New psychosis guideline: An inside view
Dr David Shiers and Professor Max Birchwood were part of the team which put together the new NICE guideline for psychosis, which has been released today. This guideline sets out what treatments people with psychosis should expect from the NHS.
Here, they reveal how the guideline was put together and the impact they hope it will have...
It took a group of 24 people over two years to draw up the new NICE guideline on schizophrenia and psychosis.
The team brought together people from different backgrounds – people with lived experience, carers, health and social care professionals and academics. We were supported by an experienced team from the National Collaborating Centre for Mental Health.
We looked at a range of different factors including the impact of changes to community mental health services over the last 10-15 years and the growing evidence around more holistic and person-centred approaches to mental health care.
We were also aware of two recent significant reports – The Abandoned Illness, which was produced by the Schizophrenia Commission and the National Audit of Schizophrenia from the Royal College of Psychiatrists.
Both of these highlighted some really key issues, such as the poor physical health of people with mental illness and lack of access to psychological therapies.
After considering all of these factors, we agreed on a number of key priorities for the new guideline. They are:
Improving people’s experience of service
We want to ensure that everyone has a positive experience of mental health services. That can mean, for example, proper information about medication and its side-effects, making sure people are involved in decisions about their treatment and providing care in an atmosphere of hope and optimism.
We also made recommendations around how families should be supported and how information should be shared between people using mental health services, their carers and health professionals.
Poor physical health of people with mental illness
One of our priorities was to tackle the shocking fact that people with severe mental illness die an average of 15-20 years earlier than the rest of the population.
Physical health problems, such as weight gain, can start within weeks of a first experience of psychosis. Even though there is evidence that medication plays a role in this, people’s physical health often goes unchecked by professionals.
Historically, part of the problem has been that the issue of physical health has fallen through the gaps in the system, as there hasn’t been clear guidance on who in the NHS should take responsibility for it. The new guideline has cleared up the confusion so there is clarity about who is responsible. However, checks by themselves are not enough. People also need access to quality physical healthcare. Our message to clinicians is ‘don’t just screen, intervene!’ – as the late Professor Lester said in her last public lecture Being Bothered about Billy.
We want everyone with mental illness to benefit from the same health initiatives that have helped the general population. This includes better support to give up smoking, more choice in treatments, healthy eating programmes and access to information about the risks and benefits of medication.
Another important focus of our group was the early phase of psychosis as there has been a lot of new research in this area. The Abandoned Illness report made the case that early intervention in psychosis (EIP) services promote hope and recovery. We have recommended that EIP services should be available to everyone experiencing psychosis for the first time, whatever their age.
We are concerned by reports of some short-sighted attempts to water down these services in the face of cuts. This will end up costing more money because if you treat psychosis early, you help people avoid crises and expensive, traumatic hospital admissions, making huge savings later down the line.
The guideline also reviews exciting new evidence that it is possible to identify people at high risk of developing psychosis and offer treatment that can reduce symptoms and prevent or delay someone becoming ill. Importantly the guideline rules out the use of medication at this stage and promotes the use of cognitive behavioural therapy (CBT) and family support. This group will also often be struggling with anxiety, depression or post-traumatic stress disorder and it is important they get the right support for this too. This is crucial as often these are seen as ‘side-effects’ of psychosis and people are not given the right support.
In summary, we hope this new guideline heralds a significant shift in how people experiencing psychosis and schizophrenia and their families will be supported. Its emphasis on recovery, rather than just reducing symptoms, is what matters to patients and their families.