System change towards a Stepped Care Model

Table of contents

System change towards a Stepped Care Model

In 2014, the National Mental Health Commission (NMHC) released Contributing lives, thriving communities: Report of the National Review of Mental Health Programs and Services,⁴ a review to assess the efficiency and effectiveness of programs and services in supporting individuals experiencing mental health issues, and their carers.

The Australian Government response detailed nine interconnected areas of reform, including ‘refocusing primary mental health care programs and services to support a stepped care model’.⁵ To this end, the government tasked PHNs in implementing the primary mental healthcare reform activities with the development and commissioning of services that apply to the Stepped Care Model.

In this document, the term ‘stepped care’ refers specifically to the government’s Stepped Care Model, a key element to its mental health reform initiative to fund PHNs for regional mental health planning and commissioning. Stepped care is an approach to care delivery where the level of intensity of care is matched to the complexity of the condition (Figure 1).

The idea is not new; GPs already use this approach in all aspects of patient care, including physical care. GPs make assessments to determine the best management approach to guide their patients in accessing services appropriate to their level of need, and thus ensure that more intensive and often costly services are directed to patients best able to benefit from them.

Figure 1. System changes to strengthen the Stepped Care Model in primary mental healthcare clinical service delivery⁶

Reproduced from the Department of Health. PHN mental health and suicide prevention implementation guidance: Stepped care. Canberra: DoH, [date unknown]; p. 3. [Accessed 21 February 2019].

In Australia, the Stepped Care Model aims to comprise a range of support services of varying interaction, where a person presenting is matched to the intervention level that most suits their current need. An individual need not start at the lowest level of intensity in order to progress; rather, they are matched with a service that meets their needs.⁶

The Stepped Care Model is an attempt to broaden the scope of treatments offered while maintaining affordable and accessible services. Because each PHN covers different populations and multiple communities, the services offered also differ. The Australian Government Department of Health (DoH) offers the following definitions:

Stepped care

Stepped care is defined as an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual’s needs.

Within a stepped care approach, an individual will be supported to transition up to higher intensity services or transition down to lower intensity services as their needs change. Stepped care is a different concept from ‘step up/step down’ services which is defined below.

Step up/step down services

These are clinically supported services which offer short-term care to manage the interface between inpatient and community settings. They provide an alternative to hospital admission (pre-acute) and provide bridging support following discharge from hospital (post-acute). Step up/step down services are usually delivered through staffed residential facilities but may be delivered in the person’s home.⁶

PHNs are tasked with structuring the model with targeted services tailored to their communities’ needs – these should assist GPs and are not intended to replace GP care. The GP role continues to ensure a patient receives guided and coordinated care across the care continuum either as a referrer, as a service provider or as a care coordinator.

The Stepped Care Model is intended to support integrated care. By working with the patient’s care team, such as GPs, allied health professionals, other specialists and carers, it aims to ensure that the most appropriate service is provided at the time the patient needs it.

The Stepped Care Models aim to:

offer a variety of support options for people with different levels and types of need, from low intensity to high intensity
provide clear pathways between these care options as individuals’ needs change
improve collaboration and integration between services
connect to other community, health and clinical mental health services available in the local area.

Care may range from using a digital app, to brief non-intensive interventions initiated by a GP, to interventions requiring the coordinated, ongoing efforts from a range of professionals on a range of conditions. Interventions within a Stepped Care Model must be consistent with the principles of self-management and have wider application beyond mental health.⁷

This document aims to clarify the role of the GP within stepped care services delivered by PHNs, providing GPs with a better understanding of the mental health care continuum across the patient journey.

References

National Mental Health Commission. Contributing lives, thriving communities: Report of the National Review of Mental Health Programs and Services. Sydney: NHMC, 2014. [Accessed 20 February 2019].
Department of Health. Australian Government response to contributing lives, thriving communities – Review of mental health programs and services. Canberra: DoH, 2015. [Accessed 13 March 2019].
Department of Health. PHN mental health and suicide prevention implementation guidance: Stepped care. Canberra: DoH, [date unknown]; p. 3. [Accessed 21 February 2019].
Eastern Melbourne PHN. Eastern Melbourne PHN mental health Stepped Care Model. Melbourne: EMPHN, 2017. [Accessed 20 February 2019].

Downloads

Working with the Stepped Care Model