Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory
Abstract
:1. Introduction
Objective
2. Materials and Methods
2.1. Research Context
2.2. Participants and Sampling
2.3. Study Design
2.4. Data Analysis
2.5. Research Ethics
3. Results
3.1. Demographics
3.2. Feasibility of PSM to Support Youth Mental Health Systems in the ACT
“… [the project] went past what I was expecting because I was anticipating reluctance like, ‘It’s the system, and we can’t change it.’ But being able to hear people who are actually running the system saying that they want to make it better made me feel like there could be positive change”.
3.3. Value of PSM for Youth Mental Health System Strengthening in the ACT
“…to make people think about what the options are. Meaning, funds can be directed in the most optimal way rather than wasting money on things that are not available or unlikely to make a difference [in youth mental health]”.
“We’re asked to provide a cost benefit analysis [for our business cases] that we’re not really equipped to do … Having this [model] that’s quite accessible and can give us that level of detail is great”.
3.4. Impact (Change and Action) of PSM to Support Youth Mental Health Systems in the ACT
“…when the model insights were presented, you could visibly see how everyone in the room was very engaged. This was a stark difference from the first workshop where I noticed quite a few people on their phones or answering emails during larger group sessions like these”.
“… most of the young people had dropped out because of COVID and things like that [at workshop one] … So before workshop two, there was a young people only workshop, which basically replicated the events of workshop one. … Since it was just me and other young people there [at the youth workshop] it was really great getting to bounce off everyone and have that environment where it’s a safe space without stakeholders or other government people. … A lot of the young people who were at the youth workshop obviously came to workshop two. … And then after workshop two, for those who couldn’t come to workshop two or those who felt like they didn’t have a chance to properly say stuff, we had a debrief meeting. And we all had another proper opportunity to discuss our thoughts which was really, really good”.Young person with lived or living experience of mental ill-health
“…I think once we got that balance between the sector and the services with the young people in the room, I think it tipped it back. And I think because we did that specific youth [only] workshop where we really made sure that the young people were set up to succeed when they attended workshop two, they knew what they were walking into. So we had youth workers there [at the PSM workshops] so that if they [young people] felt overwhelmed, they had someone to talk to. We made it a really safe space, which I think allowed them [the young people] to feel brave enough to kind of challenge the sector. And they did particularly [challenge the sector] in workshop two, which I was really proud of. … We ended up with quite a beautiful process between young people having very much a loud role in that [PSM process]. … if I was going into this process again, I would absolutely say that there needs to be a large emphasis on connecting with lived experience as early on as possible”.Health administrator
“…in terms of connection and just people saying, ‘Can you come talk to my team??’ … The Office also started a [reference] group bringing services together around the issue of youth mental health. … I don’t know whether that’s a direct outcome of this [PSM process], but that’s how I perceived it which I thought was fantastic”.
3.5. Sustainability of PSM for Youth Mental Health Systems Strengthening in the ACT
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Glossary
ACT | Australian Capital Territory |
Model | System dynamics model |
PSM | Participatory systems modelling |
Research program | Right Care, First Time, Where You Live Program |
The Office | The Office for Mental Health and Wellbeing |
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Baseline (March 2022) | Follow-Up (October 2022) | ||||
---|---|---|---|---|---|
n | % | n | % | ||
Online Survey | Completion of surveys | ||||
Fully completed | 32 | 86.5% | 26 | 83.9% | |
Partially completed | 5 | 13.5% | 5 | 16.1% | |
11 respondents fully completed baseline and follow-up surveys | |||||
Age of respondents | |||||
14–17 years old | 1 | 2.7% | 1 | 3.2% | |
18–24 years old | 3 | 8.1% | 6 | 19.4% | |
25–34 years old | 6 | 16.2% | 5 | 16.1% | |
35–44 years old | 11 | 29.7% | 7 | 22.6% | |
45–54 years old | 12 | 32.4% | 5 | 16.1% | |
55–64 years old | 4 | 10.8% | 7 | 22.6% | |
65 years old or older | 0 | 0.0% | 0 | 0.0% | |
Profession of respondents 1 | |||||
Community support professional | 9 | 28.1% | 6 | 23.1% | |
Front-line health professional | 11 | 34.4% | 8 | 30.8% | |
Health administrator | 4 | 12.5% | 6 | 23.1% | |
Young people with lived experience | 3 | 9.4% | 5 | 19.2% | |
Did not disclose | 5 | 15.6% | 1 | 3.8% | |
Other information of respondents | |||||
Culturally and linguistically diverse | 5 | 15.6% | 3 | 11.5% | |
LGBTQIA+ | 4 | 12.5% | 7 | 26.9% | |
Religious and/or spiritual | 2 | 6.3% | 0 | 0.0% | |
None of the above | 22 | 68.8% | 17 | 65.4% | |
Interviews | Completion of interviews | 24 | 25 | ||
14 respondents completed baseline and follow-up interviews | |||||
Profession of respondents | |||||
Community support professional | 12 | 50.0% | 9 | 36.0% | |
Front-line health professional | 1 | 4.2% | 6 | 24.0% | |
Health administrator | 9 | 37.5% | 6 | 24.0% | |
Young people with lived experience | 2 | 8.3% | 4 | 16.0% |
Broad Strategic Intervention Category Prioritised by Site Stakeholders | Baseline Mean 1 (SD), N = 32 | Follow-up Mean (SD), n = 25 2 | Linear Mixed-Effects Model p-Value | Estimates of Fixed Effects for p-Values <0.05 (SE) |
---|---|---|---|---|
Prevention programs focusing on health and well-being (e.g., education programs) | 4.59 (0.71) | 4.36 (0.70) | p-value for time = 0.13 | N/A |
p-value for profession = 0.03 | Community professional = 0.10 (0.33) | |||
Front-line professional = −0.49 (0.32) | ||||
Health administrator = 0.28 (0.35) | ||||
Young people = −0.16 (0.37) | ||||
Early mental health intervention programs (e.g., school counselling services) | 4.75 (0.67) | 4.80 (0.41) | p-value for time = 0.90 | N/A |
p-value for profession = 0.05 | Community professional = 0.11 (0.27) | |||
Front-line professional = −0.45 (0.25) | ||||
Health administrator = 0.24 (0.24) | ||||
Young people = −0.03 (0.30) | ||||
Community-based mental health intervention programs (e.g., alcohol and other drugs support programs) | 4.59 (0.56) | 4.76 (0.44) | p-value for time = 0.16 | N/A |
p-value for profession = 0.17 | N/A | |||
Hospital-based mental health intervention programs (e.g., hospital-to-home services) | 4.34 (0.70) | 4.20 (0.58) | p-value for time = 0.31 | N/A |
p-value for profession = 0.76 | N/A | |||
Cultural programs (e.g., Aboriginal Community Controlled Health Organisations) | 4.56 (0.62) | 4.52 (0.59) | p-value for time = 0.27 | N/A |
p-value for profession = 0.64 | N/A | |||
Access programs (e.g., creating opportunities to receive better access to care such as after-hours care or shortened waiting times) | 4.81 (0.59) | 4.64 (0.67) | p-value for time = 0.16 | N/A |
p-value for profession = 0.59 | N/A | |||
Practical employment or educational skills programs (e.g., financial counselling) | 4.50 (0.67) | 4.36 (0.49) | p-value for time = 0.57 | N/A |
p-value for profession = 0.15 | N/A |
Baseline (N = 32) Community support professional, n = 9 Front-line health professional, n = 11 Health administrator, n = 4 Young people, n = 3 Did not disclose profession, n = 5 | Gamified activities made the survey enjoyable | Overall, n = 18 (56.3%) Community support professional, n = 5 (27.8%) Front-line health professional, n = 4 (22.2%) Health administrator, n = 3 (16.7%) Young people with lived experience, n = 3 (16.7%) Did not disclose, n = 3 (16.7%) |
Gamified activities made the survey confusing | Overall, n = 10 (31.3%) Community support professional, n = 1 (10.0%) Front-line health professional, n = 7 (70.0%) Health administrator, n = 1 (10.0%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 1 (10.0%) | |
The survey was too long | Overall, n = 7 (21.9%) Community support professional, n = 2 (28.6%) Front-line health professional, n = 4 (57.1%) Health administrator, n = 0 (0.0%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 1 (14.3%) | |
The survey was no different to any other survey | Overall, n = 3 (9.4%) Community support professional, n = 2 (66.7%) Front-line health professional, n = 0 (0.0%) Health administrator, n = 1 (33.3%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 0 (0.0%) | |
Follow-up (N = 26) Community support professional, n = 6 Front-line health professional, n = 8 Health administrator, n = 6 Young people, n = 5 Did not disclose profession, n = 1 | Gamified activities made the survey enjoyable | Overall, n = 21 (80.8%) Community support professional, n = 4 (19.0%) Front-line health professional, n = 6 (28.6%) Health administrator, n = 6 (28.6%) Young people with lived experience, n = 5 (23.8%) Did not disclose, n = 0 (0.0%) |
Gamified activities made the survey confusing | Overall, n = 2 (7.7%) Community support professional, n = 1 (50.0%) Front-line health professional, n = 0 (0.0%) Health administrator, n = 0 (0.0%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 1 (50.0%) | |
The survey was too long | Overall, n = 3 (11.5%) Community support professional, n = 1 (33.3%) Front-line health professional, n = 2 (66.7%) Health administrator, n = 0 (0.0%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 0 (0.0%) | |
The survey was no different to any other survey | Overall, n = 1 (3.8%) Community support professional, n = 0 (0.0%) Front-line health professional, n = 1 (100.0%) Health administrator, n = 0 (0.0%) Young people with lived experience, n = 0 (0.0%) Did not disclose, n = 0 (0.0%) |
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Lee, G.Y.; Hickie, I.B.; Song, Y.J.C.; Huntley, S.; Ho, N.; Loblay, V.; Freebairn, L.; Skinner, A.; Crosland, P.; Moore, E.; et al. Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory. Systems 2023, 11, 386. https://doi.org/10.3390/systems11080386
Lee GY, Hickie IB, Song YJC, Huntley S, Ho N, Loblay V, Freebairn L, Skinner A, Crosland P, Moore E, et al. Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory. Systems. 2023; 11(8):386. https://doi.org/10.3390/systems11080386
Chicago/Turabian StyleLee, Grace Yeeun, Ian Bernard Hickie, Yun Ju C. Song, Sam Huntley, Nicholas Ho, Victoria Loblay, Louise Freebairn, Adam Skinner, Paul Crosland, Elizabeth Moore, and et al. 2023. "Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory" Systems 11, no. 8: 386. https://doi.org/10.3390/systems11080386