Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health?
Abstract Background Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to a...
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Cambridge University Press
2025-01-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933825100539/type/journal_article |
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| author | Jo-An Occhipinti Nicholas Ho Paul Crosland Sam Huntley Wendy Hawkins Adam Connell Judith Piccone Sarah Piper Seyed Hossein Hosseini Catherine Vacher Jordan van Rosmalen Sophie Morson Courtney Milham Wendy Burton Kayla Andrade Chloe Gosling Kristen Tran Yun Ju Christine Song Victoria Loblay Jo Robinson Adam Skinner Ian B. Hickie |
| author_facet | Jo-An Occhipinti Nicholas Ho Paul Crosland Sam Huntley Wendy Hawkins Adam Connell Judith Piccone Sarah Piper Seyed Hossein Hosseini Catherine Vacher Jordan van Rosmalen Sophie Morson Courtney Milham Wendy Burton Kayla Andrade Chloe Gosling Kristen Tran Yun Ju Christine Song Victoria Loblay Jo Robinson Adam Skinner Ian B. Hickie |
| author_sort | Jo-An Occhipinti |
| collection | DOAJ |
| description | Abstract
Background
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
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| format | Article |
| id | doaj-art-35f453ae8dbf45f8a1f1c859d456fece |
| institution | Kabale University |
| issn | 0924-9338 1778-3585 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj-art-35f453ae8dbf45f8a1f1c859d456fece2025-08-20T03:28:47ZengCambridge University PressEuropean Psychiatry0924-93381778-35852025-01-016810.1192/j.eurpsy.2025.10053Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health?Jo-An Occhipinti0https://orcid.org/0000-0002-2380-1092Nicholas Ho1https://orcid.org/0000-0001-9843-0866Paul Crosland2https://orcid.org/0000-0002-6445-7486Sam Huntley3https://orcid.org/0000-0002-2137-5755Wendy Hawkins4Adam Connell5https://orcid.org/0009-0002-6605-8670Judith Piccone6Sarah Piper7https://orcid.org/0009-0004-4307-4891Seyed Hossein Hosseini8https://orcid.org/0000-0002-0400-5613Catherine Vacher9https://orcid.org/0000-0002-6923-0993Jordan van Rosmalen10Sophie Morson11https://orcid.org/0009-0006-0051-7378Courtney Milham12Wendy Burton13Kayla Andrade14Chloe Gosling15Kristen Tran16https://orcid.org/0000-0002-3544-1696Yun Ju Christine Song17https://orcid.org/0000-0001-8776-6305Victoria Loblay18https://orcid.org/0000-0003-4094-9619Jo Robinson19https://orcid.org/0000-0001-5652-918XAdam Skinner20https://orcid.org/0000-0002-9823-1506Ian B. Hickie21https://orcid.org/0000-0001-8832-9895Brain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, Australia Computer Simulation & Advanced Research Technologies, Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaMetro South Hospital and Health Service, https://ror.org/00c1dt378 Queensland Health , Brisbane, AustraliaMental Health Alcohol and Other Drugs Strategy and Planning Branch, https://ror.org/00c1dt378 Queensland Health , Brisbane, Australiahttps://ror.org/00be8mn93 Children’s Health Queensland Hospital and Health Service , Brisbane, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaThriving Queensland Kids Partnership, Australian Research Alliance for Children and Youth, Brisbane, AustraliaBrisbane South Primary Health Network, Brisbane, AustraliaMorningside General Practice Clinic, Brisbane, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaOrygen, Melbourne, Australia Centre for Youth Mental Health, The University of Melbourne, Melbourne, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaBrain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12 University of Sydney , Sydney, AustraliaAbstract Background Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified. Methods This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted. Results Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24. Conclusions This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies. https://www.cambridge.org/core/product/identifier/S0924933825100539/type/journal_articlehealth systemssystem dynamicssocial cohesionworkforceyouth mental health |
| spellingShingle | Jo-An Occhipinti Nicholas Ho Paul Crosland Sam Huntley Wendy Hawkins Adam Connell Judith Piccone Sarah Piper Seyed Hossein Hosseini Catherine Vacher Jordan van Rosmalen Sophie Morson Courtney Milham Wendy Burton Kayla Andrade Chloe Gosling Kristen Tran Yun Ju Christine Song Victoria Loblay Jo Robinson Adam Skinner Ian B. Hickie Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? European Psychiatry health systems system dynamics social cohesion workforce youth mental health |
| title | Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? |
| title_full | Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? |
| title_fullStr | Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? |
| title_full_unstemmed | Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? |
| title_short | Beyond capacity limits: can social cohesion offset the impact of service constraints on youth mental health? |
| title_sort | beyond capacity limits can social cohesion offset the impact of service constraints on youth mental health |
| topic | health systems system dynamics social cohesion workforce youth mental health |
| url | https://www.cambridge.org/core/product/identifier/S0924933825100539/type/journal_article |
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