Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health?

IF 6.7
Jo-An Occhipinti, Nicholas Ho, Paul Crosland, Sam Huntley, Wendy Hawkins, Adam Connell, Judith Piccone, Sarah Piper, Seyed Hossein Hosseini, Catherine Vacher, Jordan van Rosmalen, Sophie Morson, Courtney Milham, Wendy Burton, Kayla Andrade, Chloe Gosling, Kristen Tran, Yun Ju Christine Song, Victoria Loblay, Jo Robinson, Adam Skinner, Ian B Hickie
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Abstract

Background: Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies - such as strengthening social cohesion - are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.

Methods: This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15-24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.

Results: Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15-24.

Conclusions: This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.

超越能力限制:社会凝聚力能否抵消服务限制对青少年心理健康的影响?
背景:近年来,青少年焦虑、抑郁和自残的比率大幅上升。临床服务能力的扩大受到劳动力短缺和系统分散的限制,即使大量投资也可能无法达到解决未满足需求所需的增长规模。因此,预防性战略——例如加强社会凝聚力——对于减轻精神卫生系统日益增加的压力至关重要,但它们弥补这些制约因素的潜力仍然无法量化。方法:采用系统动力学模型,探讨服务能力和社会凝聚力对青少年心理健康结果的影响。该模型是针对一个以城市、郊区和农村社区混合为特征的人口集水区而开发的。主要结局是预测10年内15-24岁年轻人中心理困扰和精神障碍的患病率,以及与心理健康相关的急诊科(ED)的发生率。对服务能力和社会凝聚力进行双向敏感性分析。结果:专业心理健康服务能力增长的变化对青少年心理健康结果的预测影响最大。热图揭示了社会凝聚力的改善可以抵消服务能力受限的负面影响的阈值。例如,如果服务能力增长仅维持在基线水平的80%,改善社会凝聚力仍可使有症状障碍的生存年数减少6.3%。要在不改善社会凝聚力的情况下实现类似规模的改善,目前服务能力的增长率需要提高一倍以上。将服务能力的翻番增长与扭转社会凝聚力的下降相结合,可以将ED的发病率降低25.6%,有症状精神障碍的年数降低19.2%。专业、空间和全科医生服务能力增加一倍,可以防止15-24岁青年中有24,060人患有症状性精神障碍。结论:本研究为理解社会凝聚力的改善如何有助于缓解精神卫生系统的劳动力约束提供了一个定量框架,展示了将服务扩展与社会凝聚力增强战略相结合的价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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