Steps going beyond the tip of the iceberg Jim White
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Stepsgoing beyond the tip of
the iceberg
Jim White
Problems: mental health
o 43% of us will have a mental health problem
o Stigma, mental health literacy
o office hours, one to one, passive
o waiting lists
o what’s wrong or what’s strong?
o are ‘cure’ models appropriate for all?
o mediocre outcomes and high relapse
o high DNA, high drop-out
o the link to deprivation
Designed in CaliforniaDelivered in Craigmillar?
Why separate bio from psycho from
social?The impact of deprivation
Male life expectancy, WHO (2008)
Lenzie 82
Japan 79
North Korea 71
Iraq 67
Washington DC (Black) 63
Delhi, India 62
CALTON 54
Do traditional services work in deprived areas?
SIMD (%)
Indiv tx referrals
0
10
20
30
40
1 2 3 4 5 6 7 8 9 10
SIMD (%)
0
20
40
60
80
1 2 3 4 5 6 7 8 9 10
Indiv tx referrals
Indiv tx completers
0
10
20
30
40
1 2 3 4 5 6 7 8 9 10
How do we intervene earlier?
Severe
Moderate to Severe
Moderate
Mild
Low Level
Healthy
CORE-OM
Mood Matters
Exercise Class
Stress Control
Anx/dep workshop
Connect (soc anxiety)
Advice Clinic
Individual therapy
Over 3,000 referrals to Groups, 1 to 1, and Workshops each year.
49% anti-depressants
Why don’t we intervene much earlier?
50% of adult mental health
problems develop before the age
of 14
STEPS PCMHT
o South east Glasgow
o 102,000 (84,000 adults), deprived
o 16+
o ‘mild to moderate’ mental health problems
o 5 full-time; 2 part-time therapists
Groups
Single contacts
Non face-to-face work
Working with others
Population levelAwareness raising; community involvement;
early intervention/prevention
Indiv tx
The STEPS model
STEPS goals
o very high volume,
o no waiting lists
o easy to return to service
o horses for courses
o enough work to go around so skill-sharing /
working with others
o ‘greeters’ not ‘bouncers’
Reducing stigma
• Community venues
• ‘Classes’ not ‘Group therapies’
• ‘Stress’ not ‘depression’
• Normalisation model
Usual suspects Vs The hard to reach
o 50% do not seek help; GPs
miss/misdiagnose 50%
o Services can become more
accessible but….
Accessible services
time
venues
choice
personal relevance
Helping people act
Reduce demoralisation
perfect
service
All services are self-referral
Job Centres
Bowling clubsYouth Clubs
GPs
Social Work
Housing Associations
Police
Libraries
Mother & toddlers
Gardening club
Residents Associations
CMHTsAccident and Emergency
Pubs
Community Halls
Vol Orgs
Churches / Mosques
Colleges
Cafes
Elderly lunch clubs
CarersVictim Support
Bingo Halls
Workplaces
Chemists
Betting shops
Ante-natal clinics
Employment support
Domestic abuseCABs
New STEPS Brochure
Therapist contact• Advice Clinic• ‘Call Back’
Groups• Stress Control• Mood Matters• First Steps• Step into Shape• Connect• MindGym• BodyGym• LifeGym• Day workshops
Non-therapist contact
• Healthy Reading
• Steps out of Stress booklets
• www.glasgowsteps.com
• www.glasgowhelp.com
• ‘100 people’ DVD
• ‘Everything you always..’ DVD
• STEPS sounds / podcasts
Other
• Mental health info and advice
• مدد لئے کے والوں بولنے اردو• Partner organisations
• Stay in touch with STEPS
Therapist contact
examples
Advice ClinicAdvice Clinic
o Appointment same week
o 1/3 attending live in 15% Highest Deprivation Area
o 83% Attendance Rate
o 85% people attending the Advice Clinic have not
accessed mental health services before
o Higher CORE scores than indiv tx
‘Stress Control’
o 6 session didactic CBT ‘evening/ afternoon class’
o Community venue, rolling programme
o Walk in off the street, no assessment, no attendance sheet
o Partners/friends encouraged to attend
o Easily understood booklets
o 30-140 in each class
o Normalising: men, deprivation
o As good as individual treatment? *
(*Kellett et al, 2007, BJCP)
Rolling programme of workshopsExamples:
•Assertiveness
•Self-esteem
•Sleep
•Work stress
Invite contributors, e.g. •welfare rights
•medication
•debt
Non-therapist contact
examples
• Replaced Book Prescribing
• all Glasgow libraries
• Extending to physical health
• Over 1800 books borrowed
each month
• But help or hinder?…reading
ease
Reading
age
% pop understand
Readability
Feeling Good (Burns) 15.4 40 Fairly difficult
Mind over Mood (Padesky) 15 40 Fairly difficult
Manage your Mind (Butler) 14 75 Standard
Overcoming depression (Gilbert) 14 75 Standard
Controlling your Stress (STEPS) 8.9 86 Easy
Adapted from Martinez et al, 2008
‘Steps out of Stress’ series
Stress (mixed anxiety/depression) * #
Stress (teenagers)
Panic *Insomnia *Self-esteemRelaxationFatigueGetting more activePsychosisSo you’ve had a baby?Whole Life bookWork stress
AngerAlcohol
Anti-depressants *BereavementTraumaFlying phobiaHeight phobiaHealth anxietyPhobias (general)AgoraphobiaGetting motivatedAssertivenessSocial anxietyOCD
reading <9 years 20-40 pages website * Urdu #Polish, Slovak
Information
Self-assessment
Interactive self-help
Other sections Downloads: videos, audio, booklets, podcasts
BBC programmes
On-line booking
Spirituality section
Art gallery www.glasgowsteps.com
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