RSL WA’s Veteran Central is leading the way in cooperative models of care for the benefit of both veterans and serving ADF members.
Eric Martin reports
The hub-and-spoke co-operative model of care that has been enthusiastically adopted by WA Health recently, after the release of the Infant Child and Adolescent Taskforce report in March, has been humming along successfully for five years at Anzac House, providing holistic care for veterans.
Anzac House Veteran Central, the re-envisioned service centre for the RSL WA, has produced agile adaptations to service delivery to broaden accessibility.
Medical Forum caught up with veteran and retiring CEO John McCourt to discuss the crucial insights gleaned from the Veteran Central experience.
“The hub-and-spoke concept is the exact model we have been using, along with the veteran central model, and now we can help our clients virtually. We are also looking at hubs in the greater Perth metropolitan area and in regional centres,” Mr McCourt said.
“They have been so successful that the former government instituted a series of veteran wellness centres (rebadged as ‘veteran hubs’ by Labor) nationally. They’re using our model to try and replicate them throughout Australia.
“We have found out as we have rolled out this initiative, which started about five years ago, that it works because it’s simple. You put the veteran and their family at the centre of the circle and rather than looking outwards for services, veteran service providers can reach inward – they are actively looking to give complementary services to a veteran.
“What we’ve developed at Veterans Central in Perth is that the veteran can come in – and, indeed, serving members if they feel that they have a need to – and access services. There are doctors who will treat them as a GP, all the way through to dental assistance, medical hearing assistance, legal advice, financial advice, welfare support and advocacy advice, all under one roof.
“The different service providers are private and pay a very reasonable rent at Anzac House on a contract that says that they give absolute priority to veterans. Their income is via the Medicare schedule or the DVA schedule or mixture of both.”
Mr McCourt said that veterans and their families, even with minimal service, are issued with a White Card that entitles them to free mental health care.
For injured veterans, the co-location of services enables the referral process to escalate organically from the GP to the specialist, who could attend as a consultant, to surgery at either a private or public hospital, with wait times closely monitored by the team who would advocate on their behalf.
“Similarly, if a veteran comes in and says they have mental health issues, there are three tiers of mental health services at Anzac House Veterans Central,” he said.
“There is what they call the entry service, Open Arms, which is the Federal Government Mental Health Support Service, we have clinical psychologists, and we also have a psychiatrist.”
The team is now moving beyond physical attendance to make their services available virtually, another key area highlighted for growth in wider healthcare planning, and Mr McCourt said that the value it represented for veterans was undeniable.
“For example, if someone’s living in the Pilbara region and they need various supports – they may have mental health needs or physical health needs – they will benefit being triaged virtually,” he said.
“And then if and when they must travel to Perth, they can get everything seen to at the same time, rather than up and back and up and back.”
Mr McCourt said the team had learned two key factors since the start of the hub – the first of which was to make sure that the environment was as welcoming as possible.
“And it sounds a bit trite but this building, for example, is open, it’s got plenty of large windows and sky and it’s not enclosed, it’s not intimidating, it’s relaxed. We thought carefully about what the customer’s square metre would be from the moment they enter,” he explained.
“And if our clients, especially those who have mental health issues, find they can physically experience that it’s welcoming and not intimidating, we’re already ahead of the curve.
“We also used our brains in terms of the fit-out. People are not in a big waiting room looking at someone else’s shoes or wondering what he or she is here for. Our triage service starts with the concierge people on the ground floor who know who is coming.”
Veterans are immediately sent to the appropriate level by a computerised elevator, where they can go straight to their appointment or, for a walk-in, a private interview.
“Sometimes you may have to wait, but it’s very, very rare and it’s very rarely for long. All those sorts of things are really important,” he said. “If a person comes in off the street, they can actually at least get to see someone.
“We’re still learning, but we’ve got happy customers. It is such a breezy and inviting place and it doesn’t look and smell like a museum.”
Mr McCourt said a lot of work had gone into a collaborative service approach, with service providers regarding themselves as one dealing with clients, a process that was kickstarted at Anzac House through a mix of organic growth and strategic planning.
“We have developed some great printed and virtual communications so that people understand the process, understand what it is and how they can get involved,” he said.
He explained that just by locating health-care professionals from different disciplines together, such as mental health, dental and hearing services on the second floor, the teams have not only been able to better coordinate appointment times, but also identify new cross-disciplinary topics for research.
“So just like that, they were talking to each other,” Mr McCourt said.
“For example, the psychologists were saying, ‘we’re seeing a link between hearing loss and mental health issues’, and the researchers from the Ear Science Institute and Lion’s Hearing went on to research that there is a strong causal link between hearing loss and PTSD.
“We were lucky that when we were planning this four or five years ago, we had a psychiatrist who was very interested. And it just so happens that within Anzac House, a number of veterans themselves were saying what a good idea it was.
“So that was word of mouth. It was talking to other people; it was a process of persistence and a process of developing a collaborative way of working to develop these services.”
Royal Commission wants changes at the top
The Royal Commission into Defence and Veteran Suicide has just submitted its interim report to the Australian Parliament. It still has a more than year to run until its final report is delivered in 2024.
However, it has issued a list of urgent and immediate recommendations, which the Royal Australian and New Zealand College of Psychiatrists have supported. They include:
- Legislative reform of the veteran compensation and rehabilitation system. The commissioners said that the present system was so complicated it adversely affected the mental health of some veterans and serving ADF members, which could be a contributing factor to suicidality. It recommends the Australian Government implement reforms “without delay”.
- The Department of Veterans Affairs to take “urgent and immediate steps” to fix problems with the processing of claims for serving and ex-serving ADF members. Some claims have taken more than 300 days to process. The report cited 41,799 backlogged claims as of May 31 this year. It also recommended the removal of the staffing cap so DVA can recruit more staff.
- Improved legal protections for people, especially serving members of the ADF, who want to engage with the Royal Commission.
- The commissioners believe that they are seriously constrained by the legal concepts of parliamentary privilege and public interest immunity claims to inquire into and receive the necessary evidence from prior inquiries conducted by parliament and to examine government decision-making. They are urging the Australian Government to immediately address the barriers for this Royal Commission. They added the government should also introduce an exemption for future Royal Commissions. They recommend reform of policies and practices related to public interest immunity to be limited to claims where there is a specific harm contemplated from disclosure.
- The commission has heard numerous concerns about access to information held by Defence and DVA by serving and ex-serving members of the ADF and their families. These concerns are not limited to those seeking access to their own information, but also family members of the deceased. The report recommends embedding a trauma-informed approach and developing and implementing improvements to information-seeking processes, and consent to disclose processes. It seeks a co-design and revision of information by Defence and DVA to better support those seeking information from both departments.