Adult common mental health problems
Making the case for action
The National Collaborating Centre for Mental health Improving Access to Psychological Therapies (IAPT) manual says that depression and anxiety disorders are the most common mental health problems (affecting approximately 16% of the population at any one time). They can have a devastating effect on people, their families and society.
IAPT services provide evidence-based treatments for people with depression and anxiety disorders. Services are underpinned by key principles including:
- offering the most effective and least intrusive NICE-recommended psychological therapies first, in line with a stepped-care model
- trained and competent clinicians who have regular supportive clinical supervision
- meaningful choice in treatment
- routine, session-by-session outcome monitoring.
Two-thirds of people with a long-term physical health condition also have a mental health problem, usually anxiety or depression. In addition, up to 70% of people with medically unexplained symptoms also have depression or anxiety disorders, or both. These common mental health disorders are detectable and treatable.
Five year forward view
The Five Year Forward View plans to increase access to psychological therapies, so that by 2020/21 at least 25% of people with common mental health conditions (1.5 million people) can access services each year.
Implementing the Five Year Forward View for Mental Health sets out plans to expand IAPT services to focus on people with long-term conditions or medically unexplained symptoms. Quality of services will also be maintained and developed, including meeting access and recovery standards so that 75% of people access treatment within 6 weeks, 95% within 18 weeks; with a recovery rate of at least 50% across the adult age group.
NHS Long Term Plan
The NHS Long Term Plan sets out to further improve and expand access to psychological therapies services for adults with common mental health problems. It will offer access for an additional 380,000 adults by 2023/24, and also within specialist perinatal mental health services. It will further expand the IAPT programme, particularly for people with long-term physical conditions, and will maintain existing IAPT referral to treatment time and recovery standards.
Finding the right information
Our guidelines make evidence-based recommendations on topics ranging from preventing and managing specific conditions to planning broader services and interventions to improve the health of communities. They guide decisions about health and care by practitioners, providers, commissioners, service planners and users, and promote integrated care if appropriate.
We have published guidance and quality standards to support delivery of the IAPT services for the general population, as well as those with long-term conditions and medically unexplained symptoms. Relevant guidance is embedded in national supporting guidance documents, including the National Collaborating Centre for Mental Health’s:
- improving access to psychological therapies manual
- improving access to psychological therapies pathway for people with long term conditions and medically unexplained symptoms implementation guidance.
The easiest way to find all our guidance related to adult common mental health problems is to go to our topic pages on mental health and behavioural conditions.
NICE Pathways bring together everything we’ve said on a topic in an interactive flowchart. The main NICE Pathways for this topic are:
- generalised anxiety disorder
- common mental health disorders in primary care
- post-traumatic stress disorder.
The following video explains how to use NICE Pathways.
Using quality standards to make an impact on care and support
Quality standards contain a list of quality statements, each describing a priority area for quality improvement. They include metrics that can be a useful source of key performance indicators or performance metrics for system-wide performance dashboards. They help you identify areas to make high-impact improvements for common mental health problems in adults. See how to use quality standards for more information.
The main quality standards for adult common mental health problems are:
Support for improving quality
We publish a range of tools and resources to help with putting our guidance and quality standards into practice. You can find these on the ‘Tools and resources’ tab for each piece of guidance or standard. They include:
- baseline assessment tools (for all guidelines) and a quality standard service improvement template (for all quality standards) to assess whether your services are in line with our guidelines and quality standards
- shared learning case studies showing how organisations have used the guidance or quality standards in practice.
Shared learning case studies
The shared learning collection contains over 800 case studies showing how organisations around the UK have used NICE guidance and standards to improve the quality of health and social care services.
Birmingham and Solihull Mental Health NHS Foundation Trust adapted their services to improve access to group therapy, and recognise that some communities face particular and culturally sensitive barriers to accessing these services. They have developed a culturally sensitive treatment group where patients can feel that their ethnic, cultural and spiritual beliefs were understood by the group facilitator and where specific barriers to access for these communities are addressed.
The Airedale NHS Trust adapted our guidance on anxiety and depression to use it in the workplace and use the stepped care approach to mental health.
Occupational health was restructured, and staff were given cognitive behavioural therapy training.
Staff felt more confident when communicating with people with anxiety and depression, and the number of people referred to the counsellor decreased, as did days lost because of mental health. Employees gave positive feedback about the changes.
Digitally enabled therapies
We’re working with NHS England to identify and assess digitally enabled therapies. This is psychological therapy that’s provided online or through mobile applications, with the support of a trained therapist. This therapy:
- follows our recommendations
- addresses a condition that is part of the current IAPT programme, such as anxiety or depression
- calls for submissions from developers
- plans to provide the NHS with regular briefings.
We’ve developed a set of outcome indicators to support care of adults with common mental health problems. Visit our standards and indicators page for more information. Indicators can be particularly useful to local partnerships when:
- identifying where improvements are needed
- setting priorities for quality improvement and support
- creating local performance dashboards
- benchmarking performance against national data
- supporting local quality improvement schemes
- demonstrating progress that local health systems are making on outcomes.