Psychiatrists fear draft NICE OCD guidance will restrict specialist care

Psychiatrists and mental health charities have warned that draft guidance from NICE could make it harder for people with obsessive compulsive disorder in England to get specialist care. OCD is a relatively common but serious mental health problem. It affects around 700,000 people in England. The NHS guidance on treating the condition was last written more than 20 years ago and was due to be updated.

The draft guidance is intended to help reduce stigma and diagnose people more quickly. That part has been welcomed. But clinicians fear it focuses on initial diagnosis and first-line treatment and does not set out what should happen when those treatments fail. Around half of people with OCD do not respond to their first line of treatment.

Helen, a former hairdresser, developed intrusive thoughts during a stressful divorce. She was diagnosed with OCD and given a type of talking therapy and an antidepressant, but her condition did not improve over about two to two and a half years. A specialist centre then prescribed exposure therapy, an anti-psychotic and a drug called clomipramine, which helped. She has been well for six years and fears others may not get the same access to additional care.

Professor David Veale, a leading psychiatrist who helped draft the previous guidelines in 2005, said the current advice recommends OCD-specific cognitive behaviour therapy or SSRIs. He said the problem is what happens when those treatments fail. Normally a patient would need to be seen by a more specialist service, perhaps for more intensive treatment, but that is not discussed in the draft at all.

Critics say the update has been rushed. They argue the expert committee's hands are tied by NICE management, which set a timetable for completing the work. NICE has said it may produce a second batch of guidance covering more specialist treatment, but no date has been set and it could take years.

Five mental health charities, including OCD Action, have launched a petition to NICE. They had hoped for new treatment options or innovations but said they were disappointed and deeply concerned by the final draft. When asked whether money was behind the approach, one expert said it was probably pressure on NICE and maybe financial.

NICE said it wants people with OCD to be identified earlier and to get effective evidence-based treatment. It said the update has focused on initial diagnosis and treatment and that it is reviewing consultation feedback to decide whether further updates are required. NICE also said it is not removing any treatment options. Experts warned that is not how the guidance is likely to work in practice. With no date for further guidance, there are fears that thousands of patients will be left in limbo.