Ministerial Expert Panel. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel

Transcription

1 Ministerial Expert Panel Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel 2 August 2015

2 Table of Contents 1. Introduction Purpose Veterans PTSD Centre for Excellence Expert Advisory Panel Membership Meeting details Model of Care for South Australian Veterans PTSD Centre for Excellence Existing mental health framework for Veterans Health care in South Australia Changing needs and demographics of the South Australian veteran community Opportunities Model of Care Clinical Non-Clinical Considerations for site selection Proposed sites Northern Defence/Veteran Community Mental Health Hub Caveats and drawbacks of the Glenside site Key Partnerships SA Health clinical partnerships Research partnerships Non-clinical partnerships Key outcomes Key recommendations Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 2 of 17

3 1. Introduction 1.1. Purpose The Repatriation General Hospital (RGH) was built for soldiers returning from the Second World War to provide support and rehabilitation for physical and mental injuries of war. Current veterans continue to require ongoing long-term medical care for mental health issues arising from their service. Existing facilities, in particular, the services currently provided at the Repatriation General Hospital s Ward 17 are housed in buildings that are unsuitable for a leading service and do not meet the needs of contemporary mental health management. Under the SA Government s Transforming Health plan announced in March 2015, many of the current services at the RGH site will move to more appropriate locations. This has implications for the ongoing services provided by Ward 17; specifically the ongoing treatment of veteran mental health consumers within SA Health. The plans included a new purpose built $15 million Post-Traumatic Stress Disorder Centre for Excellence to provide high-quality facilities to match our reputation as a leader in the delivery of mental health care to our veteran and service community. The timing of this announcement is particularly poignant as our nation commemorates and recognises the 100 years of military service since the Gallipoli landings. Part of Australia s national identity is formed around the courage and sacrifice of those who have served our nation in times of conflict. South Australians have proudly contributed to this service, but many continue to carry unseen wounds and mental health consequences. Over recent decades both the nature of our service community and our awareness and understanding of the effects of service-related mental health conditions have changed. In addition, new demographics, such as younger contemporary veterans, female veterans and an ageing World War 2, Korean War and Vietnam War cohort bring new health care challenges. Whilst health care for the South Australian veteran and service community has been, and continues to be world class, we must ensure that our health care system is able to support the changing needs of current and contemporary veterans and that it is positioned to cater for the health and well-being of the veteran community into the future. We recognise that we must continue to build on the lessons of the past and develop the best possible mental health care treatment and support services that the state, in conjunction with national partners, can provide Veterans PTSD Centre for Excellence Expert Advisory Panel The Veterans PTSD Centre for Excellence Expert Advisory Panel was established in March 2015 to provide advice to the Minister for Health. In line with Delivering Transforming Health Our Next Steps, the overarching aim of the expert panel was to support the establishment of a Centre for Excellence for the treatment of PTSD for the Veteran Community of South Australia. The scope and purpose of the expert panel as defined in their Terms of Reference (TOR) was to give consideration to the following: Current and future veterans mental health needs The model of care for PTSD services for the veteran community of South Australia Potential location for the Centre of Excellence Links to broader services for the Veteran community Once considered the Expert Panel were tasked with making recommendations on: Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 3 of 17

4 Proposed model of care for the Centre for Excellence for PTSD Treatment Potential location of service for Centre for Excellence of PTSD Treatment 1.3. Membership The Expert Panel was co-chaired by Associate Professor Susan Neuhaus CSC, Chair Repat Foundation and Professor Dorothy Keefe PSM, Clinical Ambassador, Transforming Health. The membership provided a broad experience base, bringing together clinical experts (including academics, allied health professionals and lead clinicians), experienced Veteran representatives (across a range of deployments including Vietnam, Peacekeeping, Middle East and contemporary operations), consumers, carers and senior Department of Health and Ageing staff. The panel included the following members: Professor Tarun Bastiampillai, Director, Mental Health Strategy, Department for Health and Ageing Chris Burns CSC, Presiding Member, Veterans Health Advisory Council (VHAC) Dr Taryn Cowain, Clinical Head of Unit, Ward 17, Department of Psychiatry Lynne Cowan, Director System Design and Strategy SA Health David Curren, Service Manager, Veterans Mental Health SALHN Warren Featherby OAM, Consumer Representative Lyn Fisher, Veteran Carer representative Judith Fuller, CPC Ambulatory Services Co-Ordinator Veronica Hancock, Assistant Secretary, Mental & Social Health, Dept Veterans Affairs (DVA) Bronson Horan, VAC and Soldier On Lesley Legg, A/Service Manager Veterans & OPMHS Southern and SEDS Brigadier (Rt d) Laurie Lewis AM, Member, VHAC and Veterans Advisory Council (VAC) Professor Sandy McFarlane AO, Director, University of Adelaide Centre for Traumatic Stress Studies (CTSS) Derrick McManus, Consumer Representative Emergency Services Robert Manton, Director, Veterans SA Calli Morgan, Soldier On Major James O Hanlon, Contemporary Veteran Representative Sandro Positano, Clinical Psychologist, Ward 17 Peter Swift, Director Capital Projects SA Health Bob Walters, Consumer representative Sharon Walters, Carer representative Mark Wilcock, Clinical Services Coordinator Ward 17 Jenny Tonks, Project Manager, Transforming Health 1.4. Meeting details The Expert Panel met five times during the period of March-July 2015 with four half-day workshops. In combination with these meetings, members were provided with the opportunity to attend site tours of Glenside Health Service and the Peter Badcoe Victoria Cross (VC) complex. The Committee thanks the staff of both facilities, and everyone involved, for their contribution. Detailed bulletins were released following each of the meetings of the Expert Panel. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 4 of 17

5 By way of overview, the meetings of the Expert Panel comprised: Tuesday 24 th March Tuesday 14 th April Tuesday 12 th May Inaugural meet and greet with acceptance of the TOR and meeting schedule Review of existing Ward 17 activities and clinical services within the context of the broader system. This process included the identification of services currently provided, with consideration of future Veterans mental health care needs, using analysis of supporting data and review of the key clinical and non clinical interdependencies needed to support the model of care. Consideration of proposed elements of the model of care, and further assessment of available data. The panel achieved consensus on a framework for the model of care for the new Post-Traumatic Stress Disorder (PTSD) Centre for Excellence (CFE), and identified the service components essential for provision of quality care for Veteran s mental health for the next 50 years. The core elements identified were: Tuesday 16 th June Tuesday 18th July Requirement for both inpatient and outpatient services Integration of services across inpatient/outpatient domains Integrated research and outcomes monitoring Networking and integration of other clinical and non-clinical services and supporting components Assessment of site suitability to support the proposed model of care. Panel members viewed aerial photographs of potential sites and reviewed each site against the comprehensive list of criteria previously developed, particularly addressing the key clinical and non-clinical requirements. A matrix was placed next to each photograph and members were asked to consider the advantages and/or benefits against the key co-dependencies for each site. Following consensus agreement on the most suitable site, arrangements were made to undertake site visits in order to complete the Expert Panel s due diligence requirements. Professor David Forbes (Director Phoenix Australia formerly National Centre for War-Related PTSD) was invited by A/Prof Neuhaus to present an overview of the current and emerging mental health challenges for the veteran community. Prof Forbes also made reference to the pivotal role that South Australian clinicians and researchers have in leading developments and innovations through the opportunities that a CFE provides. Following the presentation the panel then focussed on discussing the site visits that occurred after the last meeting as part of its due diligence process. This discussion resulted in a unanimous decision by the Expert Panel regarding a potential site. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 5 of 17

6 2. Model of Care for South Australian Veterans PTSD Centre for Excellence In determining the key elements of a Centre for Excellence for the treatment of PTSD consideration was given to the following: Current and future veterans mental health needs; The model of care for service related mental health, in particular PTSD, services for the veteran community of South Australia The underpinning quality principles of Transforming Health is a quality healthcare system that provides best care, first time, every time. A system that is: Patient centred Safe Effective Accessible Efficient, and Equitable. In summary the panel wanted a model that would provide seamless, integrated care to the veteran community and be a national leader in quality care delivery, research and support. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 6 of 17

7 The overarching principles underpinning the Model of Care- Mental health care of the Veteran and service community the next 50 years were agreed: 1. The Centre for Excellence (CFE) should have an embedded understanding of the veteran culture, military ethos and the unique health consequences of service. 2. The CFE should be a state based facility that provides evidence-based best quality mental health care to the South Australian veteran and service community. 3. The CFE should be inclusive of the broad veteran and service community, regardless of the nature of the service, geographic location or entitlements and should develop a service capability to include first responders from the SA Emergency services 4. The CFE should cater for the full spectrum of veteran and service related mental health, recognising this can include a complex mixture of presentations that are not just reflective of PTSD, but also include depression, anxiety, substance abuse, anger management, and relationship difficulties. 5. The CFE should enable integration of all current health providers, pathways and partners in the South Australian veteran mental health care space to ensure seamless holistic care. Recognising the diversity of care providers and funding pathways, the CFE should cater for flexibility and networking of diverse care models (including private sectors and partnerships e.g. Veterans and Veterans Families Counselling Service (VVCS), Australian Defence Force (ADF) mental health care teams). 6. The CFE should be configured to meet the physical and mental health needs of diverse and different sub-cohorts (e.g. > 65 year vs 19 year olds) and be adaptive and scalable to the needs of a changing veteran demographic. 7. The CFE should respect the central role that families, ESOs and contemporary groups e.g. Soldier On, Mates for Mates and Trojan s Trek provide in wellbeing and recovery. 8. The CFE should integrate research, teaching, clinical care monitoring, evaluation and quality assurance across its networks. 9. The CFE should reflect changing mental health care models which emphasise wellness and rehabilitation rather than a sickness focus and acknowledge the importance of a holistic approach to mental wellbeing, including the importance of fitness, social activities, occupational rehabilitation and integration within a broader community. 10. The CFE will establish partnerships and collaboration between mental health and physical health care clinicians to ensure that the physical health needs of mental health consumers are met Existing mental health framework for Veterans Health care in South Australia Many veterans from current and previous conflicts present with complex psychological problems including PTSD, depression, anxiety, anger, aggression, substance abuse, suicidality and relationship issues. The current mental health needs of the South Australian Veteran community are met by a complex mixture of public and private inpatient and outpatient services. The majority of these services (including the VVCS, PTSD programs, online mental health information and support, and medical and hospital services) are funded by Department of Veteran Affairs (DVA) 1. 1 DVA operates under complex legislative arrangements. Most claims are assessed under one or more of three pieces of legislation: the Veterans Entitlements Act 1986 (VEA); the Safety, Rehabilitation and Compensation Act 1988 (SRCA); and the Military Rehabilitation and Compensation Act 2004 (MRCA). However, non-liability health care allows former and current ADF personnel, depending on their eligibility, to receive Commonwealth funded treatment for: Post-traumatic Stress Disorder (PTSD) Depressive disorder Anxiety disorder Alcohol Use Disorder; and Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 7 of 17

8 Ward 17 is a designated veteran mental health facility that has been located at the RGH site for over 50 years. It provides services to veterans and ex-serving members, war widows and ADF personnel over the age of 18 years. Services provided at Ward 17 include, but are not limited to: Inpatient care including Electro convulsive therapy (ECT) with holistic management of a full range of psychiatric illnesses including psychosis, severe spectrum depression, addiction and impulse control disorders Outpatient clinics Ambulatory programs including counselling service, day programs, PTSD program Research and teaching program High risk (high acuity) patients are currently managed at off-site psychiatry ICUs until they can be supported in an open ward environment. Over its 50 year history, Ward 17 and its staff have developed considerable expertise and empathy in the management of veteran mental health disorders. Close relationships with the veteran community have enabled a deep trust and understanding of veteran experiences and military culture, which underpins the efficacy of the service. 3. Changing needs and demographics of the South Australian veteran community The veteran community will see significant demographic changes in the coming years. In particular there will be a large group of contemporary veterans both men and women who will have health challenges different to those faced by the previous generation of veterans. Currently almost 80% of South Australian DVA beneficiaries are aged over 65 years. Substance Use Disorder Without a requirement to establish that these conditions were caused by service. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 8 of 17

9 The ADF has now been continually involved in operations for the last two decades. Since 1999, ADF personnel have undertaken over 60,000 individual deployments, and many have deployed on numerous occasions. Whilst some of these operations have been carried out in benign environments, a number (particularly Afghanistan and Iraq) have been characterized by their high intensity and lethality. Modelling suggests that there will be a small, but not exponential, increase in veterans presenting with mental health problems over the next 2-3 decades (i.e. to 2035 and beyond). The social, health and wellbeing challenges facing this younger cohort differ from those of the current World War 2 and Vietnam conflict cohorts. This includes; Differing age and co-morbidities (psychiatric and non-psychiatric) Employment and occupational rehabilitation issues Young families Increasing number of women 2 Increased diversity and number of deployment experiences (multiple deployments, mixture of peacekeeping and combat operations, full time and reserve service) Diversity of entitlements Differing presentations and latency of presentations In addition to the changing veteran demographic, the panel notes that exposure to significant, often repetitive, deeply traumatic events in the course of their duties results in similar patterns of mental health presentation for first responders in our community. 4. Opportunities Under the Transforming Health Initiatives and the Government s decision to allocate $15 million for a South Australian Veteran PTSD Centre for Excellence, the Expert Panel identified the following opportunities: 1. Relocate current functions of Ward 17 to a new purpose built facility. This facility would provide world-class infrastructure one that embraces innovation, takes full advantage of technology and new advances in medical treatments and is flexible to meet the challenges of the future. 2. Expertise, dedication culture and traditions. Building on the expertise, dedication, culture and traditions of existing Ward 17 services, the Centre of Excellence would provide holistic, evidence-based best practice mental health care for the veteran and service community. 3. Coordination Enhance coordination, synergy and networking of clinical services provided by private sector and Commonwealth (e.g. VVCS) to more effectively share veteran health care expertise across other key sectors within SA and address gaps in care. 2 Noting the changing role of women in the Defence Force, with increasing numbers of women deployed and the Government formally agreeing to the removal of gender restrictions from ADF combat roles Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 9 of 17

10 4. Networked model A networked model enables improved clinical efficiency and better integration of care across all sectors. This includes more streamlined: Linkages to established clinical networks and integration with primary care Links to rehabilitation providers Education pathways Research and quality assurance pathways 5. Strategic relationships Strengthen strategic relationships with key (non-clinical) veteran support agencies within both Government and non-government sectors and provide on-site and proximity hubbed support services. Non-clinical veteran support agencies provide key services that facilitate recovery and social engagement. A coordinated approach that recognizes the importance of ensuring that adequate social and occupational support is made available to those requiring mental health treatment and provides support to partners and children) is an important element to treatment and recovery. Family and peer friendly onsite support and drop in centre will facilitate closer engagement with the ESO, philanthropic and non-government (e.g. RSL-SA, Legacy, Soldier On) veteran community. Such engagement has significant value in normalising both the existence and treatment of mental health needs and the fight to de-stigmatise PTSD and other mental health disorders in the community. This will hopefully assist more wounded members of the veteran and service community to come forward to seek support and treatment. 6. Enhanced teaching, research collaborations and quality assurance. Outstanding clinical care requires high quality and consistent training models, effective ongoing clinical supervision opportunities, and quality assurance mechanisms. The COE is ideally positioned to continue to build on the workforce expertise and trust that has been developed over many years to ensure a vibrant clinical teaching and research program. The COE provides an opportunity to develop a centralized registry that supports future clinical and non-clinical care improvements, monitors outcomes and enables evidence based and innovative models of future care that will ultimately provide benefit to the broader community South Australia has been a national and international leader in veteran health research and specifically PTSD. The COE offers an opportunity to ensure continuity of clinical providerpatient relationships and further integrate clinical and academic research to identify new and emerging treatments, evaluate treatment outcomes and provide policy advice. Key working party discussion items 5. Model of Care A brainstorming session at the first workshop reviewed the current elements of the service within the context of the broader system. Panel members were then able to develop a clear understanding of all the key attributes required for a Centre for Excellence taking into consideration both the current and future needs of the Veteran and service community for the next 50 years. This also included areas or support services that are considered essential to the delivery of quality patient centric care and integrated services. The picture below outlines the key clinical and non-clinical interdependencies needed to support the model of care. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 10 of 17

11 5.1. Clinical The model of care provides easy access to a wide range of services that are delivered in a seamless way to ensure continuity of care. The use of evidence based best practice to inform and improve service delivery focussing on tailored interventions will be essential to the model. Elements of the model include: Inpatient services Provision of a mix of acute and sub-acute psychiatric beds SA Health owned and supported site Access to specialized psychiatric treatments e.g. electroconvulsive therapy (ECT) Clinical emergency and security responses Networked access to other medical services e.g. pain services, rehabilitation etc Outpatient services and programs Support to all existing programs including PTSD and mindfulness programs Integration with non Ward 17 outpatient providers e.g. VVCS, ADF mental health care teams Clinical research and teaching Multi-disciplinary mental health teams Drug and alcohol services Sustainability of the clinical workforce The Expert Panel considered that the Centre of Excellence must provide both inpatient and outpatient services Non-Clinical When discussing the build and location of a new Centre for Excellence there were a number of considerations. The panel focussed on the following: Central geographic location Low stimulus site with ease of access Car parking and public transport Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 11 of 17

12 The site would need to provide: Flexibility of indoor/outdoor space Design based on light, space, access to gardens etc Provision of unique spaces that recognise intergenerational differences and family visitors, with access to social media Embedded within a community environment Access to sporting fields, shops, cafes, safe play areas Proximity to accommodation for carers An embedded culture that recognises and respects military heritage, customs, traditions and ceremonial events e.g. ANZAC Day, Chaplaincy services It was deemed essential that the new facility be able to improve on and facilitate better access for the Veterans community across South Australia and their families Considerations for site selection With the above elements in mind members of the Expert Panel were guided towards their decision about the most suitable re-location site. The committee considered the model of care, the relative advantages and disadvantages of each of the clinical and non-clinical co-dependencies and weighted these against eight possible sites: Flinders Medical Centre (FMC) Glenside Campus Modbury Hospital Noarlunga Hospital Oakden New Royal Adelaide (N-RAH) Repatriation General Hospital Queen Elizabeth Hospital (TQEH) Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 12 of 17

13 Clinical co-dependencies Non-clinical co-dependencies Flinders Medical Centre Suitable Not suitable Glenside Campus Suitable Suitable Modbury Hospital Suitable Not Suitable Noarlunga Hospital Not suitable Not suitable Oakden Not suitable Not suitable New Royal Adelaide Not suitable Not suitable Repatriation General Hospital Not suitable Suitable Queen Elizabeth Hospital Suitable Not suitable Due to its geographical location and the inability for the site to be able to accommodate a new build the Lyell McEwin Health Service was not considered. A summary of the key considerations relating to the other sites include: The major tertiary hospital sites (FMC, TQEH, nrah) were considered too congested, highly stimulating due to the high volume traffic and were therefore unable to provide a low stimulus site. It was noted the Repatriation General Hospital site would not be able to meet the requirement for inpatient support once those services move from the hospital. Geographic centrality was a key consideration in retaining current workforce and providing access to medical and non-clinical support services The available land foot-print at many sites would not facilitate incorporation of clustered ESO and non-government support services The Expert Panel reached unanimous agreement that the site that best met the needs of the model and offered the greatest opportunities to develop key partnerships was the land in the Glenside precinct. This recommendation was endorsed following site visits and panel feedback. It was also suggested that a northern defence/veteran community mental health hub based near RAAF Edinburgh should be explored in the next phase of the project. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 13 of 17

14 5.4. Proposed sites Centre for Excellence Location Detailed Considerations Glenside Health Service precinct was considered to offer a number of key positive attributes specifically: Clinical co-dependencies: All of the key clinical co-dependencies identified can be met at the Glenside precinct. Specifically, as an existing SA Health site, support to inpatient and outpatient care can be met. Specialised ECT services exist, along with on site (inpatient and outpatient) drug and alcohol services. Non-clinical co-dependencies: Location: centralised location for access for patients, families and workforce Easy access to city, good public transport, cycle paths Available space for car parking 3 : Gardens: well established trees, garden spaces, football fields, open space Access to shopping, supported accommodation (Greenhill Rd) 20 on site supported accommodation units (NGO supported) Flexible footprint with access to land and buildings that enables creation of a purpose built, multiuse facility Low stimulus site with high level of privacy Separate access can be made to reduce the stigma associated with the main entry of the site Existing gym facilities Glenside Health Campus is embedded within a recreational community and garden precinct (including SA Film Corporation and Arts School) with future plans to build further low density housing. 6. Northern Defence/Veteran Community Mental Health Hub The panel touched briefly on the opportunity to establish (without infrastructure investment) a northern defence/veteran community mental health hub. As this falls outside of the scope of the current brief of this panel it is suggested that the next piece of work consider exploring partnerships with an organisation such as the Peter Badcoe (VC) Centre and the CFE as a way of enhancing both clinical and non-clinical linkages between current facilities. 3 noting requirement for 4 car parks per inpatient bed Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 14 of 17

15 7. Caveats and drawbacks of the Glenside site Should the Expert Panel recommendation for the Glenside site be accepted, the following will need to be addressed in order to support the Model of Care- Mental health care of the Veteran and service community the next 50 years: 1. Networked provision of non-psychiatric medical health care. Specific consideration will need to be made for on-site or in-reach medical services which are not currently provided at the Glenside campus. These include: a. Pain services b. Sleep disorder services c. Other medical services to address a broad range of physical health conditions (e.g. diabetic education, physiotherapy, medical and surgical needs). This is to ensure that the physical comorbidities of Veterans are met in the model of care. The Clinical Ambassador Professor Dorothy Keefe will initiate the next phase of the model through the establishment of an Expert Work Group under the auspice of the Medical Clinical Advisory Group (MCAG). 2. Culture The ability of staff to relate to and support Veterans results in a stronger therapeutic alliance that translates to enhanced clinical outcomes. The positive culture at the Repatriation General Hospital has been integral to its success in working with veterans and it is therefore important that this culture be replicated within the new facility. The opportunity for staff to transfer to the new location would embed this culture within the new facility. Through military service comes a strong sense of identity and belonging. The Chapel, Museum and the Remembrance Garden will be retained at Repatriation Health site for their considerable significance as special places of remembrance that gives veterans a sense of belonging and connectedness. It will be important to replicate this within the new build. 8. Key Partnerships 8.1. SA Health clinical partnerships Provision of mental health services to the veteran and service community in South Australia is complex and requires robust clinical partnerships with commonwealth, state and private providers and funders. Ongoing Commonwealth funding (through DVA) will underpin the sustainability of the future clinical service. Networked care pathways offer the best opportunity to provide integrated care across inpatient and outpatient domains and regardless of service/funding mix and ensure that the same high level care is provided, regardless of the point of entry into the system, individual entitlements or the nature of the health needs. Success and sustainability of the COE will require comprehensive clinical partnerships to be planned, integrated and communicated to stakeholders Research partnerships Research partnerships are essential to identification of new and emerging treatments, evaluating treatment outcomes, improving clinical care and providing policy advice. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 15 of 17

16 There is considerable benefit in establishing on site, collaborative, multi-institutional research partnerships that are nationally integrated, and engages existing researchers from South Australian universities (University of Adelaide, Flinders University, University of South Australia), SAHMRI and funders (including Universities and The Repat Foundation). South Australia has nationally and internationally recognised excellence in Veterans health research and specifically PTSD. Opportunities to further integrate research and clinical partnerships exist at both at a state and national levels. Robust research partnerships will build on existing research expertise, create research synergies and develop and leverage philanthropic support to drive sustainable research funding Non-clinical partnerships Non-clinical partnerships underpin the core values of wellness models, and removing stigma. The tradition and culture of the veteran community and the support of ESO, non-government and community based support groups reflect the core values of the service community. These partnerships are critical to: Improve access to non-clinical support services, (providing efficiency, minimise duplication and service gaps) Enhancing informal access to care (e.g. drop in centres, on site health promotion) Provide a transition centre for contemporary veterans leaving the ADF (e.g. entitlements advice, continuity of care) Utilising community facilities e.g. gym, café, art program Maintaining existing relationships e.g. philanthropic, community, ceremonial and commemorative Provision of/or access to supported accommodation (e.g. for carers, partners, program attendance on outpatient basis) The Glenside campus offers the opportunity to create a designated Veteran/ESO support hub. This would require refurbishment of an existing building immediately adjacent to the proposed main Centre for Excellence building. The advantages of incorporating this hub are considerable, but will also ensure that the culture, traditions and military ethos which underpin veteran service, can be integrated into the future facility. Use of a co-located, but separate, building for this purpose will simplify governance processes around on-site partnerships with non-clinical service providers whilst ensuring that confidentiality and the privacy of Veterans is maintained. 9. Key outcomes The Expert Panel recognises that further work is required to address the detailed requirements of the Centre of Excellence. Specifically: Detailed clinical pathways, clinical governance frameworks. Detailed workforce plans. Partnership agreements with State, Commonwealth and non-government agencies. Research partnerships, governance and funding. Architectural integration of clinical inpatient, outpatient and research space. Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 16 of 17

17 10. Key recommendations The Expert panel makes the following recommendations, for consideration and endorsement by the Minister: A model of care for the South Australian Veteran PTSD Centre for Excellence (the Model of Care- Mental health care of the Veteran and service community the next 50 years). Establish the COE (including relocation of current Ward 17 services) as a purpose built facility on the Glenside Campus. Agree on a process around naming/branding the facility that is inclusive of the broad veteran and service communities, future focused and cohesive. Adopt a partnership and communication plan to support the above. Establish an oversight body that includes veteran representation at all levels of the process. For more information Health.TransformingHealth@sa.gov.au Visit: Free call: Department for Health and Aging, Government of South Australia. All rights reserved Confidentiality-IX-AX Veterans Post Traumatic Stress Disorder (PTSD) Centre for Excellence Expert Advisory Panel Page 17 of 17