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. 2021 Jun 30;23(6):e25331.
doi: 10.2196/25331.

The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model

Frank Iorfino  1 , Jo-An Occhipinti  1 , Adam Skinner  1 , Tracey Davenport  1 , Shelley Rowe  1 , Ante Prodan  2 , Julie Sturgess  3 , Ian B Hickie  1
Affiliations

The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model

Frank Iorfino et al. J Med Internet Res. .

Abstract

Background: Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on 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, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health-related emergency department (ED) presentations, and psychological distress over the period from 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 hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health-related ED presentations by 10.33% (95% interval 8.58%-12.19%), 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 substantially lower impacts. This pattern of results was replicated under post-COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce 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 targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.

Keywords: care coordination; complex systems; health systems; internet; medical informatics; mental health; policy; simulation.

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Conflict of interest statement

Conflicts of Interest: IBH was an inaugural commissioner on Australia’s National Mental Health Commission (2012-2018). He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC), University of Sydney. The BMC operates an early-intervention youth services program at Camperdown under contract to Headspace. He is the Chief Scientific Advisor to, and a 5% equity shareholder in, InnoWell Pty Ltd. InnoWell was formed by the University of Sydney (45% equity) and PwC (Australia; 45% equity) to deliver the Aus $30 million (~US $23,212,500) Australian Government–funded Project Synergy (2017-2020; a 3-year program for the transformation of mental health services) and to lead the transformation of mental health services internationally through the use of innovative technologies. JAO is Head of Systems Modelling, Simulation & Data Science and Co-Director of the Mental Wealth Initiative at the University of Sydney’s BMC, and is Managing Director of Computer Simulation & Advanced Research Technologies (CSART). TD is the Director of Research & Insights at the Australian Digital Health Agency.

Figures

Figure 1
Figure 1
Mental health outcomes for each intervention scenario. ED: emergency department.
Figure 2
Figure 2
The impact of the rate of uptake on mental health outcomes. ED: emergency department.
See this image and copyright information in PMC

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