Statement of Principles

concerning

SUICIDE AND ATTEMPTED SUICIDE
(Balance of Probabilities)

(No. 40 of 2025)

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

Dated 15 April 2025

Professor Terence Campbell AM

Chairperson

by and on behalf of

The Repatriation Medical Authority

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

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. 40 of 2025).

1.                Commencement

              This instrument commences on 19 May 2025

1.                Authority

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

1.                Repeal

The Statement of Principles concerning suicide and attempted suicide (Balance of Probabilities) (No. 66 of 2016) (Federal Register of Legislation No. F2016L01149) made under subsections 196B(3) and (8) of the VEA is repealed.

1.                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.

1.                Definitions

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

1.                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 suicide and attempted suicide.

Meaning of suicide and attempted suicide

1.           For the purposes of this Statement of Principles:
   1.           suicide means the act of intentionally killing oneself; and
   2.           attempted suicide means an attempt to intentionally kill oneself, but which has a non-fatal outcome.

Death from suicide and attempted suicide

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

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

1.                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 and attempted suicide and death from suicide and 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: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

1.                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 and attempted suicide or death from suicide and attempted suicide is connected with the circumstances of a person's relevant service:

1.           having one of the following clinically significant disorders of mental health at the time of clinical onset:
   1.           acute stress disorder;
   2.           adjustment disorder;
   3.           alcohol use disorder;
   4.           anxiety disorder;
   5.           attention hyperactivity disorder;
   6.            bipolar disorder;
   7.           body dysmorphic disorder;
   8.           brief psychotic disorder;
   9.             conduct disorder;
   10.             depressive disorder;
   11.           eating disorder;
   12.             gender dysphoria;
   13.         obsessive-compulsive disorder;
   14.           oppositional defiant disorder;
   15.           panic disorder;
   16.           personality disorder;
   17.           phobic anxiety;
   18.            posttraumatic stress disorder;
   19.            schizoaffective disorder;
   20.             schizophrenia;
   21.           substance/medication-induced anxiety disorder;
   22.           substance/medication-induced psychotic disorder;
   23.         substance use disorder.

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

1.           experiencing a category 1A stressor before clinical onset;

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

1.           experiencing a category 1B stressor before clinical onset;

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

1.           having a person with whom one has a close family bond or a close personal relationship experience a category 1A stressor within the 1 year before clinical onset;

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

1.           experiencing the death of a person with whom one has a close family bond or a close personal relationship, within the 2 years before clinical onset;
2.           experiencing the death of a parent due to suicide within the 25 years before clinical onset, where the person was aged 18 years or younger at the time of the parent's death;
3.           experiencing the attempted suicide of a parent within the 25 years before clinical onset, where the person was aged 18 years or younger at the time of the parent's attempted suicide;
4.           experiencing the suicide of an individual of a similar age, with whom the person has a personal association such as a classmate, within the 2 years before clinical onset, where the person was aged 18 years or younger at the time of the associate’s suicide;
5.           experiencing the death of a sibling due to suicide within the 15 years before clinical onset;
6.       experiencing a category 2 stressor within the 10 years before clinical onset;

Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

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

1.       being a perpetrator of bullying within the 2 years before clinical onset;
2.       having experienced as a child (under the age of 18) one of the following;
   1.           serious physical, emotional, or sexual harm;
   2.           neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing by adults with obligations to provide such necessities;

before clinical onset;

1.       performing a self-injurious act, within the 5 years before clinical onset;

Note: Self-injurious acts 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. 

1.       having a medical illness or injury which has resulted in a severe level of disability at the time of clinical onset;

Note: A person with a severe level of disability may need help with some or all activities of daily living (communication, mobility and self-care).

1.       having epilepsy at the time of clinical onset;
2.       having persistent pain, which is severe enough to interfere with daily living, for at least the 6 months before clinical onset;
3.       having failed an academic examination or other academic assessment within the 30 days before clinical onset;
4.       for persons 18 years of age and younger only, commencing a course of antidepressant therapy, or increasing or reducing the dose of that drug therapy, within the 8 weeks before clinical onset;
5.       taking any of the following medications within the 14 days before clinical onset;
   1.           benzodiazepines;
   2.            clofazimine;
   3.            corticosteroids, other than topical steroids;
   4.            interferons;
   5.            montelukast;
   6.            raltegravir;
   7.           zolpidem;
   8.            zopiclone.
6.       taking mefloquine within the 3 months before clinical onset;
7.       taking methylenedioxypyrovalerone (MDPV) or 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl)-phenylethylamine (25I-NBOMe) within the 12 hours before clinical onset;
8.       having a moderate to severe traumatic brain injury before clinical onset;
9.       having a concussion within the 5 years before clinical onset;
10.       undergoing bariatric surgery within the 10 years before clinical onset;

Note: Examples of bariatric surgery include gastrojejunostomy, gastric stapling, vertical banded gastroplasty or gastrectomy with Roux-en-Y anastomosis.

1.       experiencing intimate partner violence within the 1 year before clinical onset;

Note: intimate partner violence is defined in the Schedule 1 – Dictionary.

1.       inability to obtain appropriate clinical management for suicide and attempted suicide before clinical worsening.

1.            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(26) applies only to material contribution to, or aggravation of, suicide and attempted suicide where the person's suicide and attempted suicide was suffered or contracted before or during (but did not arise out of) the person's relevant service.
2.            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:

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 or sexual molestation;

(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)          killing or maiming a person;

(b)          being a witness to a person being killed or critically injured;

(c)          being a witness to atrocities inflicted on another person;

(d)          witnessing human remains or a critically injured casualty, excluding seeing a closed body bag or viewing a body in an open-casket.

Note: witness is 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 a full-time caregiver to a family member or a person with whom one has a close family bond or a close personal relationship with a severe physical, mental or developmental disability;

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

(c)          experiencing adverse prejudicial differential treatment or unequal access to opportunities based on membership to a particular sociocultural group (racism);

(d)          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;

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

(f)           experiencing prejudice or discrimination based on gender, or behaviour or attitudes that foster stereotyped social roles based on gender (sexism);

(g)          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;

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

(i)            having a family member or a person with whom one has a close family bond or a close personal relationship experience a major deterioration in their health.

clinically significant disorder of mental health means a disorder of mental health which is of sufficient severity to warrant ongoing management.

Note: To warrant ongoing management does not require that any actual management was received or given for the condition.

intimate partner means a person who is or has been in an intimate relationship with another person and who is not within their immediate nuclear family.

intimate partner violence means behaviour within an intimate relationship perpetrated by an intimate partner that causes or has the capacity to cause physical, sexual, economic or psychological harm and which would, in all the circumstances, be reasonably likely to cause an intimate partner such harm. It may range from one episode to a series of episodes, and it may occur between people who have a current or a previous intimate relationship. It includes but is not limited to:

1.           violence;
2.           threats;
3.           harmful behaviours or threats of harmful behaviours directed towards a child, animal or another adult;
4.           neglect where there is a relationship of dependence;
5.           coercion;
6.            stalking;
7.           humiliation;
8.           restriction of access to education, employment or medical care; or
9.             isolation from family, friends or colleagues.

Note 1: intimate relationship is defined in the Schedule 1 – Dictionary.

Note 2: intimate partner is defined in the Schedule 1 – Dictionary.

intimate relationship means a relationship that involves emotional and/or physical closeness and interdependence between people. It does not necessarily need to include sexual relations or cohabitation. Purely commercial relationships however are excluded from this definition.

MRCA means the Military Rehabilitation and Compensation Act 2004.

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

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.

witness means a person who experiences an incident at the time it occurs and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.