A decision-support tool to inform Australian strategies for preventing suicide and suicidal behaviour

Abstract

Dynamic simulation modelling is increasingly being recognised as a valuable decision-support tool to help guide investments and actions to address complex public health issues such as suicide. In particular, participatory system dynamics (SD) modelling provides a useful tool for asking high-level 'what if' questions, and testing the likely impacts of different combinations of policies and interventions at an aggregate level before they are implemented in the real world.We developed an SD model for suicide prevention in Australia, and investigated the hypothesised impacts over the next 10 years (2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024)(2025) of a combination of current intervention strategies proposed for population interventions in Australia: 1) general practitioner (GP) training, 2) coordinated aftercare in those who have attempted suicide, 3) school-based mental health literacy programs, 4) brief-contact interventions in hospital settings, and 5) psychosocial treatment approaches.Findings suggest that the largest reductions in suicide were associated with GP training (6%) and coordinated aftercare approaches (4%), with total reductions of 12% for all interventions combined. This paper highlights the value of dynamic modelling methods for managing complexity and uncertainty, and demonstrates their potential use as a decision-support tool for policy makers and program planners for community suicide prevention actions.

System Dynamics Applications to Injury and Violence Prevention: a Systematic Review

“…After excluding articles that did not involve an actual SDrelated application and were not injury-related, 62 articles remained. Two members of the research team conducted a thorough text review of these 62 and determined that 18 [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] had a direct and specific link to an injury outcome and utilized a SD-related method or tool (e.g., CLD, SD simulation model). These 18 studies were included in the review (Table 1).…”

“…Since 2009, one to three applications have been published each year. Topic areas included youth violence [50], domestic violence [55,56], community violence [51]; suicide [63]; drug overdose [54,[64][65][66][67]; occupational injury [53]; road traffic injury [52,[58][59][60][61][62]; and traumatic brain injury [57]. Studies were conducted within a variety of geographic contexts and scales.…”

Bringing new tools, a regional focus, resource-sensitivity, local engagement and necessary discipline to mental health policy and planning

“…As in other sectors, the application of systems modelling and simulation can drive better decision-making in mental health and suicide prevention by facilitating the exploration of the likely impact of alternative system design and service planning scenarios before they are implemented in the real world. Recent applications [47,56,[58][59][60][61][62][63][64][65][66][67] of these advanced decision support tools have generated new knowledge and insights that are only possible when we use systems thinking and systems modelling methods to bring together the different pieces of a complex puzzle. This puzzle has many pieces, including, for example, research into the broader social and economic determinants of mental health and suicidal behaviour, service barriers and facilitators, and assessment of local needs, evidence regarding effectiveness of mental health models of care and population-based programs, together with disparate, multi-agency data sources, expert and local knowledge, and the deep understanding and unique perspectives of those with lived experience.…”

Participatory model building for suicide prevention in Canada

“…1) [29]; a pre-existing list of risk and protective factors for suicide prevention [1] developed in 2015; a diagram from the World Health Organization showing how key risk factors for suicide align with relevant interventions (as an example of how to match interventions to risk and protective factors during the workshop) [31]; and the evaluation form. The planning team prepared four 50″ × 30″ pieces of paper and print outs of the simplified suicide process model in 32 point font to facilitate groups placing risk and protective factors onto the simplified suicide process model [29]. An additional 50″x30″ piece of paper with the process model was prepared for the subsequent discussion to allow for further diagramming, if necessary.…”

“…The aims of the model building workshop were to (1) generate a conceptual model that expanded beyond conventional models of suicide, by incorporating upstream risk and protective factors that act at the level of individuals, families, communities, and societies, and (2) identify the prevention levers that may operate upstream and across different intersecting societal structures and systems in the Canadian context. The resulting model could help inform future public health efforts around suicide prevention, guide future research, and inform micro-simulations and modelling efforts aimed at quantifying the impact of population-based interventions [29].…”