willing to answer.

Mr Hemmings : I have done six years in Defence. I did not deploy. I sustained my injury whilst on rifle combat at Butterworth over in Malaysia on a training exercise. I crushed my right arm whilst over there. Mental health within Defence is—like Matthew said, they do not care at the end of the day. The names you get called—I have got a body suit because I have got severe nerve pain. I also suffer from adjustment disorder with anxiety and depression. And in the pack mentality of Defence that does not sit well, as Matthew said, and probably the others. As soon as you are injured, you are like a dog—you are kicked out of the pack and there is no way of getting back into that pack. I was injured in 2013. I tried my hardest to get better, but the ridicule within Defence was phenomenal. Every time I tried to do something it would be like, 'Don't do that—you might hurt your other hand' or 'Come on, Michael Jackson, give us a moonwalk'. It is shocking. It just makes the mentality worse. You can speak to hierarchy about it and you get ridiculed also, like officers and so forth. You get to the point where you fear to even speak up. I did not even know places like VVCS existed until the end of my discharge. When I had done the Defence discharge thing that they do, I found out that there was help out there. It just came to the point where I had to go to the doctor on base myself and ask for help because I was the same: I was at the point where I would sit at home at night and think about suicide. It got really hard, to the point where—I have got three children—it come down to being there for my kids. I could not do this without help and seeing McLaren. The way work treated you—I hated going to work. I would sit at the back gate and struggle for half an hour to even drive into that place knowing that as soon as you did you would just get ridiculed and picked on for your condition.

It is massive in Defence and it is not looked at at all. I spoke up to mates, and stuff like that, and they would just say, 'Harden up, princess. It's not that bad.' But once you have got an injury and you are kicked out of the pack, and because you have got your brethren and your mates and stuff, the next minute you are pushed off to the side, literally. They will grab you and they will sit you in another building away from all the non-injured personnel. That is where you sit until you are kicked out.

CHAIR: Matthew and Ciaran, that is extremely powerful testimony. It is now on the public record and your courage is remarkable. I thank Dr Niall McLaren for his contribution too. It is very challenging. We will now move to questions.

Senator FAWCETT: Mr Hemmings, you said you discharged in 2013?

Mr Hemmings : No. I discharged on 24 June this year.

Senator FAWCETT: So the Soldier Recovery Centres were up and running by the time you discharged?

Mr Hemmings : Yes. They were running the whole time, but I was never offered to go to the Soldier Recovery Centre during my rehabilitation when I first got back to Australia from Malaysia.

Senator FAWCETT: Had you asked to go or was it just not offered?

Mr Hemmings : They spoke about it numerous times, but it never eventuated. They talked about getting me to seek help and stuff like that. They would pipe up and say, 'We're going to book in a month's time. We're going to look at sending you there and get you on the recovery program.' It just never eventuated. I just got pushed back into the corner and left there.

Senator FAWCETT: Did you converse with other mates who were in the Soldier Recovery Centre? Did you sense that would have been a better path?

Mr Hemmings : There were not that many. The Soldier Recovery Centre, the whole time while I was there, was always limited to numbers. Once those spots were full, that was it; there was nothing else. The size of Enoggera Barracks is large, so, with the number of people attending, one of a few spots would pop up and if you did not jump at it you missed it. In Defence they prioritise—'You're up here. You're down here.' Everyone picks and chooses, and, if you get along well with your hierarchy, they look after you more than people who do not, as they say, grovel and are drawn to the hierarchy, compared to those who do.

Senator FAWCETT: Mr McKeever, you mentioned very early in your comments that you were diagnosed with, I think, PTSD after your first deployment?

Mr McKeever : That is correct. That was my third deployment, but in my first deployment to Afghanistan I was diagnosed and then referred for counselling. That never happened. I then went through military screens that brought me to my second trip to Afghanistan. When I came home, Dr Loman made comments. I have a very colourful psych record within the Army for the stuff I have been exposed to. He said, 'If I had read your report, I would have never allowed you to deploy again.' Once you have been shot at, once you have been hit by an IED—I have lost count of how many times I have fired my weapon in battle or how many IEDs have gone off around me. It is very hard to come home and live a normal life, then deploy again and go out on patrol. All that is going through your head is that you are waiting for that explosion or that crack again. So it was very stressful for another six months.

Senator FAWCETT: Was that diagnosis done by a Defence psychiatrist or somebody outside?

Mr McKeever : It was a Defence doctor who said that I suffered severe signs and symptoms of PTSD and referred me to a Defence counsellor. That never happened.

Senator FAWCETT: When you say it did not happen, is it that they just never made an appointment or you were not able to make appointments? What transpired?

Mr McKeever : They did not make appointments. They wait for you. I think it is three months or six months. You do your POPS when you return. I told them everything I have been exposed to. I cannot close my eyes in the shower without having flashbacks. If my children scream, I have flashbacks. I want to harm my children to get the flashbacks out of my head. I told them everything and they still continued to allow me to work. There is no rehabilitation program. They did not say, 'Wait a minute, you're pretty messed up.' You know what I mean? There are different levels of being messed up when you are constantly in the front line getting blown at and shot up every day as opposed to somebody who has not been in real combat.

Senator FAWCETT: Do you know if your chain of command was informed by the medical system about their assessment?

Mr McKeever : My chain of command were not informed. My chain of command knew that I had killed someone and had handled the body on 13 August 2010, however I was not offered counselling. Maybe, if I had been offered some kind of counselling immediately after that, it would have helped me sleep a little bit better.

Senator FAWCETT: What I am hearing is that, if you had had a choice, you would not have had a second deployment after that first deployment to Afghanistan. If you could change the system, would you prefer that the medicos were required to reveal to your commanding officer that they had concerns about you going back?

Mr McKeever : Yes, they need to conduct a thorough review of your psychological files and your medical documentation before making the determination to deploy you. The military do not want to admit that there is a problem with mental health. There are different levels of severity and what I have is quite severe. It is hard to say this, but when my children scream, that takes me back to the mass casualty of five children being blown up. I feel I want to harm my children to stop that screaming—to stop my flashbacks.

Senator WHISH-WILSON: I think you have just nailed what we have been hearing in the last few days about mental health. Do you think the military do not want people to know there is a problem because it is a recruitment issue for them, or is it something else?

Mr McKeever : It is a recruitment issue for them. They could have offered me a job in recruitment, but what recruit wants to see a 34-year-old person with 14 pins in his body, two plates, lumbar spondylosis, thoracic problems, buggered knees, buggered wrists and PTSD. They do not want to put me in that position because that recruit is going to say, 'Look at him—I don't want to join'. There is a lot to come out about the Afghan war, especially with the special forces. They see a lot and do a lot; there has been a lot done by normal infantry soldiers as well. But you cannot speak up. As soon as you speak up, you are treated like an animal. I was put in a cell. That is another story, but it is something else I am going to pursue. Once they find out you are injured or you have PTSD, they try to push you over the limit. I have the paperwork of my complaint to ADFIS, the military police investigation cell, about false imprisonment. My wife is a police officer. I rang her up whilst in prison. I rang my psychiatrist up while I was in the cell. They do that to try and push you over the limit. They pick on you; they bully you—regardless of rank, regardless of what you wear on your chest.

Senator WHISH-WILSON: You were obviously very good at what you did to be able to do those deployments—as a sergeant you would have had men under your command. Did you have any idea what you would be getting into when you joined up?

Mr McKeever : Of course I did. I know what an infantry soldier does. But there should be people in specialised areas, as they had in East Timor and other places, so that when you kill somebody and they have to be dragged out and processed, there is a specialist team that comes out and does that—medical officers. I told my soldiers, 'If you do not have to see the dead body, don't see it.' There was a Senate inquiry into a green on blue incident in 2012. You are probably aware of that. I was in the vicinity. I had to pack up those three soldiers' rooms and take down the photos of their children—having had a personal connection with those soldiers. As a platoon sergeant, I should not be doing that. Someone else who has no relationship to those soldiers should be coming in and doing that.

Senator WHISH-WILSON: Dr McLaren, on this subject we had evidence from one submitter yesterday—I am asking for your view as a psychiatrist as well—that some of the mental instability or the mental disorders arise out of moral dilemmas or are what you call moral injuries. I know the situation you are in is different, but given the kind of testimony we are hearing today—dealing with a dead body and that association—how much of PTSD is moral injury? Do you accept the theory that coming to terms with these kinds of dilemmas is part and parcel of being in the military?

Dr McLaren : That is a hugely complex question. The answer to the first one is your standard psychiatric approach that it is not moral; it is biological—give them tablets; give them ECT; put them in hospital. I do not believe that. There is absolutely nothing to support that. The issue that Mr McKeever is talking about where soldiers are going around fingerprinting and taking blood samples and iris scanning troops should not happen. I wonder if this is actually against the laws of warfare. I think that that should not happen. Ordinary soldiers are not trained for that. I was trained, but we would never, ever, ever do that on somebody we knew. That is just anathema in medicine. You do not treat your family, and yet he is essentially being asked to treat his family when he had to go and take down pictures of his friends with their children. That should not happen. Yes, that is a moral injury in every sense of the word, and it should not happen, and it happens because the people who make the decisions have got no comprehension of the effect this has on people. Their attitude is, 'Well, real men don't suffer. I'm a real man. Look. I've got stripes and pips to prove it.' But they are lucky. I can take any one of those 'real men' and reduce him to a whimpering mess in 24 hours. It is that easy.

Senator WHISH-WILSON: On that point: Matthew, do you have fellow troopers who have not had similar problems to you, or is there a level where everyone has issues? The evidence we have heard from the committee is that it is a very individual thing: some people suffer and some do not. Is that not true?

Mr McKeever : No. From my first deployment in 2010—I was a section commander then and I was presented with the award for best junior leader in the Royal Australian Infantry in 2010—nearly every soldier in my section suffer PTSD. I did not realise. I knew I had something wrong with me, but it was when I came home and held my child that I knew.

Dr McLaren : I just wanted to mention a study I did in 1984 on World War II veterans that was exactly on the point that Mr McKeever has made. It involved 200 World War II veterans who served in the northern slopes of Papua New Guinea, and if you know anything about that you will know that that was deemed amongst the worst fighting of the Second World War—right up there with Stalingrad. I studied them carefully—and I take very, very extensive histories, as these chaps will affirm—and these facts emerged from it. The incidence of mental disorder had nothing to do with your family background. It had nothing to do with your premorbid personality—whether you were a Rhodes scholar or a prisoner made no difference. Only three factors had a bearing on it. The first was the duration of combat. The longer you were exposed to combat, the higher the incidence of mental disorder. The second was the perceived severity or intensity of that combat. The more stressful it was, the more your mental state deteriorated. The third was the presence or absence of debilitating physical illnesses such as malaria, hepatitis or amoebic dysentery—which these chaps, fortunately, did not get—and these weaken people. I could not get that paper published, because it said that this is not biological, it is psychological, and it can happen to anybody, and it does not matter how good your training is, that only puts off the day of reckoning. I could not get that paper published. It is buried somewhere in Veterans' Affairs' archives.

CHAIR: Clearly you have a different approach to the majority of psychiatrists.

Dr McLaren : I did; I no longer do.

Senator FAWCETT: Could you just talk to us briefly about how you work with gentlemen like this? You said you have good success rates. Could you just describe what you do?

Dr McLaren : I was showing you these flowcharts which say that this is a depersonalised type of psychiatry. Having been to the US on five occasions and having being in many of their mental hospitals and their big universities—I regularly lecture at their big universities—I can tell you their psychiatry is pretty abysmal, and the way they treat their veterans is worse. But the—

CHAIR: Dr McLaren, I think our assistants would like to table those papers. They do not come up too well on Hansard when we show them.

Dr McLaren : That is okay. And the approach is that this is a human being, not a biological specimen. It is an intensely humanist approach based on a well-researched and published theory. And, as I said previously, no psychiatrist can tell you the name of their theory of mental disorder. Well, I actually have one, which I use—and it is, as I say, intensely personal. That is the difference. It is being available and being ready, being able—as he said, he rang me from the prison. That is okay; I do not mind. It is a bit hard but that is what it is. So you can put as many services in as you like, but if the people are not available and they just think of the veteran as a number, it is not going to work. So that is the point.

CHAIR: Senator Lambie, do you have any questions?

Senator LAMBIE: I do. First of all, I am really concerned about what has happened with you in the military. They have gone and done this big thing on abuse and not abusing people, whether it is sexually, verbally or anything else. And obviously that is still continuing. So I am very grateful to you, Matthew, for bringing that up today, because it obviously has not stopped and I have been trying to tell Defence that for a long time. So thank you for that. I am sure that many victims out there who are still serving, and still going through it, would be very grateful for your testimony this morning. Mr McLaren, I am concerned that you are no longer getting funding from DVA, so you have patients that are no longer being paid for under Veterans' Affairs—is that correct?

Dr McLaren : No, these chaps are now discharged so they are being—that comes through Vet Affairs. My contract was with the ADF to provide services to serving members. In fact, it was with Medibank Health Services—you know that procurement system.

Senator LAMBIE: Yes.

Dr McLaren : That was simply terminated with no discussion with anybody.

Senator LAMBIE: So you have all this experience and they have now terminated that?

Dr McLaren : That is correct.

Senator LAMBIE: Okay, that is concerning so I would actually like you to see us before you leave today, if that is okay? You have had over 30 years worth of experience with DVA yourself, is that correct?

Dr McLaren : Yes.

Senator LAMBIE: How difficult is it to diagnose PTSD, from what you know?

Dr McLaren : Not difficult at all; you just take a history.

Senator LAMBIE: Okay. You are using alternative methods rather than using the medication?

Dr McLaren : No, I do use medication, but that is not the main thrust; that is ancillary. And I do not use the standard psychiatric drugs. The list of side of effects of psychiatric drugs is appalling. If you tell any young man: 'These are the eight main side effects of antidepressants', they will not take them. That is all there is to it. They will not take them. You are only able to get them to take them if you do not tell them what the side effects are. And when they come back a week later and say, 'I feel dreadful and I have got no sex life and I cannot stay awake', et cetera, other doctors just jolly them along. 'It's alright. It'll get better. These are well proven drugs.' They are not. They are terrible. They are appalling.

Senator LAMBIE: What is the effect on the veterans that are out there who actually are wrongly diagnosed—who do have PTSD—what path do they end up going down?

Dr McLaren : My experience is that they end up drinking, they end up separated, they end up drifting, and then a significant number of them end up dead.

Senator LAMBIE: Do you think there is a problem out there when it comes to psychiatrists and psychologists in dealing with PTSD? Do you find there are a lot of gaps and a lot of misconceptions and that some of these guys are actually being passed from one psychologist to the next psychologist to the next psychologist, making the condition a lot worse?

Dr McLaren : I know secondhand that it goes on, but I actually do not have any dealings with them because VVCS are a world unto themselves. You can contact them, but it is not that easy. They are a completely separate mental health service in their own right, now, and they do not talk to me.

Senator LAMBIE: What is your success rate with these guys with PTSD? I know there is no simple answer, but are you able to get them back up on their feet to a standard where they can, at least, get on with their lives to a certain degree?

Dr McLaren : There is a huge range. The majority of people, I would say, will get back to work, some will have to take other work or take different lifestyles and some are permanent casualties. The latter will not recover; they have gone too far. As to the success rate, my figures are very good. I look at hospital admission rates, pension rates and outcome measures. They actually are very good, but it is hard to get the statistics.

Senator LAMBIE: Do you consider PTSD is purely combat related?

Dr McLaren : No, it is not combat related. It is human experience related. There could be somebody down on that street outside who comes to work, something goes wrong, and they go home with PTSD. Women who are bashed throughout their married lives have PTSD. Children who are raised in terrible drug addled or alcohol fuelled families have PTSD. You could make a case saying that a lot of adult mental disorder is just childhood PTSD. You could make that case.

Senator LAMBIE: Do you suspect that our senior military commanders and politicians know that there is a maximum time a digger should serve in combat?

Dr McLaren : I am sure they have some inkling, somewhere, but they do not want to accept it. It goes against the ethos of the real Superman, that we can train these men to become supermen, that we can take a man and give him a 65 kilo pack, heavy weapons and heavy boots and make him walk 15 kilometres and he will be just dandy. No, he will not, because a 19-year-old spine is not designed for that. It is still soft; it is still jelly. It should not be happening. When a man complains of a backache, they say, 'Pull yourself together. Get a grip, you soft cock.' That goes on all the time. It never stops.

Senator LAMBIE: I know. Matthew, do you think that your going on to do multiple tours is because Defence just does not have enough resources to have done the Middle East for 13 years? Do you believe that you have been carrying way too much of the weight for too long?

Mr McKeever : I was exposed too long. My Afghanistan trips were back-to-back: a nine-month trip and a seven-month trip. On top of that, between my first trip to Afghanistan and my second trip to Afghanistan I was separated from my family for four years, which made me sit in my room and get even more depressed and realise I had more of a problem, and then you drink. You want to ask for help, but you know what the reaction is going to be. I was a platoon sergeant. I used to sit in on med boards. I know exactly what goes on in them. The words that are thrown around are, 'He's weak. He is a linger. Let's just kick him out.' I have seen it firsthand because, as a platoon sergeant, I am part of that criteria. I would quite often be spoken down to because I would stand up for the soldier and say, 'No, that's not right. He's got a serious injury.'

I had a soldier who, at 21, had a hip replacement. They just booted him out of the army as a linger. That is not acceptable. They go on about mateship, courage and initiative. Yes, courage and initiative is what you have. Where does the mateship come into it? It does not.

Dr McLaren : It is there while they are able to run 15 kilometres and everything like that. As soon as anybody stumbles, you are a dog, a linger. That word is used all the time: linger, linger, linger.

Senator LAMBIE: Yes, a malingerer.

CHAIR: This testimony is now on the public record, so there will be a lot of questions asked around the traps about your testimony. Is there anything that you can say to the committee that would show us the way forward—a positive step forward—about what could have happened in either of your circumstances? Do you think someone should have just pulled rank and said, 'You're not going back to Afghanistan.'

Mr McKeever : No. I think what the military needs is a proper rehabilitation program where you can be rehabilitated. For example, if you are injured, fair enough—you go to a rehabilitation cell and you do rehabilitation regardless of if it is mental health or physical health. Give them 12 months, treated like a human being. After that 12 months, everything is documented to make it easier for them to claim through DVA. Then they go, 'Look, mate, sorry. We gave you 12 months; we gave you the best opportunity. Unfortunately, you're not fit to serve our country.' I gave 16 years and three days, and five deployments. I put my life on the line and I get treated like a dog. That really kicks me in the guts, to be honest.

Mr Hemmings : I agree with Matthew. There is nothing. There needs to be more. There needs to be a new rehabilitation system set in place, and not prioritised either—it should be offered to everyone, not like, 'This runs for eight weeks and we can only take 10 people.' There is just too much of it to prioritise 10 people every eight weeks and everyone else gets left to sit on the backburners while still getting treated like crap because of injuries and everything else. You just sit there and wait 12 months, and then, by the time you have hit that 12 months, they are like, 'We've got a spot for you,' but then they stop and go, 'We're kicking you out. We're done.' So you never even get a chance to hit a rehabilitation stage at all or to receive any help—unless you do it yourself—because Defence just do not have time or cannot be bothered doing it.

Senator LAMBIE: Do you think that there is a disconnect—I never did war time—between you, being out there on the battlefield, and the officers sitting back calling the commands? Are they just not connected with the feelings and the torture and whatever you go through after you have been on that battlefield? Are they actually getting that? Are they getting that?

Mr McKeever : No, they do not. But I will tell you what they do get: they get recognised with DSMs and Medals for Gallantry and stuff like that. But the soldier like me, who has been in real combat, is not recognised for anything. But they get the big medals.

Senator LAMBIE: I know. I have heard that. The worst thing is that 23 per cent of our military is now officers. You guys are doing all the hard grinds and that is why you are doing all those rotations. And it is killing you.

Senator WHISH-WILSON: Could I ask Dr McLaren or Ciaran, in your circumstance, how much your obvious mental health illnesses were related to the trauma of your injury or the way you were treated after the injury or both?

Mr Hemmings : Both. It started from the get-go—from the injury. When I was first injured over there, I was left for almost 48 hours before they even sought help for me for my injuries. They just said, 'You'll be right. Let's see how it goes.' Obviously it just got worse from there—the swelling and everything else. From that moment I did the whole lot. I was thrown into a Malaysian hospital. I underwent surgery and spent three days in there with no contact by Defence or anyone from Army. I sat in a foreign hospital, where they spoke no English or very little English, on my own, not knowing what was going on or what was happening. I felt really alienated. Someone who was supposed to be there to look after me was not there.

After that, they sent me back, with open wounds, into a part of the jungle where there was no hot or cold running water. I sat there for a further three weeks. All of this instantly started to build on me more and more. I was then sent back to Butterworth, where I ended up back in hospital due to infections and stuff like that, where I then spent another four days in hospital with no contact from my superiors whatsoever—no 'How's it going? What's going on?' Nothing. I just sat there, alienated once again, for another four days.

I was put on a plane and thrown home. Just with my injury itself, it then took close to three months of begging—my wrist and my arm were killing me and I knew something was not right after surgery—until I could finally get an MRI, just to be called a linger and be told, 'You just want the easy way out,' and everything else like that. It just starts playing on your mental health straightaway. It starts digging into you as soon as you injure yourself. I go home and I cannot play with my children like I used to be able to. I cannot do the sports. I do not have half of my mates anymore because I cannot do what they do anymore—I cannot swing a golf club; I cannot surf; I cannot rock climb. I cannot do anything with this arm and wrist. It goes backwards and forwards, and then they just dig on you more and it keeps going.

Really, yes, the way they treat you, the fact that they do not offer you any help—they get into you straightaway, with that pack mentality. You are an injured dog. If you are injured and you cannot help fight, they attack you. They are straight onto your throat. That is what it is like. It is just the constant bullying and the mindset: 'You're worthless. You're a piece of shit now. You're no good to anybody. Just go sit in the corner and die, or hurry up and go and neck yourself because you're just a waste.' I had one officer tell me that I was nothing but a waste of taxpayers' dollars sitting in Defence: 'Just hurry up and kick the bucket, because the world would be a better place because you're an oxygen thief.' Stuff like that does get you.

CHAIR: It has been very moving testimony from both of you and Dr McLaren, and there is certainly very profound evidence there for us to continue with. We thank you very much for having the courage to come forward and put it on the public record. Thank you.

Mr McKeever : Can I just add one more thing to the record? Do an investigation into the 6th Battalion Royal Australian Regiment and you will unfold a lot of stuff. The person in command of that battalion should be in jail.

Senator LAMBIE: That is why you need a royal commission into it. For God's sake, have the guts and courage to call it.

Pr oceedings suspended from 13:01 to 14 : 02