Abstract
BackgroundReducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources.MethodsUsing a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period.ResultsA combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’ConclusionResults indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.
Highlights
Reducing suicidal behaviour (SB) is a critical public health issue globally
The findings of this study suggest that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide
The potential of systems modelling and simulation to support a more disciplined, targeted, inclusive, and transparent approach to national and regional decision-making regarding allocation of resources to reduce suicidal behaviour has been well described [12, 29, 34]. Such interactive systems models are being used to explore the impact of possible investment decisions on outcomes other than suicidal behaviour to ensure that unintended negative impacts on other parts of the system, such as mental health ED presentations, service wait times, and capacity, do not occur as a result of efforts to address suicidal behaviour
Summary
Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Further significant momentum has been achieved through the World Economic Forum’s Global Shapers Community, a grassroots network of young people, who called on all countries to increase financing, public mental health education, and quality systems of care at the Annual meeting in Davos in 2020 [8] This elevation of mental health and wellbeing and suicide prevention in the global development agenda has led to a renewed push worldwide to strengthen mental health systems ( leadership and governance, and community-based care), increase service coverage and responsiveness, and set targets for reductions in suicide deaths [3, 9, 10]. While there are numerous evidence reviews to support the case for investments aimed at addressing the social determinants of mental disorder, it is unclear whether resources should be spread across each of them or whether some are more important than others for suicide prevention in a particular context
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