Implementing clinical guidelines for bipolar disorder.
OBJECTIVE
To critically review the evidence concerning the implementation of clinical guidelines for bipolar disorder.


METHODS
A Medline search was made of the literature on the implementation of guidelines in bipolar disorder and mental health. The implementation of non-pharmacological treatments from the 2006 NICE Guideline for Bipolar Disorder was then used as a case example. May's model of normalization of complex interventions was then applied to the NICE guideline recommendations for bipolar disorder.


RESULTS
The effective local implementation of guidelines requires a detailed understanding of local barriers to their implementation. Some recommendations in the NICE Guideline on advanced directives and management of anxiety disorder in bipolar disorder appear to follow the existing trends in practice and are more likely to be implemented. Interventions concerning the psychological management of bipolar depression and maintenance psychological treatments are going to be the most difficult to implement because of shortages of skilled staff, the absence of specific training and supervision, the requirements for staff to adopt practices that are quite different from what they are used to, and some uncertainty about whether these interventions are effective in the most severe patients.


CONCLUSIONS
Without a detailed local understanding of the barriers to implementation and the resources and will to overcome them, there is likely to be a considerable local variation in the implementation of guidelines for bipolar disorder. Recommendations that require little change to working practices and resources are most likely to be implemented.
Morriss
Richard
R
Division of Psychiatry, University of Nottingham, Nottingham, UK. richard.morriss@nottingham.ac.uk
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards*; D006284:Health Plan Implementation / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D010348:Patient Care Team / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011613:Psychotherapy / Q000592:standards*; D013222:State Medicine / Q000592:standards*; D016896:Treatment Outcome; D006113:United Kingdom