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Services at the South London and Maudlsey Trust I am a member of the Centre for Anxiety Disorders and Trauma. I work with Professor Paul Salkovskis in the OCD clinic and look after a residential unit for cognitive behaviour therapy at the Bethlem Royal Hospital. I also run a national out-patient clinic for patients with Body Dysmorphic Disorder and skin-picking. There are various referral routes to the service, but it does depend on your GP's registered address and the service agreements the Maudlsey hospital has with your Primary Care Trust (PCT). For local areas (Lambeth , Southwark and Croydon) and occasionally other areas we can receive a referral direct from your GP. However, for the majority of areas the referral must come to us via your local Community Mental Health team (CMHT) and Consultant to enable us to obtain authorisation to offer you an assessment, and/or treatment. In certain cases, once we have received the referral we have to approach your local PCT on an individual basis to request authorisation to offer you our service. This is routine, similar to any specialist services that are required on the NHS i.e. you start at your local hospital, but if more specialist expertise is necessary you may be referred on to a more expert specialist in the disorder you have. At our clinic when the referral is received and authorised this will be discussed by our team. If the team decide that you would be suitable for an assessment, we will write to you and the referrer to advise you that you have ben placed on our waiting list.We will write to you again in due course inviting you to contact the Centre so that we can offer you a choice of appointment dates. It should be noted that specialist services such as ours do have rather lengthy waiting lists, but we do endeavour to offer you a choice of appointment within 13 weeks of the date of the authorised referral. Assessment: Once you have accepted an appointment you will be sent out some rather lengthy, but very important questionnaires covering different aspects of OCD, BDD, anxiety and depression. It is essential that you complete these prior to the assessment and bring them with you. You will also of course receive a map and directions to the Centre or the Bethlem Hospital. We do expect that if for any reason you are unable to attend on the day you let us know, preferably in advance. If you do not we will write to you assuming you no longer require our help, and will discharge you if we receive no reply. If you miss the appointment, but require another, there may be a lengthy delay as you will go back to the end of the list. When you come for the assessment appointment this is a rather tiring and lengthy process and usually takes at least 3-4 hours, sometimes it can take longer in which case we may need to ask you to come back. You will be asked very detailed questions about your obsessional problems and any other problems you may have. It is important that we get a very clear understanding of your problems in order to establish what kind of help you may need. We routinely video or audiotape our assessments, which we think is good practice as it means we can be sure we all carry out our assessments to a high standard. It also means that other members of the OCD and BDD team can be involved in discussion about your care. We will not make a decision about what is the best way to proceed on the day. We will consider your case and discuss it with the team, and aim to let you know within a couple of weeks. We will write back to your referrer after we have completed the assessment
and made decisions about your care. We have a policy whereby if you
wish to be copied in on letters we are happy to do so with your signed
consent. Treatment: If we feel we are able to help you with your problems there is normally a wait of 4 - 12 months before we are able to start your therapy (either as an out-patient or at the residential unit). This is due to the high national demand for this service. We would offer suggestions to your referrers about management of your care in the meantime, if this is appropriate. If, at assessment, we do not feel we are able to help you then we tell you the reasons for this and make suggestions as to what would seem more helpful ways for you to proceed towards getting help with your problems. In future, there may be a more open access for local patients with BDD and OCD and for research trials. Written referrals can be made to me but you are likely to be assessed by a member of our team. Dr David Veale |
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