CG123 Common mental health disorders - National Institute for ...

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Further assessment of risk and need for treatment, and routine outcome monitoringAll steps: Treatment and referral for treatmentIdentifying the correct treatment options6.3.8.1 When discussing treatment options with a person with a common mentalhealth disorder, consider:● their past experience of the disorder● their experience of, and response to, previous treatment● the trajectory of symptoms● the diagnosis or problem specification, severity and duration of theproblem● the extent of any associated functional impairment arising from thedisorder itself or any chronic physical health problem● the presence of any social or personal factors that may have a role inthe development or maintenance of the disorder● the presence of any comorbid disorders.6.3.8.2 When discussing treatment options with a person with a common mentalhealth disorder, provide information about:● the nature, content and duration of any proposed intervention● the acceptability and tolerability of any proposed intervention● possible interactions with any current interventions● the implications for the continuing provision of any current interventions.6.3.8.3 When making a referral for the treatment of a common mental health disorder,take account of patient preference when choosing from a range ofevidence-based treatments.6.3.8.4 When offering treatment for a common mental health disorder or makinga referral, follow the stepped-care approach, usually offering or referringfor the least intrusive, most effective intervention first (see Figure 11).6.3.8.5 When a person presents with symptoms of anxiety and depression, assessthe nature and extent of the symptoms, and if the person has:● depression that is accompanied by symptoms of anxiety, the first priorityshould usually be to treat the depressive disorder, in line with theNICE guideline on depression●●an anxiety disorder and comorbid depression or depressive symptoms,consult the NICE guidelines for the relevant anxiety disorder andconsider treating the anxiety disorder firstboth anxiety and depressive symptoms, with no formal diagnosis, thatare associated with functional impairment, discuss with the person thesymptoms to treat first and the choice of intervention 27 .6.3.8.6 When a person presents with a common mental health disorder and harmfuldrinking or alcohol dependence, refer them for treatment of the alcoholmisuse first as this may lead to significant improvement in depressive oranxiety symptoms 28 .27 Adapted from Depression (NICE, 2009a).28 Adapted from Alcohol-use Disorders: Diagnosis, Assessment and Management of Harmful Drinking andAlcohol Dependence (NICE, 2011b).175
Further assessment of risk and need for treatment, and routine outcome monitoring6.3.8.7 When a person presents with a common mental health disorder and a mildlearning disability or mild cognitive impairment:● where possible provide or refer for the same interventions as for otherpeople with the same common mental health disorder● if providing interventions, adjust the method of delivery or duration ofthe assessment or intervention to take account of the disability orimpairment 29 .6.3.8.8 When a person presents with a common mental health disorder and has amoderate to severe learning disability or a moderate to severe cognitiveimpairment, consult a specialist concerning appropriate referral and treatmentoptions.6.3.8.9 Do not routinely vary the treatment strategies and referral practice forcommon mental health disorders described in this guideline either bypersonal characteristics (for example, sex or ethnicity) or by depressionsubtype (for example, atypical depression or seasonal depression) as thereis no convincing evidence to support such action 29 .6.3.8.10 If a person with a common mental health disorder needs social, educationalor vocational support, consider:● informing them about self-help groups (but not for people with PTSD),support groups and other local and national resources● befriending or a rehabilitation programme for people with long-standingmoderate or severe disorders● educational and employment support services 29 .Step 2: Treatment and referral advice for subthreshold symptoms and mild tomoderate common mental health disorders6.3.8.11 For people with persistent subthreshold depressive symptoms or mild tomoderate depression, offer or refer for one or more of the following lowintensityinterventions:● individual facilitated self-help based on the principles of cognitivebehavioural therapy (CBT)● computerised CBT● a structured group physical activity programme● a group-based peer support (self-help) programme (for those who alsohave a chronic physical health problem)● non-directive counselling delivered at home (listening visits) (forwomen during pregnancy or the postnatal period) 30 .29 Adapted from Depression (NICE, 2009a).30 Adapted from Depression (NICE, 2009a), Depression in Adults with a Chronic Physical Health Problem(NICE, 2009b) and Antenatal and Postnatal Mental Health (NICE, 2007a).176
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Commonmental healthdisordersTHE NIC
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© The British Psychological Societ
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Contents6 FURTHER ASSESSMENT OF RIS
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Guideline development group members
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Preface1 PREFACEThis guideline has
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Prefacecollaborative manner using t
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PrefaceThe experience of people wit
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Common mental health disorders2.2 T
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Common mental health disordersto ho
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Common mental health disordersManua
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Common mental health disordershighe
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Common mental health disordersNegat
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Common mental health disorderscours
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Common mental health disordersover
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Common mental health disorders2.2.6
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Common mental health disordersTable
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Common mental health disorders1996)
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Common mental health disordersSumma
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Common mental health disordersTable
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Common mental health disordersappli
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Common mental health disorderspatie
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Methods used to develop this guidel
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Access to healthcare4. ACCESS TO HE
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Access to healthcareunder the Menta
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Access to healthcare4.2.3 Studies c
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Access to healthcareIndividual-leve
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Access to healthcareJUNG2003 review
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Access to healthcareSCHEPPERS2006).
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Access to healthcare70Table 8: Clin
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Access to healthcareTable 9: Study
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Access to healthcareCHAPMAN2004 inc
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Access to healthcare4.4 SERVICE DEV
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Access to healthcareBEACH2006 [Beac
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Access to healthcareTable 12: Summa
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Access to healthcareAll studies wer
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Access to healthcarepractitioners h
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Access to healthcareIndividual-leve
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Access to healthcarefrom such popul
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Access to healthcarestructure and d
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Case identification and formal asse
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Summary of recommendationsDiscuss w
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Summary of recommendationsinclude p
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Appendices9 APPENDICESAppendix 1: S
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Appendix 1of a depressive disorder
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Appendix 1b) Assessment of anxiety
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Appendix 2APPENDIX 2:DECLARATIONS O
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Appendix 2Mr Mike BessantEmployment
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Appendix 2Personal non-pecuniary in
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Appendix 2Actions takenMr Rupert Su
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Appendix 2Personal family interestN
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Appendix 3APPENDIX 3:STAKEHOLDERS A
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Appendix 4ClinicalpopulationPeople
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Appendix 4Case identificationNo. Pr
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Appendix 5APPENDIX 5:REVIEW PROTOCO
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Appendix 7APPENDIX 7:METHODOLOGY CH
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Appendix 9APPENDIX 9:METHODOLOGY CH
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Appendix 92.10 Are all important pa
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Appendix 9case also excludes costs
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Appendix 9For consistency, the EQ-5
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Appendix 9Answer ‘yes’ if the a
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Appendix 9Answer ‘yes’ if the e
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Appendix 9Answer ‘yes’ if appro
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Appendix 10APPENDIX 10: EVIDENCE TA
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Appendix 11APPENDIX 11:HIGH PRIORIT
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Appendix 11discussion of options bu
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Appendix 13APPENDIX 13:GENERALIZED
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ReferencesAndlin-Sobocki, P., Jöns
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ReferencesBower, P., Gilbody, S., R
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ReferencesCooper, S., Smiley, E., M
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ReferencesEhlers A., Gene-Cos N. &
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ReferencesGiles, D. E., Jarrett, R.
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ReferencesHorowitz, M. J., Wilner,
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ReferencesKnapp, M. & Ilson, S. (20
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ReferencesMarks, J., Goldberg, D. P
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ReferencesNCCMH (forthcoming) Self-
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ReferencesOzer, E. J., Best, S. R.,
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ReferencesSartorius, N. (2002) Eine
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ReferencesTiemens, B. G., Ormel, J.
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ReferencesWilkinson, M. J. B. & Bar
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Glossarybeliefs and interpretations
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Glossaryto learn to become more awa
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Abbreviations12 ABBREVIATIONSADDADS
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AbbreviationsOASISOCDONSORPHQ (-A,
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