DVA’s mental health claims backlog: a challenge that can be overcomeVeteran & Military : July 14, 2023
“Zed3 continues to deliver detailed and accurate assessments within a four-week turnaround period, a timeframe unheard of across too many Veterans Groups.”
The Royal Commission into Defence and Veteran Suicide handed down its interim report in August 2022 with a number of recommendations to improve outcomes for Veterans and Defence personnel. One significant recommendation was for the Department of Veterans’ Affairs (DVA) to eliminate the compensation claims backlog by 31 March 2024.
The backlog issue involves various hurdles, some outside of the control of the DVA, such as the intersection of complex legislative frameworks, an unexpected surge in new claims numbers and health and departmental workforce shortages.
The DVA reported 41,799 backlogged claims as of May 2022, with this number only slightly reduced to 41,597 claims by March 2023. This backlog has been accumulating for years across successive governments, so it would be reasonable to assume that the current workforce and processes are insufficient to meet the requirements of the task.
From our vast experience working with serving and ex-serving members, Zed3 Medical Group has become a trusted partner in providing mental health services to Defence personnel and veterans. This has given us a deep understanding and appreciation of the intricacies of Defence culture, and the DVA claims paperwork process, particularly when mental health conditions are involved.
“Zed3 Medical Group has become a trusted partner in providing mental health services to Defence personnel and veterans.”
Numerous key challenges are causing delays in processing claims, and these can be broken down in order to identify and implement viable solutions. Challenges include the accuracy of data being tracked, the complexity of legislative frameworks governing the claims process, shortages in the number of trained psychiatrists available to see veterans, a lack of consistent training and acculturation for those in the field, as well as other barriers.
Our veterans deserve timely access to mental health diagnoses so they can receive the appropriate treatment. If we as a country believe this is important and are committed to achieving these outcomes, then we need to understand the issues we face and undertake an innovative and collaborative approach.
Here is a breakdown of the key problems that need to be addressed.
Legislative and Regulatory Frameworks
Legislation such as the Veterans’ Entitlements Act (VEA), the Defence-Related Claims Act (DRCA), and the Military Rehabilitation and Compensation Act (MRCA) are necessary for claim processing depending on the period of service and the date of injury. However, the complexities of these legal frameworks present significant challenges. Despite numerous calls to simplify these structures, any substantive legislation harmonisation is still many years away. Maintaining the Statements of Principles (SoPs) becomes a bone of contention, especially when balancing clinical frameworks such as the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM).
A considerable obstacle to addressing the backlog is the shortage of psychiatrists available to see veterans. There is no reliable data on the number of psychiatrists working with veterans, nor specific training available to acculturate interested specialists to the unique needs of the veteran and Australian Defence Force community. Self-reported data via the Royal Australian and New Zealand College of Psychiatrists’ database, suggest there are about 300 psychiatrists Australia-wide with interest in the field, but the DVA does not maintain a database of preferred clinicians, causing further difficulty in managing psychiatric evaluations.
Specialist Reports and SRCA Requirements
The demands of obtaining specialist reports as mandated by the compensation legislation and internal DVA policy pose another problem. Contemporaneous opinions confirming diagnoses, preferred medical specialist input over general practitioners, and often necessary additional advice to make informed decisions on liability present considerable challenges. Without a treating specialist, the DVA delegate is left seeking additional medical advice to make informed decisions on liability, further complicating and delaying the claims process. This is further compounded by internal referral to the SMA which often further delays claim finalisation.
“Our veterans deserve timely access to mental health diagnoses so they can receive the appropriate treatment.”
Additional hurdles exist in the form of cultural myths, such as the belief that only treating psychiatrists can be referred to the Initial Liability and Permanent Impairment Claims. The prevailing psychiatric diagnostic frameworks (DSM/ICD) also do not align with SoPs, potentially limiting the number of recognised conditions for specialists who are not familiar with the unique intricacies of compensation legislation. Other concerns include potential legislative compliance issues regarding independent medical examinations (IME) and the remuneration rules for psychiatrists, which pose risks of allegations of Medicare fraud or lack of payment for their services.
While the quality of advice is prioritised over the cost of services according to the DVA’s Liability Handbook, the principles under the Public Governance, Performance and Accountability Act (PGPA) 2013 emphasise ‘Value for Money’. This places a focus on cost-effectiveness and efficiency in the process. Balancing quality advice with cost considerations is an ongoing issue, which is further complicated when considering the ethical practice in costing structures for psychiatrists providing these services.
Existing MBS item numbers, which are used to perform Initial Assessments leading to diagnosis of conditions, are not designed to facilitate a compensation encounter. These are clinically designed and intended to look at the whole person, not only the factors related to defence service and, therefore, potential compensation. The result is that the output of this encounter may not be fit-for-purpose for a DVA compensation application.
“Innovation and a systematic project management approach is key.”
Delivering Solutions to Complex Mental Health Challenges
The challenge facing Veterans Community is both complex and substantial, not at all dissimilar to the many challenges faced by our Defence Forces on a daily basis. As such, innovation and a systematic project management approach is key. Members of our Defence Forces have time and time again applied these concepts to achieve the unachievable. It is now time for industry and government to collaborate, innovate, and systemise to build and deliver a solution to this backlog.
Innovations in the delivery of claimant assessments must be applied immediately, current extended wait times for Veterans to see their specialists are unacceptable. The proposed solution should deliver swift, detailed, and accurate claimant assessments, and operate in an independent environment that puts the Veteran front and centre. We appreciate that a challenge of this magnitude needs a wholistic solution. DVA simply cannot clear the backlog on their own and require proactive engagement from multiple industry and government stakeholders.
Acknowledging this, Zed3 Medical Group has already demonstrated the efficacy of an innovative and systemised approach. We continue to deliver detailed and accurate assessments within a four-week turnaround period, a timeframe unheard of across too many Veterans Groups. This approach has been delivered by onboarding over 15 psychiatrists from across Australia in just nine months. Combined with our psychology and administrative workforce, and in collaboration with other medical colleagues and advocates, we have already delivered Initial Liability Assessments and Permanent Impairment Reports to thousands of Veterans.
We call on industry, Government and the DVA to open into discussions about how we can address these issues to resolve the backlog and get our veterans the help they deserve.