There are two funding schemes for the national specialist services in OCD and BDD. The first is local funding (e.g Clinical Commissioning Group) and the second is the Highly Specialised Service funded by NHS England.
The Highly Specialised Service (HSS) is a national funding stream for treating NHS patients from England with severe OCD and BDD. This means that you may be eligible for referral to one of the OCD/ BDD specialist centres – for example to myself at our Anxiety Disorders Residential Unit (ADRU) at the Bethlem or out-patients at the Centre for Anxiety Disorders and Trauma (CADAT) at the Maudsley; or to Dr Ilena Pamploni at Springfield Hospital, Tooting; or Professor Naomi Fineberg at QE2 Hospital, Welwyn Harden City. Young people may be referred to Dr Bruce Clark at the Michael Rutter Centre at the Maudsley Hospital.
To be eligible for HSS funding you must be under the care and referred by your Community Mental Health Team (CMHT) (or young person in a CAMHS) and have a care co-ordinator and the patient must meet certain clinical criteria. This usually requires a patient to have:
- Severe symptoms of OCD or BDD using the Yale Brown Obsessive Compulsive Scale (YBOCS). This will be done at an assessment.
- Two adequate trials of CBT involving exposure and response prevention. The CBT can be completed in either the NHS or the private sector. (Young people require only one trial)
- Two trials of a serotonin re-uptake inhibitor (SSRI) (for example fluoxetine, sertraline, citalopram, escitalopram, paroxetine or fluvoxamine) or of clomipramine at the maximum tolerated dose for at least 12 weeks (Young people only require 1 trial).
- Augmentation of the SSRI with an anti-psychotic at a low dose for at least 4 weeks (for example aripiprazole, or risperidone). This is not required for BDD or for young people with OCD or BDD.
If a patient is not able to take medications due to a medical condition or because of the OCD, then the medication criteria might be relaxed. Remember that the HSS is just a funding stream. It does not mean that you have to have to fulfil the criteria above to be treated at our own unit.
If a patient from England does not meet the HSS criteria, they can still be referred to us, but they will have to get local Clinical Commissioning Group (CCG) funding approval.
This funding scheme covers England only. People from Wales, Scotland, or Channel Islands may still be referred but funded by their Health Board.