A significantly improved NICE Guideline for depression in adults has been published – after five years of consultations and campaigns.

The guideline’s recommendations have a direct impact on the treatments offered for depression and whether counselling and psychotherapy is made available to people.

We believe the updated guideline is substantially better than both the previous 2009 version and the first draft of this update in 2017, which was not fit for purpose. 

The guideline now places greater emphasis on client choice when accessing services and includes the recommendation that all psychological therapies should be considered as first line treatments for depression.

However, we believe there are still some areas which need to improve.

Background to the guideline development

Since the convening of the Guideline Development Group to update the Depression in Adults clinical guideline in 2014 to 2015, we have consistently challenged NICE robustly about how the existing guideline, published in 2009, needs to improve to better meet the needs of both the public and clinicians delivering services.

We’ve continually made the case for counselling and psychotherapy as evidenced and effective interventions in the treatment of depression and have reiterated our commitment to ensuring the public have a choice of all evidence-based psychological therapies, and that they can access these services quickly and easily.

For the past four years we've been at the heart of a campaign coalition, bringing together organisations, influential individuals and politicians, who've all shared concerns with the existing guideline.

Since launching, this campaign coalition has successfully coordinated pressure on NICE. In 2017, following the first draft guideline consultation, we collectively secured an exceptional second consultation on the draft guideline in 2018. Also, in 2018 we coordinated political pressure through an Early Day Motion tabled in Parliament and a cross-party political letter signed by 26 MPs from across political parties; this letter supported the coalitions concerns with the existing guideline, re-iterated that NICE had failed to sufficiently address the coalitions concerns between the first and second draft of the guideline and called for a full and proper revision of the guideline before its publication.

This pressure culminated in a summit meeting between the stakeholders and NICE in May 2018 to discuss our six key collective concerns with the guideline, with NICE publicly responding as one of the outcomes of the meeting and committing to looking to address some these concerns.

In 2018, after two draft consultations, three years of guideline development and following pressure from BACP amongst other organisations and individuals across the mental health sector, NICE agreed to undertake an unprecedented third revision of the Depression in Adults clinical guideline to ensure the most up to date and appropriate evidence was included and to strengthen work around patient choice and shared decision making.

Further pressure was applied by the coalition in September 2019 when 61 MPs and Peers, including both a former Minster for Health and former Shadow Cabinet Minister for Mental Health and Social Care, co-signed a letter to the CEO of NICE, Sir Andrew Dillon, urging them to meaningfully respond to the repeatedly raised concerns from the coalition and to address all of these adequately in the proposed third revision of the guideline.

NICE made clear that this third consultation would be the last opportunity for stakeholders to comment and influence the work in this update cycle of the guideline.

We responded to the third and final consultation and in our consultation response, we welcomed the improved focus on client choice and the recommendation that all psychological therapies should be considered as first line treatments for depression.

We also raised concerns about issues such as how the guideline was put together, how relevant research was not considered, how treatment options were ranked, the inconsistent use of the word counselling, and that longer-term psychological therapies were not recognised.

News about the guideline development