STEPS: Going beyond the tip of the iceberg. A multi‐level, multipurpose approach to common mental health problems
| DOI | https://doi.org/10.1108/17465729200800007 |
| Published date | 01 August 2008 |
| Pages | 42-50 |
| Date | 01 August 2008 |
| Author | Jim White,A Joice,S Petrie,S Johnston,D Gilroy,P Hutton,N Hynes |
| Subject Matter | Health & social care |
STEPS is a primary care mental health team that has attempted to develop a very high volume
multi-level, multi-purpose service for those with mild to moderate problems. The service attempts
to overcome many of the limitations of more traditional services.This paper describes the ser vices
contained within the six level model.
STEPS: Going beyond the tip of
the iceberg.A multi-level, multi-
purpose approach to common
mental health problems
Jim
White,A Joice,
S Petrie,S Johnston,
D Gilroy,P Hutton
and N Hynes
STEPS Primary Care
Mental Health Team,
South-East
Community Health Care
Partnership,
Glasgow and Clyde
Primary Care NHS Trust
Correspondence to:
Dr Jim White
Govanhill Workspace
69 Dixon Road
Glasgow G42 8AT
UK
0141 433 4934
jim.white@ggc.scot.nhs.uk
PRACTICE
42 journal of public mental health
vol 7 • issue 1
As part of the development of the
mental health services in Greater
Glasgow NHS (now Greater
Glasgow and Clyde NHS), a new
tier of primary care mental health
teams (PCMHTs) has been established and
managed within community health care
partnerships (CHCPs). Health, social work and
voluntary organisations are all part of the CHCPs.
STEPS is the PCMHT providing services to
south-east Glasgow CHCP. The service began in
early 2005. The remit of the PCMHTs is to provide
care to adults (16yrs+) with mild to moderate
mental health difficulties. Community mental
health teams (CMHTs) provide services to those
with moderate to severe mental health problems.
Unlike CMHTs, we have no upper age limit. There
has been considerable local flexibility in deciding
how teams operate and develop although stepped-
care approaches are expected to be put in place. We
were clear in south-east Glasgow that we did not
want ‘more of the same’ but rather wanted to
develop a ‘multi-purpose, multi-level’ approach.
Based on a model proposed by White (2000a),
STEPS was specifically designed to provide a radical
approach to mental health in primary care with the
aim of challenging the problems noted in the
previous paper. In particular, we felt it important to
be involved with mental health awareness raising,
early intervention and prevention, working with
others when practicable as well as providing a range
of therapeutic interventions. We intended to
provide services that were effective, efficient,
equitable, acceptable and accessible (Department of
Health, 2004). We believe in a ‘horses for courses’
approach and do not accept the primacy of
individual therapy in primary care mental health.
Our role as ‘gatekeepers’ to the service differs from
more traditional services which, too often, take on
the role of ‘bouncer’ whose main task is to limit
access to services. ‘Gatekeepers’ should act more as
‘greeters’ welcoming as many people as possible into
the service. We have developed STEPS to try to
make this a realistic option.
The STEPS team
STEPS comprises four workers from a CBT
background – two clinical psychologists and two
occupational therapists; two assistant psychologists
and one (volunteer) peer-supporter. In addition,
four person-centred (PC) counsellors who were
GP-attached were brought into the team. An
additional PC counsellor is funded by Glasgow
Social Work Department. 1.6 workers provide
admin services. We are a Scottish Government
Exemplar Project.
South-east Glasgow
Demographically similar to the rest of Glasgow, the
south-east contains significant levels of deprivation.
© Pavilion Journals (Brighton) Ltd
Keywords
CBT
stepped-care
primary care
common mental health
problems
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