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NHS Specialist OCD Treatment Clinics


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Within the NHS, Primary Care Trusts (PCTs) have a responsibility to determine the health needs of their local communities and to ensure that NHS hospital trusts, mental health trusts, GPs and so on service these needs. This process is called ‘commissioning’ health care, and each Trust should provide adequate treatment for your OCD, in an ideal world!

However, sometimes, adequate treatment is either not available within some Trusts, or sometimes despite best efforts of everyone, it is just not enough. When this happens, you may need to access specialist OCD treatment, where treatment will be delivered by highly expert specialists in OCD.

There are several specialist OCD treatment clinics provided through the NHS, currently all based in the South East of England, although this will change soon we hope with two other specialist OCD treatment services currently being applied for in other parts of the country.

The Maudsley Hospital

Centre for Anxiety Disorders and Trauma (CADAT), Denmark Hill, London.

This service provides outpatient specialist Cognitive Behaviour Therapy (CBT) for people with OCD. This service is for patients where OCD is the primary problem, and they are able to look after themselves, not requiring care or help from others, where other issues such has self-harm, suicide attempts or severe clinical depression are not problems.

The Royal Bethlem Hospital

Anxiety Disorders Residential Unit (ADRU), Beckenham Kent.

This service provides residential specialist Cognitive Behaviour Therapy (CBT) for people with OCD, with or without medication. The patient remains Monday to Friday, but returns home at weekends. This service is for patients where OCD is the primary problem, and they are able to look after themselves, not requiring care or help from others, where other issues such as self-harm, suicide attempts or severe clinical depression are not problems.

Springfield University Hospital

National OCD/BDD Service - Tooting, London.

There are two services offered, In-patient treatment is for the most profoundly ill patients who cannot be managed in any other way apart from being supported with 24-hour nursing care and support. Stays are for an average 3.5 months and a maximum 6 months. They also provide an out-patient service for treatment from anywhere in the British Isles. Treatment is conducted along with a full review of medication.

Queen Elizabeth II Hospital,

Welwyn Garden City.

This is primarily an out-patient pharmacotherapy treatment (primarily medicational treatment), with or without individual or group CBT.

The Priory Hospital

Southgate, North London.

Adult admission to in-patient unit for CBT with or without pharmacotherapy if under the Mental Health Act for a reason other than OCD but requires nursing care.

For Young People

The Child and Adolescent OCD Service at the Maudsley Hospital.

An out-patient service for CBT with or without pharmacotherapy.

Initially you need to determine which service is best suited to treat your level of OCD severity, and of course geographic considerations may come into play, for example you only need outpatient treatment, but you live in Newcastle, so the Bethlem ADRU may be a better option rather than the Maudsley CADAT unit. OCD-UK will help you if you are not sure.

Once your preferred unit of treatment choice is identified, the problem then remains, who will fund your treatment there? There are actually two routes to treatment funding, neither are particular easy and simply add to the problems of people with OCD, although that is where OCD-UK can come in to help you, through our advocacy service.

The first, and most simple treatment funding route is if your local Trust agrees to fund you for treatment at the clinic of choice. In this scenario, they will refer you to the clinic, the clinic will ask to see you for an assessment, and assuming they believe you are suitable for their clinic they will then ask your local Trust to fund that treatment. The reality is that local Trust's do not want to spend their money outside of their own Trust, so will often reject your request. Again, this is where you can ask OCD-UK for help. With every local Trust tightening their belt, they may try and tell you that they have the necessary skills to treat you locally, within their Trust. In some cases they will have the necessary skills locally to help you, so we must not dismiss that, but in the majority of cases they won't as we all know OCD is complex and takes real understanding of the illness to tackle it.

So what happens if the Trust refuse to fund you?

Well another alternative is funding direct from the Department of Health, which means your local Trust would not have to fund your treatment. This funding route is provided nationally by the National Commissioning Group (NCG), part of the Dept of Health. Each of the above units is allowed to treat a certain number of patients through NCG funded criteria each year, in total I am told 400 patients per year between the units. It is only intended for the most severe of OCD patients, hence why there is very strict criteria for funding through this route. The criteria, that ascertains eligibility for a patient with OCD/BDD must be:-

• A YBOCS score of 30 or more: indicating that the OCD or BDD is severe.

• Completed two or more sets of cognitive or cognitive behavioural or behaviour therapy which include elements of graded exposure and response-prevention.

• Failed to respond to 2 previous trials of SSRIs at BNF recommended doses for a minimum of 3 months each.

• Augmentation with a neuroleptic medication or clomipramine.

• A combination of an SSRI with a tricyclic anti-depressant medication.

The problem arises when the local Trust refuse to fund, and the patient does not quite meet NCG criteria for funding either. In this case the patient faces a real battle, but again OCD-UK will support you, and take your fight on if we can.

We believe the NCG criteria is too strict, and each month the clinic heads would meet and decide which patients were going to be accepted through NCG funding. Despite some opposition from at least one OCD specialist who felt we should not be rocking the boat in this time of belt tightening, we have challenged the DOH on this, and this is part of their official response:

" The criteria for admission to this service support the recommended national position however the service' date=' in the monthly referral meetings, are flexible in applying this criteria and taking into account patients views and previous treatment history."

[/quote']

We are taking this as a victory for OCD-UK in ensuring that personal beliefs in treatment criteria by the specialist clinic leads, does not prevent patients accessing treatment.

So these are the two ways to access specialist treatment, either your local Trust will fund it, or you may be eligible through the National Commissioning Group funding criteria. If you need any advice or help then please do contact the charity.

The OCD-UK statement of policy on specialist treatment is that we would like to see increased access to specialist OCD treatment services in all areas of the UK, not just England, and until such time that is available, a commitment to ensure funding remains with the existing specialist clinics, and as demand for their service grows, an increase in funding to ensure waiting times for their service remains acceptable within the target for NHS waiting times.

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Guest Gingle1

Where are the clinics outside of the south east likely to be Ashley? Any idea on likely dates of when they will be given OCD specialist status?

This is useful information, I didn't realise there were OCD specialist clinics in the UK.

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Where are the clinics outside of the south east likely to be Ashley? Any idea on likely dates of when they will be given OCD specialist status?

Well neither have funding yet, or may even get off the ground, so at this stage it is all hypothetical I am afraid. Even if funding was provided before the end of the year by time the service is setup, staffed etc, that would be a fair few months I suspect.

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  • 1 year later...

Hello Ashley,

I have just been looking at Dr David Veale's website I am currently in need of urgent intensive treatment for my OCD. It is possible that I may be referred to The Maudsley Hospital. However, I'm concerned with statements made on Dr Veale's website about timescales. I quote...

"Specialist services such as ours may have a waiting list, but we do endeavour to offer you a choice of appointment within 13 weeks of the date of the authorised referral" and...

"If we feel we are able to help you with your problems there is normally a wait of 2-6 months before we are able to start your therapy (either as an out-patient or at the residential unit)".

Would you care to comment?

Thanks in advance.

Anon

Edited by Ashley
Removed external website link
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Hi Anon,

I am not totally clear if you are referring to the outpatient Centre for Anxiety Disorders and Trauma (CADAT) or the residential (inpatient Mon-Fri) Bethlem unit. Both are in different parts of London, but fall within the South London and Maudsley Foundation Trust.

Access to either unit is available to patients from outside the area as they are national clinics, and therefore if you are local to the units the timescales may be different than if you are a national patient due to funding. I actually don't know about waiting times for the Bethlem, but as it is a national clinic and only has so many beds/rooms then I assume waiting times and access is not going to be made available to anyone quickly. Because it is a national clinic then waiting times of 2-6 months is not unrealistic, but also I personally do not feel unreasonable. In an ideal world access would be available much quicker, but we need to remember this is a national unit that treats people from all over the UK, so when you take than into consideration 2-4 months is a reasonable wait time, 5-6 months getting a tad long, but still not totally unreasonable.

CADAT I know a little more about, when we first started the charity waiting times were 18-24 months, but towards the end of last year wait times were down to about 3 months, sometimes less, which again when you consider it is a national clinic it is not unreasonable and is in fact pretty good. I would need to check what waiting times are at the moment.

Whilst I am on the subject, when I asked last week, the Child and Adolescent OCD Service, waiting times for assessment was to be mid October, so that is not too bad either.

The other thing to remember is that sometimes waiting times are extended because of funding issues, the local trusts refusing to fund your treatment with the specialist units, so that can add to waiting times, but not the fault of the specialist units.

Ideally, we should all be able to access specialist services locally to us within a reasonable time frame, but the fact is that there are so few specialist units around the UK that these units listed above then have to take the weight of the OCD community around the UK. What we need to do is target local Trusts and pressure them, complain to them and encourage them to have smaller versions of the specialist units, where the therapists, and it only needs 2-3 therapists only treat OCD and become specialists themselves. If every Trust had such a team, then we would all benefit, and the specialist units above would only be needed for the most severe of cases, for which waiting times would be down for.

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Guest Proud Mum

Ashley, we desperately need help and treatment for Paula's OCD, which has been spiralling at the moment. She has good insight into CBT but struggles to put it into practice without support. Top up CBT is out at the mo, as the Community CAMHS psychologist has left and the other is on maternity leave. Paula never had difficulties with self harm, suicide attempts, and depression before her 7 month inpatient spell at an adolescent hospital where problems of this nature were rife which she sadly picked up on. She was also diagnosed with Aspergers. Us and the proffs concluded when she was discharged that this was a totally unsuitable environment for her, and they considered although there were many possible dangers within the home with frustration leading to outbursts it was a much safer environment than the unit was providing! It's like living in a nightmare, our GP tells us the treatment and care Paula needs does not exist! The Aspergers is the underlying problem and the OCD is co-morbid with it, however together the psychologist say they are a recipe for disaster! My mind is overwhelmed, I am exhausted, unable to access my own support due to my respnsibilities as a carer, and don't know where to go next! Any advice would be great!

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yer mum is right i defo really need treatment! i have been really struggling with depression and self harm and ocd and anixty at the moment ! and as mum said i did not did not have differculties with depression and self harm and suicide attempts untill going in the highfield. so any ideas or advice would be really helpfull because we r in crisis. thankyou :)

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Guest mumstheword

Hi Paula and gina

Can I just say you have all my sympathy.

My son also has ocd, which is extreme at the moment, and aspergers. He also has other issues which are medical.

We too are living in a nightmare at the moment because local services are very limited, and despite a good psychologist and psychiatrist, most of the time we are left to get on with it!

I am matt's carer 24hrs a day, 7 days a week!! And its really awful! But somehow we carry on don't we!?!

Don't know if it helps but just wanted you to know I am thinking of you both and praying your situation improves very soon.

Wish I could offer advice but I think you are already trying so very hard, I don't know what you do when services don't exist!!! We are very much in the same boat!

You are both wonderful people who deserve better, and you both really matter!!! Please hang on to that thought.

Gina perhaps you must pester your GP even more to get help for you, because if you can't cope anymore then what next!!!

Your GP must recognise that has to be addressed some how!

Last thought is there a local carers centre near to you? If so they may be able to help and do a carers assessment for you?

Unless you've had all this already?!

Love and hugs

Ali xx

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Hi Anon,

I am not totally clear if you are referring to the outpatient Centre for Anxiety Disorders and Trauma (CADAT) or the residential (inpatient Mon-Fri) Bethlem unit. Both are in different parts of London, but fall within the South London and Maudsley Foundation Trust.

Hello Ashley,

Sorry for the delay in replying.

I'm a tad confused as my local CMHT told me that in-patient care was available at The Maudsley Hospital itself. I don't believe this to be the case. That being so, I'd be looking at the Bethlem unit. I take your point that "Because it is a national clinic then waiting times of 2-6 months is not unrealistic...".

I notice that you edited my post above to remove the external website link. Apologies! I hadn't realized that including external website links is not permissible. I'll remember in future.

Thanks.

Anon

Edited by Anon
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  • 1 month later...
Guest stringbean

Hi Ashley,

I am surprised that this is part of the criteria. When I went to the pscych he took me off the ssris and put me on clomipramine and at a later date augmented it with a mood stabliser. He gave me the impression that this was by far the best med for obsessions

Augmentation with a neuroleptic medication or clomipramine

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  • 1 year later...
Guest Professionalocdsufferer

Hello Ashley

I'm trying to be referred to the specialist centres that you mention (I just commented on your posting about New Thoughts posted some months ago). I note that you provide advocacy. Is there any chance that you could help me as I just know this is going to be an uphill battle! Thank you ?

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