NICE Schizophrenia Guidelines

The National Institute for Health & Clinical Excellence (NICE) first produced guidelines on how schizophrenia should be treated in 2003. Following a public consultation, they updated these guidelines in 2009.

What has been changed in the guidelines?

  • Medication

It is no longer recommended that newer, atypical antipsychotics should be prescribed in the first instance. The choice of oral antipsychotic should be based on the preferences of the service user, paying particular attention to different types of potential side effects. Rethink’s survey shows that these discussions about side effects are not currently happening and NICE will have to put a great deal of resources into educating prescribing doctors about these issues.

  • Cognitive Behavioural Therapy (CBT) & Family Therapy

Another change is that people with schizophrenia should be offered Cognitive Behavioural Therapy (more than 16 sessions) and/or family therapy (more than 10 sessions) and possibly art therapy, and that these can be started during an acute phase if appropriate. Rethink welcomes this recommendation, but has told NICE that resources have to be given to provision of these therapies as waiting lists are currently too long.

  • Physical health

The guidelines recommend that GPs and other primary healthcare professionals should be checking the physical health of people with schizophrenia at least once a year. The results from these checks are to be shared with the care co-ordinator and/or psychiatrist and recorded in secondary care notes.

Rethink is pleased to see this included in the guidelines, especially as our survey shows how few GPs are discussing physical health. This is something GPs should be doing so NICE will have to do some work on educating them about why this is important.

  • Carers

The guidelines state that healthcare professionals should offer carers their 'carers assessment' and provide carers with information about schizophrenia, including how they can help and where they can get support. Also, health professionals should be able to negotiate confidentiality and information sharing between the service user and the carer.

  • Black and minority ethnic groups – access and engagement

The guidelines now state that health professionals must be competent in understanding different cultural approaches to mental illness and expectations around treatment. NICE is interested to receive information about examples of good practice.

Read the final updated guidelines: NICE schizophrenia guidelines (CG82) (256 kb) [pdf]

Read Rethink's briefing summarising the guidelines and our suggestions as to what you can do to get these changes implemented: NICE schizophrenia guidelines briefing (57 kb) [doc]

What did Rethink do?

Whilst NICE was developing the draft guidelines, Rethink conducted a survey to collect the views of people who have experienced treatment for schizophrenia. Almost 500 people responded to this – and we discovered some shocking facts:

  • Two thirds of people had not been given any choice about which medication to take.
  • Fewer than half the respondents had potential side effects of medication discussed with them.
  • Only 14% of the sample had had Cognitive Behavioural Therapy
  • Fewer than half the respondents had discussed their physical health with their GP or psychiatrist in the last 12 months

These findings have been included in the full NICE guidelines, so these issues will be brought to the attention of health professionals. Rethink will be sending a formal response to the consultation. We are also being consulted on what NICE should be providing to help make recommendations working in practice.