Stepped mental health care model leading Australia astray

Australia is facing a major transformation of its mental health system. Like any highly complex reform, selecting an appropriate change framework is critical.1

The Australian Government chose the ‘stepped care’ framework to guide mental health planning, promising people ‘varying levels of primary care treatment and support depending on their level of need as determined by a health professional, whether that be ‘at risk’, mild, moderate or severe/complex’ [https://bit.ly/2OW9NrX].

There is evidence this framework may not be appropriate, even for common disorders.2 Stepped care is typically applied to specific therapies, like the UK’s Improving Access to Psychological Therapies (IAPT). There, the model was implemented with coordinated tiers of care, from guided self-help, to low, then higher intensity and professional face-to-face care.3 Patient progress was systematically monitored.