It has long been recognised that veterans may experience mental health problems after military deployments, and that these can be overlooked in the context of concern about physical injuries. Primary care practitioners, both military and civilian, are often the first port of call for affected veterans, and are best positioned to assess these patients and commence care when necessary. As over 85% of Australia’s trained forces are male, these health problems are particularly relevant for men’s health.

American research on veterans from recent Middle East deployments shows high rates of psychological problems.1 Interestingly, British research on the same conflict found that problems are limited to reservists, with no elevated rates of mental health problems among regular personnel.2 Although local data are unavailable, it is reasonable to assume that Australian veterans from Afghanistan and Iraq will not be exempt. We learned much from the experience of Vietnam veterans, with their initial difficulties closely resembling those of younger veterans presenting today. While much attention is paid to post-traumatic stress disorder, evidence suggests that other anxiety, depression, and substance-misuse disorders are equally common.3

Providing effective mental health care for veterans presents particular challenges. For many reasons (including personality, military culture, deployment experiences, and adjustment to civilian life), veterans may be reluctant to acknowledge or report psychological problems. They may have poor mental health literacy, may avoid treatment, and can be hard to engage when they do present. Many have developed unhelpful strategies for managing distressing emotions, often channelling them into anger and aggression or covering them with substance misuse. Such strategies may have been adaptive in combat, but in civilian life they alienate the veteran from key sources of support. Veterans often present to general practitioners with physical health complaints that mask concerns about psychological issues.

Early detection and appropriate intervention often become the responsibility of GPs. Once it is determined that the patient is a veteran, a few simple questions about sleep, family relationships, mood, anger, and substance use can provide an opening for intervention.

The information in the Box identifies strategies and resources available to assist the mental health and wellbeing of veterans.