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Summary Background High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Methods Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Findings Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5–8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level. Interpretation Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits. Funding National Health and Medical Research Council (Australia), Department of Health SA.

On 20 December 2016, the Chief Executive Officer (CEO) of the Northern Adelaide Local Health Network (NALHN), Ms Jackie Hanson contacted the Chief Psychiatrist raising concerns about the level of clinical care provided at the Oakden Older Persons Mental Health Service (OPMHS). Ms Hanson requested the Chief Psychiatrist undertake an external independent review of the Oakden Facility as a matter of urgency with the intention of providing a report in April 2017.Comprehensively reviewing a service of this size is both complex and demanding. In undertaking this review, I was ably assisted by Professor Nicholas Procter, Dr Duncan McKellar and Ms Del Thomson.I am indebted to a number of people who assisted me and who were generous with their time, in order that I could fulfil the expectations of this review. I am especially grateful to the large number of brave staff of NALHN, who came forward and spoke to the Review with an openness, honesty and transparency about their experiences and observations that reflects the deeply held concerns they have harboured for many years.This report is arranged in sections that cover the background; an outline of the policy context; the history of the Oakden facility; and five Chapters each of which is devoted to one of the terms of reference.The Chapters, addressing each of the Terms of Reference, are arranged in order to describe what the Review considered as the scope of the issue, what was found and finally what recommendations are made to address that aspect of the service. In addition, where it was possible to do so, the Review has given an indicative time frame for addressing its recommendations.The report is based on numerous interviews, written submissions, reviews of clinical files, written policies, procedures and protocols, and observations made by the Review team whilst onsite at Oakden.Great care has been taken to ensure all findings within the report are based on this material and therefore this source material is available to NAHLN for verification of the findings. However to ensure the anonymity and confidentiality of those who provided this information, the report does not contain the details of who said what, or which documents, including consumers clinical files, and other correspondence has been relied upon, unless prior permission was given for this to be identified within the report.A number of Appendices, a Bibliography and a Document register together with a list of references have been provided.The Review has made findings and recommendations that can provide a new direction for Specialist Older Person Mental Health Services in South Australia. I hope they will be able to be implemented over the coming years.