Managing Madness: Mental Health and Complexity in Public Policy

Rosenberg, Sebastian; Hickie, Ian B.

doi:10.21307/eb-2013-005

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…With rates of mental disorders rising among young people, primary mental health services have been required to support those with more complex presentations without the backup of more specialist systems of care (Rosenberg and Hickie, 2013). Furthermore, although clinical complexity has long been a critical consideration in care planning and delivery, there has been no consensus, consistent definition, or established operational model of what complexity entails.…”

Section: Discussionmentioning

confidence: 99%

Capturing the clinical complexity in young people presenting to primary mental health services: A data-driven approach

Gao,

Telford,

Filia

et al. 2023

Preprint

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Background: The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental health care models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. Methods: This retrospective study involved analysis of headspace’s clinical minimum data set from young people accessing services in Australia between July 1, 2018, and June 30, 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues, and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors.Results: A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a "high complexity" group, presenting with a variety of complexity factors, including severe disorders, a trauma history, and psychosocial impairments. Two moderate complexity groups were identified representing "distress complexity" and "psychosocial complexity" (about 20% each). Compared with the "distress complexity" group, young people in the “psychosocial complexity" group presented with a higher proportion of education, employment, and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services.Discussion: The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental health care to ensure the availability of appropriate and timely support for all young people.

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Section: Discussionmentioning

confidence: 99%

Capturing the clinical complexity in young people presenting to primary mental health services: A data-driven approach

Gao,

Telford,

Filia

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…This care was mostly provided by different health care providers from different organizations. In this context of increasingly specialized and cut up care, integrated care does not sufficiently develop (Rosenberg & Hickie, 2013). Flexible interactions between stakeholders is needed (Ellis et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

It's all about the Family: Research on Dutch Families with Multiple and Complex Problems

Smit¹

2022

CJFY

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Despite the scaling up of family-focused interventions, the number of child out-of-home placements continued to rise in the Netherlands. Most of these children came from families with multiple and complex problems. The underlying reasons for the rise of out-of-home placements were unknown. The main goal is to prevent children from being placed in out-of-home care. To achieve this, research was conducted to gain insight into the experiences of youth care professionals using family-focused interventions. A mixed method research study was done based on the questionnaire of Bodden and Decovic (2015). Qualitatively, 16 semi-structured interviews with youth care providers were conducted and a quantitative statistical analysis of 206 cases of families with multiple and complex problems were analyzed. Family-focused interventions are highly regarded and used by all stakeholders. However, help for families with multiple and complex problems is fragmented and so are the multiple (and possibly contradictory) family interventions. All 206 cases showed problems in all domains. Factors that interfere with family functioning are the most common, child factors the least. There is no significant relationship between child out-of-home placement and child factors. With each additional family problem, the chance of out-of-home placement increases by 10%. This study shows the complexity, not only of the families themselves but also the caregivers involved in these families. It is important to recognize and understand this complexity. Dealing with this complexity requires a different approach. The addition of a client supporter or an expert by experience is recommended.

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“…Such programs have yet to materialize at scale ( Johansen and Thylstrup, 2019 ). While there are presumably also several causes for this lack of holistically oriented services it has been suggested that progress has been hampered by lack of engaging with the breadth of processes involved in a decentered treatment system ( Rosenberg and Hickie, 2013 ; Priebe, 2016 ). Figure 1 places the important developments in relation to each other.…”

Section: Dual Diagnosis: Emergence Of a Fieldmentioning

confidence: 99%

What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry

2022

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The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice.

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Managing Madness: Mental Health and Complexity in Public Policy

Cited by 8 publications

References 14 publications

Capturing the clinical complexity in young people presenting to primary mental health services: A data-driven approach

Capturing the clinical complexity in young people presenting to primary mental health services: A data-driven approach

It's all about the Family: Research on Dutch Families with Multiple and Complex Problems

What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry

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