Mareya Shingai, Zhao Lin, Watts Mimmie Claudine, Olasoji Michael
Federation University Australia, Ballarat, Victoria, Australia.
RMIT University, Melbourne, Australia.
Int J Ment Health Nurs. 2025 Jul;34(4):e70111. doi: 10.1111/inm.70111.
The Australian stepped care model (SCM) in primary mental healthcare aims to provide a structured, accessible and flexible approach to addressing mental health issues. This study, a subset of a broader study, explores the perspectives of multidisciplinary mental health professionals on the implementation and effectiveness of the SCM. Using an exploratory descriptive qualitative methodology, the study collected data from nine participants: mental health nurses, an occupational therapist, a psychologist, a social worker, psychiatrists and a care coordinator, all involved in an SCM. Ethical approval was obtained from the Human Research Ethics Committee (de-identified for review), and measures were implemented to ensure the privacy and confidentiality of all participants. Data were collected through face-to-face interviews and analysed using reflective thematic analysis. Four main themes were developed from the reflexive thematic analysis: working together to deliver collaborative care, a flexible and personalised approach, complexities of navigating the model and stories of success: positive client outcomes. The multidisciplinary nature of the SCM facilitates a holistic approach to mental healthcare, ensuring comprehensive support for patients. However, workforce shortages and systemic issues present significant challenges. The study found that flexibility and personalisation allow the SCM to adapt to diverse patient needs, which enhances outcomes and satisfaction, though inconsistencies in service delivery remain. Navigating the SCM is complex, requiring better coordination and more precise guidelines to ensure smooth transitions between care levels. Despite these challenges, the SCM has demonstrated considerable success in improving patient outcomes. In conclusion, the SCM represents a promising primary mental healthcare approach, emphasising tailored, multidisciplinary care. The study highlights the need for continuous improvements which include addressing workforce shortages and enhancing coordination to maximise the SCM's impact and ensure sustainable mental health services in Australia. Future research with larger samples and quantitative data is recommended to evaluate further the SCM's effectiveness in Australia.
澳大利亚初级精神卫生保健中的阶梯式照护模式（SCM）旨在提供一种结构化、可及且灵活的方法来解决心理健康问题。本研究是一项更广泛研究的子研究，探讨了多学科精神卫生专业人员对SCM实施情况及有效性的看法。该研究采用探索性描述性定性方法，从九名参与者收集数据：精神科护士、职业治疗师、心理学家、社会工作者、精神科医生和一名护理协调员，他们都参与了SCM。已获得人类研究伦理委员会的伦理批准（为便于审查进行了去识别处理），并采取了措施确保所有参与者的隐私和保密性。通过面对面访谈收集数据，并使用反思性主题分析进行分析。反思性主题分析得出了四个主要主题：共同努力提供协作式照护、灵活且个性化的方法、在该模式中导航的复杂性以及成功案例：积极的患者结局。SCM的多学科性质有助于采取整体精神卫生保健方法，确保为患者提供全面支持。然而，劳动力短缺和系统性问题带来了重大挑战。研究发现，灵活性和个性化使SCM能够适应不同患者的需求，这提高了治疗效果和满意度，尽管服务提供仍存在不一致之处。在SCM中导航很复杂，需要更好的协调和更精确的指导方针，以确保在不同护理级别之间顺利过渡。尽管存在这些挑战，SCM在改善患者结局方面已取得了相当大的成功。总之，SCM代表了一种有前景的初级精神卫生保健方法，强调量身定制的多学科照护。该研究强调了持续改进的必要性，包括解决劳动力短缺问题和加强协调，以最大限度地发挥SCM的影响，并确保澳大利亚精神卫生服务的可持续性。建议未来进行更大样本和定量数据的研究，以进一步评估SCM在澳大利亚的有效性。
