Researchers have begun a sprawling check on thousands of recently-served Kiwi veterans, amid grave warnings a lack of health support could create a "lost generation".
The new study, focusing on more than 9000 veterans who have served in deployments since the early 1990s, has been called "well overdue" by the Royal New Zealand Returned and Services' Association (RSA).
University of Otago health researcher Associate Professor David McBride, leading the work with colleagues from Otago, AUT and Auckland universities, said there were now more veterans in our community than at any time since World War II.
"They have been overlooked - and they don't see themselves as veterans exactly because of this, although the perception is slowly changing."
Multiple deployments could put strains on family life, McBride said, and the perception there had been no combat operations was wrong.
Using a survey, the researchers aimed to find out what helped the health and wellbeing of recent veterans, what factors contributed to post-traumatic stress injury (PTSI), and whether there was a pattern of "multi-system illness", where multiple minor health problems compound over time.
McBride hoped the study would result in a new red-flag system for veterans in need of support, while also revealing what services have the best impact.
The NZDF covered health and welfare of veterans still serving, and once they left, they became eligible for services and support under the Veterans' Support Act if they had or developed a condition caused or aggravated by their service.
They could access benefits such as insurance, family support through Force For Families and a crisis and confidential help line.
McBride said one major issue continued to be support for veterans in emergencies - a focus for the No Duff Charitable Trust and the RSA.
"There is virtually no research on New Zealand's younger veterans, who have served overseas since the 1970s, as compared to the wealth of research available on Australian, British, Canadian and US veterans," RSA support service manager Mark Compain said.
"We simply have no idea what the issues are, what treatment should be considered and what long-term risks there may be."
Compain, a veteran of East Timor, Bosnia and Afghanistan who suffered PTSI himself, said that had led to a large gap in understanding the true cost to veterans, their families and the public purse.
"This study is critical to developing appropriate policy and efficient care pathways that are aligned to actual need."
The RSA wanted to see the work developed to become a pro-active government-funded longitudinal study.
"We feel this is vital given the historical lack of attention, the risks identified by our partners, and the responsibility of the nation to ensure our service personnel and their families are treated fairly in return for their unique service."
The NZ Defence Force also welcomed the study, which is funded by Lottery Health, the War Pensions Medical Research Trust Fund, and the RSA.
"Anything that works to improve our understanding of what contributes to the good health and wellbeing of our veterans will help to ensure those who need it, get the right help, at the right time," a spokesperson said.
Last week, NZDF chief medical officer Dr Paul Nealis said rates of mental injury had increased in recent conflict, despite advances in physical protection and care.
"It reflects a change in how war is undertaken and the deliberate targeting of the psychology of the opponent - targeting the will to fight," Nealis said.
"It should be of little surprise then that the rate of psychological casualties increased in contemporary conflict."
Nealis feared a "lost generation" from this contemporary group of veterans unless changes are made to the support and care offered to them which would meet their complex care needs and "work hard to establish the trust that re-engages them into seeking support when they need it".
"Whilst we are improving our understanding of mental injury, there are still many barriers to care," he 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."
The problem has also been highlighted by "Not All Wounds Bleed" theme of this year's annual Poppy Appeal, of which NZME is an official media partner. Visit www.pinapoppy.co.nz 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: https://www.rsa.org.nz/support/team
• No Duff: https://www.noduff.org/
• If it is an emergency and you feel like you or someone else is at risk, call 111