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Annual Report 2016 - 2017 A

Annual Report 2016 - 2017

Promoting recovery from trauma

B AnnuAl RepoRt 2015 - 2016

Improving the wellbeing and quality of life for individuals and communities who experience trauma

Chair’s Report 2

Board of Management 3

Director’s Report 4

About phoenix Australia 6

Integration Case Study 7

Research 8

policy and Service Development 14

education and training 18

Highlight event 22

publications, presentations and Dissemination 24

our Staff 26

Governance and Management 27

Financial Statements 29

Contents

Mission

to be an international leader in building the capability of individuals, organisations and the community to understand, prevent and recover from the adverse mental health effects of trauma. to be at the forefront of world’s best practice in veteran and military mental health.

Goals

– Improve outcomes for the community

– Improve outcomes for members of the Defence community

– Advance scientific knowledge about the nature, development and impact of traumatic stress

– Provide leadership and expertise in evidence-informed posttraumatic mental health policy, service delivery and practice

– Enhance the operational and business capabilities of the organisation

Values

– We are passionate about making a real difference to the wellbeing of people impacted by trauma

– We operate with integrity in our words and actions

– We collaborate with our colleagues and partners to achieve the best possible results

– We are responsive to the changing needs of the communities we serve

– We strive for excellence

– We are guided by scientific evidence

2 Annual Report 2016 - 2017

Chair’s Report

His Honour Michael Strong

I think I can say without fear of contradiction that 2016-17 was the most exciting year in the history of our organisation – though perhaps to be exceeded by the year ahead!

our commitment to improving outcomes for the current and ex-serving Defence community remains strong. of particular note in this regard was the launch in February of the ReStoRe ptSD treatment trial by the Minister for Veterans’ Affairs and Defence personnel, the Hon Dan tehan Mp. the year also saw preparations for the much anticipated Centenary of Anzac Centre – the largest single project phoenix Australia will undertake. Final approval for this landmark initiative is anticipated early in the new financial year. I sincerely thank the Government and Minister tehan for their vision in agreeing to fund the Centenary of Anzac Centre and our colleagues in the Departments of Veterans’ Affairs and Defence for their continued faith in and support of phoenix Australia.

the diversification of our client base continues. the wide range of organisations with whom we worked during the year includes Ambulance Victoria, Western Australia police, Victoria police and the police Association of Victoria, the Australian Federal police and the Australian Border Force. the common thread is that these organisations are at the front line in protecting the Australian community and share many of the same environmental challenges. the synergies with our veteran and military work are obvious: the whole of our endeavours are thereby strengthened. We are also very pleased to be engaged in projects to improve resilience and access to mental health care in migrants and refugees, particularly in the context of domestic violence.

We have also continued the knowledge translation of our work through building our training and education initiatives. In the past year we have developed training for Defence community staff to assist them to support the mental health needs of Defence personnel and their families. And we provided training to a wide range of service providers in the general community, including medical practitioners and other health workers, pharmacists, judicial officers and youth justice workers.

on behalf of the Board I most sincerely thank our Director professor David Forbes, the management team and all phoenix Australia staff for their dedication and hard work throughout the year. I extend special thanks to Greg Ridder and paul Dolan for their work on the Finance and Risk Committee. I also express my gratitude to my fellow Board members for their enthusiasm and their support – always willingly given – to David and his team.

Annual Report 2016 - 2017 3

Board of Management

Chair: His Honour Michael Strong Professor David Forbes Ms Sue Campion Mr Paul Dolan Professor Ian Everall Major General Mark Kelly Mr Greg Ridder Air Vice-Marshal Tracy Smart

Michael Strong Michael is a former solicitor, barrister, prosecutor for the Queen, judge of the County Court of Victoria, Vice president of the Victorian Civil and Administrative tribunal and Director of the office of police Integrity (Victoria). He has a current appointment to the Australian Crime Commission as an examiner. Michael is a long-serving former director and president of Berry Street, Victoria’s largest independent child and family welfare agency and has served on boards and committees of numerous other organisations. Michael’s interest in posttraumatic mental health stems, in part, from the active military service of his forebears.

Professor David Forbes David is the Director of phoenix Australia and a clinical psychologist with many years’ experience in the assessment and treatment of mental health problems following trauma. David was the Chair of the Working party for the inaugural nHMRC-approved Australian Guidelines for the treatment of Acute Stress Disorder and posttraumatic Stress Disorder and is the Vice Chair of the ptSD Guidelines Committee for the International Society for traumatic Stress Studies. He sits on the editorial boards of key international journals and publishes widely in the international literature.

Ms Sue Campion Sue is the First Assistant Secretary of the Health and Community Services Division in the Department of Veterans’ Affairs. She is responsible for ensuring the effective sourcing and delivery of a wide range of services to the veteran community, including health and community services, mental and social health, community and aged care, and related services including home insurance. Sue has a Masters Degree in Consumer and Applied Science, majoring in Human nutrition, from the university of otago.

Mr Paul Dolan paul is Director for Australia and new Zealand with lightfoot Solutions, an Applied Analytics and Advisory business. prior to joining lightfoot, paul was an executive officer with the Department of Health and Human Services in Victoria, as the Director of System Intelligence and Analytics followed by the Director of priority Child and Family projects. prior to this position, he was lead Director in ernst & Young’s Health practice in oceania. paul has 17 years’ of international public sector and management consulting experience, working with board and executive level stakeholders in strategy, reform and operational improvement. paul holds a BA (Hons) degree in Business and German from the university of Hull, and has also studied International Business at the university of Innsbruck in Austria.

Professor Ian Everall Ian is the Cato Chair and Head of the university of Melbourne’s Department of psychiatry. He is a prominent international psychiatrist and neuropathologist who trained in the uK. His experience includes directing a large clinical service and establishing a leading research training program for psychiatrists at early career stage. Ian is a member of the Australian Advisory Council for Asia-Australia Mental Health and the Advisory Committee for the Melbourne neuroscience Institute.

Major General Mark Kelly Ao DSC Mark is the Repatriation Commissioner in the Department of Veterans’ Affairs. Mark served in a number of senior command appointments during an Army career spanning over 35 years, including Commanding officer of the 1st Battalion, the Royal Australian Regiment, Commander 3rd Brigade, Commander 1st Division, land Commander Australia and Commander Joint task Force 633 (CJtF 633). His operational experience includes service with the Commonwealth Monitoring Force in Zimbabwe/Rhodesia (1979-1980), Chief of Staff of the International Force in east timor (1999-2000), with uS CentCoM in the Middle east, Afghanistan, the Horn of Africa and Iraq (2003-2004), and as CJtF 633 commanding all ADF elements in the Middle east Area of operations, Iraq and Afghanistan (2009-10).

Mr Greg Ridder Greg joined phoenix Australia in September 2012 as interim Ceo. His role has evolved as phoenix Australia’s needs have changed, and he is currently Senior Corporate Services Manager, and a Director of phoenix Australia. Greg is an experienced business and strategy advisor, with a strong business background in strategy, finance, and general management, having previously been president of nYSe listed packaging company owens Illinois’ Asia pacific regional operations. Greg’s other board roles are at Kogan.com limited, tibaldi Australasia, oxfam Australia, oxfam trading and B lab Australia & new Zealand. He is also an Associate Director at strategy consultants, Bevington Group, and is a mentor at Kilfinan Australia. Greg is a Graduate member of the Australian Institute of Company Directors, and a CpA.

Air Vice-Marshal Tracy Smart AM tracy is the Commander Joint Health and Surgeon General Australian Defence Force. She completed her medical training at Flinders university (SA) and has specialist training in Aviation Medicine. Her career has included deployments to the united nations Assistance Mission in Rwanda as senior RAAF officer and aeromedical evacuation coordinator; to timor leste as Chief Health officer, HQ peacekeeping Force, and Australian Senior Health officer; and to the Middle east Area of operations as Senior ADF Health officer and Deputy Validating Flight Surgeon. She is a Fellow of the Royal Australasian College of Medical Administrators, the Australasian College of Aerospace Medicine, the Aerospace Medicine Association (uS) and the Centre for Defence and Strategic Studies, and an Academician of the International Academy of Aviation and Space Medicine. She is also an Honorary Fellow of the Australasian College of Health Service Management. Air Vice-Marshal Smart was made a Member of the order of Australia in 2012.


Director’s Report

Professor David Forbes

In August 2016, the prime Minister, Minister for Veterans’ Affairs, and Minister for Health and Aged Care announced an investment of $6 million in the Centenary of Anzac Centre, a phoenix Australia initiative to improve the mental health of veterans. the Anzac Centre was conceived from our experience over many years and the identification of two major unmet needs in the field of veteran and military mental health: firstly, the need to develop new and more effective treatments, and secondly, the need for an expert advisory service to assist practitioners treating often complex veteran and military mental health problems.

the Anzac Centre will comprise a treatment research collaboration that will undertake pioneering research into military and posttraumatic mental health conditions, and a practitioner support service that will provide expert advice to practitioners and ex-service organisations around the country that support veterans with mental health problems. Fundamental to the operations of the Anzac Centre will be collaborations with other research and clinical centres, expert clinicians, ex-service organisations, and professional organisations. these collaborative relationships will help to inform the work of both the research program and the practitioner support service. the Anzac Centre will be launched later in 2017 and commence in early 2018 following a period of consultation and development.

to support the future research work of the Anzac Centre as well as our other clinical research programs, this year we acquired a site for a research clinic. We were fortunate to locate a very suitable space at the Royal park Campus of the Royal Melbourne Hospital. We undertook renovations and created four therapy rooms, which have a peaceful outlook over established gardens.

one such clinical research program commenced this year. the ReStoRe trial (Rapid exposure Supporting trauma Recovery) is investigating the efficacy of Intensive prolonged exposure therapy for veterans and serving personnel with ptSD. It has the potential to make evidence-based treatment more accessible due to the shorter timeframe for treatment. the trial has been funded through the national Health and Medical Research Council (nHMRC) in partnership with the Departments of Veterans’ Affairs (DVA) and Defence, and the Veterans and Veterans Families Counselling Service. on 3rd February 2017 the Minister for Veterans’ Affairs, the Hon Dan tehan Mp launched the ReStoRe trial, and you can read more about the event on page 22-23, and more about the trial itself on page 11.

last year we reported on the International Roundtable on Disaster Recovery held in late 2015, at which international experts met to develop an evidence-based recovery program for people impacted by disaster. this year, funded through the Commonwealth Department of Health, we conducted a pilot trial of the resulting program, InterpAR (International program for promoting Adjustment and Resilience), in communities affected by bushfire in South Australia (you can read more in a case study on page 7). I’m excited to report that the pilot has demonstrated very positive results. We are planning a controlled evaluation of the InterpAR intervention in Queensland as part of the response to Cyclone Debbie and the floods, and we are seeking international partnerships to continue testing the program. plans are also in place to hold a roundtable of experts in child and adolescent mental health in october 2017 to develop an equivalent program specifically designed for the needs of young people.


this year we continued our involvement in the large collaborative transition & Wellbeing Research programme – a joint research initiative of DVA and Defence to examine the impact of contemporary military service on the mental, physical and social health of serving and ex-serving Australian Defence Force (ADF) members and their families. the phoenix Australia research team led the investigation into the pathways into, preferences for, and satisfaction with, mental health care services, developing the pathways to Care Report section of the programme. You can read more about the report on page 10.

the SpRIte trial (Screening and promoting Recovery after Injury by treating early) is a ground-breaking piece of research led by Associate professor Meaghan o’Donnell which is studying an early intervention that comprehensively addresses the complex and comorbid presentations that develop after serious injury and other traumatic events; it has significant implications for injury survivors and the health care system. Funded by an nHMRC grant in 2015, we recently received additional funding from Victoria’s transport Accident Commission (tAC) which will allow us to accelerate the pace of the trial. It is notable that the tAC recognises the importance of this work. You can read more about the trial in a case study on page 9.

phoenix Australia’s unique integration of work in the areas of research, policy and service development, and education and training, ensures that we are always mindful of translating our knowledge to improve practice and improve outcomes for people affected by trauma.

the past year has seen us continue to expand and consolidate our work with emergency and other high risk services. Among others, we have worked with Ambulance Victoria (see case study on page 13), the Australian Border Force, the Australian Federal police, WA police, Victoria police and the police Association of Victoria. We have also commenced work on a range of projects aimed at improving resilience and access to mental health care in migrants and refugees, particularly in the context of domestic violence.

I am very pleased to report that nicole Sadler is joining the phoenix Australia team in July 2017 as Senior Specialist, Military and High Risk organisations. nicole has worked as an Army psychology officer for 23 years, most recently in the most senior psychology position in the Australian Army, Director Strategic and operational Mental Health/Head of Corps of the Australian Army psychology Corps. She remains a Colonel in the Army Reserves. She has extensive expertise in military mental health and in the issues and challenges involved in improving and maintaining mental health and wellbeing within high risk populations.

I would like to thank the staff of phoenix Australia for their high quality and hard work and creativity throughout the year and for their strong commitment to the organisation and its mission.

Finally, I would like to thank our Chair, His Honour Michael Strong, and the Board for their thoughtful guidance and terrific support.

Phoenix Australia - Centre for Posttraumatic Mental Health is a not-for-profit organisation and national centre of excellence

Whether from natural disasters, transport accidents, sexual assault, or exposure through military or emergency services experiences, trauma can have lasting effects and impact people’s mental health, relationships, work, and study. phoenix Australia is at the forefront of research, policy, and training into posttraumatic mental health, utilising the latest research to improve wellbeing and build stronger communities.

phoenix Australia’s breadth of work encompasses Research and evaluation, policy and Service Development, and education and training. It is our unique ability to integrate knowledge and skills from all of these activities into best practice and tailored implementation, offering clients end-to-end service. the case study on the following page showcases this integration approach.

Research and Evaluation our program of internationally acclaimed research and evaluation aims to advance the knowledge of posttraumatic mental health; create real-world solutions through the application of diverse research methodologies; and translate research findings into practical implications for governments, organisations, and communities.

Policy and Service Development our policy and service development work aims to establish the standards of best practice for the management of trauma. We translate research into best practice policies and procedures for organisations, and work with organisations to build their capacity to minimise the impact of workplace trauma.

Education and Training our aim is to create engaging and evidence-based education and training programs that improve the practice of those working with individuals, organisations and communities affected by trauma. We provide tailored training, supervision, and consultation services that meet the specific needs of a diverse range of clients.

Promoting Understanding phoenix Australia promotes an understanding of posttraumatic mental health through online and print resources, videos, journal articles, presentations at conferences and other forums, and via expert media commentary.


Promoting recovery for the 15 million Australians affected by trauma


Case Study Integrated Delivery of Services

Filling a gap in mental health care following disaster

InterpAR (International program for promoting Adjustment and Resilience) is a new emotional recovery program for people who experience mild to moderate psychosocial difficulties in the aftermath of natural or human-made disasters. It has the potential to inform mental health response following trauma and disaster both nationally and internationally.

After a disaster such as a bushfire, earthquake, or terrorism event, many survivors experience stress, worries, sadness, anger, and relationship difficulties. over time, these difficulties may develop into serious mental health problems. Although there are effective evidence-based treatments available to treat diagnosable mental health disorders, up till now there has been no empirically proven intervention that can assist the significant number of disaster survivors who suffer mild to moderate levels of distress or impairment in the aftermath. InterpAR was designed to fill this gap in mental health care and recovery following disaster, and has now been tested in a pilot trial in South Australia.

InterpAR was developed by phoenix Australia in collaboration with 21 international experts in the field of post-disaster mental health and trauma at a roundtable in 2015, co-hosted with the prince’s trust Australia. the goal of InterpAR is to reduce distress in survivors who experience mild to moderate levels of distress and impairment, and improve their quality of life and functioning. InterpAR forms part of the stepped care approach to mental health treatment following trauma and/or disaster, and fits naturally into the Australian Government’s mental health strategy to achieve a more efficient, integrated, and sustainable mental health system to improve mental health service delivery. Importantly, InterpAR has been developed to be delivered by non-mental health specialists and paraprofessionals to increase its reach. these ‘coaches’ can be health professionals, disaster responders or community volunteers, and are trained and provided with ongoing supervision.

Funding from the Commonwealth Department of Health supported a pilot feasibility trial in 2016-17. the pilot trial took place in the Sampson Flat and pinery regions of South Australia which were devastated by bushfires in 2015. In

partnership with local organisations, the Country South Australia primary Health network, the northern Health network, and the Australian Red Cross, phoenix Australia developed program materials, a training program, and a community website to support the pilot testing of InterpAR.

As part of the pilot, local area coaches were trained and supervised to deliver InterpAR to survivors who were experiencing mild to moderate distress following the bushfires. these coaches included Red Cross Volunteers, social work interns, community nurses, and case managers. Bushfire survivors completed the five-week InterpAR program over a six-month period.

Findings from the pilot trial show that InterpAR is effective in reducing psychosocial difficulties and distress, and improving quality of life and wellbeing after disaster, and that it is feasible to be delivered in a post-disaster setting by community coaches with no formal mental health training. Feedback from the coaches and survivors about the program was also very positive.

InterpAR has the potential to inform mental health response following trauma and disaster both nationally and internationally, by offering governments, communities, and health services an easy-to-access, evidence-based emotional recovery program that can quickly and easily be put into effect to promote recovery after disaster strikes.

In planning, conducting, and evaluating the pilot trial, phoenix Australia’s integrated knowledge and expertise from our research (using the evidence to guide development of the program), service and policy development work (using our expertise to enhance delivery by providers in the community), and education and training (using our expertise and trainers to transfer knowledge and skills), brought maximum value to the trial’s funder, the Department of Health, and the community.

the next step in developing InterpAR is to conduct larger randomised controlled trials to continue to gather evidence of its efficacy in different natural and human-made disaster settings both in Australia and, through our international partners, around the world.


Associate Professor Meaghan O’DonnellDirector, Research

phoenix Australia’s internationally acclaimed program of research and evaluation aims to advance the scientific knowledge of trauma and posttraumatic mental health.

We benefit from our extensive national and international collaborative research relationships, integrating the findings from our research activities and program evaluation with advances from around the world.

phoenix Australia is proud of its unparalleled leadership in translating research into practical implications for governments, organisations and communities, thereby promoting the best possible outcomes for people affected by trauma.

Phoenix Australia’s research targets three main populations of trauma survivors:

• Militaryandveteran• Community• Industryandworkplace

We have five main programs of research:

• Epidemiology• Phenomenology• Intervention• Knowledgetranslation• Veteranandmilitarymentalhealth.

2016 - 2017 Overview

our research program at phoenix Australia has taken us in some exciting directions. this year we had a big focus on working on large datasets. We partnered with the Centre for traumatic Stress Studies and the Departments of Veterans’ Affairs and Defence to explore pathways to care in the 2015 Mental Health and Wellbeing transition Study. We also partnered with Defence to write the final report from the longitudinal ADF study evaluating Resilience (lASeR-Resilience).

We’ve continued to utilise our literature synthesis expertise to conduct a number of literature reviews including rapid evidence assessments into treatments for Adjustment Disorder and assessing the efficacy of illicit drugs as treatments for mental health disorders. We also conducted a number of systematic reviews – one examined the efficacy of creative arts therapies for treatment of ptSD, and another examined the use of person-centred analyses to examine how different traumatic events cluster together.

We continue to test new and novel treatments for posttraumatic stress disorder (ptSD). We commenced a full randomised controlled trial testing the efficacy of intensive prolonged exposure versus prolonged exposure for current and ex-serving Defence personnel with ptSD (ReStoRe trial). our early intervention trial that explores the efficacy of transdiagnostic therapy against usual care with injury patients (SpRIte trial) continued. We also completed a trial of brief cognitive behavioural therapy to facilitate adjustment after disaster exposure (InterpAR project), and we continued a trial evaluating the efficacy of theta Burst Stimulation as a treatment for ptSD.

our phD students continue to do fantastic work. Congratulations to Sonia terhaag who passed her phD this year, and welcome to loretta Watson who has commenced her phD studies with us this year. on page 12 you can read a little more about our phD student studies, including the impact of trauma exposure on firefighters (Heather Bancroft), homelessness and Complex ptSD (Renée Armstrong), social support after natural disaster (Fanhong Shang), healthy ageing in Vietnam Veterans (loretta Watson), and moral injury (Anne McDonald).

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treating posttraumatic mental health problems is often complex, particularly due to the high levels of comorbidity in patients who have suffered trauma. teasing apart multiple diagnoses requiring different treatment protocols and formulating a prioritised treatment plan can be bewildering for even experienced practitioners. perhaps for this reason, most practitioners tend not to use evidence-based treatment protocols, but a blend of treatment techniques.

the availability of a single treatment protocol to treat a complex trauma presentation may seem a fantasy, but there is a growing research interest in transdiagnostic approaches which investigate and address the common features across diagnoses and the underlying mechanism that underpins an individual’s poor mental health. transdiagnostic interventions are hypothesised to be beneficial for both patients and clinicians, acting to improve the availability of best practice treatment for patients and reducing the demand on practitioners to become proficient in multiple treatment protocols.

phoenix Australia’s SpRIte trial (Screening and promoting Recovery after Injury by treating early) commenced in 2015 and is at the forefront of this growing body of research. Funded by a national Health and Medical Research Council (nHMRC) grant, with recent additional funding from Victoria’s transport Accident Commission, it is specifically investigating the unified protocol for transdiagnostic treatment of emotional Disorders (up) as an early intervention for the treatment of posttraumatic mental health disorders in patients who have suffered serious injury.

SpRIte is the first randomised controlled trial testing the efficacy of early delivered up in reducing the prevalence and severity of posttrauma psychopathology. the trial follows on from earlier studies conducted by phoenix Australia examining transdiagnostic interventions.

the findings from this study will have significant implications for trauma survivors and the health care system. It will increase the efficiency of treatment by: a) targeting shared features of multiple disorders (thereby reducing the time and costs associated with treatment), and b) engaging patients in early mental health care while they remain connected to the healthcare system (thereby maximising uptake of mental health care). For the health care system, this study trials a process that can be easily adopted by trauma services to prevent patients falling through the gaps. For practitioners, the up intervention will simplify treatment and reduce the need for complex treatment sequencing decisions.

While this study has significant implications for injury as a traumatic event, it will have seismic implications for the trauma field. Currently there are no recommendations for addressing the full spectrum of psychiatric disorders that develop after exposure to natural and man-made disaster, sexual assault, or the cumulative trauma that emergency services and military personnel can experience. Having an evidence-based early intervention that targets multiple psychiatric presentations will help clinicians, and importantly, policy makers, to look beyond posttraumatic stress disorder (ptSD) and make a comprehensive difference in the aftermath of trauma exposure.

Case Study Research

The SPRITE trial - removing the complexity of treating trauma presentations


Research Projects

Development of a moral injury outcome measurethere is increasing international interest in the area of moral injury in military personnel, yet to date there has been no study to measure the outcomes of the exposure to potentially morally injurious events. Relative to most civilian traumas, war zone exposure is associated with more toxic and enduring psychological, social, spiritual, and behavioural difficulties, and poorer responses to treatment. It has been argued that one reason for this is that war zone exposure may include experiences that cause crises of conscience or moral injury besides (and in addition to) experiences that involve threat to life. the study of the epidemiology and treatment of moral injury has been hampered by the lack of a consensus gold standard assessment of moral injury as an outcome.

the current study, funded by the Department of Veterans’ Affairs, has been triggered by international recognition of the need for a moral injury outcome measure that can be used in the care of veterans and serving members. phoenix Australia has established a collaboration of experts from Australia, united States, united Kingdom, and Canada, with the aim of developing such a measure. It is expected that the measure will improve initial assessment, guide the provision of care, and assess changes and improvements in veterans’ wellbeing following treatment.

A systematic review of creative arts therapies there is a growing body of literature supporting the use of creative arts therapies; however, the efficacy of these therapies in the treatment of posttraumatic stress disorder (ptSD) has not been systematically evaluated. phoenix Australia partnered with professor Felicity Baker from the university of Melbourne’s Faculty of Victorian College of the Arts and Melbourne Conservatorium of Music and the Defence Health Foundation to examine the efficacy of creative arts therapies.

Specifically, the aim was to utilise a rigorous and systematic review methodology to identify the current evidence of the efficacy of music therapy, art therapy, dance/movement therapy, and drama therapy in the treatment of ptSD in adults following trauma.

A search of ten databases yielded seven studies: four investigating art therapy, two investigating music therapy, and a final study investigating drama therapy. Individual studies were initially rated on a standardised quality and bias checklist, and the Grading of Recommendations Assessment, Development and evaluation (GRADe) system for ranking the overall quality of the evidence for each treatment was then used.

the evidence for music therapy, art therapy, and drama therapy was ranked as low to very low, with no studies found for dance/movement therapy. Generally the quality of the trials was very poor. Future directions for this field were discussed, including ways in which to improve the scientific quality of the research trials in this area.

Pathways to Care Report: Findings from the 2015 Mental Health and Wellbeing Transition StudyInternationally, there is an extensive literature on the multitude of factors related to pathways to care for current military members and ex-serving personnel. Much of the existing literature is based on uS, uK, and to a lesser extent, Canadian studies. Given the need to ensure that Australian transitioned and current serving ADF members with mental health care needs have access to and receive appropriate mental health care, based on the above literature this study sought to investigate pathways to care in transitioned and currently serving ADF members.

Specifically, this study sought to investigate the patterns of health service seeking and usage of ADF members who transitioned out of the ADF between 2010 to 2014 and a stratified random sample of full-time ADF members serving in 2015.

Addressing the above questions provided critical information to better understand the uptake and utilisation of services and the factors, strengths, gaps, and preferences that guide current patterns of service utilisation. the findings of this report are currently waiting to be accepted by DVA and Defence. It is anticipated that the report’s findings will guide future service delivery and mental health initiatives to further improve outcomes for the recently transitioned and current serving ADF communities.


RESTORE Trialprolonged exposure (pe) is the gold standard treatment for posttraumatic stress disorder (ptSD). It requires weekly treatment for 10 weeks, posing a significant barrier to uptake for veterans and civilians (for whom other demands and stressors intrude into treatment attendance). the Departments of Veterans’ Affairs (DVA) and Defence have identified the need to improve access to, and availability of, effective evidence-based care for current and former Defence personnel, particularly in the provision and uptake of pe. through a partnership between phoenix Australia, Defence, DVA, and the Veterans and Veterans Families Counselling Service, the Rapid exposure Supporting trauma Recovery (ReStoRe) trial will identify whether a modified form of pe that delivers the treatment over 10 days in a two-week period (Ipe: Intensive pe) can obtain similar outcomes to standard pe (Spe). Should Ipe prove equivalent to Spe, this has the potential to significantly reduce the barriers to accessing gold standard treatment for ptSD.

ReStoRe is the first randomised controlled trial of daily, compared with weekly, pe for military personnel and veterans with ptSD. Findings will directly influence DVA and Defence policy and delivery of evidence-based treatment by service providers nationwide.

Longitudinal ADF Study Evaluating Resilience (LASER-Resilience) phoenix Australia has been collaborating with the ADF since 2010 on the lASeR-Resilience research project which aims to provide the ADF with valuable information regarding the situational and individual factors that both erode and promote psychological resilience in ADF members during training and their first three years of service. to date, phoenix Australia has delivered four reports, with the final report to be delivered in 2018. the final report will inform the ADF’s resilience program - BattleSMARt, provide baseline mental health data, and drive changes to policies to alter organisation-related factors that impact mental health outcomes.

Assessing treatments for adjustment disorderAdjustment disorder is one of the most common psychiatric disorders, yet paradoxically, the least well understood. the aim of this DVA-funded rapid evidence assessment was to examine the evidence and efficacy of psychological or pharmacological interventions targeting adjustment disorder in adults. We found that the overall quality of existing studies was moderate to low, with no studies ranked as high quality. As a result, all interventions in the treatment of adjustment disorder were ranked as ‘unknown’. While the

current evidence base for treatment of adjustment disorder is lacking in sufficiently high quality research to support direct recommendations, in the interim, clinicians and providers can rely on indirect evidence from other relevant guidelines. For example, the current recommendations for the treatment of subsyndromal depression are the use of CBt-based treatments, and as such, these should be considered a first line choice in the treatment of adjustment disorder. the stark lack of research investigating efficacious treatments for adjustment disorder, represents an opportunity for the conduct of high quality research in this area, which will ultimately benefit people who struggle to recover after a stressful event.

Assessing illicit drugs as treatments for mental health disordersthere is increasing interest in the use of certain drugs, such as psychedelics and illicit drugs, in the treatment of ptSD, depression, and anxiety. the aim of this DVA-funded rapid evidence assessment is to examine the evidence in relation to the effectiveness of cannabis, MDMA (commonly known as ecstasy), lSD, GHB, psilocybin (also known as magic mushrooms), and ketamine in the treatment of ptSD, depression, and anxiety. the level of evidence for each of the five substances will be examined in relation to each of the three disorders, using a rapid evidence assessment methodology. the findings will assist DVA policy-makers and inform funders about where more research is warranted.

TBI and PTSD brain studythere is strong evidence that ptSD and other mental health disorders either arise from, or result in disruption to, specific neural networks, with concomitant hyperactivity or hypoactivity in the affected regions. neuro-stimulation techniques such as Repetitive transcranial Magnetic Stimulation (rtMS) have been shown to ‘re-calibrate’ affected neural networks resulting in symptom improvement. A handful of studies have begun to explore the effectiveness of rtMS as a treatment for ptSD with promising preliminary results. theta Burst Stimulation (tBS) is a modified rtMS protocol that may have better efficacy than traditional rtMS protocols. tBS has not yet been trialled in a ptSD population, but holds considerable promise and requires pilot testing. phoenix Australia has received funding from Defence Health to run a pilot study in the effectiveness of tBS with a veteran population.

Optimising the ‘Driving to Health’ app for taxi driversphoenix Australia is collaborating with the Department of General practice on a feasibility study of a mobile app for reducing psychological distress among taxi drivers. the Driving to Health app is designed to increase taxi drivers’ use of self-help strategies for psychological wellbeing and to encourage help-seeking among drivers with high psychological distress. the current study will gather feedback from drivers to optimise the Driving to Health app.


To what extent are Australian Vietnam veterans ageing successfully? this research aims to investigate successful ageing in Australian Vietnam veterans and will investigate a number of important ageing areas such as cognitive, psychological, physical, social, and spiritual domains. this research will inform the development of interventions that promote successful ageing in veterans as they age. this phD is due for completion in July 2020.

Exploring Complex PTSD in a sample of people experiencing homelessness this study of 206 people experiencing homelessness investigates clinical outcomes following trauma. the findings are important for the scientific community in terms of understanding the construct of Complex ptSD and its phenomenology. this phD is due for completion in December 2017.

Mental health and wellbeing in firefighters this study aims to clarify the prevalence of the mental health disorders that are commonly associated with exposure to trauma and develop a greater understanding of the range of factors which contribute to better and worse mental health in an Australian sample of firefighters. this phD is due for completion in December 2017.

Longitudinal outcomes in wellbeing after burns this longitudinal study explored the psychological and social factors that contribute to disability, quality of life, and mental health outcomes in burns patients. Specifically, the study aimed to identify which factors, such as social support, pain, psychiatric history, appearance, perceptions, and anger, that may contribute to six-month outcomes. this phD was completed in March 2017.

Social support and wellbeing among survivors of natural disaster this longitudinal study, a collaboration between the university of Melbourne and peking university, explores the psychological impact of social support received following the lushan County earthquake in 2013. By interviewing earthquake survivors two and a half years following the disaster, the study seeks to understand the impact of received social support on longer-term mental health and wellbeing, and explore the features that determine the quality of help received. this phD is due for completion in november 2018.

Moral injury in military and emergency services personnel this study on moral injury has three components: 1) a qualitative investigation of the link between types of potentially morally injurious events and psychological responses; 2) development of a measure to assess a range of responses, with a particular focus on shame; 3) fMRI study to investigate whether there are differences at a neurobiological level between subjects with moral injury and ptSD. this phD is due for completion in 2021.

PhD Research – Primary Supervision


There are moments in life that test us, that challenge our understanding of the world and our sense of safety. We know that good outcomes are possible for people who experience trauma.

75%of Australians are

exposed to at least one traumatic event

in their lifetime

Dr Andrea Phelps Director, policy and Service Development

phoenix Australia’s policy and service development work aims to get evidence-based interventions into practice to improve outcomes for people affected by trauma. our service development work is informed by international research as well as our own expertise across research, translation and training. We translate research into best practice policies and procedures for organisations, and work with organisations to build their capacity to minimise the impact of workplace trauma.

Phoenix Australia works with organisations that have responsibility for people affected by trauma, including:

• organisationswhereexposuretotraumaisapredictablerisk of employment (e.g., Defence, police, fire, ambulance and rail services)

• organisationsthatprovidehealthandwelfareservicesto people affected by trauma (e.g., agencies working with people experiencing social disadvantage, and government departments that provide mental health and welfare services)

• organisationsthathaveresponsibilityforprovidingtrauma treatment (e.g., Veterans and Veterans Families Counselling Service (VVCS), and hospital-based ptSD treatment programs)

• organisationsresponsibleforsettingthestandardsof care for people affected by trauma (e.g., the Departments of Veterans’ Affairs and Defence, and third party insurers).


the policy and Service Development work this year reflects the depth of our relationship with long standing key stakeholders DVA and Defence, our growing influence in improving outcomes for emergency service personnel, and our reach into new sectors of the community affected by trauma.

our longstanding arrangement with DVA to monitor outcomes for veterans participating in the trauma Recovery programs continues, and in an exciting development, we will be extending this to current serving ADF members. Veterans, current serving members and families will also benefit from our work with VVCS in redeveloping the group treatment programs that are at the heart of that service.

In the emergency services sector this year we worked with Victoria police, the police Association Victoria, Ambulance Victoria, and the Australian Federal police on a range of initiatives to better understand the mental health and wellbeing needs of staff, and provide advice on best practice approaches to supporting their wellbeing. In an example of the reach of our work, we note that the stress and resilience mobile application that we developed in a collaboration between Victoria police and the police Association Victoria has been adapted for a number of other jurisdictions. our influence on outcomes for personnel in the emergency services sector has been expanded through collaboration with workplace insurer eMl to develop a range of Recovery After trauma booklets for workers in fire, police, ambulance and health services, and collaboration with rehabilitation provider IpAR in the development of a coaching manual for their return to work clients with ptSD.

Building on relationships developed over a number of years, we have been privileged this year to commence two important projects in partnership with the Australian Muslim Women’s Centre for Human Rights (AMWCHR). the goal of the first of these is to increase access to trauma informed care for culturally and linguistically diverse and Muslim women affected by violence. the second is a community development project targeting radicalisation in Muslim youth through promoting family resilience.


Policy and Service Development

Ambulance Victoria (AV) is an organisation firmly focussed on ensuring the health and wellbeing of its people to enable them to continue to do their outstanding work in the community. A primary strategic objective is “keeping our people safe, and physically and psychologically well”. this year phoenix Australia was privileged to have the opportunity to complete two pieces of work for AV with the aim of better understanding the wellbeing issues faced by paramedics and their families and improving the systems and supports available to them. the first project involved developing and implementing a psychosocial survey of AV staff to gain a better understanding of the range of workplace stressors impacting on wellbeing and current factors contributing to their mental health and wellbeing status and needs. the second project was a review of AV’s psychology and staff support services. We were pleased to partner with Associate professor Sam Harvey and his team from the Black Dog Institute on both initiatives.

the aim of the survey was to better understand the psychological health and wellbeing of the AV workforce, to inform future wellbeing programs, and to provide longitudinal information to the organisation. More than 2,307 staff and volunteers participated in the survey that we developed. the results were largely positive in terms of mental health and wellbeing and satisfaction with services provided. In light of the findings of the survey we made six recommendations to AV for ongoing improvement in promoting the wellbeing of staff.

the review of support services provided an overview of the current service delivery model benchmarked against its stated objectives and best practice models. the work commenced with a literature review, followed by a review of AV documents relating to mental health and wellbeing, and finally, consultations with key staff. on completion, we presented twelve recommendations for the improvement of services, and a mental health model incorporating the role of managers and leaders, the policy framework, preventative interventions, screening and stepped care, and an overarching framework for ongoing evaluation and quality assurance.

It was fortuitous that these two pieces of work were undertaken in close succession as they were complementary and learning from each was able to inform the other.

AV currently has a significant program of work underway to build a mentally healthy workplace and improve the mental health and wellbeing of its staff, as set out in its Mental Health and Wellbeing Strategy 2016-19. phoenix Australia was very pleased to be able to utilise our expertise in reviewing mental health models and services, and identifying workplace factors that can contribute to and protect from mental health problems, to provide practical and detailed recommendations to assist AV to make continued improvements to their Mental Health and Wellbeing Strategy. We understand that AV will use the findings from the review of support services and the survey to review and inform the delivery of the key objectives set out in their strategy. We commend AV for its leadership in prioritising the mental health of their workforce.

“Improving the health and wellbeing of our people is of utmost importance. In collaboration with Phoenix Australia we have been able to understand the intricacies and challenges we uniquely face as an emergency service organisation. This has allowed us the opportunity to build a culture that is focussed on our people, specifically their mental health, and to ensure the appropriate psychological support services are both available and accessible for all.”

Associate Professor Tony Walker ASM Chief executive officer, Ambulance Victoria


Case Study Policy and Service Development

Supporting Ambulance Victoria’s Mental Health and Wellbeing Strategy


Policy and Service Development Projects

Increasing access to trauma informed care for migrant and refugee women affected by violence

phoenix Australia has formed a partnership with the Australian Muslim Women’s Centre for Human Rights (AMWCHR) to investigate the barriers and facilitators to accessing psychological support experienced by migrant and refugee women exposed to family violence or sexual assault. this information will be used to develop and widely disseminate recommendations for policy and service delivery. A pilot of a trauma informed model of care adapted to the needs of migrant and refugee women will be conducted across a number of Geelong agencies such as Diversitat and Minerva Community Services. the aim of the pilot is to test the implementation of the model and increase access to psychological support and treatment for women who have developed mental health issues as a result of experiencing violence.

practices related to the assessment of traumatic stress and delivery of trauma informed care will be examined across a range of support services. the project will also investigate migrant and refugee women’s experience of service delivery related to trauma and mental health. Representatives from community groups and the health and welfare sectors have been actively engaged in the project and will be involved in formulating recommendations based on the research. the trauma informed care model will be piloted using a training and six-month support package aimed at front-line workers. the impact of the package on worker practice will then be evaluated. the project commenced this year and will run for the next two years. there has already been strong engagement from the community and agencies working with refugee and migrant women that have experienced violence, and we look forward to developing a practical model of care that can be applied across a number of service sectors. this project is funded by the Helen Macpherson Smith trust.

EML Recovery After Trauma booklets

eMl is a respected provider of workers compensation claims management in Australia. A mutual organisation, eMl reinvests part of its profits to benefit its members. In this context, this year eMl commissioned phoenix Australia to adapt and tailor our Recovery After trauma booklet to provide a range of workers with information and support after a potentially traumatic event. our Recovery After trauma booklet is part of a suite of products produced by phoenix Australia to support the Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder.

We adapted the content of the booklet to produce five separate guides for paramedics, firefighters, health professionals, police members, and workers in general. each booklet contains information about common posttraumatic mental health problems, how to help oneself after trauma, effective treatments and what to expect from treatment, a section for family members, helpful resources and contacts, as well as brief scenarios tailored for each specific group of workers. eMl is distributing the booklets widely, and they are available on both their and our websites.

Development of a Victoria Police app

the equipt app was developed for the police Association Victoria (tpAV) and Victoria police to provide serving and ex-serving police, non-sworn police employees, and public Safety officers with a smartphone application to assist with the management of stress, improve resilience, and develop healthy lifestyle habits. the app provides a wellbeing assessment function and two sets of tools that allow users to manage stress and distress, and track and manage their social, physical and mental health. the app is responsive to the needs of Victoria police and tpAV, adapting features and functions for users working shifts, and provides information and links to police-specific mental health supports and services.


Family resilience and radicalisation

this project is being delivered in partnership with the Australian Muslim Women’s Centre for Human Rights (AMWCHR). It will develop and test a pilot group prevention program aimed at improving family resilience and the wellbeing, sense of belonging, and capacity for community engagement for young people and parents from a Muslim and migrant background. the project is designed to help prevent radicalisation by supporting family resilience and social cohesion.

While government and other stakeholders recognise that families have an important role to play in the prevention of radicalisation of young people, approaches to promoting family resilience in the context of radicalisation have not been sufficiently researched. this project will address this knowledge gap by conducting community consultations. Muslim families and community leaders will be asked about the difficulties faced by Muslim families following migration and the way young people are supported by their family to engage in their community. A literature review was conducted to identify factors that foster family resilience in vulnerable and migrant communities. the project is funded by the Victorian Department of premier and Cabinet as part of its Social Cohesion Research Grants program.

Review of Australian Federal Police mental health strategy

phoenix Australia has been contracted by the Australian Federal police (AFp) to undertake a review of the AFp’s mental health services. this has entailed a literature review to inform the work; a review of AFp employee wellbeing and staff support; consultations with senior leaders and staff support personnel; staff focus groups; an online survey of all AFp members; and a final report with recommendations. the final report will be submitted in october 2017, followed by presentations of the findings to relevant AFp stakeholders.

Designing interoperability between DVA websites and mobile apps

this DVA-funded project seeks to combine various digital mental health products and services into a unified, interoperable ‘dashboard’ resource (interoperability refers to the capability for digital resources to share data and functionality). We developed a ‘clinical narrative’ which provides the underlying clinical rationale for the dashboard, and maps how data can be extracted from existing and potential future digital products to enhance treatment and support service delivery.

At Ease website content review

the At ease website is DVA’s primary mental health website offering veteran-specific mental health information and self-management advice to serving and ex-serving Australian Defence Force personnel and their families. We reviewed the content of the At ease desktop website and the mobile site to ensure that it is clinically accurate and in accordance with current guidelines and evidence-based treatments. links were also added to ensure that appropriate self-management tools available on other DVA mental health websites were integrated into the content of At ease.

Redevelopment of VVCS group programs

together with our partners the Flinders Human Behaviour and Health Research unit (FHBHRu), phoenix Australia is re-developing the Veterans and Veterans Families Counselling Service (VVCS) psychosocial group programs: Recovery from trauma, Management of Anger, Management of Anxiety, and psychology of pain. An overall framework for the delivery of the group programs will also be developed, including an evaluation model. the group program redevelopment will account for integration with one-on-one treatment services, consistency in approach, and a range of delivery formats including digital program delivery modes.

Trauma Recovery Programs – PTSD: Clinical Data Collection and Quality Improvement Reference Group

phoenix Australia continues to monitor and report on the treatment outcomes of DVA-funded trauma Recovery programs (tRp-ptSD) which are delivered by 17 hospitals across Australia. this year, two significant changes also occurred: 1) we updated the questionnaires to be consistent with Australian medical record standards, and 2) we gained ethics approval for the collection of ADF member data, in addition to veteran data. Hospitals were trained in these new procedures in early 2017.

the related work of the Quality Improvement project Reference Group also continued. this group comprises interested program staff to undertake analysis of the longitudinal database to address priority service development questions. this year the trajectory of ptSD symptom clusters following standard treatment for ptSD in Australian veterans was investigated. the study revealed that for avoidance, numbing, and arousal, most of the change occurred from pre to post-treatment, however, for intrusions, almost half of the improvement occurred after treatment.


Associate Professor Darryl Wade Director, education and training

At phoenix Australia, we believe that giving practitioners and other providers the skills and knowledge to provide practical, effective support and treatment will enhance the quality of life of those affected by trauma.

phoenix Australia delivers engaging and effective education and training programs, and provides supervision and consultation services to meet the needs of a diverse range of practitioners and organisations. We also develop and deliver digital, face-to-face or blended training and implementation solutions.

Typically, our education and training activities are guided by a three-level framework to deliver the most appropriate support and mental health care.

Level 1 refers to advice and simple practical and emotional support that can be provided in the days and weeks following a traumatic event, aimed at reducing distress and facilitating recovery.

Level 2 refers to recovery-oriented approaches to assist those with more persistent posttraumatic mental health problems. these approaches are well suited to practitioners with basic counselling skills working in primary care, mental health, and community-based settings.

Level 3 refers to more intensive evidence-based psychological and pharmacological interventions for people with more chronic and severe distress, including those with diagnosable posttraumatic mental health disorders.


In 2016-2017, we continued to provide high quality and evidence-based education, training, supervision, and consultation services to our partners and clients, including government departments and agencies, military and veteran support services, professional and community-based organisations, and individual practitioners. of particular note was the training program we developed and provided for the Australian Border Force to assist investigators and managers to better manage the impact of viewing objectionable materials as part of their work. other notable achievements were the development of the Defence Community organisation mental health training package to assist Defence families and military personnel dealing with mental health issues; our trauma Informed Care training delivered to a wide range of sectors and professionals; our work with eMl to assist practitioners to deliver prolonged exposure therapy for emergency service personnel with ptSD; and our ongoing work with DVA to improve the quality of their engagement with individuals with a history of abuse. our Australia-wide expanded public training programs run by our expert trainers have again been very well received by practitioners, with consistently positive feedback received.

Education & Training

Formal mental health interventions

Simple psychologicalstrategies

Early responseadvice and support

3

2

1

100%participants would recommend the training to others

98%participants rated

the quality of training as high


Defence Community organisation (DCo) offers a broad range of programs and services to help Defence families manage the military way of life - using a model of brief intervention and referral to the most appropriate form of more specialised support. this model entails an initial assessment of the issues presented followed by tailored assistance to address those issues, either from DCo services, or external providers such as the Veterans’ and Veterans Families Counselling Service (VVCS). Within DCo, support may be provided by the DCo Helpline, social work staff, or transition staff. DCo has over 200 staff around Australia, comprising both military and civilian personnel.

phoenix Australia was contracted by DCo to develop a new modularised training package in topics and practices related to mental health issues to be delivered nationally to DCo staff, utilising a train-the-trainer model.

phoenix Australia’s expertise in the Defence environment and our knowledge of mental health issues in ADF personnel, veterans, and their families, alongside our experience in the development and delivery of training to a range of professionals, was key to developing a tailored and effective training package. Fundamental to our approach was that it should be evidence-based, focussed on mental health risk assessment and management, and delivered in a way that would lead to sustained improvements in the practice of DCo professionals in assessing and managing mental health and related issues.

In conducting this work, we consulted and collaborated with DCo to develop the training program, including audio-visual materials, and developed specific train-the-trainer materials to enable DCo trainers to deliver the training.

the training program is currently being rolled out within DCo facilities across Australia.

Case Study Education & Training

Defence Community Organisation mental health training package


Education & Training Projects

EML Prolonged Exposure therapy for emergency services personnel with PTSD

eMl is a respected provider of workers compensation claims management in Australia. Consistent with their support for best practice in the management of posttraumatic mental health problems in emergency service workers, eMl engaged phoenix Australia to lead a training and consultation program on prolonged exposure therapy for psychologists working with emergency service personnel with posttraumatic stress disorder (ptSD). prolonged exposure therapy is one of the most effective psychological therapies for ptSD and is well suited to dissemination among mental health practitioners. the training workshop was very well received and has been followed by ten group-based telephone consultations with an expert from phoenix Australia. A formal evaluation of the program is examining expected changes over time of practitioners’:

• efficacytodeliverprolongedexposure• expectationsregardingpatientoutcomes• frequencyofprolongedexposureusewithclients• experienceofthetrainingandsupportprogram.

Viewing Objectionable Materials

the Australian Border Force (ABF), part of the Department of Immigration and Border protection (DIBp), engaged phoenix Australia to develop and provide training for its Child exploitation investigators to help reduce their risk of psychological harm from viewing objectionable materials in the course of their work. last year, in collaboration with ABF, phoenix Australia developed a two-day training program that integrates skill training in psychological coping strategies with learning how to record and rate objectionable materials to meet prosecutorial requirements. the training is delivered within a supportive and controlled environment and is built around a graduated viewing paradigm, where participants are gradually exposed to increasingly graphic and/or disturbing material. Viewing sessions are interspersed with skills training in coping strategies and discussions on trauma impacts and ways to minimise risk.

this year, we continued to deliver the training and also delivered an adapted pilot training for Counter terrorism Investigators and two workshops for managers. to date, 17 training courses have been delivered, and over 80 Investigators and Managers have been trained. the training has been universally endorsed by all participants.

Inquiries have been received from other sections within DIBp, as well as from other law enforcement jurisdictions doing similar work, to have the training modified for their purposes.

Managing Sensitive Conversations

the Managing Sensitive Conversations training has been delivered by phoenix Australia over a number of years in the context of DVA’s and Defence’s increased focus on the impact of sexual and institutional abuse among serving and ex-serving personnel. this year DVA contracted phoenix Australia to extend the existing training program by developing more comprehensive materials and training about the impacts of institutional abuse in the ADF and what factors promote institutional abuse. Materials on the impact of working with survivors of abuse on frontline service providers were also revised and improved. training sessions were delivered to DVA compensation staff and complex case coordinators in Melbourne, Sydney and Brisbane. Materials developed for the DVA online internal information platform supplemented the training.

Trauma Informed Care

phoenix Australia continues to expand its training and clinical supervision service offerings in the area of trauma Informed Care (tIC). phoenix Australia’s tIC program stems from a critical need for a flexible set of tools to support early engagement, stabilisation, and recovery work within clinical and community services. the program supports workers to better understand trauma and its biopsychosocial impacts, and equips them to recognise trauma-related mental health needs, convey psychoeducation, manage trauma disclosure, and provide recovery-oriented brief interventions.

this year, we delivered training and consultation services to practitioners from sectors such as alcohol and drug


treatment, adult and adolescent mental health, refugee and asylum seeker support, community health, and youth-focussed services. An emerging need for this training is in supporting the work of legal practitioners who are working in community, specialist humanitarian, and pro-bono capacities, to assist them to better recognise and manage the impact of trauma on vulnerable individuals navigating complex legal systems.

Phoenix Australia public training program

In 2017 phoenix Australia’s expanded public training programs were delivered around Australia. Forty-two training events were scheduled, aimed at mental health, health, welfare and lay personnel who support and treat individuals who have experienced the impact of psychological trauma.

the new Anger and trauma training workshops have been well attended and received. the training provides a model to better understand anger, and a set of flexible, effective interventions to address problematic anger in trauma-affected clients.

the two well established trauma-Focussed psychological therapy training programs (for therapists working with children, and with adults) provide the necessary skills to treat ptSD and related conditions. the Cognitive processing therapy program provides training in another evidence-based therapy for ptSD. these training programs include three small-group consultations following the workshop to support practitioners to implement new skills in their practice.

the neuropsychological Impact of trauma workshop provides participants with insights into the cognitive impairments commonly associated with trauma and ptSD, and helps them to identify these deficits and consider the practical implications for treatment planning.

trauma Informed Care training provides a framework for understanding, responding to, and aiding recovery from trauma-related impacts. psychological First Aid training is suited to those who provide support in the immediate aftermath of potentially traumatic events in the field (e.g., natural disaster) or within organisational settings (e.g., schools).

Psychological First Aid training

psychological First Aid (pFA) is a practical, flexible, and recommended approach to helping people in the immediate aftermath of a traumatic event, such as a disaster, workplace accident, or assault. Increasingly, organisations are wanting their staff and volunteers trained in post-incident response. phoenix Australia has provided tailored pFA training to a wide number of organisations, including the Department of Foreign Affairs and trade, Western Australia police, Department of Fire and emergency Services, Department of parks and Wildlife, life Saving Victoria, and St John Ambulance new South Wales.

Trauma-Focussed Psychological Therapy training for ACT providers

ACt Mental Health, Justice Health and Alcohol & Drug Services, engaged phoenix Australia to run a training and consultation program for local providers working with children and adults with ptSD and other posttraumatic mental health problems. the training programs provided practitioners with the confidence to use evidence-based interventions with their clients, whether their condition is related to single or repeated traumatic experiences.

Review of Australian Transport Safety Bureau training

the Australian transport Safety Bureau (AtSB) is Australia’s national transport safety investigator. the AtSB previously engaged phoenix Australia to develop the AtSB ‘Critical incident and operational stress management’ training course. this year, we were asked to review and update the existing course materials to ensure that they continue to reflect current best practice and meet the needs of AtSB training facilitators and investigators.

GP Online Training - Working with Veterans with Mental Health Problems

phoenix Australia previously developed an online training program for Gps in collaboration with DVA and the Royal Australian College of General practitioners. A focus of the program is practical strategies and resources to assist veterans and their families with mental health issues. Working with Veterans with Mental Health problems is available on the RACGp training website, gplearning. Monitoring of enrolments and usage has been underway since its release in late 2014.

CPT Sustainability

this project assessed the sustained delivery of Cognitive processing therapy following initial implementation within VVCS. evaluation findings showed that a majority of practitioners used Cpt or another evidence-based therapy for ptSD, and that clients receiving Cpt reported significant improvements in their ptSD symptoms.

Phoenix Australia Supervision

phoenix Australia has provided high quality supervision to a range of professionals and organisations. of note, we provided VVCS staff across Australia with regular group-based supervision to help support their use of Cognitive processing therapy for clients with ptSD.


On 3rd February 2017 the Minister for Veterans’ Affairs and Defence Personnel, the Hon Dan Tehan MP officially launched the RESTORE trial – an Australian-first research program led by Phoenix Australia that will help improve treatment for current and former Australian Defence Force (ADF) members who have posttraumatic stress disorder (PTSD).

the two-year Rapid exposure Supporting trauma Recovery (ReStoRe) trial is assessing whether delivering the gold standard prolonged exposure (pe) therapy over an intensive two-week period will provide equal or better mental health outcomes than the current form that involves therapy over three months. this is the first Australian trial of intensive prolonged exposure (Ipe) treatment and Australia’s largest randomised controlled trial of ptSD treatment. the trial will recruit 200 current and former ADF members across three states – Victoria, new South Wales and Queensland, and is being conducted at phoenix Australia in Melbourne, the Veterans and Veterans Families Counselling Service (VVCS) offices in Melbourne, Brisbane and Sydney, and the ADF Centre for Mental Health in Sydney.

A partnership grant to conduct the ReStoRe trial was awarded by the national Health and Medical Research Council (nHMRC) to the Departments of Veterans’ Affairs (DVA) and Defence and phoenix Australia.

Highlight EventLaunch of RESTORE PTSD Treatment Trial


the trial is a collaboration not only between nHMRC, DVA, Defence, VVCS and phoenix Australia, it also involves expert investigators from across the country: professors Richard Bryant, Alexander McFarlane and Malcolm Battersby; and it also engages therapists from a range of clinical backgrounds and services.

Minister tehan spoke at the launch about ReStoRe being part of the Government’s drive to improve the mental health of current and former ADF personnel. “the outcomes of the trial will be incredibly important in shaping how the Departments of Veterans’ Affairs and Defence approach the future delivery of mental health care for Australia’s military personnel and veterans. It will help improve our understanding of ptSD and how best to treat it, which will benefit our veterans and the broader Australian community.”

Veteran Mr Chris May was diagnosed with ptSD after his second tour of Afghanistan and was an inspiring speaker at the launch. He told of his experience of being wounded by a roadside bomb, and subsequently being diagnosed with ptSD. Chris was eventually treated with standard pe, which “assisted me in confronting some of my most difficult memories in a way that was supportive, safe and professional. For me, it has proven to be very effective, and though I still have bad days, life is getting better. ptSD doesn’t need to control your life, it can, with effective treatment and management be subdued enough for you to love your family, enjoy time with your friends, return to work or just live your life”. this is the outcome that the ReStoRe trial aims to achieve.

Further information on the RESTORE trial, including how to get involved, can be found on the Phoenix Australia website.


Publications, Presentations and Dissemination

Journal Articles PublishedBowman, S., Alvarez-Jimenez, M., Wade, D., Howie, L., & McGorry, P. (2017). The positive and negative experiences of caregiving for siblings of young people with first episode psychosis. Frontiers in Psychology, 8(730). doi.org/10.3389/fpsyg.2017.00730Brand, R.M., Chisholm, K., Terhaag, S., Forbes, D., Holmes, A., & O’Donnell, M. (2017). Understanding the early support needs of survivors of traumatic events: The example from severe injury survivors. Psychological Trauma: Theory, Research, Practice and Policy. doi: 10.1037/tra0000274 [epub ahead of print]Bryant, R., McFarlane, A., Silove, D., O’Donnell, M., Forbes, D., & Creamer, M. (2016). The lingering impact of resolved PTSD on subsequent functioning. Clinical Psychological Science, 4,493-498. doi: 10.1177/2167702615598756Byllesby, B.M., Durham, T.A., Forbes D., Armour, C., & Elhai, J. (2016). An investigation of PTSD’s core dimensions and relations with anxiety and depression. Psychological Trauma: Theory, Research, Practice, and Policy, 8(2), 214-217. doi: 10.1037/tra0000081Durham, T.A., Byllesby, B.M., Armour, C., Forbes, D., & Elhai, J. (2016). Relations between anger and DSM-5 posttraumatic stress disorder symptoms. Psychiatry Research, 244, 7. doi: 10.1016/j.psychres.2016.08.004Fletcher, S., O’Donnell, M., & Forbes, D. (2016). Personality and trajectories of posttraumatic psychopathology: A latent change modelling approach. Journal of Anxiety Disorders, 42, 9. doi: doi.org/10.1016/j.janxdis.2016.05.003Forbes, D., O’Donnell, M., & Bryant, R. (2017). Psychosocial recovery following community disasters: An international collaboration. Australian & New Zealand Journal of Psychiatry, 51(7), 2. doi: 10.1177/0004867416679737Gallagher, H., Lusher, D., Gibbs, L., Pattison, P., Forbes, D., Block, K., Harms, L., MacDougall, C., Kellett, C., Ireton, G., & Bryant, R. (2017). Dyadic effects of attachment on mental health: Couples in a postdisaster context. Journal of Family Psychology, 31, 192-202. doi: 10.1037/fam0000256Nickerson, A., Creamer, M., Forbes, D., McFarlane, A., O’Donnell, M., Silove, D., Steel, Z., Flemingham, K., Hadzi-Pavlovic, D., & Bryant, R. (2017). The longitudinal relationship between posttraumatic stress disorder and perceived social support in survivors of traumatic injury. Psychological Medicine, 47(1). doi:10.1017/S0033291716002361O’Donnell, M., Alkemade, N., Creamer, M., Mc Farlane, A., Silove, D., Bryant, R., Felmingham, K., Steel, Z., & Forbes, D. (2016). A longitudinal study of Adjustment Disorder after trauma. American Journal of Psychiatry, 173(12), 8. doi: 10.1176/appi.ajp.2016.16010071Phelps, A., Varker, T., Metcalf, O., & Dell, L. (2017). What are effective psychological interventions for veterans with sleep disturbances? A Rapid Evidence Assessment. Military Medicine, 182(1), 1541-1550. doi: 10.7205/MILMED-D-16-00010Sunderland, M., Carragher, N., Chapman, C., Mills, K., Teesson, M., Lockwood, E., Forbes, D., & Slade, T. (2016). The shared and specific relationships between exposure to potentially traumatic events and transdiagnostic dimensions of psychopathology. Journal of Anxiety Disorders, 38, 102-109. doi:10.1016/j.janxdis.2016.02.001Wade, D., Mewton, L., Varker, T., Phelps, A., & Forbes, D. (2016). The impact of potentially traumatic events on the mental health of males who have served in the military: Findings from the Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 51(7). doi.org/10.1177/0004867416671413Whittle, S., Vijayakumar, N., Simmons, J.G., Dennison, M., Schwartz, O., Pantelis, C., Sheeber, L., Byrne, M.L., & Allen, N.B. (2017). Role of positive parenting in the association between neighborhood social disadvantage and brain development across adolescence. JAMA Psychiatry, 74(8), 824-832. doi:10.1001/jamapsychiatry.2017.1558Journal Articles In PressBryant, R., Creamer, M., O’Donnell, M., Forbes, D., Mc Farlane, A., Silove, D., & Hadzi-Pavlovic, D. (in press). The emergency of posttraumatic stress disorder: A network analysis of acute and chronic posttraumatic stress symptoms. JAMA Psychiatry.

Bryant, R., Gibbs, L., Gallagher, H., Pattinson, P., Lusher, D., MacDougall, C., Harms, L., Block, K., Sinnott, V., Ireton, G., Richardson, J., & Forbes, D. (2017). Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires. Australian and New Zealand Journal of Psychiatry, 1-10. doi: 10.1177/0004867417714337Bryant, R., Gallagher, H.G., Waters, E., Gibbs, L., Pattison, P., MacDougall, C., Harms, L., Block, K., Baker, E., Sinnott, B.A., Ireton, G., Richardson, J., Forbes, D., & Lusher, D. (in press). Mental health and social networks following disaster. American Journal of Psychiatry.Phelps, A.J., Steel, A., Metcalf, O., Alkemade, N., Kerr, K., O’Donnell, M., Nursey, J., Cooper, J., Howard, A., Armstrong, R., & Forbes, D. (in press). Key patterns and predictors of response to treatment for military veterans with posttraumatic stress disorder: A growth mixture modelling approach. Psychological Medicine. Reifels, L, Mills, K, Dückers, M, & O’Donnell, M. (in press). Psychiatric epidemiology and disaster exposure in Australia. Epidemiology and Psychiatric Sciences.

Conference Presentations – Invited Cooper, J. (2017, May). Suicide amongst veterans and successful transition to civilian life. Invited presentation to the Association of Pacific Rim Universities Symposium 2017. University of Southern California, Los Angeles. Forbes, D. (2017, June). Best practice support following occupational violence. Invited presentation to the DHHS Violence in Healthcare Seminar for CEO/Board Chairs, Melbourne. Forbes, D. (2016, August). Closing presentation to the Department of Psychiatry Annual Research Symposium, the University of Melbourne. Forbes, D. (2016, August). Current practice and future directions in the treatment of PTSD. Invited presentation to the Guangdong Psychiatrist Association Annual Conference, Zhanjiang, China. Forbes, D. (2016, October). Optimising mental health and quality of life for Australia’s military personnel and veterans with PTSD: Establishing a randomised controlled trial. Paper presented at the Australasian Military Medicine Association Conference, Melbourne.Forbes, D. (2017, February). Panel member, Psychosocial perspectives and practice supporting individual recovery after traumatic events. Australian Institute for Disaster Resilience, Melbourne. Forbes, D. (2017, March). Responding to trauma. Keynote presentation to the International Medicine in Addiction 2017 Conference, Sydney. Forbes, D. (2017, May). Chair, The clinical context of PTSD. Plenary session at the International Conference on Trauma and Mental Health, Jerusalem, Israel. Forbes, D. (2017, May). Understanding anger in veterans. Invited presentation to the DVA National Information Provider Session, Melbourne. O’Donnell, M. (2016, November). An overview of interPAR – the International Program for Promoting Adjustment and Resilience. Workshop presented at the Korean Society for Traumatic Stress Studies, Seoul, South Korea.O’Donnell, M. (2016, August). Early interventions after trauma. Paper presented at the Department of Psychiatry Annual Research Symposium, the University of Melbourne.O’Donnell, M. (2016, November). Early intervention after trauma exposure – where are we at? Keynote presentation to the Korean Society for Traumatic Stress Studies, Seoul, South Korea. O’Donnell, M. (2016, August). Effective treatments for veteran mental health. Paper presented at the 2016 Military Veterans Mental Health: Trauma & Creative Arts Therapies Research Colloquium, Melbourne. O’Donnell, M. (2016, August). Panel member, Enhancing mental health via increasing resilience to adversity. Department of Psychiatry Annual Research Symposium, the University of Melbourne. Phelps, A. (2016, October). Building capacity and equipping for the future. Paper presented at the Tri-Nations Defence Community Health and Wellbeing Symposium, Adelaide.


Phelps, A. (2016, July). Cumulative trauma and impacts on work and home. Paper presented at the Emergency Management Conference, Melbourne.Phelps, A. (2017, March). Prevention and treatment of PTSD: What do we know and where are the gaps? Invited presentation to the Mental Health Strategy for First Responders Conference, Melbourne. Wade, D. (2016, September). 2016 military and veteran mental health. Paper presented at the Royal District Nursing Service Institute Showcase, Melbourne. Wade, D. (2016, August). Early support following critical incidents. Paper presented at the Lifesaving Conference, Melbourne. Wade, D. (2017, March). How to provide psychological first aid for first responders. Workshop presented at the Mental Health Strategy for First Responders Conference, Melbourne.

Conference Presentations – Peer Reviewed Couineau A.L., Kartal, D., Nixon, R., Wade D., Forbes, D. (2016). Sustainability of Cognitive Processing Therapy for PTSD 2.5 years after its implementation across national mental health service for veterans. Paper presented at the 32nd Meeting of the International Society for Traumatic Stress Studies, Dallas, USA.Couineau A.L., Poerio L., Kartal D., Nixon R., Wade, D., Forbes D. (2016). Sustainability of Cognitive Processing Therapy for PTSD in VVCS. Paper presented at the Australasian Conference on Traumatic Stress (ACOTS), Gold Coast. Lau, W., Cash, R., Couineau, A.L., Armstrong, R., O’Donnell, M., Phelps, A., Varker, T., Kartal, D., Wade, D., Dell, L., & Nursey, J. (2016, September). Applying trauma-informed care across service settings. Paper presented at the Australasian Conference on Traumatic Stress (ACOTS), Gold Coast. Nursey, J., Lau, W., Kartal, D., Howard, A., & Couineau, A.L. (September, 2016). Trauma informed care capabilities for mental health service front line staff working with people from refugee background, including asylum seekers. Paper presented at the Australasian Conference on Traumatic Stress (ACOTS), Gold Coast.O’Donnell. M., Alkemade, N., Creamer, M., McFarlane, A., Silove, D, Bryant, R., Felmingham, K., Steel, Z., & Forbes, D. (2016, November). A longitudinal study of adjustment disorder. Paper presented at the 32nd Meeting of the International Society for Traumatic Stress Studies, Dallas, USA.O’Donnell, M, Alkemade, N., Creamer, M., McFarlane, A., Silove, D, Bryant, R., Felmingham, K., Steel, Z., Forbes, D. (2016, September). Adjustment disorder after trauma. Paper presented at the 19th Australasian Conference for Traumatic Stress (ACOTS), Gold Coast. Phelps, A. (2016, October). Sleep factors underpinning nightmares of PTSD: An ambulatory PSG study. Paper presented at the Australasian Military Medicine Association Conference, Melbourne. Terhaag, S., Phelps, A., Cleland, H., Alkemade, N., Pfitzer, B., Katona, L., Ellen, S., & O’Donnell, M. (2016, September). GLOW Study: Longitudinal study to assess psychological contributors to mental health outcomes after burn injury. Paper presented at the Australasian Conference on Traumatic Stress (ACOTS), Gold Coast. Terhaag, S., Phelps, A., Cleland, H., Alkemade, N., Pfitzer, B., Katona, L., Ellen, S., & O’Donnell, M. (2016, October). GLOW Study: Longitudinal study to assess psychological contributors to mental health outcomes after burn injury. Paper presented at the Australian and New Zealand Burns Association (ANZBA) Annual Conference, Auckland, New Zealand.Wade, D. & Costello, J. (2016, October). Defence Mental Health Risk Assessment Training (MHRAT) Program. Australasian Military Medicine Association Conference, Melbourne.Wade, D., Varker, T., Kartal, D., Hetrick, S., O’Donnell, M., & Forbes, D. (2016, November) Gender difference in outcomes following trauma-focused interventions for PTSD: Systematic review and meta-analysis. Paper presented at the 32nd Meeting of the International Society for Traumatic Stress Studies, Dallas, USA.

Project Reports

Couineau A.L., Kartal, D., Ralph N., Wade D., Forbes, D. (2016). Sustainability of Cognitive Processing Therapy (CPT) for clients presenting with PTSD symp-tomatology in VVCS. Report prepared for the Department of Veterans’ Affairs. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Crane, M.F., Dell, L., Fredrickson, J., Alkemade, N., Lewis, V., O’Donnell, M.L., & Forbes, D. (2016). The Longitudinal Australian Defence Force Study Evaluating Resilience – Detailed Report 3: Exploring social support in the initial years of military service. Report prepared for the Australian Government Department of Defence. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Dell, L. (2017). Evaluation Framework for Mental Illness Education ACT 2016-2017. Report prepared for Mental Illness Education ACT. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Dell. L., Metcalf, O., Harvey, S., & Phelps, A. (2016). Ambulance Victoria psycho-social survey 2016. Report prepared for Ambulance Victoria. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Dell, L., Nursey, J., Cooper, J., Harvey, S.B., & Phelps, A. (2017). Ambulance Victoria – Review of psychology and support services. Report prepared for Ambulance Victoria. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Forbes, D., Van Hooff, M., Lawrence-Wood, E., Sadler, N., Hodson, S., Benassi, H., Hansen, C., Avery, J., Varker, T., O’Donnell, M., Phelps, A., Frederickson, J., Sharp, M., Searle, A. and McFarlane, A. (2017). The Transition & Wellbeing Research Programme: Mental Health and Wellbeing Transition Study. Report 2: Pathways to Care. Report prepared for the Department of Veteran’s Affairs and the Department of Defence.

Howard, A., Armstrong, R., Metcalf, O., & Phelps, A. (2017). Trauma Recovery Programs (PTSD) – Clinical Data Collection: Final Report. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Howard, A., Ralph, N., & Wade, D. (2016). At Ease Professional annual review: Final report. Report prepared for the Department of Veterans’ Affairs. Mel-bourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Howard, A. & Wade, D. (2016-17). Department of Veterans’ Affairs online train-ing program on veterans’ mental health for Australian general practitioners. Progress reports prepared for the Department of Veterans’ Affairs. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

O’Donnell, M., Lau, W., Fredrickson, J., Blunt, J., Phelps, A., & Forbes, D. (2017). The interPAR pilot trial: International program for promoting adjustment and resilience after disaster – Final Report. Prepared for the Australian Government Department of Health. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

O’Donnell, M., Metcalf, O., & Varker, T. (2016). What are effective interventions for adjustment disorder? A Rapid Evidence Assessment. Report prepared for the Australian Government Department of Veterans’ Affairs. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Phelps, A., Varker, T., Fredrickson, J., & Forbes, D. (2016) Military and veteran mental health literature scan: 2015. Report prepared for the Department of Veterans’ Affairs. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.

Phelps, A., Varker, T., Metcalf, O., Chisholm, K., & Forbes, D. (2016) The mental health of Australian first responders: Rapid mapping of current research. Report prepared for beyondblue. Melbourne: Phoenix Australia Centre for Posttraumatic Mental Health.


Our Staff

Management Team

Professor David Forbes Director

Greg Ridder Senior Corporate Services Manager

Dr Andrea Phelps Deputy Director Director, policy & Service Development

Associate Professor Meaghan O’Donnell Director, Research

Associate Professor Darryl Wade Director, education & training

Dr John Cooper Consultant psychiatrist

Senior Staff

Dr Richard Cash Senior Clinical Specialist

Anne-Laure Couineau Senior Clinical Specialist

Dr Lisa Dell Senior Research Fellow

Jane Nursey Senior Clinical Specialist

Our People

Renée Armstrong Research Assistant

Dr Rachel Brand Research Fellow I

Dr Katherine Chisholm Research Fellow I

Dr Megan Dennison Research Fellow I

Suzie Firth Corporate Services

Dr Julia Fredrickson Research Fellow I

Jaiganesh Govinda Swamy Finance officer

Kari Gibson Research Assistant

Alexandra Howard Clinical Specialist

Maria Humphries Communications and projects Coordinator

Dzenana Kartal Research Fellow I

Dr Holly Knight Research Fellow I

Dr Winnie Lau Research Fellow II

Lee Merzel executive Assistant

Dr Olivia Metcalf Research Fellow I

Dr Kim Murray Research Fellow I

Amanda Pearce Research Assistant

Dr Naomi Ralph Research Fellow I

Daniel Redman It officer

Rebecca Sheehan Business Services officer

Dr Sonia Terhaag Research Fellow I

Dr Tracey Varker Research Fellow II

Loretta Watson Research Assistant

Honorary Staff Members

Professor Richard Bryant professorial Fellow

Professor Mark Creamer professorial Fellow

Dr Peter Elliott Senior Fellow

Associate Professor Virginia Lewis principal Fellow

Dr Lynda Matthews Senior Fellow

Professor Reg Nixon principal Fellow

During the 2016-2017 financial year, we welcomed Research Fellows Megan Dennison, Holly Knight and Kim Murray, and Research Assistants Kari Gibson, Amanda pearce and loretta Watson.

Phoenix Australia Employees as at 30 June 2017


Governance and Management

Board of Management Membership and Meetings

the phoenix Australia Board of Management is led by an independent chair and includes representatives from the Department of Veterans’ Affairs, the Australian Defence Force and the university of Melbourne. It also includes an independent secretary, one further independent director and the executive positions of Director of phoenix Australia and Senior Corporate Services Manager.

Board Members as at 30 June 2017

Mr Michael Strong

Professor David Forbes

Ms Sue Campion

Mr Paul Dolan

Professor Ian Everall

Major General Mark Kelly Ao DSC

Mr Greg Ridder

Air Vice-Marshal Tracey Smart AM

AttendanceAGM attendance

30/08/16 26/10/16 07/12/16 21/02/17 10/05/17 26/06/17

Mr Strong • • • • • •

Professor Forbes • • • • • •

Ms Campion • • • •

Mr Dolan • • • • • •

Professor Everall • • • • • •

Major General Kelly • • • •

Mr Ridder • • • • •

Air Vice-Marshal Smart • • • • • •

•

28 Annual Report 2016 - 2017 28 Annual Report 2016 - 2017

Board Appointments, Cessations, Resignations and Re-appointments

the following movements on the Board of Management occurred during the 2016-17 year:

• MrStrongwasreappointedasaPhoenixAustraliaBoardmemberforaperiodofthreeyears from 10 December 2016 – 9 December 2019.

• ProfessorForbes’appointmentasaPhoenixAustraliaBoardmemberwasextendedtothe full extent of a period of three years from 27 February 2015 – 26 February 2018. the unusual timeframe reflects his employment contract renewal effective 1 January 2017.

• MrRidderwasreappointedasaPhoenixAustraliaBoardmemberforaperiodofthreeyears from 14 April 2017 – 13 April 2020.

• MrDolanwasreappointedasaPhoenixAustraliaBoardmemberforaperiodofthreeyears from 30 April 2017 – 29 April 2020.

the following movements on the Board of Management occurred between the end of the financial year and the signing of the Board of Management Report on 23rd october 2017:

• MsSueCampionresignedfromtheBoardon5July2017

• ProfessorIanEverallresignedfromtheBoardon30August2017

• MsVeronicaHancockwasappointedtotheBoardon30August2017

• ProfessorMalcolmHopwoodwasappointedtotheBoardon30August2017

Senior Staff Appointments

professor Forbes’ employment contract was renewed with effect from 1 January 2017 for a period of five years.

Significant Events

Annual Report 2016 - 2017 29Annual Report 2016 - 2017 29

Board of Management Report For the year ended 30 June 2017

the Board of Management submits the financial accounts of phoenix Australia Centre for posttraumatic Mental Health Inc for the financial year ended 30 June 2017.

Board Members

the Board of Management in office at any time during or since the end of the year are:

Board members have been in office since the start of the financial year to the date of this report unless otherwise noted.

Principal Activities

the principal activities of the Association during the year were to build the capability of individuals, communities and organisations to prevent, recognise and reduce the adverse mental health effects of trauma. the Association achieves this through world class research, policy and service development, and education and training.

Operating Results

the operating result for the year was a surplus of $77,493. the Association is exempt from income tax.

Significant Changes in State of Affairs

In the opinion of the Board of Management, there were no significant changes in the state of affairs of the Association that occurred during the financial year under review not otherwise disclosed in this report.

After Balance Date Events

there has not arisen in the interval between the end of the financial year and the date of the report any item, transaction or event of a material and unusual nature that in the opinion of the Board is likely to substantially affect the operations of the Association, the results of those operations or the Association’s state of affairs in future financial years.

Future Developments

the Association will continue to carry on the principal activities noted above. there are no likely developments in the activities in future years which will affect the results and therefore require disclosure.

Indemnification and Insurance of Board

During the year, the Association paid insurance premiums to Comcover to indemnify its current Board of Directors and officers for the professional risks associated with their responsibilities and roles as Board of Directors and officers of the Association.

Signed in accordance with a resolution of the Board of Management on 23rd october 2017.

Michael Strong Chair


Mr Michael Strong Professor David Forbes Ms Sue Campion Mr Paul Dolan

Professor Ian Everall Major General Mark Kelly Ao DSC Mr Greg Ridder Air Vice-Marshal Tracy Smart AM


notes 2017 2016

$ $

Income

DVA Core Funding 13 1,318,997 1,291,868

policy and Service Development Income 717,980 478,530

Research Income 1,824,516 1,807,796

training and education Income 728,798 910,721

publications and Audio Visual Sales 7,620 11,060

Donations 2,362 1,215

Income from other activities 14 53,474 24,806

Total income 4,653,747 4,525,996

Expenditure

Consultants Fees 12 (a) 1,222 49,966

Contractors Fees 12 (b) & (c) 494,278 678,554

employment expense 3,291,619 3,068,272

Depreciation and Amortisation 60,843 62,104

Independent Board Member Fees 44,000 44,000

printing and production 36,600 53,683

travel and Accommodation 154,914 163,499

Rent of premises 177,255 174,441

General expenses 348,272 383,179

Total Expenditure 4,609,003 4,677,698

Operating profit / (loss) 44,744 (151,702)

Other Income

Interest Received 30,218 40,188

premises Sublease 2,531 844

Net surplus / (deficit) for the year 77,493 (110,670)

Accumulated surplus at the beginning of the financial year 1,174,462 1,285,132

net surplus / (deficit) for the year 77,493 (110,670)

Accumulated surplus at the end of the financial year 1,251,955 1,174,462

Statement of Profit Or Loss and Other Comprehensive Income For the year ended 30 June 2017

STATEMENT OF CHANGES IN EQUITY

the Statements should be read in conjunction with the notes to the accounts.


notes 2017 2016 $ $

Current Assets

Cash and Cash equivalents 2 1,410,795 1,362,384

trade and other Receivables 3 1,122,386 417,420

other Assets 4 295,458 126,082

Work in progress / Advance 1(b) 414,573 485,402

Total Current Assets 3,243,212 2,391,288

Non-Current Assets

property, plant & equipment 5 46,301 68,344

Intangible Assets 6 79,313 101,865

Total Non-Current Assets 125,614 170,209

Total Assets 3,368,826 2,561,497

Current Liabilities

trade and other payables 7 1,527,677 785,981

Borrowings 8 4,622 5,783

other liabilities 9 584,572 595,271

Total Current Liabilities 2,116,871 1,387,035

Net Assets 1,251,955 1,174,462

Funds

Accumulated Surplus 1,251,955 1,174,462

Total Funds 1,251,955 1,174,462

Statement of Financial Position As at 30 June 2017

the Statement of Financial position should be read in conjunction with the notes to the accounts.


notes 2017 2016

$ $

Cash flows from operating activities

Receipts from sales and activities 61,094 35,866

operating income received 3,876,988 5,775,116

payments to suppliers and employees (3,903,644) (5,825,284)

Net cash provided / (used in) operating activities 10 (b) 34,438 (14,302)

Cash flows from investing activities

Interest received 30,218 40,188

payments for furniture and equipment (3,985) (28,854)

payments for website development (12,260) (99,498)

Net cash provided by / (used in) investing activities 13,973 (88,164)

Net increase / (decrease) in cash held 48,411 (102,466)

Cash and cash equivalents at the beginning of the financial year 1,362,384 1,464,850

Cash and cash equivalents at the end of the financial year 10 (a) 1,410,795 1,362,384

Statement of Cash Flows For the year ended 30 June 2017

the Cash Flow Statement should be read in conjunction with the notes to the accounts.


Notes to the Financial Statements For the year ended 30 June 2017

Note 1: Statement of Significant Accounting Policies

this financial report is a special purpose report prepared for use by the Board of Management to satisfy the financial reporting requirements of the Associations Incorporation Reform Act 2012. the Board of Management has determined that the Association is not a reporting entity.

the financial report covers phoenix Australia Centre for posttraumatic Mental Health Inc as an individual entity and as an Association incorporated in Victoria under the Associations Incorporation Reform Act 2012.

the report has been prepared in accordance with the requirements of the Associations Incorporation Reform Act 2012 and the following Australian Accounting Standards:

AASB 101: presentation of Financial Statements

AASB 107: Statement of Cash Flows

AASB 108: Accounting policies, Changes in Accounting estimates and errors

AASB 110: events after the Reporting period

AASB 116: property, plant and equipment

AASB 117: leases

AASB 118: Revenue

AASB 138: Intangible Assets

no other Australian Accounting Standards, Australian Accounting Interpretations or other authoritative pronouncements of the Australian Accounting Standards Board have been applied in the preparation of this financial report.

the financial report is prepared on an accrual basis and is based on historical costs and does not take into account changing money values or, except where specifically stated, current valuations of non-current assets.

the following is a summary of the material accounting policies adopted by the Association in the preparation of the financial report. the accounting policies have been consistently applied, unless otherwise stated.

(a) Property, Plant & Equipment each class of plant and equipment is carried at cost, less, where applicable, any accumulated depreciation.

Furniture and Office Equipment Furniture and office equipment is measured on a cost basis.

Depreciation All fixed assets are depreciated on a diminishing value basis over their useful lives to the Association.

Intangible Assets Assets related to systems and software are carried out at cost, less accumulated amortisation. Systems and software costs are amortised on a straight line basis over 5 years.

Impairment of Assets Assets are assessed for impairment annually. Any excess of an asset’s carrying amount over its recoverable value is recognised immediately as an expense in profit or loss.


(b) Unearned Income

the liability for unearned income is the unutilised amount of grants received on the condition that specified services are delivered or conditions are fulfilled. Whilst agreed services are usually provided or the conditions usually fulfilled within 12 months of receipt of the grant, where some portion of the agreed services is yet to be provided as at the end of the financial year, a provision is recognised based on the estimated amount of services that will be provided after year end.

Work in Progress / Advance

Represents any preliminary work undertaken for a project where the contract is yet to be signed or when work under contract is in progress but not yet billed.

(c) Taxation

Income Tax

the Association is a tax concession charity for the purposes of Australian taxation legislation and is therefore exempt from income tax. this exemption has been confirmed by the Australian taxation office.

Goods and Services Tax (GST)

Revenues, expenses and assets are recognised net of the amount of GSt except where the amount of GSt incurred is not recoverable from the Australian taxation office, in which case it is recognised as part of the cost of acquisition of an asset or as part of an item of expense.

(d) Operating Leases

lease payments for operating leases, where substantially all the risks and benefits remain with the lessor, are recognised as expenses on a straight-line basis over the lease term.

Note 2: Cash and Cash Equivalents

2017 2016

$ $

petty Cash 157 774

Cash at Bank - nAB public Fund Account 42,159 39,672

Cash at Bank - nAB Cheque Account 765,617 467,652

term Deposit - nAB (Bank Guarantee) 88,173 85,688

term Deposit - nAB (Investment 1) 514,689 503,723

term Deposit - nAB (Investment 2) - 264,875

1,410,795 1,362,384


Note 3: Trade and Other Receivables

notes 2017 2016

$ $

Current

trade Debtors 1,117,719 399,917

Security Deposit 4,667 17,503

1,122,386 417,420

Note 4: Other Assets

Current

Interest Accrued 9,751 7,660

prepayments 31,751 95,846

other Current Assets 15 253,956 22,576

295,458 126,082

Note 5: Property, Plant and Equipment

Furniture & office equipment 510,828 506,843

less: Accumulated Depreciation (464,527) (438,499)

46,301 68,344

Note 6: Intangible Assets

project Management System 59,125 59,125

less: Accumulated Amortisation (59,114) (54,339)

Website Development 111,759 99,498


toolbox Database and Report System 37,501 37,501


79,313 101,865

Note 7: Trade and Other Payables

Current

trade Creditors 47,192 71,500

Accruals 1,364,229 657,928

GSt owing 116,256 56,553

1,527,677 785,981

Note 8: Borrowings

Current

Credit Cards 4,622 5,783

4,622 5,783


Note 9: Other Liabilities

2017 2016

$ $

Current

unearned Income 584,572 595,271

584,572 595,271

Note 10: Notes to the Cash Flow Statement

(a) Reconciliation of cash and cash equivalents

For the purposes of the Cash Flow Statement, cash and cash equivalents includes cash on hand and in banks and investments in money market instruments, net of outstanding bank overdrafts. Cash and cash equivalents at the end of the financial year as shown in the Cash Flow Statement are reconciled to the related items in the Statement of Financial position as follows:

petty Cash 157 774

Cash at Bank - nAB public Fund Account 42,159 39,672

Cash at Bank - nAB Cheque Account 765,617 467,652

term deposit - nAB (Bank Guarantee) 88,173 85,688

term deposit - nAB (Investment I) 514,689 503,723

term deposit - nAB (Investment II) - 264,875

1,410,795 1,362,384

(b) Reconciliation of surplus / (deficit) for the year to net cash flows from operating activities

net surplus / (deficit) for the year 77,493 (110,670)

Depreciation 26,028 24,933

Amortisation of intangibles 34,813 37,171

net finance income (30,218) (40,188)

Changes in assets and liabilities, net of effects from acquisitions and disposals of business:

(Increase) / decrease in assets

trade and other receivables (704,966) 765,138

other assets (98,548) (83,181)

Increase / (decrease) in liabilities

trade and other payables 741,696 (1,123,819)

Borrowings (1,161) (3,534)

provisions (10,699) 519,848

Net cash from operating activities 34,438 (14,302)


Note 11: Lease Commitments and Bank Guarantee

2017 2016

$ $

(a) Lease Commitments

Current (less than 12 months) 182,328 179,811

non Current (more than 12 months) 64,121 246,449

246,449 426,260

the operating lease exists in relation to office rent. the lease is for a term of 5 years. Bank guarantees totalling $80,000 are in place at 30 June 2017 in respect of credit card facilities.

Note 12: Contractors and Consultants

(a) Consultants

person or company who undertakes a contract to provide specialised advice and/or labour to phoenix Australia. Consultants usually perform work outside of the skillsets available across phoenix Australia staff.

(b) Contractors

person or company who undertakes a contract to provide labour and/or materials to perform a service for and/or on behalf of phoenix Australia. Contractors usually perform overflow work that phoenix Australia would otherwise be able to perform itself given greater availability of internal resources.

(c) Contractors include Co-partners

A Co-partner is a person or company who undertakes a large portion of the work in a particular project, perhaps even a larger portion than that undertaken by phoenix Australia. Co-partners are hence project-specific. Co-partners usually perform major functions in a project that falls outside of the skillsets of phoenix Australia staff, although, phoenix Australia has been determined “lead” partner in these projects.

Note 13: DVA Core Funding

DVA provides financial assistance to phoenix Australia to provide a national base of expertise in veteran and military mental health to improve and maintain the health care and wellbeing of the veteran and defence force communities and provide support to DVA in respect of mental health policy, program development and service. the funding is acquitted similarly to other phoenix Australia projects, with its own budget and control measures to demonstrate fulfilment of funding purposes and objectives.

Note 14: Income from Other Activities

this includes income from donations, attendance at various meetings and other sundry income.

Note 15: Other Current Assets

this includes reimburseable expenses for project related activities, payments made for website development and renovation of clinic at Royal park which is currently in progress.


the Board of Management has determined that the Association is not a reporting entity.

the Board of Management has determined that this special purpose financial report should be prepared in accordance with the accounting policies described in note 1 to these financial statements.

In the opinion of the Board of Management:

1 the financial statements and notes to the financial statements for the year ended 30 June 2017 present fairly the financial position of the Association at 30 June 2017 and the results of its operations for the year then ended in accordance with the accounting policies described in note 1 to the financial statements.

2 there are reasonable grounds to believe the Association will be able to pay its debts as and when they become due and payable.

this declaration is made in accordance with a resolution of the Board and is signed for and on behalf of the Board on 23rd october 2017.

Board of Management Declaration

Michael Strong Chair



Opinion

We have audited the accompanying financial report, being a special purpose financial report, of phoenix Australia - Centre for posttraumatic Mental Health Inc. (the Association), which comprises the statement of financial position as at 30 June 2017, statement of profit or loss and other comprehensive income, statement of changes in equity, cash flow statement, a summary of significant accounting policies, other explanatory notes and the statement by the Board of Management.

In our opinion, the financial report of phoenix Australia - Centre for posttraumatic Mental Health Inc. presents fairly, in all material respects the financial position of the association as of 30 June 2017 and of its financial performance for the year then ended in accordance with the accounting policies described in note 1 to the financial statements.

Basis of Opinion

We conducted our audit in accordance with Australian Auditing Standards. our responsibilities under those standards are further described in the Auditor’s Responsibilities for the Audit of the Financial Report section of our report. We are independent of the association in accordance with the ethical requirements of the Accounting professional and ethical Standards Board’s ApeS 110 Code of ethics for professional Accountants (the Code) that are relevant to our audit of the financial report in Australia. We have also fulfilled our other ethical responsibilities in accordance with the Code.

Basis of Accounting and Restriction on Distribution

Without modifying our opinion, we draw attention to note 1 to the financial report, which describes the basis of accounting. the financial report has been prepared to assist phoenix Australia - Centre for posttraumatic Mental Health Inc. to meet the requirements of the Associations Incorporation Reform Act 2012. As a result, the financial report may not be suitable for another purpose. In conducting our audit, we have complied with the independence requirements of Australian professional ethical pronouncements.

Other Information

the Board of Management is responsible for the other information. the other information comprises the information in the Association’s annual report for the year ended 30 June 2017, but does not include the financial report and the auditor’s report thereon.

our opinion on the financial report does not cover the other information and we do not express any form of assurance conclusion thereon.

In connection with our audit of the financial report, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial report or our knowledge obtained in the audit or otherwise appears to be materially misstated. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard.

Board of Management’s Responsibility for the Financial Report

the Board of Management of the Association is responsible for the preparation and fair presentation of the financial report and have determined that the accounting policies described in note 1 to the financial statements, which form part of the financial report, are consistent with the financial reporting requirements of the Associations Incorporation Reform Act 2012 and are appropriate to meet the needs of the members. the Board of Management’s responsibilities also include establishing and maintaining internal control relevant to the preparation and fair presentation of the financial report that is free from material misstatement, whether due to fraud or error; selecting and applying appropriate accounting policies; and making accounting estimates that are reasonable in the circumstances.

Independent Auditor’s Report

To the Members of Phoenix Australia Centre for Posttraumatic Mental Health Inc.


Auditor’s Responsibility

our objectives are to obtain reasonable assurance about whether the financial report as a whole is free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with the Australian Auditing Standards will always detect a material misstatement when it exists.

Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of this financial report.

As part of an audit in accordance with the Australian Auditing Standards, we exercise professional judgment and maintain professional scepticism throughout the audit. We also:

•Identifyandassesstherisksofmaterialmisstatementofthefinancialreport,whetherduetofraudorerror,designandperform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. the risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

•Obtainanunderstandingofinternalcontrolrelevanttotheauditinordertodesignauditproceduresthatareappropriatein the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the association’s internal control.

•Evaluatetheappropriatenessofaccountingpoliciesusedandthereasonablenessofaccountingestimatesandrelateddisclosures made by the Board of Management.

•ConcludeontheappropriatenessoftheBoardofManagement’suseofthegoingconcernbasisofaccountingand,based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the association’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial report or, if such disclosures are inadequate, to modify our opinion. our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the association to cease to continue as a going concern.

•Evaluatetheoverallpresentation,structureandcontentofthefinancialreport,includingthedisclosures,andwhetherthefinancial report represents the underlying transactions and events in a manner that achieves fair presentation.

We communicate with the Board of Management of the association regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit.

CFMC Assurance Pty Ltd

Craig Silvester Director

Dated this 30th day of october 2017 at Melbourne.


Copyright © 2017. phoenix Australia Centre for posttraumatic Mental Health Inc.

All rights reserved. no part of this publication may be reproduced, stored in a retrieval system, or distributed, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission of the publisher.

published by phoenix Australia Centre for posttraumatic Mental Health Inc.

phone: +61 3 9035 5599 [email protected] www.phoenixaustralia.org

Design by www.memyselfandi.com.au

National Centre of Excellence in Posttraumatic Mental Health www.phoenixaustralia.org

level 3, Alan Gilbert Building 161 Barry Street, Carlton VIC 3053 phone: 03 9035 5599

www.phoenixaustralia.org

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