The impact of technology-enabled care coordination in a complex mental health system : a local system dynamics model

Background: Prior to the COVID-19 pandemic major shortcomings in the way mental health care systems are organised was impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and resulting social dislocation will depend on the extent to which care systems will become overwhelmed and the strategic investments made across the system to effectively respond. Objective: This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods: A system dynamics model for the regional population catchment of North Coast New South Wales was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care and suicidal behaviour (SB). The model reproduced historic timeseries data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (self-harm hospitalisations), suicide deaths, mental health-related ED presentations and psychological distress over the period of 2021 to 2030. These scenarios include: (1) business as usual; (2) increase in service capacity growth rate by 20% (3) standard telehealth; and (4) technology-enabled care coordination. Each scenario was tested using both pre- and post-COVID-19 social and economic conditions. Results: Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalisations and suicide deaths by 6·71% (95% interval, 5·63-7·8%), mental health-related ED presentations by 10·33% (95% interval, 8·58-12·1%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval, 1·35-2·32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had a substantially lower impact. This pattern of results was replicated under post-COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which effectively reduces the negative impact of the pandemic on mental health and suicide. Conclusions: The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of increasing service capacity growth rate by 20% or standard telehealth reiterates that strengthening how the whole mental health system functions together will have a greater impact on outcomes than simply improving the capacity of individual components of the system. Investments into more of the same type of programs and services alone won’t be enough to improve outcomes, instead new models of care and the digital infrastructure to support them are needed. Clinical Trial: NA