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Steps going beyond the tip of the iceberg Jim White

Steps going beyond the tip of the iceberg Jim White. Problems: mental health. 43% of us will have a mental health problem Stigma, mental health literacy office hours, one to one, passive waiting lists what’s wrong or what’s strong? are ‘cure’ models appropriate for all?

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Steps going beyond the tip of the iceberg Jim White

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  1. Stepsgoing beyond the tip of the icebergJim White

  2. Problems: mental health 43% of us will have a mental health problem Stigma, mental health literacy office hours, one to one, passive waiting lists what’s wrong or what’s strong? are ‘cure’ models appropriate for all? mediocre outcomes and high relapse high DNA, high drop-out the link to deprivation

  3. Designed in CaliforniaDelivered in Craigmillar?

  4. Why separate bio from psycho from social? The impact of deprivation

  5. Male life expectancy, WHO (2008)

  6. Do traditional services work in deprived areas?

  7. SIMD (%) Indiv tx referrals

  8. SIMD (%) Indiv tx referrals Indiv tx completers

  9. How do we intervene earlier?

  10. CORE-OM Mood Matters Exercise Class Stress Control Anx/dep workshop Connect (soc anxiety) Advice Clinic Individual therapy Severe Moderate to Severe Moderate Mild Low Level Healthy Over 3,000 referrals to Groups, 1 to 1, and Workshops each year. 49% anti-depressants

  11. Why don’t we intervene much earlier?

  12. 50% of adult mental health problems develop before the age of 14

  13. STEPS PCMHT South east Glasgow 102,000 (84,000 adults), deprived 16+ ‘mild to moderate’ mental health problems 5 full-time; 2 part-time therapists

  14. The STEPS model

  15. STEPS goals very high volume, no waiting lists easy to return to service horses for courses enough work to go around so skill-sharing / working with others ‘greeters’ not ‘bouncers’

  16. Reducing stigma Community venues ‘Classes’ not ‘Group therapies’ ‘Stress’ not ‘depression’ Normalisation model

  17. Usual suspects Vs The hard to reach 50% do not seek help; GPs miss/misdiagnose 50% Services can become more accessible but….

  18. Accessible services time venues choice personal relevance Helping people act Reduce demoralisation perfect service

  19. All services are self-referral

  20. Gardening club CMHTs Social Work Accident and Emergency Ante-natal clinics Housing Associations Job Centres Elderly lunch clubs Residents Associations Bingo Halls Community Halls Betting shops Police Libraries Employment support Bowling clubs Youth Clubs Vol Orgs CABs Domestic abuse Pubs Carers Cafes Victim Support Chemists GPs Churches / Mosques Colleges Workplaces Mother & toddlers

  21. 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 اردو بولنے والوں کے لئے مدد Partner organisations Stay in touch with STEPS

  22. Therapist contact examples

  23. Advice Clinic Appointment same week 1/3 attending live in 15% Highest Deprivation Area 83% Attendance Rate 85% people attending the Advice Clinic have not accessed mental health services before Higher CORE scores than indiv tx

  24. ‘Stress Control’ 6 session didactic CBT ‘evening/ afternoon class’ Community venue, rolling programme Walk in off the street, no assessment, no attendance sheet Partners/friends encouraged to attend Easily understood booklets 30-140 in each class Normalising: men, deprivation As good as individual treatment? * (*Kellett et al, 2007, BJCP)

  25. Rolling programme of workshops • Examples: • Assertiveness • Self-esteem • Sleep • Work stress • Invite contributors, e.g. • welfare rights • medication • debt

  26. Non-therapist contact examples

  27. Replaced Book Prescribing all Glasgow libraries Extending to physical health Over 1800 books borrowed each month But help or hinder?…reading ease

  28. Adapted from Martinez et al, 2008

  29. ‘Steps out of Stress’ series Stress (mixed anxiety/depression) * # Stress (teenagers) Panic * Insomnia * Self-esteem Relaxation Fatigue Getting more active Psychosis So you’ve had a baby? Whole Life book Work stress Anger Alcohol Anti-depressants * Bereavement Trauma Flying phobia Height phobia Health anxiety Phobias (general) Agoraphobia Getting motivated Assertiveness Social anxiety OCD reading <9 years 20-40 pages website * Urdu #Polish, Slovak

  30. 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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