Today the ACP is proud to join @UKCP and over 45 organisations, individuals and parliamentarians in signing a letter to NICE calling for an urgent review of the NICE anxiety guideline.
The NICE anxiety guideline shapes how treatment is delivered across the NHS. It has not been meaningfully updated since 2011, and the coalition has serious concerns about whether the guideline is fit for purpose. This is significant, with the guideline shaping the care of both adults and children. Meanwhile, NHS statistics from 2024 show that more than 500 children a day in England are being referred to mental health services for anxiety. This is more than double the rate than before the pandemic.
The three areas of concern identified are that the guideline is:
Outdated and internally inconsistent
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The guideline has not been meaningfully updated since 2011, resulting in direct incongruity with the recently updated NICE guideline for depression in adults. It references outdated diagnostic manuals, and the depression and anxiety guidelines contradict one another on how to treat comorbid depression and anxiety. The guideline also contains insufficient guidance on a collaborative approach to treatment between clinicians and patients.
Inadequate attention to access and equity
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The guideline contains insufficient guidance on the barriers to access faced by marginalised and hard-to-reach populations, and offers little in the way of practical methods to improve access for these groups.
Severely limited patient choice of therapies
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Only two high-intensity therapies are recommended - cognitive behavioural therapy (CBT) and applied relaxation - significantly limiting the options available to both patients and clinicians. Both therapies are primarily symptom-focused, with limited attention to approaches that address the root causes of anxiety.
People seeking help for anxiety in the NHS deserve access to a range of effective treatments and care that works for everyone regardless of their background or circumstances. Furthermore, anxiety also places additional economic burden on the economy, making the case for updating the guideline extend beyond clinical concerns. A guideline that reflects the current evidence base, offers genuine patient choice, and addresses barriers to access would represent a meaningful step toward reducing that burden.
We're calling on NICE to act. You can read the joint letters to NICE here: https://www.psychotherapy.org.uk/policy-and-research/public-policy/nice-anxietyguideline-campaign/