NICE lists 10 clinical guidelines that cover conditions that are managed by the IAPT programme:¹¹

• Common mental health problems (CG123)
• Depression in adults (CG90)
• Depression where there is a chronic physical health problem (CG91)
• Generalised anxiety disorder and panic disorder (CG113)
• OCD and body dysmorphic disorder (CG31)
• PTSD (CG26)
• Social anxiety disorder (CG159)
• Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CG53)
• Irritable bowel syndrome in adults (CG61)
• Antenatal and postnatal mental health (CG192).

A third revision of the 2009 CG90: ‘Depression in adults: recognition and management’ is underway. This follows an update in April 2018 which was challenged by a coalition of 40 organisations involved in mental health, counselling and psychotherapy and 54 individual practitioners.^12,13

The coalition issued a stakeholder position statement, questioning NICE’s methodology and calling for a “full and proper revision” of the guideline. This would include addressing “the omission of large amounts of data as well as the potentially significant material impact on the recommendations that would arise from their inclusion.”¹³

Among the key concerns raised in the stakeholder position statement are:¹³

• NICE was only using short-term outcomes data to assess effectiveness, as few long-term studies are available. NICE should conduct a proper analysis of 1 and 2-year follow-up data where available.
• The severity of depression should be categorised using validated tools, “not un-validated non-transparent functions of them."
• NICE’s methodology did not recognise people who simultaneously experience complex, chronic and/or treatment-resistant depression. Trials involving such people should be grouped together under ‘persistent depression.’
• NICE should assess the relative clinical effects of treatments, such as a partial recovery, from a severe depression baseline, and not omit studies where patients had not fully recovered by the end of the treatment.
• NICE had not given enough weight to studies detailing quality of life and/or functioning outcomes, despite these being the measures of greatest priority to service users.

With the backing of MPs, the coalition appeared successful in May 2019 in having persuaded NICE to make a third revision of CG90. This could be out for stakeholder consultation in early 2020.

However, the coalition remains concerned that NICE’s revisions might not address these matters, as NICE has indicated that it will update only the existing evidence review while including a new section on ‘patient choice’ without taking into account patient experience.