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This book is a primer on Stepped Care 2.0. It is the first book in
a series of three. This primer addresses the increased demand for
mental health care by supporting stakeholders (help-seekers,
providers, and policy-makers) to collaborate in enhancing care
outcomes through work that is both more meaningful and sustainable.
Our current mental health system is organized to offer highly
intensive psychiatric and psychological care. While undoubtedly
effective, demand far exceeds the supply for such specialized
programming. Many people seeking to improve their mental health do
not need psychiatric medication or sophisticated psychotherapy. A
typical help seeker needs basic support. For knee pain, a nurse or
physician might first recommend icing and resting the knee, working
to achieve a healthy weight, and introducing low impact exercise
before considering specialist care. Unfortunately, there is no
parallel continuum of care for mental health and wellness. As a
result, a person seeking the most basic support must line up and
wait for the specialist along with those who may have very severe
and/or complex needs. Why are there no lower intensity options? One
reason is fear and stigma. A thorough assessment by a specialist is
considered best practice. After all, what if we miss signs of
suicide or potential harm to others? A reasonable question on the
surface; however, the premise is flawed. First, the risk of
suicide, or threat to others, for those already seeking care, is
low. Second, our technical capacity to predict on these threats is
virtually nil. Finally, assessment in our current culture of fear
tends to focus more on the identification of deficits (as opposed
to functional capacities), leading to over-prescription of
expensive remedies and lost opportunities for autonomy and
self-management. Despite little evidence linking assessment to
treatment outcomes, and no evidence supporting our capacity to
detect risk for harm, we persist with lengthy intake assessments
and automatic specialist referrals that delay care. Before
providers and policy makers can feel comfortable letting go of risk
assessment, however, they need to understand the forces underlying
the risk paradigm that dominates our society and restricts creative
solutions for supporting those in need.
This book is a primer on Stepped Care 2.0. It is the first book in
a series of three. This primer addresses the increased demand for
mental health care by supporting stakeholders (help-seekers,
providers, and policy-makers) to collaborate in enhancing care
outcomes through work that is both more meaningful and sustainable.
Our current mental health system is organized to offer highly
intensive psychiatric and psychological care. While undoubtedly
effective, demand far exceeds the supply for such specialized
programming. Many people seeking to improve their mental health do
not need psychiatric medication or sophisticated psychotherapy. A
typical help seeker needs basic support. For knee pain, a nurse or
physician might first recommend icing and resting the knee, working
to achieve a healthy weight, and introducing low impact exercise
before considering specialist care. Unfortunately, there is no
parallel continuum of care for mental health and wellness. As a
result, a person seeking the most basic support must line up and
wait for the specialist along with those who may have very severe
and/or complex needs. Why are there no lower intensity options? One
reason is fear and stigma. A thorough assessment by a specialist is
considered best practice. After all, what if we miss signs of
suicide or potential harm to others? A reasonable question on the
surface; however, the premise is flawed. First, the risk of
suicide, or threat to others, for those already seeking care, is
low. Second, our technical capacity to predict on these threats is
virtually nil. Finally, assessment in our current culture of fear
tends to focus more on the identification of deficits (as opposed
to functional capacities), leading to over-prescription of
expensive remedies and lost opportunities for autonomy and
self-management. Despite little evidence linking assessment to
treatment outcomes, and no evidence supporting our capacity to
detect risk for harm, we persist with lengthy intake assessments
and automatic specialist referrals that delay care. Before
providers and policy makers can feel comfortable letting go of risk
assessment, however, they need to understand the forces underlying
the risk paradigm that dominates our society and restricts creative
solutions for supporting those in need.
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