A NICE new approach to mental health

Exercise, psychotherapy, mindfulness and meditation are to take centre stage for treating depression and mental health.

In a radical shift on dealing with mental illness post-pandemic, the National Institute for Care and Excellent (NICE) has updated its guidance, stressing that alternatives to medication should be offered as first-line treatment for those suffering from milder forms of depression. NICE covers the NHS in England, but the devolved bodies pay attention to its guidance.

The new policy means a “’menu of treatment options” should be available to patients such as advice on exercise, Cognitive Behavioural Therapy (CBT), psychotherapy, mindfulness and meditation – before they are prescribed medication. These new guidelines – the first in more than a decade – are still up for consultation.

Those with severe depression should be offered a “similar range of psychological interventions” alongside the option of anti-depressants.

Dr Paul Chrisp, a director of NICE, has urged the NHS to implement the recommendations “without delay”.

Evidence-based guidance for treating mental illness is more urgently needed than ever. Unsurprisingly, there’s been a rise in the number of Brits reporting symptoms of depression during the pandemic.

ONS data shows that 17% of adults aged 16 and over in the UK experienced some form of depression during the summer, a sharp increase from 10% during the nine-month period before the COVID-19 pandemic.

Anti-depressant use has also increased in recent years. An estimated one in seven people in England now take them. Over 20 million antidepressants were prescribed between October and December last year – a 6% increase compared with the same three months in 2019.

Of growing concern has been the age at which people are being placed on medication. Anti-depressants are being prescribed to young people in record numbers – more than 230,000 people aged five to sixteen were given the drugs last year, according to NHS data.

Advances in pharmaceutical drugs to treat mental illness are undoubtedly a cause for celebration – a development which saves many lives across the globe every year. But critics point out that those with milder forms of illness are often rushed onto medication, before they are given the chance to explore other treatment avenues.

Some will welcome NICE’s new stance. Yet, while the new guidelines provide clarity, they also raise more questions – and draw attention to further challenges.

For starters, there is the difficulty of identifying where mild depression ends and severe depression begins, a challenge for doctors prescribing medication.

Additionally, the guidelines draw attention to the the huge range of psychological treatments on offer – a reminder that it’s far more complex than simply a choice between “meds vs therapy”. Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, has emphasised the importance of tailored treatment: “Practitioners should offer people a choice of evidence-based treatments and understand that not every treatment will suit every person.”

The NICE guidelines also raise questions about funding. While many would support prioritising “talking therapies” in theory, rising anti-depressant use must be seen within the context of overstretched mental health services and ever longer waiting times for access to support.

Alexa Knight of Rethink Mental Illness says: “Improved guidelines will not, on their own, improve people’s experience of care or waiting times. The range of treatments available and how quickly they can be accessed is ultimately dependent on services being adequately funded and staffed.”

Mind, the mental health charity, reports that 1.6 million people in Britain are on waiting lists for mental health support, while a further eight million people cannot get on the waiting list because they aren’t deemed unwell enough to access care.

Those working in the field are still waiting to see how much of the NHS funding from the Spending Review will go towards mental health services.

The root of the issue isn’t purely a matter of funding mental health services. There has been a notable increase in the attention paid to this subject. There is much less stigma, but still a lot to be done in seeking an understanding of what is prompting these widespread psychological problems.