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Summary of Results

Health Topic:   Mental health and behavioural conditions
Guidance:   Depression in adults (update)
Description:   The summary of the published clinical guideline on Depression in adults (update). It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

Health Insurance (2011) Low cost depression treatments 'not funded by NHS' Article ID 377910

Description: Health Insurance issued a Freedom of Information request to PCT's. Results found that 22 of the 111 who responded said that group exercise classes were funded. Additionally, 22 PCT's said that group cognitive behaviour therapy (CBT) was not available. All of the 111 PCT's who responded said that individual CBT was available, although waits vary across the country, with many patients waiting for more than three months for their first session.

Doubts about or mixed impact in practice National

Health Insurance (2011) HI Magazine uncovers six month waits for NHS counselling

Description: The authors collected data from 120 PCT's via Freedom of Information Requests. Results found that 41% of 85 PCT's have waits of more than three months for counselling for people with depression, compared to 29% of 90 PCT's in 2009. Interpersonal therapy was not provided by 45 PCTs and Psychodynamic Therapy was not provided in 56 PCTs.

Doubts about or mixed impact in practice National

Care Quality Commission (2011) Community Mental Health Survey 2011

Description: The 2011 survey of people who used community mental health services included 65 NHS Trusts in England providing community mental health services. Results found that over half of respondents (53%) said that an NHS mental health or social care worker had discussed talking therapy with them in the last 12 months, with 39% of all respondents having received it within the same period. 14% of service users who had not received any therapy in the previous 12 months had asked for it to be arranged.

Doubts about or mixed impact in practice National

The NHS Information Centre for Health and Social Care (2011) Quarterly analysis of Improving Access to Psychological Therapies (IAPT) Key Performance Indicators (KPIs) Q1 Apr-11-June-11

Description: The Improving Access to Psychological Therapies Key Performance Indicators collection is a mandatory collection. All 151 Primary Care Trusts (PCTs) in England are required to submit a return. During the study period 210,540 people were referred for psychological therapies; 123,975 entered treatment. It is estimated that 6.1 million people suffer from anxiety and depression disorders in England indicating that the access rate of people with anxiety or depression orders to IAPT services is 2.0%

Practice appears not to be in line with guidance National

The Patients Association (2011) Postnatal Depression Services: An Investigation into NHS Service Provision

Description: A Freedom of Information (FOI) request was sent to 150 Primary Care Trusts (PCTs) to find information on the organisation of postnatal depression services. Responses were received from 77 PCTs. In response to a specific question on screening for antenal and postnatal depression, the authors received responses from 62 PCTs and the vast majority (55 out of 62) responding to this question commission mental health services that use the Whooley questions, as recommended in NICE guidance.

Doubts about or mixed impact in practice National

Royal College of Psychiatrists (2011) National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011

Description: The National Audit of Psychological Therapies for Anxiety in Depression aims to evaluate and improve the quality of treatment and care provided in England and Wales. Questionnaire data was collected during 2010 and 2011 from 357 services. Results found that the type of therapy provided was in line with NICE guidance for 83% of patients with a diagnosis, and that 70% of patients who had high intensity therapy did not receive the minimum number of treatment sessions that NICE recommends.

Doubts about or mixed impact in practice National

The NHS Information Centre (2012) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q2 2011/12 final and Q3 2011/12 provisional

Description: This is the 3rd publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2011/12. The data includes Q2 Jul-Sep data and Q3 Oct-Dec provisional data, for which all 151 PCTs in England contributed. Results showed that in Q3 218,192 people were referred for psychological therapies (up 1.9% from Q2); the access rate of people with anxiety or depression to IAPT services was approximately 2.1%; and 131,066 people entered treatment.

Practice appears not to be in line with guidance National

Da Costa E et al (2011) An audit of the management of depression in a community population with intellectual disabilities in accordance with NICE guidance British Journal of Development Disabilities 57 (2) 147-157

Description: The first small audit collected information from the casenotes of patients receiving care at Harlow and Epping specialist ID community services. A second small audit was conducted 12 months later. The first audit looked at casenotes of 34 patients, the second audit 39 patients. The second audit compared to the first revealed improvements in care delivery including clinician's awareness of psychosocial interventions. Referal improved from 2/23 patients in the first audit to 18/26 in the second.

Doubts about or mixed impact in practice Local

Royal College of Physicians (2010) Depression detection and management of staff on long-term sickness absence: Occupational health practice in the NHS in England - A national clinical audit: round 2.

Description: This 2010 retrospective case note review of Occupational Health care for NHS staff on long term sickness absence examined the extent to which OH staff were considering depression as a contributor to the sickness absence, a barrier to return to work, and the use of therapies provided by the employer. The audit of 7636 cases from 152/186 English NHS OH services showed assessing for signs of depression rose from 58% in 2008 to 67% in 2010, while an action plan was documented in over 95% of cases.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2012) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q3 2011/12 final and Q4 2011/12 provisional

Description: This is the 4th publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2011/12. The data includes Q3 Oct-Dec data and Q4 Jan-Mar provisional data, for which all 151 PCTs in England contributed. Results showed that in Q4 246,545 people were referred for psychological therapies (up 12.9% from Q3); the access rate of people with anxiety or depression to IAPT services was approximately 2.5%; and 149,849 people entered treatment.

Practice appears not to be in line with guidance National

Health and Social Care Information Centre (2012) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q4 2011/12 final and Q1 2012/13 provisional

Description: This is the 1st publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2012/13. The data includes Q4 for 2011/12 and Q1 Apr-Jun provisional data, for which all 151 PCTs in England contributed. Results showed that in Q1 233,027 people were referred for psychological therapies (down 6% from 2011/12 Q4); the access rate of people with anxiety or depression to IAPT services was approx. 2.4%; and 146,702 people entered treatment.

Practice appears not to be in line with guidance National

Health and Social Care Information Centre (2013) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q1 2012/13 final and Q2 2012/13 provisional

Description: This is the latest publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2012/13. The data includes Q1 Apr-Jun and Q2 Jul-Sep provisional data, for which all 151 PCTs in England contributed. Results showed that in Q2 238,406 people were referred for psychological therapies (up 2.3% from Q1); the access rate of people with anxiety or depression to IAPT services was approx. 2.5%; and 154,908 people entered treatment.

Practice appears not to be in line with guidance National

Department of Health (2013) IAPT three-year report. The first million patients.

Description: This report describes the progress made since the inception of the Improving Access to Psychological Therapies (IAPT) programme in October 2008. Amongst the achievements are: More than 1 million people treated in IAPT services; more than 680,000 people completing a course of treatment; and recovery rates consistently in excess of 45% and approaching those expected from the randomised controlled trials that generated the initial recommendations.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2013) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q2 2012/13 final and Q3 2012/13 provisional

Description: This is the latest publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2012/13. The data includes Q2 Jul-Sep and Q3 Oct-Dec provisional data, for which all 151 PCTs in England contributed. Results showed that in Q3 251,724 people were referred for psychological therapies (up 4.7% from Q2); the access rate of people with anxiety or depression to IAPT services was approx. 2.4%; and 144,085 people entered treatment.

Practice appears not to be in line with guidance National

Health and Social Care Information Centre (2013) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q3 2012/13 final and Q4 2012/13 provisional

Description: This is the latest publication of the Improving Access to Psychological Therapies Key Performance Indicators (IAPT KPIs) from the reporting year 2012/13. The data includes Q3 Oct-Dec and Q4 Jan-Mar provisional data, for which all 151 PCTs in England contributed. Results showed that in Q4 258,143 people were referred for psychological therapies (up 2.1% from Q3); the access rate of people with anxiety or depression to IAPT services was approx. 2.5%; and 154,254 people entered treatment.

Practice appears not to be in line with guidance National

Richards, D.A. et al (2011) Implementation of psychological therapies for anxiety and depression in routine practice: Two year prospective cohort study Journal of Affective Disorders 133 (2011) 51?60

Description: This study assessed the impact of a stepped care service utilising evidence based treatments for anxiety and depression by measuring outcomes of patients referred over a two year period to one IAPT service in northern England. Data on 7859 consecutive patients was collected between July 2006 and August 2008. Results found 4183 patients (53%) received two or more treatment sessions. Patients received a mean of 5.5 sessions over 3.5 h, mainly low-intensity CBT and phone based case management.

Doubts about or mixed impact in practice Local

Health and Social Care Information Centre (2013) Improving Access to Psychological Therapies, Key Performance Indicators (IAPT KPIs) - Q4 2012/13 final

Description: This is the most recent and final (in the current format) publication of the Improving Access to Psychological Therapies KPIs. Data collection began in 2008 from all 151 PCTs in England, and since 2011/12, reported on a quarterly basis. This report covers the period January ? March 2013, and shows that 259,016 people were referred for psychological therapies and 154,722 entered treatment. The access rate of people with anxiety or depression to IAPT services was approx. 2.5%.

Practice appears not to be in line with guidance National

Clark, M. et al (2011) Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience International Review of Psychiatry, August 2011; 23: 375?384

Description: This article provides a summary of the progress made by the Improving Access to Psychological Therapies (IAPT) programme by midway through its 3rd year in Spring 2011. Progress included that IAPT services had been established in 94% of PCTs ? though there was wide variation in therapies used and as a result, only an estimated 60% of the population had access to an IAPT service at this point. Approx. 310,000 patients were being seen per year, with the aim to see approx. 900,000 per year by 2015.

Practice appears not to be in line with guidance National

Gyani, A. et al (2012) Investigating the use of NICE guidelines and IAPT services in the treatment of depression Mental Health in Family Medicine. 2012 9 (3) PAGES 149-160

Description: This study investigated the use of NICE guidelines for depression by GPs in southeast England. Questionnaires were sent to 830 GPs and 6 GPs were interviewed. The response rate to the questionnaires was 27%, which showed 95% of GPs were aware of the guidelines and 78% had read them. Results also found that 14.5% of GPs offered medication for the treatment of mild depression and 2 GPs stated that they would offer their patients St John?s wort - which the guidelines explicitly recommend against.

Doubts about or mixed impact in practice National

Kenicer, D. et al (2012) A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland. BMC Medical Informatics and Decision Making 2012, 12:102

Description: Results are presented from a telephone survey of lead IT staff at all 14 health board areas across Scotland which examined the extent to which the NHS in Scotland is providing routine access for patients to utilise computerised cognitive behavioural therapy (cCBT). Each board area was contacted between September 2010 and March 2011. Results show only 5 (36%) of the 14 health boards regions in Scotland provide routine PC access to patients.

Practice appears not to be in line with guidance Regional

Belgamwar, M. et al (2012) Appropriateness of primary care referrals of patients with anxiety and depression. European Psychiatry. Conference Publication: (var.pagings). 27 , 2012.

Description: This study aimed to assess the appropriateness of GP referrals to community mental health services of patients with anxiety/depression in line with the stepped care approach of NICE guidelines. Analysis of GP referrals to the Royal Derby Hospital during the period of June 2008 - March 2009 showed only half of the 64 referrals that mentioned problems such as anxiety and depression followed the stepped care approach.

Doubts about or mixed impact in practice Local

Jan, F. et al (2011) Do we need specialist clinics to monitor metabolic side effects on chronic bipolar patients in Treatment?-Audit of management of bipolar disorder against NICE guidelines in South Staffordshire NHS Trust, UK. Klinik Psikofarmakoloji Bulteni. Conference Publication: (var.pagings). 21 (pp S148-S149), 2011.

Description: This audit measured the pharmacological management of patients with Bipolar Affective Disorder against guidelines. Data were collected on a random selection of 28 patients in South Staffordshire. Results found that 20/28 patients (72%) were on mood stabilizers and 12/28 (43%) were on antipsychotics. During the initial period of starting medications: 79% patients were monitored for renal disease, 75% for diabetes, 63% for obesity and 63% had their drug levels checked regularly.

Doubts about or mixed impact in practice Local

Curran, S. et al (2012) Assessment and Treatment of Older People with Depression in a Secondary Mental Health Trust Current Drug Therapy, 2012, 7, 207-211

Description: This study aimed to investigate whether older antidepressants are over prescribed to the elderly in secondary care. A retrospective case note study of 181 patients aged 65 and over referred between 2007 and 2008 to South West Yorkshire NHS Foundation Trust with depression found that ?newer? classes of antidepressants (SSRIs, SNRI and NASSA) were prescribed 85% of the time for the current episode of depression compared to 70% of the time for previous episodes of depression.

Doubts about or mixed impact in practice Local

Health and Social Care Information Centre (2014) Psychological Therapies, England: Annual Report on the use of Improving Access to Psychological Therapies services - 2012/13

Description: The experimental figures presented in this first annual report provide a picture of activity in Improving Access to Psychological Therapies (IAPT) services in England and the people that use them in 2012/13. A total of 761,848 people were referred for psychological therapies and 434,247 entered treatment. CBT was the most prevalent treatment in all but one Commissioning Region, wherein Guided Self Help was the most common therapy type ? both are recommended for anxiety and depression.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2013) Routine Quarterly Improving Access to Psychological Therapies Dataset Report: Final Q1 summary statistics and related information, England, Experimental Statistics

Description: This publication presents the latest information from the Improving Access to Psychological Therapies (IAPT) dataset. This release attempts to replicate elements of the IAPT Key performance indicators (KPIs) from the IAPT dataset at a provider and commissioner level. This report covers the period April-June 2013, for which 129 providers submitted data. The data shows there were 241,250 new psychological therapy service requests and 158,620 service requests ?entered treatment? in this quarter.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2014) Routine Quarterly Improving Access to Psychological Therapies Dataset Report: Final Q2 summary statistics and related information, England, Experimental Statistics

Description: This publication presents the latest information from the Improving Access to Psychological Therapies (IAPT) dataset. This report covers the period July to September 2013, for which 138 providers submitted data, compared with 129 in Q1 2013/14. The data shows there were 259,040 new psychological therapy service requests in Q2 2013/14, compared with 241,250 in the previous quarter and 172,980 service requests ?entered treatment? in this quarter, compared with 158,620 in Q1 2013/14.

Doubts about or mixed impact in practice National

This page was last updated: 01 January 2014

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.