Bridging the Gap in Mental Healthcare: Aligning Treatment Intensity with Clinical Need
Yasmin Bou Karim, MPH
Founder | Public Health & Global Health Expert | Driving Holistic Mental Health Solutions | Innovator in Health Tech & FinTech
This article provides a high-level overview of the stepped and stratified care approach in mental health, with a focus on how Bossa Health applies these principles to deliver structured, responsive, and clinically appropriate care for individuals with moderate to severe needs.
Across the UK, people experiencing moderate to severe mental health conditions often receive care that does not match the level of clinical support they need. While mild symptoms may be managed with interventions such as guided self-help or time-limited therapy, individuals with more complex or severe conditions typically require a greater intensity of care, which may involve structured psychological treatment, pharmacological support, and specialist input.
Intensity refers to both the type and depth of treatment: frequency of sessions, involvement of specialists, and integration of pharmacological and psychological care (Davidson and Tran, 2014; Lo et al., 2006; Andreasen et al., 2013; Ten Have et al., 2013). Yet a persistent gap exists between what people need and what they receive. For example, someone with a personality disorder may be offered only primary care support or stand-alone therapy designed for lower-acuity cases.
This mismatch between clinical need and treatment intensity is a core challenge in mental healthcare. It contributes to symptom escalation, delayed recovery, and disengagement from care. Despite the availability of effective interventions, many people are left in limbo, not “ill enough” for intensive support, but too unwell for low-intensity services. Bossa Health was created to bridge that gap, with a model that focuses on people who require more than ‘standard’, low-intensity options but who are often overlooked or delayed by existing services.
Understanding the Bossa Health Profile
Bossa Health serves those whose mental health needs extend beyond the mild spectrum. Its users frequently experience moderate to severe psychological distress or functional impairment, regardless of formal diagnostic status. A defining feature of this population is the need for timely, structured, and specialist-led care that goes beyond 'standard' low-intensity interventions. This group comprises, but is not limited to, people who are:
Bossa Health also supports people at transitional points in care, including those discharged from specialist services but still in need of oversight, or those whose current care is fragmented, delayed, or no longer meeting their needs.
At its core, the Bossa Health profile reflects people who are falling through the cracks of traditional services: not in crisis, but no longer able to manage with standard options. They need a system that can respond quickly, integrate multiple disciplines, and adapt care to clinical complexity — and that is what we provide.
Why Match Care Intensity to Clinical Need?
The effectiveness of mental health interventions depends not just on what is delivered, but how and when. The National Institute for Health and Care Excellence (NICE) and international guidelines advocate for stepped and stratified care models, where the intensity and type of care are calibrated based on a person’s clinical presentation, diagnostic complexity, and response to treatment.
Severity is often conceptualised in terms of Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses a broad range of diagnosable mental, behavioural, or emotional disorders, varying from mild to severe in impact. SMI, a subset of AMI, refers to conditions that result in significant functional impairment, such as difficulty maintaining employment, relationships, or day-to-day routines. According to the UK Office for National Statistics, around 1 in 6 adults in Great Britain report moderate to severe depressive symptoms (Baker and Kirk-Wade, 2024). Many of these individuals are not engaged in regular care, despite the likelihood of their symptoms affecting daily functioning.
This disconnect between clinical need and the care provided is where intensity of care becomes critical. Intensity reflects not just the frequency and duration of clinical contact, but also other dimensions of service delivery, such as:
When care intensity aligns with clinical need, outcomes improve, not only through remission (symptom reduction), but by restoring stability, preventing escalation, and supporting long-term recovery.
An Integrated Model Backed by Evidence
Bossa Health combines stratified and adaptive stepped care in a single, structured model designed to meet the complex realities of mental healthcare delivery. Every user begins with a comprehensive clinical assessment to determine the appropriate starting point — whether psychological therapy, psychiatric review, or both — based on the severity of symptoms and functional impairment.
This stratified approach ensures that the initial treatment intensity aligns with the user's presentation. From there, adaptive stepped care guides clinical decisions: users whose symptoms persist or worsen may be stepped up to more intensive interventions, such as combined therapy and medication. Those who enter remission can be stepped down to lower-intensity care with continued oversight. This flexibility ensures that treatment is neither prematurely escalated nor insufficient.
Bossa Health’s digital platform enables real-time collaboration between psychologists, psychiatrists, and other professionals, avoiding the fragmentation common in traditional services. Internal referrals, shared decision-making, and continuity of care are built in, especially critical for users with co-occurring or complex needs.
This model is not only clinically sound but evidence-backed. Meta-analyses have shown that stepped care improves treatment response and remission in depression and anxiety disorders (van Straten et al., 2015; Ho et al., 2016), and produces better symptom outcomes for PTSD (Mediavilla et al., 2023). Integrated, stratified approaches help prevent undertreatment of severe cases and overtreatment of milder ones, a persistent issue in primary care and community services.
By combining structured assessment, tailored intensity, and multidisciplinary coordination, Bossa Health translates evidence into everyday practice. This is not just a theoretical model, it is a living system designed to respond dynamically to the real-world needs of people navigating complex mental health challenges. In doing so, we close the gap between what care should look like and what users actually experience.
Aligning Care with Clinical Complexity
The challenge of aligning care with clinical need is not new, but solutions have often fallen short for those requiring more than low-intensity or stand-alone interventions. Bossa Health addresses this by operationalising a model that is both structured and flexible: stratified at entry, adaptive across the course of treatment, and multidisciplinary by design.
By embedding stepped care into a digitally enabled, team-based system, the model allows for responsive adjustments in treatment intensity, coordinated expertise across disciplines, and continuity that reflects the complexity of users’ lived experience. This approach supports clinical precision not only through assessment and triage, but through ongoing oversight and collaboration.
In bringing together evidence-based frameworks with integrated delivery, Bossa Health represents a shift in how care is structured for those whose needs are often underserved: individuals with moderate to severe symptoms, co-occurring conditions, or limited progress in traditional care settings. Rather than offering isolated services, the model delivers a coherent system equipped to manage variation in symptom severity, diagnostic clarity, and treatment response over time.
As mental health systems continue to evolve, models that combine adaptability with accountability will be critical. Bossa Health offers a working example of how this can be achieved, closing the gap between evidence and practice, and between user needs and the care they receive.
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