Authors: Alan Rosen, Luis Salvador-Carulla, MaryAnne Furst, Carlos Ramón García-Alonso, Nerea Almeda-Martínez
Event: 2022 TheMHS Conference
Subject: research, services, evaluation,
Type of resource: Conference Presentations and Papers
Abstract: SYMPOSIUM: The Mental Healthcare Ecosystem Approach to Complexity: A revolution in mental health service planning
A. Developing Mental Health-care Ecosystems to Navigate Complexity
Professor Alan Rosen, AO.
This entails integrating micro- with macro-level services, and community-centric care with hospital in-reach as needed, rather than hospital-centric care with community outreach only when convenient.
Mental Healthcare ecosystem research provides a new approach to community-centric integrated mental health care which eclipses the reductionistic perspective of past evidence-base healthcare, embeds complexity and entails co-design, including lived experience, family, provider and researcher expertise, applying real world solutions to complex problems. Recent experiences in Italy, Spain, and Australasia have contributed to enlarging the knowledge base, demonstrating the applicability of these new approaches to service planning. Like Alexander Calder mobiles, multiple optimal balancing points emerge which interact with each-other, whether between: a) community and/or hospital, b) biophysical or psycho-socio-cultural, c) in-person and home outreach or on-line and telehealth, d) micro-clinical/support or macro- community wellbeing-oriented care, and e) met need, un-met need and met un-need.
B. What are healthcare ecosystems and why are they so important for evidence-informed planning?
Professor Luis Salvador-Carulla
Mental health ecosystems research is an emerging discipline which takes a whole-systems approach to mental healthcare, facilitating analysis of the complex environment and context of mental health systems, and translation of this knowledge into policy and practice.
Health ecosystems refer to the totality of the circumstances that relate to a given health condition in a defined environment. They comprise the elements which together provide capital to ‘sustain and enhance human wellbeing’, including natural capital such as green spaces, and social capital, which includes both built (infrastructure) and human (institutions and governance) capital.Healthcare Ecosystem Research (HER), a new discipline in implementation sciences, is revolutionising regional research planning. We have applied a whole-system strategy based on systems research, context analysis and expert-based collaborative analysis to evidence informed planning. The organisational learning strategy included: i) the development of the conceptual model, ii) development and validation of instruments for service assessment, iii) revision of mixed methods of decision analytics, iv) atlases of regional Mental Health Care, v) integrated resource utilisation analysis, vi) knowledge translation to calculation of regional units of cost, vii) geospatial analysis of administrative prevalence, viii) financing of mental health care, ix) cost of illness of sentinel conditions such as depression. We have applied this approach to the analysis of the relative technical efficiency and benchmarking of health districts, and to the analysis of the efficiency of complex organisational interventions in local areas.
C. Applying healthcare ecosystem research to mental health planning: Experiences of the use of DESDE in Australia
Dr MaryAnne Furst
The DESDE-LTC (Description and Evaluation of Services and DirectoriEs of Long Term Care) is an instrument and a classification system to assess local provision from a healthcare ecosystem perspective. DESDE has been applied in the analysis of care in 12 Primary Health Networks in Australia. It has demonstrated its relevance for the analysis of local availability, capacity and workforce, different target population (child and adolescent, elderly, Indigenous), different conditions (mental disorders, drug and alcohol, dementia, multiple sclerosis, social care) and different sectors (health, social, education, employment).
DESDE has been used to identify and compare the patterns of service provision, including gaps in service availability, in these 12 Australian regions. It has provided the framework to develop Integrated Atlases of Health Care, which provide a holistic picture of a local healthcare ecosystem, including its socio-demographic and socio-economic characteristics, local needs, and service availability. Using the healthcare ecosystem approach, Integrated Atlases have provided evidence to inform strategic planning in these regions, including analysis of changes in the evolution of mental health and psychosocial care systems, and the effects on local care ecosystems of the implementation of the NDIS.
Information from Australian mental healthcare systems can be compared to that from international regions, through the GLOCAL (Global and Local Observation and mapping of CAre Levels) project, an international collaboration which applies the knowledge gained from assessing local health care services using the DESDE system and the Integrated Atlases of Mental Health Care to other target countries.
D. Applying healthcare ecosystems to real world planning: Experiences in England and in Spain
Professor Carlos Garcia-Alonso & Dr Nerea Almeda-Martinez
Our team applied the healthcare ecosystems research (HER) to the analysis of complex care planning challenges in the UK and in Spain. We used HER to analyse the quality and efficiency of mental health supported accommodation services in England. Given the complexity associated with MH-supported accommodation grouped by three main types of care: residential care homes (divided into two subgroups: move-on and non-move-on oriented), supported housing and floating outreach. The EDeS-MH modelling tool (efficient decision support-mental health) was used to assess the performance indicators for the selected services Quality domains significantly improved performance in every type of care. These findings can be considered from a planning perspective to facilitate the design of pathways of care with a focus on gaining individual’s autonomy and independence while sustaining an efficient provision system. The experience in the Basque Country (Spain) focused on the analysis of regional mental health and small healthcare areas and it was aimed (i) to identify potential expert-based causal relationships between inpatient and outpatient care variables, (ii) to assess them by using statistical procedures, and finally (iii) to assess the potential impact of a specific policy enhancing the MH care balance on real ecosystem performance. The analysis identified relations between inpatient and outpatient care and was used to design evidence informed policy to improve mental health services in the region.