Commentary on Sawrikar et al.: Using Staged Care to Provide “Right Care First Time” to People With Common Affective Disorders

What is it about?

Vilas Sawrikar and colleagues in this issue present staged care as a novel service delivery element for people with affective disorders, aiming to deliver “the right level of care first time”. Extending a model developed for youth to: childhood (5-11 years); youth and adults (12-54 years); and older adults (55 years and older), they engage with important aspects of health care including decision-making based on knowledge of typical clinical course, risk and patient preference. Staging as presented includes secondary prevention, important because the latter can often be overlooked – acute care may understandably be prioritised above prevention. For affective illness, a preventive focus is critical considering how prone depression is to relapse and recurrence. The authors identify issues and further directions for investigation. Reviewing work on staging in youth, Shah - as cited in the article - identified a need for ‘iterative feedback between concept and operationalization, supported by deep, enduring partnerships between researchers, clinicians, health planners, and young people themselves.’ We suggest this observation will hold for the application of staging concepts across the age ranges; many of our comments converge with suggestions for further work in the paper. Using Shah’s words as a framework may help extend these or bring out some further issues.

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