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The stepped-care approach

by Dr. Alison Darcy 11 February 2008

The favoured model of mental-health service delivery in the UK is now one of stepped care. Complimenting a move to community care, self-help interventions (manualised versions of evidence-based treatments such as cognitive behavioural therapies; CBT) are playing an important role in the treatment of a range of mental health issues. As the first step in a stepped-care approach, the service user is provided with, or they themselves seek out, a self-directed intervention. More intensive intervention can be offered in the form of guided self-help, which combines the self-help manual with a limited number of brief “therapy” sessions administered by health care professionals of varying levels of expertise. Further intensive intervention can then be offered at outpatient level, day patient, and inpatient respectively, as required. In essence, the needs of the individual are matched to the appropriate level of care, and only graduate to a more intensive intervention if required. This approach should alleviate the demand on health care resources and means that people can receive some form of intervention while on waiting lists. In practice, the resources in the UK are not sufficient to allow this system to function as intended.

Internet-based services can represent the first step in a stepped-care approach. Many charities and other health-related organisations could capitalise on recent technological advancements. Many of these organisations, particularly those that offer more involved services, such as counselling, have waiting lists. Internet-based interventions can allow these organisations to offer immediate access to evidence-based help. Internet-delivery offers people more choices of the way in which their services are delivered.