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Evidence submitted by the British Association for Counselling and Psychotherapy (NICE 92)

Rowland, N., 2007. Evidence submitted by the British Association for Counselling and Psychotherapy (NICE 92). Reformulation, Winter, p.20.

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Executive Summary

1. Psychological therapies are an important part of the delivery of health care within the NHS and the private sector. They are highly valued by patients who increasingly choose counselling and psychotherapy in preference to medication.
2. NICE guidelines now exist to support the delivery of psychological therapies across a range of mental health conditions, including depression and anxiety.
3. The NICE guideline development process is robust and transparent. NICE guidelines are based on evidence reviews, with systematic review and randomised controlled trial (RCT) evidence given most weight.
4. There are two disadvantages of maintaining this rigid hierarchy of evidence:
5. The first disadvantage relates to the lack of systematic review and RCT evidence for the psychological therapies:
6. Mental health research is seriously under-funded. RCTs are expensive, as are systematic reviews to synthesise RCT data. There is limited systematic review and RCT evidence for the efficacy of psychological therapies, with the exception of CBT for a range of conditions. Many psychological therapies remain unevaluated by RCT. Therefore NICE guidelines are based on a robust but very narrow evidence base.
7. BACP has concerns, therefore, about gaps in the evidence and in service recommendations based on a restricted evidence base. Reliance on a limited range of evidence based treatments may disadvantage patients through restricting patient choice for and access to a range of interventions and over-resource standard treatments that are not panaceas and will not suit all patients.
8. The second disadvantage relates to the downgrading of other types of research evidence, such as case studies and effectiveness studies, which are needed to assess not only whether a treatment works, but if and how it works in practice.
9. Studies that show that a therapy can work in the trial context must be complemented by other methodologies (such as audit and benchmarking) that can assure that their delivery in routine settings (such as the NHS) is still producing positive outcomes. It is important to assess not only whether a treatment works, but how it works in practice.
10. BACP recommends that NICE reviews its evidence evaluation process to admit a range of quantitative and qualitative evidence in the evaluation of psychological therapies, including highly controlled studies, case studies and effectiveness studies.
11. Besides the ways in which NICE’s evaluation may disadvantage certain groups of patients, BACP has concerns about the implementation of NICE guidance:
12. There is concern that NICE guidelines for psychological therapies might be used as a basis for new commissioning strategies or for re-designing existing psychological therapies when the evidence underlying their recommendations does not support this.
13. Implementation of NICE guidance based on a narrow evidence base will severely limit treatment options for patients at a time when the Government is responding to public concern about lack of access to, and health inequities in, the provision of psychological therapies, and prioritising patient choice.
14. The concerns stated here are shared not only by BACP but also by psychological therapists in other professional bodies and by researchers in both academic and practice settings. This lack of confidence in the evaluation process in itself constitutes a challenge to the NICE decision making process.

Nancy Rowland
British Association for Counselling and Psychotherapy
March 2007

Full details can be found at
http://www.publications.parliament.uk/pa/cm200607/ cmselect/cmhealth/503/503we18.htm

Full Reference

Rowland, N., 2007. Evidence submitted by the British Association for Counselling and Psychotherapy (NICE 92). Reformulation, Winter, p.20.

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