Stepped care, system architecture and mental health services in Australia

In its Review of Mental Health Programmes and Services (2014) the Australian National Mental Health Commission (MHC) concluded: "On the basis of our findings, it is clear that the mental health system has fundamental structural shortcomings. This same conclusion has been reached by numerous other independent and governmental reviews." The overall impact of a poorly planned and badly integrated system is a massive drain on peoples’ wellbeing and participation in the community – on jobs, on families and on Australia’s productivity and economic growth. The report was published under the banner “contributing lives, thriving communities” which summarises the mission and values of the MHC. It concluded that three key components of change were required: people centred design principles, a new system architecture, and a shift of funding to more efficient and effective ‘upstream’ services and supports. Part of the Australian Government’s response to this report was to establish a regional planning process to address these three components to be led by 31 Primary Health Networks which cover the whole of Australia. Mental health systems must balance the challenges of caring for people with mental illnesses and helping to prevent mental illness at individual, family and community levels. These objectives can require very different approaches and are often the responsibility of different organisations and disciplines. On the basis of my research experience in mental health systems and services I propose a minimalist model of stepped care as a contribution to this integrated systems architecture recommended by the MHC.