31 October 2011

Advice from NICE Aims to Improve Commissioning of Services for People with Common Mental Health Disorders

NICE has today published a guide for commissioners on services for people with common mental health disorders. The guide is the latest in its series of good practice guides to support commissioners in designing high quality, evidence-based services to improve outcomes for patients and to help the NHSmake better use of its resources. The guide draws on the recent NICE clinical guideline on the identification of and pathways to care for common mental health disordersi, as well as other relevant NICE guidance and quality standardsii.

Common mental health disorders include depression, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Around 17% of the population is affected by common mental health disorders at any one time and they account for one in five of all work days lost and cost UK employers £25bn each year. If left untreated, the outcomes of these conditions can be serious - for example, depression is the commonest cause of suicide in the UK.

Approaching the commissioning of mental health services as part of an integrated care pathway and illustrated with service models, the NICE guide for commissioners identifies the potential benefits of effectively commissioning services for people with common mental health disorders using the stepped care model. This approach allows the least intensive intervention that is appropriate for a person to be provided first, and people can step up or down the pathway according to changing needs and in response to treatment. The guide for commissioners contains a commissioning and benchmarking tool which commissioners can use to assess local service requirements.

Professor Linda Gask - Professor of Primary Care Psychiatry, University of Manchester and Honorary Consultant Psychiatrist, Royal College of Psychiatrists and NHS Salford, said: "We know that the costs of common mental health disorders are very high, both in terms of treating those affected and because of the wider economic impact of lost earnings among people of working age. Many people with common mental health disorders do not seek treatment because of the perceived stigma of being diagnosed, and the disorders often go unrecognised by healthcare professionals. The most common treatment remains psychotropic medication, partly due to a lack of access to psychological intervention services. This is despite the fact we know that psychological interventions services that comply with NICE guidance and provide stepped care have better patient outcomes and improved recovery rates. This guide for commissioners outlines a model for the development of local care pathways that promote a stepped-care model of service delivery. Such an approach can increase access to services, improve the cost-effectiveness of treating people with common mental health disorders and provide better outcomes for people who are affected by them."

While the guide for commissioners draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.



About the common mental health disorders guide for commissioners

1. The NICE guide on commissioning services for people with common mental health disorders is available on the NICE website.

2. Details of all the NICE guides for commissioners published to date can be found on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/bytopic.jsp


i. NICE clinical guideline CG123. Common mental health disorders: identification and pathways to care

ii. NICE clinical guideline CG113. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults

NICE clinical guideline CG91. The treatment and management of depression in adults with chronic physical health problems (partial update of CG23)

NICE clinical guideline CG90. The treatment and management of depression in adults (update)

NICE clinical guideline CG31. Obsessive compulsive disorder: core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder

NICE clinical guideline CG26. Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care

NICE clinical guideline (forthcoming). Social anxiety disorder: recognition, assessment and treatment of social anxiety disorder

NICE quality standard: Depression in adults

NICE quality standard (in development): service user experience in adult mental health

NICE pathway: Depression in adults

NICE pathway: common mental health disorders (forthcoming)

About NICE

3. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

4. NICE produces guidance in three areas of health:

  • public health -guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies -guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice -guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

5. NICE produces standards for patient care:

  • quality standards- these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework -NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

6. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.