Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery

Abstract

BackgroundEvidence from the context of local health ecosystems is highly relevant for research and policymaking to understand geographical variations in outcomes of health care delivery. In mental health systems, the analysis of context presents particular challenges related to their complexity and to methodological difficulties. Method guidelines and standard recommendations for conducting context analysis of local mental health care are urgently needed. This scoping study reviews current methods of context analysis in mental health systems to establish the parameters of research activity examining availability and capacity of care at the local level, and to identify any gaps in the literature.MethodsA scoping review based on a systematic search of key databases was conducted for the period 2005–2016. A systems dynamics/complexity approach was adopted, using a modified version of Tansella and Thornicroft’s matrix model of mental health care as the conceptual framework for our analysis.ResultsThe lack of a specific terminology in the area meant that from 10,911 titles identified at the initial search, only 46 papers met inclusion criteria. Of these, 21 had serious methodological limitations. Fifteen papers did not use any kind of formal framework, and five of those did not describe their method. Units of analysis varied widely and across different levels of the system. Six instruments to describe service availability and capacity were identified, of which three had been psychometrically validated. A limitation was the exclusion of grey literature from the review. However, the imprecise nature of the terminology, and high number of initial results, makes the inclusion of grey literature not feasible.ConclusionWe identified that, in spite of its relevance, context studies in mental health services is a very limited research area. Few validated instruments are available. Methodological limitations in many papers mean that the particular challenges of mental health systems research such as system complexity, data availability and terminological variability are generally poorly addressed, presenting a barrier to valid system comparison. The modified Thornicroft and Tansella matrix and related ecological production of care model provide the main model for research within the area of health care ecosystems.

Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande)

“…To our knowledge, this is the first standard description of the pattern of remote MH care across 3 OECD countries, 35 using a health care ecosystem approach 48 and a standard classification of services (DESDE-LTC). 44 This study adds to the international comparisons carried out at the macrolevel (i.e., characteristics of the national system of government, legislation, governance, and financing, as well as national data on MH service provision).…”

Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

“…Third, services should be understood in the context of the local system that they belong. Context analysis is now considered a key component of healthcare ecosystem research [9, 99]. This approach was advanced 20 years ago by the EPCAT group when the assessment of services provided by ESMS was accompanied by the standard analysis of the social and demographic context using ESDS [19], and by the description of the main modalities of care using ICMHC [18].…”

“…This approach was advanced 20 years ago by the EPCAT group when the assessment of services provided by ESMS was accompanied by the standard analysis of the social and demographic context using ESDS [19], and by the description of the main modalities of care using ICMHC [18]. Whilst WHO-AIMS [38] and the Mental Health Country Profile (MHCP) [100] have been used for describing national mental health systems worldwide, ESMS/DESDE is the only system that provides local, bottom-up information that can be used across different sectors (health, social, education, employment, housing and justice) [99] and for coding services for different target groups such as mental disorders [89, 51] intellectual disabilities [78], substance abuse [33, 88, 90], general disabilities [20], aging and long term care [21, 22]. The usability of ESMS/DESDE for the analysis of local change and improvement has been tested in Catalonia (Spain) where the evolution of the mental health care system was analysed before and after the implementation of the 2006 regional mental health plan (2002–2010) [81].…”

Experts’ perceptions on the use of visual analytics for complex mental healthcare planning: an exploratory study

“…A more comprehensive scope not limited to mental healthcare would have provided a broader perspective on the experts' perceptions on visual analytics and tools. However, it is important to consider that mental healthcare is at the core of integrated, multi-sectoral and complex approaches in healthcare systems research [31,32], thus is a start point for this exploratory research. While representing a strong cross-section of senior mental healthcare systems perspectives (e.g., policy, provision and research) in Australia and in Europe, the response rate and small sample size limit generalisability.…”