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Occhipinti JA, Prodan A, Hynes W, Eyre HA, Schulze A, Ujdur G, Tanner M. Navigating a stable transition to the age of intelligence: A mental wealth perspective. iScience 2024; 27:109645. [PMID: 38638562 PMCID: PMC11024996 DOI: 10.1016/j.isci.2024.109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
In the grand narrative of technological evolution, we are transitioning from the "Age of Information" to the "Age of Intelligence." Rapid advancements in generative artificial intelligence (AI) are set to reshape society, revolutionize industries, and change the nature of work, challenging our traditional understanding of the dynamics of the economy and its relationship with human productivity and societal prosperity. As we brace for this transformative shift, promising advancements in healthcare, education, productivity, and more, there are concerns of large-scale job loss, mental health repercussions, and risks to social stability and democracy. This paper proposes the concept of Mental Wealth as an action framework that supports nations to proactively position themselves for a smooth transition to the Age of Intelligence while fostering economic and societal prosperity.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
| | - William Hynes
- The World Bank, Paris, France
- Santa Fe Institute, Santa Fe, NM, USA
| | - Harris A. Eyre
- Brain Capital Alliance, San Francisco, CA, USA
- Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Meadows Mental Health Policy Institute, Dallas, TX, USA
| | | | - Goran Ujdur
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Marcel Tanner
- Swiss Academies of Arts and Sciences, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Basel, Switzerland
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Occhipinti JA, Skinner A, Doraiswamy PM, Saxena S, Eyre HA, Hynes W, Geli P, Jeste DV, Graham C, Song C, Prodan A, Ujdur G, Buchanan J, Rosenberg S, Crosland P, Hickie IB. The influence of economic policies on social environments and mental health. Bull World Health Organ 2024; 102:323-329. [PMID: 38680470 PMCID: PMC11046160 DOI: 10.2471/blt.23.290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 05/01/2024] Open
Abstract
Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes.
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Affiliation(s)
- Jo-An Occhipinti
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Adam Skinner
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, United States of America (USA)
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Harris A Eyre
- Baker Institute for Public Policy, Rice University, Houston, USA
| | | | - Patricia Geli
- Reform for Resilience Commission, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics, San Diego, USA
| | | | - Christine Song
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Goran Ujdur
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - John Buchanan
- Business School, University of Sydney, Sydney, Australia
| | - Sebastian Rosenberg
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Paul Crosland
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Ian B Hickie
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
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Skinner A, Occhipinti JA, Song YJC, Hickie IB. Mental health impacts of COVID-19: A retrospective analysis of dynamic modelling projections for Australia. Heliyon 2024; 10:e28250. [PMID: 38586382 PMCID: PMC10998102 DOI: 10.1016/j.heliyon.2024.e28250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Background In early 2020, we developed a dynamic model to support policy responses aimed at mitigating the adverse mental health effects of the COVID-19 pandemic in Australia. As the pandemic has progressed, it has become clear that our initial model forecasts overestimated the impacts of infection control measures (lockdowns, physical distancing, etc.) on suicide, intentional self-harm hospitalisation, and mental health-related emergency department (ED) presentation rates. Methods Potential explanations for the divergence of our model predictions from observed outcomes were assessed by comparing simulation results for a set of progressively more refined models with data on the prevalence of moderate to very high psychological distress and numbers of suicides, intentional self-harm hospitalisations, and mental health-related ED presentations published after our modelling was released in July 2020. Results Allowing per capita rates of spontaneous recovery and intentional self-harm to differ between people experiencing moderate to very high psychological distress prior to the pandemic and those developing comparable levels of psychological distress only as a consequence of infection control measures substantially improves the fit of our model to empirical estimates of the prevalence of psychological distress and leads to significantly lower predicted effects of COVID-19 on suicide, intentional self-harm hospitalisation, and mental health-related ED presentation rates. Conclusion Accommodating the influence of prior mental health on the psychological effects of population-wide social and economic disruption is likely to be critical for accurately forecasting the mental health impacts of future public health crises as they inevitably arise.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Jones AR, Currie D, Peng C, Ebeling PR, Center JR, Duque G, Lybrand S, Lyubomirsky G, Mitchell RJ, Pearson S, Seibel MJ, Occhipinti JA. Expanding access to fracture liaison services in Australia for people with minimal trauma fractures: a system dynamics modelling study. Med J Aust 2024; 220:243-248. [PMID: 38409791 DOI: 10.5694/mja2.52241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/07/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVES To project how many minimal trauma fractures could be averted in Australia by expanding the number and changing the operational characteristics of fracture liaison services (FLS). STUDY DESIGN System dynamics modelling. SETTING, PARTICIPANTS People aged 50 years or more who present to hospitals with minimal trauma fractures, Australia, 2020-31. MAIN OUTCOME MEASURES Numbers of all minimal trauma fractures and of hip fractures averted by increasing the FLS number (from 29 to 58 or 100), patient screening rate (from 30% to 60%), and capacity for accepting new patients (from 40 to 80 per service per month), and reducing the proportion of eligible patients who do not attend FLS (from 30% to 15%); cost per fracture averted. RESULTS Our model projected a total of 2 441 320 minimal trauma fractures (258 680 hip fractures; 2 182 640 non-hip fractures) in people aged 50 years or older during 2020-31, including 1 211 646 second or later fractures. Increasing the FLS number to 100 averted a projected 5405 fractures (0.22%; $39 510 per fracture averted); doubling FLS capacity averted a projected 3674 fractures (0.15%; $35 835 per fracture averted). Our model projected that neither doubling the screening rate nor reducing by half the proportion of eligible patients who did not attend FLS alone would reduce the number of fractures. Increasing the FLS number to 100, the screening rate to 60%, and capacity to 80 new patients per service per month would together avert a projected 13 672 fractures (0.56%) at a cost of $42 828 per fracture averted. CONCLUSION Our modelling indicates that increasing the number of hospital-based FLS and changing key operational characteristics would achieve only moderate reductions in the number of minimal trauma fractures among people aged 50 years or more, and the cost would be relatively high. Alternatives to specialist-led, hospital-based FLS should be explored.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Monash Health, Melbourne, VIC
| | | | | | | | - Jackie R Center
- Garvan Institute of Medical Research, Sydney, NSW
- St Vincent's Hospital Sydney, Sydney, NSW
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC
- Western Health, Melbourne, VIC
| | | | | | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
- Centre of Research Excellence in Medicines Intelligence, University of New South Wales, Sydney, NSW
| | - Markus J Seibel
- Concord Clinical School, University of Sydney, Sydney, NSW
- ANZAC Research Institute, University of Sydney, Sydney, NSW
| | - Jo-An Occhipinti
- Brain and Mind Centre, University of Sydney, Sydney, NSW
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, NSW
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Crosland P, Ho N, Hosseini SH, Vacher C, Skinner A, Natsky AN, Rosenberg S, Hasudungan R, Huntley S, Song YJC, Lee GY, Marshall DA, Occhipinti JA, Hickie IB. Cost-effectiveness of system-level mental health strategies for young people in the Australian Capital Territory: a dynamic simulation modelling study. Lancet Psychiatry 2024; 11:123-133. [PMID: 38245017 DOI: 10.1016/s2215-0366(23)00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Regional mental health planning is a key challenge for decision makers because mental health care is a complex, dynamic system. Economic evaluation using a system dynamics modelling approach presents an opportunity for more sophisticated planning and important evidence on the value of alternative investments. We aimed to investigate the cost-effectiveness of eight systems-based interventions targeted at improving the mental health and wellbeing of children, adolescents, and young adults in the Australian Capital Territory (ACT). METHODS We assessed eight interventions for children and young people (aged ≤25 years) with low, moderate, and high-to-very-high psychological distress: technology-enabled integrated care, emergency department-based suicide prevention, crisis response service, family education programme, online parenting programme, school-based suicide prevention programme, trauma service for youths, and multicultural-informed care. We developed a system dynamics model for the ACT through a participatory process and calibrated the model with historical data, including population demographics, the prevalence of psychological distress, and mental health services provision. We calculated incremental cost-effectiveness ratios compared with business as usual for cost (AU$) per: quality-adjusted life-year (QALY), suicide death avoided, self-harm related hospital admissions avoided, and mental health-related emergency department presentation, using a 10-year time horizon for health-care and societal perspectives. We investigated uncertainty through probabilistic sensitivity analysis and deterministic sensitivity analysis, including using a 30-year timeframe. FINDINGS From a societal perspective, increased investment in technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care were expected to improve health outcomes (incremental QALYs 4517 [95% UI -3135 to 14 507] for technology-enabled integrated care; 339 [91 to 661] for family education; 724 [114 to 1149] for the online parenting programme; and 137 [88 to 194] for multicultural-informed care) and reduce costs ($-91·4 million [-382·7 to 100·7]; $-12·8 million [-21·0 to -6·6]; $-3·6 million [-6·3 to 0·2]; and $-3·1 million [-4·5 to -1·8], respectively) compared with business as usual using a 10-year time horizon. The incremental net monetary benefit for the societal perspective for these four interventions was $452 million (-351 to 1555), $40 million (14 to 74), $61 million (9 to 98), and $14 million (9 to 20), respectively, compared with business as usual, when QALYs were monetised using a willingness to pay of $79 930 per QALY. Synergistic effects are anticipated if these interventions were to be implemented concurrently. The univariate and probabilistic sensitivity analyses indicated a high level of certainty in the results. Although emergency department-based suicide prevention and school-based suicide prevention were not cost effective in the base case (41 QALYs [0 to 48], incremental cost $4·1 million [1·2 to 8·2] for emergency department-based suicide prevention; -234 QALYs [-764 to 12], incremental cost $90·3 million [72·2 to 111·0] for school-based suicide prevention) compared with business as usual, there were scenarios for which these interventions could be considered cost effective. A dedicated trauma service for young people (9 QALYs gained [4 to 16], incremental cost $8·3 million [6·8 to 10·0]) and a crisis response service (-11 QALYs gained [-12 to -10], incremental cost $7·8 million [5·1 to 11·0]) were unlikely to be cost effective in terms of QALYs. INTERPRETATION Synergistic effects were identified, supporting the combined implementation of technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care. Synergistic effects, emergent outcomes in the form of unintended consequences, the capability to account for service capacity constraints, and ease of use by stakeholders are unique attributes of a system dynamics modelling approach to economic evaluation. FUNDING BHP Foundation.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Andrea N Natsky
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Raphael Hasudungan
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sam Huntley
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
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Skinner A, Occhipinti JA, Song YJC, Scott EM, Hickie IB. Dynamic modelling of the impact of community-based acute mental health services for children and adolescents. Aust N Z J Psychiatry 2023; 57:1562-1569. [PMID: 37641519 PMCID: PMC10666480 DOI: 10.1177/00048674231195555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To evaluate the potential impact of the recently announced 'Safeguards' initiative on mental health-related emergency department presentation rates for children and adolescents (0-17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. METHODS We estimated the effects of the 'Safeguards' initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. RESULTS Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022-2031 by 15.0% (95% interval, 12.0-18.2%) and 31.7% (26.2-37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the 'Safeguards' initiative significantly. CONCLUSION Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the 'Safeguards' initiative on demand for hospital-based emergency mental health care is to be realised.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Loblay V, Freebairn L, Occhipinti JA. Conceptualising the value of simulation modelling for public engagement with policy: a critical literature review. Health Res Policy Syst 2023; 21:123. [PMID: 38012664 PMCID: PMC10680332 DOI: 10.1186/s12961-023-01069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/04/2023] [Indexed: 11/29/2023] Open
Abstract
As we face complex and dynamically changing public health and environmental challenges, simulation modelling has come to occupy an increasingly central role in public engagements with policy. Shifts are occurring not only in terms of wider public understandings of modelling, but also in how the value of modelling is conceptualised within scientific modelling communities. We undertook a critical literature review to synthesise the underlying epistemic, theoretical and methodological assumptions about the role and value of simulation modelling within the literature across a range of fields (e.g., health, social science and environmental management) that engage with participatory modelling approaches. We identified four cross-cutting narrative conceptualisations of the value of modelling across different research traditions: (1) models simulate and help solve complex problems; (2) models as tools for community engagement; (3) models as tools for consensus building; (4) models as volatile technologies that generate social effects. Exploring how these ideas of 'value' overlap and what they offer one another has implications for how participatory simulation modelling approaches are designed, evaluated and communicated to diverse audiences. Deeper appreciation of the conditions under which simulation modelling can catalyse multiple social effects is recommended.
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Affiliation(s)
- Victoria Loblay
- The Australian Prevention Partnership Centre, Sydney, Australia.
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Louise Freebairn
- The Australian Prevention Partnership Centre, Sydney, Australia
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
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Skinner A, Occhipinti JA, Song YJC, Hickie IB. Population-level effectiveness of alternative approaches to preventing mental disorders in adolescents and young adults. Sci Rep 2023; 13:19982. [PMID: 37968445 PMCID: PMC10652005 DOI: 10.1038/s41598-023-47322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 11/12/2023] [Indexed: 11/17/2023] Open
Abstract
Preventive interventions that are effective in reducing the incidence of mental disorders in adolescence and early adulthood may impact substantially on lifetime economic, educational, and health outcomes; however, relatively few studies have examined the capacity of alternative approaches to preventing youth mental disorders (specifically, universal, selective, and indicated prevention) to reduce disorder incidence at a population level. Using a dynamic model of the onset of non-specific, relatively mild symptoms and progression to more severe disease, we show that: (1) indicated preventive interventions, targeting adolescents and young adults experiencing subthreshold symptoms, may often be more effective in reducing mental disorder prevalence than universal interventions delivered to the general population (contrary to the widely accepted view that a 'high risk' prevention strategy, focussing on those individuals with the greatest risk of developing a disorder, will generally be less effective than a whole-population strategy); and (2) the ability of selective preventive interventions (targeting vulnerable, asymptomatic youth) to alter the prevalence of mental disorders is severely restricted by an inverse relationship between the prevalence of significant risk factors for mental illness and the relative risk of developing symptoms.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Camacho S, Hilber AM, Ospina-Pinillos L, Sánchez-Nítola M, Shambo-Rodríguez DL, Lee GY, Occhipinti JA. Can participatory processes lead to changes in the configuration of local mental health networks? A social network analysis. Front Public Health 2023; 11:1282662. [PMID: 38026382 PMCID: PMC10663236 DOI: 10.3389/fpubh.2023.1282662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Systems modeling offers a valuable tool to support strategic decision-making for complex problems because it considers the causal inter-relationships that drive population health outcomes. This tool can be used to simulate policies and initiatives to determine which combinations are likely to deliver the greatest impacts and returns on investment. Systems modeling benefits from participatory approaches where a multidisciplinary stakeholder group actively engages in mapping and contextualizing causal mechanisms driving complex system behaviors. Such approaches can have significant advantages, including that they may improve connection and coordination of the network of stakeholders operating across the system; however, these are often observed in practice as colloquial anecdotes and seldom formally assessed. We used a basic social network analysis to explore the impact on the configuration of the network of mental health providers, decision-makers, and other stakeholders in Bogota, Colombia active in a series of three workshops throughout 2021 and 2022. Overall, our analysis suggests that the participatory process of the systems dynamics exercise impacts the social network's structure, relationships, and dynamics.
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Affiliation(s)
- Salvador Camacho
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laura Ospina-Pinillos
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Mónica Sánchez-Nítola
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Débora L. Shambo-Rodríguez
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
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Whiteford H, Bagheri N, Diminic S, Enticott J, Gao CX, Hamilton M, Hickie IB, Khanh-Dao Le L, Lee YY, Long KM, McGorry P, Meadows G, Mihalopoulos C, Occhipinti JA, Rock D, Rosenberg S, Salvador-Carulla L, Skinner A. Mental health systems modelling for evidence-informed service reform in Australia. Aust N Z J Psychiatry 2023; 57:1417-1427. [PMID: 37183347 DOI: 10.1177/00048674231172113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Australia's Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population.
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Affiliation(s)
- Harvey Whiteford
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra
| | - Sandra Diminic
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Joanne Enticott
- Southern Synergy, Monash Centre of Health Research & Implementation, Monash University, Dandenong, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Matthew Hamilton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Long Khanh-Dao Le
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yong Yi Lee
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katrina M Long
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Dandenong, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo-An Occhipinti
- Systems Modelling, Simulation & Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Australia
- Discipline of Psychiatry, Medical School University of Western Australia
- Faculty of Health, University of Canberra
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Occhipinti JA, Hynes W, Geli P, Eyre HA, Song Y, Prodan A, Skinner A, Ujdur G, Buchanan J, Green R, Rosenberg S, Fels A, Hickie IB. Building systemic resilience, productivity and well-being: a Mental Wealth perspective. BMJ Glob Health 2023; 8:e012942. [PMID: 37748793 PMCID: PMC10533664 DOI: 10.1136/bmjgh-2023-012942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - William Hynes
- New Approaches to Economic Challenges, Office of the Chief Economist, OECD, Paris, France
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Patricia Geli
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Reform for Resilience Commission, Secretariat, Boston, Massachusetts, USA
| | - Harris A Eyre
- Brain Capital Alliance, San Francisco, California, USA
- Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development, Paris, France
- Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University, Houston, Texas, USA
- Meadows Mental Health Policy Institute, Dallas, Texas, USA
- Euro-Mediterranean Economists Association, Barcelona, Spain
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California and Trinity College, Dublin, Dublin, Ireland
| | - Yun Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Ante Prodan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
- School of Computer Science, Engineering and Mathematics, Western Sydney University, Penrith South, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Goran Ujdur
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Business School, University of Sydney, Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Roy Green
- University of Technology Sydney, Broadway, Sydney, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Allan Fels
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
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Michail M, Robinson J, Witt K, Occhipinti JA, Skinner A, Lamblin M, Veresova M, Kartal D, Waring J. Which programmes and policies across health and community settings will generate the most significant impacts for youth suicide prevention in Australia and the UK? Protocol for a systems modelling and simulation study. BMJ Open 2023; 13:e071111. [PMID: 37580093 PMCID: PMC10432673 DOI: 10.1136/bmjopen-2022-071111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/05/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Suicide is a leading cause of mortality among young people aged 15-24 globally. Despite the deployment of comprehensive suicide prevention strategies, we still do not know which interventions, for which groups of young people, for how long and with what intensity could generate the most significant reductions in suicide rates. System dynamics modelling has the potential to address these gaps. SEYMOUR (System Dynamics Modelling for Suicide Prevention) will develop and evaluate a system dynamics model that will indicate which suicide prevention interventions could generate the most significant reductions in rates of suicide and attempted suicide among young people aged 12-25 in Australia and the UK. METHODS AND ANALYSIS A comparative case study design, applying participatory system dynamics modelling in North-West Melbourne (Australia) and Birmingham (UK). A computer simulation model of mental health service pathways and suicidal behaviour among young people in North-West Melbourne will be developed through three workshops with expert stakeholder groups (young people with lived experience, carers, clinicians, policy makers, commissioners). The model will be calibrated and validated using national, state and local datasets (inputs). The simulation model will test a series of interventions identified in the workshops for inclusion. Primary model outputs include suicide deaths, self-harm hospitalisations and self-harm presentations to emergency departments. An implementation strategy for the sustainable embedding of promising suicide prevention interventions will be developed. This will be followed by model customisation, re-parameterisation, and validation in Birmingham and adaptation of the implementation strategy. ETHICS AND DISSEMINATION The project has received approval from the University of Melbourne Human Research Ethics Committee (2022-22885-25971-4), the University of Birmingham Science, Technology, Engineering and Mathematics Ethics Review Committee (ERN_21-02385) and the UK HRA (22/HRA/3826). SEYMOUR's dissemination strategy includes open-access academic publications, conference presentations, accessible findings coproduced with young people, e-briefs to policy makers, webinars for service providers and commissioners.
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Affiliation(s)
- Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Jo Robinson
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Witt
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Lamblin
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Veresova
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dzenana Kartal
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Waring
- School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
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13
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Skinner A, Osgood ND, Occhipinti JA, Song YJC, Hickie IB. Unemployment and underemployment are causes of suicide. Sci Adv 2023; 9:eadg3758. [PMID: 37436996 PMCID: PMC10337900 DOI: 10.1126/sciadv.adg3758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/08/2023] [Indexed: 07/14/2023]
Abstract
Epidemiological studies indicate that labor underutilization and suicide are associated, yet it remains unclear whether this association is causal. We applied convergent cross mapping to test for causal effects of unemployment and underemployment on suicidal behavior, using monthly data on labor underutilization and suicide rates in Australia for the period 2004-2016. Our analyses provide evidence that rates of unemployment and underemployment were significant drivers of suicide mortality in Australia over the 13-year study period. Predictive modeling indicates that 9.5% of the ~32,000 suicides reported between 2004 and 2016 resulted directly from labor underutilization, including 1575 suicides attributable to unemployment and 1496 suicides attributable to underemployment. We conclude that economic policies prioritizing full employment should be considered integral to any comprehensive national suicide prevention strategy.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Mental Wealth Initiative, University of Sydney, Sydney, Australia
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Mental Wealth Initiative, University of Sydney, Sydney, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Mental Wealth Initiative, University of Sydney, Sydney, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Mental Wealth Initiative, University of Sydney, Sydney, Australia
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14
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Farina FR, Booi L, Occhipinti JA, Quoidbach V, Destrebecq F, Muniz-Terrera G, Eyre HA. Young Adult Brain Capital: A New Opportunity for Dementia Prevention. J Alzheimers Dis 2023:JAD230260. [PMID: 37302036 DOI: 10.3233/jad-230260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The potential for future prevention of Alzheimer's disease and related dementias (ADRD) through healthy lifestyle change is spurring a positive brain health movement. However, most ADRD research continues to focus on mid- and later life. We lack evidence regarding risk exposure and protective factors in young adulthood, i.e., 18-39 years. Brain capital is an emerging framework that represents the combination of education, knowledge, skills, and optimal brain health that people accumulate over their lives. Building on this framework, we present a new model that focuses on optimizing brain health in young adulthood; namely, young adult brain capital. Increasing focus on younger populations is critical for developing citizens who are emotionally intelligent, resilient and can anticipate and cope with rapid changes in the world. By understanding the values that are key drivers and motivators for young adults, we can empower the next generation to become active agents in optimizing their brain health and reducing their risk for future ADRD.
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Affiliation(s)
- Francesca R Farina
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
| | - Laura Booi
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds, UK
| | - Jo-An Occhipinti
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Vinciane Quoidbach
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Frédéric Destrebecq
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Graciela Muniz-Terrera
- Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, OH, USA
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Harris A Eyre
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Neuroscience-Inspired Policy Initiative, Organisation for Economic Co-operation and Development (OECD), Paris, France
- Center for Health and Bioscience, The Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Meadows Mental Health Policy Institute, Dallas, TX, USA
- Euro-Mediterranean Economists Association, Barcelona, Catalonia, Spain
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Brain Capital Alliance, San Francisco, CA, USA
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Lee GY, McKenna S, Song YJC, Hutcheon A, Hockey SJ, Laidler R, Occhipinti JA, Perry C, Lindsay-Smith T, Ramsay A, Choi S, Feirer D, Shim AW, Cottle J, Mukherjee A, New J, Yu R, Scott EM, Freebairn L, Hickie IB. Strengthening mental health research outcomes through genuine partnerships with young people with lived or living experience: A pilot evaluation study. Health Expect 2023. [PMID: 37195575 DOI: 10.1111/hex.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Despite increasing support for stakeholder inclusion in research, there is limited evaluative research to guide safe (i.e., youth-friendly) and meaningful (i.e., non-tokenistic) partnerships with young people with lived experience of mental ill-health in research. This paper describes a pilot evaluation and iterative design of a Youth Lived Experience Working Group (LEWG) protocol that was established by the Youth Mental Health and Technology team at The University of Sydney's Brain and Mind Centre, based on the results of two studies. METHODS Study one consisted of a pilot evaluation of the extent to which youth partners felt empowered to contribute, to qualitatively explore how LEWG processes could be improved. Youth partners completed online surveys, and results were shared over two LEWG meetings in 2021 to empower youth partners to collectively identify actions of positive change regarding LEWG processes. These meetings were audio-recorded and transcripts were subsequently coded using thematic analysis. Study two assessed whether LEWG processes and proposed improvements were acceptable and feasible from the perspective of academic researchers via an online survey in 2022. RESULTS Quantitative and qualitative data collected from nine youth partners and 42 academic researchers uncovered initial learnings regarding facilitators, motivators, and barriers to partnering with young people with lived experience in research. Implementing clear processes for youth partners and academic researchers on effective partnership strategies, providing training opportunities for youth partners to develop research skills, and providing regular updates on how youth partner contributions led to research outcomes were identified as key facilitators. CONCLUSIONS This pilot study provides insight into a growing international field on how to optimise participatory processes so that researchers and young people with lived experience can be better supported and engaged to make meaningful contributions to mental health research. We argue that more transparency is needed around participatory research processes so that partnerships with young people with lived experience are not merely tokenistic. CONSUMER CONTRIBUTIONS Our study has also been approved by and reflects the concepts and priorities of our youth lived experience partners and lived experience researchers, all of whom are authors of this paper.
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Affiliation(s)
| | | | | | | | | | | | - Jo-An Occhipinti
- Brain and Mind Centre, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | | | | | | | - Skye Choi
- Brain and Mind Centre, New South Wales, Australia
| | | | | | | | | | - Joshua New
- Brain and Mind Centre, New South Wales, Australia
| | - Rebecca Yu
- Brain and Mind Centre, New South Wales, Australia
| | | | - Louise Freebairn
- National Centre for Epidemiology and Population Health, The University of Canberra, Canberra, Australian Capital Territory, Australia
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Skinner A, Occhipinti JA, Prodan A, Song YJC, Hickie IB. Bi-stability and critical transitions in mental health care systems: a model-based analysis. Int J Ment Health Syst 2023; 17:5. [PMID: 36959667 PMCID: PMC10037813 DOI: 10.1186/s13033-023-00573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
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).
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Ante Prodan
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Lee GY, Robotham J, Song YJC, Occhipinti JA, Troy J, Hirvonen T, Feirer D, Iannelli O, Loblay V, Freebairn L, Agung-Igusti R, Chang EP, Dudgeon P, Hickie IB. Partnering with Aboriginal and Torres Strait Islander Peoples: An Evaluation Study Protocol to Strengthen a Comprehensive Multi-Scale Evaluation Framework for Participatory Systems Modelling through Indigenous Paradigms and Methodologies. Int J Environ Res Public Health 2022; 20:53. [PMID: 36612375 PMCID: PMC9819653 DOI: 10.3390/ijerph20010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
The social and emotional wellbeing of young Aboriginal and Torres Strait Islander peoples should be supported through an Indigenous-led and community empowering approach. Applying systems thinking via participatory approaches is aligned with Aboriginal and Torres Strait Islander research paradigms and can be an effective method to deliver a decision support tool for mental health systems planning for Indigenous communities. Evaluations are necessary to understand the effectiveness and value of such methods, uncover protective and healing factors of social and emotional wellbeing, as well as to promote Aboriginal and Torres Strait Islander self-determination over allocation of funding and resources. This paper presents modifications to a published evaluation protocol for participatory systems modelling to align with critical Aboriginal and Torres Strait Islander guidelines and recommendations to support the social and emotional wellbeing of young people. This paper also presents a culturally relevant participatory systems modelling evaluation framework. Recognizing the reciprocity, strengths, and expertise Aboriginal and Torres Strait Islander methodologies can offer to broader research and evaluation practices, the amended framework presented in this paper facilitates empowering evaluation practices that should be adopted when working with Aboriginal and Torres Strait Islander peoples as well as when working with other diverse, non-Indigenous communities.
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Affiliation(s)
- Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Julie Robotham
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Yun Ju C. Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
| | - Jakelin Troy
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Tanja Hirvonen
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Dakota Feirer
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Olivia Iannelli
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Victoria Loblay
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Louise Freebairn
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
| | - Rama Agung-Igusti
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Ee Pin Chang
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Pat Dudgeon
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Ian Bernard Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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Tran K, Buchanan J, Song YJC, Rosenberg S, Occhipinti JA, Hickie IB. A Mental Wealth perspective: crossing disciplines to understand the value of collective mental and social assets in the post-COVID-19 era. Int J Ment Health Syst 2022; 16:56. [PMID: 36503682 PMCID: PMC9742032 DOI: 10.1186/s13033-022-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A reconceptualised global strategy is key as nations begin to shift from crisis management to medium- and long-term planning to rebuild and strengthen their economic, social and public health systems. Efforts towards measuring, modelling, and forecasting Mental Wealth could serve as the catalyst for this reconceptualization. The Mental Wealth approach builds systemic resilience through investments which promote collective cognitive and emotional wellbeing. This paper presents the theoretical foundations for Mental Wealth. It presents, for the first time, literature across the disciplines of health and social sciences, economics, business, and humanities to underpin the development of an operational metric of Mental Wealth. DISCUSSION An approach which embeds social and psychological dimensions of prosperity, alongside the economic, is needed to inform the effective allocation of investments in the post-pandemic world. The authors advocate for a transdisciplinary framework of Mental Wealth to be applied in innovating population-level policy interventions to address the growing challenges brought on by COVID-19. Mental Wealth highlights the value generated by the deployment of collective mental assets and supporting social infrastructure. In order to inform this position, a review of the literature on the concepts underpinning Mental Wealth is presented, limitations of current measurement tools of mental and social resources are evaluated, and a framework for development of a Mental Wealth metric is proposed. CONCLUSION There are challenges in developing an operational Mental Wealth metric. The breadth of conceptual foundations to be considered is extensive, and there may be a lack of agreement on the appropriate tools for its measurement. While variability across current measurement approaches in social resources, wellbeing and mental assets contributes to the difficulty creating a holistic and generic metric, these variations are now clearer. The operationalisation of the Mental Wealth metric will require comprehensive mapping of the elements to be included against the data available.
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Affiliation(s)
- Kristen Tran
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - John Buchanan
- grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834X Sydney Business School, University of Sydney, Sydney, Australia
| | - Yun Ju Christine Song
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Sebastian Rosenberg
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia ,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
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Skinner A, Occhipinti JA, Song YJC, Hickie IB. Population mental health improves with increasing access to treatment: evidence from a dynamic modelling analysis. BMC Psychiatry 2022; 22:692. [PMID: 36352384 PMCID: PMC9644460 DOI: 10.1186/s12888-022-04352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Multiple studies indicate that the prevalence of mental disorders in high-income countries has remained stable or increased despite substantial increases in the provision of care, leading some authors to question the effectiveness of increasing access to current treatments as a means of improving population mental health. METHODS We developed a system dynamics model of mental disorder incidence and treatment-dependent recovery to assess two potential explanations for the apparent failure of increasing treatment provision to reduce mental disorder prevalence: 1) an increase in the individual-level risk of disorder onset; and 2) declining effectiveness of care resulting from insufficient services capacity growth. Bayesian Markov Chain Monte Carlo (MCMC) methods were used to fit the model to data on the prevalence of high to very high psychological distress in Australia for the period 2008-2019. RESULTS Estimates of yearly rates of increase in the per capita incidence of high to very high psychological distress and the proportion of patients recovering when treated indicate that the individual-level risk of developing high to very high levels of distress increased between 2008 and 2019 (posterior probability > 0.999) but provide no evidence for declining treatment effectiveness. Simulation analyses suggest that the prevalence of high to very high psychological distress would have decreased from 14.4% in 2008 to 13.6% in 2019 if per capita incidence had not increased over this period (prevalence difference 0.0079, 95% credible interval 0.0015-0.0176). CONCLUSIONS Our analyses indicate that a modest but significant effect of increasing access to mental health care in Australia between 2008 and 2019 was obscured by a concurrent increase in the incidence of high to very high psychological distress.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
| | - Jo-An Occhipinti
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Yun Ju Christine Song
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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20
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Occhipinti JA, Buchanan J, Skinner A, Song YJC, Tran K, Rosenberg S, Fels A, Doraiswamy PM, Meier P, Prodan A, Hickie IB. Measuring, Modeling, and Forecasting the Mental Wealth of Nations. Front Public Health 2022; 10:879183. [PMID: 35968431 PMCID: PMC9368578 DOI: 10.3389/fpubh.2022.879183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has exposed the deep links and fragility of economic, health and social systems. Discussions of reconstruction include renewed interest in moving beyond GDP and recognizing "human capital", "brain capital", "mental capital", and "wellbeing" as assets fundamental to economic reimagining, productivity, and prosperity. This paper describes how the conceptualization of Mental Wealth provides an important framing for measuring and shaping social and economic renewal to underpin healthy, productive, resilient, and thriving communities. We propose a transdisciplinary application of systems modeling to forecast a nation's Mental Wealth and understand the extent to which policy-mediated changes in economic, social, and health sectors could enhance collective mental health and wellbeing, social cohesion, and national prosperity. Specifically, simulation will allow comparison of the projected impacts of a range of cross-sector strategies (education sector, mental health system, labor market, and macroeconomic reforms) on GDP and national Mental Wealth, and provide decision support capability for future investments and actions to foster Mental Wealth. Finally, this paper introduces the Mental Wealth Initiative that is harnessing complex systems science to examine the interrelationships between social, commercial, and structural determinants of mental health and wellbeing, and working to empirically challenge the notion that fostering universal social prosperity is at odds with economic and commercial interests.
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Affiliation(s)
- Jo-An Occhipinti
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C. Song
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Kristen Tran
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Allan Fels
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, VIC, Australia
| | - P. Murali Doraiswamy
- Departments of Psychiatry and Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Petra Meier
- Systems Science in Public Health, University of Glasgow, Glasgow, United Kingdom
| | - Ante Prodan
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Ian B. Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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21
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Song YJC, Rosenberg S, Smith B, Occhipinti JA, Mendoza J, Freebairn L, Skinner A, Hickie IB. Missing in action: the right to the highest attainable standard of mental health care. Int J Ment Health Syst 2022; 16:26. [PMID: 35690833 PMCID: PMC9187849 DOI: 10.1186/s13033-022-00537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The right to the highest attainable standard of mental health remains a distant goal worldwide. The Report of the UN Special Rapporteur on the right of all people to enjoyment of the highest attainable standard of physical and mental health pleaded the urgent need for governments to act through appropriate laws and policies. We argue that Australia is in breach of international obligations, with inadequate access to mental health services, inconsistent mental health legislation across jurisdictions and ongoing structural (systematic) and individual discrimination. DISCUSSION Inadequate access to mental health services is a worldwide phenomenon. Australia has committed to international law obligations under the Convention on the Rights of Persons with Disabilities (CRPD) to 'promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disability, with respect to their inherent dignity'. This includes people with mental health impairment and this convention includes the right to 'the highest attainable standard of mental health'. Under the Australian Constitution, ratification of this convention enables the national government to pass laws to implement the convention obligations, and such national laws would prevail over any inconsistent state (or territory) laws governing mental health service provision. The authors argue that enabling positive rights through legislation and legally binding mental health service standards may facilitate enhanced accountability and enforcement of such rights. These steps may support critical key stakeholders to improve the standards of mental health service provision supported by the implementation of international obligations, thereby accelerating mental health system reform. Improved legislation would encourage better governance and the evolution of better services, making mental health care more accessible, without structural or individual discrimination, enabling all people to enjoy the highest attainable standard of health.
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Affiliation(s)
- Yun Ju C Song
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia. .,Mental Wealth Initiative, University of Sydney, Camperdown, Australia.
| | - Sebastian Rosenberg
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Belinda Smith
- Sydney Law School, University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - John Mendoza
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Health and Sport Science, University of Sunshine Coast, Sippy Downs, Australia
| | - Louise Freebairn
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Adam Skinner
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
| | - Ian B Hickie
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
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22
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Freebairn L, Song YJC, Occhipinti JA, Huntley S, Dudgeon P, Robotham J, Lee GY, Hockey S, Gallop G, Hickie IB. Applying systems approaches to stakeholder and community engagement and knowledge mobilisation in youth mental health system modelling. Int J Ment Health Syst 2022; 16:20. [PMID: 35462553 PMCID: PMC9036722 DOI: 10.1186/s13033-022-00530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a significant push to change the trajectory of youth mental ill-health and suicide globally. Ensuring that young people have access to services that meet their individual needs and are easily accessible is a priority. Genuine stakeholder engagement in mental health system design is critical to ensure that system strengthening is likely to be successful within these complex environments. There is limited literature describing engagement processes undertaken by research teams in mental health program implementation and planning. This protocol describes the methods that will be used to engage local communities using systems science methods to mobilize knowledge and action to strengthen youth mental health services. Methods Using participatory action research principles, the research team will actively engage with local communities to ensure genuine user-led participatory systems modelling processes and enhance knowledge mobilisation within research sites. Ensuring that culturally diverse and Aboriginal and Torres Strait Islander community voices are included will support this process. A rigorous site selection process will be undertaken to ensure that the community is committed and has capacity to actively engage in the research activities. Stakeholder engagement commences from the site selection process with the aim to build trust between researchers and key stakeholders. The research team will establish a variety of engagement resources and make opportunities available to each site depending on their local context, needs and audiences they wish to target during the process. Discussion This protocol describes the inclusive community engagement and knowledge mobilization process for the Right care, first time, where you live research Program. This Program will use an iterative and adaptive approach that considers the social, economic, and political context of each community and attempts to maximise research engagement. A theoretical framework for applying systems approaches to knowledge mobilization that is flexible will enable the implementation of a participatory action research approach. This protocol commits to a rigorous and genuine stakeholder engagement process that can be applied in mental health research implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00530-1.
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Affiliation(s)
- Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia. .,Research School of Public Health, Australian National University, Canberra, Australia. .,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
| | - Samantha Huntley
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Pat Dudgeon
- School of Indigenous Studies, University of Western Australia, Perth, Australia
| | - Julie Robotham
- School of Indigenous Studies, University of Western Australia, Perth, Australia
| | - Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Samuel Hockey
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Geoff Gallop
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW, 2050, Australia
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23
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Lee GY, Hickie IB, Occhipinti JA, Song YJC, Skinner A, Camacho S, Lawson K, Hilber AM, Freebairn L. Presenting a comprehensive multi-scale evaluation framework for participatory modelling programs: A scoping review. PLoS One 2022; 17:e0266125. [PMID: 35452462 PMCID: PMC9032404 DOI: 10.1371/journal.pone.0266125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Systems modelling and simulation can improve understanding of complex systems to support decision making, better managing system challenges. Advances in technology have facilitated accessibility of modelling by diverse stakeholders, allowing them to engage with and contribute to the development of systems models (participatory modelling). However, despite its increasing applications across a range of disciplines, there is a growing need to improve evaluation efforts to effectively report on the quality, importance, and value of participatory modelling. This paper aims to identify and assess evaluation frameworks, criteria, and/or processes, as well as to synthesize the findings into a comprehensive multi-scale framework for participatory modelling programs. MATERIALS AND METHODS A scoping review approach was utilized, which involved a systematic literature search via Scopus in consultation with experts to identify and appraise records that described an evaluation framework, criteria, and/or process in the context of participatory modelling. This scoping review is registered with the Open Science Framework. RESULTS The review identified 11 studies, which varied in evaluation purposes, terminologies, levels of examination, and time points. The review of studies highlighted areas of overlap and opportunities for further development, which prompted the development of a comprehensive multi-scale evaluation framework to assess participatory modelling programs across disciplines and systems modelling methods. The framework consists of four categories (Feasibility, Value, Change/Action, Sustainability) with 30 evaluation criteria, broken down across project-, individual-, group- and system-level impacts. DISCUSSION & CONCLUSION The presented novel framework brings together a significant knowledge base into a flexible, cross-sectoral evaluation effort that considers the whole participatory modelling process. Developed through the rigorous synthesis of multidisciplinary expertise from existing studies, the application of the framework can provide the opportunity to understand practical future implications such as which aspects are particularly important for policy decisions, community learning, and the ongoing improvement of participatory modelling methods.
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Affiliation(s)
- Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | | | - Adam Skinner
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Salvador Camacho
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kenny Lawson
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Louise Freebairn
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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24
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LaMonica HM, Iorfino F, Lee GY, Piper S, Occhipinti JA, Davenport TA, Cross S, Milton A, Ospina-Pinillos L, Whittle L, Rowe SC, Dowling M, Stewart E, Ottavio A, Hockey S, Cheng VWS, Burns J, Scott EM, Hickie IB. Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy. JMIR Ment Health 2022; 9:e33060. [PMID: 34974414 PMCID: PMC8943544 DOI: 10.2196/33060] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users' needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. OBJECTIVE Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. METHODS Participating health care organizations included the following: Open Arms-Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation's National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. RESULTS Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. CONCLUSIONS Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.
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Affiliation(s)
- Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Lisa Whittle
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Shelley C Rowe
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Mitchell Dowling
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth Stewart
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Antonia Ottavio
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia.,InnoWell Pty Ltd, Sydney, Australia
| | - Samuel Hockey
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | | | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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25
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Freebairn L, Occhipinti JA, Song YJC, Skinner A, Lawson K, Lee GY, Hockey SJ, Huntley S, Hickie IB. Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol. JMIR Res Protoc 2022; 11:e32988. [PMID: 35129446 PMCID: PMC8861863 DOI: 10.2196/32988] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized; however, the methods for doing so are often not well-described. Objective This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. Methods The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. Results The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Conclusions Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from diverse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. International Registered Report Identifier (IRRID) PRR1-10.2196/32988
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Affiliation(s)
- Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
| | - Yun Ju C Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Kenny Lawson
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Samuel J Hockey
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Samantha Huntley
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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26
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Occhipinti JA, Rose D, Skinner A, Rock D, Song YJC, Prodan A, Rosenberg S, Freebairn L, Vacher C, Hickie IB. Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention? Int J Environ Res Public Health 2022; 19:ijerph19031468. [PMID: 35162491 PMCID: PMC8835017 DOI: 10.3390/ijerph19031468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic demonstrated the significant value of systems modelling in supporting proactive and effective public health decision making despite the complexities and uncertainties that characterise an evolving crisis. The same approach is possible in the field of mental health. However, a commonly levelled (but misguided) criticism prevents systems modelling from being more routinely adopted, namely, that the presence of uncertainty around key model input parameters renders a model useless. This study explored whether radically different simulated trajectories of suicide would result in different advice to decision makers regarding the optimal strategy to mitigate the impacts of the pandemic on mental health. Using an existing system dynamics model developed in August 2020 for a regional catchment of Western Australia, four scenarios were simulated to model the possible effect of the COVID-19 pandemic on levels of psychological distress. The scenarios produced a range of projected impacts on suicide deaths, ranging from a relatively small to a dramatic increase. Discordance in the sets of best-performing intervention scenarios across the divergent COVID-mental health trajectories was assessed by comparing differences in projected numbers of suicides between the baseline scenario and each of 286 possible intervention scenarios calculated for two time horizons; 2026 and 2041. The best performing intervention combinations over the period 2021–2041 (i.e., post-suicide attempt assertive aftercare, community support programs to increase community connectedness, and technology enabled care coordination) were highly consistent across all four COVID-19 mental health trajectories, reducing suicide deaths by between 23.9–24.6% against the baseline. However, the ranking of best performing intervention combinations does alter depending on the time horizon under consideration due to non-linear intervention impacts. These findings suggest that systems models can retain value in informing robust decision making despite uncertainty in the trajectories of population mental health outcomes. It is recommended that the time horizon under consideration be sufficiently long to capture the full effects of interventions, and efforts should be made to achieve more timely tracking and access to key population mental health indicators to inform model refinements over time and reduce uncertainty in mental health policy and planning decisions.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- Correspondence: ; Tel.: +61-467-522-766
| | - Danya Rose
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Daniel Rock
- Medical School, University of Western Australia, Perth, WA 6009, Australia;
- WA Primary Health Alliance, Perth, WA 6008, Australia
| | - Yun Ju C. Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Ante Prodan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
| | - Catherine Vacher
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- St Vincent’s Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
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Lawson KD, Occhipinti JA, Freebairn L, Skinner A, Song YJC, Lee GY, Huntley S, Hickie IB. A Dynamic Approach to Economic Priority Setting to Invest in Youth Mental Health and Guide Local Implementation: Economic Protocol for Eight System Dynamics Policy Models. Front Psychiatry 2022; 13:835201. [PMID: 35573322 PMCID: PMC9103687 DOI: 10.3389/fpsyt.2022.835201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mental illness costs the world economy over US2.5 Bn each year, including premature mortality, morbidity, and productivity losses. Multisector approaches are required to address the systemic drivers of mental health and ensure adequate service provision. There is an important role for economics to support priority setting, identify best value investments and inform optimal implementation. Mental health can be defined as a complex dynamic system where decision makers are challenged to prospectively manage the system over time. This protocol describes the approach to equip eight system dynamics (SD) models across Australia to support priority setting and guide portfolio investment decisions, tailored to local implementation context. METHODS As part of a multidisciplinary team, three interlinked protocols are developed; (i) the participatory process to codesign the models with local stakeholders and identify interventions for implementation, (ii) the technical protocol to develop the SD models to simulate the dynamics of the local population, drivers of mental health, the service system and clinical outcomes, and (iii) the economic protocol to detail how the SD models will be equipped to undertake a suite of economic analysis, incorporating health and societal perspectives. Models will estimate the cost of mental illness, inclusive of service costs (health and other sectors, where necessary), quality-adjusted life years (QALYs) lost, productivity costs and carer costs. To assess the value of investing (disinvesting) in interventions, economic analysis will include return-on-investment, cost-utility, cost benefit, and budget impact to inform affordability. Economic metrics are expected to be dynamic, conditional upon changing population demographics, service system capacities and the mix of interventions when synergetic or antagonistic interactions. To support priority setting, a portfolio approach will identify best value combinations of interventions, relative to a defined budget(s). User friendly dashboards will guide decision makers to use the SD models to inform resource allocation and generate business cases for funding. DISCUSSION Equipping SD models to undertake economic analysis is intended to support local priority setting and help optimise implementation regarding the best value mix of investments, timing and scale. The objectives are to improve allocative efficiency, increase mental health and economic productivity.
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Affiliation(s)
- Kenny D Lawson
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Louise Freebairn
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia.,Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Adam Skinner
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C Song
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sam Huntley
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Law PCF, Too LS, Hill NTM, Robinson J, Gould M, Occhipinti JA, Spittal MJ, Witt K, Sinyor M, Till B, Osgood N, Prodan A, Zahan R, Pirkis J. A Pilot Case-Control Study of the Social Media Activity Following Cluster and Non-Cluster Suicides in Australia. Int J Environ Res Public Health 2021; 19:343. [PMID: 35010601 PMCID: PMC8751152 DOI: 10.3390/ijerph19010343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
Social media may play a role in the "contagion" mechanism thought to underpin suicide clusters. Our pilot case-control study presented a novel methodological approach to examining whether Facebook activity following cluster and non-cluster suicides differed. We used a scan statistic to identify suicide cluster cases occurring in spatiotemporal clusters and matched each case to 10 non-cluster control suicides. We identified the Facebook accounts of 3/48 cluster cases and 20/480 non-cluster controls and their respective friends-lists and retrieved 48 posthumous posts and replies (text segments) referring to the deceased for the former and 606 for the latter. We examined text segments for "putatively harmful" and "putatively protective" content (e.g., discussion of the suicide method vs. messages discouraging suicidal acts). We also used concept mapping, word-emotion association, and sentiment analysis and gauged user reactions to posts using the reactions-to-posts ratio. We found no "putatively harmful" or "putatively protective" content following any suicides. However, "family" and "son" concepts were more common for cluster cases and "xx", "sorry" and "loss" concepts were more common for non-cluster controls, and there were twice as many surprise- and disgust-associated words for cluster cases. Posts pertaining to non-cluster controls were four times as receptive as those about cluster cases. We hope that the approach we have presented may help to guide future research to explain suicide clusters and social-media contagion.
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Affiliation(s)
- Phillip Cheuk Fung Law
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3053, Australia; (L.S.T.); (M.J.S.); (J.P.)
| | - Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3053, Australia; (L.S.T.); (M.J.S.); (J.P.)
| | - Nicole T. M. Hill
- Telethon Kids Institute, Nedlands 6009, Australia;
- School of Population and Global Health, The University of Western Australia, Nedlands 6009, Australia
| | - Jo Robinson
- Orygen, Parkville 3052, Australia; (J.R.); (K.W.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville 3053, Australia
| | - Madelyn Gould
- Departments of Epidemiology and Psychiatry, Columbia University, New York, NY 10032, USA;
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia; (J.-A.O.); (A.P.)
- Computer Simulation and Advanced Research Technologies (CSART), Sydney 2021, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3053, Australia; (L.S.T.); (M.J.S.); (J.P.)
| | - Katrina Witt
- Orygen, Parkville 3052, Australia; (J.R.); (K.W.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville 3053, Australia
| | - Mark Sinyor
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Benedikt Till
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Nathaniel Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (N.O.); (R.Z.)
| | - Ante Prodan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia; (J.-A.O.); (A.P.)
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Rifat Zahan
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (N.O.); (R.Z.)
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3053, Australia; (L.S.T.); (M.J.S.); (J.P.)
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Peng CQ, Lawson KD, Heffernan M, McDonnell G, Liew D, Lybrand S, Pearson SA, Cutler H, Kritharides L, Trieu K, Huynh Q, Usherwood T, Occhipinti JA. Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia. PLoS One 2021; 16:e0257760. [PMID: 34591888 PMCID: PMC8483334 DOI: 10.1371/journal.pone.0257760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To construct a whole-of-system model to inform strategies that reduce the burden of cardiovascular disease (CVD) in Australia. METHODS A system dynamics model was developed with a multidisciplinary modelling consortium. The model population comprised Australians aged 40 years and over, and the scope encompassed acute and chronic CVD as well as primary and secondary prevention. Health outcomes were CVD-related deaths and hospitalisations, and economic outcomes were the net benefit from both the healthcare system and societal perspectives. The eight strategies broadly included creating social and physical environments supportive of a healthy lifestyle, increasing the use of preventive treatments, and improving systems response to acute CVD events. The effects of strategies were estimated as relative differences to the business-as-usual between 2019-2039. Probabilistic sensitivity analysis produced uncertainty intervals of interquartile ranges (IQR). FINDINGS The greatest reduction in CVD-related deaths was seen in strategies that improve systems response to acute CVD events (8.9%, IQR: 7.7-10.2%), yet they resulted in an increase in CVD-related hospitalisations due to future recurrent admissions (1.6%, IQR: 0.1-2.3%). This flow-on effect highlighted the importance of addressing underlying CVD risks. On the other hand, strategies targeting the broad environment that supports a healthy lifestyle were effective in reducing both hospitalisations (7.1%; IQR: 5.0-9.5%) and deaths (8.1% reduction; IQR: 7.1-8.9%). They also produced an economic net benefit of AU$43.3 billion (IQR: 37.7-48.7) using a societal perspective, largely driven by productivity gains. Overall, strategic planning to reduce the burden of CVD should consider the varying effects of strategies over time and beyond the health sector.
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Affiliation(s)
- Cindy Q. Peng
- Decision Analytics, The SAX Institute, Sydney, Australia
- * E-mail:
| | - Kenny D. Lawson
- Adjunct, Western Sydney University, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Mark Heffernan
- Adjunct, Western Sydney University, Sydney, Australia
- Dynamic Operations, Sydney, Australia
| | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leonard Kritharides
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Decision Analytics, The SAX Institute, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
- Computer Simulation & Advanced Research Technology (CSART), Sydney, Australia
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Abstract
Background Regional planning may help to ensure that the specific measures implemented as part of a national suicide prevention strategy are aligned with the varying needs of local services and communities; however, there are concerns that the reliability of local programme development may be limited in practice. Aims The potential impacts of independent regional planning on the effectiveness of suicide prevention programmes in the Australian state of New South Wales were quantified using a system dynamics model of mental health services provision and suicidal behaviour in each of the state's ten Primary Health Network (PHN) catchments. Method Reductions in projected suicide mortality over the period 2021–2031 were calculated for scenarios in which combinations of four and five suicide prevention and mental health services interventions (selected from 13 possible interventions) are implemented separately in each PHN catchment. State-level impacts were estimated by summing reductions in projected suicide mortality for each intervention combination across PHN catchments. Results The most effective state-level combinations of four and five interventions prevent, respectively, 20.3% and 22.9% of 10 312 suicides projected under a business-as-usual scenario (i.e. no new policies or programmes, constant services capacity growth). Projected numbers of suicides under the optimal intervention scenarios for each PHN are up to 6% lower than corresponding numbers of suicides projected for the optimal state-level intervention combinations. Conclusions Regional suicide prevention planning may contribute to significant reductions in suicide mortality where local health authorities are provided with the necessary resources and tools to support reliable, evidence-based decision-making.
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Iorfino F, Occhipinti JA, Skinner A, Davenport T, Rowe S, Prodan A, Sturgess J, Hickie IB. The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model. J Med Internet Res 2021; 23:e25331. [PMID: 34077384 PMCID: PMC8274674 DOI: 10.2196/25331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/20/2020] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. Objective This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. Results Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. Conclusions The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Shelley Rowe
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ante Prodan
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Julie Sturgess
- North Coast Primary Health Network, Coffs Harbour, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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Occhipinti JA, Skinner A, Carter S, Heath J, Lawson K, McGill K, McClure R, Hickie IB. Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation. Sci Rep 2021; 11:11209. [PMID: 34045644 PMCID: PMC8160145 DOI: 10.1038/s41598-021-90762-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Jo-An Occhipinti
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia. .,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia. .,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Adam Skinner
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
| | - Samantha Carter
- Hunter New England & Central Coast Primary Health Network, Newcastle, Australia
| | - Jacinta Heath
- Everymind, Hunter New England Local Health District, Newcastle, Australia
| | - Kenny Lawson
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Katherine McGill
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia.,MH-READ, Hunter New England Local Health District, Newcastle, Australia
| | - Rod McClure
- Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Ian B Hickie
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
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Occhipinti JA, Skinner A, Iorfino F, Lawson K, Sturgess J, Burgess W, Davenport T, Hudson D, Hickie I. Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants. BMC Med 2021; 19:61. [PMID: 33706764 PMCID: PMC7952221 DOI: 10.1186/s12916-021-01935-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources. METHODS Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period. RESULTS A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3-30.8%) and suicide deaths by 29.3% (95% interval 27.1-31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that 'more is not necessarily better.' CONCLUSION Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Kenny Lawson
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | | | | | - Tracey Davenport
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Danica Hudson
- North Coast Primary Health Network, Ballina, Australia
| | - Ian Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Skinner A, Occhipinti JA, Osgood ND. A dynamic modelling analysis of the impact of tobacco control programs on population-level nicotine dependence. Sci Rep 2021; 11:1866. [PMID: 33479364 PMCID: PMC7820504 DOI: 10.1038/s41598-021-81460-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
According to the 'hardening hypothesis', average nicotine dependence will increase as less dependent smokers quit relatively easily in response to effective public health interventions, so that sustained progress in reducing smoking prevalence will depend on shifting the emphasis of tobacco control programs towards intensive treatment of heavily dependent smokers (who comprise an increasing fraction of continuing smokers). We used a system dynamics model of smoking behaviour to explore the potential for hardening in a population of smokers exposed to effective tobacco control measures over an extended period. Policy-induced increases in the per capita cessation rate are shown to lead inevitably to a decline in the proportion of smokers who are heavily dependent, contrary to the hardening hypothesis. Changes in smoking behaviour in Australia over the period 2001‒2016 resulted in substantial decreases in current smoking prevalence (from 23.1% in 2001 to 14.6% in 2016) and the proportion of heavily dependent smokers in the smoking population (from 52.1% to 36.9%). Public health interventions that have proved particularly effective in reducing smoking prevalence (tobacco tax increases, smoke-free environment legislation, antismoking mass media campaigns) are expected to also contribute to a decline in population-level nicotine dependence.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nathaniel D Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
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Occhipinti JA, Skinner A, Freebairn L, Song YJC, Ho N, Lawson K, Lee GY, Hickie IB. Which Social, Economic, and Health Sector Strategies Will Deliver the Greatest Impacts for Youth Mental Health and Suicide Prevention? Protocol for an Advanced, Systems Modelling Approach. Front Psychiatry 2021; 12:759343. [PMID: 34721120 PMCID: PMC8548722 DOI: 10.3389/fpsyt.2021.759343] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Current global challenges are generating extensive social disruption and uncertainty that have the potential to undermine the mental health, wellbeing, and futures of young people. The scale and complexity of challenges call for engagement with systems science-based decision analytic tools that can capture the dynamics and interrelationships between physical, social, economic, and health systems, and support effective national and regional responses. At the outset of the pandemic mental health-related systems models were developed for the Australian context, however, the extent to which findings are generalisable across diverse regions remains unknown. This study aims to explore the context dependency of systems modelling insights. Methods: This study will employ a comparative case study design, applying participatory system dynamics modelling across eight diverse regions of Australia to answer three primary research questions: (i) Will current regional differences in key youth mental health outcomes be exacerbated in forward projections due to the social and economic impacts of COVID-19?; (ii) What combination of social policies and health system strengthening initiatives will deliver the greatest impacts within each region?; (iii) To what extent are optimal strategic responses consistent across the diverse regions? We provide a detailed technical blueprint as a potential springboard for more timely construction and deployment of systems models in international contexts to facilitate a broader examination of the question of generalisability and inform investments in the mental health and wellbeing of young people in the post COVID-19 recovery. Discussion: Computer simulation is known as the third pillar of science (after theory and experiment). Simulation allows researchers and decision makers to move beyond what can be manipulated within the scale, time, and ethical limits of the experimental approach. Such learning when achieved collectively, has the potential to enhance regional self-determination, help move beyond incremental adjustments to the status quo, and catalyze transformational change. This research seeks to advance efforts to establish regional decision support infrastructure and empower communities to effectively respond. In addition, this research seeks to move towards an understanding of the extent to which systems modelling insights may be relevant to the global mental health response by encouraging researchers to use, challenge, and advance the existing work for scientific and societal progress.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Ho
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kenny Lawson
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Iorfino F, Piper SE, Prodan A, LaMonica HM, Davenport TA, Lee GY, Capon W, Scott EM, Occhipinti JA, Hickie IB. Using Digital Technologies to Facilitate Care Coordination Between Youth Mental Health Services: A Guide for Implementation. Front Health Serv 2021; 1:745456. [PMID: 36926493 PMCID: PMC10012639 DOI: 10.3389/frhs.2021.745456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022]
Abstract
Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah E Piper
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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