NICE guidance
Stepped Care Model
- Identification; assessment; psychoeducation; active monitoring by primary health care professionals.
- Depression, GAD, Insomnia (where it is a symptom of Depression/GAD), OCD, Health Anxiety, Social Anxiety, Panic Disorder, Agoraphobia, Specific Phobia.
- Mild to moderate symptoms and/or where no previous CBT based treatment has been tried.
- PTSD, Depression, GAD, OCD, Health Anxiety, Social Anxiety, Panic Disorder, Agoraphobia, Specific Phobia.
Those that have not responded to step 2 interventions, and/or severe presentations with marked functional impairment.
Step 4 Psychological Services:
- Complexity; several or frequent recurrences; multiple traumas; childhood abuse.
- Poor response to other treatment, has had a treatment of CBT in the past (if appropriate).
- Significant and sustained impact on daily functioning or relationships with others.
- History or continuing risk of moderate to severe harm to self or others.
- Several mental health diagnoses or several different areas of difficulty.
- Duration is greater than 12 months.
- No current drug use or alcohol dependency
Adult Mental Healthcare Team AMHT:
If a client is presenting with a high level of risk and/or requires a psychiatric assessment:
- EMERGENCY- to be seen within 4 hours
- URGENT – to be seen within 7 days (inclusive of weekends)
- ROUTINE – to be seen within 28 days, for mental health assessment, psychiatric diagnoses or medication review.
IAPT questionnaires
To measure depression symptoms, score ranges:
0 – 4: normal
5 – 9: mild
10 – 14: moderate
15 – 19: moderately severe
20 – 27: severe
A score of 9 or above would be determined as in caseness for depressive symptoms.
To measure generalised anxiety symptoms, score ranges:
0 – 4: normal
5 – 9: mild
10 – 14: moderate
15 – 21: severe
A score of 7 or above would be determined as in caseness for anxiety symptoms.
An additional measure can also be used to assess for GAD, the Penn State Worry questionnaire (short version) a score of 45 or above would indicate caseness.
IAPT phobia scale for assessing avoidance due to fear of outlined situations (panic attacks, social situations, or specific situations such as driving, flying, heights, confined spaces, vomit, blood, animals, etc.)
0 – would not avoid
2 – slightly avoid
4 – definitely avoid
6 – markedly avoid
8 – always avoid
Work and social adjustment scale, assessing the impact on different areas of day-to-day activities due to experienced difficulties. This includes work, home management, social leisure activities, private leisure activities, family and relationships.
0 – would not avoid
2 – slightly avoid
4 – definitely avoid
6 – markedly avoid
8 – always avoid
Obsessive Compulsive Inventory, to measure symptoms of OCD, using the distress scale:
0 – not at all
1 – a little
2 – moderately
3 – a lot
4 – extremely
A score of 40 or above would indicate symptoms of OCD.
Health Anxiety Inventory (short version), to measure symptoms of health anxiety. Each question consists of 4 statements, with the patient choosing which statement best fits with their feelings over the last week.
A score of 18 or above would indicate symptoms of health anxiety.
Social Phobia Inventory, to measure symptoms of social anxiety, using the following scale:
0 – not at all bothered
1 – a little bothered
2 – moderately bothered
3 – bothered a lot
4 – extremely bothered
A score of 19 or above would indicate symptoms of social anxiety.
Mobility Inventory, to measure symptoms of agoraphobia, using the following scale:
1 – never avoid
2 – rarely avoid
3 – avoid about half of the time
4 – avoid most of the time
5 – avoid always
A score of 60 or above would indicate symptoms of agoraphobia.
Panic Disorder Severity Scale, to measure symptoms of panic disorder, using the following scale:
0 – none
1 – mild
2 – moderate
3 – severe
4 – extreme
A score of 8 or above would indicate symptoms of panic disorder.
Posttraumatic Check List (PCL-5), to measure for symptoms of PTSD, using the following scale:
0 – not at all bothered / distressed
1 – a little
2 – moderately
3 – quite a bit
4 – extremely bothered / distressed
A score of 32 or above would indicate symptoms of PTSD.
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