How our service can help you
We aim to offer high quality CBT , working towards reducing symptoms of anxiety disorder s , ultimately improving functioning and quality of life. This would lead to a reduced need for local service provision.
The advantages of admission to a residential setting are the ability to deliver CBT in a more intensive format. Staff may assist in frequent exposure or behavioural experiments in a supportive environment , with more opportunities for modelling and positive reinforcement by others in the moment. There is increased flexibility in delivery of the therapy that can keep the momentum going. Sometimes there are advantages to removing a person from their home context.
We integrate occupational therapy into the therapy . We also encourage residents to assist in our GUTS caf e to confront their anxiet ies and to help prepare them for life after discharge . Living in a residential unit increases responsibility that may not occur on an inpatient unit with nursing staff as well as the support and reinforcement from other residents. Lastly the unit can monitor any medication changes or adherence.
For patients with obsessive compulsive disorder (OCD) and b od y dysmorphic disorder (BDD), we operate at the highest level of stepped care in the National Institute for Health and Care Excellence (NICE) guidelines. We do this by providing intensive CBT for the treatment of severe OCD and BDD.
For patients with other anxiety disorders (post-traumatic stress disorder (PTSD), social phobia, agoraphobia/panic, specific phobias, generalised anxiety disorder) the service also operates at the highest level of stepped care in the respective NICE guidelines. We do this by providing intensive CBT and optimisation of medication for the relevant anxiety disorder. The service is for those who have severe symptoms and who have failed treatment locally .
Philosophy of Care at the Anxiety Disorders Residential Unit (ADRU)
Our programme is tailored to our residents’ individual needs. We do not ask anything we would not expect of ourselves. All of our staff are honest, respectful and open throughout the programme. We focus on the development of alternative ways of thinking, behaving and learning about problems. We provide a safe, caring, supportive and compassionate environment to support long-term change by:
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Prioritising the client’s recovery and wellbeing
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Delivering personalised, evidence-based care
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Believing in the client's potential to overcome their difficulties, no matter how complex, or their previous experiences of therapy
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Promoting a supportive environment where people can learn, support and encourage each other
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Working collaboratively to enable people to overcome their difficulties, identify and achieve their goals
King’s Health Partners
Our service is part of the Psychological Medicine and Older Adult Academic Group . SLAM has joined with King’s College London, Guy’s and St Thomas’ NHS Foundation Trust and King’s College NHS Foundation Trust to establish King’s Health Partners, an Academic Health Sciences Centre . King’s Health Partners involves bringing clinical care, research and education much more closely together . Our aim is to reduce the time it takes for research discoveries and medical breakthroughs to become routine clinical practice . This will lead to better care and treatment for patients.
Visit www.kingshealthpartners.org for more information.
Highly Specialised Service for severe OCD and BDD
ADRU holds a highly specialised service (HSS) contract, which is centrally funded by NHS England to provide treatment for people with OCD and BDD for whom numerous previous treatments have been unsuccessful. This particular contract is at no additional cost to Integrated Care Boards (ICBs).
- Service Borough Covers: National (Adult services) Treatment type: Community/Residential
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Contact the service
Site Location: Bethlem Royal Hospital Email: Anxiety.DisordersResidentialUnit@slam.nhs.uk Phone Number: 020 3228 4146 or 020 3228 4545 - Disabled Access: No
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Address:
Dower House
Bethlem Royal Hospital
Monks Orchard Road,Beckenham, BR3 3BX - Business Hours/Visiting Hours: 9am - 5:00pm, Monday - Friday
- Conditions: Addictions, Anxiety, Attention deficit hyperactivity disorder (ADHD), Autism, Bipolar disorder, Body dysmorphic disorder (BDD), Childhood degenerative disorders, Conduct disorder, Dementia, Depression, Dissociative disorders, Eating disorders, Learning disabilities, Neuropsychiatry, Obsessive compulsive disorder (OCD), Perinatal disorders, Persistent physical symptoms, Personality disorders, Post-traumatic stress disorder (PTSD), Psychosexual, Psychosis, Self-harm
Other essential information
Eligibility criteria
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Patients who are not yet at a point where willing to actively participate in exposure-based therapy, where applicable, as this is core component of our treatment
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Direct referrals from other SLAM services (with the exception of referrals to our Highly Specialised Service for OCD and BDD: we regret for funding reasons we are not able to accept referrals directly from other SLAM services. In these cases, the referrals will need to be made by a patient’s local mental health team.
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Current psychosis or bipolar disorder requiring treatment.
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Current alcohol or drug dependence requiring treatment in its own right.
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Current severe depression requiring treatment in its own right, in particular ongoing self-harm or immediate suicide risk.
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Complex PTSD which requires treatment in its own right.
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For PTSD referrals, people who are likely not sufficiently stable to engage in trauma-focused treatment due to factors including social problems, severe physical health problems, or significant mental health problems (including recent inpatient or crisis admissions or likely crisis admissions while waiting for therapy) or level of dissociation. People who are not willing or able to talk about past trauma and do not want to engage in exposure-based (e.g., re-living or processing) treatment.
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Personality disorder, emotional regulation or enduring personality characteristics which require treatment in their own right.
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Individuals with current or historical risk of violence towards others
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Individuals in inpatient care, or who have been discharged from inpatient care for less than 2 months, or who require inpatient care
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Unstable housing or housing issues requiring assistance as a point of priority, or current inpatient status.
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Poorly managed medical or psychological comorbidity which is currently associated with an increase in mortality risk, and which needs to be addressed in the first instance before psychological treatment for anxiety can be attempted e.g., BMI of below 17.5, electrolyte imbalance, ongoing medical investigations or indication of a need for medical investigation in the first instance.
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Not motivated or willing to attend therapy sessions or to have Cognitive Behaviour Therapy.
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We regret we no longer have capacity to treat compulsive hoarding.
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Moderate or severe learning disability.
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Dissociation, including dissociative identity disorder (DID).
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Where alcohol or drug use is at problematic levels, clients must have a minimum period of 6 months of abstinence from their problematic substance prior to treatment at ADRU, where they are receiving support from their local alcohol service during this time.
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As a specialist anxiety treatment clinic, we only offer 16 weeks of treatment. This means that we are not in a position to offer treatment for conditions requiring long term interventions, as this is not part of our treatment offer or specialism.
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Referrals requesting assessment and treatment for skin picking.
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Clients who are requesting treatment for BDD who are currently engaging or have cosmetic procedures planned and are unwilling to cancel these for the duration of treatment.
Outcomes
- Following therapy, the patient has developed a psychological understanding of how their problem developed and how it is being maintained. The patient has been provided with a toolbox of effective psychological techniques that will help them to manage any residual symptoms and reduce relapse
- A co-therapist should be identified from the local referring team before admission and consultation will take place between the therapist at the unit to establish the understanding of the approach learned and further needs
- During the latter part of the admission, relapse prevention techniques will be included in sessions and the essential follow up sessions
We use all the recommended National IAPT outcome measures for each disorder.
For obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD), we also use the Yale Brown Obsessive Compulsive Scale (a measure of symptom severity).
Care Options
Interventions
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First assessment is a three-hour structured interview by a trained CBT therapist and junior doctor or consultant
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Admission to Longfield House or Dower House, which is unstaffed from 5pm until 9am. The unit is a detached house in the ground of the Bethlem Royal Hospital
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Attendance at therapy sessions is mandatory with homework and experiential work at evenings and weekends
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Home visits accompanied and unaccompanied are part of the agreed programme
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The treatment programme is 16 weeks
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The service is for patients with severe anxiety disorders who have failed treatment locally
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Patients in England who meet the severe treatment refractory criteria for the highly specialised service for obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) may be funded by NHS England
Our treatment interventions include:
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A structured assessment and formulation of the person’s problems by a cognitive behavioural therapist
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Individualised CBT supported by group treatment and Therapy in Action
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Formal treatment review by the team every two weeks, or more frequently depending on individualised circumstances
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Daily Occupational Therapy
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Weekly community meeting
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Home treatment session, both accompanied and unaccompanied
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Monthly carers support group
A co-therapist should be identified from the local referring team before admission and consultation will take place between the therapist at the unit to establish the understanding of the approach learned and further needs. During the latter part of the admission, relapse prevention techniques will be included in sessions and the essential follow up sessions.
Our experts
Barbara King (Senior Administrator)
Ben Hicks (Compassion Focused Coach and GUTS Cafe Manager)
Dr Robert Medcalf (Highly Specialist CBT & EMDR Therapist): Read more
Helene Lomenech (Occupational Therapist)
Jeremy Lock (Highly Specialist CBT & EMDR Therapist): Read more
Joel Oliver (Highly Specialist CBT & EMDR Therapist): Read more
Lisa Kirkby (Therapeutic House Manager and GUTS Cafe Head Chef)
Lisa Williams (Principal Cognitive Behavioural Therapist and Manager): Read more
Michaela Lutz (Highly Specialist CBT & EMDR Therapist)
Prof David Veale (Consultant Psychiatrist): Read more
Sarah Cleary (Senior Administrator)
Whitney Williams (Occupational Therapist)
We also have undergraduate psychology students working alongside us and two doctors.
GUTS Cafe
We have an on-site café called Guts, serving delicious coffees and gut friendly foods ranging from sourdough toasties, hearty dahls and our famous 5-bean chilli. The name GUTS comes from the evidence surrounding the gut-brain axis, the bi-directional relationship between our gut and our brain. Our slogan ‘a healthy gut happier mind’ captures the effect of the foods we eat on our levels of anxiety.
Our compassion focused coach can provide the residents with barista training in GUTS. Upon completion, residents will receive an official certificate. Working in the cafe provides an opportunity for residents to confront their anxieties and help to bridge the gap between ADRU and life post-discharge, gaining valuable skills. GUTS is open to the public, with many staff coming from the other Bethlem sites. We also host events, including our famous pizza days, which provides the chance for residents to get involved in preparing and delivering the food.
Referrals
Referrals must be supported by a psychiatrist from the local CMHT. We have a standard referral form so that referrers can provide adequate details regarding previous treatments for us to establish whether clients are eligible for HSS funding.
We do not 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 summaries from these providers. As an NHS provider however, we are unable to accept referrals or recommendations from private practices.
Priority assessment/admission
Priority assessments and admissions are given to the following:
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Armed Forces personnel
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Primary carers/parents of children 5 years and under
Find the referral form in Appendix A.
