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Cited by 45Psychiatric care and mental health servicesMental Health Treatment and AccessHealthcare Quality and Management

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

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Furst, Mary Anne, Gandré, Coralie, Romero López-Alberca, Cristina, Salvador-Carulla, Luis·2019·BMC Health Services Research
DOI 10.1186/s12913-019-4005-5PMC PMC6423877
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Abstract

BACKGROUND: Evidence 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. METHODS: A 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. RESULTS: The 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. CONCLUSION: We 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.

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  • Research into how context shapes resource use and outcomes is underdeveloped.

    “Research into how context shapes resource use and outcomes, however, is underdeveloped. 460,461”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [461]

    The Conclusion (no page given) calls context studies in mental health services a limited research area, and the Background links local context to healthcare outcomes. The review focuses on methods for describing local mental health care; it does not establish that research specifically examining how context shapes resource use and outcomes is underdeveloped. (LLM, conf=0.82)

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  1. [1]Raine R Fitzpatrick R Barratt H Bevan G Black N Boaden R Challenges, solutions and future directions in the evaluation of service innovations in health care and public health Health Serv Deliv Res 2016 4 16 1 136 27227187
  2. [2]Lee BY Wong KF Bartsch SM Yilmaz SL Avery TR Brown ST The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system J Am Med Inform Assoc 2013 20 e1 e139 e146 23571848 PMC3715346
  3. [3]Y Chung, L Salvador-Carulla, J Salinas-Perez, J Uriarte-Uriarte, A Iruin-Sanz, CR García-Alonso. Use of the Self-Organising Map Network (SOMNet) as a Decision Support System for Regional Mental Health Planning. Health Res Policy Syst. 2018;In press. PMC5922302 29695248
  4. [4]Salvador-Carulla L Lukersmith S Sullivan W From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health Epidemiol Psychiatr Sci. 2017 26 2 105 114 28290273 PMC6998697
  5. [5]Lewin S Oxman AD Lavis JN Fretheim A Marti SG Munabi-Babigumira S SUPPORT Tools for evidence-informed Policymaking in health 11: Finding and using evidence about local conditions Health Res Policy Syst Lond 2009 7 Suppl 1 S11 PMC3271822 20018101
  6. [6]World Health Organization, Mental Health Gap Action Programme, World Health Organization. MhGAP: Mental Health Gap Action Programme: scaling up care for mental, neurological, and substance use disorders [Internet]. 2008 [cited 2017 Nov 21]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK310851/
  7. [8]Goodwin N. Understanding integrated care: a complex process, a fundamental principle. Int J Integr Care [Internet]. 2013 22 [cited 2018 Feb 26];13(1). Available from: http://www.ijic.org/articles/abstract/10.5334/ijic.1144/ PMC3653279 23687483 · DOI
  8. [9]THORNICROFT G TANSELLA M Balancing community-basedand hospital-based mental health care World Psychiatry 2002 1 2 84 90 16946858 PMC1489876
  9. [10]Brien SE Lorenzetti DL Lewis S Kennedy J Ghali WA Overview of a formal scoping review on health system report cards Implement Sci Lond. 2010 5 2 PMC2823624 20205791
  10. [12]Levac D Colquhoun H O’Brien KK Scoping studies: advancing the methodology Implement Sci Lond 2010 5 69 PMC2954944 20854677
  11. [13]Peters MDJ Godfrey CM Khalil H McInerney P Parker D Soares CB Guidance for conducting systematic scoping reviews Int J Evid Based Healthc 2015 13 3 141 26134548
  12. [14]Frenk J The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress: e1000089 PLoS Med San Franc 2010 7 1 e1000089 PMC2797599 20069038
  13. [15]Tansella M Thornicroft G A conceptual framework for mental health services: the matrix model Psychol Med 1998 28 3 503 508 9626707
  14. [16]Vinci ALT, Rijo RPCL, Marques JM de A, Alves D. Proposal of an Evaluation Model for Mental Health Care Networks Using Information Technologies for its Management. Procedia Comput Sci 2016;100:826–831.
  15. [18]Donabedian A The Quality of Care: How Can It Be Assessed? JAMA. 1988 260 12 1743 3045356
  16. [19]Kahng SK Kim H A Developmental Overview of Mental Health System in Korea Soc Work Public Health 2010 25 2 158 175 20391259
  17. [20]Dernovsek MZ Sprah L A preliminary report on the implementation of the European Service and Mapping Schedule (ESMS) in Slovenia to map preventive and promotion activities in mental health Psychiatr Danub 2008 20 2 141 147 18587281
  18. [21]Ofori-Atta A Read UM Lund C A situation analysis of mental health services and legislation in Ghana: challenges for transformation Afr J Psychiatry 2010 13 2 99 108 20473470
  19. [22]Li Y Jia F Hou C Ryan B Blashki G Everall I A survey of the mental health workforce in Guangdong: implications for policy and workforce planning Australas Psychiatry 2015 23 6 675 678 26405074
  20. [23]Glover G Adult mental health care in England Eur Arch Psychiatry Clin Neurosci 2007 257 2 71 82 17200878
  21. [24]Roberts M Mogan C Asare JB An overview of Ghana’s mental health system: results from an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Int J Ment Health Syst. 2014 8 16 24817908 PMC4016652
  22. [25]Saymah D Tait L Michail M An overview of the mental health system in Gaza: an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Int J Ment Health Syst 2015 9 4 25780385 PMC4361134
  23. [26]Lora A An overview of the mental health system in Italy Ann DellIstituto Super Sanità 2009 45 5 16 19567972
  24. [27]Kigozi F Ssebunnya J Kizza D Cooper S Ndyanabangi S An overview of Uganda’s mental health care system: results from an assessment using the world health organization’s assessment instrument for mental health systems (WHO-AIMS) Int J Ment Health Syst. 2010 4 1 20180979 PMC2831025
  25. [28]Dernovsek MZ Sprah L Assessment of mental health services in Slovenia with The European Service Mapping Schedule Psychiatr Danub 2008 20 3 439 442 18827780
  26. [30]Koenig HG Al Zaben F Sehlo MG Khalifa DA Al Ahwal MS Current State of Psychiatry in Saudi Arabia Int J Psychiatry Med 2013 46 3 223 242 24741832
  27. [31]Saxena S Lora A Morris J Berrino A Esparza P Barrett T Focus on Global Mental Health: Mental Health Services in 42 Low- and Middle-Income Countries: A WHO-AIMS Cross-National Analysis Psychiatr Serv Arlingt 2011 62 2 123 125 21285088
  28. [32]Neri G Guzzetta F Pazzi L Bignami R Picardi A de Girolamo G How Does the Residential Care System Change? A Longitudinal Survey in a Large Region of Italy Community Ment Health J 2011 47 2 201 208 21061170
  29. [33]Sikwese A Mwape L Mwanza J Kapungwe A Kakuma R Imasiku M Human resource challenges facing Zambia’s mental health care system and possible solutions: Results from a combined quantitative and qualitative study Int Rev Psychiatry 2010 22 6 550 557 21226643
  30. [34]Fernandez A Gillespie JA Smith-Merry J Feng X Astell-Burt T Maas C Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations Aust Health Rev Collingwood 2017 41 1 38 44 27007640
  31. [35]ITO H SETOYA Y SUZUKI Y Lessons learned in developing community mental health care in East and South East Asia World Psychiatry 2012 11 3 186 190 23024679 PMC3449347
  32. [37]Tosevski DL Pejuskovic B Mental health care in Belgrade — Challenges and solutions Eur Psychiatry 2005 20 Supplement 2 S266 S269 16446205
  33. [38]Li K Sun X Zhang Y Shi G Kolstad A Mental health care in China: review on the delivery and policy issues in 1949–2009 and the outlook for the next decade Acta Neuropsychiatr 2014 26 3 134 145 25279417
  34. [39]Chahine LM, Chemali ZN. Mental health care in Lebanon: policy, plans and programmes. East Mediterr Health J. 2009;15(6):1596-612. 20218153
  35. [40]Ferre Navarete F Palanca I Mental health care in Madrid Eur Psychiatry 2005 20 S279 S284 16446208
  36. [41]Raboch J Wenigova B Mental health care in Prague Eur Psychiatry 2005 20 Supplement 2 S289 S293 16446210
  37. [42]Gaddini A Ascoli M Biscaglia L Mental health care in Rome Eur Psychiatry 2005 20 Supplement 2 S294 S297 16446211
  38. [43]Jenkins R Heshmat A Loza N Siekkonen I Sorour E Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9 Int J Ment Health Syst. 2010 4 17 20576104 PMC2910029
  39. [44]Kiima D Jenkins R Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations Int J Ment Health Syst. 2010 4 19 20584266 PMC2907308
  40. [45]Niemi M Thanh HT Tuan T Falkenberg T Mental health priorities in Vietnam: a mixed-methods analysis BMC Health Serv Res Lond. 2010 10 257 PMC2942883 20813036
  41. [46]Liu J H M YL H B X YF X HY T Mental health system in China: history, recent service reform and future challenges World Psychiatry 2011 10 3 210 216 21991281 PMC3188776
  42. [47]Priebe S Matanov A Barros H Canavan R Gabor E Greacen T Mental health-care provision for marginalized groups across Europe: findings from the PROMO study Eur J Pub Health 2013 23 1 97 103 23132869
  43. [48]Salvador-Carulla L Saldivia S Martinez-Leal R Vicente B Garcia-Alonso C Grandon P Meso-level Comparison of Mental Health Service Availability and Use in Chile and Spain Psychiatr Serv Arlingt. 2008 59 4 421 428 18378842
  44. [49]Picardi A Lega I Candini VP Dagani JP Iozzino LP de Girolamo G Monitoring and Evaluating the Italian Mental Health System: The “Progetto Residenze” Study and Beyond. [Review] J Nerv 2014 202 6 451 459 24879571
  45. [50]Petersen I Bhana A Campbell-Hall V Mjadu S Lund C Kleintjies S Planning for district mental health services in South Africa: a situational analysis of a rural district site Health Policy Plan 2009 24 2 140 150 19147698
  46. [51]Lund C Kleintjes S Kakuma R Flisher AJ Consortium the MhRP. Public sector mental health systems in South Africa: inter-provincial comparisons and policy implications Soc Psychiatry Psychiatr Epidemiol 2010 45 3 393 404 19506789
  47. [52]Rezvyy G Øiesvold T Parniakov A Ponomarev O Lazurko O Olstad R The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County Soc Psychiatry Psychiatr Epidemiol 2007 42 2 131 139 17160593
  48. [53]Fernandez A Salinas-Perez JA Gutierrez-Colosia MR Prat-Pubill B Serrano-Blanco A Molina C Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain) Epidemiol Psychiatr Sci 2015 24 6 512 524 25226091 PMC8367369
  49. [55]Beecham J Access to mental health supports in England: Crisis resolution teams and day services Int J Law Psychiatry 2005 28 5 574 587 16153709
  50. [56]Pirkola S Sund R Sailas E Wahlbeck K Community mental-health services and suicide rate in Finland: a nationwide small-area analysis Lancet 2009 373 9658 147 153 19097638
  51. [57]Cooper SL Lezotte D Jacobellis J DiGuiseppi C Does Availability of Mental Health Resources Prevent Recurrent Suicidal Behavior? An Ecological Analysis Suicide Life - Threat Behav Wash 2006 36 4 409 417 16978095
  52. [59]Tibaldi G Munizza C Pasian S Johnson S Salvador-Carulla L Zucchi S Indicators predicting use of mental health services in Piedmont Italy J Ment Health Policy Econ 2005 8 2 95 106 15998981
  53. [60]Salvador-Carulla L Tibaldi G Johnson S Scala E Romero C Munizza C Patterns of mental health service utilisation in Italy and Spain Soc Psychiatry Psychiatr Epidemiol 2005 40 2 149 159 15685407
  54. [61]Ala-Nikkola T, Pirkola S, Kaila M, Saarni SI, Joffe G, Kontio R, et al. Regional Correlates of Psychiatric Inpatient Treatment. Int J Environ Res Public Health [Internet]. 2016 Dec [cited 2017 Nov 21];13(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201345/ PMC5201345 27929403
  55. [62]Lora A Kohn R Levav I McBain R Morris J Saxena S Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries Bull World Health Organ 2012 90 1 47 54B 22271964 PMC3260570
  56. [64]Salvador-Carulla L Garcia-Alonso C Gonzalez-Caballero J Garrido-Cumbrera M Use of an Operational Model of Community Care to Assess Technical Efficiency and Benchmarking of Small Mental Health Areas in Spain J Ment Health Policy Econ 2007 10 87 100 17603149
  57. [65]Salvador-Carulla L Alvarez-Galvez J Romero C Gutiérrez-Colosía MR Weber G McDaid D Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study BMC Health Serv Res Lond 2013 13 218 PMC3685525 23768163
  58. [66]Gagliardi AR, Whitney B, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: a scoping review. Implement Sci Lond [Internet]. 2016;11. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0399-1. [cited 2017 Nov 21]. PMC4797171 26988000 · DOI
  59. [67]Chambers D Wilson P Thompson C Harden M Social Network Analysis in Healthcare Settings: A Systematic Scoping Review PLoS One San Franc 2012 7 8 e41911 PMC3411695 22870261
  60. [68]Montagni I Salvador-Carulla L Mcdaid D Straßmayr C Endel F Näätänen P The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment Adm Policy Ment Health Ment Health Serv Res 2018 45 2 342 351 28918502
  61. [70]Thornicroft G Cooper S Van Bortel T Kakuma R Lund C Capacity Building in Global Mental Health Research: Harv Rev Psychiatry 2012 20 1 13 24 22335179 PMC3335140
  62. [72]Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen J-A, Dröschel D, et al. Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development. PLoS Med [Internet]. 2012 Mar 6 [cited 2017 Nov 26];9(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295823/ PMC3295823 22412356

Cited by

Sorted by citations

Authors
Furst, M. A., Gandré, C., Romero López-Alberca, C., & Salvador-Carulla, L.
Affiliations
  • Australian National University (AU)
  • Inserm (FR)
Corresponding author
Furst, Mary Anne
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2019-03-18
Volume
19
Issue
1
Pages
173-173
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-019-4005-5
PMC
PMC6423877
OpenAlex
W2944146627
Cited by
45
References
3
Citations by year
2026: 2 · 2025: 7 · 2024: 11 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 8 · 2019: 4
FWCI
0.75
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
  • RODIN (Universidad de Cádiz) (submittedVersion, cc-by-nc-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
mental health system, healthcare ecosystem, contextual analysis, service availability, care capacity, system complexity, methodological limitations, psychometric validation, system comparison, regional variation
MeSH terms
Delivery of Health Care, Health Services Research, Humans, Mental Health, Mental Health Services

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