NICE work on schizophrenia

Liz Newstead explains the purpose of NICE guidance on schizophrenia.

The National Institute for Clinical Excellence issued a clinical guideline in 2002 on the appropriate treatment and care of individuals with schizophrenia within the NHS in England and Wales. Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and conditions. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals.

NICE is part of the NHS but is an independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for health care professionals, patients and their carers, and is designed to help them make decisions about treatment and health care. NICE produces guidance in three areas of health:

  • appropriate treatment and care of patients with specific diseases and conditions - clinical guidelines
  • whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use - interventional procedures
  • the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.

There are 35 clinical guidelines under current commission from NICE but the one on schizophrenia, entitled Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care, is the first fully commissioned clinical guideline to be published. Its aim is to ensure that no matter where people live in England and Wales health professionals caring for individuals with schizophrenia are working towards high-quality evidence-based national standards. The guideline offers clear advice to people with schizophrenia, their carers and the health professionals responsible for their care on what the NHS should provide. NHS organisations will be expected to review their existing service provision against the recommendations.

The guideline outlines best practice for health professionals caring for individuals with schizophrenia in a range of areas. However, the scope of the guideline is specifically for adults and it does not extend to younger or older aged people with schizophrenia or those who have co-occurring substance abuse. The guideline should be read within this context. Nevertheless, the evidence reviewed does provide guidelines for the care and treatment of people with schizophrenia at the initiation of treatment, during acute episodes and in the promotion of recovery. There is an emphasis upon developing meaningful partnerships with service users and carers across all stages of care and treatment.

The guidance provides evidence on the use of antipsychotic drugs but within a comprehensive package of care that also addresses the individual's emotional and social needs. An example of this is the recommendation of psychological and social interventions such as cognitive behavioural therapy and family interventions, which are both aimed at reducing psychological distress, preventing relapse and reducing clinical symptoms.

The guideline was developed within the National Collaborating Centre (NCC) for Mental Health. This comprises a group of professional and patient/carer organisations that were charged with managing the development of clinical guidelines for NICE. The NCC for Mental Health is led jointly at the British Psychological Society and the Royal College of Psychiatrists, and 13 organisations, including the RCN, form a reference group for the Centre.

The NCC followed international standards of guideline development. They established a guideline development group consisting of service users and carers, health professionals (including a pharmacist, a nurse, psychiatrists and psychologists) and academics. This group then reviewed the worldwide data, taking into consideration differences in systems of health care provision, current clinical practice and the experience of service users. Following this review process the group produced the first draft of the guideline, which underwent two widespread rounds of consultation. The first draft was sent to stakeholder organisations and feedback from them was then reviewed and the guideline amended. The second consultation document was on the NICE website and was downloaded more than 17,000 times.

The implementation of the guideline will build on the National Service Framework for Mental Health in England and Wales and should form part of the service development plans for each local health community, although it is in the interests of service users and carers that implementation is prompt. The recommendations made within the guideline are based upon the best available evidence on interventions known to effect improvements in health and social outcomes for people with schizophrenia.

Implementation of the guideline will require NHS organisations to review how their services are organised to meet the needs of people with schizophrenia and the skills of the staff working within those services. This will help identify gaps in service configuration and training needs of staff. These gaps can then be taken into consideration during service planning and inform training requirements to ensure staff are adequately prepared to implement the recommended interventions.

For further information visit the NICE website.

Liz Newstead is Nurse Representative, NICE Schizophrenia Guideline Development Group, and Clinical Education Co-ordinator for Mental Health and Learning Disability (Bournemouth University)/Clinical Nurse Specialist (Honorary with Dorset Healthcare Trust)

Email: lnewstea@bournemouth.ac.uk