Patients with psychosis should be offered therapy

Clinical Commissioning Groups should commission services for people with schizophrenia and psychosis in line with NICE guidelines, including the use of cognitive behavioural therapy (CBT) for psychosis, say experts.

Clinical Commissioning Groups should commission services for people with schizophrenia and psychosis in line with NICE guidelines, including the use of cognitive behavioural therapy (CBT) for psychosis, say experts.

Currently, just one in ten people who could benefit from the therapy have access to it, despite being approved by NICE.

At the same time, almost half of all practitioners, people using mental health services and their families say that CBT is the most important intervention alongside the use of medication.

The findings come from an independent inquiry into the standard of care for people with schizophrenia in England published by The Schizophrenia Commission - which was set up by the charity Rethink Mental Illness.

The inquiry found that patients are spending too long in "demoralised and dysfunctional" hospital wards, and that the condition is costing society almost £12bn a year, money which would be better spent on preventing illness.

Among the 42 recommendations, the report calls for action to improve access to CBT and other effective support.

The report authors say that the current situation is “totally unacceptable” and argue that services should be commissioned in line with the evidenced-based treatment recommendations in the NICE guidelines for people with schizophrenia and their families.

They add that they are “particularly concerned about the lack of access to CBT and other psychological therapies which are recommended in the NICE guidelines and can be very valuable in helping people deal with the impact of symptoms and in keeping them out of hospital.”

NICE recommends that CBT is offered to all people with schizophrenia. This can be started either during the acute phase or later, including in inpatient settings.

The inquiry recommends that the existing nursing workforce, particularly in acute units, should be better trained to deliver simple talking and supportive therapies and that the Department of Health should introduce a maximum waiting time for access to psychological therapies for people with severe mental illness which is embedded in the NHS Constitution.

The authors also urge the Department of Health and NHS Commissioning Board to agree arrangements for continuing the Improving Access to Psychological Therapies (IAPT) programme for people with severe mental illness beyond March 2013.

It is often stated that acutely unwell people are unable to make use of psychological interventions, in particular CBT.

However the inquiry found that although it may be difficult to provide one-to-one CBT to an acutely psychotic person, psychologists need to be more willing to work within acute care teams and help support as well as supervise nursing staff, to provide a psychologically-informed approach to the work they do.

This includes talking constructively and compassionately, listening and providing support and assertive encouragement to take up various treatments, including medication, ward activities and, crucially, exercise.

As the person's mental state improves, they should be better able to take up formal CBT.

Professor Tim Kendall, Director of the National Collaborating Centre for Mental Health that developed the NICE recommendations, said: “It is disappointing that patients are missing out on access to CBT which is currently recommended by NICE for all patients with schizophrenia.

“It is important to ensure that patients are not over reliant on medication and are offered therapy. CBT is proven to help patients better manage their symptoms of psychosis.

“From next year, clinical commissioning groups must ensure that adequate services are commissioned for patients with psychosis, a condition that is still surrounded by stigma and often overlooked by the NHS”

Professor Sir Robin Murray, chair of the commission said: “We have spent the last year listening to expert professionals and more importantly, the experiences of people who have schizophrenia and psychosis and their families.

“The message that comes through loud and clear is that people are being badly let down by the system in every area of their lives. People with psychosis need to be given the hope that it is perfectly possible to live a fulfilling life after diagnosis. We have no doubt that this is achievable.”