The National Institute for Clinical Excellence (NICE) this week launched its first set of guidelines on the treatment and management of schizophrenia in primary and secondary care, in an attempt to improve healthcare outcomes among patients in England and Wales.
People with schizophrenia often encounter stigmatisation and discrimination, says the report. “This may occur not only in wider society… but also with the NHS,” where, say the authors, people with schizophrenia often receive substandard care.
According to the report schizophrenia costs the NHS more than any other mental illness, consuming more than 5% of the NHS budget. However, say the authors, provision of effective psychiatric treatment varies across the country. “The introduction of this guideline means that no matter where they live in England and Wales people with schizophrenia can expect the same high standards of care,” says Dr Tim Kendall, from the Royal College of Psychiatrists' Research Unit, London.
The guidelines, a result of over two years' work by the National Collaborating Centre for Mental Health—one of seven collaborating centres funded by NICE to develop evidence based guidelines on treatment—gives recommendations on the best psychological and drug treatments. It also recommends how best to organise mental health services for adult patients with schizophrenia and outlines the role of general practice in managing these patients.
“Although the focus is on treatment, these guidelines place much stress on a holistic and social approach… Treatment failure is often a result of a breakdown in social circumstances,” said Dr Mike Shooter of the Royal College of Psychiatrists at a press conference this week.
Professor Erwin Nazareth, of the Royal Free and University College London Medical School, said that the guidelines highlighted some particular areas for GPs. He said that GPs had an important role in the prevention of cardiovascular problems and in health promotion and drug monitoring among patients with schizophrenia, 10% to 12% of whom are cared for exclusively by GPs.
At the press conference to launch the guidelines many speakers called for their swift implementation, for resources to be made available to carry the process through, and for continuous audit. Dr Kendall stressed that there was “a will to implement this and make it happen.” Local healthcare groups will now be expected to produce a plan and identify resources for implementation in the near future, he said. The report recommends that a multidisci-plinary group involving commissioners of health care, primary care and specialist mental health professionals, service users, and carers should work to translate the implementation plan into local protocols, according to the local context.
Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care can be ordered at www.rcpsych.ac.uk/ publications or by phoning the Royal College of Psychiatrists, tel 020 7235 2351. A training session on the guideline is available at www.rcpsych.ac.uk/cru/sts/index.htm.
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Dr Mike Shooter: “These guidelines place much stress on a holistic and social approach”