Explore evidence-based alternatives and personalized approaches to mental health treatment.

This blog will cover:

• An overview of the NICE guidelines and their role in informing healthcare professionals and the public.
• Examples of mental health conditions and the treatment recommendations provided by the NICE guidelines.
• The benefits of using the NICE guidelines, including reducing stigma, evidence-based recommendations, consistency of care, and cost-effectiveness.
  Limitations of the NICE guidelines, such as generalization, limited evidence, resource constraints, and lack of patient involvement.
• Reasons why therapists may choose not to strictly follow the NICE guidelines, including personal preference, complexity of client needs, and client preferences.
• Alternative evidence-based therapies that therapists may utilize, such as EMDR, ACT, Mindfulness-based therapies, and the RESET approach.
• Emphasizing the importance of individualized treatment and considering client needs and preferences for optimal mental health outcomes.

What are the NICE guidelines?

The NICE guidelines are a set of evidence-based recommendations and best practice guidance produced by the National Institute for Health and Care Excellence (NICE). These guidelines help to provide healthcare professionals and the general public with advice and evidence-based information that help to inform decisions on the prevention, diagnosis and treatment of health conditions. 

The guidelines are informed by up-to-date research, and they are developed through a rigorous process that involves many different professions including health practitioners and researchers as well as reviewing scientific evidence and engaging with patients. The guidelines are increasingly used by other countries, updated regularly and held to a high standard, particularly in the UK. 

Examples of NICE guidelines

They provide guidelines on both physical and mental health conditions. In terms of mental health, they outline assessment and then treatment based on the condition and its severity. For this article, we will focus on the recommendations they make for mental health. Here are some examples in the table below. 

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For each disorder, the NICE guidelines recommend regular follow-ups and monitoring of symptoms. They also highlight that each individual case is unique and therefore treatment recommendations may vary depending on the severity of symptoms, personal preferences and response to treatment. 

What are the benefits of using the NICE guidelines?

There are many benefits to using the NICE guidelines to inform mental health treatment. 

By providing clear and evidence-based guidance on the treatment of mental health conditions, the NICE guidelines can help to reduce the stigma associated with these conditions. This can help to encourage individuals to seek help for their mental health problems and reduce the social and emotional barriers to treatment.

They are evidence-based recommendations meaning they are developed using the most up-to-date scientific evidence. All treatments recommended by NICE go through a rigorous and systematic review. 

The guidelines also allow for consistency of care as healthcare professionals can use the guidelines to provide a constant standard of care across different settings and regions. This can help to improve the quality of care and reduce variation in treatment outcomes.

The NICE guidelines take into account the cost-effectiveness of different treatments, which means that healthcare professionals can provide treatments that are both effective and affordable. This can help to reduce the financial burden on healthcare settings. This is especially important when we consider the financial pressure on our national health service. 

Why might we not want to use them?

NICE guidelines are an important resource for healthcare professionals, but they have limitations. These include generalization, limited evidence, resource constraints, and lack of patient involvement. That is why healthcare professionals should use their clinical judgment and involve patients when using NICE guidelines.

The first limitation is the generalization, that is, NICE guidelines may not cover all possible treatment options or address every aspect of a particular condition. They are developed based on the available evidence at the time, which may be limited or incomplete. For instance, there are many emerging therapies such as Compassion Focussed Therapy that are building a strong evidence base but are not being recommended by the nice guidelines because of the need for so much evidence. 

In addition to that, NICE guidelines only have limited evidence to draw from. The NICE guidelines are developed by collating evidence of the population’s response to certain treatments. This means that outcomes are incredibly generalised and although this can be useful, it can mean that the treatment may not apply to every individual case.  Due to this, healthcare professionals will need to use clinical judgement to adjust the guidelines to the needs of their clients. 

Resource constraints are yet another limitation meaning that the guidelines may be difficult for some trusts to follow due to time and resource constraints. 

It is already difficult to implement any programmes or quality control, with the immense pressure on the NHS due to the COVID-19 pandemic, austerity and a lack of mental health professionals, things become even more difficult. 

Using the guidelines also may mean there is a lack of patient involvement, as the guidelines may be followed above the wishes of the patient. For instance, if you went to your GP and requested to receive a different form of therapy such as EMDR, you may be told this is not possible. Although the guidelines to some extent take patient preferences into account, there is limited involvement from patients in the development of the guidelines. 

Finally, the guidelines to some extent are still open to interpretation and implementation variability. This means that different healthcare professionals might interpret and implement the guidelines differently. This could result in inconsistent treatment outcomes for some patients. 

Why your therapist might not be using them

If you notice your therapist isn’t using the NICE guidelines, this does not mean that they are not a good therapist. There are a number of reasons why the person supporting you with your mental health may have chosen to not use the NICE guidelines to inform your treatment plan. 

• Personal preference: The therapist may have their own preferred approach to treatment that they find more effect of aligned with their own personal values, skills and beliefs. 
• Complexity of patient needs: The NICE guidelines are based on recommendations for the average patient. However, each one of us is a unique individual and therefore might have needs that require a more tailored approach to treatment. 
• Your preferences: You might have tried say Cognitive Behavioural Therapy before and found that it didn’t align with what you wanted to get out of treatment. Therefore your therapist may need to deviate from the guidelines to help you become more comfortable with your treatment plan as well as to align your treatment with your personal preferences. 

What could be used instead of the NICE guidelines?

To highlight how the NICE guidelines might often not include some effective therapies that have shown promise in research but are not yet included in the guidelines, we thought we’d give you a rundown of some therapies not included. 

Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapy that involves recalling traumatic memories while tracking a therapist’s finger movements or other forms of bilateral stimulation. EMDR has been shown to be effective in treating post-traumatic stress disorder (PTSD), although it is not yet recommended by the NICE guidelines.

Acceptance and Commitment Therapy (ACT): ACT is a type of cognitive-behavioural therapy (CBT) that emphasizes acceptance of uncomfortable thoughts and feelings rather than trying to eliminate them. ACT has shown promise in treating a range of mental health conditions, including depression, anxiety, and substance use disorders, but it is not yet recommended by the NICE guidelines.

Mindfulness-based therapies: Mindfulness-based therapies, such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), involve practising mindfulness meditation and applying its principles to daily life. These therapies have been shown to be effective in treating depression, anxiety, and other mental health conditions, but they are not yet in the NICE guidelines – at least not for all conditions.

The RESET approach: Our very own model, the RESET therapy is an evidence-based integrative psychotherapeutic model that combines a compassionate humanistic approach with cognitive/ behavioural change techniques, somatic interventions (i.e. physical exercise, breathwork and mindful awareness largely derived from contemplative meditative practice) and a systemic approach (environment). This allows service users to process past experiences that are affecting their mental and physical health/well-being and implement sustainable change to ultimately lead a more fulfilling life.

Summary

To summarise:

• The NICE guidelines are evidence-based guidelines that help to inform the assessment and treatment of physical and mental health conditions
• All treatments recommended by NICE go through a vigorous and systematic review
• They allow for consistency of care across services 
• Not all therapists follow the NICE guidelines for numerous valid reasons including personal preference, complexity of client needs and client preferences
• Instead, therapists might use therapies such as EMDR, ACT, Mindfulness-based therapies or the RESET approach.

Ultimately, the decision of whether therapists should follow the NICE guidelines is theirs and the organisations they work with. Our aim here at RESET is to provide you with as much information as possible so that you can make an informed decision as to whether you should follow the NICE guidelines or not. And if you are reading this, you are likely a healthcare provider or psychological service provider looking for Psychologists or Clinical Psychologists, so here is a blog about why is it so difficult to hire a Psychologist in the UK. And here is a blog about how to hire and (retain) a Psychologist in the UK.

Msc Shannen Poulton is a Psychology BSc, MSc and Senior Assistant Psychologist at The RESET Health Group with over 5 years of experience in mental health services.