Abstract
We describe a modelling toolkit that was developed with the aim of assisting those responsible for introducing stepped care systems to local mental health services in the UK. The toolkit was pre-populated with real patient flow data collected from four sites that piloted the stepped care system design. Two analytical models were developed and coded as part of the toolkit to provide insights concerning workload, patient throughput, and changes in waiting times and waiting list size. An interface was built to allow users to specify their own stepped care system and input their own estimates or data of service demands and capacities at different steps. Despite the challenges and limitations, the use of modelling to inform the design of new service configurations is an important step in the right direction and we would recommend this as a reasonable way forward.
Similar content being viewed by others
References
Bennett-Levy J, Richards D and Farrand P (2010). Low intensity CBT interventions: A revolution in mental health care. In: Bennett-Levy J, Richards D, Farrand P, Christensen H, Griffiths K and Kavanagh D (eds). Oxford Guide to Low Intensity CBT Interventions. Oxford University Press: Oxford.
Bower P and Gilbody S (2005a). Managing common mental health disorders in primary care: Conceptual models and evidence base. British Medical Journal 330 (7495): 839–842.
Bower P and Gilbody S (2005b). Stepped care in psychological therapies: Access, effectiveness and efficiency. Narrative literature review. British Journal of Psychiatry 186 (1): 11–17.
Cuijpers P, Donker T, van SA, Li J and Andersson G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40 (12): 1943–1957.
Davison GC (2000). Stepped care: Doing more with less? Journal of Consulting and Clinical Psychology 68 (4): 580–585.
Fletcher A and Worthington D (2009). What is a ‘generic’ hospital model? A comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows. Health Care Management Science 12 (4): 374–391.
Medical Research Council (2008). Developing and Evaluating Complex Interventions: New Guidance. MRC: London.
Miles MB and Huberman AM (1994). Qualitative Data Analysis: An Expanded Sourcebook. Sage Publications: London.
National Institute for Clinical Excellence (2009). Depression: Management of Depression in Primary and Secondary Care. NICE: London.
National Institute for Health Clinical Excellence (2011). Generalised Anxiety Disorder and Panic Disorder (With or Without Agoraphobia) in Adults. Management in Primary, Secondary and Community Care. NICE: London.
Pagel C, Richards D and Utley M (2012). A mathematical modelling approach for systems where the servers are almost always busy. Computational and Mathematical Methods in Medicine. ID:290360, doi:10.1155/2012/290360.
Pilling S, Whittington C, Taylor C and Kendrick T (2011). Identification and care pathways for common mental health disorders: Summary of NICE guidance. British Medical Journal 342: d2868.
Richards D and Suckling R (2009). Improving access to psychological therapies: Phase IV prospective cohort study. British Journal of Clinical Psychology 48 (4): 377–396.
Richards D et al (2010). Developing Evidence Based and Acceptable Stepped Care Systems in Mental Health Care: An Operational Research Project Final Report. NIHR Service Delivery and Organisation programme: London.
Richards DA et al (2012). Delivering stepped care: An analysis of implementation in routine practice. Implementation Science 7: 3.
Acknowledgements
The study was funded by the NIHR-SDO (08/1504/109). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR-SDO programme or the Department of Health. The UCL Clinical Operational Research Unit receives funding from the UK Department of Health. David Richards acknowledges funding from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care. We thank the site-based NHS audit clerks who collected and collated the data on patient throughputs and to Kerry Cipriano and Joanne English who provided administrative support. We acknowledge the contribution of the NHS clinical staff, patients, managers and commissioners who were involved in testing the toolkit.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vasilakis, C., Pagel, C., Gallivan, S. et al. Modelling toolkit to assist with introducing a stepped care system design in mental health care. J Oper Res Soc 64, 1049–1059 (2013). https://doi.org/10.1057/jors.2012.98
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1057/jors.2012.98