Service Detail

CLINICAL EXCLUSION CRITERIA 

• Patients who are not yet at a point where willing to actively participate in exposure-based therapy, where applicable, as this is a core component of our treatment.
• 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 Clients who are actively psychotic - symptoms of psychosis or bipolar affective disorder need to be stabilised before treating an anxiety disorder.
• We will also assess whether CBT and high levels of anxiety could aggravate any psychosis or bipolarity and make it difficult to manage in our environment (for example paranoia) or to engage in therapy.
• Current severe depression requiring treatment in its own right, in particular ongoing self-harm or immediate suicide risk.
• Personality disorder, emotional regulation or enduring personality characteristics which require treatment in their own right.
• Clients who have a history of violent or impulsive behaviour that requires treatment in its own right.  Here the concern is predominantly about risk to other residents.
• Individuals in inpatient care, or who have been discharged from inpatient care for less than 6 months, or who require inpatient care.
• Unstable housing, e.g. temporary accommodation, risk of eviction, preoccupation with housing situation.   
• Preoccupation with asylum status, e.g. awaiting an appeal hearing, unable to put thoughts of this process out of mind.  Where people are preoccupied by current psychosocial stressors like asylum status, we may recommend referral once these issues have been resolved.
• 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.
• For BDD referrals, we do not see clients who are seeking psychological assessment to enable them to receive surgery on their appearance, nor do we take on clients for CBT who are currently having or planning to have cosmetic surgery, as this is contraindicated to a CBT approach.
• 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 15, electrolyte imbalance, ongoing medical investigations or indication of a need for medical investigation in the first instance.
• Not motivated or willing to attend therapy sessions or to have Cognitive Behaviour Therapy.
• Moderate or severe learning disability.
• Dissociation, including dissociative identity disorder (DID).
• As a specialist anxiety treatment clinic, we only offer 20 weeks of residential 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.
• Referrals requesting assessment and treatment for skin picking.
• We do not treat compulsive hoarding.
• There have been two or more incidents of presenting in crisis in the last 12 months, eg: presenting to A&E or calling the police.
• Two or more discontinuations of treatment in adult life, e.g. dropped out of treatment early.   If previously engaged with a full course of high quality and evidence-based intervention, the client must demonstrate engagement and benefit.
• Not have a major reduction in symptoms by virtue of admission and changing the context in which the compulsions and avoidance occur.  For example, a reduction in responsibility may occur as a resident transfers responsibility on to staff and other residents (eg. checking of door locks).  A change in environment may mean reduced OCD symptoms in the short term (for example “an OCD holiday”) or a lack of generalisation of gains made.  In this case, there is an expectation to find new targets when away from home.  Bringing cues from home or home leave generally helps to resolve this difficulty.
• Clients who have had 2 full previous treatment admissions at this Unit.
• It is clear from the referral that the client meets post assessment exclusion criteria.