Stephen Pilling (left) and Dr Tim Kendall, co-directors of the NICE National Collaborating Centre for Mental Health
The National Collaborating Centre for Mental Health is one of six collaborating centres recently established by the National Institute for Clinical Excellence (NICE) to be responsible for guideline development and related audit activities in the NHS.
Each centre will have responsibility for a specific area, but it is expected that there will be considerable collaboration between centres, taking on and developing joint projects where appropriate and sharing expertise.
The other five collaborating centres have responsibility for:
- Primary Care
- Women and Child Health
- Nursing and Supportive Care
- Chronic Care
- Acute Care.
The background to development of the wider collaborating centre network is covered on the NICE website (www.nice.org.uk).
The centres will not be responsible for health technology appraisals, which will continue to be managed centrally by NICE, using other appropriate academic centres.
The National Collaborating Centre for Mental Health is a joint project between the College Research Unit (CRU) of the Royal College of Psychiatrists and the British Psychological Society's Clinical Effectiveness Unit (CORE) based at University College London.
The establishment of the six collaborating centres by NICE arose from a review in 2000 of the guideline and audit work supported by NICE since its inception in 1999.
At that time, NICE was funding some 26 units with a broad range of guideline and audit projects. Following the review it was decided to establish just six centres to provide greater concentration of expertise and economies of scale.
In establishing these centres, NICE was also concerned to ensure that there were effective links with the professional organisations and hence with those people who would be primarily responsible for guideline implementation. It is for this reason that the national collaborating centres have a strong professional base.
The delivery of mental health services is a complex process, not just spanning primary and secondary care, but also moving beyond the healthcare field into social care.
Therefore, in addition to the two units leading the National Collaborating Centre, it is supported by a reference group which has membership from the Royal College of General Practitioners, the Royal College of Nursing, the College of Occupational Therapy, the Royal Pharmaceutical Society, the Institute of Psychiatry and the National Institute of Social Work.
Technical support is provided from the Centre for Evidence-Based Mental Health in Oxford, and the Centre for the Economics of Mental Health based in London.
In addition, the centre has strong user representation, and three of the leading user and carer groups in the field of mental health – the National Schizophrenia Fellowship, MIND and the Manic Depression Fellowship – are also represented on the Reference Group.
The purpose of the Reference Group is to see that the programme of the National Collaborating Centre is in line with the broad agreement established with NICE, that its work is of a high standard and, importantly, that the centre effectively links into the wide range of professional and user organisations whose support is required if effective implementation of the guidelines is to be achieved.
Both the CRU and CORE have a background in guideline development and audit. For example, the CRU led on the development of the Management of Imminent Violence guideline,1 and CORE led on the recent Department of Health Guideline on Treatment Choice in Psychological Therapies and Counselling, described in this issue.
The overall aim in producing guidelines (and subsequent audit and implementation plans) is to bring about genuine and lasting improvements in patient care. NICE guidelines will be condition or disease based only.
To be taken on by the collaborating centre, a guideline will need to:
- 'Add significant value' (e.g. by resolving existing uncertainties)
- Bring significant positive health benefit for patients (i.e. have good potential to reduce disability, morbidity or mortality)
- Have a significant positive impact on the implementation of government health policies (e.g. the NHS Plan, and National Service Frame-work [NSF]).
- Have sufficient current evidence to support its development and be likely to have a significant impact on NHS resources, as well as helping to resolve unacceptably wide variation in health outcomes and/or clinical practice.
In addition to contributing to the changes described above, clinical guidelines should also inform service users and carers of what they may expect from services.
They may also contribute to professional training and education and raise the profile of research with both practitioners and the public.
As well as producing a full guideline, the collaborating centres will be expected to produce a brief clinician guide and a brief patient version of the guideline along with specific audit tools.
The collaborating centres will be expected to produce between two and three new guidelines per year, but will be committed to the regular revision of existing guidelines. The work programme for the first year will focus on three areas:
- Eating disorders.
Schizophrenia presents a major challenge to mental health services and is addressed significantly in both the NSF for Mental Health and the NHS Plan, e.g. in the development of crisis response and home treatment services, the establishment of early intervention services for psychosis and the requirement for referral protocols between primary and secondary care.
Details of the full scope of the schizophrenia guideline are available from the NICE website. The guideline will cover a broad range of pharmacological treatments (and will link with the health technology assessment of atypical antipsychotics), psychological treatments and a range of service level interventions (e.g. the use of assertive outreach services).
It will be concerned with the acute treatment, stabilisation and maintenance of schizophrenia in both primary and secondary care. The guideline, although extensive, will not cover all areas of schizophrenia, e.g. it does not directly address the issue of assessment and diagnosis, although this may be taken up in further editions of the guideline.
However, it will address the development of early intervention services for psychosis. There is some evidence to suggest that the early detection of schizophrenia and the reduction of the duration of untreated psychosis may have a significant impact on the longer-term outcome of schizophrenia.2 Although somewhat controversial, this is a key area for development and will be addressed in the guideline.
It is anticipated that the completed guideline will be available in the late summer of 2002.
Depression is one of the most common psychological problems presenting in primary care. However, there are frequently expressed concerns:
- Depression often goes undetected and therefore untreated
- Treatment for resistant depression is not well understood or co-ordinated.
The guideline should address both areas. In doing so, it will review emerging evidence on the treatment of the disorder, e.g. in the use of the combination of pharmacological and psychological treatments for long-term care and management of resistant depression.
The scope for the depression guideline is being developed by NICE and is currently out for consultation; details are on the website. It is anticipated that work will start on this guideline in July 2001.
Eating disorders (anorexia nervosa and bulimia nervosa) present with wide variations in the course and duration of the disorder. Many individuals will recover after a single episode, but some will go on to develop chronic problems requiring very high levels of care and, in some cases, hospitalisation.
The scope for the guideline is in development at NICE, but will shortly be out for consultation. The guideline will consider both pharmacological and psychological treatments as well as addressing the service systems required to develop effective treatment programmes across primary and secondary care services. It is anticipated that work will start on this guideline in late 2001.
NICE, and the collaborating centres, have responsibility for guideline production and dissemination but not implementation. However, it is the intention of both the CRU and CORE to support a significant programme of guideline implementation and evaluation.
This will be achieved in a number of ways. For example:
- The Clinical Governance Support Service of the CRU will use its extensive network with trusts to promote guideline uptake and integration with local protocols.
- The professional base of the centre will support integration with professional training and development programmes, and this will be reinforced by the links that both units have through both the reference group and other professional groupings.
- Finally, CORE and the CRU also have considerable experience in the area of health services research, and will seek to ensure that all implementation programmes are effectively evaluated.
- Wing JK, Marriott S, Palmer C, Thomas V. The Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services. Occasional Paper OP41. London: Royal College of Psychiatrists, 1998.
- Ho B-C, Andreasen NC. Long delays in seeking treatment for schizophrenia. Commentary. Lancet 2001; 357: 898-900.
The national collaborating centre for mental health
|Objectives||To be responsible for guideline development in mental health and related audit activities in the NHS|
|Funding||National Institute for Clinical Excellence|
|Key personnel||Director:||Stephen Pilling|
|Director:||Dr Tim Kendall|
|Senior Project Manager:||Maureen McGeorge|
|Contact details||CRU:||Address:||83 Victoria Street, London SW1H 0HW|
|Tel:||020 7227 5320|
|Fax:||020 7227 0850|
|CORE:||Address:||Sub-Department of Clinical Health Psychology, University College London, Philips House, 1-19 Torrington Place, London WC1E 6BT|
|Tel:||020 7679 1785|
|Fax:||020 7916 8511|