What you can expect from the NHS

National Institute for Health and Care Excellence (NICE) recommendations

The National Institute for Health and Care Excellence (NICE) produces guidance that states how people with specific illnesses and conditions should be cared for in the NHS, and what treatment they should be offered. All treatment and support offered by the NHS in England and Wales should be based on NICE guidance.

Each NICE 'clinical guideline' focuses on an individual condition or illness and is prepared by a 'guideline development group', made up of experts in that particular field.

Members of guideline development groups include health professionals, researchers, people who have personal experience of the illness or condition covered by the guideline, and their family members. They work together to review and consider 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 clinical guidelines are reviewed every few years to make sure they reflect and include new knowledge and new treatments proven through research to be effective.

NICE also produces 'technology appraisals' about when and how new and existing medicines, diagnostic tests, medical devices and surgical procedures should be used, and recommends whether 'interventional procedures' for diagnosis or treatment, such as deep brain stimulation, are effective and safe. NICE 'quality standards' are sets of statements that describe what high quality health and social care should be like for a particular condition or in a particular service.

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.

Doctors, nurses and other healthcare professionals in England and Wales 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 for England, people have a right to be given NICE-recommended medication and treatments if their doctor thinks they are appropriate for them – sometimes doctors don't think NICE-recommended drugs or treatments are appropriate for a particular individual.

NICE 'public health guidance' for England 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.

In addition, NICE is responsible for producing guidance and quality standards about social care in England. This has been the case since 1 April 2013 (before then, the organisation was called the National Institute for Health and Clinical Excellence and produced only guidance for the NHS). For example, NICE has produced guidance for social care professionals about the 'Mental wellbeing of older people in care homes' and is developing guidance about 'Mental health problems in people with a learning disability' and 'Transition from children's to adult's services.'

In 2014, NICE was given another new role: to develop evidence-based guidelines about safe staffing levels in the NHS in England.

In Scotland, the Scottish Intercollegiate Guidelines Network (part of Healthcare Improvement Scotland) develops evidence-based clinical practice guidelines for the NHS.

In Northern Ireland, 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 there.

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NICE guidance on treatment and support for psychosis and schizophrenia in adults

The NICE clinical guideline about treatment of schizophrenia is called 'Psychosis and schizophrenia in adults: treatment and management' (clinical guideline 178). It was published in February 2014 and uses the term 'psychosis' to describe the symptoms of psychosis experienced by people who have a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder or delusional disorder. Recommendations for supporting people who are having psychotic-like experiences that are distressing are also included. The guideline does not include recommendations about treatment of psychosis experienced by people who have bipolar disorder or psychotic depression – or people who have Parkinson's disease or dementia, or another condition that causes the symptoms of psychosis. Recommendations for treatment in these circumstances are included in other NICE guidance.

This is the second update of the NICE clinical guideline about schizophrenia, which was initially published in 2002. A first update was published in 2009. The 2014 guideline replaces the 2009 update and makes recommendations about both treatment and types of service that should be offered. It says, for example, that everyone experiencing an episode of psychosis for the first time should be supported by an early intervention service.

Recommended treatment for psychosis and schizophrenia is antipsychotic medication as well as cognitive behaviour therapy for psychosis (CBT) and family intervention (family therapy). Mental health professionals may also consider offering an arts therapy. The guideline recommends mental health professionals consider offering peer support from someone who has had experience of schizophrenia or the symptoms of psychosis, or a 'self management programme' led by a health and social care professional. Both types of support should include information and advice about the symptoms of psychosis and schizophrenia, treatment and recovery. Mental health professionals should help people to stay in work or education, or return to work or education.

The guideline stresses the importance of good physical health. People on antipsychotic medication should have a regular physical health check and be given advice about healthy eating and physical activity, and help to stop smoking.

It recommends family members and other carers of people who are experiencing psychosis, or have a diagnosis of schizophrenia, be offered support from mental health professionals and social care professionals.

The guideline says people who have distressing psychotic-like experiences, should be offered an immediate assessment by early intervention services and CBT for psychosis. People and their family members may also be offered family intervention (family therapy). People who have psychotic-like experiences should not initially be offered antipsychotic medication.

On the NICE website, you can view the full clinical guideline about psychosis and schizophrenia in adults as well as summary versions in different formats.

These different versions include 'information for the public'.

There is more information about the treatment and care recommended by NICE on relevant pages throughout this website.

NICE is developing a quality standard about treatment for adults who have a diagnosis of schizophrenia, and this is due to be published in February 2015.

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NICE guidance on treatment and support for psychosis and schizophrenia in children and young people

A NICE clinical guideline called 'Psychosis and schizophrenia: recognition and management of psychosis and schizophrenia in children and young people' (clinical guideline 155) was published in January 2013.

It is about treatment and support for children and young people who have not yet reached their 18th birthday.

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 who is 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 diagnose a first episode of psychosis, they should offer the child or young person CBT and family therapy for psychosis as well as antipsychotic medication.

If a child or young person has already experienced a first episode of psychosis and goes on to experience another, he or she should be offered medication, CBT and family intervention. He or she may also be offered arts therapies.

A child or young person 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 is able to continue their education, and is given appropriate help and support to do so.

Parents or other carers should be involved in planning treatment and support for the majority of children. Health professionals should encourage young people who are mature enough to make their own decisions to involve parents and other carers in their care, and to allow information about them to be shared.

On the NICE website, you can view the full clinical guideline about psychosis and schizophrenia in children and young people as well as summary versions in different formats.

These different versions include 'information for the public'.

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NICE guidance on treatment and support for bipolar disorder

A NICE clinical guideline called 'The management of bipolar disorder in adults, children and adolescents in primary and secondary care' (clinical guideline 38) was published in July 2006.

It is currently being updated and the new guideline is due to be ready in September 2014.

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. It 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 view the full clinical guideline about bipolar disorder as well as summary versions in different formats.

These different versions include 'information for the public'.

There is more information about the treatment and care recommended by NICE for bipolar disorder on relevant pages throughout this website.

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NICE guidance on mental health services

A NICE clinical guideline called 'Service user experience in adult mental health: Improving the experience of care for people using adult NHS mental health services' (clinical guideline 136) was published in December 2011.

It explains the procedure for getting a referral from a GP to a specialist mental health service; 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 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 view the full clinical guideline about mental health services as well as summary versions in different formats.

These different versions include 'information for the public'.

NICE has produced a 'quality standard' based on this guideline.

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NICE guidance on making decisions about prescribed medicines

A NICE clinical guideline called 'Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence' (clinical guideline 76) was published 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 guideline offers practical advice on involving patients, helping them make informed decisions, and supporting ‘adherence’ – the taking of medication as prescribed.

On the NICE website, you can view the full clinical guideline about encouraging people to take medication and enabling them to make informed decisions as well as summary versions in different formats.

These different versions include 'information for the public'.

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NICE guidance on violent and disturbed behaviour in hospital

A NICE clinical guideline called 'Violence: the short-term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments' (clinical guideline 25) was published in February 2005.

It is currently being updated and a new guideline is due to be published in April 2015.

The existing guideline sets out how doctors, nurses and other health professionals should manage disturbed or violent behaviour in psychiatric units, wards and emergency departments.

It recommends methods staff may use when talking doesn’t calm people down, including ‘rapid tranquillisation’, and the use of medication. The guideline specifies what drugs can be used in these circumstances, and procedures that should be followed before and after an incident of violent or disturbed behaviour.

On the NICE website, you can view the full clinical guideline about violent and disturbed behaviour in hospital, as well as summary versions in different formats.

These different versions include 'information for the public'.

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NICE guidance on electroconvulsive therapy (ECT)

NICE issued guidance on the use of electroconvulsive therapy (ECT) in 2003. The guidance is a 'technology appraisal' and is called 'The clinical effectiveness and cost effectiveness of electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania' (technology appraisal 59).

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.

Download the 'Understanding NICE guidance' summary for the public about 2003 recommendations on the use of ECT.

Recommendations about the use of ECT for severe depressive illness are contained in the October 2009 NICE clinical guideline on depression (Depression: the treatment and management of depression in adults, clinical guideline 90). 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 NICE website contains 'information for the public' about the treatment of depression.

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.

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NICE guidance on treatment and support for people who experience psychosis and use drugs and alcohol

A clinical guideline called 'Psychosis with coexisting substance misuse: assessment and management in adults and young people' (clinical guideline 120) was published in March 2011.

The guideline says people who experience the symptoms of psychosis and have 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.

On the NICE website, you can view the full clinical guideline about treatment for people who experience psychosis and who use drugs and alcohol, as well as summary versions in different formats.

These different versions include 'information for the public'.

There are summaries of NICE guidance for the public about:

Treating harmful drinking and alcohol dependence
Physical health problems caused by drinking alcohol
Treatments for drug misuse

There is more information about the treatment and care recommended by NICE on the Psychosis, drugs and alcohol page of this website.

NICE has published quality standards about 'Drug use disorders' and 'Alcohol dependence and harmful alcohol use'.

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NICE guidance on the treatment of depression, anxiety, borderline personality disorder and antisocial personality disorder

People who have a serious mental illness like schizophrenia may also experience other mental health problems – such as depression, anxiety or personality disorder. Each of the links below go to NICE 'information for the public' about guidance for that particular condition:

• NICE clinical guideline on depression (clinical guideline 90): 'Treating depression in adults'.

• NICE clinical guideline on anxiety (clinical guideline 113): 'Treating generalised anxiety disorder and panic disorder in adults'.
There is also a NICE quality standard about 'Anxiety disorders'.

• NICE clinical guideline on borderline personality disorder (clinical guideline 78): 'Borderline personality disorder'.

• NICE clinical guideline on antisocial personality disorder (clinical guideline 77): 'Antisocial personality disorder'.

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NICE guidance on the treatment of self-harm

A NICE clinical guideline called 'Longer-term care and treatment of self-harm' (clinical guideline 133) was published in 2011.

The recommendations include offering psychological interventions that are specifically designed to help people reduce and then stop self-harming behaviour, and that are tailored to people's individual needs. The guidance stresses the need for health professionals to develop trusting and supportive relationships with individuals, and to formulate care plans in collaboration with the person who self-harms and their family members.

On the NICE website, you can view the full clinical guideline about the treatment of self-harm (in the longer-term) as well as summary versions in different formats.

These different versions include 'information for the public'.

There is a second NICE clinical guideline that focuses on the first 48 hours following self-harm and the care people receive in an emergency department. It is called 'The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care' (clinical guideline 16) and was published in July 2004.

On the NICE website, you can 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 the public.

Some of the recommendations and advice contained in the guideline about short-term treatment and care have been replaced with advice in the 2011 clinical guideline about longer-term care. NICE has made it clear in the 'Understanding NICE guidance' summary what changes have been made following the publication of the guideline about longer-term treatment and support in 2011.

In December 2013, the guideline about short-term management was transferred onto the NICE 'static list' – this means it will not now be routinely reviewed. However, NICE proposes to review its contents when it next reviews the guideline about longer-term treatment.

There is a NICE quality standard about 'Self-harm' (quality standard 34).

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NICE guidance on brain scans to help diagnose psychosis

This guidance is called 'Structural neuroimaging in first-episode psychosis' (technology appraisal 136) and was published 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 of psychosis.

On the NICE website, you can view the full guidance, as well as summary versions in different formats.

These different versions include an 'Understanding NICE guidance' summary for the public.

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NICE guidance on the treatment of physical health problems

NICE stresses the important of making sure people who have a diagnosis of serious mental illness get regular physical health checks and treatment for any physical health problems.

On the NICE website, you can view information about NICE recommended treatments for different physical health problems. There is a list with links to all published clinical guidelines.

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What to do if you think doctors and other health professionals aren’t following NICE guidance

If someone feels treatment and care recommended by NICE is suitable for them, but they are not offered that treatment by the NHS, they can make a complaint. If you want to complain about NHS treatment or care, you have to start by complaining to the NHS organisation that runs the service that is offering treatment. Visit the How to complain page to find out more information.

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Get involved with the creation of NICE guidance

NICE is keen to involve patients, service users family members, other carers and members of the public in the process of creating guidance about health and social care. Patients, family members and members of the public can join a NICE committee, or join a guidance development group (places are advertised on the NICE website). 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.

 

 


This page was updated on 22 March 2014
Links on this page last checked: 30 August 2014
Next links check due: December 2014