Moral injury conference, Launceston

Introduction 

Good morning everybody, and welcome. 

I’d like to begin by acknowledging we meet on the Traditional lands of the Palawa people and pay my respects to their Elders past and present, including any who may be here today. 

I want to acknowledge any current and former serving personnel who join us today - thank you for your service. 

To all defence and veteran families present, I want to acknowledge the crucial contribution you make to the service of our Nation - thank you for what you do. 

And thank you to all of you who are working to improve the mental health and wellbeing of Defence personnel, veterans, their families, and so many others across the community, through your research and through your work. 

Thank you all for being here and your interest in this really important cause. 

Veteran wellbeing 

Coming into this portfolio of Veterans’ Affairs and Defence Personnel in 2022 was somewhat of a baptism of fire – there was a Royal Commission into Defence and Veteran Suicide underway and what was emerging through harrowing evidence and submissions was the failures of successive Governments to look after our people - our Defence and veteran community - as they deserve. 

The Royal Commission into Defence and Veteran Suicide made it abundantly clear: we needed to make significant, cultural and systemic change in both Defence and the Department of Veterans’ Affairs to reduce the rates of suicide in our veteran community. 

Fast forward to now and while there’s a lot that’s been done, there’s no doubt there’s still a huge amount left to do to improve the lifetime wellbeing of our Defence and veteran community and tackle the surge of suicide in that cohort and indeed across the broader Australian society as well. 

Overall in Defence and DVA we’ve now got a more concerted focus on broader veteran wellbeing, recognising that early intervention in injury and illness goes a long way to the lifetime wellbeing of a veteran, whether they’re in service or living life post service. 

We want to prevent harm where possible and get in before a condition becomes chronic. 

And we’re doing that across the board, be it through a feedback loop between Defence and DVA where trends are identified so injuries can be prevented or mitigated, new medical treatments are now available, rehabilitation more accessible and a better understanding across the board of mental health and wellbeing.

The Royal Commission into Defence and Veteran Suicide in their 2024 Final Report made 122 recommendations, we’d implemented 32 by the end of last year and there’s a huge amount of work underway at the moment. We expect two thirds of recommendations will be implemented by the end of this year. 

Moral Injury 

One of the more difficult nuts to crack that the Royal Commission tasked us with was Recommendation 78 - to prevent, minimise and treat moral injury. 

In order to prevent, minimise and treat I think in the first instance we all need to better understand. In their final report, the Royal Commission said: 

“Moral injury, therefore, while not as well understood and well documented as PTSD, is critical to our inquiry. It is deeply connected to the tragedy of suicide and suicidality of serving and ex-serving members…” 

The Royal Commission acknowledged that: 

“While we do make a specific recommendation about moral injury in this chapter, many of the recommendations of our final report aim to shift structural conditions and military culture in the Australian Defence Force (ADF) so that moral injury is less likely to occur.” 

The Government agreed in principle to this recommendation specific to moral injury, not because there wasn’t a willingness to agree to it on the spot or an appetite to achieve its intent, but in acknowledgment of the massive hill we have to climb in getting there. 

I have no doubt moral injury plays a key role in the mental health and wellbeing of the Defence and veteran community. 

I also have no doubt that while this is an emerging area of research, moral injury by many other names over the years is not an emerging issue… when you think about moral injury through the lens of the ADF but also through the lens of front line workers and first responders this is a real issue of true significance.

I think in getting my own head around moral injury the way I think about it is through the prism of the experience of our Vietnam veterans. 

There’s a few elements to that. 

First of all for many of this cohort they weren’t looking to go to war. 

They were called up not with a compulsion to serve their nation, rather via a birthday ballot. 

What they were asked to do while deployed might have been at odds with their own personal values. 

Then back home, Vietnam was the first conflict in Australian history that those left behind had the opportunity to see, to feel, to experience war in a whole new and vivid way. 

War was projected into people’s living rooms every night as they watched the evening news. 

The sentiment at home against the war and those who served was politicised – something that should have never happened. 

And that meant that when those veterans came home from Vietnam they were not treated as they should have been, by Government or by the community. 

People felt betrayed by the system they only set out to serve. 

I have no doubt that the culmination of all of this, the real existential nature of being let down by the Authorities who sent them to war in the first place and the shame they experienced when they came home would have resulted in some sort of moral injury… but it just wasn’t called that at the time. 

And much like the work and advocacy of Vietnam veterans lead to the recognition of PTSD as a diagnosable condition in DMS-III in 1980, there is much work coming from Defence and veteran circles now pushing for similar recognition of moral injury. 

Responding together 

As a Government charged with responding to the Royal Commission, we’ve been exploring moral injury in the Australian military population, commissioning and conducting research and I’m pleased that many of you who are involved in that, join us here today. 

The Departments of Defence and Veterans’ Affairs have been working together to identify and mitigate the risk of moral injury among current and former ADF members. 

Inside Defence, guidance has been developed for Command, health practitioners, and ADF members on moral injury. 

These products introduce moral injury, outline indicators, and identify appropriate support pathways and resources when moral injury is disclosed. 

Defence has developed in-person Moral Injury Skills Training to educate pastoral practitioners about moral injury with the latest research and best practice. 

Defence has even developed and recently updated a practical pocket-sized reference book for Commanders and practitioners (including Chaplains) to enhance moral injury literacy across Defence. 

Meanwhile, Defence and DVA are now progressing implementation and operationalisation of the Defence and Veteran Mental Health and Wellbeing Strategy 2025-2030 and the supporting Mental Health and Wellbeing Action Plan and Suicide Action Plan. That work has an eye to moral injury considerations. 

But we need to know more – we need more research to properly act. Especially, where a lack of being a separately recognised condition can inhibit how governments and practitioners can formerly support patients. 

This field is still very much in its infancy in terms of what we know about it, and how we standardise how we talk about, diagnose, manage, and further study Moral Injury in general. 

As an example, one key area identified by DVA is the impact of Moral Injury on veteran families. To use the Vietnam veteran example once again there’s a known link between those who served in Vietnam and intergenerational trauma. We are already starting to look at this with our Afghanistan and Iraq veteran cohorts. 

Where does Moral Injury fit with that? 

The path ahead 

Work is already underway to address moral injury in a coordinated way involving people like our Veteran Family Commissioner Annabelle Wilson, who joins us here today, as well as Open Arms, Policy, our Transition team, DVA Chaplaincy, external researchers and importantly, those with lived experience. 

Research into moral injury in Australian veteran contexts will be supported through the implementation of the Veteran and Family – Learning and Innovation Network of Knowledge (VF-LINK) model, which will draw on recommendations from the Royal Commission final report, including this Recommendation 78, to guide future research priorities. 

Under the current veterans’ entitlements system, administered by DVA, moral injury in itself is not a compensable medical condition, having not been recognised as such by the Repatriation Medical Authority’s SOPs, however, there is recognition that being exposed to events that are morally injurious may play a role in the causation of certain conditions like anxiety and depressive disorders, alcohol use and suicidal ideation. 

Where a veteran has rendered one day of full time service they can access treatment for mental health conditions at DVA expense without having to establish a formal link to their service. 

Open Arms, DVA’s mental health and counselling service, has also been establishing the use of the Moral Injury Outcomes Scale and the Moral Injury Events Scale as part of Open Arms practice in assessing clients who have experienced an event that might be deemed morally injurious. 

People both inside and outside service can also access more pastoral supports through Defence and DVA – notably chaplaincy which is an especially trusted support in the defence and veteran community… I’m pleased that today this conference welcomes, from across the community, chaplains alongside medical professionals and researchers – I have no doubt your insights combined will be extremely valuable over the next two days. 

To all of you who join us today, whether Defence and veteran focused, or looking at first responders, or health and support settings, education, and so many other areas, I’m really interested in the work you’re doing, and we will all benefit from it. 

In my view, if our combined efforts can see Moral Injury better understood, it’s antecedents and consequences better recognised, recognising its distinct causes and treatments, despite it sharing symptomatic presentations to other conditions, then we would be contributing a great deal to increased and more effective prevention, mitigation and treatment, in particular at the Moral Injury Disorder end of the trauma spectrum. 

What I’m really concerned about is the possibility we are treating too many veterans – but also first responders and others who have been faced with moral trauma of some kind – in the wrong way. 

Because we don’t know enough, we’re not doing enough to mitigate the causes, we’re not recognising moral injury when we come across it and we’re subsequently not enabling appropriate treatments to flow. 

From the other end, we also need to be careful about pathologizing normal human reactions to difficult events. 

I’m so glad you’ve all come together for this conference to share research and experiences so we can better prevent, identify and treat moral injury. I also think there’s an interesting societal piece in this research. 

I do worry people could be more vulnerable today to this form of injury due to people having less certain world views growing up, whether it’s religion or other spirituality, or stable and connected communities. 

And I’ve read conflicting views on that too. 

Moral injury goes right to the soul… it raises questions about right and wrong, of self-worth, meaning and purpose. 

I’ve read that loss of religious faith and seeking out religious faith can emerge in equal measure. 

And I’d be interested in your views on moral injury on families – that is not just moral injury on a veteran or first responder, but can their family members suffer a moral injury? What does that look like? What can we do about it? 

With that – over to you, I really look forward to learning of your findings and discussions over these days so that we can work to ensure all those at risk of moral injury can receive the treatment and support they need, as quickly and effectively as we all know they deserve. 

ENDS

Open Arms – Veterans & Families Counselling provides 24/7 free confidential crisis support for current and ex-serving ADF personnel and their families on 1800 011 046 or the Open Arms website. Safe Zone Support provides anonymous counselling on 1800 142 072. Defence All-Hours Support Line provides support for ADF personnel on 1800 628 036 or the Defence Health Portal. Defence Member and Family Helpline provides support for Defence families on 1800 624 608