Recommendation 3

HM Government Accepted

The government agrees with the committee that the diagnosis and treatment of BDD is a priority. This prioritisation is best achieved through the current training, referral routes and curriculum. Mental health professionals, including mental health nurses, psychiatrists and psychological professionals, are skilled through their core training in the identification of BDD . Evidence-based treatment is delivered by specially trained staff. NHS talking therapies (formerly IAPT ) therapists are already trained in the identification and awareness of BDD , while high-intensity CBT therapists in NHS talking therapies are also trained in delivering the specific interventions. This service model is in line with the National Institute for Health and Care Excellence ( NICE ) guidance, which recommends high-intensity CBT as a treatment for BDD . Staff in community mental health settings should also be able to identify and support this issue where it presents alongside serious mental illness, and the NHS England national mental health team is exploring how to improve the interface between NHS talking therapies and community mental health services. The national obsessive-compulsive disorder ( OCD ) and BDD service is directly commissioned by NHS England, delivers highly specialised interventions in conjunction with local mental health services, and is available to people of all ages on the basis of need. New community models are centred around an individual’s needs, and NHS England has not outlined a prescriptive service model or specific resourcing of sub-specialisms so integrated care systems can tailor their models to local population need. NHS England will continue to work closely with services and systems to understand how workforce development and training can support service users. The EMHP curriculum is designed to equip trainees with the skills and competence to work with children and young people with common mental health problems, particularly mild to moderate symptoms of anxiety, depression and behavioural difficulties, through providing training to deliver low-intensity interventions in response. There is no explicit reference to BDD in the curriculum because these practitioners are not being trained to offer high-intensity CBT as recommended by NICE . Any changes to the curriculum development must remain within the clinical scope of the low-intensity model, which BDD does not fit (based on NICE ’s recommendation for high-intensity CBT as a treatment). EMHPs are encouraged throughout their training and in practice to: recognise those presenting issues that may be of a complexity requiring additional support help people access further advice and support for themselves, children and young people This includes those related to body image. EMPHs work in MHSTs , based within educational settings, alongside more senior therapists and supervisors who also provide clinical supervision. While it would not be clinically appropriate for EMHPs to diagnose and treat BDD , one of the key functions of MHSTs is to liaise with external specialist services to help children and young people to get the right support. This could include, for example, referral to a specialist eating disorder service or medical practitioner. Body image is already covered in statutory relationships, sex and health education ( RSHE ), which is often taught as part of personal, social, health and economic ( PSHE ) education. Teacher training modules on these topics are free to download – however, schools have the freedom to ensure the curriculum meets the need of their pupils. This flexibility allows schools to respond to local public health and community issues, such as BDD , and adapt material and programmes to suit the needs of their pupils.