STEPS is the NHS primary care mental health team in South East Glasgow. It is pioneering an approach to offering services to people with common mental health problems, such as anxiety and depression.
STEPS began in 2005, as part of South East Glasgow Community Health and Care Partnership (CHCP). The remit was early intervention and prevention of common mental health problems with the hard-to-reach population of South East Glasgow. The thinking behind the initiative was taking a different approach to mental health care in the community, offering a wide range of interventions beyond one-to-one therapy during the day.
The project is open to working in partnership with other organisations in the community, and actively encourages links to other services. These include:
To engage with a hard-to-reach population, STEPS had to think creatively. Dr Jim White, STEPS team leader, explains,
'Particularly in deprived areas, there are issues with people not approaching their GP to discuss mental health issues. We’ve moved away from traditional one-to-one therapies towards complete self-referral, and we provide choice.
'People can come to an advice clinic where we can triage them onto other services. We also offer ‘call back’ where you call and leave a message and someone will get back to you within nine hours. We are determined not to have waiting lists.'
STEPS also runs a psycho-educational class called 'Stress Control', which regularly reaches more than 100 people a week. Jim says, 'We have a range of non-therapist contact services, such websites, where people can download videos and self-help booklets.'
There is also a project called Healthy Reading, with every library in Glasgow now having a mental health section. 'Literacy is of course an issue,' Jim says, 'so we’ve put together a couple of DVDs. One called ‘Everything you ever wanted to know about stress but were afraid to ask’ which features Glasgow stand-up comedians has gone down particularly well with the most hard-to-reach people.'
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Feedback from service users and GPs has been overwhelmingly positive. In the previous GP-referral approach, completion rates in individual cognitive-behavioural therapy were 31%. With STEPS call-back, they are now 79%.
Research evaluation into the initiatives used has also been excellent, showing, for instance, that the Stress Control class works at least as well as individual therapy (Kellett et al (2008), British Journal of Clinical Psychology).
Glasgow STEPS website receives more than 800,000 hits each month.
'Mental health services should leave the clinic and not be so risk averse,' says Jim. 'So much of it is 'you come to us', but it is important to go out into the communities.
'Another message is to work in partnership with other organisations in the community who can add value to services. In the current climate, this is even more important.'
STEPS is building on preventative projects such as a ‘self-help’ package for GPs – offering an alternative to prescribing anti-depressants. There is also a move towards starting to look more holistically at people’s lives, including social issues such as lack of exercise and poor diet in the interventions offered.The STEPS approach is now being emulated across the UK.
Dr Jim White STEPS Team Leader STEPS NHS Primary Care Mental Health Team Glasgow South EastTel: 0141 433 4934 Email:
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