Limited evidence exists for strategic actions in improving mental health at the youth population–level, particularly in low- and middle-income countries. This study investigates the health and economic impacts of intersectoral mental health programs to inform the optimal suite of interventions for young people in Bogotá, Colombia, where many are at risk of mental disorders and lack access to appropriate health services.
This study evaluated 9 interventions compared with business as usual over a projected 10-year time horizon using a system dynamics model developed through a participatory process involving diverse local stakeholders. Sensitivity analyses were performed to account for uncertainties from a healthcare payer perspective.
Anti-bullying, community-based rehabilitation, and online mental health programs were dominant. General practitioner mental health training and gatekeeper suicide prevention training could significantly improve mental health outcomes at an incremental cost-effectiveness ratio below the threshold of US dollars $4890/quality-adjusted life-years. Nevertheless, simultaneously implementing all 9 strategies could produce a synergistic effect, yielding the greatest benefit relative to business as usual with an incremental net monetary benefit of $465 million and an incremental cost-effectiveness ratio of $586 per quality-adjusted life-years gained.
Combined intersectoral mental health strategies were synergistic and resulted in optimal health outcomes relative to business as usual. The system dynamics approach offers additional attributes to economic evaluation in mental health settings by considering capacity constraints, unintended consequences, and interactions between multiple interventions. It is a valuable approach for decision-makers to effectively and efficiently prioritize and allocate scarce resources in complex public health systems.
This research explores how different strategies can improve mental health for young people in Bogotá, Colombia, where many face mental health challenges and lack access to effective treatment. Understanding how to better allocate limited resources in healthcare is vital, especially in countries with fewer financial resources for mental health services. This study specifically evaluates 9 interventions over 10 years to see how they could impact health outcomes and costs.
Key findings indicate that certain programs, such as antibullying initiatives, community-based rehabilitation, and online mental health services can improve mental health outcomes and reduce costs. Training general practitioners in mental health care and providing gatekeeper suicide prevention training also show promise, being cost-effective when compared to current practices. Interestingly, when all 9 strategies are implemented together, they create a synergistic effect that leads to the best overall health benefits and a significant financial return, estimated at $465 million over the period studied.
The research uses system dynamics modeling, which allows for a comprehensive analysis of how various interventions interact within the healthcare system. This approach highlights the importance of considering potential unintended consequences and the overall capacity of healthcare services to handle increased demand. The results suggest that using a combination of different strategies can lead to better health outcomes at a lower cost than maintaining the status quo.
For healthcare decision makers, the findings underscore the value of investing in a mix of targeted mental health programs, particularly in low- and middle-income countries like Colombia. These strategies not only address immediate mental health needs but also promise long-term economic benefits. For researchers, this study demonstrates the effectiveness of system dynamics modeling in evaluating complex health interventions and emphasizes the need for further research in diverse contexts to refine these approaches and ensure their applicability.
In summary, this research offers important insights into how mental health interventions can be effectively combined to enhance outcomes for young people while managing costs, making a compelling case for coordinated strategies in mental healthcare.