Quality statement 3: Psychological intervention

Quality statement

Children and young people newly diagnosed with bipolar depression or a first episode of psychosis are offered a psychological intervention.

Rationale

Psychological interventions (in conjunction with antipsychotic medication, or on their own if medication is declined or not needed) can improve outcomes for bipolar depression and psychosis. The psychological intervention will be based on a psychological assessment and formulation, and will aim to reduce distress, promote social and educational recovery, reduce social anxiety and depression, and prevent relapse in children and young people.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people newly diagnosed with bipolar depression or a first episode of psychosis are offered a psychological intervention.

Data source: Local data collection.

Process

a) Proportion of children and young people newly diagnosed with bipolar depression who receive cognitive behavioural therapy or interpersonal therapy.

Numerator – the number in the denominator who receive cognitive behavioural therapy or interpersonal therapy.

Denominator – the number of children and young people newly diagnosed with bipolar depression.

Data source: Local data collection.

b) Proportion of children and young people newly diagnosed with a first episode of psychosis who receive cognitive behavioural therapy.

Numerator – the number in the denominator who receive cognitive behavioural therapy.

Denominator – the number of children and young people newly diagnosed with a first episode of psychosis.

Data source: Local data collection.

Outcomes

a) Relapse rates for children and young people with bipolar depression.

Data source: Local data collection.

b) Relapse rates for children and young people with psychosis.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as child and adolescent mental health services and early intervention in psychosis services) ensure that a psychological intervention is available as a treatment option for children and young people newly diagnosed with bipolar depression or a first episode of psychosis. They should ensure that practitioners are trained and have the appropriate competencies to deliver psychological interventions.

Healthcare professionals (such as psychologists, psychiatrists and psychotherapists) offer a psychological intervention to children and young people newly diagnosed with bipolar depression or a first episode of psychosis.

Commissioners (such as clinical commissioning groups and NHS England) commission services that offer a psychological intervention to children and young people newly diagnosed with bipolar depression or a first episode of psychosis.

What the quality statement means for children, young people, parents and carers

Children and young people who are diagnosed with bipolar depression or a first episode of psychosis are offered a psychological therapy. This involves meeting a healthcare professional on their own or with a parent or carer to talk about their feelings and thoughts, which can help them to find ways to cope with their symptoms. For children and young people with psychosis, psychological therapy works better when they also take antipsychotic medication (medicine to help with psychosis).

Source guidance

Definitions of terms used in this quality statement

Psychological intervention

Children and young people with a first episode of psychosis should be offered cognitive behavioural therapy. It should be delivered in at least 16 planned sessions, follow a treatment manual and include at least 1 of the following:

  • normalising

  • personal monitoring

  • promoting alternative ways of coping

  • reducing distress

  • improving functioning.

Children and young people newly diagnosed with bipolar depression should be offered cognitive behavioural therapy or interpersonal therapy. The intervention should be delivered over at least 3 months and have a published evidence‑based manual describing how it should be delivered.

[Adapted from Psychosis and schizophrenia in children and young people (NICE guideline CG155) recommendation 1.3.28 and Bipolar disorder (NICE guideline CG185) recommendation 1.11.11 (key priority for implementation)]

Equality and diversity considerations

The delivery and duration of a psychological intervention should be adjusted if necessary to take account of any learning disabilities, autism or cognitive impairment a child or young person with bipolar depression or psychosis has, and healthcare professionals should consider consulting a relevant specialist.

Specialist mental health services should provide children and young people from diverse ethnic and cultural backgrounds with culturally appropriate psychological and psychosocial treatment, and address cultural and ethnic differences in beliefs about biological, social and family influences on mental states.