The national OCD charity, run by and for people with lived experience of OCD
The National Institute for Health and Clinical Excellence (NICE) is part of the NHS and is the independent organisation responsible for providing national guidance on treatments and care for people using the NHS in England and Wales.
On the 23rd November 2005, The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health launched their set of clinical guidelines for the identification, treatment and management of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder for children and adults. OCD-UK was involved as a stakeholder in the initial development of the guidelines for OCD and we were involved in the subsequent press launch.
The NICE guidance is intended for health care professionals, patients and their carers to help them make decisions about treatment and health care. What this should do is ensure people in England and Wales are offered evidence based treatment as recommended by NICE.
The benefit for us is we can quote the NICE recommendations when we are trying to access treatment, or being offered less therapy than recommended by NICE.
For example, NICE refer to treatment as up to 10-hours of therapy per course of treatment (then being offered another 10 hours if needed), but some IAPT therapy services are currently not providing that amount of therapy (routinely they only offer 6 hours of therapy and no more), so when fighting for additional therapy you may wish to remind the service of that NICE recommendation.
The information that follows is a summary of the basic points that the NICE Guideline recommend for the management of OCD for children and adults:
1.5.1 Initial treatment options
The intensity of psychological treatment has been defined as the hours of therapist input per patient. By this definition, most group treatments are defined as low intensity treatment (less than 10 hours of therapist input per patient), although each patient may receive a much greater number of hours of therapy.
18.104.22.168 In the initial treatment of adults with OCD, low intensity psychological treatments (including ERP) (up to 10 therapist hours per patient) should be offered if the patient’s degree of functional impairment is mild and/or the patient expresses a preference for a low intensity approach. Low intensity treatments include:
- brief individual CBT (including ERP) using structured self‑help materials
- brief individual CBT (including ERP) by telephone
- group CBT (including ERP) (note, the patient may be receiving more than 10 hours of therapy in this format).
22.214.171.124 Adults with OCD with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low intensity treatment has proved to be inadequate, should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.
126.96.36.199 Adults with OCD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.
188.8.131.52 Adults with OCD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP).
184.108.40.206 Adults with BDD with mild functional impairment should be offered a course of CBT (including ERP) that addresses key features of BDD in individual or group formats. The most appropriate format should be jointly decided by the patient and the healthcare professional.
220.127.116.11 Adults with BDD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive individual CBT (including ERP) that addresses key features of BDD.
18.104.22.168 Adults with BDD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP) that addresses key features of BDD.
It’s important to note though that the NICE Guidelines do not cover Scotland or Northern Ireland, although NICE is widely respected, so patients in Scotland or Northern Ireland can still make reference to them to their own local NHS services should they feel need to.
You can download different versions of the NICE guidelines from the NICE website.
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