TUE 2:30 PM: Parallel Session: Mental Health Care Systems
The first paper, Emerging opportunities for System Dynamics in UK Health and Social Care (Wolstenholme et al) gave an encouraging report on the demand from health care providers in the UK to use system dynamics techniques to support the development of, among others, mental health services. The paper gave as an example the service line (or care pathway) organisation of services to ensure continuing of care, service coherence, and appropriate access based on need. The case study described modeling stepped care services for depression, anxiety, and post traumatic stress disorder in Lincolnshire (UK). The system dynamics language provided a natural way of describing service lines, modeling their behaviour, and helping to realise the benefits of service line reporting and needs analysis. Putting together patient needs and services into a whole system was critical to understanding the economics of service provision and need.
Science Meets Policy and Practice (Hovmand et al) gave two successful examples of the use of system dynamics techniques in mental health services, firstly in the context of understanding organisational behaviour, and secondly in identifying factors that are either barriers or facilitators to the adoption of evidence-based practices in mental health. An emergent theme from this work is that policy makers became more aware and started to factor into their thinking and work the possibility of unintended consequences and how to minimise their impact. The second example related to the Missouri Transformation Project, with an emphasis on eliminating inequalities in provision and making services user-led. It called for an approach that was broadly based, involving a state-wide process with over 250 individuals working in groups. Success was attributed to the improvements, taking the whole system view, in the mental models used by decision makers over their current approaches.
The third paper, Broadening Boundary Perception in a Multi-organisational Context (Hyunjug Kim), applied system dynamics to helping healthcare administrators and practitioners create a shared understanding of the community mental health programme in New York State. The work had identified a misalignment in the service boundaries as seen by administrators at the state level, driven by court mandated Assisted Outpatient Treatments (AOTs). Local levels also needed to deal with voluntary AOT agreements, as well as provide access to services for those who were not under an AOT. Again, this paper and presentation underlined the importance of capturing the "whole system" in a multi-organisational context, creating a shared and coherent view about the patient flows, workforce issues, and assessment of system performance.
Dr. Savas Hadjipavlou