NICE Impact Mental Health

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NICEimpact mental healthOne in 4 adults experiences a mental healthcondition in any given year, and mental healthconditions are the largest single cause ofdisability in the UK. This report considers howNICE’s evidence-based guidance cancontribute to improvements in the care ofpeople with mental health conditions.This report highlights progress madeby the health and care system inimplementing NICE guidance. Werecognise that change can sometimesbe challenging and may requirepathway reconfiguration. It may alsorequire additional resources such astraining and new equipment.We work with partners including NHSEngland and Public Health Englandto support changes, and we also lookfor opportunities to make savingsby reducing ineffective practice. Wewill explore areas of unwarrantedvariation to understand the challengesof implementing the recommendationsdiscussed in this report.Common mental health disorders p4Over 1 million people received NICE-recommendedpsychological treatments for common mental health disordersin 2017/18. NICE is working with NHS England to assessdigitally-enabled therapies which offer the potential to expandservices further.Severe mental illness p8People with severe mental illness are at risk of dyingmuch earlier than other people. To help improve outcomes,NICE recommendations include early intervention for peoplewith a first episode of psychosis, offering comprehensivephysical health assessments and making psychologicaltherapies available.People’s experience of care p15Survey results suggest that more could be done toensure that people using specialist mental health servicesexperience good care as described by NICE.Spotlight on children andyoung people p18More children and young people are receiving specialist mentalhealthcare but there is unmet need. The NHS Long Term Planand a government green paper lay out plans to transformchildren and young people’s mental health provision.Commentary p20Paul Farmer, Chief Executive of Mind, reviewsrecent achievements and considers NICE’s role in improvingmental healthcare.2

NICEimpact mental healthWhy focus onmental health?NICE impact reports review how NICErecommendations for evidence-based andcost-effective care are being used in priorityareas of the health and care system, helping toimprove outcomes where this is needed most.331885guidelinesquality standardstechnology appraisalsImproving Access to PsychologicalTherapies assessment briefings3interventional procedureguidanceNICE provides evidence-based guidance and advice to helpimprove health and social care services. The uptake of NICEguidance is influenced by close relationships with partnerssuch as NHS England, NHS Improvement and Public HealthEngland (PHE).Since 2002 and the publication of NICE’s first clinicalguideline, on schizophrenia, we have produced an extensivesuite of guidance and quality standards to support theidentification and management of mental health conditions.Our guidance covers common and severe mental healthconditions in children, young people and adults.In 2015, the independent Mental Health Taskforce wasformed to create the Five Year Forward View for MentalHealth for the NHS in England. The NHS Long Term Planbuilds on this strategy and pledges to grow investment inmental health services faster than the overall NHS budget foreach of the next 5 years.NICE guidance is the foundation of many commitments inthese national strategies, including improvements in: access to psychological therapies, physical healthcare for people with severe mental illness,and people’s choice and control over their care.We routinely collect data which give us information aboutthe uptake of our guidance. To produce this report, we haveworked with national partners to select those data which tellus about how NICE guidance might be making a difference inthese priority areas of mental healthcare. They also highlightareas where there is still room for improvement.3

NICEimpact mental healthCommon mental healthdisorders in adultsCommon mental health disorders affect anestimated 1 in 6 adults at any one time. TheImproving Access to Psychological Therapies(IAPT) programme offers NICE-recommendedtreatments for these conditions.Common mental health disordersinclude depression and anxietydisorders such as generalised anxietydisorder, panic disorder, obsessivecompulsive disorder, body dysmorphicdisorder, post-traumatic stress disorderand social anxiety disorder.IAPT has made NICE-recommendedpsychological therapies for theseconditions more widely available butthere remains unmet need. NICE isworking with NHS England to identifyand assess digitally enabled therapieswhich offer the potential to expandservices further.NICE’s guideline on identification and pathways to carefor common mental health problems aims to improve howmental health conditions are identified and assessed.This is supported by a suite of guidance and quality standardson the recognition and management of depression andanxiety disorders.Estimates of the total prevalence of common mental healthdisorders vary, but data from the Quality and OutcomesFramework show that over 4.5 million adults had a diagnosisof depression in 2017/18. This is around 10% of all adultsregistered with a GP, up from around 6% in 2012/13, and thereis wide regional variation. The proportion of people with mentalhealth conditions is higher in areas with more deprivation;poverty can be a cause or consequence of mental ill health.The percentage of adults with a diagnosis of depression ranged from5% to 15% across England’s clinical commissioning groups in 2017/18Increasing access to evidence-based psychological therapiesfor people with common mental health conditions is a priorityin the Five Year Forward View for Mental Health and theNHS Long Term Plan. This section reviews how NICE iscontributing to that ambition.Psychological therapiesNICE recommends psychological therapies as part of astepped-care model for treating common mental healthdisorders. This means providing the least intrusive, mosteffective intervention first, and monitoring progressand outcomes to ensure the person moves to a higherstep if needed. NHS England’s IAPT programme deliverspsychological therapies in line with these recommendations.4

NICEimpact mental health2016/172012/132013/14The number of people who enteredtreatment after referral to IAPTservices, EnglandThe programme began in 2008 and NHS Digital has publishedannual data since 2012. The number of people receiving NICErecommended psychological therapies through the IAPTprogramme has more than doubled since then, from around435,000 in 2012/13 to over 1 million in 800,0001m2015201620172014The Five Year Forward View for Mental Health highlights that,at the time of publication in 2016, around 15% of people withanxiety and depression were being seen by IAPT services.NHS England plans to extend that to 25%, so that at least1.5 million adults each year will access NICE-recommendedcare by 2020/21. The NHS Long Term Plan commits to anadditional 380,000 adults being able to access IAPT servicesby 2023/24.IAPT for people with long term health conditions and medicallyunexplained symptomsNICE’s guideline on depression in adults with achronic physical health problem highlights thatdepression is approximately 2 to 3 times morecommon in people with a chronic physical healthproblem than in people who have good physical offer IAPT services integrated with physicalhealthcare pathways.To help with implementation, an IAPT pathway forlong term physical health conditions and medicallyunexplained symptoms has been commissionedThe Five Year Forward View for Mental Healthby NICE on behalf of NHS England. This sets outrecommended that delivering psychologicalthe treatment pathway underpinning the accesstherapies to people with long term conditions should and waiting time standards. It references NICEbe prioritised in the expansion of IAPT.recommendations and provides evidence on whatworks, as well as local case studies of service-ledIn response, NHS England has introduced aexamples that describe how to make IAPT for longrequirement for all clinical commissioning groupsterm conditions a reality.5

NICEimpact mental healthDigitally enabled therapies50digital therapies presented toIAPT expert panel13digital therapies assessed aseligible for the programme5IAPT assessment briefingspublished3digital therapies recommended forevaluation in practiceThe Five Year Forward View for Mental Health: One YearOn highlights that digitally enabled therapies present anopportunity to broaden access to IAPT services and couldhelp deliver NHS England’s plans for IAPT expansion. NICEis working with NHS England to identify and assess digitallyenabled therapies which offer the potential to expandIAPT services.The new digitally enabled therapy assessment programmeaims to identify good quality, evidence-based digitally enabledpsychological therapies. The programme will use ongoingdata collection in IAPT services to assess whether patientoutcomes are at least as good as those achieved by NICErecommended, non-digital therapy. It will also determinewhether there are improvements in service efficiency bysaving therapist time.NICE is leading the first phase by selecting and assessingdigital therapies. Each digital therapy is assessed on itstherapeutic content, clinical evidence, expected resourceimpact and whether it meets NHS Digital’s digital standards.After reviewing the assessment evidence, NICE’s IAPT expertpanel decides whether the digital therapy is suitable for theevaluation in practice phase or not. They can also recommendthat it needs further development.Digital therapies which are recommended for the evaluationin practice phase will be assessed in selected IAPT servicesfor up to 2 years. The outcomes of this evaluation will helpservices choose high quality, evidence-based products whichare cost-effective and achieve good outcomes for those whowish to access therapy in this way.IAPT for people from black, Asian and otherminority ethnic groupsNICE’s quality standard on promoting health and preventingpremature mortality in black, Asian and other minorityethnic groups draws attention to areas of inequality, includingincreased health risks, poor access to and experience ofservices, and worse health outcomes. One area of inequalityhighlighted in the quality standard is mental healthcare.Historically, surveys have suggested that fewer people fromblack, Asian and other minority ethnic groups have accessed6

NICEimpact mental healthmental health treatment. In 2014, NHS Digital’s AdultPsychiatric Morbidity Survey found that 14% of people witha white British family background said they were receivingtreatment at the time of the interview, compared to only 7% ofpeople from minority ethnic groups.51%More recent data show that rates of IAPT treatmentcompletion and recovery vary by ethnicity. In 2017/18, around43% of all people referred to IAPT went on to completetreatment. However, for people from black, Asian or otherminority groups who were referred, only around 37%completed treatment and recovery rates were poorer.46%The Five Year Forward View for Mental Health emphasisedthe need to tackle inequalities. To help address this, since2017 NHS England’s Quality Premium has included a focuson improving mental health outcomes for people from black,Asian and other minority ethnic groups. This payment isintended to reward Clinical Commissioning Groups (CCGs) forimprovements in the quality of the services they commission.of all people moved to recoveryafter completing IAPT treatmentof people from a black, Asian orother minority ethnic groupmoved to recovery aftercompleting IAPT treatmentTo achieve this element of the payment, CCGs must showimprovement in the recovery rate of people accessing IAPTservices who are from a black, Asian or other minority ethnicgroup. Progress against this measure is now tracked in thequarterly Mental Health Five Year Forward View Dashboard.Improving access to mental healthcare for women ofsouth Asian family originTo help reduce mental healthcare inequalities,NICE’s quality standard on promoting health andpreventing mortality in black, Asian and otherminority ethnic groups states that people fromthese groups should be able to access mental healthservices in a variety of community-based settings.Birmingham and Solihull Mental Health NHSFoundation Trust identified that there were barriersto accessing mental healthcare for women of southAsian family origin. They adapted their IAPT serviceby developing a culturally sensitive treatment group,described in a NICE shared learning example.The group-based intervention, delivering care inline with NICE recommendations, is facilitated bypsychological wellbeing practitioners who speakHindi, Urdu, Punjabi or Bengali. Sessions are heldin community centres in order to reduce the stigmaand overcome reluctance to engage with mentalhealth services.Analysis of recent sessions showed a recovery rateof 54% for those who entered treatment with mildto moderate symptoms. A feedback exercise foundthat 95% of the women who took part in the groupsreported having a positive experience.7

NICEimpact mental healthSevere mental illnessPeople with severe and prolonged mentalillness are at risk of dying on average 15 to20 years earlier than other people. Goodphysical healthcare and access to evidencebased treatments are important to reducethis health inequality.People with severe mental illness havepsychological problems that mayseverely impact on their ability toengage in functional and occupationalactivities. Severe mental illnessesinclude schizophrenia, bipolar disorderand other psychoses.More people are starting treatmentearly for a first episode of psychosissince the introduction of a waiting timestandard based on NICE guidance.Monitoring of physic

areas of the health and care system, helping to improve outcomes where this is needed most. NICE provides evidence-based guidance and advice to help improve health and social care services. The uptake of NICE guidance is influenced by close relationships with partners such as NHS England, NHS Improvement and Public Health England (PHE). Since 2002 and the publication of NICE’s first clinical .

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