Making a referral to the service
This page covers all the information that psychiatrists might need in order to make a referral to the service. We have included lots of specific questions in our referral frequently-asked questions page, and people are encouraged to read that for more information about referring from the private sector, who can refer, and referring from non-Scotland NHS organisations.
Referral checklist (OCD referrals only)
For OCD referrals, we ask that you also complete our referral checklist so that we also have key information that allows us to make a quick decision about referral. Having these details means that we don't have to ask for further information which can delay decisions about care and treatment. The checklist is downloadable in MS Word format so it can be completed electronically, or printed out and filled in manually.
Who can refer?
Referrals are accepted from throughout the UK and Ireland. For referrals originating within one of the Scottish Health Board areas, there is no requirement to seek financial authorisation for assessment. However, referrals from outside of Scotland will require funding to be approved. We would recommend that referrals from outside of the UK are only made following prior discussion.
Although we prefer referrals to come from consultant psychiatrists, we can accept referrals from other senior (non-consultant) psychiatrists. However, referrals need to have a named consultant psychiatrist who will retain overall responsibility for the patient during the assessment process. We require you to indicate who the named consultant is (even if it is a locum). Please get in touch if you are unsure.
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.
Criteria for OCD referrals
Our referral criteria for OCD are generally the same as those for similar specialist services for OCD throughout the UK. In order to be suitable for assessment, people usually need to have tried (and failed to respond to) the following:
- Two adequate trials of different serotonergic antidepressants (this includes all SSRIs and also Clomipramine), at doses suitable for OCD, and for suitable durations (usually around three months). A trial of Clomipramine is desirable, but not essential. See below for target doses.
- At least one trial of an augmentation strategy for OCD. This will usually be an antipsychotic medication such as Risperidone or Aripiprazole. If someone has had a trial of a different drug (such as Olanzapine or Quetiapine), we are very likely to make suggestions about further trials of better-evidenced drugs before we would be able to assess the patient.
- At least one trial of CBT/ ERP, with a total duration of at least 12 hours.
- Psychoeducation and support for the family.
If there are reasons why these criteria are not currently met, we would invite the potential referrer to get in touch with us to discuss further.
Target doses of SRIs for treating OCD
In principle, each trial should be at the maximum or maximum-tolerated dose for at least 10-12 weeks.
| Drug | Target dose |
| Fluoxetine | ≥ 40mg/ day |
| Sertraline | ≥ 200mg/ day |
| Citalopram | ≥ 40mg/ day (please note relevant warnings about high dose Citalopram) |
| Escitalopram | ≥ 20mg/ day |
| Paroxetine | ≥ 40mg/ day |
| Fluvoxamine | ≥ 200mg/ day |
| Clomipramine | ≥ 200mg/ day |
Guidance on referral letters
We don't require a referral proforma, but a standard referral letter containing the following information helps decision-making about the referral much quicker. If information is missing, we will often need to contact the referrer to obtain details about previous treatment, for example.
- Details about primary diagnosis, and concurrent (comorbid) diagnoses.
- Details of onset, duration, and pattern of symptoms over time.
- Description of current symptoms and their severity.
- Information about previous treatments (pharmacological and psychological), including approximate dates, doses and durations. Number of sessions (and modality) of psychological therapy is also helpful.
- Personal circumstances, including whether the patient requires support from carers/ relatives.
- Information about significant diagnostic uncertainty or ongoing conflicts about diagnosis/ treatment.
- Risks that we should know about, particularly if the patient might be seen at home.
- Expectations from assessment. For example, whether the referral is for treatment or clarification of diagnosis.
Where to send the referral
Our address is:
Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee
DD1 9SY
Our contacts page has additional information on how to get in touch if you have any questions.
Please use secure email for sending any patient-identifiable information. This means that both email addresses (sender and recipient) should end in either nhs.net or nhs.scot. Our 'enquiries' email should only be used for general enquiries.
Availability of case notes
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. Photocopies or electronic copies of case records are fine. Since treatment recommendations are usually based on a detailed understanding of previous treatments, if we can't access records in advance of assessment, we may have to postpone an assessment appointment until we have had the opportunity to review the notes.
If people have had previous treatment in other NHS Boards or NHS Trusts, it would be very helpful for the referrer to obtain the case notes prior to referral. This minimises delays in assessment or recommendations due to trying to obtain the notes.
Last Updated on 28 June 2024 by David Christmas