Expert answers from
What you can expect from the NHS
- Treatment recommended by the National Institute for Health and Care Excellence (NICE)
- NICE guideline on schizophrenia
- NICE guideline on psychosis and schizophrenia in children and young people
- NICE guideline on bipolar disorder
- NICE guideline on mental health services
- NICE guideline on making decisions about prescribed medicines
- NICE guideline on violent and disturbed behaviour in hospital
- NICE guidelines on self-harm
- NICE guidelines on treating people with psychosis who use drugs and alcohol
- NICE guidance on electroconvulsive therapy (ECT)
- NICE guidance on brain scans to help diagnose psychosis
- What to do if you think doctors aren’t following NICE guidance
- Get involved with the creation of NICE guidance
- NICE quality standards
All treatment and support offered by the NHS in England and Wales should be based on guidance issued by the National Institute for Health and Care Excellence (NICE) [before 1 April 2013, the organisation was called the National Institute for Health and Clinical Excellence].
This organisation is responsible for producing ‘clinical guidelines’ that state how people with specific illnesses and conditions should be cared for and what treatment they should be offered. NICE also produces 'technology' appraisals about when and how new and existing medicines and treatments should be used, and other guidance that recommends diagnostic tests and medical procedures. NICE 'public health guidance' recommends how to prevent illness and disease and how to improve people's health – recommendations about how to stop people smoking, for example, increase physical activity and prevent sexually transmitted diseases. NICE 'quality standards' describe what high quality health care should be like.
From 1 April 2013, NICE is responsible for producing guidance and quality standards about social care (this responsibility was outlined in the Health and Social Care Act 2012).
All NICE guidance about specific illnesses and conditions is prepared by 'guideline development groups', which are made up of experts in the particular field, including health professionals, people who have personal experience of that illness or condition and their family members. The guideline development groups review the most recent, relevant research that shows what treatments and services work best. They also take into account ‘value for money’, looking at the costs of each treatment compared to its benefits.
NICE guidance helps to make sure people across England and Wales receive the same standard of care. Doctors, nurses and other healthcare professionals are expected to take clinical guidelines and other NICE guidance into account in their work, and NHS organisations must by law pay for medicines and treatments recommended by NICE. Under the NHS Constitution, people have a right to be given NICE-recommended medication and treatments if their doctor thinks they are right for them (sometimes doctors don't think NICE-recommended treatments are appropriate for a particular individual).
There are separate NICE clinical guidelines for the treatment of schizophrenia and the treatment of bipolar disorder.
Other guidance that may be relevant to the treatment of someone who has experienced the symptoms of psychosis is listed on this page.
NICE guidance is reviewed every few years to make sure it reflects and includes new knowledge and new treatments proven to work through research. Each set of guidance is produced in different formats, including a summary for members of the public.
The Department of Health, Social Services and Public Safety in Northern Ireland has a formal link with NICE and reviews clinical guidelines to see if they are applicable in Northern Ireland.
In Scotland, the Scottish Intercollegiate Guidelines Network develops evidence-based clinical practice guidelines for the NHS.
This guideline is called Core interventions in the treatment and management of schizophrenia in primary and secondary care (update) and was issued in March 2009.
The guideline outlines what treatment, care and support should be offered to adults who are given a diagnosis of schizophrenia – antipsychotic drugs and talking therapies, including cognitive behaviour therapy and family therapy. The guideline recommends mental health professionals work in partnership with family members and carers.
The guideline is currently being reviewed (2011-2014) and Professor Elizabeth Kuipers from the Institute of Psychiatry, King's College London – who leads the development of mentalhealthcare.org.uk – is chairing the expert group that is considering new evidence about some aspects of treatment of care for psychosis and schizophrenia. Professor Kuipers previously chaired the group responsible for producing the existing guideline on schizophrenia.
On the NICE website, you can download or view the existing full schizophrenia guideline as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Schizophrenia.
People with schizophrenia often have other conditions such as depression, anxiety or personality disorder. Each of the links listed below go to 'Understanding NICE guidance' summary for members of the public about that particular condition:
• NICE guideline on depression: Treating depression in adults
• NICE guideline on anxiety: Treating generalised anxiety disorder and panic disorder in adults
• NICE guideline on borderline personality disorder: Borderline personality disorder
• NICE guideline on antisocial personality disorder: Antisocial personality disorder
This guideline is called Psychosis and schizophrenia in children and young people and was issued in January 2013
The guideline is about people younger than 18. It recommends GPs should refer children or young people who are having psychotic-like experiences that are distressing, or symptoms that suggest they may be experiencing psychosis, to specialist mental health services as quickly as possible. This means referring them to child and adolescent mental health services (CAMHS) or to an early intervention in psychosis service. Antipsychotics should not be prescribed for someone having psychotic-like experiences, or for suspected psychosis, or as a preventative measure (ie to decrease the risk of psychosis). Antipsychotics should only be prescribed following a diagnosis. Mental health professionals should consider offering people who are having distressing psychotic-like experiences cognitive behaviour therapy for psychosis (CBT) and/or family intervention (family therapy for psychosis).
If mental health professionals diagnosis a first episode of psychosis, they should offer the child or young person CBT and family intervention (family therapy for psychosis) as well as antipsychotic medication.
If children and young people have already experienced a first episode of psychosis and go on to experience another, they should be offered medication, CBT and family intervention. They may also be offered arts therapies. Children and young people will be encouraged to take medication for one to two years after an episode of psychosis.
The guideline also covers crisis care and treatment in hospital: it says children and young people should be admitted to a hospital ward that is suitable for their age.
Health professionals should always work to ensure that a child or young person continues their education and is given appropriate help and support to do so.
On the NICE website, you can download or view the full guideline about the recognition and management of psychosis and schizophrenia in children and young people as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public.
The guideline is called The management of bipolar disorder in adults, children and adolescents in primary and secondary care and was issued in July 2006. An update of this guideline was due to begin in October 2012. A publication date for that update has not yet been announced.
The existing guideline covers what treatment and support people with bipolar disorder can expect to be offered, including medication, talking therapies and advice on self-help. The guideline suggests how family members and carers may be able to support people with bipolar disorder, and how they can get support for themselves.
On the NICE website, you can download or view the full bipolar disorder guideline as well as summary versions in different formats. These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Bipolar disorder.
This guideline is called Service user experience in adult mental health: Improving the experience of care for people using adult NHS mental health services. It was issued in December 2011.
It explains the procedure for getting a referral from a GP; what should happen during an assessment; how a care plan should be developed; what should happen in a crisis; what should happen if someone needs to be admitted to hospital; and what should happen if someone is detained and treated under the Mental Health Act.
The guideline says mental health professionals should work in partnership with service users and their family members (if appropriate) and treat people with respect and dignity. They should be friendly and welcoming and encourage people to feel optimistic. They should give people information about their diagnosis and information about the proposed treatment to enable them to make informed decisions. They should not be critical of the lifestyles of the people they support.
Mental health professionals should be trained to understand information-sharing and confidentiality rules. They should make sure family members know about carers assessments and have information about services that can support them, even if the individual who has a mental health problem does not want them to be involved in their care.
On the NICE website, you can download or view the full mental health services guideline as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Improving your experience of mental health services in the NHS.
NICE has produced a 'quality standard' based on this guideline. See 'NICE quality standards' below and NICE information about this quality standard: Information for people who use NHS mental health services.
This guidance is called Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence and was issued in January 2009. It will be reviewed in January 2015.
The guideline looks at why some patients don’t use their medicines as prescribed (this is called ‘non-adherence’) either because they don’t want to, or because they have practical problems doing so. One of the main recommendations of the guideline is about improving communication and people’s understanding of why drugs are prescribed, and involving people in decisions about their medicines. The guidelines offers practical advice on involving patients in decisions, and supporting ‘adherence’ – the taking of medication as prescribed.
On the NICE website, you can download or view the full guideline about encouraging people to take medication and involving them in decisions about treatment, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called You and your prescribed medicines: enabling and supporting patients to make informed decisions.
This guidance is called Violence: the short-term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments and was issued in February 2005. An updated guideline is due to be published in December 2014.
The existing guideline sets how doctors, nurses and other health professionals should manage disturbed or violent behaviour in psychiatric units, wards and emergency departments. It includes methods staff may use if talking doesn’t calm people down, including ‘rapid tranquillisation’, and the use of medication. It specifies what drugs can be used, and procedures that should be following before and after an incident of violent or disturbed behaviour.
On the NICE website, you can download or view the full guideline about violent and disturbed behaviour in hospital, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Violence: managing disturbed/violent behaviour.
There are two clinical guidelines about self-harm.
This first is called The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care and was issued in July 2004. It is due to be reviewed in February 2015.
The guideline outlines what care, support and treatment (including physical treatment) people can expect to receive within the first 48 hours after self-harming.
Some of the recommendations and advice contained in the guideline have been replaced with advice in the second clinical guideline about self-harm (Longer term care and treatment of self-harm), which was produced in 2011.
On the NICE website, you can download or view the full guideline about the short-term support and treatment that should be offered to people who have self-harmed, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Self-harm: short-term treatment and management. NICE has made it clear in this booklet what changes have been made to the guidance following the publication of the second guideline in 2011.
You can also download or view the second full guideline about self-harm (longer term management) issued in November 2011, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Longer-term care and treatment of self-harm.
This guideline is called Psychosis with coexisting substance misuse: assessment and management in adults and young people. It was issued in March 2011.
The guideline says people who have psychosis and a drug or alcohol problem should be given treatment outlined in the NICE guidelines for schizophrenia and bipolar disorder as well as treatments specified in the NICE guidelines about drug dependency and/or harmful alcohol use. The treatments for alcohol dependence may include detoxification, medication and talking therapies as well as treatments for physical health problems caused by drinking alcohol. The treatments for drug dependency may include detoxification, a prescribed heroin substitute, talking therapies or an incentives programme.
There are 'Understanding NICE guidance' summaries for members of the public about:
The guideline about treatment for psychosis and drug or alcohol dependency also recommends people draw up advance decisions and statements (see People who have experienced psychosis before page), and that the treatment wishes expressed in those documents are taken into account by health professionals.
On the NICE website, you can download or view the full guideline about treating people with psychosis who use drugs and alcohol, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Treatment and support for people with psychosis who use drugs and/or alcohol.
NICE issued guidance on the use of ECT in 2003. The guidance is a 'technology appraisal' and is called: The clinical effectiveness and cost effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania.
The 'Understanding NICE guidance' summary for the public is called: The use of electroconvulsive therapy.
Electroconvulsive therapy (ECT) should only be used for:
• the treatment of severe depressive illness;
• a prolonged or severe episode of mania;
• or catatonia. Catatonia is sometimes associated with schizophrenia or with mood disorders. Someone with catatonia may stop moving and remain rigid, may stop eating and drinking, or may become very excited for no apparent reason and move around excessively.
Recommendations about the use of ECT for severe depressive illness are contained in the October 2009 NICE clinical guideline on depression. This says that ECT should be considered for severe depression that is life-threatening, when a rapid response is required, or when other treatments have failed.
The 'Understanding NICE guidance' is called: Treating depression in adults.
People must be given information about potential risks and benefits of ECT in order to make an informed decision about whether to have the treatment. Doctors must not put pressure on a patient to have the treatment, and an independent person – a family member or advocate – should be involved in the decision if possible.
This guidance is called Structural neuroimaging in first-episode psychosis and was issued in February 2008. The guidance is a 'technology appraisal'.
The NICE guidance say MRI or CT scanning (structural neuroimaging) of people’s brains should not be routinely used to help diagnosis after someone has had a first episode of psychosis. The guidance says scanning does not aid diagnosis and is not cost-effective. However, people should be given a brain scan if doctors think a physical illness is causing the symptoms psychosis.
On the NICE website, you can download or view the full Structural neuroimaging in first-episode psychosis guidance, as well as summary versions in different formats.
These different versions include an 'Understanding NICE guidance' summary for members of the public: it is called Structural neuroimaging for examining people who have had a first episode of psychosis.
If people feel treatment and care recommended by NICE is suitable for them, but are not offered that treatment by the NHS, they have a right to seek help or complain.
If you want to complain about NHS treatment or care, you have to start by complaining to the NHS trust that runs the service. Visit the How to complain page to find out more information.
There is information about accessing treatment recommended by NICE on the NICE website that you may also find useful.
NICE is keen to involve patients, family members, other carers and members of the public in the process of creating guidance for the NHS. Patients, family members and members of the public can suggest a topic for guidance, or join a NICE committee or working group. They can also comment on the contents of proposed guidance during the consultation stages of the guidance development process. For more information, visit the NICE website.
NICE 'quality standards' describe what 'high quality' health and social care services should be like. The idea is that NHS and social care organisations can use them to improve the quality of the services they offer, and people can refer to them to make sure the care and support they are being offered meets national standards.
The quality standards are based on NICE clinical guidelines and other evidence-based guidance.
A quality standard describing what high quality NHS mental health services should be like was published in December 2011.
This page was last updated 7 February 2013 (NICE name change incorporated 9 April 2013).
There are no plans to update the page because funding for mentalhealthcare.org.uk ended in April 2013.
We will, however, continue to regularly check that all links are working.
Links on this page last checked: 4 December 2013
Next links check due: April 2014