What you can expect from the NHS

• What are NICE guidelines?
• NICE guidance on schizophrenia
• NICE guidance on bipolar disorder
• NICE guidance on making decisions about prescribed medicines
• NICE guidance on violent and disturbed behaviour
• NICE guidance on self-harm
• NICE guidance on electroconvulsive therapy (ECT)
• NICE guidance on brain scans to help diagnose psychosis
• What to do if you think doctors aren’t following NICE guidelines
• Get involved with the creation of NICE guidance

What are NICE guidelines?

NHS care given to people with psychosis in England and Wales should be based on guidance issued by the National Institute for Health and Clinical Excellence (NICE). This organisation is responsible for producing ‘clinical guidelines’ for health professionals, which state how people with specific illnesses and conditions should be cared for. NICE also produces ‘technology appraisal’ guidance, which advises on when and how drugs and other treatments and procedures should be used in the NHS.

NICE guidance helps to make sure people across England and Wales receive the same standard of care. The NHS must by law pay for medicines and treatments recommended by technology appraisal guidance, for example. This means people should be able to get NICE recommended medicines and treatments from the NHS, if their doctors thinks they are right for them.

Doctors, nurses and other healthcare professionals are expected to take NICE guidance into account in their work. However, each health professional also has a responsibility to offer care tailored to an individual patient’s needs, in consultation with them and, where appropriate, their family members.

There is separate NICE guidance for the treatment of schizophrenia and the treatment of bipolar disorder.

Other guidance that may be relevant to the treatment of someone with the symptoms of psychosis is:
• Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence;
• Violence: the short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments;
• Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care.

A guideline called Psychosis with substance misuse is currently being developed and due for publication in March 2011.

There is also ‘technology’ guidance about the use of electroconvulsive therapy and the use of MRI and CT scans to help diagnose psychosis.

NICE guidance is reviewed every few years to make sure it reflects and includes new knowledge and new treatments proven to work through research. Each set of guidance is produced in different formats, including a summary for people who used NHS services, their families and friends.

Each guidance is produced by a ‘Development Group’, set up to review the evidence provided by research, which shows what treatments work best for different illnesses and health problems. Each Development Group is made up of health and social care professionals working in the field. Patients, family members and members of the public can also be invited to join these groups. NICE guidance also takes into account ‘value for money’, looking at the costs of each treatment compared to its benefits.

The Department of Health, Social Services and Public Safety in Northern Ireland has a formal link with NICE, under which all NICE guidance published from 1 July 2006 is reviewed for its applicability to Northern Ireland. If the guidance is found to be applicable, it is endorsed for use.

In Scotland, the Scottish Intercollegiate Guidelines Network develops evidence-based clinical practice guidelines for the NHS.

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NICE guidance on schizophrenia

This guidance is called Core interventions in the treatment and management of schizophrenia in primary and secondary care (update) and was issued in March 2009. It is due to be reviewed in March 2012.

The guideline covers what treatment, care and support adults with schizophrenia should be offered. It includes guidance on the use of antipsychotic drugs and talking therapies for the treatment of schizophrenia, including cognitive behavioural therapy and family therapy. It recommends health professionals work in partnership with family members and carers. The Guidance Development Group was chaired by Professor Elizabeth Kuipers from the Institute of Psychiatry, King’s College London. Her colleague Professor Philippa Garety, also from the Institute of Psychiatry, was a member of the Group.

Read the NICE guidance on schizophrenia
Read a summary for people who use NHS services and their families.

People with schizophrenia often have other conditions such as depression, anxiety or personality disorder. NICE has separate guidelines about the treatment of these conditions:

• Guidance on depression – Depression: management of depression in primary and secondary care
• Guidance on anxiety – Anxiety: management of anxiety in adults in primary, secondary and community care
• Guidance on borderline personality disorder – Borderline personality disorder: treatment and management
• Guidance on antisocial personality disorder – Antisocial personality disorder: treatment, management and prevention

Each of these links go to a page where you can download the full guidance and an ‘Understanding NICE guidance’ summary for people who use the NHS and their families.

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NICE guidance on bipolar disorder

The guidance is called The management of bipolar disorders in adults, children and adolescents, in primary and secondary care and was issued in July 2006. It is due to be reviewed in July 2011.

The guideline covers what treatment people with bipolar disorder can expect to be offered, including medication, talking therapies and advice on self-help. It includes how family members and carers may be able to support people with bipolar disorder, and how they can get support for themselves.

The guidance recommends families be involved in treatment and, if appropriate and without breaking confidence, and that both the individual with bipolar disorder and their families should be given information at every stage – from assessment, through diagnosis to treatment.

Read the NICE guidance on bipolar disorder
Read a summary for people who use NHS services and their families.

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NICE guidance on making decisions about prescribed medicines

This guidance is called Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence and was issued in January 2009. It is due to be reviewed in January 2012.

The guideline looks at why some patients don’t use their medicines as prescribed (this is called ‘non-adherence’) either because they don’t want to, or because they have practical problems doing so. One of the main recommendations of the guidance is about improving communication and people’s understanding of why drugs are prescribed, and involving people in decisions about their medicines. The guidelines offers practical advice on involving patients in decisions, and supporting ‘adherence’ – the taking of medication as prescribed.

Read the NICE guidance on making decisions about prescribed medicines
Read a summary for people who use NHS services and their families.

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NICE guidance on violent and disturbed behaviour

This guidance is called Violence: the short-term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments and was issued in February 2005. It is due to be reviewed in February 2012.

The guideline sets how doctors, nurses and other health professionals should manage disturbed or violent behaviour in psychiatric units, wards and emergency departments. It includes methods staff may use if talking doesn’t calm people down, including ‘rapid tranquillisation’, the use of medication. It specifies what drugs can be used, and procedures that should be following before and after an incident of violent or disturbed behaviour.

Read the NICE guidance on violent and disturbed behaviour
Read a summary for people who use NHS services and their families.

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NICE guidance on self-harm

This guidance is called Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care and was issued in July 2004. Its review date is to be confirmed.

The guideline covers the care people who harm themselves can expect to receive from healthcare professionals in hospital and in the community, and what kinds of services best help people.

Read the NICE guidance on self-harm
Read a summary for people who use NHS services and their families.

A new guideline called Self-harm (longer term management) is in development. It is due to be issued in November 2011.

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NICE guidance on electroconvulsive therapy (ECT)

The National Institute of Health and Clinical Excellence (NICE) issued guidance on the use of ECT in 2003, stating electroconvulsive therapy (ECT) should only be used for:

• the treatment of severe depressive illness;

• a prolonged or severe episode of mania;

• or catatonia. Catatonia is sometimes associated with schizophrenia or with mood disorders. Someone with catatonia may stop moving and remain rigid, may stop eating and drinking, or may become very excited for no apparent reason and move around excessively.

This guidance says ECT should only be used to gain fast improvement of severe symptoms when all other treatment options have failed, or when the situation is thought to be life-threatening. Unless it is an emergency, the Mental Health Act says that patients who have the capacity to consent cannot be given ECT unless they agree.

The NICE guidance says people must be given information about potential risks and benefits of ECT in order to make an informed decision about whether to have the treatment. Doctors must not put pressure on a patient to have the treatment, and an independent person – a family member or advocate – should be involved in the decision if possible.

The guidance is called The clinical effectiveness and cost effectiveness of electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania.

The recommendations on the use of ECT for depression have been updated in an October 2009 NICE guidance on Depression. This says that ECT should be considered for severe depression that is life-threatening, and when a rapid response is required, or when other treatments have failed.

Read the NICE guidance on ECT

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NICE guidance on brain scans to help diagnose psychosis

This guidance is called Structural neuroimaging in first-episode psychosis and was issued in February 2008. It is due for review in January 2011.

The NICE guidelines say MRI or CT scanning (structural neuroimaging) of people’s brains should not be routinely used to help diagnosis after someone has had a first episode of psychosis. The guidance says scanning does not improve diagnosis and is not cost-effective. However, people should be given a brain scan if doctors think a physical illness is causing psychosis.

Read the NICE guidance on brains scans to help diagnosis
Read a summary for people who use the NHS and their families and carers. 

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What to do if you think doctors aren’t following NICE guidelines

If people feel treatment and care recommended by NICE is suitable for them, but are not offered that treatment by the NHS, they have a right to seek help or complain.

If you want to complain about NHS treatment or care, you have to start by complaining to the NHS Trust that runs the service.

In England, there are two organisations that can help if you are thinking about making a complaint.

All NHS Trusts have a Patient Advice and Liaison Service (known as ‘PALS’). PALS staff will tell you about the Trust’s complaints procedure. A complaint can be made by a patient, or a family member, acting on their behalf. Find out more about PALS – or visit the website of the Mental Health NHS Trust that runs services in your area and search for ‘PALS’ to get local details.

You can also get independent advice and representation in England from the Independent Complaints Advocacy Service. This is a free, confidential and independent service that can help you make a formal complaint about NHS services.

The Service is run by three organisations:,

• The Carers Federation
• POhWER
• SEAP (South of England Advocacy Projects)

If you aren’t satisfied with the way the local NHS Trust deals with a complaint, you can ask the Health Service Ombudsman for England to investigate.

In Wales, you can get free confidential help from Complaints Advocates who are part of local Community Health Councils. Ring 0845 644 7814 to get in touch with a local advocate.

If you’re not happy with the way the NHS handles your complaint, you can contact the Public Services Ombudsman for Wales.

In Scotland, you can contact the Independent Advice and Support Service to help you make a complaint about the NHS. This is part of the Scottish Citizens Advice Bureau.

You can find out more about the NHS complaints procedure in Scotland by visiting Health Rights Information Scotland.

If you’re not happy with the way the NHS handles your complaint, you can contact the Scottish Public Services Ombudsman.

In Northern Ireland, the Patient Client Council can offer confidential, free and independent help making a complaint.

If you’re not happy with the way the NHS handles your complaint you can contact the Northern Ireland Ombudsman.

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Get involved with the creation of NICE guidance

NICE is keen to involve patients, family members, other carers and members of the public in the process of creating guidance for the NHS. Patients, family members and members of the public can suggest a topic for guidance, or join a NICE committee or working group. They can also comment on the contents of proposed guidance during the consultation stages of the guidance development process. For more information, visit the NICE website.