Identifying and managing common mental health disorders. New NICE guideline focuses on primary care and the stepped care model.

nhs evidence eye

NICE have published a new guideline today with the usual collection of supporting documents.  Here’s the blurb from their website:

This clinical guideline offers evidence-based advice on the care and treatment of adults who have common mental health disorders, with a particular focus on primary care. It brings together advice from existing guidelines and combines it with new recommendations on access to care, assessment and developing local care pathways for common mental health disorders. Common mental health disorders include depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post‑traumatic stress disorder and social anxiety disorder.

The guideline covers the care provided by primary, community, secondary care and other healthcare professionals who have direct contact with, and make decisions concerning the care of adults with common mental health disorders.

It will also be relevant to the work, but will not cover the practice, of those in occupational health services, social services the independent sector.

The guideline promotes the development of local care pathways that promote the stepped care model.  It encourages collaborative working between primary and secondary care clinicians, managers and commissioners. It also includes treatment and referral advice for mild to moderate disorders.

Here are the summary recommendations in full:

Improving access to services

  • Primary and secondary care clinicians, managers and commissioners should collaborate to develop local care pathways that promote access to services for people with common mental health disorders by: supporting the integrated delivery of services across primary and secondary care; focusing on entry and not exclusion criteria; having multiple means (including self-referral) to access the service.


  • Be alert to possible depression (particularly in people with a past history of depression, possible somatic symptoms of depression or a chronic physical health problem with associated functional impairment) and consider asking people who may have depression two questions: During the last month, have you often been bothered by feeling down, depressed or hopeless? During the last month, have you often been bothered by having little interest or pleasure in doing things? If a person answers ‘yes’ to either of the above questions, consider depression and follow the recommendations for assessment.
  • Be alert to possible anxiety disorders (particularly in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or in those who have experienced a recent traumatic event). Consider asking the person about their feelings of anxiety and their ability to stop or control worry, using the 2-item Generalized Anxiety Disorder scale.

Developing local care pathways

  • Primary and secondary care clinicians, managers and commissioners should work together to design local care pathways that promote a stepped-care model of service delivery that: provides the least intrusive, most effective intervention first; does not use single criteria such as symptom severity to determine movement between steps; monitors progress and outcomes to ensure the most effective interventions are delivered and the person moves to a higher step if needed.
  • Primary and secondary care clinicians, managers and commissioners should work together to ensure effective communication about the functioning of the local care pathway. There should be protocols for: sharing and communicating information with people with common mental health disorders, and where appropriate families and carers, about their care; sharing and communicating information about the care of service users with other professionals (including GPs); communicating information between the services provided within the pathway.

Common mental health disorders: identification and pathways to care. NICE, May 2011.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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