What you can expect from the NHS

• About the National Institute for Health and Clinical Excellence (NICE)
• NICE guidance on schizophrenia
• NICE guidance on bipolar disorder
• NICE guidance on the experience of using mental health services
• NICE guidance on making decisions about prescribed medicines
• NICE guidance on violent and disturbed behaviour
• NICE guidance on self-harm
• NICE guidance 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 guidelines
• Get involved with the creation of NICE guidance
• NICE quality standards

About the National Institute for Health and Clinical Excellence (NICE)

NHS treatment and support given to people with psychosis in England and Wales should be based on guidance issued by the National Institute for Health and Clinical Excellence (NICE).

This organisation is responsible for producing ‘clinical guidelines’ for health professionals, which state how people with specific illnesses and conditions should be cared for. NICE also produces ‘technology appraisal’ guidance, which advises on when and how drugs and other treatments and procedures should be used in the NHS, and other sorts of guidelines and guidance – public health guidance promoting good health and the prevention of ill health, for example.

All NICE guidance is prepared by 'development groups' of experts in the particular field, including health professionals and people who have personal experience of a specific illness or condition. The groups review all the relevant evidence (provided by 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. The NHS must by law pay for medicines and treatments recommended by technology appraisal guidance, for example. This means people should be able to get NICE recommended medicines and treatments from the NHS, if their doctors think they are right for them.

Doctors, nurses and other healthcare professionals are expected to take NICE guidance into account in their work. However, each health professional also has a responsibility to offer care tailored to an individual patient’s needs, in consultation with them and, where appropriate, their family members.

There is separate NICE guidance for the treatment of schizophrenia and the treatment of bipolar disorder.

Other guidance that may be relevant to the treatment of someone with 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 people who used NHS services, their families and friends.

The Department of Health, Social Services and Public Safety in Northern Ireland has a formal link with NICE and reviews clinical guidance to see if it is applicable in Northern Ireland.

In Scotland, the Scottish Intercollegiate Guidelines Network develops evidence-based clinical practice guidelines for the NHS.

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NICE guidance on schizophrenia

This guidance is called Core interventions in the treatment and management of schizophrenia in primary and secondary care (update) and was issued in March 2009.

The guidance is currently being reviewed (2011-2013) and Professor Elizabeth Kuipers from the Institute of Psychiatry, King's College London – who leads the development of this website – has been appointed to lead the expert group that will consider new evidence about some aspects of treatment of care. Professor Kuipers previously chaired the group responsible for producing the existing guidance on schizophrenia.

This outlines what treatment, care and support adults with schizophrenia should be offered. It includes guidance on the use of antipsychotic drugs and talking therapies for the treatment of schizophrenia, including cognitive behaviour therapy and family therapy. It recommends health professionals work in partnership with family members and carers.

Read the NICE guidance on schizophrenia.

Read a summary for people who use NHS services and their families.

People with schizophrenia often have other conditions such as depression, anxiety or personality disorder. NICE has separate guidelines about the treatment of these conditions:

• Guidance on depression – Depression: the treatment and management of depression in adults
• Guidance on anxiety – Generalised anxiety disorder and panic disorder in adults
• Guidance on borderline personality disorder – Borderline personality disorder: treatment and management
• Guidance on antisocial personality disorder – Antisocial personality disorder: treatment, management and prevention

Each of these links goes to a page where you can download an ‘Understanding NICE guidance’ summary for people who use the NHS and their families.

NICE is currently preparing a clinical guideline called Psychosis and schizophrenia in children and young people. This is due to be ready in March 2013.

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NICE guidance on bipolar disorder

The guidance is called The management of bipolar disorder in adults, children and adolescents in primary and secondary care and was issued in July 2006. Some areas of the guidance are to be reviewed and updated, though the scheduled publication date for an update is yet to be confirmed.

The guideline covers what treatment people with bipolar disorder can expect to be offered, including medication, talking therapies and advice on self-help. It includes how family members and carers may be able to support people with bipolar disorder, and how they can get support for themselves.

The guidance recommends families be involved in treatment and, if appropriate and without breaking confidence, that both the individual with bipolar disorder and their families should be given information at every stage – from assessment, through diagnosis to treatment.

Read the NICE guidance on bipolar disorder.

Read a summary for people who use NHS services and their families.

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NICE guidance on the experience of using mental health services

This guidance 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 who are unwell information about their diagnosis and 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 their right to a carers assessments and have information about services that can support them, even if an individual who is unwell does not want them to be involved in their care.

Read the NICE guidance on the experience of using mental health services.

Read a summary for people who use NHS services and their families.

This is called Improving your experience of mental health services in the NHS.

NICE has also produce a 'quality standard' describing high quality care for adults with mental health problems who access NHS mental health services, which is based on this guideline. There is more information about this quality standard on the NICE quality standards page on the NICE website and on the NICE quality standards page on this website.

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NICE guidance on making decisions about prescribed medicines

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 guidance 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.

Read the NICE guidance on making decisions about prescribed medicines.

Read a summary for people who use NHS services and their families.

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NICE guidance on violent and disturbed behaviour

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. The review process is due to start in February 2012.

The 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’, 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.

Read the NICE guidance on violent and disturbed behaviour.
Read a summary for people who use NHS services and their families.

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NICE guidance on self-harm

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 people can expect to receive within the first 48 hours after self-harming.

Read the NICE guidance on self-harm, short-term treatment and management.
Read a summary for people who use NHS services and their families.

A second guideline called Self-harm: longer-term management was issued in November 2011.

Read the NICE guidance on longer term care and treatment for self-harm. 

Read a summary for people who used NHS services and their families.

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NICE guidance on treating people with psychosis who use drugs and alcohol

This guidance 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 AND treatments outlined in the NICE guidelines for drug dependency 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 heroin substitute, talking therapies or an incentives programme.

Read a summary of NICE guidance on treating harmful drinking and alcohol dependence.

Read a summary of NICE guidance on physical problems caused by drinking alcohol.

Read a summary of NICE guidance on treatments for drug misuse.

The guideline about treatment for psychosis and drug or alcohol dependency recommends people draw up advance decisions and statements (see Relapse page), and that the treatment wishes expressed in those documents are taken into account when they are unwell.

The guidance also says health professionals should encourage family members to be involved in treatment, if their relative gives consent, and should be given information and support.

Read the NICE guidance on treating people with psychosis who used drugs and alcohol.

Read a summary for people who use NHS services and their families.

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NICE guidance on electroconvulsive therapy (ECT)

The National Institute of Health and Clinical Excellence (NICE) issued guidance on the use of ECT in 2003. It is called The clinical effectiveness and cost effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania.

Read a summary of the NICE guidance on ECT.

The guidance states 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 guidance 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.

Unless it is an emergency, patients who have the capacity to consent cannot be given ECT unless they agree.

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.

Read a summary of the NICE guidance on depression in adults.

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NICE guidance on brain scans to help diagnose psychosis

This guidance is called Structural neuroimaging in first-episode psychosis and was issued in February 2008.

The NICE guidelines 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 improve diagnosis and is not cost-effective. However, people should be given a brain scan if doctors think a physical illness is causing psychosis.

Read the NICE guidance on brains scans to help diagnose psychosis.

Read a summary for people who use the NHS and their families and carers. 

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What to do if you think doctors aren’t following NICE guidelines

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. 

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Get involved with the creation of NICE guidance

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.

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NICE quality standards

NICE is also now producing 'quality standards' for different conditions and diseases. These describe what 'high-quality' health and social care services should be like. Organisations can use them to improve the quality of the services they offer, and patients and their families can refer to them to make sure the care they are being offered meets national standards.

A quality standard describing high quality care for adults with mental health problems who access NHS mental health services was published in December 2011. Quality standards describing the best treatment and services for schizophrenia and bipolar disorder are to be developed soon. Visit the NICE quality standards page or the NICE website to find out more.