The National Institute for Health and Care Excellence (NICE) has issued standards to improve the care and support of children and young people with depression.

Depression affects people in different ways and can cause a wide variety of symptoms. They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety. There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite, and complaining of aches and pains [i]. Depression can range in intensity from mild to severe. Nearly 80,000 children and young people in the UK suffer from severe depression, including over 8,000 children aged under 10 years old [ii].

The NICE quality standard is based on the NICE clinical guideline on depression in children and young people, and is designed to improve the diagnosis and management of those aged 5 - 18 years old with this condition.

In summary:

• Diagnosing depression in children and young people can be difficult. Children and young people with suspected depression should have a diagnosis confirmed and recorded in their medical records.
• Children and young people need age-appropriate information they can understand about their diagnosis and treatment options, so they can participate in shared decision making.
• Prompt access to services is essential if children and young people are to receive the right treatment at the right time. Arrangements should be in place so that children and young people referred to Child and Adolescent Mental Health Services (CAMHS) with suspected severe depression and at high risk of suicide are assessed as an emergency, within a maximum 24 hours of referral. Healthcare professionals referring children and young people to CAMHS should ensure they assess the need for a safe place [iii] at the point of referral until the assessment by CAMHS is carried out to help prevent injury or worsening of symptoms.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Depression in children and young people is more common than people might think and can be particularly distressing, both for the child or young person affected and their family. It is important there are clear steps in place to aid healthcare professionals involved in treating children and young people with depression, so that they can deliver the very best levels of care across the NHS.”

Charlotte Libman, member of the specialist committee which developed the quality standard said: “My daughter, who is now 19, experienced depression in her younger teenage years. She suffered anxiety, panic attacks, lost a lot of weight and couldn't find pleasure in anything. I think it may have been triggered, in part, by the death of a much-liked teacher and by bullying at school. Although she has now made a full recovery, and is currently studying at university, it felt like it took a very long time to get here; there were multiple appointments with a number of healthcare professionals, across many months, during which time we had to deal with the depression as a family, and cope the best way we could, which, at times, was very difficult indeed. These quality standards are essential to improve the care and treatment of children and young people with depression, and it's especially important they are seen rapidly by the appropriate healthcare professionals.”

Ricky Emanuel, Consultant Child and Adolescent Psychotherapist at the Royal Free Hospital, London, and member of the specialist committee which developed the quality standard said: “I hope this quality standard can be used as a template to improve the care received by children and young people with depression in England. There are huge variations in the type and quality of care available, which can have long-term consequences on the child or young person and family themselves, as well as for society as a whole. From the available data, we know that there are increasing numbers of such children and young people who are being seen in a constrained financial environment, which has meant Child and Adolescent Mental Health Services are under increasing pressure. The new standards set out the very best care and support for children and young people with depression.”

Dr Gemma Trainor, Nurse Consultant, Greater Manchester West Foundation Mental Health Trust, and member of the specialist committee which developed the quality standard said: “I have over 30 years of direct clinical experience of children and young people presenting with symptoms of depression. In that time, there have been many changes and trends; over the past ten years the increase of primary school-age children presenting with depression is a particularly worrying phenomena. I was very pleased to have been involved in the development of these quality standards and feel they will help ensure a timely and consistent response, providing children, young people and their families / carers with high quality, effective and safer services across the system.”

Lucie Russell, Director of Campaigns at YoungMinds, which endorsed the quality standard said:“The World Health Organisation predicts that by 2030, more people will be affected by depression than any other health problem. If we are to try and tackle this trend, it is vital that we get care for children and young people right. Over 80,000 children and young people are diagnosed with severe depression in the UK, and it is important that they receive timely, quality care.

“This quality standard will help deliver early intervention for depression in children and young people, and improve service provision. YoungMinds hopes that these quality standards are now implemented, so that children and young people receive the very best care and support.

“We particularly welcome the need for age-appropriate information. Children and young people we work with tell us how important it is to have information that enables them to be involved in decisions about their care.”

Ends

Notes to Editors

References

i. NHS Choices

ii. Green, H., McGinnity, A., Meltzer, H., et al. (2005).

iii. A safe place is considered to be anywhere which helps to prevent injury or worsening of symptoms.

About the quality standard

1. The NICE quality standard for depression in children and young people is available on the NICE website from 00:01hrs on Monday 30 September.

2. The NICE quality standard for depression in children and young people is based on the following NICE accredited guideline:

• Depression in children and young people: Identification and management in primary, community and secondary care. NICE CG28. (2005)

3. NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or guidance from other sources that have been accredited by NICE, and apply right across the NHS in England.

Related NICE quality standards

Published

4. Self-harm. NICE quality standard 34 (2013).

5. Patient experience in adult NHS services. NICE quality standard 15 (2012).

6. Depression in adults. NICE quality standard 8 (2011).

In development

7. Anxiety. NICE quality standard. Publication expected March 2014.

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

Follow us on Twitter: @NICEcomms.