The battle diggers face after war
For hundreds, perhaps thousands, of Australian troops, withdrawal from Afghanistan will simply bring a new battle - with mental illness.
The mission of Australia's conventional armed forces in Afghanistan, codenamed Operation Slipper, concludes in 2014 after 12 years of fighting, at least 38 deaths and 241 diggers wounded.
But there is compelling evidence the death and injury toll is only half the picture, with significant numbers of soldiers going on to develop post traumatic stress disorder (PTSD), depression and alcoholism.
"We believe that the numbers presenting over the next 20 to 30 years will be significant," Returned and Services League (RSL) of Australia president, Rear Admiral Ken Doolan, told reporters.
"... One of the things we wish to avoid as best we can is men, 30 years on, waking up in the middle of the night screaming or crying, or suddenly they get vicious with the family."
The simple fact is neither the authorities nor the academics know exactly how many troops will be affected by mental illness after the allied forces' 2014 drawdown.
Estimates based on UK- and US-led studies of returning Western troops, in 2004, 2004 and 2009, suggest that between four and 18 per cent have developed PTSD.
At least 44,000 Australian troops have deployed to Iraq and Afghanistan.
It could be roughly surmised, based on the academic studies, that at least 2000 may develop PTSD.
A relatively small number of returned Iraq and Afghanistan war veterans have already developed mental illness, although it can take years for symptoms to show.
Minister for Defence, Science and Personnel Warren Snowdon told September's RSL national conference that 964 Australian troops had been medically discharged after Middle East deployment.
Of those, 440 were discharged for mental health reasons and 70 per cent had become ill as a direct result of deployment.
Australian psychiatrist Dr Samuel Harvey said there was no compelling evidence to suggest Australia would suffer a "tidal wave" of disorders.
"But that doesn't mean that we don't need to be alert for and have systems in place for individuals who suffer problems later," he added.
Dr Harvey, who is associated with the Black Dog Institute, said the number of soldiers with PTSD had varied among the military forces of Western nations.
This reflected differences in the health systems the veterans returned to, the social backgrounds warriors came from and varying levels of familial support.
Dr Harvey, who was involved in some of the PTSD studies at London's King's College, said reservists may be particularly at risk.
"A lot of that increased risk seems to be associated with the way in which they deploy - they have to come out of civilian life ... and then after they return home they have to reintegrate into normal life," he added.
The RSL has criticised the federal government's recent response to the problem, not least because of cuts to the defence budget which it said did "little to inspire confidence that anything meaningful can be done".
But the Australian Defence Force (ADF) itself is said to be "on top of it" and adopting a robust approach to helping current and ex-servicemen.
To mark National Mental Health Week, which ends on Saturday, chief of army Lieutenant-General David Morrison AO ordered all serving army units to spend at least two hours discussing mental health.
The awareness initiative has included battalions in Afghanistan.
The army is acutely aware that a stigma remains attached to mental illness, perhaps even more so in the macho world of frontline combat.
"Of particular concern is the inaccurate belief that coming forward to seek help will prevent members from deploying and lead to medical discharge," army health director Colonel Len Brennan said.
Two Australian soldiers have featured in an army video marking the mental health week.
They describe the battle they've endured with mental illness since deployment.
"We saw death and destruction on a scale that shocked us," said Captain Ash Judd, who fought in Afghanistan between 2008 and 2009.
"... I was fine when I first came home, it was only later that the trouble started.
"Those who were working with me definitely would have noticed the deterioration in my mood, my degree of irritability, my emotional disengagement, certainly the degree of alcohol I was drinking."
But he said as PTSD was "such an awkward subject" in the army, few people spoke to him directly about it.
Corporal Sarah Archibald, who served in Iraq between 2006 and 2007, said stigma about PTSD was "rife" within the army.
"I think talking about it like an injury is what we need to do, and that's right up the chain (of command)," she said.
"... There's too many of us slipping through the cracks."
In a statement, Snowdon said the ADF had a comprehensive system of care in place and was working to increase support further.
"I understand there is still reluctance amongst some personnel and their families to seek help for mental health conditions," he said.
"This often stems from a fear it may affect an ADF career, which isn't the case at all."
Have your say...
The approval of your comment is at the discretion of this article's publisher. Write your comment with the following in mind to ensure the highest likelihood of it being approved:
- No promotional undertones
- No use of profanity
- Good spelling, grammar and layout
- Check punctuation, language and missing words
- No use of aggression
- No unsubstantiated claims
We reserve the right to remove comments at our discretion.
Your name is used alongside Comments.