16 June 2011
The new NICE clinical guideline 123 focuses on improving access to services for people with common mental health disorders. This involves improving identification and recognition of these disorders and provides advice on treatment, referral and developing local care pathways. It brings together advice adapted from existing guidelines with new recommendations.
Health care professionals, managers and commissioners should familiarise themselves with this guideline and collaborate to develop local care pathways that promote access to services for people with common mental health disorders. Health care professionals should be alert to possible depression or anxiety and follow the stepped care approach to treatment outlined in the guideline with regard to identification, assessment, treatment and referral for treatment.
This NICE guideline, issued in May 2011, advocates a stepped-care approach for organising the provision of services and to help people with common mental health disorders, their families and carers, and healthcare professionals to choose the most effective interventions.
- Step 1 covers identification, assessment, psychoeducation, active monitoring and referral for further assessment and interventions, which is common for all disorders. For suspected anxiety and depression the guideline suggests simple screening questions, to aid in identifying whether further assessment/referral is appropriate.
- Step 2 covers treatment and referral advice for subthreshold symptoms and mild to moderate disorders. Low-intensity psychological interventions are generally recommended for all people with anxiety disorders and depression. Although there are certain circumstances where drug treatment can be considered for people with depression, this should not be offered routinely. In addition at this step, consideration should be given to psychosocial interventions, i.e. informing people about self-help groups, support groups and other local and national resources, and to educational and employment support services.
- Step 3 covers treatment and referral advice for persistent subthreshold symptoms, mild to moderate disorders with inadequate response to initial interventions, or moderate to severe disorders. High-intensity psychological interventions and/or drug treatment is recommended at this stage, together with psychosocial interventions.
The guideline recommends that local care pathways should be developed to promote implementation of key principles of good care. Clinicians, managers and commissioners should work together to design these local care pathways, requirements for which are provided in detail in the guideline.
Other NICE guidelines are referred to for recommendations focused solely on specialist mental health (e.g. depression, generalised anxiety disorder and panic disorder, obsessive compulsive disorder and post-traumatic stress disorder).
Improving access to psychological interventions
Other resources to support practitioners, service providers and commissioners in providing psychological interventions for common mental health disorders can be found on the Improving Access to Psychological Interventions (IAPT) website. The IAPT programme was set up to assist the NHS in implementing NICE guidelines for people suffering from depression and anxiety disorders.
More information on the treatment of depression and anxiety can be found on the CNS and mental health section of NPC
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