Bi-stability and critical transitions in mental health care systems: a model-based analysis.
Australia
Bifurcation
Disease progression
Mental health services
Nonlinear dynamics
System dynamics
Journal
International journal of mental health systems
ISSN: 1752-4458
Titre abrégé: Int J Ment Health Syst
Pays: England
ID NLM: 101294224
Informations de publication
Date de publication:
24 Mar 2023
24 Mar 2023
Historique:
received:
26
11
2021
accepted:
07
03
2023
entrez:
24
3
2023
pubmed:
25
3
2023
medline:
25
3
2023
Statut:
epublish
Résumé
Delayed initiation and early discontinuation of treatment due to limited availability and accessibility of services may often result in people with mild or moderate mental disorders developing more severe disorders, leading to an increase in demand for specialised care that would be expected to further restrict service availability and accessibility (due to increased waiting times, higher out-of-pocket costs, etc.). We developed a simple system dynamics model of the interaction of specialised services capacity and disease progression to examine the impact of service availability and accessibility on the effectiveness and efficiency of mental health care systems. Model analysis indicates that, under certain conditions, increasing services capacity can precipitate an abrupt, step-like transition from a state of persistently high unmet need for specialised services to an alternative, stable state in which people presenting for care receive immediate and effective treatment. This qualitative shift in services system functioning results from a 'virtuous cycle' in which increasing treatment-dependent recovery among patients with mild to moderate disorders reduces the number of severely ill patients requiring intensive and/or prolonged treatment, effectively 'releasing' services capacity that can be used to further reduce the disease progression rate. We present an empirical case study of tertiary-level child and adolescent mental health services in the Australian state of South Australia demonstrating that the conditions under which such critical transitions can occur apply in real-world services systems. Policy and planning decisions aimed at increasing specialised services capacity have the potential to dramatically increase the effectiveness and efficiency of mental health care systems, promoting long-term sustainability and resilience in the face of future threats to population mental health (e.g., economic crises, natural disasters, global pandemics).
Sections du résumé
BACKGROUND
BACKGROUND
Delayed initiation and early discontinuation of treatment due to limited availability and accessibility of services may often result in people with mild or moderate mental disorders developing more severe disorders, leading to an increase in demand for specialised care that would be expected to further restrict service availability and accessibility (due to increased waiting times, higher out-of-pocket costs, etc.).
METHODS
METHODS
We developed a simple system dynamics model of the interaction of specialised services capacity and disease progression to examine the impact of service availability and accessibility on the effectiveness and efficiency of mental health care systems.
RESULTS
RESULTS
Model analysis indicates that, under certain conditions, increasing services capacity can precipitate an abrupt, step-like transition from a state of persistently high unmet need for specialised services to an alternative, stable state in which people presenting for care receive immediate and effective treatment. This qualitative shift in services system functioning results from a 'virtuous cycle' in which increasing treatment-dependent recovery among patients with mild to moderate disorders reduces the number of severely ill patients requiring intensive and/or prolonged treatment, effectively 'releasing' services capacity that can be used to further reduce the disease progression rate. We present an empirical case study of tertiary-level child and adolescent mental health services in the Australian state of South Australia demonstrating that the conditions under which such critical transitions can occur apply in real-world services systems.
CONCLUSIONS
CONCLUSIONS
Policy and planning decisions aimed at increasing specialised services capacity have the potential to dramatically increase the effectiveness and efficiency of mental health care systems, promoting long-term sustainability and resilience in the face of future threats to population mental health (e.g., economic crises, natural disasters, global pandemics).
Identifiants
pubmed: 36959667
doi: 10.1186/s13033-023-00573-y
pii: 10.1186/s13033-023-00573-y
pmc: PMC10037813
doi:
Types de publication
Journal Article
Langues
eng
Pagination
5Informations de copyright
© 2023. The Author(s).
Références
Front Psychiatry. 2018 Oct 26;9:536
pubmed: 30416460
JAMA Psychiatry. 2021 Apr 1;78(4):372-379
pubmed: 33533876
BMJ. 2012 Jul 31;345:e4933
pubmed: 22849956
Lancet Public Health. 2018 Jun;3(6):e296-e303
pubmed: 29884435
Lancet. 2007 Sep 8;370(9590):841-50
pubmed: 17826169
Int Rev Psychiatry. 2014 Aug;26(4):392-407
pubmed: 25137105
Br J Psychiatry. 2004 Oct;185:283-90
pubmed: 15458987
Lancet. 2021 May 22;397(10288):1992-2011
pubmed: 33965066
J Stat Softw. 2017;76:
pubmed: 36568334
Med J Aust. 2019 Nov;211 Suppl 9:S3-S46
pubmed: 31679171
Cochrane Database Syst Rev. 2014 Nov 30;(11):CD008324
pubmed: 25433518
Lancet. 2020 Oct 17;396(10258):1204-1222
pubmed: 33069326
World Psychiatry. 2017 Oct;16(3):299-307
pubmed: 28941090
Biol Psychiatry. 1998 Aug 1;44(3):193-206
pubmed: 9693391
Psychol Med. 2014 Apr;44(6):1303-17
pubmed: 23931656
Am J Public Health. 2006 Mar;96(3):452-8
pubmed: 16449591
Lancet Psychiatry. 2018 Apr;5(4):339-347
pubmed: 29496589
Br J Psychiatry. 2008 Apr;192(4):290-3
pubmed: 18378992
Br J Gen Pract. 1998 Dec;48(437):1840-4
pubmed: 10198504
Depress Anxiety. 2018 Mar;35(3):195-208
pubmed: 29356216
Lancet. 2012 Nov 24;380(9856):1813-4
pubmed: 23141814
Eur Psychiatry. 2020 Jul 24;63(1):e75
pubmed: 32703326
Br J Psychiatry. 2017 Feb;210(2):119-124
pubmed: 27908899
Arch Gen Psychiatry. 2003 Nov;60(11):1117-22
pubmed: 14609887
Arch Gen Psychiatry. 1997 Nov;54(11):1009-15
pubmed: 9366657
BMC Med. 2021 Mar 12;19(1):61
pubmed: 33706764
Lancet Psychiatry. 2020 Oct;7(10):883-892
pubmed: 32707037
CNS Spectr. 2008 May;13(5):415-22
pubmed: 18496479
Lancet Planet Health. 2017 Jul;1(4):e134-e141
pubmed: 28944321
Br J Psychiatry. 2014 Aug;205(2):88-94
pubmed: 25252316