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Criteria for treatment/Maudsley


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Hi I'm new to the forum, but sadly not to OCD which I've had on and off all my life (mostly themed around responsibility and contamination). It's only been diagnosed in recent years, also with a diagnosis of Aspergers. 

After years of struggling with it (and them) my cmht have admitted my ocd is severe and are looking at treatment further to some basic cbt I had a number of years ago. They're wanting to refer to the Maudsley but have said I need further cbt locally which hasn't yet been agreed. (Obviously if that happened and was successful I wouldn't need further treatment.) I live near, but not in, London. 

How would a referral to the Maudsley work and how do they decide which unit to refer to? Are there set criteria (eg y-bocs, meds etc) or are they just for national funding? I've obsessed over the internet (ha!) but find it all a bit complicated. Can anyone help? 

Thanks 

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12 minutes ago, Em00 said:

How would a referral to the Maudsley work and how do they decide which unit to refer to? Are there set criteria (eg y-bocs, meds etc) or are they just for national funding? I've obsessed over the internet (ha!) but find it all a bit complicated. Can anyone help? 

The clinic that provided the treatment for OCD is the Centre for Anxiety Disorders and Trauma (CADAT).  To be honest if the local CMHT claim your OCD is severe, and if they feel they can't help then another course of local CBT may not be the logical step, it may be worth asking them to refer directly to CADAT.

There are two routes to treatment at CADAT.

1 - Your local NHS agree to fund the treatment (if they feel they can't help you locally, they should be doing that). Funding needs to come from the local Clinical Commissioning Group (CCG). If the CCG are funding there is no clinical criteria.

2 - You may be eligible for national (HSS - Highly Specialised Service) funding if you meet certain clinical criteria.  Basically 2 previous courses of CBT and 3 attempts at medication (2 x SSRI and 1 x augmentation of SSRI and other med).  If you don't meet those clinical criteria you can still go to CADAT but you just need to get the local CCG to agree to fund it.

 

 

 

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Ah ok. What's the difference with ADRU? My care coordinator seems to think (from calling them) I have to meet criteria for funding. Which is what confused me because I thought that was just for national funding. Maybe I should ask again. 

Do you know if they would have experience with Aspergers as well? 

(thank you for your speedy, helpful reply) 

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Hi Em,

CADAT is an outpatient specialist service. 

ADRU (Anxiety Disorders Residential Unit) is its sister service, which is a form of inpatient. I say a form of inpatient, patients get their own room on a same-sex corridor. Patients have to be able to self-care because it is not staffed out of hours. So patients have to be able to toilet, shower and feed themselves.

For both clinics the referral process is the same, either CCG or HSS referral.

Yes, both will have experience of treating patients who are what we call co-morbid, with more than one diagnosis. 

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Thanks so much. I'm seeing cc on Monday I think so will ask her about it again. It's been so long I've been struggling I don't believe they'll give me any treatment til it's sat in front of me. And I'm terrified it won't work (if it even is OCD - obsessions are such fun right?) but I can't go on like I am now. I just about exist. ?

Em 

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I'm reading this with great interest. I live in Wales where we don't have any specialist OCD treatment centres (as far as I'm aware),

and apparently to get a referral from Wales to England is notoriously difficult. 

When I even mention OCD to my local cmht they really seem to not want to know. They prefer to try to treat the anxiety and distress that my OCD causes. It's a no win situation at the moment.

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10 minutes ago, Gary.p said:

 

 

10 minutes ago, Gary.p said:

When I even mention OCD to my local cmht they really seem to not want to know. They prefer to try to treat the anxiety and distress that my OCD causes. It's a no win situation at the moment.

I'm sorry you're struggling with your cmht and being in Wales. I hope it improves for you soon. 

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10 minutes ago, Em00 said:

Is it 'normal' to question whether you have ocd, and if you do,  whether it's bad or important enough for treatment? 

Not at all, it's actually usually a 'compulsion' in itself to question and doubt the diagnosis in the first place Em. :)

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21 minutes ago, Gary.p said:

I'm reading this with great interest. I live in Wales where we don't have any specialist OCD treatment centres (as far as I'm aware),

and apparently to get a referral from Wales to England is notoriously difficult. 

It is Gary, but not impossible. 

Where in Wales are you? if you are in South Wales then the nearest specialist treatment clinic is the Specialist Anxiety and related Problems clinic led by Prof Salkovskis at the University of Bath.

Referral is different for patients in Wales, in that we have to persuade your local welsh health board to fund the referral. It is hard, but not impossible but you should prepare yourself for a fight to get them to agree. Happy to help.

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Can I ask one more thing? (sorry, don't want to start a million threads) Is avoidance a compulsion as well? There's so many things I just don't do anymore because I don't want to deal with the compulsions and distress. But is that counted as another compulsion? 

Thanks. It's really helpful having information about ocd etc because it hopefully means I'm less likely to obsess about those things like I have been doing. 

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Hi Ashley 

ive actually spoken to Paul salkovskis, he's such an inspirational person, I am from South Wales, so I'm not too far from the bath area.

i know that he has been quoted as saying that OCD services in Wales are very poor, and he is right to be honest.

im certainly going to look into the referral process and see where that takes me, fed up of suffering in silence.

thanks for your words of encouragement em and Ashley.

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15 hours ago, Em00 said:

Can I ask one more thing? (sorry, don't want to start a million threads) Is avoidance a compulsion as well? There's so many things I just don't do anymore because I don't want to deal with the compulsions and distress. But is that counted as another compulsion? 

Thanks. It's really helpful having information about ocd etc because it hopefully means I'm less likely to obsess about those things like I have been doing. 

No worries (sorry I had gone to bed when you posted last night) but feel free to ask whatever you want to ask :)

Yes, absolutely avoidance is a compulsion. A compulsion is any ritual/action that is carried out in response to an obsession/trigger. Usually we avoid something to avoid being triggered, so I consider an avoidance to be a compulsion.

Ashley :)

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15 hours ago, Gary.p said:

ive actually spoken to Paul salkovskis, he's such an inspirational person, I am from South Wales, so I'm not too far from the bath area.

im certainly going to look into the referral process and see where that takes me, fed up of suffering in silence.

Please do let me know if I can help.  Usually the health board will want to see that the patient has exhausted all local treatment options first, so often in Wales it is often a cause of asking for referral to Bath, health board offers XYZ, so you have to do that first before eventually getting the Bath referral. 

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5 hours ago, Ashley said:

Please do let me know if I can help.  Usually the health board will want to see that the patient has exhausted all local treatment options first, so often in Wales it is often a cause of asking for referral to Bath, health board offers XYZ, so you have to do that first before eventually getting the Bath referral. 

Thanks Ashley,

I have only been using my local mental health team for about a year this time around.  I was initially referred to them by my doctor but after one meeting they lost my paperwork. So my doctor had to submit the referral again. 

I eventually seen someone but I was already in a terrible state by then, with my intrusive thoughts, so was referred to the crisis team as I thought I was suicidal, but I'm pretty sure that was my OCD. I'm now waiting to see the cbt specialist, I've been waiting since April so I'm hoping it won't be too long now. I'm just going to have to see how things go from there.

I was lucky the last time that I used the cmht as I was volunteering for mind in the local mental health unit and was given preferential treatment. I literally had months of one to one with an occupation therapist.

ill certainly be in touch if I need advice regarding getting a referral to bath.

 

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