Periodic Reporting for period 1 - SEYMOUR (SYSTEM DYNAMICS MODELLING FOR SUICIDE PREVENTION)
Reporting period: 2022-02-01 to 2024-01-31
Suicide is one of the leading causes of mortality among young people aged 15–24 globally. The suicide mortality rate is one of the indicators within the UN’s Sustainable Development Goal (SDG) 3, and the WHO Comprehensive Mental Health Action Plan (2013–2030) identifies young people as a high-risk group. Despite increasing investment in suicide prevention activities from many governments worldwide, we still do not know which interventions, policies, or programs, for which groups of young people, for how long and with what intensity could generate the greatest reductions in youth suicide rates. Progress in youth suicide prevention has been stalled by many factors including:
• A lack of involvement of young people in the design of interventions meaning that they are not youth-focused and, therefore, not acceptable to end-users.
• A lack of planning for the systematic uptake and implementation of strategies in the real world.
• Limited adequacy and accuracy of current methodological approaches (e.g. meta-analyses, regression models) which do not account for the interdependence of suicide risk factors as they operate across multiple levels (e.g. individual, social, health system); and consider the complexity of health systems and the influence of factors such as healthcare constraints.
SEYMOUR (System Dynamics Modelling in Suicide Prevention) offers a novel paradigm for guiding the efficient and effective deployment of national and global youth suicide prevention strategies using system dynamics modelling (SDM). SDM is a computer-assisted method that helps frame, test and simulate the causal processes and interactions that underlie complex systems or behaviours (such as suicide) to inform policy making.
SEYMOUR will use SDM to develop and evaluate a computational model to inform youth suicide prevention policy, planning and implementation in Australia and the UK.
Objectives
1. Develop and validate a model to inform the most appropriate combination of population-level suicide prevention interventions that would generate the most significant reductions in rates of suicide and attempted
suicide among young people aged 12–25 over a 10-year period in North-West Melbourne (2023–2033).
2. Develop an implementation strategy to facilitate the adoption of the model as a decision-making tool in youth suicide prevention policy and practice in North-West Melbourne.
3. Adapt and validate the model in the UK context and optimise how it can inform policy, system-level reform, and service redesign in relation to youth suicide.
• A lack of involvement of young people in the design of interventions meaning that they are not youth-focused and, therefore, not acceptable to end-users.
• A lack of planning for the systematic uptake and implementation of strategies in the real world.
• Limited adequacy and accuracy of current methodological approaches (e.g. meta-analyses, regression models) which do not account for the interdependence of suicide risk factors as they operate across multiple levels (e.g. individual, social, health system); and consider the complexity of health systems and the influence of factors such as healthcare constraints.
SEYMOUR (System Dynamics Modelling in Suicide Prevention) offers a novel paradigm for guiding the efficient and effective deployment of national and global youth suicide prevention strategies using system dynamics modelling (SDM). SDM is a computer-assisted method that helps frame, test and simulate the causal processes and interactions that underlie complex systems or behaviours (such as suicide) to inform policy making.
SEYMOUR will use SDM to develop and evaluate a computational model to inform youth suicide prevention policy, planning and implementation in Australia and the UK.
Objectives
1. Develop and validate a model to inform the most appropriate combination of population-level suicide prevention interventions that would generate the most significant reductions in rates of suicide and attempted
suicide among young people aged 12–25 over a 10-year period in North-West Melbourne (2023–2033).
2. Develop an implementation strategy to facilitate the adoption of the model as a decision-making tool in youth suicide prevention policy and practice in North-West Melbourne.
3. Adapt and validate the model in the UK context and optimise how it can inform policy, system-level reform, and service redesign in relation to youth suicide.
Development and validation of a system dynamics model for youth suicide prevention in North-West Melbourne, Australia.
A participatory systems modelling approach was adopted to develop a computer simulation model of mental health service pathways and suicidal behaviour among young people in North-West Melbourne.
A multidisciplinary group of thirteen stakeholders was recruited including young people aged 12-25 with lived experience of self-harm or suicidal; family members/carers of young people; health and social care policy makers; primary/ secondary/tertiary healthcare providers.
Three participatory workshops were conducted with the expert stakeholder group to codesign a conceptual model mapping the pathways for the development of self-harm and suicidal behaviour in young people, young people’s help-seeking journey through educational, community and health service pathways as well as the factors that influence the flow of the population along these pathways. The expert stakeholder group identified policy levers and prioritised interventions, policy initiatives or programmes that they would like to see included in the model to capture their effects.
The conceptual model was used to design a computer simulation model (stock and flow diagram) using Stella Architect. The expert stakeholder group reviewed the computer simulation model structure and logic to ensure face validity.
The computer simulation model was calibrated using national, state, and local datasets (inputs). Primary model outputs include suicide deaths, self-harm hospitalisations and self-harm presentations to emergency departments.
Model validation by testing whether the model replicates historic time series data across a range of key indicators (e.g. self-harm hospitalisations, ED presentations, suicide deaths) is at the final stages. Upon completion of model validation, a series of hypotheses will be modelled to identify which combination of population-level interventions generates the most significant reductions in rates of suicide and attempted suicide among young people during a 10yr period (2022-2032) in North-West Melbourne.
Evaluation of using participatory modelling to inform the development of the system dynamics model.
This part of the project addressed the following questions:
1. Is it feasible to develop a complex systems model for youth suicide prevention in North-West Melbourne using participatory systems modelling (PSM)?
2. What is the value of PSM in developing a complex systems model for youth suicide prevention in North-West Melbourne?
3. What is the impact of PSM on the model development process?
A range of data collection methods was used to document and evaluate the feasibility, value, and impact of PSM before (briefing questionnaires), during (field notes, audio-recordings), and after (evaluation questionnaires) the workshops. Data from each source were analysed separately and then synthesized to address the three research questions.
Feasibility
The findings of the evaluation identified several factors that influenced the feasibility of undertaking an inclusive, accessible, and transparent PSM project including stakeholder cultural diversity, appropriate representation of those with lived and lived experience of self-harm or suicidal behaviour, translation of technical information and effectively managing group dynamics.
Value
The value of adopting PSM in developing a complex systems model for youth suicide prevention in North-West Melbourne was demonstrated in the collaborative learning that took place between stakeholders. Engaging in dialogue and debate was invaluable in fostering mutual learning and trust in the PSM.
Impact
Stakeholder feedback was considered throughout the project to enhance the PSM process and the development of the systems model. For example, stakeholder’s knowledge of the regional mental health system informed the structure, logic and assumptions of the model thereby increasing its face validity.
A participatory systems modelling approach was adopted to develop a computer simulation model of mental health service pathways and suicidal behaviour among young people in North-West Melbourne.
A multidisciplinary group of thirteen stakeholders was recruited including young people aged 12-25 with lived experience of self-harm or suicidal; family members/carers of young people; health and social care policy makers; primary/ secondary/tertiary healthcare providers.
Three participatory workshops were conducted with the expert stakeholder group to codesign a conceptual model mapping the pathways for the development of self-harm and suicidal behaviour in young people, young people’s help-seeking journey through educational, community and health service pathways as well as the factors that influence the flow of the population along these pathways. The expert stakeholder group identified policy levers and prioritised interventions, policy initiatives or programmes that they would like to see included in the model to capture their effects.
The conceptual model was used to design a computer simulation model (stock and flow diagram) using Stella Architect. The expert stakeholder group reviewed the computer simulation model structure and logic to ensure face validity.
The computer simulation model was calibrated using national, state, and local datasets (inputs). Primary model outputs include suicide deaths, self-harm hospitalisations and self-harm presentations to emergency departments.
Model validation by testing whether the model replicates historic time series data across a range of key indicators (e.g. self-harm hospitalisations, ED presentations, suicide deaths) is at the final stages. Upon completion of model validation, a series of hypotheses will be modelled to identify which combination of population-level interventions generates the most significant reductions in rates of suicide and attempted suicide among young people during a 10yr period (2022-2032) in North-West Melbourne.
Evaluation of using participatory modelling to inform the development of the system dynamics model.
This part of the project addressed the following questions:
1. Is it feasible to develop a complex systems model for youth suicide prevention in North-West Melbourne using participatory systems modelling (PSM)?
2. What is the value of PSM in developing a complex systems model for youth suicide prevention in North-West Melbourne?
3. What is the impact of PSM on the model development process?
A range of data collection methods was used to document and evaluate the feasibility, value, and impact of PSM before (briefing questionnaires), during (field notes, audio-recordings), and after (evaluation questionnaires) the workshops. Data from each source were analysed separately and then synthesized to address the three research questions.
Feasibility
The findings of the evaluation identified several factors that influenced the feasibility of undertaking an inclusive, accessible, and transparent PSM project including stakeholder cultural diversity, appropriate representation of those with lived and lived experience of self-harm or suicidal behaviour, translation of technical information and effectively managing group dynamics.
Value
The value of adopting PSM in developing a complex systems model for youth suicide prevention in North-West Melbourne was demonstrated in the collaborative learning that took place between stakeholders. Engaging in dialogue and debate was invaluable in fostering mutual learning and trust in the PSM.
Impact
Stakeholder feedback was considered throughout the project to enhance the PSM process and the development of the systems model. For example, stakeholder’s knowledge of the regional mental health system informed the structure, logic and assumptions of the model thereby increasing its face validity.
The adoption of systems modelling in tackling youth suicide rats is in its infancy; yet its potential to efficiently and effectively guide suicide prevention strategies tailored to the unique needs of young people is great. SEYMOUR will bridge the gap between methodological approaches, such as participatory action research and simulation modelling, to help us address some of the most pressing and, so far, unsolved questions in suicide prevention: What interventions can effectively and efficiently reduce the increasing rates of suicide and attempted suicide among young people? In doing so, this programme of work has the potential to facilitate the transferability, internationalisation and adoption of systems modelling as a decision-making tool in youth suicide prevention policy and practice globally to meet the mental health needs of young people and help reduce suicide and its associated burden.