Quality statement 4 (developmental): Psychological interventions

Developmental quality statements set out an emergent area of cutting‑edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.

Quality statement

Adults with bipolar disorder are offered psychological interventions.

Rationale

Currently very few adults with bipolar disorder can access appropriate psychological interventions because of capacity and training issues within mental health services. Psychological interventions specifically developed for adults with bipolar disorder (such as enhanced relapse prevention/individual psychoeducation or cognitive behavioural therapy for bipolar disorder) have been shown to improve symptoms and prevent relapses and hospitalisation. Adults with bipolar disorder can be offered psychological intervention as individual, group or family intervention depending on accessibility and suitability to them.

Quality measures

Structure

a) Evidence of local arrangements for the provision of psychological intervention programmes.

Data source: Local data collection.

b) Evidence of practice arrangements and written clinical protocols to ensure that adults with bipolar disorder are offered psychological interventions.

Data source: Local data collection.

Process

Proportion of adults with bipolar disorder who receive a psychological intervention.

Numerator – the number in the denominator who receive a psychological intervention.

Denominator – the number of adults with bipolar disorder.

Data source: Local data collection.

Outcome

a) Relapse rates for adults with bipolar disorder.

Data source: Health and Social Care Information Centre Improving Access to Psychological Therapies dataset (IAPT) and local data collection.

b) Hospital admission rates for adults with bipolar disorder.

Data source: Health and Social Care Information Centre Hospital Episode Statistics and local data collection.

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

Service providers (such as GP practices, community health services and mental health services) ensure that systems are in place for adults with bipolar disorder to be offered psychological interventions.

Healthcare professionals offer adults with bipolar disorder psychological interventions.

Commissioners (such as clinical commissioning groups, NHS England local area teams and local authorities) commission services that deliver psychological interventions and ensure that adults with bipolar disorder are offered a referral to these services.

What the quality statement means for service users and carers

Adults with bipolar disorder are offered psychological treatment for bipolar disorder to help them manage their symptoms and stay well in the future.

Source guidance

  • Bipolar disorder (2014) NICE guideline CG185, recommendations 1.2.5, 1.6.1 and 1.7.3 (key priority for implementation).

Definitions of terms used in this quality statement

Psychological interventions

Psychological interventions recommended specifically for adults with bipolar disorder include:

  • a psychological intervention that has been developed specifically for bipolar disorder and has a published, evidence‑based manual[1] describing how it should be delivered or

  • a high‑intensity psychological intervention (cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy) in line with recommendations 1.5.3.1–1.5.3.5 in the NICE clinical guideline on depression.

Psychological interventions can be delivered as a one‑to‑one, group or family therapy and should address the presentation of adults with bipolar disorder.

[Bipolar disorder (NICE guideline CG185) recommendations 1.2.5, 1.6.1 and expert opinion]

Equality and diversity considerations

Specialist mental health services should provide person‑centred psychological interventions that are appropriate for different ethnic and cultural backgrounds and that take into account differences in beliefs about biological, social, psychological and family influences on mental states.



[1] A manual based on at least 1 randomised controlled trial published in a peer‑reviewed journal showing effectiveness of the intervention in reducing depression symptoms in bipolar depression or, when used as long‑term treatment, reducing relapse in people with bipolar disorder.