STEPS: working in deprived communities to reach the hard to reach. Dr Jim White Consultant Clinical Psychologist Scotland

Transcription

1 STEPS: working in deprived communities to reach the hard to reach Dr Jim White Consultant Clinical Psychologist Scotland

2 Mental disorders are the core health challenge of the 21 st century Wittchen et al (2011) European Neuropsychopharmacology, 21,

3 Part 1: The problems

4 Numbers

5 38% of the EU pop suffers from a mental disorder (12 m prevalence) low treatment rates and grossly inadequate treatment

6 In England, only 4% of those suffering from CMHPs stress receive appropriate help IAPT 5

7 1 in 7 Scots takes an antidepresant

8

9 Damage

10 Russ et al, 2012, BMJ Clinical-level mental health problems:

11 Russ et al, 2012, BMJ Clinical-level mental health problems: 67% more likely to die of CVD and cancers

12 The Usual suspects versus the hard to reach

13 Usual Suspects Realise they have a problem Cope with stigma Motivated Go to GP and explain in psychological terms Assertive Can attend day-time sessions Identify with therapy model More likely women, middle class?

14 Usual Suspects Hard to Reach Realise they have a problem Cope with stigma Motivated Go to GP and explain in psychological terms Assertive Can attend day-time sessions Identify with therapy model More likely women, middle class

15 Deprivation

16 o 50% F / 75% M do not seek help for mental health o double prevalence rates o stigma (are women more prone to anxiety/depression?)

17 Toryglen

18 Toryglen 1 in 5 adults take an antidepressant

19 Early intervention

20 49% of adult mental health problems develop before the age of 14 US National Comorbidity Survey

21 Edinburgh Lothian 59% of young men who commit suicide have had no contact with mental health services

22 How do we intervene much, much earlier?

23 1 st trimester anxiety

24 Services

25 demoralised demotivated not psychologicallyminded

26 Hurdles

27 Waiting lists

28 Risk averse

29 Too much focus on 1-to-1? Lack of choice?

30 Our guilty secret? high DNA, drop-out, poor outcomes, high relapse rates

31 Part 2: The STEPS service

32 o South east Glasgow o 130,000 o Deprived area o 16+ o common mental health problems o NHS: free at the point of delivery

33 Indiv Classes Single contacts Non face-to-face work Working with others Population level Awareness raising; community involvement; early intervention/prevention

34 Indiv No mental health record Classes Single contacts Non face-to-face work Working with others Population level Awareness raising; community involvement; early intervention/prevention

35

36 leave the clinic and go hunting and

37 leave the clinic and go hunting and raise awareness, counter stigma

38 leave the clinic and go hunting and raise awareness, counter stigma prevent, promote and intervene early

39 leave the clinic and go hunting and raise awareness, counter stigma prevent, promote and intervene early reach the hard to reach so

40 leave the clinic and go hunting and raise awareness, counter stigma prevent, promote and intervene early reach the hard to reach so work with others

41 Finding out about the service: The service brochure

42

43 avoid mental

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

45 Therapist contact Advice Clinic Call Back Classes Stress Control Mood Matters First Steps Step into Shape LifeGym Day workshops Non-therapist contact Healthy Reading Steps out of Stress booklets 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

46 Finding out about the service: Other access points

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49 Going to where people are

50 Leaflets and posters, e.g. Mosques

51 groups

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53 Service brochures Booklets DVDs Sign up for services

54 Service brochures Booklets DVDs Sign up for services

55

56 Usual suspect territory

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58 Hard to reach territory

59

60 Very hard to reach territory

61 Pubs Beer mats Posters Service brochures

62 Classes and workshops

63 mixed anxiety/depression depression peer-support exercise social anxiety recovery/well-being

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65

66 1 6 session didactic CBT class Community venue, rolling programme (daytime); (evening) Normalising (men)

67 2 Partners/friends encouraged to attend No discussion of personal problems No attendance sheet / walk in off the street As good as individual tx?

68 Recovery Individual therapy 50% Stress Control 59% Sheffield IAPT, BABCP, Leeds, 2012

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70 Getting beneath the tip of the iceberg: Reaching the hard to reach

71 The Toryglen project Kick off with stand-up comedy Newsletter in every letterbox Taster classes / workshops Advice Clinics in GP practice Head above water (psychosocial) roadshow Get the media s attention The Choir

72 all Glasgow libraries Extended to physical health Over 1800 books borrowed each month But help or hinder? reading ease

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

74 E-newsletters stress informative, relevant, entertaining quarterly as many organisations as we can find

75 But what about those who don t want to / can t read?

76 DVDs Everything you always wanted to know about stress (but were afraid to ask) 100 People

77 DVDs Everything you always wanted to know about stress (but were afraid to ask) 100 People AUDIO/VIDEO Relaxation English, Urdu, Polish (CDs and on-line) Video (online) Spoken-word information (online) Spoken-word booklets (online)

78 Dvd cover YouTube and

79

80 Websites antidepressantsteps.com glasgowhelp.com glasgowsteps.com

81 BBC programmes On-line booking Spirituality section Art gallery / personal stories Service information >5 million hits pa >70,000 booklets in 3 years

82 More than enough work to go around So work with others

83 Hard to reach for us Easier to reach for others The Strategy Factory

84 Targeted in deprived areas Life skills Strengths / Recovery-based (WRAP)

85 Targeted in deprived areas Life skills Strengths / Recovery-based (WRAP)

86 DVDs, match programmes, video screen

87 Radio Ramadhan daily stress tips Awaz FM phone-ins Imams: mental health awareness training Translation of booklets/audio CDs into Urdu Articles in Urdu papers (Ujala)

88 Schools Awareness Project

89 Working with GPs Alternatives to antidepressants Training GPs to identify and triage

90 GPs Vol Orgs Podiatrists

91 Thank you