Why updating the NICE guideline for treating generalised anxiety and panic disorder is vital for practitioners and people seeking support

Why updating the NICE guideline for treating generalised anxiety and panic disorder is vital for practitioners and people seeking support 

UKCP is leading a campaign for a comprehensive update of the NICE guideline to treat generalised anxiety and panic disorder in adults. Last week, we were joined by over 70 organisations, individuals and parliamentarians to call for a comprehensive update of this guideline.   

The guideline has not been meaningfully updated since 2011. Since then, the number of adults who have a condition like anxiety has steadily grown.  

Following the success of previous work to update the depression guideline, we want to work with NICE to ensure that the guideline:  

• is compatible with other revised guidelines and uses the most up to date diagnostic criteria     
• includes guidance for addressing barriers to access for marginalised and hard-to-reach populations   
• increases the number of therapies approved to treat anxiety to facilitate patient choice     
• considers a broader range of high-quality evidence available on treating anxiety (such as service user experience, long term and follow-up studies). 

With rates of anxiety rising across the UK, it is crucial that NHS mental health services deliver timely, high-quality care to every person in need of support.  

The importance of patient choice  

Despite NHS talking therapies services receiving almost half a million presenting complaints of either anxiety or stress-related disorders in 2022-23, less than half of people that access treatment via NHS talking therapies reliably recover from their presenting issue.  

The depression guideline contains guidance for clinicians about discussing with patients their prior experiences with depression, previous treatment options that patients found helpful, any contributing factors, and what they hope to gain from treatment. Including this collaborative approach in the anxiety guideline is an essential part of ensuring that there is parity between the anxiety and depression guidelines.  

Additionally, patient choice is vital, as recognised by NICE in the guideline for depression and across the mental health field. Allowing patients a choice between therapy types has been shown to lead to better outcomes for those seeking mental health support from the NHS. The current version of the anxiety guideline is highly limiting – with the choice of CBT, applied relaxation or medication. This significantly impacts not only the patient’s ability to choose between treatments, but also restricts the number of treatment options clinicians are able to offer. Providing other therapies is also essential for those with a more complex underlying cause, such as childhood-based trauma, to access the support they need.   

This change in how anxiety is treated matters. It is essential for providing high-quality care, but can also reduce waiting times by removing unnecessary siloing of mental health professionals in the context of an already reduced workforce. This is a clear benefit for both people accessing support and clinicians.

Ensuring accessibility, reducing inequality  

In addition to offering effective treatment options, it is critical that support must be accessible. The current guideline ignores specific barriers to access for people from marginalised people, such as those from minoritised ethnic backgrounds. Patients that have the worst health outcomes are often from one or more of these groups, so it is vital that the healthcare provision does not further entrench systemic patterns of health inequality.  

Accessibility difficulties and appropriate accommodations are mentioned repeatedly in the depression guideline. As the depression guideline and other studies suggest, difficulties in access will be similar when individuals seek support via other mental health services for various conditions, including anxiety disorders. The omission of barriers to access will therefore mean that some affected by anxiety will not have equitable access to care, impacting their quality of life and chance of recovery. This demonstrates why it is essential that the anxiety guidelines are updated to be consistent with other NICE guidelines that reflect barriers to treatment, ensuring adequate provision for similar groups to those highlighted in the depression guidelines, such as specific minoritised ethnic communities, people experiencing homelessness, or asylum seekers.  

Next steps  

We want to work with NICE to ensure that any update to the guideline addresses our concerns. We invite them to meet with stakeholders from our coalition to discuss the concerns raised and agree on next steps. We suggest that these involve a multi-step review of the whole guideline that includes a representative range of stakeholders and evidence, ensuring that organisations must have the opportunity to comment on any updates before publishing. This should result in a guideline that addresses our key concerns of the campaign. At a minimum, NICE must ensure that it is up to the standard of the depression guideline, which includes a wider range of therapies, highlights barriers to access and is more accessible for clinicians.  

Conclusion  

If our concerns are not adequately addressed, the treatment recommendations cannot be relied on and will be misleading, invalid and impede the care of millions of people in the UK, significantly limiting patient choice and potentially causing clinical harm. We will continue to push for guidelines that allow everyone to access timely care, and for clinicians to deliver high-quality, effective care.  

You can find out more about the campaign on our website: https://www.psychotherapy.org.uk/policy-and-research/public-policy/nice-anxiety-guideline-campaign/

Jon Levett 

UKCP CEO