Mental Health Stepped Care Model

Following the Australian Government’s response to the National Mental Health Commission’s review of programs and services in 2014, PHNs across Australia are leading reform initiatives in a number of key areas including the introduction of stepped care in mental health.

Transition timelines

Within the EMPHN catchment, a phased transition to our Mental Health Stepped Care Model is underway:

• Phase 1: north east (service started 15 Jan 2018)  local government areas of Whittlesea, Nillumbik, Banyule and parts of the shires of Mitchell and Murrindindi within the EMPHN catchment. 

• Phase 2: outer east (service started 2 Jul 2018) local government areas of Knox, Maroondah and Yarra Ranges. 

• Phase 3: inner east (service started 14 Jan 2019) local government areas of Manningham, Boroondara, Whitehorse and Monash. 



About the Mental Health Stepped Care Model

  • Mental Health Stepped Care is an evidence-based, staged system of care that includes a range of mental health interventions, from the least to the most intensive.
  • Clinical staging (0-4) is determined by using a combination of assessment information about help-seeking, and level of symptoms and functioning.
  • According to the clinical stage, the level of intensity of care is matched to the complexity of the conditions experienced by the consumer.
  • People presenting with increased risk will be given priority access to services. People presenting with high risk should directly access support by hospital or emergency services. 
  • There are a range of service interventions including eHealth solutions such as online support groups and apps, to group therapy, individual therapy and care coordination.
  • The range of services are delivered by psychologists, social workers, occupational therapists, credentialed mental health nurses and peer workers among others.
  • The model emphasises collaborative care working with the consumer’s GP, care team and significant others when appropriate.
  • The model also addresses other needs including physical health, education and employment, alcohol and other drug harm reduction, family and social functioning, and suicide and self-harm reduction.


The below videos help explain EMPHN's Mental Health Stepped Care Model.

Video 1: A guide for GPs (10 mins)

Video 2: A new way of delivering mental health services (5mins)

Educational videos and resources:

Engagement and co-design

Consultations and co-design forums with stakeholders commenced in the latter half of 2016 and early 2017 to develop EMPHN's Mental Health Stepped Care Model and low intensity services. It was clear from these consultations that the current system of care could improve to better meet the needs of the people of the region.

Engagement resources: