Enhancing Care Transition Pathways in Regional Acute Mental Healthcare Settings: Insights From Lived Experience Group Model Building Workshops

Effective care transitions are critical to patient safety and recovery in mental healthcare, yet they remain a point of vulnerability due to fragmented communication, restrictive practices and systemic pressures. This study aimed to identify priority issues and leverage points for improving care transitions in a regional acute mental health service using group model building (GMB), a structured systems thinking co-design approach. Seventeen participants-including service users, family carers and healthcare workers-engaged in a series of participatory workshops to map the factors influencing care transitions. With the use of causal loop diagrams and network analysis, the study identified key leverage points for intervention including patient empowerment, staff empathy, self-advocacy and integration of lived experience roles, alongside systemic barriers such as bed pressures and hierarchical decision-making. Findings highlighted staff communication and the lived experience workforce as central to improving care transitions, fostering trust and enhancing service user autonomy. Participants identified nine action areas for further exploration, including increased service user involvement in decision-making, expanded peer workforce integration and enhanced staff training in trauma-informed care and Safewards principles. This research demonstrates that structured systems thinking methods, particularly GMB, can provide actionable, system-level insights for improving mental health service delivery.