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
The service is a tertiary service serving five boroughs – Wandsworth, Merton, Richmond, Kingston and Sutton. We provide assessments and treatment for people with OCD or BDD, and we often work closely with other teams. We provide advice and consultation to primary and secondary care services, and the voluntary sector for OCD and BDD.
Referral inclusion criteria
- Adults aged 18 and above.
- Living in the boroughs of Merton, Kingston, Wandsworth, Richmond or Sutton with a registered GP in the borough
- Main presenting problem : Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Panic Disorder with/without Agoraphobia, Health Anxiety Disorder, Emetophobia, Specific Phobias, Social Anxiety Disorder, General Anxiety Disorder and Hoarding Disorder
- Previous treatment required: At least one previous trial of CBT for the anxiety disorder(s) that the person is being referred for – CBT should include at least 10 sessions with an emphasis on behavioural change.
- At least one trial of appropriate SSRI medication at maximum dose for OCD or appropriate medication for the anxiety disorder they are referred for. If patients can not take medication by virtue of their diagnosis or intolerable side effects, we welcome discussion first.
- For young people transferring from CAMHS to adult services, we request that the person is already under an adult CMHT.
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.
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.
Exclusion criteria
- A body mass index (BMI) of under 18. We welcome discussion about this prior to referral to evaluate the reasons for a low BMI.
- Current and active alcohol or drug dependency/harmful use. A six-month period of stability is recommended if the use has recently ceased.
- Significant acute unmanaged risk issues requiring stabilisation prior to therapy.
- Active psychotic symptoms – unless the referral is for OC induced or worsened by clozapine, which will be discussed on a case-by-case basis
- Primary diagnosis of an untreated personality disorder
- Organic conditions such as dementia.
- Patients who are detained under the Mental Health Act. Once the section has been lifted we would consider a referral, assuming the patient is in agreement.
Referral for a Hoarding Assessment
- Living in the boroughs of Merton, Kingston, Wandsworth, Richmond or Sutton with a registered GP in the borough and have stable accommodation
- Willingness to have a home-based assessment including photos being taken as part of the process.
- Willingness to take part in CBT treatment for Hoarding Disorder and be able to independently implement the strategies learned.
- An ability to tolerate a degree of emotional distress that goes along with behavioural change
- Although it is not essential to be on medication we do recommend that clients consider a referral to their local IAPT or attend a Hoarding support group to start the process of therapeutic change.
- It is preferable for clients to have other avenues of support during the treatment if offered. As such we strongly advocate a multidisciplinary approach to treating Hoarding Disorder.
- We ask that all prospective referrers contact us by phone in the first instance to talk through any possible referrals. This is now a requirement due to the number of inappropriate referrals received.
- A referral form needs to be completed in full
Exclusion criteria for Hoarding Assessment
- Alcohol or drug dependency
- Significant risk issues currently in evidence
- Actively psychotic
- Primary diagnosis of an untreated personality disorder in particular those with poor emotional regulation skills, anger management issues etc.
- Organic conditions such as dementia
- Lack of insight into Hoarding behaviour
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 meet criteria for Tier 6 (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.
Please also see:
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
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.
NSCT Referral Criteria Referrers Guide
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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