Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia.
Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia.
BMC Psychiatry. 2024 Sep 27;24(1):627. doi: 10.1186/s12888-024-06066-7.
Emergency departments (EDs) are often the front door for urgent mental health care, especially when demand exceeds capacity. Long waits in EDs exert strain on hospital resources and worsen distress for individuals experiencing a mental health crisis. We used as a test case the Australian Capital Territory (ACT), with a population surge of over 27% across 2011-2021 and a lagging increase in mental health care capacity, to evaluate population-based approaches to reduce mental health-related ED presentations.
We developed a system dynamics model for the ACT region using a participatory approach involving local stakeholders, including health planners, health providers and young people with lived experience of mental health disorders. Outcomes were projected over 2023-2032 for youth (aged 15-24) and for the general population.
Improving the overall mental health care system through strategies such as doubling the annual capacity growth rate of mental health services or leveraging digital technologies for triage and care coordination is projected to decrease youth mental health-related ED visits by 4.3% and 4.8% respectively. Implementation of mobile crisis response teams (consisting of a mental health nurse accompanying police or ambulance officers) is projected to reduce youth mental health-related ED visits by 10.2% by de-escalating some emergency situations and directly transferring selected individuals to community mental health centres. Other effective interventions include limiting re-presentations to ED by screening for suicide risk and following up with calls post-discharge (6.4% reduction), and limiting presentations of frequent users of ED by providing psychosocial education to families of people with schizophrenia (5.1% reduction). Finally, combining these five approaches is projected to reduce youth mental health-related ED presentations by 26.6% by the end of 2032.
Policies to decrease youth mental health-related ED presentations should not be limited to increasing mental health care capacity, but also include structural reforms.
急诊科（ED）通常是紧急心理健康护理的前门，尤其是当需求超过能力时。ED 中的长时间等待会给医院资源带来压力，并使经历心理健康危机的个人的痛苦加剧。我们以澳大利亚首都领地（ACT）为案例研究，该地区在 2011-2021 年间人口增长超过 27%，而心理健康保健能力的增长滞后，评估了减少与心理健康相关的 ED 就诊的基于人群的方法。
我们使用一种参与式方法为 ACT 地区开发了一种系统动力学模型，该方法涉及当地利益相关者，包括卫生规划者、卫生提供者和有心理健康障碍经历的年轻人。结果预测在 2023-2032 年期间，年轻人（15-24 岁）和一般人群的结果。
通过提高整体心理健康保健系统的策略，如将心理健康服务的年度容量增长率提高一倍，或利用数字技术进行分诊和护理协调，预计将分别减少青年心理健康相关 ED 就诊的 4.3%和 4.8%。实施移动危机应对小组（由一名心理健康护士陪同警察或救护车人员）预计将减少 10.2%的青年心理健康相关 ED 就诊，方法是缓解一些紧急情况，并直接将选定的人转移到社区心理健康中心。其他有效干预措施包括通过筛查自杀风险和在出院后进行电话随访（减少 6.4%）限制 ED 的再次就诊，以及通过向精神分裂症患者家属提供心理社会教育来限制 ED 的频繁就诊者就诊（减少 5.1%）。最后，到 2032 年底，结合这五种方法预计将减少 26.6%的青年心理健康相关 ED 就诊。
减少青年心理健康相关 ED 就诊的政策不应仅限于增加心理健康保健能力，还应包括结构性改革。
