Stepped psychological care after stroke

Purpose: Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. It is a challenge to manage these problems effectively, particularly in times of resource stringency. One proposal for how to do this has arisen out of an approach to general mental health management: a system of 'stepped care'. Such a system directs intervention by considering level of need, thereby making the most efficient use of available resources. It is the purpose of this article to articulate a stepped psychological care approach for emotional problems after stroke. Method: Narrative review and elaboration of the model proposed by the Department of Health in England for the management of emotional problems after stroke. Results: A stepped care model for the management of emotional problems after stroke is presented in detail, including descriptions of specific interventions and guidance to inform the level of management. Conclusions: The stepped psychological care proposal for emotional problems after stroke requires evaluation but is potentially of use within comparable healthcare systems.