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Services at The Priory Hospital North London Appointments Appointments for private consultation can be made by telephoning my secretary, on 020 8920 5611 (direct line) or 020 8882 8191 (hospital)(Fax:020 8447 8138). Private consultations at The Priory Hospital North London may be paid for either by an individual, a health insurer or a third party such as an NHS Primary Care Trust or solicitors (but only if it has been pre-authorised in writing). It is normally recommended that a patient obtains a referral to see a specialist from their general practitioner. This is not necessary if, for example, you do not have a GP or do not wish your GP to be involved. However if you wish to claim the fees from your health insurer, they will usually require you to be referred by your GP. Furthermore if we agree to prescribe medication, there are risks if your GP does not have the whole picture. I usually have a waiting list of about 3 weeks but will endeavour to see you the same or next day in an emergency (for example if you are feeling suicidal). I regret I do not see patients at weekends. However I start at 8.30am and see one new patient at 6pm on one evening each week. I charge £250 for an initial consultation and £120-£160 for follow up appointments depending on the length of the consultation. These fees are normally recoverable under medical insurance if you have been referred by your GP. My terms will be sent or emailed to you when an appointment is confirmed. Fees for Domiciliary Visit are slightly higher and reflect my travelling time. I am also able to see patients at The Priory on the NHS with funding from your local Primary Care Trust. Advice on seeking funding at the Priory from the NHS is here. The Priory Hospital North London Click here for directions to The Priory Hospital North London and here for a map. I also have a very limited service on one a week in Muswell Hill, N10 at 8.15am. I am not a specialist in Child and Adolescent Psychiatry but I do assess and treat children and adolescents who suffer from OCD or BDD or a Specific Phobia of Vomiting. For children with OCD under the age the 12 or for adolescents who have complex problems, I would initially recommend an assessment with Dr Isobel Heyman who see NHS patients at the OCD clinic at the Maudsley Hospital in London. We also admit young people with severe OCD or BDD to our adolescent unit who have not been able to make progress as an out-patient (both NHS and private). This requires a referral from a Consultant Child and Adolescent Psychiatrist if you are seeking funding from a PCT on the NHS. For young children or adolescents problems which do not have OCD or BDD and you need a private appointment, I would recommend Dr Carmen Clemente and Dr Lawrence Sheldon at The Priory Hospital North London. For an initial consultation, I will ask you to complete some questionnaires beforehand, which provides a comprehensive picture of your background and information on your problem. I will gain further information during our consultation and usually come to a diagnosis and some understanding of what is keeping your problem going. Occasionally I might recommend some investigations. This will then lead to a discussion of treatment options and the advantages and disadvantages of each. Usually there is a choice of cognitive behaviour therapy or medication or a combination of the two. In moderate to severe cases, there is the option of in-patient or day-patient care on a more intensive programme at The Priory North London. For therapy I will usually recommend a colleague as I have a limited private practice and I tend to be quite busy with in-patients or day-patients. Lastly I may recommend some reading or a self-help charity. I prefer to see an individual alone first and then if requested see the person's partner or relatives. Our consultation will normally last about an hour to an hour and a quarter depending on the complexity of the problem. I will then provide a written summary of our assessment and recommendations which can be sent to your GP, Consultant or therapist with a copy to you. You may also withhold consent for a report to be sent. Treatment programmes for OCD and BDD The Priory Hospital North London offers intensive treatment programmes for adolescents or adults with Obsessive Compulsive Disorder (OCD) or Body Dysmorphic Disorder (BDD) as an in-patient, day-patient, or out-patient. Treatment guidelines recommend that adolescents or adults with OCD or BDD should be offered Cognitive Behaviour Therapy (CBT) including exposure and response prevention. The hospital is located in a secluded part of Southgate, North London and set in several acres of private grounds. Individuals with OCD or BDD are normally admitted when they have failed to make progress as an out-patient or their handicap is too severe for out-patient care or for geographical reasons. Alternatively additional diagnoses such as depression, schizophrenia, or disordered eating may make out-patient treatment more complex. Others may be housebound, have a reversal of their sleep pattern or suffer from obsessional slowness so that attendance as an out-patient has become almost impossible. The programme is also suitable for adolescents.Other problems that our team specialise in include severe phobia of vomiting and depression. The emphasis is on individuals having a good psychological understanding of how your solutions have become their problem and the implications for overcoming their problems. Once patients are engaged, they are expected to conduct exposure or behavioural experiments at least three times a day and complete their homework diaries and weekly ratings of outcome. In addition, all staff may model exposure or participate in behavioural experiments to help test out a patient’s beliefs. In-patients with OCD or BDD receive: • Three individual sessions of CBT with their key therapist. • Group CBT sessions which are specific to OCD or BDD. • A wide range of other groups for related problems such as depression, low selfesteem or social anxiety. • Regular monitoring of progress which is used to audit outcome. Medication is also reviewed. A SSRI or clomipramine or augmentation of a SRI may be offered. CBT may have a better outcome when combined with an SRI than CBT alone in those with moderate to severe impairment but patient's make the decision whether to combine treatments. Assessment An initial assessment for suitability and treatment planning is offered with Dr David Veale and one of the therapy team. This gives an opportunity for a treatment plan to be jointly agreed with the patient prior to admission. If this not possible, then an initial assessment may be conducted as a domiciliary visit or over the telephone. The admission criteria can be provided on request. A formal assessment of response to treatment is completed on the ward within the first 2 weeks. This assessment is focused on the patient’s ability to engage in treatment. Family therapy Partners and relatives are encouraged to meet with the therapy team. The team will want to assess their involvement in the OCD or BDD and they will be advised on how best to support a patient’s treatment. Local involvement We aim for patients to be able to travel (if necessary with a relative or friend) so they may return home on therapeutic leave as soon as possible at weekends to practice exposure in their own environment. NHS patients must have an identified local care coordinator who can discuss follow up arrangements and attend a CPA meeting with a family member. There should be follow up by a local cognitive behaviour therapist who would preferably act as the care co-coordinator. Alternative follow up arrangements including telephone consultations and day-patient or out-patient care can also be arranged. Outpatient or day-patient service Patients may also be treated on a weekly or intensive programme of CBT with the same services as an in-patient. Literature OCD patients are encouraged to read the book “Overcoming Obsessive Compulsive Disorder: a self help guide using cognitive behavioural therapy” by David Veale and Rob Willson (published by Robinson). BDD patients are encouraged to read “The Broken Mirror” by Katharine Phillips (published by Oxford University Press). A self-help book on “Overcoming Body Image problems” by David Veale and Rob Willson is to be published by Robinson in 2009. Teaching The Priory is part of the Royal Free Hospital psychiatric rotation. There are attachments for medical students from the Royal Free and University College Medical School. Dr David Veale regularly provides workshops in OCD and BDD for mental health specialists. David Veale with Fugen Neziroglu is publishing a treatment manual for therapists on body dysmorphic disorder to be published next year by Wiley. Self-help groups We provide premises for self-help groups for OCD and BDD, which meet once a month at The Priory Hospital, North London. Groups are free of charge. For further information contact OCD Action at 020 7226 4000. Obtaining NHS funding for treatment at The Priory We are often asked by patients or families about how they can obtain NHS funding for treatment of Obsessive Compulsive Disorder or Body Dysmorphic Disorder at the Priory. It is sometimes
possible to obtain NHS funding either here or at teh South London and
Maudsley but it is difficult to initiate this yourself. Even when you
follow the recommended route, it does not guarantee funding and if you
are successful, it will not usually happen immediately. The recommended
route is: 4) If your local consultant and community mental health team support your referral to the services at the Priory or the Maudsley and apply for funding to the local Primary Care Trust, this does necessarily mean that funding will be successful as there many competing priorities within the NHS and they have a limited budget. It is also possible for adolescents and adults with OCD or BDD to obtain funding from the National Commissioning Group for severe treatment refractory OCD and BDD which is funded by the Department of Health (and not your PCT). Details are here In reality, only those with severe distress and handicap tend to obtain funding for in-patient care or are refered when there is no suitable local expertise in treating OCD or BDD. The best advice is to work with your local services and to keep trying to get what you believe is the most appropriate option for you. | |||||||||||||||
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