Non-medicalised and non-pharmacological options where appropriate

Reference numbers^65-67

While a range of activities may help with common mental health problems and pain management, these will vary with individuals’ preferences, capabilities, and locality. Some of the following may be appropriate and should be considered and discussed before initiating an antidepressant, as well as when continuing an antidepressant for more severe illness. Where appropriate and available, a Community Link Worker may be able to support and enable individuals to access or develop some of the options below.

• exercise and regular physical activity e.g. 30-minute walks
• debt advice and/or money management e.g. seeking advice from appropriate agencies such as Citizens Advice
• hobbies and interests e.g. gardening, crafts, etc.
• ensuring a healthy work-life balance
• lunch clubs and other activities which help to reduce social isolation
• discussing problems, where appropriate, with a close friend or confidante that is willing and able to listen

The Psychological Therapies Matrix (2015) outlines a matched care approach to support the safe and effective delivery of evidence based psychological interventions. Both the Matrix and clinical guidelines advocate decisions regarding psychological interventions based on a comprehensive assessment of need and suitability, individual preferences, availability of trained practitioners and cultural appropriateness.^36,37

This matched care model considers ‘high volume’, low intensity interventions for mild to moderate symptoms, in addition to high intensity and highly specialist interventions delivered by practitioners with additional competences, for those presenting with more complex presentations.

The Matrix acknowledges those in primary care who regularly identify and support those presenting with psychological issues and mental health disorders. They are often able to provide support for low intensity interventions and referral to specialist mental health services where indicated.

For mild to moderate symptoms of depression and/or anxiety these include guided self-help and computerised cognitive behavioural therapy (cCBT). Psychoeducation can support self-management. A range of evidence based cCBT programmes and telephone supports are available to support general mental wellbeing, sleep problems (including insomnia) and mild to moderate symptoms of depression. Links to these programmes can be accessed via NHS Inform (Mental Health). Please refer to Resources for clinicians and patients for a detailed description and links to these resources.

For those individuals who present with moderate to severe symptoms of depression and/or anxiety, a referral for High Intensity and/or Highly Specialist Interventions may be indicated and may include CBT. These interventions are usually delivered within NHS or non-NHS specialist services.

(Note: non-NHS services: ensure non-NHS practitioners providing psychological therapies are registered with appropriate professional bodies e.g. Health and Care Professions Council, British Association of Behavioural and Cognitive Psychotherapy, British Association of Counselling and Psychotherapy.)