Transdiagnostic stepped care in mental health

Abstract

A component of Australia's recent national reform agenda for mental health services is the directive to the Primary Health Networks to develop and implement stepped-care models of service delivery. The current guidance proposes that interventions are aligned to mild, moderate and severe illness categories. Other models in operation are tied to single disorders, such as depression. Both approaches have a number of limitations when applied to real-world, complex clinical practice, especially in primary care.This article outlines some limitations of these models and argues for the development of a transdiagnostic model, based on developments in our work in primary care youth services, which can be generalised to adult populations. Such models aim to ensure that consumers receive the right intensity of care at the right time. The adjunct use of technology within services could also improve service accessibility and outcomes monitoring, and help to improve the efficiency of resource allocation based on consumer need.

A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia‐Pacific: Implications for practice and policy

“…Hanlon () suggests that to achieve the desired goal of universal health care for people with SMI, there is a need to develop system interventions to support task sharing, improve the evidence base in rural and resource‐poor LMIC settings, and pay greater attention to those people with higher care needs (Hanlon, ). The concept of transdiagnostic stepped care, ensuring that consumers receive the right intensity of care at the right time, has also been discussed in Australia, where work by Cross and Hickie () suggests a model of stepped care based on previous work in primary care youth services may be beneficial (Cross & Hickie, ).…”

“…Positively for psychiatric rehabilitation, while the evidence behind the benefit of early psychosis services to overall psychiatric care is contentious (Bosanac et al, ; Castle, ), there is little controversy, despite little implementation, for psychiatric rehabilitation. Cross and Hickie demonstrate how existing models can be readily adapted and applied (Cross & Hickie, ). This review demonstrates that strong leadership, collaboration, and coordinated action among all stakeholders will be crucial for advocating for further development and implementation of rehabilitation services.…”

Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study (Preprint)

“…This framework supports the promotion of self-help and encourages an easier navigation for stepping-up through the mental health system [18]. Stepped (or clinically-staged) care aims to provide evidence-based, less intensive, low risk, and low-cost interventions to the less severe cases, while prioritising more intensive or prolonged interventions for more complex cases [5,[19][20][21][22][23].…”

Targeting mental health care attributes by diagnosis and clinical stage: the views of youth mental health clinicians

“…In practical terms, full-threshold disorder is an inappropriately high bar for access to care for many young people with emerging mental health problems, [4][5][6] and this approach may promote potentially harmful over-reliance on "watchful waiting" strategies. 7 An alternative approach is the clinical staging concept, which has been progressively developed in mental health for more than a decade. 5,[8][9][10][11][12][13][14][15][16][17] Clinical staging is increasingly being used in clinical services and mental health research and has recently been recommended as a basis for an alternative stepped model of mental health care.…”

“…5,[8][9][10][11][12][13][14][15][16][17] Clinical staging is increasingly being used in clinical services and mental health research and has recently been recommended as a basis for an alternative stepped model of mental health care. 7 The clinical staging model uses a combination of help-seeking, symptoms and functioning information to categorise a mental health problem into one of six stages (Box 1).…”