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Anxiety Disorders Residential Unit

How our service can help you

We aim to offer high quality CBT aimed at reducing symptoms of anxiety disorder and improve functioning and quality of life. This would lead to 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 or residents may assist in frequent exposure or behavioural experiments in a supportive environment. There are 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. 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 body 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.

  • Service Type: Adult Mental Health Services (National) Service Borough Covers: National (Adult services) Treatment type: Inpatient
  • Contact the service

    Site Location: Bethlem Royal Hospital Email: Anxiety.DisordersResidentialUnit@slam.nhs.uk Fax Number: 020 3228 4146 or 020 3228 4051
  • Disabled Access: Yes
  • Address: Dower House
    Bethlem Royal Hospital
    Monks Orchard Road,
    Beckenham,
    BR3 3BX
  • Business Hours/Visiting Hours: 9am - 4:30pm, Monday - Friday
  • Other essential information

  • 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

Interventions

  • First assessment is a three hour structured interview by an a trained CBT therapist and junior doctor or consultant
  • 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
  • Attendance at therapy sessions is mandatory with homework and experiential work at evenings and weekends
  • Home visits accompanied and unaccompanied are part of the agreed programme
  • The average length of stay is 12 to 16 weeks
  • The service is for patients with severe anxiety disorders who have failed treatment locally
  • 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

Eligibility criteria

  • 18 years and above
  • Willing to travel home independently on weekend leave (or with relatives initially)
  • Have accommodation maintained in the community throughout the admission in order to go home on leave. If a person’s condition deteriorates then a bed must be made available at the person’s local psychiatric hospital. Alternatively, other arrangements must be made in the community within 24 hours
  • Have basic self-care skills and are able to self-medicate
  • Have an anxiety disorder as their primary diagnosis. Examples include obsessive compulsive disorder, body dysmorphic disorder, post-traumatic stress disorder, health anxiety, agoraphobia, social phobia, specific phobia)
  • Willing to complete questionnaires to monitor progress; we prefer to have treatment sessions audio recorded for supervision purposes
  • Able to undertake the treatment in a language shared with one of the therapists
  • Have a nominated local key worker (preferably a trained cognitive behavioural therapist) who we can liaise with over discharge and ensure adequate follow-up
  • Be able to travel alone on home leave
  • Support from local community mental health team
  • We ensure that regular reports and meetings take place with the referring team and that discharge back into the local community happens at the earliest opportunity

Exclusion criteria and thresholds

  • Under 18 years
  • Dependent on alcohol, illegal substances or benzodiazepines
  • Current psychosis or mania requiring active treatment
  • Current alcohol or substance dependence requiring treatment in its own right. People cannot use alcohol or illegal substances on hospital premises
  • Borderline personality disorder as the main problem that requires treatment. However, we can accept people who self-harm so long as there is no significant risk of severe injury, and the self-harm does not interfere with other residents who may have significant fears of contamination
  • Recent history of violence or harm to others that may jeopardise the safety of others on the unit
  • BMI less than 17.5
  • Clients who have had two full previous treatment admissions


As a national specialist service the interdependence is with the referring clinical team or GP and the mental health commissioner.

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

Inpatient

Care option: Assessment for treatment

Code: 56781

Unit: Per assessment

Description: Assessment involves completion of self-report questionnaires and up to a three-hour interview with a senior therapist or psychiatrist to assess suitability for treatment as either an outpatient or on the residential unit. The assessor will consult with the clinical team and provide a report with full recommendations. 

NHSE commissioned for people who fulfil the NHS England specified criteria. 

 

Care option: Treatment, obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), post-traumatic stress disorder (PTSD) and other severe anxiety disorders, 12 to 16 weeks

Code: 57770

Unit: Occupied bed days

Description: A residential unit programme and follow-up package, where people stay in a house within Bethlem Royal Hospital and undertake therapy with a cognitive behaviour therapist. Service users stay on average for 12 to 16 weeks. Home leave is integrated to ensure generalisation of improvements. People are also provided with an individually tailored occupational therapy programme, life skills sessions and compassionate mind groups within a therapeutic community. 

Three follow-ups are offered at one, two and three months post discharge. 

NHSE commissioned for people who fulfil the NHS England specified criteria.

 

Care option: Second opinion assessment

Code: 93351

Unit: Per assessment

Description: Second opinion assessments are for referrers who are seeking expert guidance and treatment options for their clients. Clients may have complex problems like failing to respond to previous treatments, a problem that is so severe, extensive co-morbidity or where diagnosis is unclear assessment involves completion of self-report questionnaires and up to a three-hour interview with a senior therapist or psychiatrist. 

The assessor will consult with the clinical team and provide a report with full recommendations. 

NHSE commissioned for people who fulfil the NHS England specified criteria.

Our experts

Alexandra Keyes: Read more

Jeremy Lock: Read more

Dr Robert Medcalf: Read more

Joel Oliver: Read more

Prof David Veale: Read more

Lisa Williams: Read more

 

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