I can try, and then maybe my colleagues will help me with that a little bit.
The whole concept of stepped care is the idea that, if people have very mild symptoms, you want to be able to give them the least invasive treatments first and the ones that are most easily available. Then, you would want to add on another, higher step—something that takes more resources, takes more of their time, or maybe has more safety issues associated with it—only if they really needed it.
What we normally think of as step one of care for perinatal mental health is education, self-guided treatments, and public health nurses' supportive counselling. There is so much evidence, for example, for peer support—as we talked about today—as well as for protecting people's sleep and dealing with all sorts of social issues that are happening, and the support.
If those things don't work, then you'd want to move to the next step of care, which maybe involves formal psychotherapy, like cognitive behaviour therapy or interpersonal psychotherapy. If that doesn't work, you'd want to move up another step, maybe to medications. Then, if something is very severe, you might be talking about hospitalization or different kinds of more serious treatments.
You also have to remember that in stepped care, depending on someone's level of severity, you might give them the step one things, but also realize that they need step two. If somebody is very ill—let's say, suicidal—you would move them to step four right away. Stepped care really is about what step they need. Sometimes you can go up a little bit, but sometimes, if someone is really sick, you might start them at step three.
Does that help?