Bi-stability and critical transitions in mental health care systems: a model-based analysis
Abstract 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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | International Journal of Mental Health Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13033-023-00573-y |
| _version_ | 1797860011777458176 |
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| author | Adam Skinner Jo-An Occhipinti Ante Prodan Yun Ju Christine Song Ian B. Hickie |
| author_facet | Adam Skinner Jo-An Occhipinti Ante Prodan Yun Ju Christine Song Ian B. Hickie |
| author_sort | Adam Skinner |
| collection | DOAJ |
| description | Abstract 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 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 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 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). |
| first_indexed | 2024-04-09T21:38:50Z |
| format | Article |
| id | doaj.art-40616c23131d408093436775379730bf |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-04-09T21:38:50Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-40616c23131d408093436775379730bf2023-03-26T11:06:52ZengBMCInternational Journal of Mental Health Systems1752-44582023-03-0117111210.1186/s13033-023-00573-yBi-stability and critical transitions in mental health care systems: a model-based analysisAdam Skinner0Jo-An Occhipinti1Ante Prodan2Yun Ju Christine Song3Ian B. Hickie4Brain and Mind Centre, Faculty of Medicine and Health, University of SydneyBrain and Mind Centre, Faculty of Medicine and Health, University of SydneyComputer Simulation and Advanced Research Technologies (CSART)Brain and Mind Centre, Faculty of Medicine and Health, University of SydneyBrain and Mind Centre, Faculty of Medicine and Health, University of SydneyAbstract 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 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 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 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).https://doi.org/10.1186/s13033-023-00573-yAustraliaBifurcationDisease progressionNonlinear dynamicsMental health servicesSystem dynamics |
| spellingShingle | Adam Skinner Jo-An Occhipinti Ante Prodan Yun Ju Christine Song Ian B. Hickie Bi-stability and critical transitions in mental health care systems: a model-based analysis International Journal of Mental Health Systems Australia Bifurcation Disease progression Nonlinear dynamics Mental health services System dynamics |
| title | Bi-stability and critical transitions in mental health care systems: a model-based analysis |
| title_full | Bi-stability and critical transitions in mental health care systems: a model-based analysis |
| title_fullStr | Bi-stability and critical transitions in mental health care systems: a model-based analysis |
| title_full_unstemmed | Bi-stability and critical transitions in mental health care systems: a model-based analysis |
| title_short | Bi-stability and critical transitions in mental health care systems: a model-based analysis |
| title_sort | bi stability and critical transitions in mental health care systems a model based analysis |
| topic | Australia Bifurcation Disease progression Nonlinear dynamics Mental health services System dynamics |
| url | https://doi.org/10.1186/s13033-023-00573-y |
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