The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future

Purpose. 'Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care' was the first National Institute of Clinical Effectiveness (NICE) guidance to be produced in 2002. This guidance includes a recommendation in relation to cognitive behavioural therapy (CBT) and family interventions (FI) in schizophrenia. This review reviews this guidance and assesses the extent of their implementation in services and the barriers to this implementation. Methods. The review draws on data from empirical studies specifically focused on the NICE guidance for FI for schizophrenia, papers discussing implementation issues in relation to other psychological therapies in schizophrenia and empirical studies investigating the implementation of similar evidence-based guidelines in Australia and the USA. Results. Although there is relatively limited research investigating implementation of the NICE guidelines, the available evidence suggests that people with schizophrenia still have poor access to psychological interventions. Barriers to implementation involve factors associated with: mental health professionals, the needs of service recipients and of organizations. Conclusions. In order to improve the implementation of the updated version of the schizophrenia guidance due to be published in 2009, it will therefore be necessary to target barriers at all of these levels. There are also problems associated with the way in which the NICE guidance, generally, and those for psychological interventions in schizophrenia in particular, are developed. It will be necessary to address these in order to facilitate successful implementation.