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Changing the mental health paradigm with simulatio...

Changing the mental health paradigm with simulation

Key Takeaways
  • Modeling and simulation can play a critical role in designing a more efficient, effective and coordinated mental healthcare system by helping decision makers to understand the impact of alternative system designs and service planning scenarios before they are implemented.
  • A unique aspects of the design of these simulation models is the use of participatory approaches that includes up to 50 actors or influencers of the mental healthcare system – government and private stakeholders, policy planners, clinical practitioners and people with lived experience.
  • Prof. Jo-An Atkinson and her team at The Brain and Mind Centre, University of Sydney, developed a prototypic model to mitigate the impact of the ongoing uncertainty of the pandemic and the subsequent economic downturn. The model facilitated the simulation of cross-sectoral strategies (economic, educational and social) that could bring about a positive impact and significantly bring down mental health-related emergencies over the period of 2020 – 2025.

This article is a summation of the insights provided by Prof. Jo-An Atkinson and her colleagues at the Brain and Mind Centre, Faculty of Health, University of Sydney.

One out of five people between the ages of 16 and 85 years experience some form of mental ill health each year in Australia. The prevalence of mental health problems have had a direct impact on productivity in the country (the cost of lost productivity associated with mental illness was conservatively estimated to be between AUD $43 and AUD $51 billion per year). Federal and state governments spend up to AUD $9 billion on mental health services every year. Many millions have been additionally spent over the last decade by government and philanthropic organisations in reforming the mental healthcare system and researching effective strategies for reducing the burden of mental illness and suicide. Despite these significant efforts, the prevalence of mental illness in Australia has remained unchanged, and the rates of suicides has been steadily increasing.

Decision makers are faced with multiple challenges in tackling this problem – including navigating system complexities arising from the division of funding and responsibilities between different levels of government, regional primary health networks, and private and non-government sectors), making sense of the many risk factors that contribute to mental ill health and which should be priority targets for investments and actions, and differing expert and stakeholder perspectives about what should be done – are some of the prominent ones.

There has been increasing recognition of the benefits of employing advanced modelling and simulation to support and enable better decision making in mental health services planning and suicide prevention in Australia and elsewhere. Systems modelling and simulation is now being used to inform more strategic and effective frameworks for investments and action. The Brain and Mind Centre at the University of Sydney has been at the forefront of designing and developing such models.

Modeling & Simulation and their potential impact on mental health

Systems modeling and simulation is the act of creating mathematical models that are representations of the real world. They allow scientists and decision makers to test and forecast the impact of alternative strategies in a safe way, before implementing them in the real world; saving time and resources.

Modeling and simulation have long been used by various industries across the world – defense, engineering, ecology, business, etc – in determining the impact of large investments, radical changes or new strategies, prior to making them. They’ve contributed significantly to scientific, technological and industrial advances, and forecasting of extreme weather events, saving countless lives. However, so far, their widespread use in the health and social sectors has not been seen, except in specific scenarios such as elimination of global infectious diseases, epidemic and bioterrorism preparedness, etc.

Modeling and simulation can play a critical role in designing a more efficient, effective and coordinated mental healthcare system by helping decision makers to understand the impact of alternative system designs and service planning scenarios before they are implemented.

Australia has been harnessing the benefits of systems modelling and simulation to inform policy, planning and investments in  the mental healthcare system by providing insights into  the optimal combination,  timing, scale, frequency and intensity of mental health initiatives to improve population-level impacts.

Unique aspects of this work has been the co-design of simulation models using participatory approaches that has included up to 50 actors or influencers of the mental healthcare system – government and private stakeholders, policy planners, clinical practitioners and people with lived experience. Taking a participatory approach in designing a healthcare model has decided advantages – it facilitates communication between the parties involved, resolves contentions issues and encourages transparency.

This process of knowledge mobilisation, where the decision makers, researchers and end users are brought together to share experiences and challenges, discuss and debate, has enabled modellers in Australia to design decision support tools that are robust and contextually relevant, with direct impact on policy and planning.

A prototype to study the impact of the pandemic and recession on mental health

The ongoing uncertainty of the pandemic and the subsequent economic downturn has negatively affected the state of mental health in Australia. Psychological distress, depression, anxiety and suicidal behaviours are rising, particularly among the young and the vulnerable communities in the country. So far, public discourse on addressing these challenges have not placed sufficient importance on understanding the dynamic and complex relationship between the economy, the education sector, and health and social policies. It was anticipated that a model that facilitates this understanding could add tremendous value to mitigate the impact of the pandemic on mental health and wellbeing.

Prof. Jo-An Atkinson and her team at The Brain and Mind Centre, University of Sydney, developed a prototypic model to predict the short and long term impact of the proposed economic, educational and social measures.

Even under the most optimistic scenarios, the model forecasts a deterioration in the state of mental health in the country. Between 2020 – 2025, the model predicts a 13.7% increase in suicides deaths and a 12.3% increase in hospitalisations for suicide attempts. However, the model also facilitated the simulation of cross-sectoral strategies that could bring about a positive impact  – maintaining employment support programs for two years, running programs that support education and vocational training and a range of investments to strengthen mental health services. The model found that the implementation of these measures can prevent as many as 1,590 suicides and 13,842 hospitalisations for suicide attempts and 97,030 mental health-related emergency department presentations over the period of 2020 – 2025.

The model will continue to be updated with the most recent data on unemployment, psychological distress and also include parameters such as the cost associated with mental health services. It will continue to aid the country in mitigating the impact of the pandemic and recession on the social and economic burden of mental ill health in Australia.

Declining mental health is a growing concern around the world. Prof. Jo-An Atkinson and her transdisciplinary partners, through their organisation Computer Simulation and Advanced Research Technology (CSART), aim to tackle complex health and social problems in countries that are lacking in resources to deal with them. One such example is their initiative to develop advanced decision analysis, monitoring and evaluation infrastructure in Bogota, Columbia for strengthening the mental health systems for young people. This initiative has been funded by Switzerland-based Botnar Foundation, an organisation that supports futuristic solutions that enhance the health and wellbeing of children and young people in urban areas around the world. The Brain and Mind Centre, University of Sydney and Swiss Tropical and Public Health Institute (STPH) are partners of this initiative.

Modelling and simulation offers advanced analytic capability that can aid decision making for responsive actions to emerging threats, population, mental health, for strengthening healthcare delivery systems and for forecasting the likely impacts of new, proposed interventions, reducing trial and error. It has the potential to significantly improve the mental and emotional wellbeing of a nation, which is why its adoption is encouraged. It is truly the technology of tomorrow.

 

Further resources

Bringing new tools, a regional focus, resource-sensitivity, local engagement and necessary discipline to mental health policy and planning: https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-020-08948-3

Participatory approach to model development empowers communities: https://youtu.be/VCMr-7vRQqE

Road to Recovery: Systems modelling to inform responses to COVID-related mental health impacts: https://www.sydney.edu.au/content/dam/corporate/documents/brain-and-mind-centre/road-to-recovery_brain-and-mind-centre.pdf

Systems modelling to support youth mental health system strengthening in Bogota, Colombia: http://www.csart-world.com/2020/02/fondation-botnar-supports-csart-to-deliver-a-systems-approach-to-youth-mental-health/