Things to know about our Model of Care

Leonie Nowland, Open Arms First Assistant Secretary, and Dr Jon Lane, DVA’s Acting Chief Psychiatrist and military veteran, sat down with the host of the Military Life podcast for an in-depth interview.

They spoke about how we deliver military-aware and trauma informed care through our Model of Care. They gave an overview of Open Arms and dispelled some misconceptions about the help and support that we provide.  Leonie and Jon also re-enforced that the long-term health and wellbeing of our clients and their immediate families remains our number one priority.  

We’ve put together some highlights from their conversation below. 

We encourage you to listen to the full podcast.

Military Life: A lot of those listening will know what and who Open Arms is, but for those who haven't heard of Open Arms or Access Services, can you tell us a little about Open Arms?

Leonie: Open Arms is a mental health, counselling and a treatment service with a very proud tradition having been established by Vietnam veterans more than 40 years ago.

In 2018, Open Arms became a service for all members of the Australian Defence Forces with one day's continuous full-time service and their families. 

Last year, we saw around 43,000 individual clients seeking support for conditions including anxiety, depression, Post-traumatic stress disorder (PTSD) as well as for relationship counselling.

We provide telehealth services and have a 24-hour telephone contact line, which can also provide counselling 24 hours a day.

We are located in areas throughout Australia where we know there is a high concentration of veterans to reduce the need for them to travel to receive services. 

Jon: One of the strengths of Open Arms is that because we are a national organisation, a client can move cities and still have access to care. 

And with our outreach providers, these are the clinicians, they're not direct employees of Open Arms, but they contract their services to Open Arms. 

A lot of those provide remote telehealth delivery of services as well, too. And so, at least because Open Arms has got services all around the country, you can get care all around the country.

What services does Open Arms provide? 

Leonie: We offer a range of programs, as well as individual counselling and family and relationship counselling which is an important part of what we do.  

Open Arms also has peer support workers with around 80 per cent who are veterans with lived experience of having served in the ADF and about 20 per cent who are family members. 

We are always seeking to increase the number of family peers that we have because we are recognising what an important role families play in supporting the health and wellbeing of the veteran.

Our individual clients can also access group programs, which may include a group treatment program or a psycho-education program.

One of the things we've found is that with our group programs, that people might think, I need to see a counsellor, but in the meantime, they might be interested in doing one of our group programs. And sometimes the group program in itself is sufficient to meet the needs of the client, because they learn the skills that they're seeking.

Jon: In wider society at the moment, there's a real sort of trend, I suppose, towards pathologising stressors. And what we're trying to talk about here is the fact that you might have more stressors and stressors in your life because of your partner's employment or whatever else as well.

But that doesn't mean we have to give you a diagnosis and call you broken or something like that, because one of the biggest things, I think, with service personnel and families is their really high degree of resilience.

And it's really important to actually promote the fact that often times those kind of stressors develop really strong family and family bonds. And this is why what we're talking about now is helping people cope with those things so that they become stronger and better able to manage themselves and their lives. 

A large percentage of Open Arms clients are family members, can you tell me about the services you offer veteran families?

Jon: As an example, we've recently started new things in Tasmania and this includes an intensive peer and clinician-led group program for stress and trauma. And that's currently for veterans.

And we're starting a new one for partners of veterans and Defence members in the coming month.

But as a part of organising all of that and access to other services within the local wider mental health community, Kath, who is one of the leading clinicians in Hobart, we had a bunch of people from other mental health organisations come in. And Kath did an exercise where she walked people through what, say, four or five years in Defence life might look like for a spouse or partner of someone who was serving.

And it was simple things like, you're in this chair and you've been posted to Brisbane. So, I'm now going to get you to move to this chair. And you're sitting in now with a bunch of people that you don't know. Oh, and by the way, you have a child with special needs. So, you have to organise enrolment in a particular school for them.

And you also want some other care and various other sorts of things as well too. And so, she sent people through what that experience might be like over time and how difficult it might be. And so that's an absolutely classic example of that kind of military and partner awareness that's required for clinicians that are working within our service. 

Because they understand that sort of stuff and they understand how frustrating and difficult that can make life for those people over time. You don't get that if you just go and see any clinician anywhere in the community.

Open Arms has recently introduced a model of care. Can you tell me what a model of care is and why now? What is it? How was it developed? 

Leonie: Having a Model of Care means we can be clearer about what we do and how we do it. 

Prior to this model, Open Arms was a counselling service, which meant that there wasn't necessarily the same emphasis on treatment and goal setting and outcome measurement. 

And part of what we have done in the last two years is brought in much more of an emphasis on quality and safety and outcome measurements, bearing in mind that the people we see range from the worried well, who may need some counselling through to people who are actually quite unwell, who need treatment.

But by definition, if you have an outcome, you need to have a beginning, a middle and an end to your intervention, your episode, whether that's a counselling, whether it's peer support, whether it's a group program, or whether it's treatment, to ensure that we are actually delivering quality services that make a difference.

If we need to assist people outside the scope of our Model of Care, then we look at how we can refer them to an appropriate service to support the family member, or the current serving member, or the former serving member. 

So, we've got that clarity of contract, as it were, with the veteran community and including families in that, so they know what we do and why we don't do other things. It would be irresponsible of us, from a clinical perspective, to work outside our scope of practice in attempting to deliver those services without having the necessary qualifications and experience and skills.

Jon: As a psychiatrist, a big part of our training is actually about understanding the need to help people to move on. 

And when I see all of my new patients, the first thing I say to them is that my job isn't to cure you, my job is to help you help yourself. 

And the second part is that my job is to actually make you not need me.

You might still want to see me, but my job is to make it so that you don't need to see me. 

And that is something that can be a little bit tricky for some people to wrap their heads around, because when we think about counselling, people can often think about that as, like, a years long relationship. 

To me, that's really unhealthy, because what it sets up is this kind of dependent relationship on someone needing to see their counsellor, you know, to offload whatever's going on or whatever else as well, too.

And that creates a dependency that stops that particular person from moving on and dealing with issues by themselves.

In terms of our Model of Care, it's about an Episode of Care, because you have a specific problem that needs support and needs help with. And, so the idea is that someone comes in and they have treatment for their particular condition. 

So, something we can obviously fix. So that's how the Model of Care is framed. 

In regard to the Model of Care, there's been feedback of Open Arms clients being told that they need to have a break between recommencing counselling with Open Arms. How does that work and is there a rule with the three-month break between the three and six-month mark of services? 

Leonie: No, that is absolutely incorrect. 

There is no such thing as having to have a break at three months or a break between Episodes of Care. 

However, what we do is evidence-based and actually has an end. If you keep people as a patient or a client, that is not consistent with a recovery focus and can indeed exacerbate the individual’s feelings of helplessness and distress.

With an Episode of Care, we do not have a cap on the number of sessions that are provided, but most people have between three and six sessions.

That's, by far and away, the biggest episode of care that we deliver.

By having that episodic Model of Care, it's making sure that we align ourselves with a recovery focus, and also ensure that we are meeting the needs of the client within those goals, rather than seeing somebody and not actually being able to make a difference to help them.

For people who require more, we will deliver more, but we need to ensure that we are actually meeting the client's needs and operating in a way that is consistent with the rest of the health services across Australia. 

We need to be really clear that what we're doing is evidence-based and supportive, which doesn't mean that there is an arbitrary cut-off point. 

What do the timeframes look like for individual counselling?

Leonie: For individual counselling, it’s about two weeks from when you first contact our 24/7 help line on 1800 011 046.

We try to look at what we can do in the meantime to support individuals before we can see them face-to-face.

Couples counselling may have a longer waiting time to access support, depending upon the region because telehealth doesn’t necessarily suit couple or relationship counselling.