The RSA is this week running its annual Poppy Appeal – with its theme 'Not All Wounds Bleed' shining a focus on the non-physical injuries veterans and their families face. NZME is an official media partner of the RSA's campaign

New Zealand's contemporary veterans could become a "lost generation" if changes to mental health support and care are not made, the Defence Force's top medical expert has warned.

The stark message by Dr Paul Nealis, NZDF chief medical officer, comes during the annual Poppy Appeal – with its theme this year of 'Not All Wounds Bleed' shining a focus on the non-physical injuries veterans and their families face.

Nealis, himself a contemporary veteran who has suffered a mental injury in service, says Kiwi veterans over the last century fall into three groups: conventional conflicts up to the Korean War; the transitional conflicts of Malaya and Vietnam; and the contemporary conflicts post-Vietnam, most notably East Timor and Afghanistan.


Given how conflict has changed, in length, scale, "vastly improved" force protection, and how they are fought, a rethink on how returning servicepeople are supported has been needed.

"Whilst remarkable advances in physical protection and care have taken place, the rate of mental injury has in fact increased in recent conflict," Nealis said.

"It reflects a change in how war is undertaken and the deliberate targeting of the psychology of the opponent - targeting the will to fight. It should be of little surprise then that the rate of psychological casualties increased in contemporary conflict."

The changing wars have also resulted in a shift from the predominantly post-traumatic stress injuries adjustment disorders and moral injuries.

Moral injuries, first formally recognised in Vietnam veterans, is a" particularly devastating" form of injury, Nealis said, eroding the veteran's sense of trust and self-worth, often termed an injury to the soul.

But veterans care has been slow to evolve along with the changing needs.

Nealis says key reasons for contemporary veterans not getting help include the fact they don't identify themselves being veterans; that those supplying veterans support services were controlled by and geared towards the "old" veterans; and their military training teaches them to accept discomfort and not to complain in adversity.

Coupled with the nature of mental injury itself, which can reduce trust, heighten suspicion, affect memory and result in a lack of insight and depression, means that the chance of people seeking help is slashed.


"Just as some things will trigger the exaggerated fear in PTSI, others will trigger overwhelming waves of emotion from a trigger that the veteran may not even be consciously aware of. For many veterans with mental injury these things are very unnerving and lead to avoiding social situations where it is embarrassing," said Nealis, who also stressed that mental injury also hurts loved ones, including families and colleagues.

Stigma, the fear of being seen as weak, or the consequences of seeking help, are often raised as reasons for not coming forward while both in service and post-service, Nealis said.

He fears a "lost generation" from this contemporary group of veterans unless changes are made to the support and care offered to them which will meet their complex care needs and "work hard to establish the trust that reengages them into seeking support when they need it".

"Whilst we are improving our understanding of mental injury, there are still many barriers to care," Nealis said.

"These range from the veteran recognising they have a problem through to achieving an accurate diagnosis to enable appropriate care. This becomes very complicated when there is a delay to care, as all of the forms of injury present in a very similar fashion when left long enough.

"All people whom deploy will come home with an adjustment disorder. In the majority it is transient, lasting a few months, following which the person experiences personal growth. In a minority the injury is more serious, requiring support to enable the person to grow through it. If left unsupported it is this group whom develop the problems."


With changes to the care pathways and how servicemen and women are rehabilitated post-injury, a greater understanding of people's ability to serve post-injury, and with changes to society's understanding of veterans issues, Nealis says New Zealand is getting better outcomes.

And while the Defence Force says it takes its responsibility for the care of its people very seriously, the responsibility for supporting veterans lies with the public too, Nealis says.

"We represent the New Zealand people, and we are proud to do so and make a difference in the world," he said.

"It must be remembered that serving comes at a cost for some of our people. We don't ask to be a special case, but we do ask for support and understanding when some of us require a helping hand."

&bull NZME is an official media partner of this year's Pin A Poppy campaign. Visit to donate – including the option to get a $3 virtual poppy via text

Where to get help

If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.


Or if you need to talk to someone else:

• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Samaritans 0800 726 666
• RSA:
• No Duff:

• If it is an emergency and you feel like you or someone else is at risk, call 111.