National Clinical Guidelines published by the National Institute for Clinical Excellence cover clinical depression in adults. The publication CG90, (http://guidance.nice.org.uk/CG90), makes recommendations on the identification, treatment and management of depression in adults aged 18 years and older, in primary and secondary care; it covers people whose depression occurs as the primary diagnosis.
These guidelines state that:
- There is currently insufficient evidence to determine the value of Crisis Resolution and Home Treatment Teams (CRHTT’s) for people with depression. The main benefit of CRHTT’s is cost savings against normal admittance to hospital
- Traditionally, a depressive episode marked by serious risk to self (most often suicidal ideation and intent) or very severe deterioration to care for the self is managed by admission to an acute inpatient unit.
- Use crisis resolution and home treatment teams to manage crises for people with severe depression who present significant risk, and to deliver high-quality acute care.
- When working with people with depression and their families or carers:
- Ensure that comprehensive written information is available in the appropriate language and in audio format if possible
- Inform people with depression about self-help groups, support groups and other local and national resources.
- When families or carers are involved in supporting a person with severe or chronic depression, consider:
- Providing written and verbal information on depression and its management, including how families or carers can support the person depression, consider:
- Offering a carer’s assessment of their caring, physical and mental health needs if necessary
- Providing information about local family or carer support groups and voluntary organisations, and helping families or carers to access these
- Negotiating between the person and their family or carer about confidentiality and the sharing of information.
- The Patient Association investigation into PCT commissioning and provision of Perinatal Mental Health Services identifies significant gaps in:
- Knowledge and understanding regards the number and severity of mothers requiring treatment and services they should be offered
- A failure to provide access to the ‘Specialist Perinatal Psychiatrists’ patients should expect
- A failure to provide written information on PND to mothers and their carers who are then left to support themselves
These gaps in service provision leave potentially 22,000 mothers and babies at unacceptable risk. This figure represents the expected cases of psychotic postnatal depression where mothers at very high risk require ‘Home Care’, and in addition, the cases of women with severe postnatal depression that require Specialist Perinatal Psychiatric Services.
Figures such as these, and reports such as the one published by the Patients Association in March 2011 highlight the failure by Strategic Health Authorities to implement NHS National Service Frameworks and PCTs to implement NICE guidelines.
The National Collaborating Centre for Primary Care, and the National Collaborating Centre for Mental Health have worked with NICE to produce a number of guidelines relevant to the care and treatment of women suffering from mental illness in the Postnatal period. These are:
- ‘Postnatal Care, Routine postnatal care of women and their babies’ pub 2006. This is available from the NICE website (www.nice.org.uk/CG037fullguideline)
- Antenatal and postnatal mental health, THE NICE GUIDELINE ON CLINICAL MANAGEMENT AND SERVICE GUIDANCE: http://www.nice.org.uk/nicemedia/live/11004/30431/30431.pdf
These documents provide an outline and structure for the treatment and care of women during the postnatal period by:
- identifying the types of and severity of the different types of Postnatal depression
- outlining what information should be given to women during this period
- describing treatment in the NHS
- risk factors
- addressing carer’s needs and the role they play in support and recovery
- identifying the structure of services
- identifying a need for services.
Click here to see a list of reference material