Key priorities for implementation

Key priorities for implementation

Improving access to services

  • Primary and secondary care clinicians, managers and commissioners should collaborate to develop local care pathways (see also section 1.5) that promote access to services for people with common mental health disorders by:

    • supporting the integrated delivery of services across primary and secondary care

    • having clear and explicit criteria for entry to the service

    • focusing on entry and not exclusion criteria

    • having multiple means (including self-referral) to access the service

    • providing multiple points of access that facilitate links with the wider healthcare system and community in which the service is located.

Identification

  • Be alert to possible depression (particularly in people with a past history of depression, possible somatic symptoms of depression or a chronic physical health problem with associated functional impairment) and consider asking people who may have depression two questions, specifically:

    • During the last month, have you often been bothered by feeling down, depressed or hopeless?

    • During the last month, have you often been bothered by having little interest or pleasure in doing things?

If a person answers 'yes' to either of the above questions consider depression and follow the recommendations for assessment (see section 1.3.2)[3]

  • Be alert to possible anxiety disorders (particularly in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or in those who have experienced a recent traumatic event). Consider asking the person about their feelings of anxiety and their ability to stop or control worry, using the 2-item Generalized Anxiety Disorder scale (GAD-2; see appendix D).

    • If the person scores three or more on the GAD-2 scale, consider an anxiety disorder and follow the recommendations for assessment (see section 1.3.2).

    • If the person scores less than three on the GAD-2 scale, but you are still concerned they may have an anxiety disorder, ask the following: 'Do you find yourself avoiding places or activities and does this cause you problems?'. If the person answers 'yes' to this question consider an anxiety disorder and follow the recommendations for assessment (see section 1.3.2).

Developing local care pathways

  • Primary and secondary care clinicians, managers and commissioners should work together to design local care pathways that promote a stepped-care model of service delivery that:

    • provides the least intrusive, most effective intervention first

    • has clear and explicit criteria for the thresholds determining access to and movement between the different levels of the pathway

    • does not use single criteria such as symptom severity to determine movement between steps

    • monitors progress and outcomes to ensure the most effective interventions are delivered and the person moves to a higher step if needed.

  • Primary and secondary care clinicians, managers and commissioners should work together to design local care pathways that provide an integrated programme of care across both primary and secondary care services. Pathways should:

    • minimise the need for transition between different services or providers

    • allow services to be built around the pathway and not the pathway around the services

    • establish clear links (including access and entry points) to other care pathways (including those for physical healthcare needs)

    • have designated staff who are responsible for the coordination of people's engagement with the pathway.

  • Primary and secondary care clinicians, managers and commissioners should work together to ensure effective communication about the functioning of the local care pathway. There should be protocols for:

    • sharing and communicating information with people with common mental health disorders, and where appropriate families and carers, about their care

    • sharing and communicating information about the care of service users with other professionals (including GPs)

    • communicating information between the services provided within the pathway

    • communicating information to services outside the pathway.



[3] Adapted from 'Depression' (NICE clinical guideline 90).

  • National Institute for Health and Care Excellence (NICE)