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

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Further assessment of risk and need for treatment, and routine outcome monitoringimpact of routine feedback, the GDG decided to support ROM, for the benefits it maybring both to the individual patients and to the information it may supply about theoverall effectiveness of local care pathways. Therefore, the GDG recommended theadoption of sessional ROM using measures already in place in the NHS, but with flexibilityfor individual practitioners to draw on a range of other formal assessment measuresthat have good psychometric properties and are feasible for routine use. The GDGwas aware that such a recommendation has, essentially, a service focus and so developedthe recommendation with the intent of ensuring that it formed an importantelement of any local care pathway for people with a common mental health disorder.6.4.8 Recommendations6.4.8.1 Primary and secondary care clinicians, managers and commissionersshould work together to design local care pathways that have robustsystems for outcome measurement in place, which should be used toinform all involved in a pathway about its effectiveness. This shouldinclude providing:● individual routine outcome measurement systems● effective electronic systems for the routine reporting and aggregationof outcome measures● effective systems for the audit and review of the overall clinical andcost effectiveness of the pathway.6.4.9 Research recommendations6.4.9.1 In people with a common mental health disorder, what is the clinical utilityof routine outcome measurement and is it cost effective compared withstandard care? (See Appendix 11 for further details.)187
Systems for organising and developing local care pathways7 SYSTEMS FOR ORGANISING ANDDEVELOPING LOCAL CARE PATHWAYS7.1 INTRODUCTIONIt has long been argued that the effective and efficient organisation of healthcare systemsis associated with better outcomes, and much of the effort of managers and funders ofhealthcare is focused on the re-organisation of healthcare systems. Unfortunately, few ofthese re-organisations have been subject to formal evaluation so the benefits that mayhave followed from this process have been difficult to quantify and, in the absence ofaccurate description, difficult to replicate. Although this has led to considerable uncertaintyabout the best methods by which to organise healthcare systems, in recent years aconsensus has emerged to support the development of clinical care pathways as onemodel for doing this (Vanhaecht et al., 2007; Whittle & Hewison, 2007), including interestin the field of mental health (Evans-Lacko et al., 2008).Recent developments in the NHS have supported the development of clinical carepathways for the organisation of care, and discussions are currently underway as towhether these may also form the basis for the future funding of mental healthcare (seeHoNOS-PbR 47 ). While there is general agreement about the potential advantages forclinical care, there is less evidence for benefits such as changes in professional practice,more efficient care, and more informed and empowered patients (Dy et al., 2005;Emmerson et al., 2006). Within specific areas of mental health there is emergingevidence, for example in the area of collaborative care for depression (Bower et al.,2006; Gilbody et al., 2006), but precise methods for the organisation of care across thewhole range of mental healthcare have not been well developed. An additional problem,particularly with common mental health disorders, is that most care is deliveredin a primary care setting. Historically, the development of care pathways has tended tofocus more on the provision of specialist services, and so uncertainty remains aboutthe best way of structuring mental healthcare in primary care (the major focus on thisguideline) and the links between primary and secondary/specialist services. In addition,as has been noted elsewhere in guidelines developed by NICE (NICE, 2009b),many people, particularly as they get older, develop comorbid physical health problems,and pathways therefore potential need to take into account not only the links withsecondary and specialist mental health services but also with secondary care andspecialist physical health services. Again, there is some emerging evidence (NICE,2009b) demonstrating that integration (for example, the integration for physical andmental healthcare for people with depression) can bring real benefits.47 http://webarchive.nationalarchives.gov.uk//www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/NHSFinancialReforms/DH_4137762188
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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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Page 137 and 138: Further assessment of risk and need
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Page 219 and 220: Summary of recommendationsFigure 12
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Page 231 and 232: Appendices9 APPENDICESAppendix 1: S
Page 233 and 234: Appendix 1of a depressive disorder
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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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