The National Institute for Health and Care Excellence (NICE) is to consider the US approach to treating people with depression, following new research showing that the treatment model could be successfully replicated in the UK.
Currently, treatment for 85%-95% of cases of depression in the UK is through GPs, but problems with this setting include barriers between GPs and specialist mental health services, patients not taking their medication and limited specialist support for patients.
In contrast, collaborative care involves a structured management plan, regular follow-up with patients and better communication between health professionals. To achieve this, a care manager is appointed to act under a specialist’s supervision and to liaise between GPs and mental health specialists.
NICE was unable to recommend this approach in its guideline on depression in adults, issued in October 2009, because of a lack of non-US evidence, so it issued a call for a UK evaluation of collaborative care.
This week, University of Exeter Medical School researchers published, on BMJ online, findings of a study on the use of such care across 51 GP practices in Bristol, London and Manchester.
The collaborative care was delivered by a team of care managers supervised by expert mental health clinicians, and consisted of antidepressant medication management, behavioural activation, symptom assessment and communication between GPs and the care managers.
The study found this approach led to improvement of depression symptoms immediately after treatment. Also, 15% more patients continued to show signs of improvement after 12 months of collaborative care, compared with those who saw their GP.
"This is one of the largest studies of collaborative care internationally, and demonstrates that it is as effective in the UK as it is in the US and could reliably be imported. Importantly, patients also told us that they preferred the approach to their usual care," said lead researcher Professor David Richards.
“We are now working on a full economic evaluation, and it will be for NICE to decide how to take this forward," he said.
NICE welcomed the findings of the study; when the Institute last looked at the evidence for treating depression, there was insufficient data to recommend the collaborative model of care, said Professor Mark Baker, director of the centre for clinical practice at NICE.
"We will look closely at these findings when our depression guideline next comes up for review," he added.