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RCN issues warning as digital therapy recommended for children

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Nurses will be asked to prescribe online therapy sessions as a first port of call for children with mild depression, if new guidance is approved.

The proposals by the National Institute for Health and Care Excellence (NICE) have been met with caution by a senior union nurse who warned technology could not stand in for registered nurses. 

“Nurses working with children and young people have the personal contact that digital platforms cannot provide”

Fiona Smith

The draft recommendation from NICE is out for consultation until the end of February. If given the green-light, digital cognitive behavioural therapy (CBT) will be offered to people aged five to 18 with mild depression as a “first-line treatment”.

Digital CBT is delivered on mobile phones, tablets or computers. The NICE committee in charge of the review noted that digital CBT would be cheaper and quicker to access than face-to-face therapy.

Group therapy such as mindfulness classes was also recommended as a first treatment choice for these patients.

Fiona Smith, professional lead for children and young people at the Royal College of Nursing, said better use of technology to provide earlier intervention to children battling mental health difficulties was to be welcomed.

“We want to ensure children are offered a range of therapies to suit their needs”

Paul Chrisp

However, she added that such technology could not replace “personal contact” with trained nurses and other health professionals.

“Tackling depression and mental health at the earliest possible stage is vitally important,” she said. “We know that technology can play a vital role in engaging with young people and the recommendations are a welcome step.

“Such technology, however, should not be seen as a way of filling in for the damaging cuts to the part of the nursing workforce that works directly with children and their families, including mental health nurses and those who work with children and young people to improve their health,” Ms Smith said.

“School and mental health nurses working with children and young people have the personal contact that digital platforms cannot provide and it is important the findings from this consultation are properly analysed to ensure those working with children and young people can provide the best possible targeted care,” she added.

Royal College of Nursing

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Fiona Smith

The guidance made clear that nurses should take into consideration the patient’s personal and clinical history, their maturity and development level, and patient and carer preferences when making treatment choices.

If digital CBT or group therapy was not appropriate, individual CBT or family therapy should be offered, according to the NICE proposals.

The NICE committee that drew up the proposals made its recommendations based on “effectiveness, availability and cost”.

It noted that digital CBT was likely to be “more readily available” than one-to-one therapy due to long waiting lists.

It added that the average costs estimated for digital CBT and group therapy were lower than those for individual CBT.

“Therefore, the committee agreed that a choice of digital CBT or group therapy should be offered first,” the guidance added.

“[The committee] acknowledged that these options may not be suitable for everyone and that individual CBT or family therapy could be offered in these situations,” it said.

Analysis of evidence found that digital CBT, group therapies, individual CBT and family therapy reduced depression symptoms compared to “waiting list control or no treatment”.

“Digital and online interventions can play an effective and important role in treatment”

Claire Murdoch

Paul Chrisp, director of the Centre for Guidelines at NICE, said the guidance emphasised the importance of taking into account the young patient’s personal choice of treatment.

“We want to ensure children are offered a range of therapies to suit their needs and individual preferences are placed at the heart of their care,” he added.

“The evidence showed digital CBT and group therapy were most effective at reducing depressive symptoms and we have recommended these as first-line options for children and young people with mild depression,” he said.

Digital CBT is already recommended for adults with mild to moderate depression.

Technology is set to take a leading role in the future transformation of the NHS. The recently released NHS Long Term Plan announced an ambition to bring “digitally-enabled care” into the mainstream.

“In 10 years’ time, we expect the existing model of care to look markedly different,” the plan stated.

“The NHS will offer a ‘digital first’ option for most, allowing for longer and richer face-to-face consultations with clinicians where patients want or need it,” it added.

Claire Murdoch, NHS England’s national mental health director, welcomed the new recommendations from NICE.

claire murdoch

claire murdoch

Claire Murdoch

She said: “Given how quickly technology is constantly evolving and the fact that young people are usually at the forefront of this change, updating this draft guidance is another step forward. 

“Digital and online interventions can play an effective and important role in treatment, particularly when backed up by face to face support, and the NHS Long Term Plan makes clear that the health service will continue to look to harness the benefits these advancements can bring,” she added.

The guidance is now out for consultation and the closing date for comments is 20 February 2019.

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