Systems modelling identifies barriers to effective regional mental health systems

A recent publication exploring the implementation of best practice suicide prevention initiatives in the NSW Hunter New England and Central Coast regions identified that systems modelling could act as an effective evidence-based regional decision-making tool to facilitate optimally coordinated investment in suicide prevention.

The study titled, Federal and state cooperation necessary but not sufficient for effective regional mental health systems: Insights from systems modelling and simulation, explores the continued increase in mental health-related emergency department (ED) presentations in Australia, despite national commitment and reforms to the mental health system. 

Using a systems dynamics model, the study mapped multiple pathways a person experiencing psychological distress may encounter in primary and tertiary health services. The systems model also factored in components that may contribute to psychological distress and suicidal behaviour and analysed the potential result of discord between services or client disengagement. 

Outputs of the model presented several findings, including: 

• A combination of family psychoeducation, post-attempt aftercare, safety planning, and social connectedness programs minimises the number of suicides across the PHN, suggesting aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide rates.
• There were 495 possible combinations from the 12 types of interventions modelled that a consumer could journey.
• There were 17 intervention combinations identified that may have the most significant impact on preventing suicide and reducing mental health-related ED presentations and reducing disengagement from services in Hunter New England Central Coast PHN.
• Combinations of interventions that are most effective in reducing suicides can increase the risk of service disengagements.
• Combinations of most effective interventions in preventing disengagement with services are not predicted to reduce suicide. 

In addition to modelling suicide and mental health-related ED presentations, the study also found a marginal difference in predicted suicide rates between Hunter New England LHD and Central Coast LHD when optimal intervention modelling was used. 

This marginal difference suggests that suicide prevention approaches can be led at either a regional (PHN) or subregional (LHD) level, provided that strategic decision making for suicide prevention is based on informed decisions, such as the data produced from the suicide prevention systems modelling. Failure to align suicide prevention priorities between the LHDs and PHNs, however, has the potential to undermine the effectiveness of suicide prevention interventions.