The Cheryl Lacey Show
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The Cheryl Lacey Show
SUICIDE WAR: Veterans, first responders and PTSD
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Combat and first responder trauma is costing the lives of those charged with saving the lives of others. 1 veteran died by suicide every week between 1997 and 2020. All while PTSD has become shorthand for a bad week at work.
A conversation with Mark Pavilach
Right now though we have Mark Pavilarch on the show, and Mark is a mental health social worker working for Veterans Counselling Services, and his major work is with veterans and first responders, not just current treatments but also emerging treatments as well. Mark, welcome to the show.
SPEAKER_11Yeah, thanks for having me on, Cheryl.
SPEAKER_17Now, Mark, you've got quite an extraordinary responsibility, really. That's how I how I see this, post-traumatic stress disorder. It's something that gets talked about a lot, but quite often it's largely misunderstood by the by communities, particularly when it comes to these very severe cases that you would be dealing with with veterans and first responders. Can you explain a little bit about what PTSD is and then perhaps the distinction between uh the clients you work with and and PTSD generally?
SPEAKER_11Um yeah, PTSD uh uh is we couldn't see it as um trauma that's been experienced um that then for for whatever reason um hasn't been fully processed and so the uh thought or flight response that we have to a very shocking or traumatic experience um sort of continues and it c uh can very much feel like it's in the present rather than in the past if it's but things are process process sort of normally after sort of a month or so it sort of starts to drift off into the background and people don't have re-experiencing symptoms like nightmares and um flashbacks and things of that nature.
SPEAKER_17And this is something when you say there's been an experience, obviously there has been a trauma, and you're saying the way to the way I read what you're telling us is that in order to work through that difficult time, then we have to process what occurred and then we can come through and move forward, but there are people who get stuck.
SPEAKER_10Yes, so and that and that is no reflection on them as a strong person of course.
SPEAKER_11Anything like that. Um yeah, it um yeah, the the uh processing of it, yeah, it just seems to get stuck and so the therapies that we mainly use um uh or mainly used uh for some time are things like um prolonged exposure, uh which involves gratefully um safely confronting the trauma-related memories uh and situations that the the veteran or first responder's been avoiding, so um there tends to be quite a quite a bit of avoidance behaviors with PCSD, so people might avoid crowds, um loud um uh loud spaces like shopping centres or uh things like that and kind of start to sort of shut themselves off uh from the world. Uh so we'd gra you know gradually expose people back to um places, people, things that um are challenging and distressing with um arousal reduction strategies, um breathing, sort of uh healthful self-talk, um and stay within those environments until their sort of distress level reduces. Um yeah, so that's that's one of them. I've I've found um cognitive processing therapy um quite helpful. It's very much a um a structured program uh that's that helps uh veterans and first responders on identify and change unhelpful beliefs related to their trauma.
SPEAKER_17It's quite uh it's quite extraordinary, isn't it? For something that is uh so common PTSD. We we hear about it, as I said, a lot. And then you have uh cases that are I'll use the word genuine, these genuine cases of horrific experiences that first responders and our veterans would have lived through. And then not to be disrespectful because everybody is different and how we all respond to various stimuli is very different. I get concerned sometimes that everything becomes a trigger after a while where i it it becomes commonplace, a bit like you know, uh currently th there's a one in three children are suffering from some sort of disability, and now I don't believe that for a minute. So we have these trends that pick up. Do you distinguish between that and the people that you're dealing with with this therapy? Is it quite a different therapy for your clients?
SPEAKER_08Um, as in the cognitive processing therapy.
SPEAKER_17Yes.
SPEAKER_11Um yeah, look the word I word trauma is kind of maybe i it's a little overused now because people are identifying other emotions. Um uh there are maybe things that are disappointing or grief and loss or things like that as uh well that was that was traumatic. Um which yes, it might be distressing, um but yeah, there's I guess there's quite varying degrees of what is as traumatic.
SPEAKER_17Yes, you've you've actually just used some key words there which is really helpful for me as well, what I was very much what I was trying to share. So grief and loss is not the same as trauma. Disappointment not the same as trauma. And something that could be distressing doesn't necessarily mean that it's traumatic.
SPEAKER_11Yes. Yeah. Yeah, I I remember actually um reading a situation of a a young person at work that uh felt traumatized by not getting to go on a work work trip. Uh someone else was chosen and they were described described that as traumatic. And I was kind of like, well that sounds disappointing, but it sounds very far from um going, you know, giving a a death message to a family member of of a first you know, a a police officer. Um that's gotta see their family on um families on their worst days or uh vet you know, veterans that um have you know mates that uh take their own lives or uh lose their life in training accidents or um yeah, it's by comparison it's not not really in the same area.
SPEAKER_17No, I can understand that. I uh um a c one of my cousins, and I'll shout out to Michael, Michael Lewis, he uh his wife uh tragically uh died a number of years ago, and she was a paramedic and uh she's one of those who died by suicide, and my understanding is that there is one suicide a month with our first responders, and sadly Michael's wife is one of those. It's an extraordinary statistic, isn't it? One person a month in our emergency services kills themselves. And it really does bring home exactly what you were just saying there about the distinction between disappointment or distress, grief and loss and PTSD. And I we really need some more education around that, don't we?
unknownYeah, yeah.
SPEAKER_11I mean it's it's um yeah, it's fine, yeah, fine to be disappointed, but yeah, we'd probably um perhaps use the the former description of things maybe a bit loos loosely these days. Um yeah.
SPEAKER_17And the the other side of things too is that we're t speaking of these suicide figures, uh one veteran a week since nineteen ninety-seven, so we're talking nearly you know, thirty years, m one suicide a week for veterans. I mean that is extraordinary. Were you involved at all in uh looking at the Royal Commission into Veteran Suicide that took place in twenty twenty one?
SPEAKER_11Um I did participate in a um a discussion group here in Monthora where I worked from. Um yeah, that I mean that was a a great sort of investigation. Um because yes, of course veterans are um at very high risk, um, as are first responders as well. Um so um but yes, I didn't make any submission to the uh Royal Commission. Um but certainly, yeah, encouraged um any any of the veterans I had contact with to make submissions. Um, you know, if they felt that they could.
SPEAKER_17Well that's an issue too, isn't it? If you're going to be making submissions you've got to revisit that, and as you said, if you know, many of them uh find it difficult to do so and that suppression is is what contributes to the PTSD as well. It was interesting just on that Royal Commission, if you don't mind me sharing, Mark, that there were anti-malaria drugs that were being used by the Australian Defence Force, and many of these ADF uh citizens were in clinical trials during the nineties and the two thousands, and it came out that these drugs could and did cause side effects including psychiatric disorders. Now I was blown away when I read that uh given that we've got people that we're expecting to protect our country and at the same time we've got them in clinical trials. It's what what are your thoughts on that?
SPEAKER_07Um yeah, no, it's that is interesting.
SPEAKER_11They the well, when people sign on the dotted line to the military, they are, you know, literally offering their life for the country as well. Um so they don't get a lot of choice in terms of um you know what in terms of you know, they d kind of do what they're told. So and yes, like um medications or um anti-malaria sort of stuff, um probably wasn't necessarily fully explained. Um I don't have a lot of knowledge of that, but yes, I've certainly seen a number of these Timor veterans, um, and a lot of those veterans certainly struggled um after returning.
SPEAKER_17Yes, absolutely. And when tell us a little bit about how uh you go about supporting these uh emergency service workers and veterans on a day-to-day basis. Do you do you ac do you get a case and then work with them until they're able to overcome some of these major issues that you know that they're hiding behind, they're preventing, you know, you s you're talking about triggers and noisy places and so forth. Or is there a point at which you pull back and and other professionals have to step in?
SPEAKER_09Yeah, well it really depends on uh what the goals of the person are.
SPEAKER_11So uh some people don't want to address their their past trauma, they just kind of want support and um you know, someone to sort of um uh um yeah, support them ch people have a chat about things um more perhaps everyday things that are bothering them. Um some people don't actually like it's just that's kind of too much or they're not ready to to really try and ad address um the trauma stuff or or they might have been um someone um that, you know, was deployed, you know, many years ago. Um and they just kind of got on with life and got th throw threw themselves into work and um uh uh and a lot of times people kind of think they're okay and then they kind of uh fall over much later uh down the track. Uh so but yes, we uh it is very much about what the person's individual goals are, but yeah, I I try and develop a treatment team around people so if their symptoms are particularly bad, we uh one thing in the in regional Victoria uh and Australia for that matter is access to psychiatrists is very difficult. Um so I've developed uh a really good relationship with a number of um hospitals in in some of the cities. Uh so we've got um there's a a new centre uh called the Langmore Center out at Berck and they see um they have inpatient admissions for lots of first responders, also veterans. Um uh the uh what's the other one? The Austin Health, um I keep thinking um Otterby Repat, that's what it was always called after the Second World War. Um, but Austin Health run that now, the the um trauma recovery uh unit. Uh they have lots of admissions of um first responders and veterans as well. So the advantage of um, you know, perhaps a two to four week stay in those areas is that you've got everyone on site, so they've got a psychiatrist, yeah, psychiatrists, uh, mental health nurses, mental health social workers, psychologists, um, and that can really help people get stabilised. Uh and then they can be in a much better space to perhaps do some longer term therapy with myself. Um so I find that's a quite helpful approach.
SPEAKER_17That sounds uh extraordinary that you've been able to tap into some of those services. As you said, when there's been shortages for such a long time, it's commendable that they've Berick, you said, and then also Austin Health in Heidelberg there, well done. Now, just before we wrap up, moral injury is a term that is again being shared quite broadly. Moral injury. That's not a PTSD issue, it's a it's another issue where people feel as though they've been forced into acting in a particular way that's against their principles. Does that come up with your clients at any point in time that they've had to particularly the uh veterans had to behave in a way that that goes against their moral principles?
SPEAKER_11Yeah, look, even even when um uh people know I guess um intellectually that they did everything they could, um, yeah, they can still have um some um kind of guilt about what happened or I guess the moral injury, I mean it crosses into um you know a number of uh the ch sort of chaplains in terms of the military and uh police chaplains as well, for example, with the police. Um it does cross over into that sort of um like a wound of the soul almost, um where you know the the ch people in the chaplain space can be quite helpful um with those sort of things. It is it is seen as something a l a bit different to PTSD itself.
SPEAKER_17Mm. It's it's really comes back to forgiveness, doesn't it, I suppose, in some respects.
unknownYeah.
SPEAKER_17Forgiving self.
SPEAKER_11Yes, but yes, we're when there's something that's um very much against your values and beliefs, um um yeah, like um you know, when these people do sign up to be to work as a first responder or um uh in the military, um they uh you know, told what to do and um of course um felt just you know, I was just following orders doesn't doesn't cut it.
SPEAKER_16No, indeed.
SPEAKER_11Uh today, uh like it didn't cut it in the past. But um yeah, by by and large, uh people have to do you know, do what they're told to do even if they don't really agree with with that.
SPEAKER_17Indeed. Mark, it's been terrific to have you on the show. Uh Mark Pavalach, our mental health social worker for Veterans Counselling Services. Your work with first responders and veterans is something I'm sure that many of our listeners wouldn't be fully uh abreast of the implications also for you as a professional. You must be a very strong and compassionate man to do the work that you do. And I'm very, very grateful that you've shared some of this with us this morning.
SPEAKER_18Yeah, thank you very much, Cheryl.
SPEAKER_17Thank you. Thank you so much for you coming on the show. Be well. Thank you. You're listening to 88.9 Win FM The Cheryl Lacey Show. Again, that was Mark Pavilash discussing the veterans' counselling services and the therapies that he focuses on to assist those with PTSD. Obviously there has been a trauma, and you're saying the way to the way I read what you're telling us is that in order to work through that difficult time, then we have to process what occurred and then we can come through and move forward. But there are people who get stuck.
SPEAKER_10Yes, so and that and that is no reflection on them as a strong person. Of course.
SPEAKER_11Anything like that. Um yeah, it um yeah, the the uh processing of a chair just seems to get stuck in so the therapies that we mainly use um mainly used uh for some time are things like um prolonged exposure, uh, which involves greatly um safely confronting the trauma-related memories uh and situations that the the veteran or first responders been avoiding, so um there tends to be quite a quite a bit of avoidance behaviors with BTSD, so might avoid crowds, um loud um uh loud spaces like shopping centers or uh things like that and kind of start to sort of shut themselves off uh from the world. Uh so we'd gra you know gradually expose people back to um places, people, things that um are challenging and distressing with um arousal reduction strategies, um breathing sort of uh helpful self-talk, um and stay within those environments until their sort of distress level reduces. Um yeah, so that's that's one of them. I've I've found um cognitive processing therapy um quite helpful. It's very much a um constructed program uh that's that helps uh veterans and first responders on identify and change unhelpful beliefs related to their trauma.
SPEAKER_17It's quite uh it's quite extraordinary, isn't it? For something that is uh so common PTSD, we we hear about it, as I said, a lot. And then you have uh cases that are I'll use the word genuine, these genuine cases of horrific experiences that first responders and our veterans would have lived through. And then not to be disrespectful because everybody is different and how we all respond to various stimuli is very different. I get concerned sometimes that everything becomes a trigger after a while, where it it becomes commonplace, a bit like you know, it currently there's one in three children are suffering from some sort of disability, and now I don't believe that for a minute. So we have these trends that pick up. Do you distinguish between that and the people that you're dealing with with this therapy? Is it quite a different therapy for your clients?
SPEAKER_08Um, as in the cognitive processing therapy.
SPEAKER_17Yes.
SPEAKER_11Um yeah, look the word I trauma is kind of maybe it's a little overused. Now because people are identifying other emotions. Um there are maybe things that are disappointing or grief and loss or things like that as um well oh that was that was traumatic. Um which yes, it might be distressing, um but yeah, there's I guess there's quite varying degrees of what is as traumatic.
SPEAKER_17Yes, you've you've actually just used some key words there which is really helpful for me as well, what I very much what I was trying to share. So grief and loss is not the same as trauma. Disappointment not the same as trauma. And something that could be distressing doesn't necessarily mean that it's traumatic.
SPEAKER_11Yes. Yeah. Yeah, I I remember actually um reading a situation of a a young person at work that uh felt traumatized by not getting to go on a work work trip. Uh someone else was chosen and they were described described that as traumatic. And I was kind of like, well, that sounds disappointing, but it sounds very far from um going, you know, giving a a death message to a family member of a first you know, a a police officer. Um that's gotta see their family on um families on their worst days or uh vet you know, veterans that um have, you know, mates that uh take their own lives or lose their life in training accidents or um yeah, it's by comparison it's not not really in the same area.
SPEAKER_17No, I can understand that. I uh um one of my cousins, and I'll shout out to Michael, Michael Lewis, he uh his wife uh tragically uh died a number of years ago, and she was a paramedic. And uh she's one of those who died by suicide, and my understanding is that there is one suicide a month with our first responders, and sadly Michael's wife is one of those. It's an extraordinary statistic, isn't it? One person a month in our emergency services kills themselves. And it really does bring home exactly what you were just saying there about the distinction between disappointment or distress, grief and loss and PTSD. And I we really need some more education around that, don't we?
unknownYeah, yeah.
SPEAKER_11I mean that's it's um yeah, it's fine yeah, fine to be disappointed, but yeah, we'd probably um abuse use the the former description of things maybe a bit weak which we um yeah.
SPEAKER_17And the the other side of things too is that we're t speaking of these suicide figures, uh one veteran a week since nineteen ninety seven, so we're talking nearly you know, thirty years, m one suicide a week for veterans. I mean that is extraordinary. Were you involved at all in uh looking at the Royal Commission into Veteran Suicide that took place in twenty twenty-one?
SPEAKER_11Um I did participate in a um a discussion group here in Moldura where I worked from. Um yeah, that I mean that was a great sort of investigation. Um because yes, it was veterans of um at very high risk um as our first responders as well. Um so um but yes, I didn't make any submission to the uh Royal Commission. Um but certainly, yeah, encouraged um any any of the veterans I had contact with to make submissions. Um, you know, if they felt that they could.
SPEAKER_17Well that's an issue too, isn't it? If you're going to be making submissions, you've got to revisit that, and as you said, if you know, many of them uh uh find it difficult to do so and that suppression is is what contributes to the PTSD as well. What's interesting, just on that Royal Commission, if you don't mind me sharing, Mark, that there were anti-malaria drugs that were being used by the Australian Defence Force, and many of these ADF uh citizens were in clinical trials during the 90s and the 2000s, and it came out that these drugs could and did cause side effects, including psychiatric disorders. Now, I was blown away when I read that uh given that we've got people that we're expecting to protect our country and at the same time we've got them in clinical trials. It's what what are your thoughts on that?
SPEAKER_07Um yeah, no, it's it is interesting.
SPEAKER_11The well, when people sign on the dotted line to the military, they are, you know, literally offering their life for the country as well. Um, so they don't get a lot of choice in terms of um you know what in terms of you know, they d kind of do what they're told. So and yes, like in um medications or um anti-malaria sort of stuff, um probably wasn't necessarily fully explained. Um I don't have a lot of knowledge of that, but yes, I've certainly seen a number of these Timor veterans, um and a lot of those veterans certainly struggled um after returning.
SPEAKER_17Yes, absolutely. And when tell us a little bit about how you go about supporting these uh emergency service workers and veterans on a day-to-day basis. Do you do you act do you get a case and then work with them until they're able to overcome some of these major issues that you know that they're hiding behind, they're preventing. You know, you s you're talking about triggers and noisy places and so forth. Or is there a point at which you pull back and and other professionals have to step in?
SPEAKER_09Yeah, well it really depends on uh what the goals of the person are.
SPEAKER_11So uh some people don't want to address their their past trauma, they just kind of want support and um you know, someone to sort of um uh yeah, support them, ch have a chat about things um more perhaps everyday things that are bothering them. Um some that don't actually like it's just that's kind of too much or they're not ready to to really try and address um the trauma stuff, or or they might have been um someone um that, you know, was deployed, you know, many years ago. Um and they just kind of got on with life and got through threw themselves into work and um uh uh and a lot of times people kind of think they're okay and then they kind of uh fall over much later uh on the track. Um so but yes, we uh it is very much about what the person's individual goals are, but yeah, I I try and develop a treatment team around people so if the symptoms are particularly bad, we uh one thing in in regional Victoria uh and Australia for that matter is access to psychiatrists is very difficult. Um so I've developed uh a really good relationship with a number of um hospitals in in some of the cities. Uh so we've got um there's a a new centre uh called the Waynemore Centre at it, I reckon they see um they have inpatient admissions with lots of first responders, also veterans. Um uh the uh what's the other one? The Austin Health, um I keep thinking um Ottawa Big REPAT, that's what it was always called after the Second World War. Um, but Austin Health run that now, the the um trauma recovery uh unit. Um they had lots of admissions of um veteran sponders and veterans as well. So the advantage of um, you know, perhaps uh two to four weeks a in those areas is that you've got everyone on site, so they've got a psychiatrist, yeah, psychiatrists, uh, mental nurses, mental social workers, psychologists. Um and that can really help people get stabilized. Uh and then they can be in a much better space to perhaps do some longer term therapy with myself. Um so I find that's a quite helpful approach.
SPEAKER_17That sounds uh extraordinary that you've been able to tap into some of those services, as you said, when there's been shortages for such a long time. It's commendable that they're Derek, you said, and then also Austin Health in Heidelberg there, well done. Now, just before we wrap up, moral injury is a term that is again being shared quite broadly, moral injury. That's not a PTSD issue, it's a it's another issue where people feel as though they've been forced into acting in a particular way that's against their principles. Does that come up with your clients at any point in time that they've had to, particularly the uh veterans, had to behave in a way that that goes against their moral principles?
SPEAKER_11Yeah, look, even even when um uh people know, I guess, um, intellectually that they did everything they could, um, yeah, they can still have um some um kind of guilt about what happened or I guess the moral injury, I mean it crosses into um you know a number of uh the ch sort of chaplains in terms of the military and uh police chaplains as well, for example, with the police. Um, it does cross over into that sort of um like a wound of the soul almost um where you know the the ch people in the chaplain space can be quite helpful. Um with those sort of things. It is it is seen as something a l a bit different to PTSD itself.
SPEAKER_17Mm, it's it's really comes back to forgiveness, doesn't it, I suppose, in some respects. Yeah. Forgiving self.
SPEAKER_11Yes, but yes, we're when there's something that's um very much against your values and beliefs, um um yeah, like uh you know, when these people do sign up to be to work as a Christmas wanderer or um uh in the military, um they uh you know, told what to do and um of course um folk just you know, I was just following orders doesn't doesn't cut it no indeed. Uh today. Uh like it didn't cut it in the past. But um yeah, by by and large, um people have to d you know, do what they're told to do even if they don't really agree with with that.
SPEAKER_17Indeed. Mark, it's been terrific to have you on the show. Uh Mark Power. Avalanche, our mental health social worker for veterans and counselling services. Your work with first responders and veterans is something I'm sure that many of our listeners wouldn't be fully abreast of the implications. But also for you as a professional, you must be a very strong and compassionate man to do the work that you do. And I'm very, very grateful that you've shared some of this with us this morning. Thank you. Thank you so much for you for coming on the show. Be welcome. You're listening to 88.9 Win FM The Cheryl Lazy Show. Again, that was Mark Pavelash discussing the veterans' counselling services and the therapies that he focuses on to assist those with PTSD. Coming up after this break, we have Lawrence Rojak, and he is our US correspondent. We'll be discussing the unions in the United States, specifically the teachers' unions. So stay with us and lots more coming up after that.
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