Intended for healthcare professionals

Practice Guidelines

Identification and care pathways for common mental health disorders: summary of NICE guidance

BMJ 2011; 342 doi: (Published 24 May 2011) Cite this as: BMJ 2011;342:d2868
  1. Stephen Pilling, professor, director12,
  2. Craig Whittington, senior systematic reviewer2,
  3. Clare Taylor, editor3,
  4. Tony Kendrick, professor of primary care and dean4
  5. on behalf of the Guideline Development Group
  1. 1Centre for Outcomes Research and Effectiveness, University College London, WC1E 7HB, UK
  2. 2National Collaborating Centre for Mental Health, University College London (Clinical, Educational and Health Psychology), London WC1E 7HB
  3. 3National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA
  4. 4Hull York Medical School, Hull HU6 7RX, UK
  1. Correspondence to: S Pilling s.pilling{at}

At any one time, as many as 15% of people in the United Kingdom1 experience common mental health problems such as depression and anxiety disorders, including generalised anxiety disorder, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. These may cause considerable impairment and disability, with high costs for both the person and society. Most people who are diagnosed with a common mental health disorder (about 80%) are treated in primary care2; however, there is widespread under-recognition of depression and anxiety disorders.3 4

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) to improve identification of common mental health disorders, access to services, and pathways to care.5 The guideline also adopted or adapted treatment recommendations from existing NICE guidance on depression,6 7 generalised anxiety disorder and panic disorder,8 post-traumatic stress disorder,9 obsessive-compulsive disorder,10 and antenatal and postnatal mental health11 and organised them into a common stepped care framework.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are in the full version of this article on

Identification of common mental health disorders

  • Be alert to possible depression (particularly in people with a history of depression or a chronic physical health problem with associated functional impairment), and consider asking people who may have depression two questions, specifically:

    • -During the past month, have you often been bothered by feeling down, depressed, or hopeless?

    • -During the past month, have you often been bothered by having little interest or pleasure in doing things?

If a person answers “yes” to either of the above questions consider depression and follow …

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