Common mental health problems: identification and pathways to care

Search and selection strategy

The 2013 evidence update for NICE guideline CG123 identified 9 studies that were considered to have no impact on recommendations. This surveillance review found no new evidence in these areas to suggest an update.

Using the static list process, we searched for new Cochrane reviews related to the whole guideline. We found 3 relevant Cochrane reviews published between October 2012 and May 2018. However, none were considered to impact NICE guideline CG123 recommendations.

We also identified 1 NIHR signal on a relevant study.

From all sources, we considered 13 studies to be relevant to the guideline.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to NICE guideline CG123.

There were 6 responses (out of 11 questionnaires sent) from topic experts, of which 3 suggested an update and 3 suggested no update. Comments received with the potential to change recommendations stated that NICE guideline CG123 should consider source guidelines as some of these are being updated, and that the guideline should include social anxiety disorder recommendations. These changes will be actioned through editorial amendments.

A topic expert also commented that NICE guideline CG123 includes self-help groups as a treatment option for generalised anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) when the individual guidelines for these conditions do not. However, NICE guideline CG31 on OCD includes recommendation 1.1.3.3 which states that healthcare professionals should encourage people with OCD to participate in local self-help and support groups where appropriate. Also, NICE guideline CG113 on GAD and panic disorder includes recommendations 1.3.7 and 1.4.6 which recommend offering self-help groups.

Implementation of the guideline

Two topic experts indicated that uptake and implementation of the guideline recommendations is low. The suggestion was that the stepped care model was not being followed in most cases in services as instead they used a stratified care model. However, the surveillance review did not find any evidence on the use of a stratified care model for common mental health problems. Uptake data is available on the NICE guideline CG123 webpage for recommendation 1.4.1.10 only. The recommendation advises on how to meet the social, educational or vocational needs of people with common mental health problems. The annual data states that 23–27% of people surveyed indicated that they had received information or advice on support groups or employment services. The source of the uptake data was the Care Quality Commission, community mental health survey and the reason(s) for the low response rates are not known.

Views of stakeholders

Stakeholders are consulted on all surveillance decisions except if the whole guideline will be updated and replaced. Because this surveillance decision was to not update the guideline, we consulted on the decision.

Overall, 6 stakeholders commented; of these, 1 represented a charity organisation, 2 were government organisations, 2 were professional bodies, and 1 response was received from a voluntary organisation.

Three stakeholders agreed with the decision to not update the guideline, 1 disagreed and 2 did not state a response.

One stakeholder suggested updating the guideline to include recommendations on screening and treatment for people with a common mental health problem who also misuse alcohol, drugs or tobacco. This is not likely to impact recommendations as the scope of NICE guideline CG123 does not include people for whom alcohol or drug misuse is the primary problem. Also, there are other published NICE guidelines covering screening, interventions and service provision for people who use alcohol, drugs or tobacco. There is currently 1 recommendation in NICE guideline CG123 that advises on a referral for treatment of harmful drinking or alcohol dependence before treating the common mental health disorder. We propose to amend the footnote to this recommendation to include a cross-referral to NICE guideline PH24 for advice on alcohol screening.

One stakeholder suggested the need for recommendations on health anxiety to be included in NICE guideline CG123. However, the guideline was developed to bring together advice from other existing guidelines. As there are currently no recommendations specific to health anxiety within the source guidelines, this disorder is unlikely to be included within NICE guideline CG123.

One stakeholder commented that prisoners have a lack of access to mental healthcare. Although the scope of NICE guideline CG123 does not include recommendations specific to prison medical services, the guideline will be relevant to their work. The NICE Pathway on common mental health disorders advises that local care pathways should be developed that promote access to services for people from a range of socially excluded groups including those in prison or in contact with the criminal justice system. NICE guideline NG66 also covers the mental health of adults in contact with the criminal justice system.

One stakeholder commented that symptoms of some common mental health problems make it difficult for people to attend appointments. NICE guideline CG123 already includes recommendations 1.1.1.7 and 1.1.1.9 which advises on providing services in a variety of settings and modes of delivery to improve access to services.

One stakeholder commented that the age cut‑off of 18 in NICE guideline CG123 is arbitrary as adolescents can also experience common mental health problems. This is not likely to impact recommendations as the scope of the guideline only covers adults aged 18 and over. Also, there are other published NICE guidelines on the assessment and treatment of mental health problems in children and young people.

Other general comments from stakeholders supported the review proposal subject to the editorial amendments being actioned and for the guideline to remain in line with related NICE guidelines.

See appendix A for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

Equalities

No equalities issues were identified during the surveillance process.

Editorial amendments

During surveillance of the guideline, we identified the following points in the guideline that should be amended.

The following cross-referrals should be added:

The following amendments should be made: