Improving care for people with anxiety
6th February 2014 – The National Institute for Health and Care Excellence (NICE) has issued standards for the NHS in England to improve the quality of care for children, young people and adults with anxiety disorders.
Recognition of anxiety disorders, especially in primary care, is poor, leading to many people not receiving the support they need. NICE says even when anxiety disorders are diagnosed, treatment is often limited to the prescription of drugs rather than offering psychological interventions, which it recommends as the first-line of treatment.
In a media release, Jo, 52 from Manchester, says: “It took many years to be diagnosed specifically with social anxiety, after initially being told I was just experiencing anxiety and given medication. When I was finally told it was social anxiety disorder, I didn’t feel like my GP fully understood the condition or how to manage it. I think if my GP would have better understood what I was going through, I may have received the help I needed much earlier.”
Anxiety disorders are types of common mental health disorders. They include generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder ( PTSD), panic disorder, obsessive-compulsive disorder and body dysmorphic disorder.
Although anxiety disorders vary considerably in their severity, they are associated with significant long-term disability and can have a lifelong course of relapse and remission. In children and young people they are also associated with an increased risk of other serious mental health problems, including depression and substance misuse.
A snapshot of anxiety disorders in adults in England over a 1-week period carried out by the Office of National Statistics in 2007 found that 4.4% of adults had generalised anxiety disorder, 3% had post-traumatic stress disorder, 1.1% had panic disorder and 1.1% had obsessive-compulsive disorder.
Professor Gillian Leng, deputy chief executive and director of health and social care at NICE says in a press release: “Anxiety disorders are surprisingly common, and many people will experience one or more periods of this type of illness during their life, or live and work with others who are affected. Yet many people who experience them do not receive the help or support they require. This is often because their symptoms are not picked up or the treatment they need is not available.
“Receiving an accurate and timely diagnosis, then following this up with the right type of care can be key in determining whether someone progresses towards recovery or whether their mental health further deteriorates.”
NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them when it comes to planning and delivering services.
The new quality standard aims to improve recognition, assessment and availability of treatments for anxiety disorders. It says:
- Accurate diagnosis of a person’s specific anxiety disorder can help them understand their condition and ensure they are offered the most appropriate treatment at the earliest opportunity. Therefore, people with a suspected anxiety disorder should receive an assessment that identifies whether they have a specific anxiety disorder, how severe it is and how it impacts their life.
- Evidence-based psychological interventions are effective treatments for anxiety disorders and should be offered as first-line treatments in preference to pharmacological treatment. They include both low-intensity interventions incorporating self-help approaches and high-intensity psychological therapies.
- People with anxiety disorders should not be prescribed benzodiazepines or antipsychotics unless there are specific clinical reasons why these treatments may be of short term benefit (for example, in anxiety disorder crisis).
- Patients should have their response to treatment recorded at each treatment session. This ensures that the effectiveness of treatment can be assessed and adjustments made if needed. It also provides an opportunity for the health practitioner to monitor other outcomes, such as the person’s ability to continue or return to employment.