Anxiety Disorders Residential Unit

Referrer information

The Anxiety Disorders Residential Unit offers a national service in cognitive behaviour therapy (CBT) where people can stay in a residential unit throughout treatment. This service, based at the Bethlem Royal Hospital is unique in the UK.

Although we treat adults with anxiety disorders, we specialize in the treatment of Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), a specific phobia of vomiting and habits such as skin picking and trichotillomania.

The multidisciplinary team is run under the direction of Dr. David Veale, Consultant Psychiatrist in CBT, and Head and Principal Therapist Simon Darnley. The unit has a long history of high quality care with proven outcome results.

The service is especially suitable for those who have not made sufficient progress locally or where services are not developed. We also specialise in the treatment of patients with complex additional problems (for example, people who have difficulties in relationships; low self esteem, and past traumatic experiences).

We will also take referrals for the National Commissioning Group scheme for severe OCD and BDD.

Our philosophy and approach

We believe that everyone has the potential to overcome their problems and increase the quality of their life no matter what past treatment they have had or how long they have had their problems.

Our therapy is based on current research, is evidence based and recommended by the NICE guidelines on various anxiety disorders. We continually monitor our effectiveness using questionnaires as well as feedback from patients and carers. We will continually update our therapy in line with research and feedback.

Our programme will be tailored to your individual needs. We will not ask anything of you that we would not expect of ourselves. We will be honest, respectful and open throughout the time you spend with us.

Our emphasis is for you to discover alternative ways of thinking, behaving and learning about your problems to maintain a long term change.

We expect you to be prepared to gradually face your fears and learn how this can change your life for the better. We will provide a safe, caring and supportive environment for you to do this.

While at the unit we expect you to make treatment the main focus of your stay and work on this every day. We encourage each person to share, learn, support and strengthen each other in making the difficult changes necessary to move forward.

How you will reach your goals

The Unit (ADRU)

ADRU is based in 2 buildings within the grounds of the Bethlem Royal Hospital; Longfield House and Alexandra House.

Longfield House

A 12 bedded detached house where all residents live during their stay. Longfield House is set in open spaces and protected woodland. You will have your own bedroom with wash basin. We have laundry facilities as well as TV room, dining room, meeting room, telephone room, and quiet room. Other facilities on site include gym, tennis court and an indoor swimming pool.

Also within Longfield House, there is a self-contained flat for specific therapy use consisting of lounge, double bedroom, fully equipped kitchen, and shower room/WC.

You will be expected to live with other people with similar problems learning from each other. We foster an environment where our patients are living the therapy and their recovery.

All meals, linen, duvet, towels are provided. We cater for all dietary needs. We have our own housekeeper who is responsible for the day to day running of the house.

Staff

The therapy team is made up of psychotherapists, psychologists, psychiatrists, occupational therapists, administrators and a housekeeper.

Carers Group

The carers only group aims to provide support and information for all carers, family and friends of people with Anxiety Disorders. The group is facilitated by therapists and runs from 2.00pm -3.30pm the first Friday of every month.

We also provide weekly Life Skills teaching group and support group.

Exclusion criteria

We are always flexible in considering referrals, but as our unit is unstaffed at night, there are times we cannot admit people. People admitted to the unit cannot:

It is also important that all residents have their own accommodation throughout their admission.

We also ask your referrer be able to make a bed available within your local services within 24 hours if an emergency arises.

Prior to admission

Prior to admission you should have read one of the following:

These books will prepare you for our approach to your problems and give you an idea of what to expect in treatment.

Admission

Admissions to the unit are for an initial 2-week assessment period during which time you can decide if you are willing and able take part in the treatment we offer. During this time you and the team will decide if the treatment we offer is suitable for you. Each person recovers at a different pace, on average treatment lasts from 8-12 weeks. The team will review your progress weekly and if you are not engaging in treatment we may discharge you. If this is the case you can be referred to return when you are more ready to change

As treatment progresses you will want to spend longer and longer periods at home so that you can practice what you have learnt in therapy.

Discharge and follow-up

Discharge planning starts within the first few weeks of treatment with a discharge date usually being set after mid-treatment review. We will liaise with your local services to identify a co-therapist who can work with you after discharge. We offer 2 follow up appointments within 12 months of your discharge to monitor and encourage further progress.

Referrals

Referrals are accepted on a national basis for service users whose GP is registered outside the catchment area of Lambeth, Southwark, and Lewisham. The unit cannot usually accept referrals from a service user's GP. A referral must be made by a member of the service user's community mental health team or consultant psychiatrist. Referrals should be made to:
Dr David Veale
Anxiety Disorders Residential Unit
Bethlem Royal Hospital
Monks Orchard Road
Beckenham
Kent BR3 3BX
Enquiries: Telephone: 020 3228 4146, Fax: 020 3228 4051 or email: Kaye.Wake@slam.nhs.uk

An initial assessment is offered to service users who are referred to determine the nature of their problem and suitability for treatment.

Further information about referrals in BDD

Our service does not do psychiatric or psychological assesments for people who are requesting a cosmetic procedure to be funded by their Primary Care Trust as an exceptional case. An example is a woman who is requesting breast augmentation or reduction or a person who has lost a lot of weight and is seeking abdominoplasty or liposuction. Referrals for assessments for cosmetic procedures should be guided towards a person's catchment area service or relevant specialist service (e.g eating disorders if they have anorexia nervosa or bulimia).

We take referrals of patients who may have Body Dysmorphic Disorder (that is people who are preoccupied and very distressed by a minor bodily defect or one that is not generally noticeable to others) and who may be interested in a psychological treamtent and/or advice on medication. People with eating disorders with body image problems around their weight and shape should be referred to the eating disorders unit. People who have an eating disorder and who are ALSO preoccupied and distressed with, for example, their face are appropriate to refer to us for an assessment and we may then refer them on to the eating disorders unit, depending on the outcome of the asessment of the main problem.

Exclusion criteria:

  1. Current psychosis or mania requiring active treatment.
  2. Current alcohol or substance dependence requiring treatment in its own right. Alcohol and substance misuse can be included if not the main problem and will not interfere in CBT. Service users cannot however use alcohol or illegal substances on hospital premises.
  3. Severe depressive disorder as the main problem requiring treatment in its own right. This excludes individuals who are severely self-neglectful, psychomotor retarded or an immediate suicide risk.
  4. Borderline Personality Disorder (BPD) as the main problem and requiring treatment in its own right. We are however able to accept people with BPD who harm themselves 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.
  5. Recent history of violence or harm to others that may jeopardise safety of others on the unit.
  6. If taking psychotropic medication, the service user should be on a stable dose prior to starting treatment. Medication may be reviewed during admission, but in general, it is kept stable.
  7. Note we do not take people under a Section of the Mental Health Act

Inclusion criteria

Our residents must:

  1. Be willing to complete questionnaires to monitor progress. There is a strong preference by the team to have treatment sessions audio-taped for supervision purposes.
  2. Be able to conduct the treatment in a language shared with one of the therapists on the unit.
  3. Be willing to travel home on weekend leave (or with relative or friends initially)
  4. Have basic self-care skills and be able to self-medicate
  5. Have accommodation maintained in the community throughout their admission to go on home leave. If a person's condition deteriorates then a bed must be made available at a service user's local psychiatric hospital or alternative arrangements made within the community.
  6. Have a nominated local key worker (preferably a trained cognitive behaviour therapist) who can liase over discharge and ensure adequate follow up.

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