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National Disaster Mental Health and Wellbeing Framework 2021

3.2 Stepped care and the IASC guideline

Stepped care is the nationally adopted model that informs mental health planning and service provision in Australia. Like the IASC guideline, it is based on the idea that people’s needs and preferences vary, and the type of service provision should vary accordingly. The principles informing both stepped care and the IASC mental health and psychosocial support pyramid used in this Framework are similar. Both models:

  • • propose low-intensity supports as an early ‘step’, followed by more intensive interventions and treatment if a person requires them; and
  • • emphasise that people need to be able to increase or reduce their level of support as their needs change.

However, specific to a disaster, the IASC guideline:

  • • has a large base, as the majority of the population is likely to need low intensity services following a significant crisis or trauma; and
  • • emphasises community, as well as individual and family recovery, noting that in emergencies, community connections (sometimes called ‘social capital’) are a critical resource which need to be nurtured and strengthened.

The following three-tiered matrix of psychological intervention and skills was developed through expert consensus to accompany the stepped care model of treatment and support following the Black Saturday bushfires.14 It has been updated for this Framework to reflect emerging evidence on recent Level 2 interventions.

The IASC pyramid and levels in the matrix align as follows:

  • • Levels 1 and 2 align with focused non-specialised support.
  • • Level 3 aligns with specialised services.

Table 1 The three-tiered disaster mental health response matrix


Psychological First Aid (Level 1) Skills for Psychological Recovery (Level 2) Skills for Life Adjustment and Resilience (Level 2) Problem Management Plus (Level 2) Intensive Mental Health Treatments (Level 3)
Population level support of common distress responses in the immediate aftermath
Support of individuals with mild to moderate sub-clinical levels of distress
Support of individuals with ongoing distress, adjustment issues and sub-clinical mental health problems
Support of individuals with symptoms of common mental health problems and self-identified practical problems
Treatment of minority experiencing significant mental health conditions
Core Principles
  1. 1. Promote safety
  2. 2. Promote calming
  3. 3. Promote selfefficacy
  4. 4. Promote connectedness
  5. 5. Promote hope
  6. 6. Promote help
  1. 1. Gathering information and prioritising assistance
  2. 2. Problem-solving skills
  3. 3. Promoting positive activities
  4. 4. Managing reactions
  5. 5. Promoting helpful thinking
  6. 6. Rebuilding healthy social connections
  1. 1. Healthy living
  2. 2. Managing strong emotions
  3. 3. Getting back into life
  4. 4. Coming to terms with the disaster
  5. 5. Managing worry and rumination
  6. 6. Maintaining healthy relationships
  1. 1. Understanding adversity
  2. 2. Managing stress
  3. 3. Managing problems
  4. 4. Get going, keep doing
  5. 5. Strengthening social support
  6. 6. Staying well and looking forward
Evidence-based Interventions
  1. 1. Exposure treatments
  2. 2. Cognitive therapy
  3. 3. Goal setting/activity scheduling
  4. 4. Managing anger
  5. 5. Treatment of complicated grief
  6. 6. Managing comorbidity
  7. 7. Pharmac-otherapy
Disaster relief workers, volunteers, community leaders, generic workers
Primary care providers including: GPs, allied health professionals, counsellors, welfare staff
Community-based or frontline health or disaster workers
Community workers, health workers, lay helpers, mental health professionals
Specialist mental health care staff including: psychologists, psychiatrists