Skinner Adam, Occhipinti Jo-An, Prodan Ante, Song Yun Ju Christine, Hickie Ian B
Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia.
Int J Ment Health Syst. 2023 Mar 24;17(1):5. doi: 10.1186/s13033-023-00573-y.
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.).
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.
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.
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).
由于服务的可获得性和可及性有限，治疗开始延迟和早期中断往往会导致轻度或中度精神障碍患者发展为更严重的疾病，从而增加对专科护理的需求，而这预计会进一步限制服务的可获得性和可及性（由于等待时间延长、自付费用增加等）。
我们开发了一个关于专科服务能力与疾病进展相互作用的简单系统动力学模型，以研究服务的可获得性和可及性对精神卫生保健系统有效性和效率的影响。
模型分析表明，在某些条件下，增加服务能力可能会促使从专科服务长期存在高未满足需求的状态突然发生类似阶梯状的转变，进入另一种稳定状态，即前来就诊的患者能够立即获得有效治疗。服务系统功能的这种质性转变源于一个“良性循环”，即轻度至中度疾病患者中依赖治疗的康复人数增加，减少了需要强化和/或长期治疗的重症患者数量，有效地“释放”了可用于进一步降低疾病进展速度的服务能力。我们提供了澳大利亚南澳大利亚州三级儿童和青少年精神卫生服务的实证案例研究，证明这种关键转变能够发生的条件适用于现实世界的服务系统。
旨在增加专科服务能力的政策和规划决策有可能显著提高精神卫生保健系统的有效性和效率，在面对未来对人群心理健康的威胁（如经济危机、自然灾害、全球大流行）时促进长期可持续性和恢复力。
