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Patients ‘should be allowed to self-refer for psychological therapies’

By Lilian Anekwe

GPs should encourage patients with mental health disorders to self-refer to psychological therapies and counseling services, according to new NICE guidelines – prompting fears that already stretched services could be overwhelmed.

The NICE guideline on common mental health disorders says although the 'vast majority' of depressive and anxiety disorders that are diagnosed are treated in primary care, 'recognition of anxiety disorders by GPs is particularly poor, and only a small minority of people who experience anxiety disorders ever receive treatment.'

It blames this 'in part' on GPs' difficulties in recognising the disorder, and calls on GPs to be alert to possible anxiety disorders as well as depression, particularly in patients with a past history, possible somatic symptoms, a chronic physical health problem, or a recent traumatic event.

The guidance also notes patients are most often treated with psychotropic medication in primary care, 'due to the limited availability of psychological interventions.' Despite this limited availability, the guidance recommends GPs refer all appropriate patients with depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and social anxiety disorder for psychological therapies as part of a stepped model of care.

The new guideline is the first to be explicitly targeted at GP commissioning consortia, as well as GPs, and looks at the identification and care pathway for patients with mental health problems. It says, in order to improve access to services, services should have 'clear and explicit criteria for entry to the service focusing on entry and not exclusion criteria', and to further widen access services should have multiple means of referral to psychological therapies and counseling services, 'including self-referral'.

Dr Chris Manning, a former GP and chief executive of Primary Care Mental Health and Education, said he welcomed the idea of more self-referral for common mental health problems but felt it would stretch resources: 'The system isn't even coping at the moment. But the solution is to work more at community level, so patients have more options than just NHS providers. We need to be thinking much more broadly about local choice and diversity of services for patients.'

The guideline also recommends GPs develop local care and referral pathways for patients with mental illnesses that focus on outcome measures including service-user experience and reductions in harm.

Dr Barbara Compitus, a GP in Bristol and member of the guideline panel, said the shift to recommending and offering guidance on care pathways rather than specific interventions was a natural development for NICE, and would be welcomed by GPs.

'Success would be building on depression detection and making sure anxiety detection is as much in GPs' consciousness as depression. The guidance is aimed at ensuring quality and consistency - so that GPs always pick up on those areas and given them the tools to set patients on the right path.'

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