Steps going beyond the tip of the iceberg Jim White.

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