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Perinatal mental health service

The Community Perinatal Mental Health Service provides a single point of access to community perinatal mental health services for people resident in Richmond, Kingston, Sutton, Merton and Wandsworth.  

We are a week-day only, 9-5 service.

The philosophy of the service is to, whenever possible, minimise disruption to family life.

We believe that the women who use our services should feel respected and staff strive to maintain privacy and dignity at all times.

We aim to work collaboratively and encourage mothers to be actively involved, whenever possible, in the development of their treatment plan.

Who is the service for?

The service can work with women who are either pregnant or in the first year following the birth of their baby and present with moderate to severe mental health problems or with high risk factors for perinatal mental health problems due to past history or family history are eligible for referral. Women with known history of mental illness on psychotropic medication are eligible for pre-conception counselling and advice.

Our team can assess and advise on the management of women who are in the perinatal period dealing with mental health problems, such as:

  • bipolar disorder
  • depression
  • schizophrenia
  • eating disorders
  • OCD (obsessive compulsive disorder)
  • anxiety disorders
  • personality disorders
  • Puerperal or postpartum psychosis.
Telephone: 020 3513 6577

Fax: 020 3513 4461

Email: ssg-tr.perinatalswlstg@nhs.net

What we offer

The service provides:
  • Comprehensive psychiatric assessment and treatment (preconception, antenatally and postnatally).
  • Advice on, and monitoring of, evidence based medication.
  • Conjoint inpatient admission for women and their babies (under one year-old), for new mothers experiencing severe mental illness.
  • Comprehensive, multidisciplinary inpatient assessment and treatment.
  • Psychological assessment and evidence based psychological treatment and counselling for inpatient and outpatients.
  • Time-limited, symptom-focused, psycho-educational group work and therapeutic groups for mothers with moderate mental health problems not requiring inpatient treatment.
  • Occupational therapy assessment (inpatients only) and support including assessment and development of activities of daily living. Community nursing assessment and support.
  • Facilitation of mother infant interaction through bonding interventions and nursery nurse support.
  • Advice and support to other mental health services and social services.
  • Engagement with local authority when there are issues of child protection, including attendance at child protection conferences.
We are a community service operating from 9-5.

Psychiatric emergencies should be referred should follow the usual emergency care route.

There is a duty person available everyday to answer any queries about referrals and to triage referrals that have been sent.

Who is in the team?

The perinatal mental health team comprises a comprehensive multidisciplinary team who co-ordinate the assessment, treatment and care of women in our care.

The team comprises of:
  • consultant psychiatrists & trainee doctors
  • nursery nurses,
  • an occupational therapist,
  • a social worker
  • clinical psychologist,
  • Perinatal mental health nurses,
  • Administration staff.

How to refer

The service takes referrals directly from primary care as well as co-working with community mental health teams (CMHTs).

Referrals to the service should be directed to the Multi-disciplinary Team (MDT) which offers care and treatment to women experiencing:
  • Antenatal and postnatal affective disorders including depression and bipolar affective disorder.
  • Antenatal and postnatal anxiety disorders impacting on pregnancy and childbirth such as tokophobia, perinatal onset OCD and PTSD arising from childbirth.
  • Severe and enduring mental illness in the perinatal period.
  • Postpartum/puerperal psychosis.
  • Mothers experiencing bonding disorders (infants under 1 year).
Referrals can be submitted by either fax or email using the following details. The referral form is available here.

Telephone: 020 3513 6577

Fax: 020 3513 4461

Email: ssg-tr.perinatalswlstg@nhs.net

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Neuropsychiatry service

Our neuropsychiatry service is an outpatient regional service. It provides  assessment and treatment for adults with neurological illness or head injuries who have associated neuropsychiatric problems.

Patients with functional neurological disorders and organic psychiatric conditions are also assessed and managed. The service is closely allied to the regional neuroscience centre based at the Atkinson Morley Wing of St. George's Hospital, serving SW London and Surrey.

We take pride in providing evidence-based cutting-edge clinical services which follow the latest clinical and research advances and set national examples.

Who is this service for?

This service offers assessment and treatment for patients with:

  • Neuropsychiatric consequences of neurological conditions, e.g. stroke, head injury, epilepsy, multiple sclerosis or movement disorders.
  • Functional Neurological disorders including somatoform, dissociative or conversion disorders, e.g. non-epileptic fits, non-organic movement disorders.
  • Organic psychiatric illness, e.g. schizophreniform disorders with organic brain changes
  • “Grey zone" disorders which straddle neurology and psychiatry or various rare Neuropsychiatric syndromes

We accept referrals from a wide range of neuroscience and mental health professionals, as well as from GPs as long as they are appropriate.

New patients can  be seen whilst they are inpatients or day patients at one of the neurology or neurosurgical wards of St. George's Hospital or Queen Mary's Hospital in Roehampton. 

However, the majority of referrals involve outpatient assessment and treatment.

planning your care and support

Traumatic stress service

Our Traumatic Stress Service (TSS) is national specialist service which works with people suffering from Post-Traumatic Stress Disorder (PTSD) and associated conditions.

We offer assessment, psychological treatment and consultation for people with PTSD. This can include victims of rape and sexual assault; victims of serious physical assaults; victims of serious road traffic accidents; and victims of other ‘single incident’ traumas. 

Over the years our work has expanded to also include the needs of refugees and asylum seekers, many of whom have experienced multiple traumas including war, torture and violent bereavements.  In addition, we treat service and ex-military personnel, as well as victims of terrorist attacks. We work with patients from a wide variety of ethnic groups and many of our clients do not speak English.

The service primarily covers five boroughs of London as well as taking some national referrals.  We provide psychological assessment and treatment of PTSD on an outpatient basis.  We do not have inpatient or community outreach facilities.  Our clinicians work within a Cognitive-Behavioural Therapy (CBT) framework and can also offer Eye Movement Desensitisation and Reprocessing Therapy (EMDR).  We offer appointments on Monday-Friday between 9am and 5pm. 

As well as treatment, we provide teaching, training and supervision to colleagues working with PTSD.  We also undertake and support a range of research activity in the areas of trauma and recovery.

Eligibility

This service is for adults who have experienced severe trauma and subsequently developed Post-Traumatic Stress Disorder (PTSD).

PTSD is an anxiety disorder caused by experiencing or witnessing life-threatening events. PTSD can develop immediately after someone experiences a traumatic event or it can occur weeks, months or even years later.

Inclusion criteria

  • People over the age of 18 years. There is no upper age limit.
  • People who have experienced one or more traumatic events in adulthood and have subsequently developed PTSD from those events.

Exclusion Criteria

Concurrent conditions requiring treatment in their own right:

  • Active psychotic symptoms
  • Alcohol, drug or medication abuse or dependence
  • Severe depression and/or suicidality
  • Other severe current risk to self or others

How to refer

The service accepts referrals from Community Mental Health Teams (CMHTs) and Improving Access to Psychological Therapy (IAPT) services within the Trust catchment area. Referrals from outside the Trust catchment area are also accepted where funding is agreed in advance.

Access to the TSS is via written referral, and should include an assessment letter that covers relevant background and personal history, trauma history and current symptoms. It should also include details of any previous treatment, a risk history and an up-to-date risk assessment.

Please Read more for our referral leaflet.

Read more

Treatment

The service’s treatment orientation is cognitive behaviour therapy (CBT), specifically trauma-focused CBT. Our main treatment models are Ehlers and Clark’s (2000) integrated cognitive model, and Judith Herman’s (1996) phased treatment model.

Treatments include anxiety management and emotion skills training, reliving and reprocessing of traumatic memories, cognitive restructuring outside and within reliving, imagery rescripting, behavioural experiments, in vivo (field) work, and schema-level work.

We offer treatment in the following formats: standard (12-16 sessions), extended (16-40 sessions) and intensive (18 hours over 5 days). Our clinicians also provide EMDR therapy for PTSD as a secondary or alternative evidence-based treatment.

Treatment is delivered by trained specialist staff using a phased treatment framework. All our treatments are compliant with NICE guidelines for PTSD, other anxiety disorders, depression, self-harm and personality disorders.

Treatment is always individually tailored to the patient based on a detailed assessment of their needs. Condition-specific outcome measures are used to evaluate the effectiveness of treatment and the service.

Training and Supervision

We offer teaching and training on PTSD at four levels:

  • Introductory courses for professional groups at increased risk of developing PTSD (such as aid workers and paramedics)
  • Teaching sessions for clinicians likely to encounter PTSD in the course of their work (victim liaison officers and medical staff);
  • Multi-sessions training packages for clinical psychologists and CBT therapists in the identification and treatment of people with PTSD
  • Combined supervision and training packages to whole psychological services to help them improve their outcomes for people with PTSD.

Tailored training programmes can be developed and delivered to services to meet their requirements. For example, a training package in TF-CBT comprising face-to-face workshops, webinars and supervision was recently delivered to therapists across 10 IAPT services. Evaluation of the programme revealed large improvements in therapist knowledge, skills and self-efficacy in treating PTSD.

We also offer CPD placements to clinicians inside and outside the Trust, who already have a foundation in CBT skills and wish to develop their competencies working with PTSD and trauma. Please read more for our training leaflet.

Read more

Staff

Our core team is made up of three full-time clinical psychologists and a team administrator. We also have an assistant psychologist who works part-time on our research and training projects.

Our core team is:

  • Dr Sharif El-Leithy, Consultant Clinical Psychologist
  • Dr Eleanor Cross, Principal Clinical Psychologist
  • Dr Abigail Pain, Highly Specialist Clinical Psychologist
  • Dr Jenny Rahemtulla, Highly Specialist Clinical Psychologist
  • Elizabeth Hardcastle, Assistant Psychologist
  • Bartholomew Tenerowicz, Team Administrator

A number of other psychologists and psychiatrists work in the service part-time, undertaking specialist continuing professional development (CPD). We also offer clinical and counselling psychology trainee placements on a national basis.

Outcomes

The Traumatic Stress Service routinely collects information to help us monitor the effectiveness of the treatments we offer. We use a number of standardised symptom questionnaires to do this.

Every patient completes the Post Traumatic Stress Diagnostic Scale (PDS) and the Beck Depression Inventory (BDI-II) at their assessment and then at the end of their treatment. The PDS questionnaire measures the severity of their PTSD symptoms. The BDI-II measures the severity of their depression symptoms.

Our results show that, in terms of PTSD symptoms, 74% of our patients report a significant improvement after treatment, with 51% making a recovery. In terms of depression symptoms, 60% of our patients report a significant improvement after treatment, with 47% making a recovery.

Testimonials

Some things our patients have told us after treatment:

“The Traumatic Stress Service has helped me to achieve many things in my life, and also with my family. When my friends see me now they see the change in me.”

“That was the hardest part for me…admitting that I had a problem. Since then, it has been difficult getting through the treatment but the end result is my life has become more manageable”.

“The doctor asked me several times to recall the incident which happened. It was really difficult to confront this memory. It was so distressing talking about the past that I wanted to leave, but after a few sessions, I started to use the treatment techniques at home and I realised that what the doctor had told me was helping me to deal with my memories of the incident”.

“When the doctor said that he wanted me to talk about what happened in the past, I was not willing to do it. But after he explained that it would help to talk about the past, I agreed. I told the doctor I would only talk about what I was able to. It was very difficult in the beginning but it got easier”.

“My advice would be to continue coming to the treatment sessions and not to stop. It will be difficult at first, but they will get results and feel much better in themselves if they finish the whole course of treatment, and they need to have patience”.

“It’s hard getting it out of you, and bearing your soul so to speak, but it is definitely worth it”.

 

selection and interviews

OCD/BDD service

We are a multidisciplinary national service providing treatment for the most severely ill patients with Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD) in the form of intensive homebased therapy, outpatient, and inpatient treatment.

Trustwide service

We provide community-based treatment advice, support and joint working with CMHTs. We also provide  information, education and consultation including at the primary care level and the voluntary sector for OCD and BDD. We accept patients with OCD/BDD and other neurotic conditions who have failed previous treatment elsewhere (including CBT in most cases). This service can accept referrals from GPs or any mental health care professional.

Eligibility

Usually it will be expected that patients have failed to respond to two trials of appropriate medication for OCD/BDD as well as a previous trial of CBT.

Exceptions to the above can be made in individual circumstance depending on severity and need of the individual patient.

Referrals

Intensive home-based, community or outpatient treatment

Referrals for complex assessment and treatment may be made by the healthcare worker direct to the therapist or the service directly.

Referrals can be made by Primary and Secondary Care.

All referrals should contain:

  • a brief description of patient's current problems
  • relevant history
  • current care plan and risk assessment.
If significant risk is identified then details of the patient's care co-ordinator and their continued involvement must be provided.

Referrals of patients under section are not accepted. We are happy to assess once the patient is voluntary. This is to ensure that the patient is providing informed consent to undertake therapy.

Referral Criteria

Referral Form

Joint working with other healthcare professionals

Referrals for joint assessment and joint working, supervision and support may be made direct to the therapist or to the address above by Primary or Secondary Care Mental Health Teams.

The therapist will work with the CMHT or referrer to deliver therapy as part of the care plan.

National service (NHS England funding)

We offer home-based therapy throughout England and inpatient treatment as the ONLY 24-hour staffed dedicated service. We accept referrals from throughout England for patients who have profound treatment refractory OCD or BDD. It is a service for patients who level 5 (funded by NHS England HSS). There are strict criteria to be accepted as a Nationally funded patient. 

 

About the service

The National OCD/BDD Service, affiliated with St George's University of London, is a nationally and internationally renowned treatment centre dealing with severe, complex and resistant obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD).

It is one of two services offered by the OCD/BDD service. The other is a local service for clients living in south west London.

The National OCD/BDD service is an enhanced community service offering intensive home-based treatment, liaison work with other teams and telephone monitoring advice for patients throughout the United Kingdom.

We combine behavioural and cognitive methods with state-of-the art psychopharmacological and other treatments where necessary. We liaise closely with specialists who work in the neurobiology and psychopharmacology of these disorders as well as with psychotherapists of various schools.

We have an experienced staff-base. Some staff have worked with these complex patients in our unit for 20 years. Our commitment to teaching and research, however, means that we have young enthusiastic professionals also joining the team which ensures we are continuously challenged to ensure our treatments are at the forefront of modern psychiatric and psychological treatment.

Each patient is fully assessed and has an individualised treatment programme. Progress is constantly monitored using questionnaires of known reliability and validity. Thus, any treatment which is not effective is discovered early and the reasons why this is the case are examined and treatment changed or modified.

Eligibility

The unit is now a nationally funded tertiary service (commissioned by NCG), which specialises in treating people with severe, complex, resistant obsessive-compulsive disorders (OCD), and body dysmorphic disorder (BDD).

Referrals of patients under section are not accepted. Once the section has expired or been rescinded then assessment will be conducted. This is to ensure the client is providing informed consent to undertake therapy.

The OCD/BDD service is unable to accept clients with a primary condition of acute psychosis, depression, anti-social behaviour, drug/alcohol dependency or current self-harm/suicidal/violent behaviour.

Referrals

Referral Criteria

As the OCD/BDD service is a specialist service all referrals should derive from local community mental health teams (CMHTs) and will be ratified by a Consultant Psychiatrist.

Clients should have received the following prior to referral:

  • treatment with at least two serotonin reuptake inhibiting drugs (SRIs) including clomipramine and/or an SSRI. Each trial should be for a minimum of 3 months and at optimal British National Formulary doses.
  • two trials of cognitive and behavioural psychotherapy (CBT). A trial of therapy is defined as at least 10 hours of therapist time. One treatment trial should have taken place in the patients home environment or where the symptoms are maximal.
  • augmentation of SRI treatment either with first or second generation antipsychotic drugs or by extending the SSRI dose beyond normal formulary limits.
  • YaleBrown Obsessive Compulsive Scale (YBOCS) score of 30 or more out of 40.

Allowance may be made in exceptional circumstances, such as:

  • Patient refuses medication due to OCD beliefs
  • Patient is unable to take medication due to side effects
  • Patient has not fulfilled the criteria for previous CBT treatment due to mental or physical illness.

NB. These exceptions will not be used to allow patients to gain entry to the National Service simply due to lack of organisation of local services. All CMHTs should have access, either locally or in a neighbouring Trust, to a clinical psychologist or other trained in CBT for OCD. Similarly some patients may prefer not to take medication but could do so and should be encouraged to do so before referral to the National Service.

All referrals will be expected to have a full risk assessment and description of ongoing Care Programme under the Care Programme Approach (CPA). The referrer will be expected to confirm commitment from the local CMHT (as far as possible) to collaborate with care plans drawn up by the National Service including to continue therapy and consolidate treatment gains during periods of home leave or following discharge from the Service.

Referrals of patients under section are not accepted. Once the section has expired or been rescinded then assessment will be conducted. This is to ensure the client is providing informed consent to undertake therapy.

The OCD/BDD service is unable to accept clients with a primary condition of acute psychosis, depression, anti-social behaviour, drug/alcohol dependency or current self-harm/suicidal/violent behaviour.

It is the referrers responsibility to notify the OCD/BDD service of any marked change in the clients condition once they have been assessed and are on the OCD/BDD service waiting list. The OCD/BDD service reserves the right to reassess if any significant change in a clients mental state occurs. Written referrals should come from a consultant psychiatrist and should include presenting problems, past psychiatric history, prior treatment, medication history, current care plan and the appropriate forms.

Basic Requirements Form

Inpatient admission requirements

Referrers Guide

Level 5 Pathway

National service  (non NHS England funding)

The National OCD/BDD Service, affiliated with St George's University of London, is a nationally and internationally renowned treatment centre dealing with severe, complex and resistant obsessive-compulsive disorder (OCD) , body dysmorphic disorder (BDD) and hoarding. It is a service for patients who do NOT meet criteria for NHS England HSS funding.

Eligibility

We provide level or tier 5 treatment inpatient or home-based or community treatment to secondary care mental health teams throughout the UK teams, who do not have an easy access to regional specialist multidisciplinary teams as per the NICE stepped care model.

If you are unsure of the suitability of a patient, we are always delighted to discuss the case with them and offer advice or specialist comprehensive assessments (subject to funding approval).

To be accepted for treatment, patients must be over 18 years and be at level 5 severity according to NICE guidelines.

Funding for this service should be sought from the local CCG.

Referrals

All written referrals should come from a consultant psychiatrist and should include presenting problems, past psychiatric history, prior treatment, medication history, current care plan and the appropriate forms.

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