Commissioning stepped care for people with common mental health disorders

NICE commissioning guides [CMG41] Published date:

1 Executive Summary

1 Executive Summary

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This guide for commissioners on common mental health disorders is a resource to help commissioners, clinicians and managers commission high-quality and evidence-based services across England.

Reducing the prevalence of common mental health disorders is a major public health concern. In 2007 the annual cost to treat depression and anxiety disorders in England was nearly £3 billion, with an additional economic impact of around £13 billion in lost earnings among people of working age.

The guide highlights the benefits of a partnership approach to commissioning services for people with common mental health disorders (see section 3.1). It also recommends commissioning for outcomes (see section 3.3) – principally increasing the proportion of people with common mental health disorders who are identified, assessed and receive treatment in accordance with NICE guidance, and the proportion that go on to make a clinically significant improvement or recover.

It is estimated that around 17.7% of adults aged 18 and older meet the diagnostic criteria for at least one common mental health disorder. Section 4 will help commissioners determine local service levels for people with common mental health disorders by considering prevalence and a range of demographic factors that may affect local need.

Section 5 of the guide provides support for commissioners to commission services using the stepped care model:

  • Chapter 5.1 helps commissioners to specify step 1 services for people presenting with known or suspected common mental health disorders.

  • Chapter 5.2 helps commissioners to specify step 2 services for people with subthreshold, mild and moderate common mental health disorders.

  • Chapter 5.3 helps commissioners to specify step 3 services for people with moderate to severe common mental health disorders.

  • Chapter 5.4 helps commissioners to specify step 4 services for people with severe functional impairment or complex mental health disorders.

Section 5.5 offers examples of service models, including case studies and ideas for using Quality, Innovation, Productivity and Prevention (QIPP) and Commissioning for Quality and Innovation (CQUIN) to drive improvements to common mental health disorder services. There is also an outline service specification (see section 6) to assist commissioners when tendering or contract managing common mental health disorder services.

The guide contains a commissioning and benchmarking tool that can be used to calculate the costs of commissioning or redesigning local common mental health disorder services. The tool identifies a number of primary and secondary care costs that may be avoided by commissioning common mental health disorder services.

NICE has accredited the process used by NICE to produce guides for commissioners. Accreditation is valid for 5 years from November 2011 and applies to guides produced since November 2008 using the processes described in 'Process manual for developing guides from NICE for commissioners: Information for internal NICE teams' (2011). More information on accreditation can be viewed at www.nice.org.uk/accreditation
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