Tertiary / specialist level care

This is usually done as a pre-curser to therapy, like with any other service. The assessor will get a full picture of what you are experiencing and discuss treatment options, then produce a report. The report will cover symptoms, diagnosis, and treatment recommendations. Sometimes, it can be easier for someone to get funding for just an assessment and use the report to get funding for the treatment.

Outpatient means that you are living at home throughout your treatment, and travel into the centre for therapy on a regular basis, generally once a week. If necessary, the services can also offer options if you can’t travel. They can work over video and sometimes offer home visits, until you are able to travel into the centre.

Inpatient means that you would be staying in the clinic for the duration of the treatment. Intensive means that you would be working with a professional multiple times a week, or even per day.
These are only offered in the most severe cases, for example when there is a high level of risk or self-neglect, or if your symptoms make it impossible for you to attend regular outpatient treatment.

Some of the services offer specialist medication advice for those who have struggled to find the right combination of medications so far. This is depending on the type of referral used.

Currently, neurosurgery is not recommended by NICE because of the limited improvement it has been found to bring. For a few very extreme cases, though, that small improvement can be what allows the recommended treatments to work. Very few people are offered neurosurgery per year.
The guidelines are currently under review and part of this will be considering new research on neurosurgery.
At the moment the only specialist centre that offers neurosurgery is the Advanced Interventions Service at Ninewells Hospital in Scotland. This is only available to people who have recently tried all of the recommended treatments at the highest level.

Including ‘CADAT-PAX’ (Parents with AnXiety) unit

Postal address:
Centre for Anxiety Disorders and Trauma,
The Maudsley Hospital,
South London & Maudsley Trust,
99 Denmark Hill,
London,
SE5 8AZ
Telephone: 020 3228 2101

Email addresses:
CADAT@slam.nhs.uk (general queries)
cadatreferrals@slam.nhs.uk (for referrals)

More details about the information below:
https://slam.nhs.uk/service-detail/service/centre-for-anxiety-disorders-and-trauma-112/

Care options–
(Based on treatment needs, referral type, and location)

• Outpatient CBT for OCD, BDD, and Hoarding Disorder (12-20 sessions)
• Home-based CBT for OCD and BDD (12-20 sessions)
  • For Hoarding Disorder specifically in Lambeth, Southwark, and Lewisham
• Intensive CBT for OCD, BDD, and Hoarding Disorder (1 week of treatment)
• Medication advice for individuals funded by HSS
• ‘Team assessment’ – Treatment recommendations to your local mental health team

Who the service is for–

• Adults whose main psychological concern is an anxiety or trauma condition (or both)
  • OCD, BDD, Hoarding Disorder, PTSD, Depersonalisation, Mysophonia, and other panic/anxiety/phobic conditions
• If taking medication, must be a ‘stable dose’ – meaning you aren’t currently testing out different tablets and dosages
• If you are pregnant or a parent of a child under 4yo you will be seen through CADAT-PAX, which has a shorter waiting list and specialises in this period of life

How to get a referral–
You can download the referral form by clicking here

GP in Lambeth, Southwark, and Lewisham:
Do not use the form unless you are applying through HSS (see below)

• CADAT is included within your local services so is already funded for suitable referrals. You can self-refer directly to your local IAPT/Talking Therapies service, because the centre offers treatment at all levels. IAPT/Talking Therapies will triage you so it’s important to confirm that you are struggling with OCD or a related condition at the screening and assessment stage, and you can ask about a referral to CADAT if you want to.
  Lambeth 0203 228 6747
  Lewisham 0203 049 2000
  Southwark 0203 228 2194

Bexley, Bromley, and Greenwich residents:

• Funding is only available through your local Health Board/ICB. You can read more about this option below.

Other England residents:

1. Patient Choice/Right to Choose (if you are not under the care of a mental health team) – this type of referral is made a GP and is used to access CADAT’s non-specialist services. You can read more about this here.
   GP fills out the form, including ‘Patient Choice only’ section at the top of page 3, confirming you meet the criteria listed in that section.
   CADAT receives the referral form, and can immediately add you to their waiting list.
2. Funding through the local Health Board/ICB to access specialist care at CADAT. You can read more about this type of funding here.
   Your CMHT consultant (usually psychologist/psychiatrist) fills out CADAT’s referral form, including ICB funding/‘National Specialist’ section on page 3, confirming you meet the criteria listed in that section.
   CADAT receives the referral form, and will do the funding request for you.
   *In some areas* the ICB will require that your consultant does the funding request instead. If this is the case, CADAT will let them know.
3. NHS England Funding/Highly Specialised Service (HSS) to access specialist care at CADAT if you have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that need to be met here.
   Your CMHT consultant (usually psychologist/psychiatrist) fills out the form, including ‘Treatment Resistant Obsessive Compulsive Disorder / Body Dysmorphic Disorder Service’ Section on pages 3 and 4, confirming you meet the criteria for that section.
   CADAT receives the referral form, and may assess you. If they agree that you meet the criteria they will apply to the funding for you.

Wales and Northern Ireland residents:

• Funding only available through your local Health Board.
  CMHT consultant fills out the form, including local Health Board funding/‘National Specialist’ section on page 3, confirming you meet the criteria listed in that section.
  If you aren’t under the CMHT, your GP can do the referral but must confirm that you don’t need local support for complex needs.
  CADAT receives the referral form, and will do the funding request for you.
  *In some areas* the local Health Board will require that your GP does the funding request instead. If this is the case, CADAT will let them know.

Scotland residents:

1. Funding through the local Health Board
   Your CMHT consultant fills out the form, including local Health Board funding/‘National Specialist’ section on page 3, confirming you meet the criteria listed in that section.
   If you aren’t under the CMHT, your GP can do the referral but must confirm that you don’t need local support for complex needs.
   CADAT receives the referral form, and will contact your local Health Board to request the funding.
   *In some areas* the local Health Board will require that your GP does the funding request instead. If this is the case, CADAT will let them know.
2. NHS England Funding/Highly Specialised Service (HSS) if you have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that need to be met here.
   Your CMHT consultant (usually psychologist/psychiatrist) fills out the form, including ‘Treatment Resistant Obsessive Compulsive Disorder / Body Dysmorphic Disorder Service’ Section on pages 3 and 4, confirming you meet the criteria for that section.
   CADAT receives the referral form, and may assess you. If they agree that you meet the criteria they will apply to the funding for you.

Postal address:
Oxford Health Specialist Psychological Intervention Centre
Warneford Hospital
Headington
Oxford
OX3 7JX

Telephone: 01865 226361

Email address:
ohspic@oxfordhealth.nhs.uk

More details about the information below:
http://www.oxfordhealth.nhs.uk/ohspic

Care options–
(Based on treatment needs, referral type, and location)

• Outpatient CBT for OCD and Hoarding Disorder
• Home-based or ‘outreach’ CBT for OCD and Hoarding Disorder
• Intensive CBT for OCD and Hoarding Disorder
• Medication advice
• ‘Team assessment’ – Treatment recommendations to your local mental health team

Who the service is for–

Adults and children whose main psychological concern is an anxiety or trauma condition (or both)

• OCD, Hoarding Disorder, PTSD, other panic/anxiety/phobic conditions
• If there is also a secondary condition outside of these (like BDD or ASD), care for this will be considered as well

How to get a referral–
Whole of UK. You can read about this in more detail here.

1. An NHS healthcare professional who knows your case well fills out the referral form and adds a referral letter outlining any further information and treatment documentation
2. The clinic lets the referrer know whether the referral is appropriate and how much an assessment will cost. They will provide a ‘Funding Approval Form’ (FAF)
3. Your referrer makes a request for funding from your Local Health Board. If approved, the health board will confirm this by filling out the FAF
4. You will be assessed through a single, 2-3 hour appointment. Within 3 weeks, the clinic will send a report to your referrer, outlining their treatment recommendations and the cost of this. They will again provide a FAF for this
5. Your referrer makes a second request to the Health Board, this time for the treatment funding. Again, your Local Health Board will fill out the FAF if they approve it
6. You will be put on a waiting list for treatment, which will start within 18 weeks

The referral route outlined above is essentially requesting funding from the local Health Board/ICB, which you can read more about here.

Postal address:
Dower House
Bethlem Royal Hospital
Monks Orchard Road
Beckenham
Kent
BR3 3BX

Telephone: 01865 226361

Email address:
Anxiety.DisordersResidentialUnit@slam.nhs.uk

More details about the information below:
https://slam.nhs.uk/service-detail/service/anxiety-disorders-residential-unit-111/

Care options–
(Based on treatment needs, referral type, and location)

• Residential treatment (up to 20 weeks)
  • Different from inpatient because unstaffed evenings and nights
  • CBT, compassion focused therapy, occupational therapy, regular reviews, group work
  • Home treatment session, both accompanied and unaccompanied
  • Monthly carers support group
  • Relapse prevention plan as part of discharge
  • Follow up appointments for up to 12 months
  • Advice on how to optimise medication for an individual before or during an admission but there is no requirement to take medication
• Second opinion assessment for complex cases
• A care co-ordinator and bed are available at the local psychiatric hospital within 24 hours if someone’s condition should deteriorate (e.g. suicidality)

Who the service is for–

• Adults (18 +) whose main presenting condition is OCD, BDD, PTSD, social anxiety, emetophobia, panic disorder, health anxiety, and other specific phobias, including if these are occurring in context of co-occurring neurodevelopmental conditions (e.g. ADHD, Autism)
• You must be able to attend initial assessment appointments at ADRU in person and be willing to have home visits and a family assessment
• You must be willing to complete regular questionnaires to monitor progress and attend individual therapy, therapy groups and occupational therapy
• If taking psychotropic medication, you must be on a stable dose prior to starting treatment
• You must have home accommodation maintained in the community and be able to travel home alone at the weekends or be accompanied by a carer/friend
• You must be able to perform basic self-care and self-medicate
• You must be willing to live in a small supportive community
• Priority assessments and admissions are given to primary carers/parents of children 5 years and under as well as to Armed Forces personnel

How to get a referral–
You can download the referral form from ADRU’s website here under the tab ‘Appendices’ at the bottom of the page. Referrals must be supported by a psychiatrist from the local CMHT. ADRU cannot accept GP referrals, self-referrals, or referrals from acute/inpatient hospital settings. Patients who have been seen through private practices are welcome to provide letters or information from these providers, however ADRU cannot accept referrals directly from private services.

Whole of UK

1. Funding through the local Health Board/ICB. You can read more about this type of funding here.
   Your consultant (usually psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   Your consultant also needs to make a funding request to your local Integrated Care Board (ICB). This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.
2. NHS England Funding/Highly Specialised Service (HSS) if you live in England or Scotland and have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that needs to be met here.
   Your consultant (usually psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   They would also make a funding request to NHS England, outlining how you meet the HSS criteria. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.
3. ADRU also accept self-funding clients who are residing in the UK and have been referred by a GP or consultant

Postal address:
National OCD/BDD Service
Springfield University Hospital
61 Glenburnie Road
Tooting
London
SW17 7DJ

Telephone: 020 3513 6961

Email address:
ocdbdd@swlstg.nhs.uk

More details about the information below:
https://www.swlstg.nhs.uk/our-services/specialist-services/ocd-bdd-service

Who the service is for–

Adults whose main psychological concern is OCD, BDD, or Hoarding Disorder.

Care options–
Read more on all of these here

Trustwide Service (OCD/BDD)
Read more here

Your GP or consultant (psychiatrist/psychologist) can ask for support from one of the therapists in the service. This can be:

• Support and guidance for the mental health professionals who work with you
• Joint working with your team and delivering therapy as part of your care plan
• Treatment for you directly from the service in your home or as an outpatient

The usual criteria for this service is to have tried 1 round of CBT and 2 rounds of medication unsuccessfully, but if your case is clearly quite severe or complex, they might consider you without these having been met.

National Services (OCD/BDD/HD)
(Based on treatment needs, referral type, and location)

• Outpatient/community CBT
• Home-based CBT
• Inpatient treatment
  • Appropriate for people who are not able to self-care independently

How to get a referral–
You can find the referral forms for the different services here

Whole of UK

1. Funding through the local Health Board/ICB. You can read more about this type of funding here.
   Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   Your consultant also needs make a funding request to your local Health Board/ICB. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.
2. NHS England Funding/Highly Specialised Service (HSS), if you live in England or Scotland and have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that needs to be met here.
   Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   They would also make a funding request to NHS England, outlining how you meet the HSS criteria. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.

through the Hertfordshire Partnership University NHS Foundation Trust

Postal address:
Prof NA Fineberg
Consultant Psychiatrist
Rosanne House
Parkway
Welwyn Garden City
AL8 6HG

More details about the information below:
https://www.hpft.nhs.uk/services/community-services/highly-specialised-services-for-obsessive-compulsive-disorders-ocds-and-applied-neuroscience/

Care options–

• Outpatient CBT for OCD, BDD, Hoarding Disorder, and BFRB
• Inpatient CBT for OCD, BDD, Hoarding Disorder, and BFRB
• Medication treatment for OCD, BDD, Hoarding, and BFRB
• Outreach for people admitted onto psychiatric wards at Hertfordshire Partnership University NHS Foundation Trust and inpatient units elsewhere in England, including for people receiving treatment under the mental health act
• Assessment for neurosurgery

Who the service is for–

• Adults whose main psychological concern is OCD or a related condition (including Hoarding Disorder and BFRB) at levels 4-6 on the stepped care chart
• Needs, criteria, and cost of treatment will be discussed individually

How to get a referral–
Whole of UK

1. Funding through the local Health Board/ICB.
2. You can read more about this type of funding here.
   Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   Your consultant also needs make a funding request to your local Health Board/ICB. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.
3. NHS England Funding/Highly Specialised Service (HSS), if you live in England or Scotland and have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that needs to be met here.
   Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   They would also make a funding request to NHS England, outlining how you meet the HSS criteria. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.

Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee
DD1 9SY

Telephone: 01382 496233

Email address:
enquiries@advancedinterventions.org.uk

More details about the information below:
https://www.advancedinterventions.org.uk/

Care options–

• Assessment with treatment advice for your local team
• Intensive inpatient or home-based CBT with ERP for OCD
• Neurosurgery (Anterior Cingulotomy)
• Inference-Based Therapy (OCD Action does not have any further information on this treatment)

Who the service is for–

• Adults whose main psychological concern is OCD at levels 5 or 6 on the stepped care chart

Usually expected to have tried multiple rounds of CBT and medication

How to get a referral–
Read more about the referral process, guidelines, and criteria here

For Scottish residents, the consultant (usually psychologist/psychiatrist) just needs to write to the service with information about your condition and treatment history. The funding for this service is provided by the National Services Division.

Rest of UK

1. Funding through the local Health Board/ICB. You can read more about this type of funding here.
2. Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   Your consultant also needs make a funding request to your local Health Board/ICB. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.
3. NHS England Funding/Highly Specialised Service (HSS), if you live in England and have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that needs to be met here.
   Your CMHT consultant (usually psychologist/psychiatrist) would send a completed referral form for assessment and/or treatment to the unit, outlining your symptoms and treatment history.
   They would also make a funding request to NHS England, outlining how you meet the HSS criteria. This can be done beforehand or alongside, but you cannot be placed on a waiting list until the funding is approved.

Postal address:
Michael Rutter Centre
De Crespigny Park
London
SE5 8AZ

Telephone: 020 3228 5222

Email address: ocdbdd.camhs@slam.nhs.uk
“Families, GPs, and referrers are welcome to contact us for information.”

More details about the information below:
https://slam.nhs.uk/service-detail/service/child-and-adolescent-obsessive-compulsive-disorder-service-101/

Care options–

• Outpatient CBT for OCD (14-20 sessions avg.), BFRB, and BDD (20 sessions avg.). Also ASD, tic conditions, and other anxiety disorders
  • Where appropriate, will include and work with parents/carers
  • Remote options like telephone and video available
• Some inpatient and outreach treatment
• Medication treatment
• ‘Team assessment’ – Treatment recommendations to your local mental health team
• Follow-up appointments for a year after treatment

Who the service is for–

• Young people (up to 18) with a suspected diagnosis of OCD, BFRB, BDD
• Must be under the care of a local mental health team

How to get a referral–
Read more about what goes into a referral here

Whole of UK

1. Funding through the local Health Board/ICB. You can read more about this type of funding here.
   The CAMHS consultant (usually psychologist/psychiatrist**) would send a completed referral form for assessment and/or treatment to the service, outlining the young person’s symptoms and treatment history.
   When the service receives the referral form, they will contact the young person’s local Health Board/ICB to apply to the funding for the young person.
   In some areas the local Health Board/ICB will require that the young person’s GP does the funding request instead. If this is the case, the service will let them know.
   **If the young person’s GP knows their case best or is more helpful, they can make the referral. CAMHS must be involved and has to support the referral, but this might be easier to convince them to do.
2. NHS England Funding/Highly Specialised Service (HSS), for people in England or Scotland who have had lots of unsuccessful rounds of the recommended treatments. You can read more about this type of funding and the specific criteria that needs to be met here.
   The CAMHS consultant (usually psychologist/psychiatrist**) would send a completed referral form for assessment and/or treatment to the service, outlining the young person’s symptoms and treatment history.
   When the service receives the referral form, they may assess the young person. If they agree that they meet the criteria for HSS they will apply to the funding for them.
   **If the young person’s GP knows their case best or is more helpful, they can make the referral. CAMHS must be involved and has to support the referral, but this might be easier to convince them to do.