IT’s A NICE Fiction That Mental Health Guidelines Are Implemented

It is a working assumption of NICE that its’ mental health  clinical practice guidelines (CPGs) will be implemented. If they are not what is the point? NHS Talking Therapies has fostered the myth of compliance without providing any evidence, to secure Government funding.

 To take an example in 2022 NICE published its’ Depression Guidelines advocating group CBT as the gateway to treatment. But this has never happened. BABCP is currently providing webinars on ‘CBT Informed Groupwork’ despite the lack of evaluation in randomised controlled trials and inattention to reliable diagnosis. The evidence-based protocols for group CBT are diagnosis specific [see my book Simply Effective Group CBT published by Routledge in 2013.. NHS Talking Therapies will undoubtedly embrace ‘groupwork’, as part of its mission to increase accessibility turning a blind eye to the issue of effectiveness  and reliable diagnosis. 

The problem with Clinical Practice Guidelines is however not confined to UK. A recent review of CPG ‘s for PTSD [PTSD Research Quarterly vol 35]  by the US National Center for PTSD subject found that most clinicians a) didn’t know about the CPGs and b) of those that did most chose to ignore, largely because of their belief that their client was somehow ‘special’ and was not appropriate for an evidence-based protocol (EBP).

There needs to be a debate about fidelity, it seems likely that what the public are served is  poor fare. But the Service Providers and their fellow travellers including government  will not countenance such a notion and studiously avoid, not only open debate but any support for an independent evaluation. 

Dr Mike Scott