In short: Tasmanian veterans are forced to travel interstate to receive mental health care because no inpatient care is available. Advocates say veterans need care specific to their needs and they are being left behind.
What's next? There is no sign of a solution. The state government says it is working to make sure mental health care is accessible, but ultimately veterans' mental health services are a federal issue. The federal government says it funds access to existing services but states provide the infrastructure.
When he's bushwalking, Joshua Weir is far from the whirring of helicopters.
Even the sound of a diesel truck using its engine brakes can take him back to Iraq.
"It gives you that, 'Oh yeah, job's on', just for that second, but it's enough to give you, not an adrenaline boost, but a reminder, a trigger," Mr Weir said.
"And so walking in the bush … you don't often hear it. You just hear nature," he said.
Mr Weir returned to civilian life after 15 years of service, discharged for medical and mental health reasons.
He had served as a sergeant in the Royal Australian Army Medical Corps.
The deaths of fellow soldiers and atrocities at war weighed heavily on him.
He was anxious, depressed, suffering from PTSD and in chronic pain.
But to get help, he had to fly to Melbourne, despite the fact he had developed a severe fear of flying after his years as a helicopter medic.
Tasmania has no inpatient care or specific mental health services for veterans.
Instead, he spent 12 weeks at the Heidelberg Repatriation Hospital.
"Going to Melbourne, having the treatment facility there was akin to saving my life and others that I know,' he said.
"It was a very big inconvenience, I was coming off a medication at the time.
"If I'd been in my home state, close to home, it would have been much easier."
No inpatient beds for two decades
Tasmania is home to 17,515 veterans. That is 3.5 per cent of the population, the highest proportion of any state or territory, tied with the ACT.
Access to mental health care in Tasmania can be limited, even for those who have not served.
Psychologists have full books and one of the state's biggest providers of inpatient care, St Helen's Private Hospital, is shutting down.
Dr Jon Lane is one of very few psychiatrists in Tasmania who specialise in treating veterans, and he has to turn back referrals weekly.
He said it has been nearly 20 years since Tasmania had dedicated inpatient beds for veterans and first responders, and his patients needed to travel interstate for acute care.
"When you look at a typical mental health ward, particularly in the private system, there's a lot of noise, people running around there's a lot of stimulation going on and even though they try to keep it to a minimum, it's really hard for someone with that hyper-vigilance and increased sense of threat to be able to relax in that environment," Dr Lane said.
"We want to put people in hospital to get better, not to get freaked out and re-traumatised because someone came up behind them and touched them on the shoulder and then they lost it."
He said if veterans needed an acute admission locally, they faced a traumatising wait.
"One of my patients spent four days in emergency waiting for a bed because he was suicidal, and he couldn't go into a private hospital because he was suicidal," Dr Lane said.
"He was there for suicidality and the environment made him more suicidal."
He said that 12 dedicated, quarantined beds would be enough to service the veteran community, and first responders or emergency services personnel who may also struggle with PTSD.
"I don't think we can afford to have purely veteran-orientated services, but we certainly could when we start talking about emergency services personnel and their mental health care," he said.
'The community doesn't care if it's a federal or state issue': RSL
RSL Tasmania said it was agitating to make sure veterans did not have to travel interstate for care.
"That is possibly the worst thing you could do: we are isolating, we are making people remote, we are moving people away from their own communities and families," said chief executive John Hardy.
"None of that would be seen as a caring health plan."
Mr Hardy said he had raised the issue with the state government several times, only to be met with the response that veterans affairs was predominantly a federal issue.
"One suicide will affect up to 133 people in the community. That community doesn't care if it's a federal or a state issue, that's everyone's issue," Mr Hardy said.
The organisation's welfare services have seen a surge in demand.
It has expanded its team to take on a bigger caseload.
"Let's stop taking pictures of ANZAC day, and saying that we support veterans. OK— let's see what you can do."
Governments aim to ensure access to services
The state government said it was working to ensure mental health care was "accessible and available to the whole community".
"The Department of Health is working closely with RSL Tasmania on these important matters and to better understand how we can improve our mental health services to ensure they are meeting the needs of our community, including veterans, and improve connection and integration between national and state-based mental health services accessed by veterans," a spokesperson said.
But it said the federal government had agreed to be primarily responsible for mental health services for veterans, under the National Agreement for Mental Health and Suicide Prevention.
The federal government said it funded access to existing healthcare services, but it did not provide healthcare infrastructure.
It said it had arrangements with all states and territories for eligible veterans to access public and private hospital services as required.
"Where a veteran cannot access specific services in their local area, [the Department of Veterans' Affairs] will support veterans to access services by arranging and paying for transport costs to ensure essential clinical care is received," a department spokesperson said.
