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About the Advanced Interventions Service

The Dundee Advanced Interventions Service is a specialist service providing assessment and treatment for severe and chronic treatment-refractory depression (TRD) and obsessive-compulsive disorder (OCD).

We are a National Specialist Service, which means that we are one of over 70 national services in Scotland, receiving funding directly from the National Services Division (NSD) of NHS Scotland. Referrals (and some treatments, such as neurosurgery or intensive exposure and response prevention) are cost-free to NHS Boards in Scotland. This works because monies for specialist services are 'top sliced' from money given to NHS Boards by the Scottish Executive.

We are 'hosted' by NHS Tayside and whilst most of the staff are employed by NHS Tayside, many of the staff hold honorary contracts (or indeed, full contracts) with the University of Dundee.


 

How to Refer to the Service

NHS organisations in Scotland who wish to make a referral can do so without having to apply for separate funding. NHS Trusts in England and Wales are required to obtain funding before patients can be seen.

Please see the table below to determine whether funding is required:

Patient from:

Assessment

NMD

VNS

Intensive ERP

Scotland

Funding not needed

Funding not needed

Funding required

Funding not needed

England / Wales / NI / Eire

Funding required

Funding required

Funding required

Funding required

Patients from Scotland can be assessed without additional funding. If they proceed to neurosurgery, this can be provided within the Service Level Agreement (SLA). If Vagus Nerve Stimulation (VNS) is requested and is clinically-appropriate, additional funding will be required even for Scottish patients as VNS is no longer funded as part of our SLA.


 

How to get in touch with the service

Our mailing address is:

Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee
DD1 9SY

Our main telephone number is:

+44 (0)1382 496233

Our fax number is:

+44 (0)1382 633865

We have a number of email addresses which will ensure that your query reaches the best person:

 

Use this address

For

This email address is being protected from spambots. You need JavaScript enabled to view it. Patient enquiries about the service. Note that we will not routinely give individual advice on treatment.
This email address is being protected from spambots. You need JavaScript enabled to view it. Clinicians wishing information about the referral process. You might find the information you need on the referrals page. Note that we do not accept referrals via email, and patient-identifiable information should not be sent.

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Information for patients and carers

How referral is made

The following criteria guide the referral process:

  1. Referrals should come from a consultant psychiatrist working in the NHS.
  2. All patients should have a nominated consultant psychiatrist who will retain responsibility for the individual's care.
  3. Referrals will be accepted from throughout the UK. Individuals referred from out with the UK may be considered for assessment. However, the process of acquiring external funding may take longer and may be more complex than usual. We would encourage the referrer to discuss such a potential referral with us.
  4. If you are not resident in Scotland, funding may be required for assessment. Unfortunately, we cannot allocate appointment dates until we have confirmation of funding.

Can I pay privately?

Due to the nature of the service, we unable to accept self-referrals and individuals cannot fund their own assessment/ treatment. The AIS works within the NHS, which has, at its core, a different method of funding than many other countries' systems.

More importantly, in order to deliver the highest levels of service we believe that individuals must receive treatment with the support of - and in the context of - an ongoing package of care from their local services and this could not be guaranteed if we accepted private patients.

What happens during assessment?

It is important to remember that everything starts with assessment. You may have been referred with a view to suitability for a particular treatment but we this is only a small part of the process.

Prior to your visit, we would review your casenotes to get helpful information about the course of your illness and we will complete a detailed review of previous treatments.

Typically, assessment will take most of the day. The morning consists of detailed assessment of symptoms, confirmation of diagnosis, and psychiatric history. We will commonly use a variety of validated rating scales. After lunch, time is spent reviewing the adequacy of previous psychological treatments. Finally, we will meet with you (and accompanying family/ spouse) to discuss the likely outcome of assessment and some of our recommendations.

In many cases, we will be unable to give a full report on the day but we hope to be able to explain whether particular treatments are appropriate, and which treatments may be recommended.

Who gets the report?

We aim to send the report to your consultant psychiatrist within 3-4 weeks of being seen. Your GP will also receive a copy. The report may be delayed if case notes are not sent to us in time.

In most cases, we will offer you the chance to have a copy of the completed report. You do not have to accept, but many people find it helpful to have the information when they next meet up with their psychiatrist.

What is the outcome of assessment?

Quite frequently our recommendations will comprise of a number of recommendations:

  1. We may recommend that you receive a particular psychological treatment, and we will usually ask that this is provided locally.
  2. We may make recommendations regarding additional drug treatments that haven't been tried, and which may offer reasonable chances of success.
  3. We may explain that most criteria are met for interventions such as Anterior Cingulotomy. However, in most cases the time taken from assessment to surgery can be lengthy and we rarely make such recommendations without suggesting that further antidepressants or psychological treatments are tried in the meantime.

We will not always arrange a follow-up appointment after assessment, and most people will return back to the follow-up of their own psychiatric team.


 

Information on making a referral to the Advanced Interventions Service

Making an enquiry

We encourage psychiatrists to get in touch with us if they have any queries about suitability of their patients, or the referral process. Our telephone number is on the contacts page, and email addresses for the staff are also available. We also have a specific email address for enquiries.

If you do contact us, it is extremely helpful for us to have some details of the patient you are calling about. We acknowledge that some people may be wary of giving details when making a 'casual' enquiry but at least having a name allows us to track individuals through the referral and assesment process. For example, it is useful to know if it takes 3-6 months after an initial enquiry before we receive a referral. Long delays might reflect funding applications which occur in Primary Care Trusts out with Scotland.

Referral Guidelines

  1. Referrals are accepted from consultant psychiatrists only.  All referred patients should have a nominated consultant psychiatrist who will retain clinical responsibility for the patient during the assessment process. Psychiatrists working in the private sector are referred to the information on transfer of care.
  2. Referrals are accepted on the understanding that the referring consultant retains overall clinical responsibility for the ongoing care of the patient, including the implementation of any treatment recommendations made by the service.
  3. Referrals are accepted from throughout the UK and Ireland. We would recommend that referrals from outside of the UK are only made following prior discussion.
  4. All referrals require a formal letter detailing current circumstances, clinical history, a summary of previous treatments, and the current treatment plan. We require referral letters to be sent by post (not e-mail).
  5. We will be pleased to discuss any preliminary queries about referral by telephone, or by e-mail.
  6. To facilitate the assessment process, we require timely access to all relevant clinical case records (psychiatric / general medical / clinical psychology). All case records should be with us at least 2 weeks before the patient is seen (see 7. below).  Copies of contemporary case records are acceptable. We would expect that a comprehensive medication review will have been completed prior to referral and that ECT records (if applicable) will be provided.
  7. Treatment recommendations are usually dependent upon a detailed review of previous treatments. Where case records cannot be reviewed in advance of assessment, we may be forced to defer an assessment appointment until we have had the opportunity to review the notes.  We believe that it is more acceptable for patients to attend when all relevant information is available.
  8. Please note that we aim to provide a comprehensive, multidisciplinary, assessment service and to generate the most suitable, evidence-based and effective treatment recommendations tailored for each individual patient. This may, or may not, involve neurosurgical treatment methods. Accordingly, we generally discourage referrers and patients from assuming in advance they are being considered for any one specific therapy.   
  9. For referrals originating within one of the Scottish Health Board areas, there is no requirement to seek financial authorisation for assessment.
  10. For referrals originating from elsewhere in the UK, we can only proceed with assessment following receipt of written confirmation that funding has been authorised by the relevant local body (Primary Care Trust, Health Board, etc.).
  11. We aim to acknowledge and to respond to your referral within 10 working days of receipt.

How to make a referral

  1. Please read the criteria for ablative neurosurgery and criteria for VNS to ensure that the patient is suitable. If you are uncertain, please contact us to discuss a possible referral.
  2. You may find it helpful to review treatment pathways for treatment-refractory depression and Treatment Guidelines for OCD when consideration is given to referring a patient. However, it is not expected (or required) that all possible treatment trials have been exhausted at the time of referral.
  3. Our address is given here. It is helpful to have as much information as possible regarding clinical history and previous treatments. Whilst the patient may be referred for assessment of suitability for a particular treatment, we focus on assessment as being the initial contact.
  4. We would aim to acknowledge your referral within a week or two and would hope to be able to give you an approximate time when the patient would be seen. For patients outside of Scotland, this is dependent on funding being available and the casenotes being sent for review.
  5. If funding is required, we will not be able to see the patient until we have written confirmation of funding for the assessment.

Assessment Location

  1. We anticipate that patients will normally be able to travel to Dundee for assessment.  However, it is acknowledged that there are clinical circumstances where it is better for us to travel to conduct the assessment:
  • Where the patient is currently a hospital inpatient and travel to Dundee may be impractical.
  • Where the patient cannot attend for reasons such as: infirmity, risks related to mental state, legal status, or inability to leave home.
  • Where it is considered of additional importance to assess the patient at home. For example, in the case of severe obsessive-compulsive disorder.
  1. If you feel that your patient would be unable to attend Dundee, or that a local assessment would be preferable, please indicate this in the referral letter. We would normally make arrangements to visit the patient at the most appropriate location for them.

PDF SmallReferral Guidelines (PDF; 192Kb)

 

Transferring detained patients from England/ Wales to Scotland

In most cases, where the patient is detained under the Mental Health Act, we will arrange to visit the patient in their locality.

Should neurosurgical treatment be offerred, and where the patient remains subject to compulsory powers, the host Primary Care Trust will need to contact the Department of Health (who will liasise with the Scottish Government) to ensure that the same (or equivalent) compulsory powers remain in place once the patient crosses the border. Information, and the relevant forms, can be obtained from the Department of Health's webpage on Cross-border transfers of patients under the Mental Health Act.

When the patient is being transferred back to England/ Wales, we will liaise with the Health Division of the Scottish Government to ensure that the transfer takes place with continuity of the compulsory powers.

It should be noted, however, that the majority of patients undergoing neurosurgery in Scotland and England are not subject to compulsory powers under the Mental Health Act(s).


 

National Services Scotland

Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee, DD1 9SY. UK.
Tel: +44 (0)1382 496233

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