Stepped mental health care model needs more thought

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A proposal to use a ‘stepped care’ model for mental health services on campuses is well intentioned, but has some serious pitfalls for those in immediate distress. 

The Stepped Care 2.0 program, launched by the Student Wellness and Counselling Centre at Memorial University, is aimed at providing efficient care that reduces wait times for mental health services. The model sends students through chronological levels of care that build in intensity and cost depending on the severity of the issue they are dealing with.

This model frees up resources for students who may not require psychiatric care and acknowledges that not every mental health issue needs the exact same type of treatment. By not treating every situation in the same way, Memorial’s system sees the benefit for both intensive therapy and online counseling sessions. 

Although this has the potential to open up mental health resources, there are still some serious issues. 

A major gap in this model is the importance placed on the first walk-in consultation. Through this brief first meeting, professionals are expected to determine whether a student is in crisis or their situation can be managed by a gradual increase of care.  Placing a lot of pressure on getting it right the first time, there can be potentially serious consequences for students directed to a lower level of care than what they actually need. 

Another potential concern for Stepped Care is that the lower levels rely on students to manage their care by themselves. While this model tries to empower students to take charge of their own mental health care, it doesn’t take into account that students seeking help have likely already tried to deal with it on their own. It feels counter intuitive to the problem of reducing wait times by having people sent away because their problem isn’t ‘severe’ enough. Step two is meant to be a ‘higher level of care’ than step one, but it feels more isolating for someone in trouble than helpful. 

While the Stepped Care program intends to empower students to seek out solutions to their mental health issues, it puts the onus on themselves to decide what level of care they need when they may not even know themselves. A bad experience at one level could discourage someone from continuing to seek care. 

Proceeding through chronological steps from low to high intensity care follows the assumption if the system at first fails a student, they will continue down the path until they find the right treatment. While this scenario may work in theory, it neglects that symptoms of mental health struggles and mental illness aren’t always presented in the same way.

Stepped Care might be more successful for universities at pushing their students through the campus mental health system efficiently and at a lower cost, but the model forgets that the quality of care each student will realistically receive is dubious. 

The Stepped Care model attempts to simplify something extremely complicated, confusing the quality of care with efficiency. While it’s a step in the right direction for improving choice of treatment, it ignores the complicated and unpredictable nature of the mental health issues it attempts to tackle. 

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