Table 35Step 2 treatment and referral advice

DisorderPsychological interventionsPharmacological interventionsPsychosocial interventions
Depression persistent subthreshold symptoms or mild to moderate depressionOffer or refer for one or more of the following low-intensity interventions: Do not offer antidepressants routinely but consider them for, or refer for an assessment, people with:
  • initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or
  • subthreshold depressive symptoms or mild depression that persist(s) after other interventions or
  • a past history of moderate or severe depression or
  • mild depression that complicates the care of a physical health problema,b.
Consider:
  • informing people about self-help groups, support groups and other local and national resources
  • educational and employment support servicesa.
GAD – that has not improved after psychoeducation and active monitoring in Step 1Offer or refer for one of the following low-intensity interventions: N/A
Panic disorder mild to moderateOffer or refer for one of the following low-intensity interventions: N/A
OCD – mild to moderateOffer or refer for individual CBT including ERP of limited duration (typically up to 10 hours), which could be provided using self-help materials or by telephone or
Refer for group CBT (including ERP)e,f.
N/A
PTSD – including mild to moderate PTSDRefer for a formal psychological intervention (trauma-focused CBT or EMDR)g.N/AConsider:
  • informing people about support groups and other local and national resources
  • educational and employment support servicesa.
All disorders – women planning a pregnancy, during pregnancy or following pregnancy who have subthreshold symptoms that significantly interfere with personal and social functioningFor women who have had a previous episode of depression or anxiety, consider providing or referring for individual brief psychological treatment (four to six sessions), such as IPT or CBTc.

Women requiring psychological interventions during pregnancy or the postnatal period should be seen for treatment within 1 month of (and no longer than 3 months from) initial assessmentc.
When considering drug treatments for women who are pregnant, breastfeeding or planning a pregnancy, consult Antenatal and Postnatal Mental Health (NICE, 2007a) for advice on prescribing.For women who have not had a previous episode of depression or anxiety, consider providing or referring for social support during pregnancy and the postnatal period; such support may consist of regular informal individual or group-based supportc.
a

Adapted from Depression (NICE, 2009a).

b

Adapted from Depression in Adults with a Chronic Physical Health Problem (NICE, 2009b).

c

Adapted from Antenatal and Postnatal Mental Health (NICE, 2007a).

d

Adapted from Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in Adults (NICE, 2011a).

e

Adapted from Obsessive-compulsive Disorder (NICE, 2005a).

f

Group formats may deliver more than 10 hours of therapy.

g

Adapted from Post-traumatic Stress Disorder (NICE, 2005b).

From: 6, FURTHER ASSESSMENT OF RISK AND NEED FOR TREATMENT, AND ROUTINE OUTCOME MONITORING

Cover of Common Mental Health Disorders
Common Mental Health Disorders: Identification and Pathways to Care.
NICE Clinical Guidelines, No. 123.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2011.
Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.

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