Commissioning stepped care for people with common mental health disorders
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg41
2 Commissioning care for people with common mental health disorders
For the purposes of this guide for commissioners, common mental health disorders are defined as a range of depression and anxiety disorders that include:
generalised anxiety disorder
mixed depression and anxiety
social anxiety disorder (social phobia)
post-traumatic stress disorder.
The Topic Advisory Group recognised that the diagnosis of common mental health disorders can be complex. For some people common mental health disorders are recurrent or lifelong conditions, and often they occur with a range of other physical, mental health and behavioural comorbidities. Figure 1 shows factors that can increase the risk of developing a common mental health disorder. A localised approach and integration with a range of other physical and mental health pathways is needed when commissioning services for common mental health disorders.
Figure 1 Risk factors for common mental health disorders
Overall it is estimated that 17.7% of adults meet the diagnostic criteria for at least one common mental health disorder (see section 4.1). Data from the Adult Psychiatric Morbidity Survey 2007 show the prevalence of the various types of disorder (see figure 2).
Figure 2 Prevalence of common mental health disorders
Reducing the prevalence of common mental health disorders is a major public health concern. In 2007 the annual health and social care costs to treat depression and anxiety disorders were estimated to be nearly £3 billion, with an additional economic impact of around £13 billion in lost earnings among people of working age.
Most people diagnosed with anxiety and depression disorders are treated in primary and community settings. However, many people do not seek treatment and common mental health disorders often go unrecognised. The reasons for this are complex, but include: the perceived stigma of being diagnosed and receiving treatment for a common mental health disorder; lack of recognition of anxiety disorders in primary care (only a small minority of people experiencing anxiety disorder receive treatment); service design that inhibits access; lack of knowledge about services and differing cultural interpretations of mental health.
The most common form of treatment for common mental health disorders in primary care is psychotropic medication because availability of psychological interventions is limited. Since its launch in 2008, the Department of Health's Improving Access to Psychological Interventions (IAPT) programme has delivered significant improvements in access to some of the psychological interventions recommended by NICE. However there is evidence that the demand for these interventions continues to outstrip capacity in many areas.
 McManus S, Meltzer H, Brugha T et al. (2009) Adult psychiatric morbidity in England, 2007. Results of a household survey.The NHS Information Centre for health and social care: Leeds
 McCrone P, Dhanasiri S, Knapp M et al. (2008) Paying the price: the cost of mental health care in England to 2026. London: King's Fund
 National Collaborating Centre for Mental Health (2011) Common mental health disorders: identification and pathways to care. London: Royal College of Psychiatrists