Clinical Practice Guidelines (CPGs) are evidence-based documents that provide recommendations to support clinical decision-making in specific circumstances. They draw on a rigorous review of the best available evidence in forming those recommendations.

CPGs may be used by clinicians to optimise decisions in patient care, by trainees studying for exams, and by interested practitioners seeking to stay current with the latest clinical guidance in an area of interest.

In 2022, the RANZCP commissioned an independent review of its approach to the development of CPGs for psychiatry in Australia and Aotearoa/New Zealand.

Based on the results of that review, the College is moving towards a new Best Practice Resources (BPRs) Pathway. This approach strives to build on the existing suite of CPGs to keep up with shifts in professional and clinical practice and new approaches to evidence synthesis and communication, such as the advent of living guidelines, which seek to harness digital technology to facilitate the update of recommendations as soon as new relevant evidence is available.

It also recognises that for some topics, shorter form resources or audio-visual modes of communicating best practice will better meet the needs and expectations of practitioners and trainees.

The RANZCP will engage in ongoing advocacy seeking external funding (e.g., federal government funding) for guideline development. This will also involve creating opportunities for our expert members to collaborate with non-government organisations, academic institutions, and other leading organisations. The RANZCP will continue to be a key authoritative body providing leading expertise in psychiatric practice, within the Australian and New Zealand context. 

The Board highlights that the clinical expertise of RANZCP members will continue to be involved in guideline development through collaborating on National Health and Medical Research Council (NHMRC) level guideline development, as an essential member of external expert panels and providing expert input via academic reviews. 

In addition to member involvement via collaboration on guideline development, membership in external expert panels, and through academic reviews, the RANZCP will be a key voice in pursuing support for the development of best-practice resources (BPR) including clinical practice guidelines.

The RANZCP will engage in ongoing advocacy seeking external funding (e.g., federal government funding) for guideline development. This will also involve creating opportunities for our expert members to collaborate with non-government organisations, academic institutions, and other leading organisations. The RANZCP will continue to be a key authoritative body providing leading expertise in psychiatric practice.  

The new Best-Practice Resource (BPR) Pathway includes a broad range of options to effectively meet the needs of practitioners. These can range from Clinical Memoranda and Professional Practice Guidelines to CPD webinars, podcasts, and other innovative mechanisms to communicate best-practice as they emerge.

The BPR Pathway also allows for existing high-quality external BPRs, including CPGs, to be considered for endorsement or adaptation.

The RANZCP is committed to providing contemporary resources and remaining current with changes in practice, needs, and expectations surrounding the provision of clinical guidance.

New and emerging formats have changed the way practitioners expect to access information. They also provide new opportunities to build on the current CPGs to ensure that up-to-date, evidence-based information is readily and easily accessible.

The Future Development of CPGs project was commissioned by the Board in 2022 as part of the RANZCP’s dedication to examining and updating our processes.

A Future Development of CPGs Steering Group (the Steering Group), chaired by Professor Helen Herrman AO, was formed to progress the project, and met regularly from December 2022 to June 2023. In addition to their review and analysis of CPGs and best-practice guidance communication, the Steering Group also provided support to the external independent contractor, hereco.

Key considerations of the Steering Group included:

• Audience and readership of CPGs
• Scope of CPGs
• Authorship and resourcing
• Evidence-base for CPGs
• The form and function of CPGs and other RANZCP resources.

The recommendations of the Steering Group were accepted by the Board and formed the basis for the RANZCP stepping towards the Best-Practice Resource (BPR) Pathway.

The review recommended that the RANZCP revise its approach to CPG development and step towards the Best Practice Resources (BPRs). This includes implementing the new BPR Pathway which was designed to build on the current CPGs and support the endorsement, adaptation, or development of high quality BPRs.

The process for the prioritisation and selection of topics proposed for BPRs is being developed by the Committee for Evidence Based Practice in partnership with relevant stakeholders. Consultation will be ongoing regarding the draft scope of BPRs that may be developed by the RANZCP.

The RANZCP produced six CPGs in 2003 as part of the RANZCP Clinical Practice Guideline Project to guide management of anorexia nervosa, bipolar disorder, depression, schizophrenia, and deliberate self-harm, panic, and agoraphobia. At the time, there was a recognised lack of guidelines and evidence-based practice in mental health.*

These CPGs were externally funded by the Australian National Mental Health Strategy with the NZ Ministry for Health also financially contributing to their development.

Between 2014–2018, the original CPGs were updated to ensure they reflected current evidence base. Government funding was sought for this update but was not available.

The updated CPGs were published on eating disorders (2014), mood disorders (2015), schizophrenia (2016), deliberate self-harm (2016), and anxiety disorders (2018). The mood disorders guideline was updated by the RANZCP in 2020. 

* Boyce P, Ellis P, Penrose-Wall J. Introduction to the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines series. Australian & New Zealand Journal of Psychiatry. 2003 Dec;37(6):637-40.

RANZCP CPGs relied primarily on the pro bono work of members, and the Board acknowledges the invaluable pro bono work that RANZCP members have contributed to the creation of the current suite of Clinical Practice Guidelines and their review. It required the establishment of working groups of expert psychiatrists alongside other relevant clinicians or professionals, and a major investment of time and expertise by members.

The working groups collaborated to review literature and develop content informed by relevant National Health and Medical Research Council (NHMRC) guidelines. The draft CPGs were reviewed by relevant College committees.

The CPGs were then approved by the RANZCP Board before being submitted to the Australian and New Zealand Journal of Psychiatry for peer review and publication. 

The Future Development of CPGs review highlighted that the RANZCP is an outlier in how it has funded and created RANZCP CPGs. Similar organisations to the RANZCP only engage in CPG development when commissioned and funded by an external body, typically a government agency. All CPGs developed by other medical colleges in Australia and Aotearoa/New Zealand are externally funded.

CPGs are resource-intensive to produce, and previous RANZCP CPGs required a significant investment of pro-bono time from members.

While time and cost will vary between CPGs, the hereco report finds that a high-quality CPG can take between 18-30 months to produce and cost an estimated $1 million AUD.

The Future Development of CPGs was a significant project for the RANZCP and required a detail-oriented approach. The careful consideration that the project entailed is reflective of the importance and impact of this project.

The current suite of CPGs have been published in academic journals and will always be available for clinicians, trainees, and the community to access. Next steps regarding advocacy for CPG funding and the resource needs of members are being considered by the Committee for Evidence-based Practice, the RANZCP Board, and other key stakeholders.

The Mood Disorders Psychodynamic Psychotherapy Evidence Review project is unrelated to the Future Development of CPGs Steering Group. The Mood Disorders Psychodynamic Psychotherapy Evidence Review Steering Group is progressing a separate review.

Further information and regular updates regarding the progress of this work can be found on the Mood Disorders webpage.