One of the good moments Kamaia Alexander had with her stepfather after he came back from Afghanistan was when he was in hospital recovering from a suicide attempt. That day was like the old times when they had joked and played pranks together.
"We made his escape plan. Our plan was to get the food trays and skate our way out. We forgot that home was actually uphill, not down. It was a good plan in our heads," she says.
![Kamaia Alexander with her stepfather Andrew Perry, a veteran.](http://web.archive.org./web/20170517155239im_/https://www.fairfaxstatic.com.au/content/dam/images/g/w/0/v/8/3/image.related.articleLeadwide.620x349.gw2yj9.png/1494809229610.jpg)
But there were mostly bad moments, like one afternoon in bushland north-east of Darwin. Alexander was just 18 at the time.
"He had 10 knives and a machete on his person. He had carved some words into his legs," she says.
"We spent from 4.30 in the afternoon to midnight to slowly convince him to get rid of each knife.
"Once I got him down to one knife, I got him to drop it and I ended up just lying on the dirt with him and giving him a hug and letting him cry."
Andrew "Mung" Perry, an Air Force sharpshooter who had spent eight months in Afghanistan watching the backs of other Australian troops, tried eight times to kill himself after he returned, with some incidents requiring police tactical response teams. On the eighth attempt, in December 2015, he took his life.
He'd always been a rugged joker. But in Afghanistan he had become obsessed with the fear of losing a soldier under his protection. The heightened state of alert stayed with him when he came home and he had been unable to unwind. A colleague remarked at his funeral that if it could happen to Mung, it could happen to anyone.
![Andrew "Mung" Perr was an Air Force sharpshooter who had spent eight months in Afghanistan.](http://web.archive.org./web/20170517155239im_/https://www.fairfaxstatic.com.au/content/dam/images/g/w/3/9/n/p/image.related.articleLeadwide.620x349.gw2yj9.png/1494809229610.jpg)
When we send people to war, we ask a select group of mostly young Australians to prepare themselves to kill or die to defend the nation. That is at the heart of the challenge of military mental health and suicide. The sense of responsibility, the comradeship, the tough internal culture, the mental preparedness, not to mention the experience of combat, can have lasting effects.
A groundswell of concern is being fuelled by revelations that the suicide rate among veterans aged 18 to 24 is double that of their peers in the general community. Among those aged 25 to 29 it is 1.5 times the national average for their age. Those figures, from the Australian Institute of Health and Welfare from November, are based on a tally of 292 certified suicides between 2001 and 2014. This total is regarded as conservative by most veterans groups, some of which counted between 70 and 80 military suicides last year alone.
![Kamaia Alexander with her mother Bonny Perry.](http://web.archive.org./web/20170517155239im_/https://www.fairfaxstatic.com.au/content/dam/images/g/w/0/v/8/6/image.related.articleLeadwide.620x349.gw2yj9.png/1494809229610.jpg)
Grassroots groups are emerging among the 700,000-strong veterans community, especially on social media, demanding greater action.
A recent Facebook post by official war artist Ben Quilty about Ashley Meek, a former soldier who killed himself in early March, attracted more than 2500 comments and was shared more than 18,000 times.
Tasmanian Senator Jacqui Lambie has successfully pushed for a Senate inquiry into military suicides, which will report in June, and the Turnbull government has commissioned further studies and introduced new measures, including a $350 million package in this week's budget.
The research so far is patchy, inconsistent and at times contradictory. Veterans Affairs Minister Dan Tehan says it is not certain, for instance, why younger veterans are particularly prone and this is one reason he has asked the AIHW to do a deeper dive and report back later in the year. Experts say there is also insufficient research on what exactly it is about military life that raises the risk of some mental illnesses.
There are defined conditions like post-traumatic stress disorder, depression and anxiety, all of which which Andrew Perry was diagnosed with six months after he returned from Afghanistan.
The manuals define PTSD as characterised by intrusive thoughts, memories and flashbacks about a traumatic experience, hypervigilance, anger, emotional numbing and a feeling the world is not safe.
Perry's widow Bonny describes it as "hell".
"You're walking around on eggshells all the time because you don't want to trigger it," she says. "Things would escalate, we'd have a fight and then he'd have another attempt on his life."
But the suicide risk is not just about overseas deployment and PTSD. In fact, substance abuse and depression/anxiety are more common than PTSD among veterans. Any of the three raises the risk of suicide.
Researchers are paying particular attention to the transition period when people leave Defence but fail to reconnect with civilian life. It is particularly hard for younger people who don't always have the life experience and resilience to adjust.
Military service poses risks to mental health but it also confers protections, such as steady employment, ready access to medical services, a strong sense of identity and purpose, and a close network of peers. But after people leave, those protections are stripped away, leaving them only with the risks.
"Obviously young people making the transition from Defence into civilian life seems to be something that we've got to get better at," says Tehan.
"We ask these young men and women in many instances to go out and kill on our behalf. Let's not beat around the bush on this. So we do have to make sure that when they transition, we are making sure it is as smooth as possible and the assistance is there if it's required."
Kiel Goodman ticked all the boxes. He joined shortly after he turned 18 and served six years which included two tours as an artillery gunner to Afghanistan. His vehicle was hit by a roadside bomb on his first tour in 2008. Something happened on his second tour in 2010 that was so bad he doesn't want to talk about it.
With his army mates around him he felt cushioned. But six months after getting back from the second tour he lost interest in army work and returned to his home town of Roma in rural Queensland. He didn't talk about his military experiences with his old school mates.
"I sort of felt lost. Being overseas, doing your job, is a great feeling and you have an identity. Normal mundane life getting back from overseas is hard to deal with."
He started drinking and taking drugs. He hadn't thought the traumatic moments in Afghanistan had affected him but in the quiet of home, the memories began to crowd in. At the same time, the practicalities of civilian life, including the freedom, were harder than he'd expected.
"When you're out of the military, there's no one telling you what to do … It's just all on you. That was a massive shock to me."
It was three years before he sought help. "I didn't give a shit about myself. I thought I'd be one of those typical, screwed-up veterans – that's what I thought of myself."
It was his partner who pulled him back from the edge, sending him to the veterans group Mates4Mates, where he now works as a liaison officer. If he'd been a single man, he says, "I wouldn't be sitting here right now."
![Kiel Goodman, right, with Mates4Mates CEO Simon Sauer.](http://web.archive.org./web/20170517155239im_/http://www.smh.com.au/content/dam/images/g/w/3/8/z/8/image.imgtype.articleLeadwide.620x349.png/1494549317629.png)
Kiel Goodman, right, with Mates4Mates CEO Simon Sauer. Photo: Supplied
There is also the lingering problem of stigma. While it's widely felt that Defence has improved, Tehan acknowledges more work is needed – though he stresses this is true across the community.
Talissa Papamau served as a combat medic in Afghanistan at a time when seven Australian soldiers were killed. It took her two-and-a-half years to accept that she had PTSD. She even completed the special forces support staff psychological test during that time and wanted to become a doctor.
"That's why it took me so long to accept it," said Papamau, who has since founded the popular Modern Soldier web page. "It's scary – you're already losing control of your life and you know by speaking up you are at risk of losing your career. These factors will drive suicide risk as well."
Breaking the mould
Although serving personnel are less likely to kill themselves than the community average, they are more likely to think about or plan suicide. Usually the aforementioned protective factors kick in, but they don't work for everybody, especially if they don't fit the mould.
Daniel Garforth hanged himself at the age of 21 at Robertson Barracks in late 2014. A suicide note that was found stated he'd had enough of "constantly being demoralised and ridiculed" by one of his corporals.
![Private Daniel Garforth died at age 21.](http://web.archive.org./web/20170517155239im_/http://www.smh.com.au/content/dam/images/g/w/3/9/7/7/image.imgtype.articleLeadwide.620x349.png/1494549772007.png)
Private Daniel Garforth died at age 21. Photo: Supplied
According to the coroner's report, he confided to another private that he wanted to kill another of his superiors, a sergeant, who he regarded as bullying him. Other privates interviewed by the coroner described the sergeant as "not a good leader" who has hard on everyone but felt he singled out Garforth, though investigations are continuing.
The report described as "inappropriate" and "most regrettable" some conduct by the sergeant and other officers.
And it charts an obvious mental health deterioration in Garforth. The coroner and a Work Health and Safety inspector investigation deemed it a misjudgement that Garforth had been rated as only a "low" risk of self-harm.
But the most devastating conclusion by the coroner was that the army, faced with a young man who was clearly on his knees, did not lift him up.
"One would hope," the coroner wrote, "that a pathway to recognising a purpose [for Garforth] would be provided and it is a significant indictment of the Army that his suffering in that regard was not recognised at a much earlier time. He needed affirmation and love. He did not get it from the army."
Garforth's mother, Nikki Jamieson, a social worker who is now doing a PhD on ADF suicide, says an old, one-size-fits-all approach to building robust soldiers did not work in the 21st century and Defence needed more sophisticated, refined and systemic approaches to building and nurturing its workforce.
![Private Daniel Garforth with his mother Nikki Jamieson.](http://web.archive.org./web/20170517155239im_/http://www.smh.com.au/content/dam/images/g/w/3/9/7/8/image.imgtype.articleLeadwide.620x349.png/1494549773680.png)
Private Daniel Garforth with his mother Nikki Jamieson.
She says after her son died, a senior officer at Robertson Barracks told her: "We don't want to raise a weak workforce. These are people who are going to be defending our country's front line."
She replied: "I absolutely understand that, but you are not supporting the process. These kids have the capacity to be able to do that, given the right tools. But they're not; they're just thrown into an environment unprepared psychologically and pretty much destroyed."
That view is shared by Cherene Thomas-Smith, whose son Alex Thomas died while serving at Enoggera Army base in Queensland. Although a coroner found he did not intend to kill himself, the distinction is a fine one – he was depressed, anxious and showing scant regard for his own health when he took an overdose of Beta-phenylethylamine, a stimulant popular with bodybuilders.
![Alex Thomas and his mother Cherene Thomas-Smith.](http://web.archive.org./web/20170517155239im_/http://www.smh.com.au/content/dam/images/g/w/3/9/i/q/image.imgtype.articleLeadwide.620x349.png/1494550248384.png)
Alex Thomas and his mother Cherene Thomas-Smith. Photo: Supplied
"The reality of it is nobody can know for sure whether it was an accident or intentional. That is something I'll have to live with for the rest of my life – not really knowing," Thomas-Smith says.
Like Garforth, Alex Thomas was not the archetypal soldier. A skinny, quiet redhead, he spent a lot of time on his computer. His mother says he was "bullied, he was humiliated, he was targeted on a daily basis" by a superior officer.
"[Alex] just wanted to join the Army and become a medic so he could help those big guys who get shot up on the battlefield. To treat him like an SAS soldier and expect that mindset is just unrealistic."
Tehan said Defence had driven cultural change through the organisation from the top down.
"But like any organisation, you will sadly always get incidents of bullying and other types of behaviour," he says. "Where there are incidents, everything that I've seen is that Defence have looked to act and in particular have been prepared to allow independent inquiries to occur."
Both Jamieson and Thomas-Smith are awaiting final Defence inquiry reports into their sons' deaths.
Turning point
For every suicide there are many more veterans of the Afghanistan, Iraq and East Timor era who have plumbed the depths but managed somehow to climb out of the hole and often gone on to form their own groups to help others. Invariably they describe moments that were, in retrospect, turning points but at the time could have gone the other way.
Iraq veteran Dane Christison, after years of suffering chronic post-traumatic stress disorder, was in Bunnings with his fiancee when he saw rope for sale and knew that he was going to kill himself with it. His fiancee smiled at him innocently and he took her back to the car and told her everything, crying like he'd never cried before while she begged him not to leave her alone in the world.
Afghanistan veteran Chris May stood on top of a 10-storey building, leant over the edge and thought he could end "all the suffering, all the pain, all the nightmares" before telling himself he had a mother and a father and a partner.
Both now are involved in helping troubled veterans get better, Christison through his program Survive to Thrive, and May with a group called Young Veterans.
They are among the hundreds of grassroots groups that have sprung up among the tens of thousands of veterans of East Timor, Afghanistan and Iraq amid concerns of a new wave of mental illness and distrust of the Department of Veterans Affairs and older veterans groups.
Lifeline 13 11 14; MensLine 1300 789 978; Beyondblue 1300 224 636