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New NICE quality standard to improve care of people with psychosis and schizophrenia

The National Institute for Health and Care Excellence (NICE) has issued a new quality standard to help adults with psychosis and schizophrenia have a positive experience of mental health services and ensure they receive the support they need [1].

Psychosis and schizophrenia cover a range of disorders in which a person’s thoughts, mood and behaviour are significantly altered. Each person will have a unique combination of symptoms and experiences. They can include hallucinations, delusions, social withdrawal or self-neglect.

Recent figures showed that up until 2009, there were about 17,000 new cases of psychosis and 8,000 new cases of schizophrenia in England each year2.

People with severe mental illness such as schizophrenia often die 15-20 years earlier than people without a severe mental illness3. There may be several reasons why. For instance, many people with psychosis and schizophrenia will often have other health problems such as heart disease and diabetes, that can be made worse by antipsychotic drugs.

The latest service audit showed an increase in the number of people with schizophrenia receiving physical health checks; however this was still only a third of service users4. The quality standard includes a statement to continue to drive improvements, calling for regular health checks to be prioritised. Healthcare professionals should monitor weight, waist and blood pressure measurements with results to be shared with a person’s GP and mental health team.

In 2014, only 7% of people using mental health services were in paid employment5. The latest audit of schizophrenia services also found that less than half (48%) of those who wanted to find work felt they got any help job hunting4. The quality standard stresses the need for structured employment programmes to be made available to people with psychosis and schizophrenia who would like to find work.

Other priorities in the quality standard cover the treatment of people with psychosis and schizophrenia, as well as support for their family and carers including:

  • Ensuring people who have a first episode of psychosis start treatment in an early intervention in psychosis service within 2 weeks of being referred.
  • Offering cognitive behavioural therapy for psychosis to help people with psychosis and schizophrenia cope with their symptoms.
  • Providing education and support programmes for carers.

Professor Gillian Leng, deputy chief executive and director of health and social care for NICE, said: “Psychosis and the specific diagnosis of schizophrenia are serious mental illnesses that have debilitating symptoms and can affect all aspects of a person’s life. Many people with severe mental illness will also suffer from additional health problems, like heart disease and diabetes, which can significantly affect how long they live. Other symptoms such as a lack of drive or social withdrawal, means they might also struggle to contribute to society.

“We are seeing improvements in mental health services but there is still some way to go before we can be sure that all people with psychosis and schizophrenia are getting high-quality care. There are certain areas such as offering health checks, providing access to psychological therapies and employment support, where we know more still needs to be done to drive improvements in care.

“With this new quality standard we want to highlight what health and social care services need to prioritise to make sure all people with psychosis and schizophrenia are getting the care they need and deserve.”

Mark Winstanley, chief executive officer of Rethink Mental Illness said: “We know from our supporters that thousands of people with psychosis and schizophrenia are still missing out on a range of effective services and support which could transform their lives.

“These quality standards highlight where improvements in care need to be made, including making sure everyone with psychosis gets proper treatment for their physical health, and improving access to early intervention support and talking therapies.

“Now we urge mental health professionals, service providers and local commissioners to act on the quality standards, and ensure that they inform the provision of better quality care for people with psychosis and schizophrenia in their communities.”

The full quality standard which includes 8 statements is available at /guidance/QS80.

Original Source

Further information

  1. The quality standard is available at /guidance/QS80.
  2. A 2012 review of the incidence of schizophrenia and psychosis found a pooled incidence of 31.7 per 100,000 person-years for psychosis and 15 per 100,000 person-years for schizophrenia in England between 1950 and 2009.
    Kirkbride JB, et al. Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS ONE 7(3): e31660
  3. Schizophrenia Commission. The Abandoned Illness. 2012.
  4. Royal College of Psychiatrists. Report of the National Audit of Schizophrenia (NAS) 2014.
  5. Health and Social Care Information Centre. Measures from the Adult Social Care Outcomes (2013-14). 2014.


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