Exploring the Stepped Care Model in Delivering Primary Mental Health Services—A Scoping Review

• Published in: International journal of mental health nursing Vol. 33; no. 6; pp. 2026 - 2042
• Main Authors: Mareya, Shingai, Watts, Mimmie Claudine, Zhao, Lin, Olasoji, Michael
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.12.2024
• Subjects: Academic libraries; Clinical outcomes; Cost analysis; Effectiveness; Efficacy; Health services; Humans; Literature reviews; Mental Disorders - therapy; Mental health care; Mental health services; Mental Health Services - organization & administration; mental illness; patient outcomes; Patient-centered care; Patient-Centered Care - organization & administration; patient‐centred care; Primary care; Primary Health Care - organization & administration; primary mental health; Search strategies; Sequences; service delivery models; stakeholder experience; stepped care model; Subject headings; Treatment outcomes; effectiveness; mental illness; patient‐centred care; primary mental health; stepped care model; patient outcomes; stakeholder experience; service delivery models
• ISSN: 1445-8330; 1447-0349; 1447-0349
• DOI: 10.1111/inm.13427

ABSTRACT The stepped care model (SCM) is a patient‐centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword‐based search using terms like “stepped care model,” “mental health,” and “primary care”; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross‐sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost‐effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally.