Statement of Principles

concerning

SUICIDE AND ATTEMPTED SUICIDE
(Balance of Probabilities)

(No. 66 of 2016)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 24 June 2016

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO

Chairperson

Contents

1 Name

2 Commencement

3 Authority

4 Revocation

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning suicide and attempted suicide (Balance of Probabilities) (No. 66 of 2016).

2               Commencement

              This instrument commences on 25 July 2016.

3               Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

4               Revocation

The Statement of Principles concerning suicide and attempted suicide No. 12 of 2010 made under subsection 196B(3) of the VEA is revoked.

5               Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about suicide and attempted suicide and death from attempted suicide.

Meaning of suicide and attempted suicide

(2)          For the purposes of this Statement of Principles

(a)          suicide means the intentional act of taking one's own life; and

(b)          attempted suicide means an intentional act, the purpose of which is to take one's own life, but which has a non-fatal outcome.

Death from attempted suicide

(3)          For the purposes of this Statement of Principles, attempted suicide, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's attempted suicide.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that suicide or attempted suicide and death from attempted suicide can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, suicide or attempted suicide or death from attempted suicide is connected with the circumstances of a person's relevant service:

(1)          having a clinically significant disorder of mental health as specified at the time of the suicide or the attempted suicide;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.               

(2)          experiencing a category 1A stressor within the two years before the suicide or the attempted suicide;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.             

(3)          experiencing a category 1B stressor within the two years before the suicide or the attempted suicide;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

(4)          having a significant other who experiences a category 1A stressor within the one year before the suicide or the attempted suicide;

Note: category 1A stressor and significant other are defined in the Schedule 1 - Dictionary.

(5)          experiencing the death of a significant other within the two years before the suicide or the attempted suicide;

Note: significant other is defined in the Schedule 1 - Dictionary.

(6)          experiencing the death of a parent due to suicide within the 25 years before the suicide or the attempted suicide, where the person was aged 18 years or younger at the time of the parent's death;

(7)          for persons 18 years of age and younger only, experiencing the suicide of a peer within the two years before the suicide or the attempted suicide;

Note: peer is defined in the Schedule 1 - Dictionary.

(8)          experiencing a category 2 stressor within the two years before the suicide or the attempted suicide;

Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

(9)          being a perpetrator of bullying within the two years before the suicide or the attempted suicide;

(10)      having experienced severe childhood abuse before the suicide or the attempted suicide;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(11)      attempting suicide or performing a self-injurious act, within the five years before the suicide or the attempted suicide;

Note: performing a self-injurious act is defined in the Schedule 1 - Dictionary.

(12)      having a medical illness or injury which has resulted in, or where the prognosis involves, a severe level of disability at the time of the suicide or the attempted suicide;

Note: severe level of disability is defined in the Schedule 1 - Dictionary.

(13)      having epilepsy at the time of the suicide or the attempted suicide;

(14)      having persistent pain as specified of at least six months duration at the time of the suicide or the attempted suicide;

Note: persistent pain as specified is defined in the Schedule 1 - Dictionary.

(15)      having failed an academic examination or other academic assessment within the 30 days before the suicide or the attempted suicide;

(16)      for persons 18 years of age and younger only, commencing a course of Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) drug therapy, or increasing or reducing the dose of that drug therapy, within the eight weeks before the suicide or the attempted suicide, and during that time reporting new or worse symptoms of agitation, aggression, insomnia, irritability, hyperkinesia, mania, hypomania or worsening of depressive symptoms;

(17)      taking a drug or a drug from a class of drugs from the specified list of drugs, within the 14 days before the suicide or the attempted suicide;

Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

(18)      taking mefloquine within the three months before the suicide or the attempted suicide;

(19)      using methylenedioxypyrovalerone (MDPV) or 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl)-phenylethylamine (25I-NBOMe) within the 12 hours before the suicide or the attempted suicide;

(20)      having a moderate to severe traumatic brain injury before the suicide or the attempted suicide;

(21)      undergoing bariatric surgery within the ten years before the suicide or the attempted suicide;

Note: bariatric surgery is defined in the Schedule 1 - Dictionary.

(22)      inability to obtain appropriate clinical management for the attempted suicide.

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factor set out in subsection 9(22) applies only to material contribution to, or aggravation of, attempted suicide where the person's attempted suicide was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               bariatric surgery means weight reduction surgical procedures including gastrojejunostomy, gastric stapling, vertical banded gastroplasty and gastrectomy with Roux-en-Y anastomosis.

                               category 1A stressor means one of the following severe traumatic events:

(a)          experiencing a life-threatening event;

(b)          being subject to a serious physical attack or assault including rape and sexual molestation; or

(c)          being threatened with a weapon, being held captive, being kidnapped, or being tortured.

                               category 1B stressor means one of the following severe traumatic events:

(a)          being an eyewitness to a person being killed or critically injured;

(b)          viewing corpses or critically injured casualties as an eyewitness;

(c)          being an eyewitness to atrocities inflicted on another person or persons;

(d)          killing or maiming a person; or

(e)          being an eyewitness to or participating in, the clearance of critically injured casualties.

Note: eyewitness is also defined in the Schedule 1 - Dictionary.

                               category 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:

(a)          being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;

(b)          experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation, or divorce;

(c)          having concerns in the work or school environment including on-going disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful workloads, or experiencing bullying in the workplace or school environment;

(d)          experiencing serious legal issues including being detained or held in custody, on-going involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;

(e)          having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property, or bankruptcy;

(f)           having a family member or significant other experience a major deterioration in their health; or

(g)          being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability.

                               clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management, which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner:

(a)          acute stress disorder;

(b)          adjustment disorder;

(c)          alcohol use disorder;

(d)          anxiety disorder;

(e)          attention-deficit/hyperactivity disorder;

(f)           bipolar disorder;

(g)          body dysmorphic disorder;

(h)          brief psychotic disorder;

(i)            conduct disorder;

(j)            depressive disorder;

(k)          eating disorder;

(l)            obsessive-compulsive disorder;

(m)        oppositional defiant disorder;

(n)          panic disorder;

(o)          personality disorder;

(p)          phobic anxiety;

(q)          posttraumatic stress disorder;

(r)           schizoaffective disorder;

(s)           schizophrenia;

(t)            substance/medication-induced anxiety disorder;

(u)          substance/medication-induced psychotic disorder; or

(v)          substance use disorder.

                             eyewitness means a person who observes an incident first hand and can give direct evidence of it.  This excludes a person exposed only to media coverage of the incident.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                               peer means an individual of a similar age, with whom the person has a personal association, such as a classmate.

                               performing a self-injurious act means committing deliberate harm to one's own body and may include cutting, burning, hitting or poisoning.  The injury is done independently, without the aid of another person, and is severe enough for tissue damage (such as scarring) to result.  This definition excludes acts associated with suicidal intent and acts related to social and cultural rites of passage which result in cosmetic scarring.

                               persistent pain as specified means:

(a)          continuous pain; or

(b)          almost continuous pain; or

(c)          frequent, severe, intermittent pain;

which is severe enough to interfere with usual work or leisure activities or activities of daily living.

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: VEA and MRCA are also defined in the Schedule 1 - Dictionary.

                               severe childhood abuse means:

(a)          serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or

(b)          neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;

where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.

                               severe level of disability means needing help with some or all activities of daily living (communication, mobility and self-care).  This definition includes, for example, individuals with serious spinal injury, motor neurone disease or a disseminated malignancy.

                               significant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.

                               specified list of drugs means:

(a)          benzodiazepines;

(b)          corticosteroids, other than topical steroids; or

(c)          opioid analgesics.

                             suicide and attempted suicide—see subsection 7(2).

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.