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Focused on students

Mental health innovation: Leading with Stepped Care 2.0 at Memorial

Campus and Community

By Peter Cornish

The Mental Health Commission of Canada has called for the development of a more efficient mental health care system — one that provides early and rapid assessment as well as systematic and monitored access to the most effective but least intensive treatment.

Such a system could not only reduce the chronicity of mental illness throughout the lifespan, but could also serve to prevent more serious mental health issues from developing.

At Memorial University, we have developed such a system.

Suite of intervention programs

Memorial is leading in North America with an innovative, empowering, highly efficient, rapid access suite of primary care intervention programs.

As is the case with traditional primary care models, highly skilled generalists, i.e. family physicians and, in the case of our model, also psychologists, are the default case managers who rapidly assess, problem solve, refer and prescribe solutions.

As generalists, these primary care providers fulfill a variety of functions, and assume responsibility for ensuring that patient care and health system navigation is co-ordinated.

Memorial’s model, stepped care, offers the lowest level of intervention intensity warranted by the initial and ongoing assessments. Treatment intensity can be either stepped up or down depending on the level of patient distress or need.

Stepped Care 2.0

Stepped Care 2.0 takes the U.K. model and the re-imagined model described by O’Donahue and Draper and extends it to health and mental health promotion and illness prevention activities. Programs can be selected and arranged based on intensity, cost and level of engagement.

At Memorial, we’ve developed a nine-step model of wellness service care and management with potential for electronic medical record integration and commercialization.

Stepped care provides rapid, same day, flexible access to wellness and mental health resources. The approach is aimed at empowering patients to maximize and manage their own wellness to the best of their ability.

The Stepped Care 2.0 approach is like that of a family physician practice — one that offers rapid access walk-in clinics.

Clients making a first visit are seen on a walk-in basis, usually within an hour to an hour and a half. This rapid access is important since early intervention is key to preventing more serious health and mental health conditions.

Array of programs available

On a first visit, an experienced primary care provider meets with a patient to determine, together, the best combination of resources or programs for the presenting issues. A tentative written treatment plan is developed and given to the patient. In some cases, a follow-up session is scheduled, in others the onus is on the patient to request.

An array of programs are available within the Stepped Care 2.0 approach, programs that are designed to assist patients, including online self-help, blended in-person/online provider assisted programs, peer support, drop-in seminars and workshops, structured and unstructured groups, one-on-one sessions, psychiatric consults and health system navigation.

Early results of implementation of Memorial’s model at three North American Universities, showing increased service capacity and elimination of wait times, will be published later this year in the American Psychological Association journal, Psychological Services.

Intensity where appropriate

Research shows that up to 80 per cent of people presenting to a health professional with health concerns are not ready to take action or make full use of available interventions.

Stepped care acknowledges this and provides less intense resources first.

“The stepped care approach offers flexibility and presumes that individuals may need different types of programs at different times.”

Care intensity is only stepped up when appropriate. Often, the less intensive programs resolve the issues. However, if not fully resolved, these less intense resources typically help prepare patients for making full use of the more intensive resources when care is stepped up.

The stepped care approach offers flexibility and presumes that individuals may need different types of programs at different times. Thus, a patient may begin with one type of intervention and move to another as the needs change.

We encourage patients to ask questions and to work collaboratively with their provider to find the program(s) that will work best for them.

Opportunities for collaboration

Building upon Memorial’s Centre for Collaborative Health Professional Education’s success in interprofessional learning and curriculum development, there is an appetite for the establishment of a dedicated, collaborative primary care practice and training site.

With Memorial’s solid foundation in interprofessional teaching and learning, the development of a dedicated wellness and service training site would not only enhance interprofessional care, it would foster research innovation through expanded collaborative projects.

The Student Wellness and Counselling Centre is poised for such an opportunity as renovations are underway on the fifth floor of the University Centre on Memorial’s St. John’s campus to establish shared space for family medicine, psychiatry, nursing and psychological services, as well as other allied health-care programming, including whole population initiatives aimed at increasing the well-being, engagement and productivity of all members of the campus community.

As a signatory to the International Okanagan Charter on Health Promoting Universities, Memorial is committed to setting conditions for a thriving campus environment.

For the latest updates on Stepped Care 2.0 ©, I invite you to follow my blog here.

Focused on Students is a summer series featuring members of the Office of the Deputy Provost (Students) leadership team sharing their insights on hot button, student success-related topics. The next installment will feature Shona Perry-Maidment, deputy registrar, strategic enrolment management, Office of the Registrar, as she takes a look at student recruitment of the past and that of the future.

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