Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT

Mary Anne Furst; Jose A. Salinas-Perez; Mencia R. Gutiérrez-Colosía; John Mendoza; Nasser Bagheri; Lauren Anthes; Luis Salvador-Carulla

doi:10.1371/journal.pone.0284241

Abstract

Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level.

Citation: Furst MA, Salinas-Perez JA, Gutiérrez-Colosía MR, Mendoza J, Bagheri N, Anthes L, et al. (2023) Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT. PLoS ONE 18(4): e0284241. https://doi.org/10.1371/journal.pone.0284241

Editor: Daniel Rock, University of Western Australia, AUSTRALIA

Received: June 2, 2022; Accepted: March 24, 2023; Published: April 12, 2023

Copyright: © 2023 Furst et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data underlying the results presented in the study are available from GLOCAL (Global and Local Observation and mapping of CAre Levels) project (https://www.canberra.edu.au/research/institutes/health-research-institute/glocal).

Funding: LSC Western Sydney Partners in Recovery, 2014 http://www.newhorizons.net.au/temp/pir/ No LSC the University of Sydney, 2015 https://www.sydney.edu.au/ No LSC PIR East and South East Sydney, 2015 https://www.neaminational.org.au/ No LSC PHN Canberra ACT, 2016 https://www.chnact.org.au/ No LSC Western Australia Primary Health Alliance, 2018 https://www.wapha.org.au/ No No author CONICYT (National Commission for Scientific and Technological Research), 2008 https://www.conicyt.cl/ No LSC #A/ 013204/07 and #A/019376/08 Inter-University Cooperation Program projects, AECID, 2007-2008 https://www.aecid.es/ES/sectores-de-cooperaci%C3%B3n No LSC Mental Health Network of Gipuzkoa, Departamento de Salud, 2015 https://www.euskadi.eus/gobierno-vasco/departamento-salud/inicio/ No Not author Project number: 261459 Refinement project, Seventh Framework Programme (7FP), 2011-13 https://ec.europa.eu/info/index_es No The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: NO authors have competing interests.

Introduction

Urbanisation presents specific challenges to planning and provision of mental health services. It is associated with a higher prevalence of psychiatric disorders [1–8], and characterised by a range of psychosocial stressors including high density living in some major urban centres, social fragmentation, and exposure to crime. A study of people with psychotic disorders in four major urban areas in Australia showed high levels of social isolation, unemployment and poverty, with those living in marginal accommodation unable to access community based services [9]. Global strategies for urban mental health care have been called for [10, 11].

Urban centres comprise most of the population in many countries: 86% in Australia, 80.3% in Spain, 85.4% in Finland and 87.6% in Chile [12]. Better assessment of mental health care availability considering the particular challenges of urbanisation is needed.

Comparison across geographic regions can help identify and monitor differences and inequities in service availability. The World Health Organisation (WHO) has underscored the importance of international comparisons of care systems availability through its own repository of resources and tools [13, 14].

However, use of these approaches in planning for complex health systems is subject to two major biases. The “ecological fallacy” assumes that population means and national averages apply to individuals or to local areas [15, 16], while “terminological unclarity” refers to ambiguity and vagueness in the naming and definition of services [17] and interventions [18]. These biases can be managed with detailed local context information, including standardised service descriptions and classifications [19]; and a common reference framework [20, 21].

Mental “Health Ecosystems Research” (HER) is a new, whole systems approach to the study of complex local and regional health systems. Mental health HER provides a framework for the analysis of the diverse components of mental health systems [22], their socio-economic and demographic contexts [23], and enable identification of patterns of care and gaps in service availability [24].

In this study we use anHER approach to identify and compare patterns of mental health provision in urban areas across a range of national contexts, and to determine if these findings could have application for local policy and planning.

Material and methods

We analysed availability, bed capacity and diversity of mental health services in our reference area, the Australian Capital Territory (ACT), and compared this with other selected urban regions in Australia (10^th highest GDP in the OECD), Finland (14^th highest GDP), Spain (24^th) and Chile (33^rd). All regions have been previously analysed using the same method and instrument [23].

Following an HER approach [24], and based on epidemiological study principles, we provide a comparative demonstration study of the “what, where and when” of whole systems of mental health care provision, and not just a sample. We use a validated and standardised service classification instrument to provide meaningful regional and longitudinal comparisons; and enable a comparison of prevalence with provision to enable estimates of unmet need.

Catchment area

The terms “urban” and “rural’ are also subject to a terminological lack of clarity, The regions in this study have all been classified as urban according to OECD typology, which is characterised by population density and size of the region, and proportion of the population living in rural areas which must be less than 15% [25]. We considered the OECD typology as the most relevant for this study as all included regions are in OECD countries.

The population in the four Australian areas is between 400,000 and 1.5 million. Perth North (PN) is on Australia’s west coast, and South East Sydney (SES) and Western Sydney (WS) on its east coast. ACT is home to the national capital, Canberra. ACT, Western Sydney, and Perth North are part of the network of 31 Primary Health Networks (PHNs) in Australia whose role is to commission local health services, help build workforce capacity and integrate health services at the local level. South East Sydney is a Local Health District: these are responsible for managing public hospitals and specialised mental health services. Mental healthcare in all Australian health regions is provided by a combination of state funded public organisations and Non-Government Organisations (NGOs).

The population in the three international regions is between 290,000 and 1.65 million. Talcahuano is one of 28 autonomous Health Districts in Chile. These districts are organised by mental health catchment areas where publicly funded care is coordinated by a single reference community mental health centre [26]. Gipuzkoa is a province in the Basque Autonomous Community in Spain with 13 mental health catchment areas [27]. In Spain, healthcare is also publicly funded, and devolved to its 17 autonomous communities [28]. Access to specialised mental healthcare is through primary care. The Helsinki-Uusimaa region (herein “Helsinki”) in Finland comprises 26 municipalities and includes the capital, Helsinki. Municipalities are responsible for health and social care services, which are tax funded and may join to form hospital districts for more specialised mental healthcare [29].

The three international regions are considered benchmark areas for mental health ecosystem analysis: Gipuzkoa for its system- wide transformation towards integrated chronic care. the use of mapping for mental health planning [30] and the development of advanced decision support tools for planning [31]; Chile as a model of health care in South America, with Talcahuano the area of most community orientated service provision [26, 32]; and Helsinki Uusimaa has been identified as a benchmark area in mental healthcare in Europe by the REFINEMENT project [33–35].

Measure

Data in all regions were collected using the DEscription and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC), an internationally validated instrument for the standard description and coding of services [19]. DESDE addresses the above-mentioned methodological biases [17] by defining the core units of service delivery, and incorporating these into a taxonomy of service types. DESDE’s units of analysis are professional teams with organisational and temporal stability (described as Basic Stable Inputs of Care or BSICs), and the Main Type of Care they provide (MTCs). Using the lowest units of care production as a common unit of analysis enables international and regional comparison of service provision at the local level.

DESDE is a multiaxial system, incorporating local area context data with service characteristics including target population, workforce, and type of care. From the six main branches (Residential, Outpatient, Day Care, Self-help and Voluntary Care, Information and Assessment, and Accessibility to services) 25 clusters of care typologies emerge, grouped according to characteristics such as acuity, mobility, and intensity of service provision.

Inclusion criteria

Services included in the study:

target people with a lived experience of mental illness
are universally accessible: without significant out-of-pocket expenses
are within the boundaries of the study region
provide direct care to consumers.

Data collection and analysis

In all cases, data collection was made in collaboration with regional public agencies. In ACT, our reference area, services were identified in consultation with Capital Health Network, ACT Health and relevant peak bodies; through searches of service directories; and desktop web search. Ethics approval was from ACT Health HREC, ETHLR.16.094. All identified service organisations in ACT were contacted by phone and email to request an interview. Service managers were interviewed either face to face or by telephone, and consented verbally for this information to be included in the research. Service information collected including name, location, area of coverage, target population and main type of care was entered into an Excel file and coded using the DESDE tool.

Socio-economic and socio-demographic data from the Australian regions from Australian Bureau of Statistics (ABS) and Public Health Information Development Unit (PHIDU) were mapped with services distribution at different levels of aggregation. Data from the European regions and Chile were from previous studies using population statistics from their national institutes [26, 29, 36, 37].

Data comparison and analysis

The availability, placement capacity, and diversity of service provision in ACT was analysed according to the Main Types of Care provided by identified Basic Stable Units of Care (professional teams). “Availability” is defined as a service being operable upon demand to perform its designated or required function; “placement capacity” as the maximum number of beds in residential care; and “diversity” as the number of different individual MTC identified. Service availability rate was calculated per 100,000 adults. Data was coded and analysed according to the DESDE coding system, and revised following review by expert local planners. Socio-economic/socio-demographic data were presented using maps and other visual analytics.

Integrated Atlases of Mental Health for the Australian regions which include all the above data are available at The University of Canberra Global and Local Observation and mapping of CAre Levels (GLOCAL) metadata repository https://www.canberra.edu.au/research/institutes/health-research-institute/glocal). The standard description of these areas is part of a larger project comparing patterns of mental healthcare in Australia and Europe. The Mental Health Policy Unit (University of Canberra) together with Psicost Research Association and Andalucia Loyola University (Spain) developed this data repository on local service provision collected using the ESMS (European Service Mapping Schedule -the original instrument for mapping adult MH care on which DESDE is based) and DESDE classification system and methods of data collection [38].

ACT data were compared with information in the repository from Western Sydney [39], South Eastern Sydney [40], and Perth North [41] in Australia; and Helsinki, Finland [29, 37], Gipuzkoa, Spain [36] and Talcahuano, Chile [26, 32]. Information and Assessment services and Self-help and Volunteer services were not included. Accessibility services were not included in the European and Chilean studies as this function is included in the role of other teams in these countries, not designed as separate services.

We analysed the homogeneity of the patterns of care between study areas through chi-squared tests. The population groups were the study areas, and the categories were five large “care groupings” (hospital, non-hospital, day, acute outpatient, and non-acute outpatient care). These aggregate clusters were used to avoid categories with too low a number of cases, which could compromise validity of the analysis. The analyses were carried out for: 1) all the study areas; and 2) ACT paired with another comparator area.

We followed a heuristics approach in the analysis of service availability, capacity and diversity. Mental healthcare systems are complex, operating under conditions of high uncertainty, with multiple sources and types of evidence [42]. Under these conditions, an heuristic approach using “simple and transparent statistical approaches to allow maximum opportunity for debate and consideration” can be more accurate than more complex analytical tools [43].

The applicability of Atlas information to local mental health planning in ACT followed previous analyses of applicability of the Atlas in Spain [27]. Atlas data impact was rated on the Adoption Impact Ladder (AIL) [44], based on available evidence of levels of adoption in every district, not on narratives. The AIL level of awareness considered invited presentations of the results organised by public agencies in ACT and the other regions. Translation level was based on use of the DESDE-LTC data in regional planning documents, and resource allocation considered funding of consecutive atlases by local agencies, as well as the direct participation of officers from public agencies in analysis and use of the results. A full outline of the AIL is available in Annex 1.

Results

Socio-demographic indicators

Despite its relative socio-economic advantage, psychological distress and suicide rates in ACT were the second highest nationally. Western Sydney is more socio-economically disadvantaged, with higher levels of psychological distress, but the lowest suicide rate. Unemployment and suicide rates were higher in the international than in Australian regions (Table 1).

Download:

Table 1. Socio-demographic indicators of the study regions.

https://doi.org/10.1371/journal.pone.0284241.t001

Service availability

Overview.

ACT provided more community residential care and less hospital care than the other Australian areas, and overall was second to Finland in availability of the former. Day care was significantly more available in the international regions, particularly Spain, than in all Australian regions. Outpatient care of all types was less available in the international regions than Australia. Services coordinating or providing access to care were more available in ACT than in the other Australian regions (Fig 1).

Download:

Fig 1. Main types of care per 100,000 adults: Australian and international comparison.

Coloured sections of each radar graph represent the main branches of care, with each axis representing a main type of care within each of these branches. Coloured lines representing each region join the points on each axis showing the rates per 100,000 adults of that type of care for that region.

https://doi.org/10.1371/journal.pone.0284241.g001

Statistical comparison of the homogeneity of the patterns of care showed significant differences between the seven study areas (χ2 = 260.733; p-value = 0.000). In the analyses in pairs, ACT pattern of care was statistically different to South East Sydney (χ2 = 25.883; p-value = 0.000), Perth North (χ2 = 10.665; p-value = 0.031), and Helsinki (χ2 = 53.321; p-value = 0.000), while it was similar to Western Sydney (χ2 = 6.802; p-value = 0.147). Gipuzkoa (χ2 = 50.286; p-value = 0.000) and Talcahuano (χ2 = 23.466; p-value = 0.000) were also significantly different to ACT, but the analyses were not reliable given the low number of observations in some care groupings.

Residential care.

Fig 2 compares availability and bed capacity of residential care per 100,000 adult residents in ACT, Perth North, Western Sydney, South East Sydney, Talcahuano, Gipuzkoa and Helsinki.

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Fig 2. Availability of residential care per 100,000 adults: Australian and international comparison.

The axes of these graphs represent each of the study regions. Coloured lines representing the different types of residential care join the points on each axis indicating the rate of that type of care per 100,000 adults for that region.

https://doi.org/10.1371/journal.pone.0284241.g002

Australian comparison. Hospital care in Australia was significantly more acute based than non-acute. Perth North had the highest rate of care provided by acute hospital services, which includes those provided by Graylands Hospital, the only stand alone psychiatric hospital in WA, and was the only district to provide alternatives to hospitalisation. ACT had the second lowest rate of acute hospital care and the highest rate of community residential care, despite having less bed capacity than Perth North, where hostel type accommodation provides much residential care in the community.

International comparison. Helsinki had the highest rate of residential care in the study, and was the only international region to provide alternatives to hospitalisation. Unlike the Australian regions, Spain and Finland provided more non-acute than acute care. Talcahuano provided acute hospital care only.

Day care.

Fig 3 compares availability and placement capacity of day care per 100,000 adult residents between ACT, Perth North, Western Sydney, South East Sydney, Talcahuano, Gipuzkoa and Helsinki.

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Fig 3. Availability of day care per 100,000 adults: Australian and international comparison.

The axes of these graphs represent each of the study regions. Coloured lines representing the different types of day care join the points on each axis indicating the rate of that type of care per 100,000 adults for that region.

https://doi.org/10.1371/journal.pone.0284241.g003

Australian comparison. Acute health-related day care was not available in any Australian health district, and non-acute health-related day care was only available in ACT. Work related day care was not available in either ACT or Perth North.

International comparison. Health and work-related day care were more available in all three international regions, especially Spain, than in all Australian regions.

Outpatient care.

Fig 4 compares availability of outpatient care per 100,000 adult residents between ACT, Perth North, Western Sydney, South East Sydney, Talcahuano, Gipuzkoa and Helsinki.

Download:

Fig 4. Availability of outpatient care per 100,000 adults: Australian and international comparison.

The axes of these graphs represent each of the study regions. Coloured lines representing the different types of outpatient care join the points on each axis indicating the rate of that type of care per 100,000 adults for that region.

https://doi.org/10.1371/journal.pone.0284241.g004

Australian comparison. Outpatient care was more health than social related in all Australian regions except Perth North, and was predominantly non-acute. Rates of centre based non-acute services such as psychological counselling were higher in ACT.

International comparison. All Australian regions provided more health-related outpatient care than all international regions. Outpatient mental health care in the Spanish and Chilean regions was centre based (non-mobile) only. These regions did not provide any outpatient care outside the health sector. Helsinki provided some outpatient care outside the health sector but at a much lower rate than in the Australian regions.

Accessibility.

Accessibility care, or services providing access to other types of care rather than providing direct care themselves was not assessed in the international studies.

However, in Australia, case coordination was significantly more available in ACT than in the other areas (Fig 1), although it provided less of other types of accessibility care (e.g. to employment, housing).

Service diversity-national (Australia)

Differences between regions in number of services available was not necessarily reflected in differences in care diversity (Table 2): while Perth North, with the highest number of services also provided the greatest diversity of care types, ACT provided relatively high diversity for the number of services available.

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Table 2. Diversity of main types of care: Comparison between Australian regions (number).

https://doi.org/10.1371/journal.pone.0284241.t002

Applicability of the DESDE-LTC results to mental health planning

Adoption of the study results in ACT reached level 5 in the AIL (the translation of new knowledge has had an impact on budget, funding, or resource allocation in the target environment). Although this indicates a high impact, the system has not been adopted as a routine tool for planning. Adoption level was 5 in North Perth and Western Sydney, and 3 in Central Eastern Sydney; 6 in Gipuzkoa (Spain), 5 in Helsinki (Finland) and 3 in Talcahuano (Chile).

Discussion

To the best of our knowledge this is the first international comparison of patterns of urban mental health service provision using a bottom-up approach, and standardised methods and tools. It follows the analysis of rural care patterns in Australia as part of the GLOCAL (Global-Local) Atlas project [38, 45], which identified significant interstate variation [46]. Previous bottom-up studies have been limited to Europe [30, 34]. Other previous studies, such as the WHO Mental Health Atlas series (https://www.who.int/publications/i/item/9789240036703), use top down national or regional data as well as official service directories, and were subject to ecological fallacy and terminological bias. The ecological fallacy derives from assuming that mean values and national averages apply directly to individuals or local services [15]. The healthcare ecological approach provides bottom-up contextual information critical to guide resource allocation and policy-to-action planning. The importance of the ecological approach to this aim has been revised in a series of previous papers [15, 24, 47, 48]. On the other hand, the problem of terminological variability is due to the unclarity of the official names of services or non-ontology based national classifications and directories. This problem has been identified as a major source of systematic bias in international health service research [49]. As an example, the “National Mental Health Service Planning Framework” adopted by the Department of Health in Australia has shown terminological problems when compared to DESDE in the description of “psychosocial/rehabilitation” services [50] and in its practical use to map the availability of local care provided by the NGO sector [51].

Therefore the first aim of the study was to identify and compare patterns of mental health provision across urban areas using standard and non-ambiguous tools such as the regional Atlases of Care, and the DESDE service coding. We identified a common lack of alternatives to hospitalisation, suggesting that in many systems, acute hospital care may be filling gaps that could be more efficiently filled by less resource intensive services. Higher service numbers in some Australian centres without corresponding increases in diversity suggest a focus on a core range of higher demand services. An increase in core, high demand, services but not in the diversity of types of service available could indicate relatively lower availability of specialised services for people from groups with specific, but lower demand needs, such as those from Culturally and Linguistically Diverse or LGBTIQ+ populations.

Australian regions relied more on the typically more intensive one-to-one pattern of outpatient care, and less on day services, than the international regions. Day services include any service that a person is able to attend for part of or all the day: this can include specialist mental health or psychosocial services providing employment, education, life skills development or social opportunities that can reduce the need for more acute support [52, 53].

Our second aim was to investigate whether these findings have application for local policy and planning. The heterogeneity in local care ecosystems, even within the same country, that we identified should be taken into account in planning or monitoring policy changes and reform at the macro level [54]. The stepped care policy in Australia [55] assumed a comprehensive availability and diversity of service types that we have shown to be locally relatively unavailable, even in the larger urban centres.

On the other hand, urban patterns of care that are common at regional level, even internationally, such as limited alternatives to hospital admission, show that international comparisons at the regional level may provide useful knowledge to local policy and planners. Unexpected issues of equality of access may be identified: for example, people in Talcahuano, the poorest region in the study, had better access to day services than did the relatively wealthier Australian population.

The analysis of differences in the pattern of care between rural and urban areas in Australia is also necessary. Differences between these clusters included higher rates of supported accommodation and day centres in rural areas, but lower availability of acute residential care, showing a need for planning in rural and urban areas to be informed by different models of care delivery [46].

Additionally, the visual tools and analytics, including coding systems, used in Atlases of Care are useful in translating complex data for planners, aiding rapid identification of patterns of care provision and gaps in availability [56].

Limitations

Although results are limited to seven urban areas, the same taxonomy and method was used in all studies, with extensive evaluation, including with managers or contact points in every organisation identified in the local area. Moreover, definitions of “urban” vary: we used OECD’s population density cut-off point [57]. The selection of areas for the comparison is purposive. In any case the comparator mental health care systems in Chile, Spain and Finland have been extensively analysed using the same tools and procedures [26, 30, 37].

Data collection was conducted at different times over four years (2012–2016). However, this time frame is short enough to limit the impact of new local services in the comparison [58]. Only adult services providing free or low out-of-pocket expenses were included. The inclusion of private providers in the mapping of publicly available services may increase noise, hamper the interpretation of the results and misrepresents the universality of access to services. Private services should be included as an additional map in future analysis. Primary care services such as general practitioners were also not included: primary care represents a separate tier of service provision to the more specialised services included here and should also be included separately. Accuracy of the data is dependent on the accuracy of the information provided by the services.

Heuristics and expert pattern recognition based on detailed systematic description of the whole system of care may be of greater use than significance of differences and power calculations across local areas. Saunders [16] discussed the limitations of samples below 100 in healthcare systems research; a problem also described in previous studies [59]. Analytically, there are three broad strategies that can be taken when approaching the analysis of data with low sample sizes: a) maximise power using techniques specifically equipped for low samples; b) maximise the utility of available data and inference through permutation, resampling, or bootstrap methods; or c) use fuzzy logics for sensitivity analysis or undertake advanced modelling combining the other approaches.

In any case, the incorporation of expert knowledge is required to improve, interpret and refine the results and provide better estimates [60]. We use a systems approach to heuristics in our analysis to identify gaps, and elicit meaningful expert knowledge for modelling and informed decision making, as shown in previous studies. The usability of this approach to heuristics under conditions of high complexity and uncertainty has been reported previously by mental health planners in Spain and Australia [38, 39].

Implications

This study has shown the importance of national and international standardised comparisons, and of understanding system complexity and patterns of care, in urban mental health planning. This understanding is required by groups such as iCircle [10] which are engaged with ways of promoting the mental health of people in cities. Planners in local health jurisdictions, such as the PHNs in Australia, need to have an understanding of the gaps or duplications in service provision in their area in the context of local need if they are to plan efficient service delivery.

The significance of this type of data is evidenced by its citation in local strategic documents [61]; and by the co-operation in our ACT study of local health organisations responsible for planning and/or commissioning services, including ACT Health, the Capital Health Network, and the Office of Mental Health and Wellbeing. A representative of the Capital Health Network co-authored this study (LA). The Atlas project is the first work that provides this type of co-operation between policy makers, planners and researchers. The adoption of the results of the study was high in three Australian areas (ACT, Western Sydney, and North Perth) that have made consecutive analyses of the regional service provision using the DESDE tool. It was also high in the international comparators (Talcahuano, Gipuzkoa and Helsinki-Uusimaa).

Conclusion

The identification of common gaps and important differences in patterns of care between ACT and other jurisdictions highlights the relevance of an ecosystems approach to context analysis and service planning in mental healthcare at the local level, and the relevance of using a standardised instrument to provide valid comparisons.

Variations in service availability have implications for geographic and socio-economic equality of access to care, and for the implementation of national level interventions at the local level. Commonalities between urban regions and differences between rural and urban areas indicate the need for models of care sensitive to mental healthcare ecosystem indicators.

Future steps

This information should be complemented with data on service utilisation, financing, and quality indicators to support organisational learning. The incorporation of new knowledge into complex systems such as mental healthcare is important in both managing and making change, and is particularly relevant within the context of significant changes originating outside the system, such as those in Australia resulting from the Fifth National Mental Health and Suicide Prevention Plan, the change to PHNs and the introduction of the National Disability Insurance Scheme (NDIS).

Acknowledgments

This study used data from the research projects developed by the Glocal Integrated Mental Health Atlas project composed of researchers from the University of Canberra, ConNectica Consulting Pty Ltd., University of Sydney, PSICOST Research Association, and Universidad Loyola Andalucía. Authors wish to thank Western Australia Primary Health Alliance (WAPHA). Especially to Learne Durrington, Daniel Rock, Linda Richardson, and Frances Casella (WAPHA), Elaine Paterson and David Axworthy (Mental Health Commission of WA), David Naughton (Country Health WA), and the project reference group; Álvaro Iruin and Andrea Gabilondo (Mental Health Network of Gipuzkoa); and Sandra Saldivia and Pamela Grandon (Universidad de Concepción), and Alberto Minoletti (Universidad de Chile) (Chile), Kristian Wahlbeck, Niklas Grönlund, Irja Hemmilä, Grigori Joffe, Jutta Järvelin, Raija Kontio, Maili Malin, Petri Näätänen, Sami Pirkola, Minna Sadeniemi, Eila Sailas, Marjut Vastamäki (Finland).

References

1. Sundquist K, Frank G, Sundquist J. Urbanisation and incidence of psychosis and depression: Follow-up study of 4.4 million women and men in Sweden. Br J Psychiatry. 2004;184:293–8. pmid:15056572
- View Article
- PubMed/NCBI
- Google Scholar
2. Helbich M, de Beurs D, Kwan MP, O’Connor RC, Groenewegen PP. Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study. Lancet Planet Health. 2018;2:e134–9. pmid:29546252
- View Article
- PubMed/NCBI
- Google Scholar
3. Kirkbride JB, Keyes KM, Susser E. City Living and Psychotic Disorders—Implications of Global Heterogeneity for Theory Development. JAMA Psychiatry. 2018;75:1211–2. pmid:30304485
- View Article
- PubMed/NCBI
- Google Scholar
4. Krabbendam L, Van Os J. Schizophrenia and Urbanicity: A Major Environmental Influence—Conditional on Genetic Risk. Schizophr Bull. 2005;31:795–9. pmid:16150958
- View Article
- PubMed/NCBI
- Google Scholar
5. Lederbogen F, Kirsch P, Haddad L, Streit F, Tost H, Schuch P, et al. City living and urban upbringing affect neural social stress processing in humans. Nat 2011 4747352. 2011;474:498–501. pmid:21697947
- View Article
- PubMed/NCBI
- Google Scholar
6. Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand. 2010;121:84–93. pmid:19624573
- View Article
- PubMed/NCBI
- Google Scholar
7. Tomita A, Vandormael AM, Cuadros D, Di Minin E, Heikinheimo V, Tanser F, et al. Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting. Lancet Planet Health. 2017;1:e152–62. pmid:28890948
- View Article
- PubMed/NCBI
- Google Scholar
8. Van den Berg M, Van Poppel M, Van Kamp I, Andrusaityte S, Balseviciene B, Cirach M, et al. Visiting green space is associated with mental health and vitality: A cross-sectional study in four european cities. Health Place. 2016;38:8–15. pmid:26796323
- View Article
- PubMed/NCBI
- Google Scholar
9. Jablensky A, McGrath J, Herrman H, Castle D, Gureje O, Evans M, et al. Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Aust N Z J Psychiatry. 2000;34:221–36. pmid:10789527
- View Article
- PubMed/NCBI
- Google Scholar
10. International CIty and urban Regional CoLlavorativE. I-CIRCLE. https://www.iimhl.com/icircle-homepage. Accessed 25 May 2022.
11. Underhill C. Sliding towards mental health momentum at the World Economic Forum—Centre for Urban Design and Mental Health. J Urban Des Ment Health. 2018;4:5.
- View Article
- Google Scholar
12. World Urbanization Prospects 2018. Population Division, Department of Economic and Social Affairs, United Nations. 2018. https://population.un.org/wup/. Accessed 25 May 2022.
13. Lora A, Sharan P. Information for global mental health. Glob Ment Health. 2015;2:1–13. pmid:28596865
- View Article
- PubMed/NCBI
- Google Scholar
14. O’Neill K, Takane M, Shefel A, Abou-Zahr C, Boerma T. Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment. Bull World Health Organ. 2013;91:923–31. pmid:24347731
- View Article
- PubMed/NCBI
- Google Scholar
15. Rosen A, Rock D, Salvador-Carulla L. The interpretation of beds: More bedtime stories, or maybe they’re dreaming? Aust N Z J Psychiatry. 2020;54:1–3, 1154–6. pmid:33131281
- View Article
- PubMed/NCBI
- Google Scholar
16. Saunders CL, Elliott MN, Lyratzopoulos G, Abel GA. Beyond the ecological fallacy: potential problems when studying healthcare organisations. J R Soc Med. 2016;109:92–7. pmid:26450917
- View Article
- PubMed/NCBI
- Google Scholar
17. Salvador-Carulla L, Amaddeo F, Gutiérrez-Colosía MR, Salazzari D, Gonzalez-Caballero JL, Montagni I, et al. Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care. Int J Integr Care. 2015;15:e042. pmid:27118959
- View Article
- PubMed/NCBI
- Google Scholar
18. Castelpietra G, Salvador-Carulla L, Almborg AH, Fernandez A, Madden R. Working draft: Classifications of interventions in mental health care. An expert review. Eur J Psychiatry. 2017;31:127–44.
- View Article
- Google Scholar
19. Salvador-Carulla L, Alvarez-Galvez J, Romero C, Gutierrez-Colosia MR, Weber G, McDaid D, et al. 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. 2013;13:218. pmid:23768163
- View Article
- PubMed/NCBI
- Google Scholar
20. Montagni I, Salvador-Carulla L, Mcdaid D, Straßmayr C, Endel F, Näätänen P, et al. The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment. Adm Policy Ment Health Ment Health Serv Res. 2018;45:342–51. pmid:28918502
- View Article
- PubMed/NCBI
- Google Scholar
21. Leginski WA, Croze C. Data standards for mental health decision support systems. Rockville: National Institute of Mental Health; 1989.
- View Article
- Google Scholar
22. Furst MA, Gandré C, Romero López-Alberca C, Salvador-Carulla L. Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery. BMC Health Serv Res. 2019;19:173. pmid:30885186
- View Article
- PubMed/NCBI
- Google Scholar
23. Romero-López-Alberca C, Gutiérrez-Colosía MR, Salinas-Pérez JA, Almeda N, Furst MA, Johnson S, et al. 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). Eur Psychiatry. 2019;61:97–110. pmid:31426008
- View Article
- PubMed/NCBI
- Google Scholar
24. Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int. 2021;18:23–5. pmid:34287396
- View Article
- PubMed/NCBI
- Google Scholar
25. OECD Regional Typology. Directorate for Public Governance and Territorial Development; 2011.
- View Article
- Google Scholar
26. Salinas-Perez JA, Salvador-Carulla L, Saldivia S, Grandon P, Minoletti A, Romero Lopez-Alberca C. Integrated mapping of local mental health systems in Central Chile. Pan Am J Public Health. 2018;42:e144. pmid:31093172
- View Article
- PubMed/NCBI
- Google Scholar
27. Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, et al. [Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. Gac Sanit. 2020;34:11–9.
- View Article
- Google Scholar
28. Salvador-Carulla L, Costa-Font J, Cabases J, McDaid D, Alonso J. Evaluating mental health care and policy in Spain. J Ment Health Policy Econ. 2010;13:73–86. pmid:20919594
- View Article
- PubMed/NCBI
- Google Scholar
29. Gutierrez-Colosia MR, Salvador-Carulla L, Salinas-Perez JA, Garcia-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2019;28:210–23. pmid:28918762
- View Article
- PubMed/NCBI
- Google Scholar
30. Iruin-Sanz A, Pereira-Rodríguez C, Nuño-Solinís R. The role of geographic context on mental health: lessons from the implementation of mental health atlases in the Basque Country (Spain). Epidemiol Psychiatr Sci. 2015;24:42–4. pmid:25308285
- View Article
- PubMed/NCBI
- Google Scholar
31. Chung Y, Salvador-Carulla L, Salinas-Pérez JA, Uriarte-Uriarte JJ, Iruin-Sanz A, García-Alonso CR. Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning. Health Res Policy Syst. 2018;16:35. pmid:29695248
- View Article
- PubMed/NCBI
- Google Scholar
32. Salvador-Carulla L, Saldivia S, Martinez-Leal R, Vicente B, Garcia-Alonso C, Grandon P, et al. Meso-level comparison of mental health service availability and use in Chile and Spain. Psychiatr Serv Wash DC. 2008;59:421–8. pmid:18378842
- View Article
- PubMed/NCBI
- Google Scholar
33. Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, et al. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci. 2018;29:e6. pmid:30328401
- View Article
- PubMed/NCBI
- Google Scholar
34. Gutiérrez-Colosía MR, Salvador-Carulla L, Salinas-Pérez JA, García-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2017;:1–14. pmid:28918762
- View Article
- PubMed/NCBI
- Google Scholar
35. Junttila K, Meriläinen M, Tervo-Heikkinen T, et al. National benchmarking of nursing- sensitive outcomes: initial steps in Finland. 2018.
- View Article
- Google Scholar
36. Iruin A, Ruiz M, Salinas JA. [Mental Health Atlas of Gipuzkoa]. San Sebastian: Unidad de Comunicación Hospital Universitario Donostia; 2013.
37. Sadeniemi M, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, García-Alonso C, Ala-Nikkola T, et al. A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. Int J Environ Res Public Health. 2018;15:1133. pmid:29857556
- View Article
- PubMed/NCBI
- Google Scholar
38. Research School of Population Health. GLOCAL (Global and Local Observation and mapping of CAre Levels) | Research School of Population Health. 2021. https://rsph.anu.edu.au/research/projects/glocal-global-and-local-observation-and-mapping-care-levels. Accessed 18 Oct 2021.
- View Article
- Google Scholar
39. Salvador-Carulla L, Fernandez A, Feng X, Astell-Burt T, Maas C, Smith-Merry J, et al. The Integrated Mental Health Atlas of Western Sydney. Sydney: Mental Health Policy Unit, Brain and Main Research Institute, Faculty of Health Sciences, University of Sydney. Western Sydney Partners in Recovery; 2016.
40. Furst MC, Salinas-Perez JA, Hopman K, Maas C, Fernandez A, Xu T, et al. The Integrated Mental Health Atlas of the Central and Eastern Sydney PHN Region. Annex 2: The Integrated Mental Health Atlas of the South Eastern Sydney Local Health District. Sydney: Mental Health Policy Unit. Brain and Mind Centre. Faculty of Health Sciences. University of Sydney; 2016.
- View Article
- Google Scholar
41. Furst MA, Reynolds J, Salinas J, Tsou C, Rock D, Hopkins J, et al. The Integrated Atlas of Mental Health of the Perth North Primary Health Network Region. Perth: Australian National University and Western Australia Primary Health Alliance (WAPHA); 2018.
- View Article
- Google Scholar
42. Wolpert M, Rutter H. Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: Learning from the case of child mental health. BMC Med. 2018;16:1–11. pmid:29895295
- View Article
- PubMed/NCBI
- Google Scholar
43. Marewski JN, Gigerenzer G. Heuristic decision making in medicine. Dialogues in Clinical Neuroscience. 2012;14:77–89. pmid:22577307
- View Article
- PubMed/NCBI
- Google Scholar
44. Alonso-Trujillo F, Salinas-Pérez JA, Gutiérrez-Colosía MR, González-Caballero JL, Pinzón Pulido S, Jiménez González S, et al. Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain). Gac Sanit. 2020;34:615–23.
- View Article
- Google Scholar
45. Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, et al. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland). Can J Psychiatry. 2020;65:721–30.
- View Article
- Google Scholar
46. Spijker BA van Salinas-Perez JA, Mendoza J, Bell T, Bagheri N, Furst MA, et al. Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas. Aust N Z J Psychiatry. 2019;53:1–13.
- View Article
- Google Scholar
47. Rosen A, Gill NS, Salvador-Carulla L. The future of community psychiatry and community mental health services. Curr Opin Psychiatry. 2020;33:375–390. pmid:32452944
- View Article
- PubMed/NCBI
- Google Scholar
48. Rosen A, Salvador-Carulla L. No service is an island: towards an ecosystem approach to mental health service evaluation. World Psychiatry. 2022;21:237–8. pmid:35524610
- View Article
- PubMed/NCBI
- Google Scholar
49. Gutierrez-Colosia M, et al. Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health. Epidemiol Psychiatr Sci. 2022;In press. pmid:35993182
- View Article
- PubMed/NCBI
- Google Scholar
50. Salvador Carulla L. Semantic mapping between the Australian NMHSPF and the DESDE-LTC. Applications in Western Australia. 2018.
- View Article
- Google Scholar
51. Wright E, Leitch E, Fjeldsoe K, Diminic S, Gossip K, Hudson P, et al. Using the National Mental Health Service Planning Framework to support an integrated approach to regional mental health planning in Queensland, Australia. Aust J Prim Health. 2021. pmid:33653507
- View Article
- PubMed/NCBI
- Google Scholar
52. Sanches SA, Swildens WE, van Busschbach JT, van Weeghel J. Identifying social participation subgroups of individuals with severe mental illnesses: a latent class analysis. Soc Psychiatry Psychiatr Epidemiol. 2019;54:1067–77. pmid:31127349
- View Article
- PubMed/NCBI
- Google Scholar
53. Smith-Merry J, Mellifont D, Gillespie J, Salvador-Carulla L. Recovery-oriented community mental health models. Sax Institute; 2017.
- View Article
- Google Scholar
54. Lavis JN, Permanand G, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP). 13. Preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst. 2009;7.
- View Article
- Google Scholar
55. Department of Health. The Fifth National Mental Health and Suicide Prevention Plan. Commonwealth of Australia; 2017.
- View Article
- Google Scholar
56. Walsh EI, Chung Y, Cherbuin N, Salvador-Carulla L. Experts’ perceptions on the use of visual analytics for complex mental healthcare planning: an exploratory study. BMC Med Res Methodol. 2020;20:1–9. pmid:32380946
- View Article
- PubMed/NCBI
- Google Scholar
57. Ruiz V, Dijkstra L. Refinement of the OECD regional typology: Economic Performance of Remote Rural Regions. In: ERSA conference papers from European Regional Science Association. European Regional Science Association; 2011.
58. Anna Fernandez, Salinas-Perez JA Gutierrez-Colosia MR, Prat-Pubill B, Serrano-Blanco A, Molina C, et al. Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain). Epidemiol Psychiatr Sci. 2015;24:512–24. pmid:25226091
- View Article
- PubMed/NCBI
- Google Scholar
59. Tabatabaei-Jafari H, Salinas-Perez JA, Anne Furst M, Bagheri N, Mendoza J, Burke D, et al. Patterns of Service Provision in Older People’s Mental Health Care in Australia. Int J Environ Res Public Health. 2020;17:8516. pmid:33212966
- View Article
- PubMed/NCBI
- Google Scholar
60. Gibert K, García-Alonso C, Salvador-Carulla L. Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support. Health Res Policy Syst. 2010;8:28. pmid:20920289
- View Article
- PubMed/NCBI
- Google Scholar
61. Capital Health Network. Australian Capital Territory Mental Health and Suicide Prevention Plan 2019–2024. 2019.
- View Article
- Google Scholar

[ref1] 1. Sundquist K, Frank G, Sundquist J. Urbanisation and incidence of psychosis and depression: Follow-up study of 4.4 million women and men in Sweden. Br J Psychiatry. 2004;184:293–8. pmid:15056572
View Article
PubMed/NCBI
Google Scholar

[2] View Article

[3] PubMed/NCBI

[4] Google Scholar

[ref2] 2. Helbich M, de Beurs D, Kwan MP, O’Connor RC, Groenewegen PP. Natural environments and suicide mortality in the Netherlands: a cross-sectional, ecological study. Lancet Planet Health. 2018;2:e134–9. pmid:29546252
View Article
PubMed/NCBI
Google Scholar

[6] View Article

[7] PubMed/NCBI

[8] Google Scholar

[ref3] 3. Kirkbride JB, Keyes KM, Susser E. City Living and Psychotic Disorders—Implications of Global Heterogeneity for Theory Development. JAMA Psychiatry. 2018;75:1211–2. pmid:30304485
View Article
PubMed/NCBI
Google Scholar

[10] View Article

[11] PubMed/NCBI

[12] Google Scholar

[ref4] 4. Krabbendam L, Van Os J. Schizophrenia and Urbanicity: A Major Environmental Influence—Conditional on Genetic Risk. Schizophr Bull. 2005;31:795–9. pmid:16150958
View Article
PubMed/NCBI
Google Scholar

[14] View Article

[15] PubMed/NCBI

[16] Google Scholar

[ref5] 5. Lederbogen F, Kirsch P, Haddad L, Streit F, Tost H, Schuch P, et al. City living and urban upbringing affect neural social stress processing in humans. Nat 2011 4747352. 2011;474:498–501. pmid:21697947
View Article
PubMed/NCBI
Google Scholar

[18] View Article

[19] PubMed/NCBI

[20] Google Scholar

[ref6] 6. Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand. 2010;121:84–93. pmid:19624573
View Article
PubMed/NCBI
Google Scholar

[22] View Article

[23] PubMed/NCBI

[24] Google Scholar

[ref7] 7. Tomita A, Vandormael AM, Cuadros D, Di Minin E, Heikinheimo V, Tanser F, et al. Green environment and incident depression in South Africa: a geospatial analysis and mental health implications in a resource-limited setting. Lancet Planet Health. 2017;1:e152–62. pmid:28890948
View Article
PubMed/NCBI
Google Scholar

[26] View Article

[27] PubMed/NCBI

[28] Google Scholar

[ref8] 8. Van den Berg M, Van Poppel M, Van Kamp I, Andrusaityte S, Balseviciene B, Cirach M, et al. Visiting green space is associated with mental health and vitality: A cross-sectional study in four european cities. Health Place. 2016;38:8–15. pmid:26796323
View Article
PubMed/NCBI
Google Scholar

[30] View Article

[31] PubMed/NCBI

[32] Google Scholar

[ref9] 9. Jablensky A, McGrath J, Herrman H, Castle D, Gureje O, Evans M, et al. Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Aust N Z J Psychiatry. 2000;34:221–36. pmid:10789527
View Article
PubMed/NCBI
Google Scholar

[34] View Article

[35] PubMed/NCBI

[36] Google Scholar

[ref10] 10. International CIty and urban Regional CoLlavorativE. I-CIRCLE. https://www.iimhl.com/icircle-homepage. Accessed 25 May 2022.

[ref11] 11. Underhill C. Sliding towards mental health momentum at the World Economic Forum—Centre for Urban Design and Mental Health. J Urban Des Ment Health. 2018;4:5.
View Article
Google Scholar

[39] View Article

[40] Google Scholar

[ref12] 12. World Urbanization Prospects 2018. Population Division, Department of Economic and Social Affairs, United Nations. 2018. https://population.un.org/wup/. Accessed 25 May 2022.

[ref13] 13. Lora A, Sharan P. Information for global mental health. Glob Ment Health. 2015;2:1–13. pmid:28596865
View Article
PubMed/NCBI
Google Scholar

[43] View Article

[44] PubMed/NCBI

[45] Google Scholar

[ref14] 14. O’Neill K, Takane M, Shefel A, Abou-Zahr C, Boerma T. Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment. Bull World Health Organ. 2013;91:923–31. pmid:24347731
View Article
PubMed/NCBI
Google Scholar

[47] View Article

[48] PubMed/NCBI

[49] Google Scholar

[ref15] 15. Rosen A, Rock D, Salvador-Carulla L. The interpretation of beds: More bedtime stories, or maybe they’re dreaming? Aust N Z J Psychiatry. 2020;54:1–3, 1154–6. pmid:33131281
View Article
PubMed/NCBI
Google Scholar

[51] View Article

[52] PubMed/NCBI

[53] Google Scholar

[ref16] 16. Saunders CL, Elliott MN, Lyratzopoulos G, Abel GA. Beyond the ecological fallacy: potential problems when studying healthcare organisations. J R Soc Med. 2016;109:92–7. pmid:26450917
View Article
PubMed/NCBI
Google Scholar

[55] View Article

[56] PubMed/NCBI

[57] Google Scholar

[ref17] 17. Salvador-Carulla L, Amaddeo F, Gutiérrez-Colosía MR, Salazzari D, Gonzalez-Caballero JL, Montagni I, et al. Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care. Int J Integr Care. 2015;15:e042. pmid:27118959
View Article
PubMed/NCBI
Google Scholar

[59] View Article

[60] PubMed/NCBI

[61] Google Scholar

[ref18] 18. Castelpietra G, Salvador-Carulla L, Almborg AH, Fernandez A, Madden R. Working draft: Classifications of interventions in mental health care. An expert review. Eur J Psychiatry. 2017;31:127–44.
View Article
Google Scholar

[63] View Article

[64] Google Scholar

[ref19] 19. Salvador-Carulla L, Alvarez-Galvez J, Romero C, Gutierrez-Colosia MR, Weber G, McDaid D, et al. 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. 2013;13:218. pmid:23768163
View Article
PubMed/NCBI
Google Scholar

[66] View Article

[67] PubMed/NCBI

[68] Google Scholar

[ref20] 20. Montagni I, Salvador-Carulla L, Mcdaid D, Straßmayr C, Endel F, Näätänen P, et al. The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment. Adm Policy Ment Health Ment Health Serv Res. 2018;45:342–51. pmid:28918502
View Article
PubMed/NCBI
Google Scholar

[70] View Article

[71] PubMed/NCBI

[72] Google Scholar

[ref21] 21. Leginski WA, Croze C. Data standards for mental health decision support systems. Rockville: National Institute of Mental Health; 1989.
View Article
Google Scholar

[74] View Article

[75] Google Scholar

[ref22] 22. Furst MA, Gandré C, Romero López-Alberca C, Salvador-Carulla L. Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery. BMC Health Serv Res. 2019;19:173. pmid:30885186
View Article
PubMed/NCBI
Google Scholar

[77] View Article

[78] PubMed/NCBI

[79] Google Scholar

[ref23] 23. Romero-López-Alberca C, Gutiérrez-Colosía MR, Salinas-Pérez JA, Almeda N, Furst MA, Johnson S, et al. 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). Eur Psychiatry. 2019;61:97–110. pmid:31426008
View Article
PubMed/NCBI
Google Scholar

[81] View Article

[82] PubMed/NCBI

[83] Google Scholar

[ref24] 24. Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int. 2021;18:23–5. pmid:34287396
View Article
PubMed/NCBI
Google Scholar

[85] View Article

[86] PubMed/NCBI

[87] Google Scholar

[ref25] 25. OECD Regional Typology. Directorate for Public Governance and Territorial Development; 2011.
View Article
Google Scholar

[89] View Article

[90] Google Scholar

[ref26] 26. Salinas-Perez JA, Salvador-Carulla L, Saldivia S, Grandon P, Minoletti A, Romero Lopez-Alberca C. Integrated mapping of local mental health systems in Central Chile. Pan Am J Public Health. 2018;42:e144. pmid:31093172
View Article
PubMed/NCBI
Google Scholar

[92] View Article

[93] PubMed/NCBI

[94] Google Scholar

[ref27] 27. Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, et al. [Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. Gac Sanit. 2020;34:11–9.
View Article
Google Scholar

[96] View Article

[97] Google Scholar

[ref28] 28. Salvador-Carulla L, Costa-Font J, Cabases J, McDaid D, Alonso J. Evaluating mental health care and policy in Spain. J Ment Health Policy Econ. 2010;13:73–86. pmid:20919594
View Article
PubMed/NCBI
Google Scholar

[99] View Article

[100] PubMed/NCBI

[101] Google Scholar

[ref29] 29. Gutierrez-Colosia MR, Salvador-Carulla L, Salinas-Perez JA, Garcia-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2019;28:210–23. pmid:28918762
View Article
PubMed/NCBI
Google Scholar

[103] View Article

[104] PubMed/NCBI

[105] Google Scholar

[ref30] 30. Iruin-Sanz A, Pereira-Rodríguez C, Nuño-Solinís R. The role of geographic context on mental health: lessons from the implementation of mental health atlases in the Basque Country (Spain). Epidemiol Psychiatr Sci. 2015;24:42–4. pmid:25308285
View Article
PubMed/NCBI
Google Scholar

[107] View Article

[108] PubMed/NCBI

[109] Google Scholar

[ref31] 31. Chung Y, Salvador-Carulla L, Salinas-Pérez JA, Uriarte-Uriarte JJ, Iruin-Sanz A, García-Alonso CR. Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning. Health Res Policy Syst. 2018;16:35. pmid:29695248
View Article
PubMed/NCBI
Google Scholar

[111] View Article

[112] PubMed/NCBI

[113] Google Scholar

[ref32] 32. Salvador-Carulla L, Saldivia S, Martinez-Leal R, Vicente B, Garcia-Alonso C, Grandon P, et al. Meso-level comparison of mental health service availability and use in Chile and Spain. Psychiatr Serv Wash DC. 2008;59:421–8. pmid:18378842
View Article
PubMed/NCBI
Google Scholar

[115] View Article

[116] PubMed/NCBI

[117] Google Scholar

[ref33] 33. Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, et al. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci. 2018;29:e6. pmid:30328401
View Article
PubMed/NCBI
Google Scholar

[119] View Article

[120] PubMed/NCBI

[121] Google Scholar

[ref34] 34. Gutiérrez-Colosía MR, Salvador-Carulla L, Salinas-Pérez JA, García-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2017;:1–14. pmid:28918762
View Article
PubMed/NCBI
Google Scholar

[123] View Article

[124] PubMed/NCBI

[125] Google Scholar

[ref35] 35. Junttila K, Meriläinen M, Tervo-Heikkinen T, et al. National benchmarking of nursing- sensitive outcomes: initial steps in Finland. 2018.
View Article
Google Scholar

[127] View Article

[128] Google Scholar

[ref36] 36. Iruin A, Ruiz M, Salinas JA. [Mental Health Atlas of Gipuzkoa]. San Sebastian: Unidad de Comunicación Hospital Universitario Donostia; 2013.

[ref37] 37. Sadeniemi M, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, García-Alonso C, Ala-Nikkola T, et al. A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. Int J Environ Res Public Health. 2018;15:1133. pmid:29857556
View Article
PubMed/NCBI
Google Scholar

[131] View Article

[132] PubMed/NCBI

[133] Google Scholar

[ref38] 38. Research School of Population Health. GLOCAL (Global and Local Observation and mapping of CAre Levels) | Research School of Population Health. 2021. https://rsph.anu.edu.au/research/projects/glocal-global-and-local-observation-and-mapping-care-levels. Accessed 18 Oct 2021.
View Article
Google Scholar

[135] View Article

[136] Google Scholar

[ref39] 39. Salvador-Carulla L, Fernandez A, Feng X, Astell-Burt T, Maas C, Smith-Merry J, et al. The Integrated Mental Health Atlas of Western Sydney. Sydney: Mental Health Policy Unit, Brain and Main Research Institute, Faculty of Health Sciences, University of Sydney. Western Sydney Partners in Recovery; 2016.

[ref40] 40. Furst MC, Salinas-Perez JA, Hopman K, Maas C, Fernandez A, Xu T, et al. The Integrated Mental Health Atlas of the Central and Eastern Sydney PHN Region. Annex 2: The Integrated Mental Health Atlas of the South Eastern Sydney Local Health District. Sydney: Mental Health Policy Unit. Brain and Mind Centre. Faculty of Health Sciences. University of Sydney; 2016.
View Article
Google Scholar

[139] View Article

[140] Google Scholar

[ref41] 41. Furst MA, Reynolds J, Salinas J, Tsou C, Rock D, Hopkins J, et al. The Integrated Atlas of Mental Health of the Perth North Primary Health Network Region. Perth: Australian National University and Western Australia Primary Health Alliance (WAPHA); 2018.
View Article
Google Scholar

[142] View Article

[143] Google Scholar

[ref42] 42. Wolpert M, Rutter H. Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: Learning from the case of child mental health. BMC Med. 2018;16:1–11. pmid:29895295
View Article
PubMed/NCBI
Google Scholar

[145] View Article

[146] PubMed/NCBI

[147] Google Scholar

[ref43] 43. Marewski JN, Gigerenzer G. Heuristic decision making in medicine. Dialogues in Clinical Neuroscience. 2012;14:77–89. pmid:22577307
View Article
PubMed/NCBI
Google Scholar

[149] View Article

[150] PubMed/NCBI

[151] Google Scholar

[ref44] 44. Alonso-Trujillo F, Salinas-Pérez JA, Gutiérrez-Colosía MR, González-Caballero JL, Pinzón Pulido S, Jiménez González S, et al. Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain). Gac Sanit. 2020;34:615–23.
View Article
Google Scholar

[153] View Article

[154] Google Scholar

[ref45] 45. Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, et al. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland). Can J Psychiatry. 2020;65:721–30.
View Article
Google Scholar

[156] View Article

[157] Google Scholar

[ref46] 46. Spijker BA van Salinas-Perez JA, Mendoza J, Bell T, Bagheri N, Furst MA, et al. Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas. Aust N Z J Psychiatry. 2019;53:1–13.
View Article
Google Scholar

[159] View Article

[160] Google Scholar

[ref47] 47. Rosen A, Gill NS, Salvador-Carulla L. The future of community psychiatry and community mental health services. Curr Opin Psychiatry. 2020;33:375–390. pmid:32452944
View Article
PubMed/NCBI
Google Scholar

[162] View Article

[163] PubMed/NCBI

[164] Google Scholar

[ref48] 48. Rosen A, Salvador-Carulla L. No service is an island: towards an ecosystem approach to mental health service evaluation. World Psychiatry. 2022;21:237–8. pmid:35524610
View Article
PubMed/NCBI
Google Scholar

[166] View Article

[167] PubMed/NCBI

[168] Google Scholar

[ref49] 49. Gutierrez-Colosia M, et al. Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health. Epidemiol Psychiatr Sci. 2022;In press. pmid:35993182
View Article
PubMed/NCBI
Google Scholar

[170] View Article

[171] PubMed/NCBI

[172] Google Scholar

[ref50] 50. Salvador Carulla L. Semantic mapping between the Australian NMHSPF and the DESDE-LTC. Applications in Western Australia. 2018.
View Article
Google Scholar

[174] View Article

[175] Google Scholar

[ref51] 51. Wright E, Leitch E, Fjeldsoe K, Diminic S, Gossip K, Hudson P, et al. Using the National Mental Health Service Planning Framework to support an integrated approach to regional mental health planning in Queensland, Australia. Aust J Prim Health. 2021. pmid:33653507
View Article
PubMed/NCBI
Google Scholar

[177] View Article

[178] PubMed/NCBI

[179] Google Scholar

[ref52] 52. Sanches SA, Swildens WE, van Busschbach JT, van Weeghel J. Identifying social participation subgroups of individuals with severe mental illnesses: a latent class analysis. Soc Psychiatry Psychiatr Epidemiol. 2019;54:1067–77. pmid:31127349
View Article
PubMed/NCBI
Google Scholar

[181] View Article

[182] PubMed/NCBI

[183] Google Scholar

[ref53] 53. Smith-Merry J, Mellifont D, Gillespie J, Salvador-Carulla L. Recovery-oriented community mental health models. Sax Institute; 2017.
View Article
Google Scholar

[185] View Article

[186] Google Scholar

[ref54] 54. Lavis JN, Permanand G, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP). 13. Preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst. 2009;7.
View Article
Google Scholar

[188] View Article

[189] Google Scholar

[ref55] 55. Department of Health. The Fifth National Mental Health and Suicide Prevention Plan. Commonwealth of Australia; 2017.
View Article
Google Scholar

[191] View Article

[192] Google Scholar

[ref56] 56. Walsh EI, Chung Y, Cherbuin N, Salvador-Carulla L. Experts’ perceptions on the use of visual analytics for complex mental healthcare planning: an exploratory study. BMC Med Res Methodol. 2020;20:1–9. pmid:32380946
View Article
PubMed/NCBI
Google Scholar

[194] View Article

[195] PubMed/NCBI

[196] Google Scholar

[ref57] 57. Ruiz V, Dijkstra L. Refinement of the OECD regional typology: Economic Performance of Remote Rural Regions. In: ERSA conference papers from European Regional Science Association. European Regional Science Association; 2011.

[ref58] 58. Anna Fernandez, Salinas-Perez JA Gutierrez-Colosia MR, Prat-Pubill B, Serrano-Blanco A, Molina C, et al. Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain). Epidemiol Psychiatr Sci. 2015;24:512–24. pmid:25226091
View Article
PubMed/NCBI
Google Scholar

[199] View Article

[200] PubMed/NCBI

[201] Google Scholar

[ref59] 59. Tabatabaei-Jafari H, Salinas-Perez JA, Anne Furst M, Bagheri N, Mendoza J, Burke D, et al. Patterns of Service Provision in Older People’s Mental Health Care in Australia. Int J Environ Res Public Health. 2020;17:8516. pmid:33212966
View Article
PubMed/NCBI
Google Scholar

[203] View Article

[204] PubMed/NCBI

[205] Google Scholar

[ref60] 60. Gibert K, García-Alonso C, Salvador-Carulla L. Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support. Health Res Policy Syst. 2010;8:28. pmid:20920289
View Article
PubMed/NCBI
Google Scholar

[207] View Article

[208] PubMed/NCBI

[209] Google Scholar

[ref61] 61. Capital Health Network. Australian Capital Territory Mental Health and Suicide Prevention Plan 2019–2024. 2019.
View Article
Google Scholar

[211] View Article

[212] Google Scholar

Figures

Abstract

Introduction

Material and methods

Catchment area

Measure

Inclusion criteria

Data collection and analysis

Data comparison and analysis

Results

Socio-demographic indicators

Service availability

Overview.

Residential care.

Day care.

Outpatient care.

Accessibility.

Service diversity-national (Australia)

Applicability of the DESDE-LTC results to mental health planning

Discussion

Limitations

Implications

Conclusion

Future steps

Acknowledgments

References