Common mental health problems: identification and pathways to care

Reasons for the decision

NICE guideline CG123 was developed to be a high-level, principle-based guideline. It brings together advice from existing guidelines and combines it with recommendations concerning access, assessment and local care pathways for common mental health disorders. Although some evidence was identified for these source guidelines concerning the management of common mental health disorders, this is not in the scope of NICE guideline CG123. Since the publication of NICE guideline CG123 in May 2011, there have been related NICE guidelines published or updated which should be considered for cross-referencing to, these are detailed in the editorial amendments section of this report.

From the evidence considered in this surveillance, a Cochrane review (Gillies et al. 2015) indicated that a consultation liaison model of care may improve the delivery of mental healthcare in primary care. However, there is currently insufficient evidence comparing consultation liaison to the standard stepped care model as recommended in section 1.2 of the guideline. Also, a National Institute for Health Research (NIHR) signal indicated that consultation liaison may not be the most effective model of support and that cost effectiveness was not examined; although another Cochrane review (Smith et al. 2017) supported the use of a stepped care model for depression. It was therefore considered that given this mixed evidence, there is currently insufficient evidence to change recommendations away from the stepped care model for the delivery of care for common mental health problems.

A Cochrane review (Kendrick et al. 2016) evaluated the effects of using patient-reported outcome measures (PROMs) for the management of common mental health disorders. The use of such measures are recommended in 1.3.2.3, 1.3.2.5 and 1.5.1.10 of the guideline. Although the study found evidence which does not support the use of PROMs, a high risk of bias created uncertainty in the results. This study is unlikely to change recommendations in NICE guideline CG123 on the use of outcome measures as part of assessment and treatment of common mental health problems.

The new evidence is unlikely to affect recommendations in NICE guideline CG123. No ongoing studies were identified, so it is unlikely that new evidence will be available in the near future.