Introducing Stepped Care 2.0

On September 9, 2019, the Mental Health Commission of Canada (MHCC), together with the Government of Newfoundland and Labrador and Memorial University, hosted an event in St. John’s to mark the launch of a report detailing the success of a new way of improving access to mental health services.

“Between 2014 and 2016, the number of people waiting for mental health and addiction counselling services rose about 56 per cent,” recalled the Hon. John Haggie, minister of health and community services. “We were talking about annual referrals of 20,000 and 3,000 admissions to inpatient mental health and addiction services. We heard from residents throughout the province that we needed to do something differently, and quickly.”

One such initiative was Stepped Care 2.0. “When someone says they are stressed or feeling down, society tends to tell us, ‘Get in line. Go see a psychologist or a psychiatrist. You may have to wait for six months or more.’ However, not everyone needs that level of expertise all the time,” said Peter Cornish, PhD, who conceived the idea of Stepped Care 2.0 and ran an extraordinarily successful initial program at Memorial University.

As he explained: “Stepped care means you start with the least invasive, least costly mental health intervention likely to succeed, and you progress from there — stepping up or down as your needs change.”

By broadening the scope of the project to 15 mental health and addiction clinics and two primary care sites — reaching some 300,000 people — Stepped Care 2.0 has shown that providing rapid, flexible, same-day care in combination with e-mental health apps, online self-help services, and behavioural prescriptions can significantly reduce wait times.

Haggie said that through the many initiatives taking place under the province’s Towards Recovery mental health and addiction action plan, they are seeing results that are nothing short of extraordinary. “We’ve seen a 68 per cent reduction in wait times, and Stepped Care 2.0 contributed to this success. In some instances, wait times have been eliminated altogether. We made a commitment to improve access to mental health services in Newfoundland and Labrador, and together with the MHCC, Memorial University, and our valued community partners, we continue to deliver on that promise.”

“What’s really amazing,” added MHCC president and CEO Louise Bradley, who was joined at the launch by Haggie and Cornish and by clients of Stepped Care 2.0, “is that the satisfaction rating for stepped care is as high among patients as it is among providers.” 

Sixty-seven per cent of clients rated the quality of e-mental health tools “good” or “excellent,” while providers who received stepped care training reported much greater comfort with e-mental health programs.

For Bradley, returning to her home province for this event meant coming full circle.

“We chose the launch date to coincide with a satellite meeting of the International Initiative for Mental Health Leadership,” she explained. “A group of global mental health leaders were going to be in St. John’s for a match meeting with their local counterparts, and we thought it would be a great opportunity to showcase our homegrown success story for a world audience.”

Bradley sees the value of this kind of meeting of the minds. “I first learned about e-mental health in New Zealand on a match very much like the one happening here. It was through a meeting with New Zealander Anil Thapliyal, who overhauled that country’s mental health service delivery through e-mental health, that I realized we were missing a huge opportunity at home.”

Now, Bradley is delighted about the chance to showcase a Canadian innovation, with Thapliyal in attendance, at the launch of the Stepped Care 2.0 report. “New Zealand taught us so much, and I’m proud of what we’ve been able to accomplish.”

Haggie agreed. “We’re a small province, but we’re willing to do things differently to get results. I can’t tell you how proud I am of the accomplishments we’ve achieved to date, including Stepped Care 2.0. We’re excited to share our results with anyone interested in learning what we have learned so far through Stepped Care 2.0 and transforming our mental health and addiction services.”