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Which Social, Economic, and Health Sector Strategies Will Deliver the Greatest Impacts for Youth Mental Health and Suicide Prevention? Protocol for an Advanced, Systems Modelling Approach

ABSTRACT: Background: Current global challenges are generating extensive social disruption and uncertainty that have the potential to undermine the mental health, wellbeing, and futures of young people. The scale and complexity of challenges call for engagement with systems science-based decision analytic tools that can capture the dynamics and interrelationships between physical, social, economic, and health systems, and support effective national and regional responses. At the outset of the pandemic mental health-related systems models were developed for the Australian context, however, the extent to which findings are generalisable across diverse regions remains unknown. This study aims to explore the context dependency of systems modelling insights. Methods: This study will employ a comparative case study design, applying participatory system dynamics modelling across eight diverse regions of Australia to answer three primary research questions: (i) Will current regional differences in key youth mental health outcomes be exacerbated in forward projections due to the social and economic impacts of COVID-19?; (ii) What combination of social policies and health system strengthening initiatives will deliver the greatest impacts within each region?; (iii) To what extent are optimal strategic responses consistent across the diverse regions? We provide a detailed technical blueprint as a potential springboard for more timely construction and deployment of systems models in international contexts to facilitate a broader examination of the question of generalisability and inform investments in the mental health and wellbeing of young people in the post COVID-19 recovery. Discussion: Computer simulation is known as the third pillar of science (after theory and experiment). Simulation allows researchers and decision makers to move beyond what can be manipulated within the scale, time, and ethical limits of the experimental approach. Such learning when achieved collectively, has the potential to enhance regional self-determination, help move beyond incremental adjustments to the status quo, and catalyze transformational change. This research seeks to advance efforts to establish regional decision support infrastructure and empower communities to effectively respond. In addition, this research seeks to move towards an understanding of the extent to which systems modelling insights may be relevant to the global mental health response by encouraging researchers to use, challenge, and advance the existing work for scientific and societal progress.

SUBMITTER: Occhipinti J

PROVIDER: S-EPMC8548722 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveUniversal Basic Income (UBI)-a largely unconditional, regular payment to all adults to support basic needs-has been proposed as a policy to increase the size and security of household incomes and promote mental health. We aimed to quantify its long-term impact on mental health among young people in England.MethodsWe produced a discrete-time dynamic stochastic microsimulation that models a close-to-reality open cohort of synthetic individuals (2010-2030) based on data from Office for National Statistics and Understanding Society. Three UBI scheme scenarios were simulated: Scheme 1-Starter (per week): £41 per child; £63 per adult over 18 and under 65; £190 per adult aged 65+; Scheme 2-Intermediate (per week): £63 per child; £145 per adult under 65; £190 per adult aged 65+; Scheme 3-Minimum Income Standard level (per week): £95 per child; £230 per adult under 65; £230 per adult aged 65+. We reported cases of anxiety and depression prevented or postponed and cost savings. Estimates are rounded to the second significant digit.ResultsScheme 1 could prevent or postpone 200 000 (95% uncertainty interval: 180 000 to 210 000) cases of anxiety and depression from 2010 to 2030. This would increase to 420 000(400 000 to 440 000) for Scheme 2 and 550 000(520 000 to 570 000) for Scheme 3. Assuming that 50% of the cases are diagnosed and treated, Scheme 1 could save £330 million (£280 million to £390 million) to National Health Service (NHS) and personal social services (PSS), over the same period, with Scheme 2 (£710 million (£640 million to £790 million)) or Scheme 3 (£930 million (£850 million to £1000 million)) producing more considerable savings. Overall, total cost savings (including NHS, PSS and patients' related costs) would range from £1.5 billion (£1.2 billion to £1.8 billion) for Scheme 1 to £4.2 billion (£3.7 billion to £4.6 billion) for Scheme 3.ConclusionOur modelling suggests that UBI could substantially benefit young people's mental health, producing substantial health-related cost savings.

Project description:BackgroundThe present study aimed to identify and critically appraise the quality of model-based economic evaluation studies in mental health prevention.MethodsA systematic search was performed on MEDLINE, EMBASE, EconLit, PsycINFO, and Web of Science. Two reviewers independently screened for eligible records using predefined criteria and extracted data using a pre-piloted data extraction form. The 61-item Philips Checklist was used to critically appraise the studies. Systematic review registration number: CRD42020184519.ResultsForty-nine studies were eligible to be included. Thirty studies (61.2%) were published in 2015-2021. Forty-seven studies were conducted for higher-income countries. There were mainly cost-utility analyses (n = 31) with the dominant primary outcome of quality-adjusted life year. The most common model was Markov (n = 26). Most of the studies were conducted from a societal or health care perspective (n = 37). Only ten models used a 50-year time horizon (n = 2) or lifetime horizon (n = 8). A wide range of mental health prevention strategies was evaluated with the dominance of selective/indicate strategy and focusing on common mental health problems (e.g., depression, suicide). The percentage of the Philip checkilst's criteria fulfilled by included studies was 69.3% on average and ranged from 43.3 to 90%. Among three domains of the Philip checklist, criteria on the model structure were fulfilled the most (72.1% on average, ranging from 50.0% to 91.7%), followed by the data domain (69.5% on average, ranging from 28.9% to 94.0%) and the consistency domain (54.6% on average, ranging from 20.0% to 100%). The practice of identification of 'relevant' evidence to inform model structure and inputs was inadequately performed. The model validation practice was rarely reported.ConclusionsThere is an increasing number of model-based economic evaluations of mental health prevention available to decision-makers, but evidence has been limited to the higher-income countries and the short-term horizon. Despite a high level of heterogeneity in study scope and model structure among included studies, almost all mental health prevention interventions were either cost-saving or cost-effective. Future models should make efforts to conduct in the low-resource context setting, expand the time horizon, improve the evidence identification to inform model structure and inputs, and promote the practice of model validation.

Project description:Youth stand at the core of much mental health promotion, yet little is written about their experiences of such efforts. We aimed to take this on by interviewing youth after they participated in Youth Aware of Mental Health (YAM), a universal mental health promotion program. YAM has a non-anticipatory methodology that provides youth with a safe space for reflection, role-play, and discussion. Addressing everyday mental health, YAM invites the experiences and issues relevant to the youth present to influence the program in a slightly different direction every time. The YAM instructor guides the participants but does not present the youth with given formulas on how to solve their problems. Like any mental health promotion, YAM appeals to some more than others in its intended audience and individuals engage with the program in many different ways. We set out to learn more about these experiences.Thirty-two semi-structured interviews were conducted with 15-17 year olds in Estonia, Italy, Romania and Spain. In these interviews, the researchers made an effort to discuss mental health in terms relevant to youth. Still, wide-ranging levels of motivation, ease with engaging in dialogue with mental health professionals, and comfort with the format and content of YAM were detected. The youth were clustered in five different groups relating to their positioning vis-à-vis the researcher during the interview. The following evocative labels were used: "interested", "foot in the door", "respect for authority", "careful", and "not my topic". Corresponding labels were devised for their YAM experience: "engaged", "initially hesitant", "cautious", "eager to please", or "disengaged". We also observed that the researchers brought their own expectations and employed a variety of approaches that led to anticipating answers, stating the obvious, or getting along better with some of the youth. These modes of interaction were categorized under: "favoritism", "familiarity", "frustration", "out of sync", and "insecurity". Similar power dynamics likely transpire in other encounters between youth and researchers, including interventions such as YAM.As mental health professionals, we need to be aware of the professional habits and biases that sometimes obstruct us in understanding the experiences of youth. By initiating dialogue and listening closely to youth we can find a way to those experiences. Qualitative research can help bring the underlying interplay between mental health professionals and youth to the surface while also orienting the conversation towards topics that matter to youth. Some youth are more interested or feel more at ease in speaking openly with mental health professionals, while others find such exchanges less appealing or almost intolerable. Future mental health promotion initiatives would benefit from involving youth in the design of interventions to create an inclusive atmosphere and engage with topics that appeal to youth with diverse experiences of mental health.

Project description:BackgroundThe COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic's global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes.MethodsWe conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme.ResultsOur search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes.ConclusionsThis review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.

Project description:BackgroundFollowing a situation appraisal in 2001, a six year mental health reform programme (Egymen) 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009.MethodsA multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services.ResultsThe project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines) to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers.ConclusionsThe bilateral collaboration programme initiated a reform programme which has been sustained beyond the end of the funding. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, and media work to mobilize community engagement.

Project description:BackgroundThere is a significant push to change the trajectory of youth mental ill-health and suicide globally. Ensuring that young people have access to services that meet their individual needs and are easily accessible is a priority. Genuine stakeholder engagement in mental health system design is critical to ensure that system strengthening is likely to be successful within these complex environments. There is limited literature describing engagement processes undertaken by research teams in mental health program implementation and planning. This protocol describes the methods that will be used to engage local communities using systems science methods to mobilize knowledge and action to strengthen youth mental health services.MethodsUsing participatory action research principles, the research team will actively engage with local communities to ensure genuine user-led participatory systems modelling processes and enhance knowledge mobilisation within research sites. Ensuring that culturally diverse and Aboriginal and Torres Strait Islander community voices are included will support this process. A rigorous site selection process will be undertaken to ensure that the community is committed and has capacity to actively engage in the research activities. Stakeholder engagement commences from the site selection process with the aim to build trust between researchers and key stakeholders. The research team will establish a variety of engagement resources and make opportunities available to each site depending on their local context, needs and audiences they wish to target during the process.DiscussionThis protocol describes the inclusive community engagement and knowledge mobilization process for the Right care, first time, where you live research Program. This Program will use an iterative and adaptive approach that considers the social, economic, and political context of each community and attempts to maximise research engagement. A theoretical framework for applying systems approaches to knowledge mobilization that is flexible will enable the implementation of a participatory action research approach. This protocol commits to a rigorous and genuine stakeholder engagement process that can be applied in mental health research implementation.

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Which Social, Economic, and Health Sector Strategies Will Deliver the Greatest Impacts for Youth Mental Health and Suicide Prevention? Protocol for an Advanced, Systems Modelling Approach

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