Common mental health disorders: identification and pathways to care

National Institute for Health and Care Excellence


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Introduction

  • Common mental health disorders, such as depression, generalised anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and social anxiety disorder, may affect up to 15% of the population at any one time
  • They vary considerably in their severity but all of these conditions can be associated with significant long-term disability
  • The vast majority of depression and anxiety disorders that are diagnosed are treated in primary care (up to 90%). However, many individuals do not seek treatment and common mental health disorders often go unrecognised
  • Recognition of anxiety disorders is particularly poor in primary care and only a small minority of people experiencing anxiety disorders ever receive treatment
  • The aim of this guideline, which is focused on primary care, is to improve access to services, improve identification and recognition of common mental health disorders, and provide advice on treatment, referral and developing local care pathways. It brings together advice adapted from existing guidelines with new recommendations

Key priorities for implementation

Improving access to services

  • Primary and secondary care clinicians, managers and commissioners should collaborate to develop local care pathways that promote access to services for people with common mental health disorders by:
    • supporting the integrated delivery of services across primary and secondary care
    • having clear and explicit criteria for entry to the service
    • focusing on entry and not exclusion criteria
    • having multiple means (including self-referral) to access the service
    • providing multiple points of access that facilitate links with the wider healthcare system and community in which the service is located

Identification

  • Be alert to possible depression (particularly in people with a past history of depression, possible somatic symptoms of depression or a chronic physical health problem with associated functional impairment) and consider asking people who may have depression two questions, specifically:
    • during the last month, have you often been bothered by feeling down, depressed or hopeless?
    • during the last month, have you often been bothered by having little interest or pleasure in doing things?
  • If a person answers 'yes' to either of the above questions consider depression and follow the recommendations for assessment*
  • Be alert to possible anxiety disorders (particularly in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or in those who have experienced a recent traumatic event). Consider asking the person about their feelings of anxiety and their ability to stop or control worry, using the 2-item Generalized Anxiety Disorder scale (GAD-2):
    • if the person scores three or more on the GAD-2 scale, consider an anxiety disorder and follow the recommendations for assessment
    • if the person scores less than three on the GAD-2 scale, but you are still concerned they may have an anxiety disorder, ask the following: 'Do you find yourself avoiding places or activities and does this cause you problems?'
    • if the person answers 'yes' to this question consider an anxiety disorder and follow the recommendations for assessment
  • *adapted from Depression (NICE Clinical Guideline 90)

    The stepped-care model

  • A stepped-care model is used to organise the provision of services and to help people with common mental health disorders, their families, carers and healthcare professionals to choose the most effective interventions. The model presents the key interventions from this guideline
  •  

    the stepped-care model

References

full guideline available from…
National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT
www.nice.org.uk/guidance/CG123

National Institute for Health and Care Excellence. Common mental health disorders: identification and pathways to care. Quick reference guide . May 2011
First included: Oct 05.


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