The New Savoy Partnership Website

Towards Best Practice: How to design ‘stepped care pathways’

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SEMINAR 1: To be efficient, effective and acceptable to patients
Matt Fossey, Deputy Director, Care Services Improvement Partnership, National Institute for Mental Health in England
Professor Karina Lovell, Professor of Mental Health, University of Manchester

SEMINAR 2: To achieve equity, as well as access
Dr John Cape, Head of Psychology, Camden and Islington, Mental Health and Social Care Trust
John Mellor-Clark, Director, CORE IMS

SEMINAR 3: To improve quality, as well as access
Dr Paul Walters, Specialist Psychiatrist, MRC Fellow and Programme Leader, MSc in Mental Health Services Research Institute of Psychiatry

Matt Fossey

Matt Fossey took a Masters Degree in Social Work at the University of Birmingham. where he concentrated on social work and mental health (particularly the forensic social work arena) and wrote his dissertation on the experiences of families of murder victims within the criminal justice system. He has worked as an Approved Social Worker and mental health manager for East Sussex County Council and Brighton and Hove City Council, and Warwickshire County Council.

In 2004 Matt started work for the National Institute for Mental Health (NIMHE) as a member of the core Service Improvement Team. Since September 2005 he has been working on the Improving Access to Psychological Therapies Programme, one of the Care Services Improvement Partnership’s (CSIP) key work-streams and a Government White Paper commitment. Since March 2007 he has been the Deputy Director of the programme.


A stepped care model for the delivery of health care has been described in the literature (notably Bower and Gilbody 2005: The British Journal of Psychiatry (2005) 186: 11-17). NICE also recommends using this model as a way of delivering psychological interventions for people with depression and different anxiety disorders. The delivery of interventions using a stepped care approach is inconsistent and the principles are not well understood. This session will give participants the opportunity to understand the theory that underpins stepped care and will offer those attending a chance to discuss the practical application of stepped care, the barriers to success and how these can be overcome.

Biography: Dr John Cape

John Cape is Head of Psychological Therapies, Camden and Islington Mental Health and Social Care Trust. He has worked for over 30 years in the NHS as a clinical psychologist, manager of psychological therapy services and researcher with a particular interest in mental health in primary care. He is co-investigator on a current SDO funded research project on implementation of stepped care systems in mental health.


There is good evidence of inequity in psychological therapy provision. Black and minority ethnic groups, people who do not speak English, older people, people of lower social-economic status, young men, people who are housebound as a result of physical illness or disability are all less likely to receive psychological therapy. If they do, they will have less choice and the psychological therapy they receive may be of lower quality. There are also inequities between parts of the country and between GP practices.

The workshop will explore how stepped care pathways may be designed to achieve equity of access to and quality of psychological therapy provision for groups who historically have been disadvantaged in provision.

Issues covered in the workshop will include:

  • Access, triage and assessment systems including place of self-referral and outreach, and initial triage by skilled staff determining initial step vs. all patients starting by receiving a low intensity intervention.
  • Choice and diversity of interventions, staff and supporting materials.
  • Measurement systems for determining appropriate steps and guiding decisions on stepping up and stepping down.

Biography: John Mellor-Clark

John Mellor-Clark is a research psychologist who's been engaged in the evaluation of psychological therapies and counselling for the past 15 years. Currently, he's Director of CORE Information Management Systems Ltd who specialise in providing training, benchmarking and data management services to users of CORE System tools.