Layered care: a proposal to develop better primary care mental health services

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There is increasing pressure on primary care mental health services to meet more needs in the community, provide new and different methods of delivering services, and redesign care pathways and models of care. Layered care is a response to these requirements; it is a development of the stepped care approach that could provide a quicker, more accessible and user-involved experience for patients. The model provides patients with easy access to a variety of mental health responses that build up into an individual programme through one initial contact with a mental health worker. It provides access to a range of services from minimal interventions (e.g. support, advice, information) to more specialist mental health treatments (e.g. counselling, cognitive–behavioural therapy (CBT), psychotherapy). Following the general practitioner’s initial triage assessment there is a single point entry into layered care through a new role, the key worker, who may be a primary care mental health worker. This person meets with the patient, and discusses and selects from a variety of treatment or non-treatment options for their individual care plan. The model therefore enables service users to construct their own individual treatment package. Integral to the layered care model is the belief that greater collaboration, shared care, user involvement and integration between primary and secondary mental health service are required to modernise primary care mental health services and simplify care pathways. This paper presents the layered care model and the thinking behind it for criticism, discussion and consideration of its suitability in primary care settings.

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