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Federal and state cooperation necessary but not sufficient for effective regional mental health systems - insights from systems modelling and simulation1.56 MB
Published VersionCC BY V4.0, Open Access
Journal article
Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation
Scientific Reports, Vol.11(1), pp.11209-11209
2021
PMID: 34045644
Abstract
For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of 'taxpayer money.' This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3-14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5-16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.
Details
- Title
- Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation
- Authors
- Jo-An Occhipinti (Author) - The University of SydneyAdam Skinner (Author) - The University of SydneySamantha Carter (Author) - Hunter New England HealthJacinta Heath (Author) - Hunter New England HealthKenny Lawson (Author) - The University of SydneyKatherine McGill (Author) - University of Newcastle AustraliaRod McClure (Author) - University of New EnglandIan B. Hickie (Author) - The University of Sydney
- Publication details
- Scientific Reports, Vol.11(1), pp.11209-11209; 12
- Publisher
- Nature Publishing Group
- Date published
- 2021
- DOI
- 10.1038/s41598-021-90762-x
- ISSN
- 2045-2322
- PMID
- 34045644
- Copyright note
- Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Organisation Unit
- Centre for Human Factors and Systems Science; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99654137902621
- Output Type
- Journal article
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- Psychiatry
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