NICE guidelines in the UK for PTSD
The NHS receives its national guidance on treatments and care from the National Institute for Health and Clinical Excellence (NICE). This internationally respected independent organisation develops guidelines for use in the healthcare system.
NICE clinical guidelines, based on the best evidence available, are designed to help and support healthcare professionals at work and to make the treatment process easier for all concerned. Clinical guidelines fulfil many roles in the healthcare system. Among other things, they should:
* Give healthcare professionals recommendations for the best treatment of patients.
* Help to develop standards for assessing healthcare professionals’ clinical practices.
* Be used in the process of education and training healthcare professionals.
* Enable patients to make better decisions from an informed position.
* Improve communication between patients and healthcare professionals.
Who are the guidelines for?
Officially, due to the varying healthcare systems used in the devolved areas of the UK, NICE guidelines are used only in England. However, there are a number of agreements in place between organisations in the constituent countries. This means that some NICE guidelines are also followed in the other parts of the UK: Scotland, Wales and Northern Ireland. There is no standard, across-the-board rule governing this. Instead, each set of guidelines must be considered on a case by case basis by the governmental organisations of these countries.
The NICE guidelines for PTSD
The NICE guidelines for PTSD covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. It aims to improve quality of life by reducing symptoms of PTSD such as anxiety, sleep problems and difficulties with concentration. Recommendations also aim to raise awareness of the condition and improve coordination of care.
The creation of an updated guideline is currently in progress and during 2016, PTSD UK was involved as a stakeholder in the initial development of this. You can find an update on the development of the guideline here.
The current guidelines are still in force in the meantime, and can be briefly summarised as follows:
Initial response to trauma
- For individuals who have experienced a traumatic event, the systematic provision to that individual alone of brief, single-session interventions (often referred to as debriefing) that focus on the traumatic incident, should not be routine practice when delivering services.
- Where symptoms are mild and have been present for less than 4 weeks after the trauma, watchful waiting, as a way of managing the difficulties presented by people with post-traumatic stress disorder (PTSD), should be considered. A follow-up contact should be arranged within 1 month.
Trauma-focused psychological treatment
- Trauma-focused cognitive behavioural therapy should be offered to those with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event. These treatments should normally be provided on an individual outpatient basis.
- All people with PTSD should be offered a course of trauma-focused psychological treatment (trauma-focused cognitive behavioural therapy [CBT] or eye movement desensitisation and reprocessing [EMDR]). These treatments should normally be provided on an individual outpatient basis.
Children and young people
- Trauma-focused CBT should be offered to older children with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event.
- Children and young people with PTSD, including those who have been sexually abused, should be offered a course of trauma-focused CBT adapted appropriately to suit their age, circumstances and level of development.
Drug treatments for adults
- Drug treatments for PTSD should not be used as a routine first-line treatment for adults (in general use or by specialist mental health professionals) in preference to a trauma-focused psychological therapy.
- Drug treatments (paroxetine or mirtazapine for general use, and amitriptyline or phenelzine for initiation only by mental health specialists) should be considered for the treatment of PTSD in adults who express a preference not to engage in trauma-focused psychological treatment.
Screening for PTSD
- For individuals at high risk of developing PTSD following a major disaster, consideration should be given (by those responsible for coordination of the disaster plan) to the routine use of a brief screening instrument for PTSD at 1 month after the disaster.
PTSD is a condition that was recognised relatively recently. As such, although awareness and understanding of the condition has been growing, it is still true that some healthcare professionals might not know how best to treat the disorder, or how to recognise its symptoms, and therefore not follow these guidelines. If you are concerned about this, you should refer your GP or mental health care professional to the NICE guidelines.
How are the guidelines created?
When formulating guidelines, NICE posts a list of planned topics on its website. It then invites relevant stakeholder organisations to register their interest. Each set of guidelines is limited by boundaries, decided upon by the National Collaborating Centre (NCC) which has been commissioned to develop the guidelines. A document explaining these boundaries, known as the scope, is first prepared, with the input not only of NICE but also of registered stakeholders and a Guideline Review Panel, which remains an independent organisation.
A Guideline Development Group is then formed by the NCC. This group is made up of healthcare professionals and technical experts, as well as representatives of laypeople. Each group is different, and they have the responsibility of assessing all the evidence that has been compiled about the guideline topic. Using this evidence, they will then make recommendations. These recommendations should become the basis of the guidelines to be developed.
Before the guidelines are completed, registered stakeholders are given two separate opportunities to make comments. The draft guideline will be posted on the NICE website and is accessible for consultation. The Guideline Review Panel plays a part here, reviewing the documentation being prepared and making sure that the concerns and comments of stakeholders are appropriately addressed.
After the second and last consultation period, the recommendations will be finalised by the Guideline Development Group. At this point, the NCC produces a final version of the guidelines, which will be submitted to NICE. Following the formal approval of the guidelines, NICE issues its guidance to the NHS.
Treatments for PTSD
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.
PTSD UK Blog
You’ll find up-to-date news, research and information here along with some great tips to ease your PTSD in our blog.
Case Study: Melissa’s EMDR Treatment Melissa* underwent EMDR treatment after being diagnosed with PTSD following a medical emergency which resulted in an induced coma. Here, Melissa explains more about her treatment, what happened in her sessions, and the incredible difference
Guest Post: ‘How Forest bathing made me feel supported and happy’ Having originated in Japan and China, forest bathing – or Shinrin-Yoku – can be used to help decrease undue stress and potential burn-out. Research has found that immersion in