Please see our referral page for more information on making a referral. This contains all the information that clinicians should need in order to make a referral.

Not currently, because all patients are different and it's hard to capture all the most useful information in a single 'one-size-fits-all' form. We have, however, developed a referral checklist for patients with OCD. This is available on our 'how to refer' page, along with additional guidance on the most useful information to include in any referral letter.

No, we are not able to accept GP referrals. All referrals need to come from secondary care (i.e. specialist) mental health services. Ideally, it will be a consultant psychiatrist making the referral but there are some circumstances where a referral from a non-consultant psychiatrist will be accepted.

However, all patients need to be currently under the care of secondary care MH services and have a named consultant psychiatrist overseeing their care.

We sometimes have enquiries from psychiatrists working within the private sector about referring a patient for treatment. Such a route of referral may be possible if a designated NHS consultant psychiatrist agrees to take over formal care of the patient; not just for the referral for but for any follow-up care as well.

How to Transfer Care

1. It may be the case that the patient is already being seen by an NHS consultant and the patient is only receiving additional services (such as therapy) within the private sector. In this case, we would advise that you discuss the matter with the patient's NHS consultant who should make the referral.
2. If the patient is not in contact with NHS psychiatric services, then a referral should be made by the General Practitioner (GP) to the local community mental health team (CMHT). This ensures that the GP remains 'in the loop' and makes sure the patient is within NHS services.
3. Finally, if you are an NHS consultant psychiatrist but are seeing the patient privately, we would suggest that the referral is made via the NHS part of the patient's care and that their ongoing care is delivered by the NHS.

We are able to assess patients from England or Wales, but separate funding needs to be confirmed before we can accept the referral. Also, it is very difficult to provide estimated costs for any OCD treatment package because of the bespoke nature of treatment (the patient may need treatment at home, for example). Therefore, we ask clinicians to contact us before making such a referral. This makes it easier to provide guidance on funding issues and we may also be able to recommend that if the patient has OCD, they are seen by English specialist (tertiary) services rather than being referred to us. This pathway does not usually have additional costs to English commissioners.

Not necessarily. However, we do require all patients to have a named NHS consultant who is in charge of their care and we expect any referrals to have already been discussed with the consultant.

Yes...most of the time. We recognise that locum psychiatrists make up a significant proportion of the NHS workforce and we will accept referrals from locums.

However, we normally expect that locums who are making referrals will have seen the patient on several occasions previously and have a reasonable expectation that they will continue to provide ongoing care after assessment and treatment recommendations. This is to ensure that appropriate assessments and case reviews have been done, that the locum is familiar with the case, and that there is appropriate continuity of care after any assessment.

If these conditions are not met, we would advise you to get in touch with us before making a referral.

No. Although most people we see are between the ages of 18 and 65, we will see people under the age of 18 and over the age of 65. In most cases, however, we would invite the referrer to get in touch before making a referral so that we can make sure a referral to our service is the best option.

In some circumstances (e.g. onset of first episode of depression in later life) we might ask for additional investigations (such as an MRI and neuropsychological testing) to be completed before making a referral.

We assess the majority of people in Dundee. However, where people cannot travel (perhaps because they are too unwell or in hospital), we will discuss the best place to assess the patient with the referring clinician.

If you feel that your patient cannot be seen for assessment in Dundee, we would be grateful if you could indicate this in the referral letter. We will then explore alternative arrangements with the referrer and the patient.

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. We also have a specific email address for general 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 doctors may be wary of giving details when making a 'casual' enquiry but having a name allows us to track individuals through the referral and assessment process and to make sure that there are no preventable delays. 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 are happening in Primary Care Trusts outwith Scotland.

In most cases, where the patient is detained under the Mental Health Act, we will arrange to visit the patient in their locality. All additional costs of assessment will need to be funded by the referring NHS organisation.

If the patient remains subject to compulsory powers, and the patient is to be seen in Dundee, the host Primary Care Trust will need to contact the Department of Health (who will liaise 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.

We would be happy to provide estimates on the costs of multidisciplinary local assessment.

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

Before offering an appointment, we will try to discuss the best place to see people with the referrer. We are able to visit hospitals in Scotland where this is the preferred option.

Yes, and they 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:

1. Two adequate trials of 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.
2. At least one trial of an augmentation strategy for OCD. This will ideally 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 may make suggestions about trials of better-evidenced drugs, but will assess each case on an individual basis.
3. At least one trial of CBT/ ERP, with a total duration of at least 12 hours.
4. Psychoeducation and support for the family.

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 (most of which will presumably have been included in the referral letter) 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. Either is fine.

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.

We are able to assess patients from England or Wales, but separate funding needs to be confirmed before we can accept the referral. Also, it is very difficult to provide estimated costs for any treatment package because of the bespoke nature of treatment (the patient may need treatment at home, for example). Therefore, we ask clinicians to contact us before making such a referral. This makes it easier to provide guidance on funding issues and we may also be able to recommend that the patient is seen by English specialist (tertiary) services rather than being referred to us.

The NICE guidelines on OCD are a good place to start, but like most NICE guidelines they only deal with the first few steps. We've put together some thoughts and suggestions about a whole range of treatments in our guide to treating OCD. We cover: a) choice of antidepressant; b) augmentation strategies; c) psychological treatment; and d) include information on making a referral to us.

We recognise that it can often be difficult to access the kind of psychological therapy that is often recommended by guidelines. Patients with more severe and more chronic OCD will often need longer sessions, for more time, and treatment often has to be delivered at home. Most services struggle to deliver treatment outside of an office-based environment.

We would advise getting in touch to discuss things with us. We can often liaise with local services to help support delivery of treatment (a.k.a. 'outreach'), and to look at options for ensuring that people don't get caught in a catch-22 where they need more treatment, but can't get that treatment locally.

This can be very difficult to untangle and often it's a complex combination of both. We fully recognise that mapping out complicated symptoms can be challenging and can take a lot of time. Over the years, we have developed a range of tools that can be helpful for trying to understand which symptoms might respond to treatment. Please get in touch if you'd like more information.

Our general advice is where someone has only compulsive behaviours with a well-established diagnosis of ASD, it's not clear that we would have much to offer. However, where there is significant diagnostic uncertainty, and where someone has clear symptoms of OCD along with other behaviours that are more autistic, we would suggest that you get in touch to discuss the patient. Whilst we cannot guarantee that we would be able to offer treatment within the AIS, we often suggest that a comprehensive diagnostic assessment and recommendations for further treatment can be helpful in moving care forward.

Again, overlaps between OCD and OCPD can be complex, and both can often co-exist. It's probably worth bearing in mind that with the introduction of ICD-11 a distinct diagnosis of OCPD will no longer exist (although 'anankastia' as a type of personality disorder will still exist).

The transition to a different way of approaching personality disorder in ICD-11 is likely to be a slow one, but there is no reason why someone cannot have both OCD and 'anankastic' personality disorder/ personality difficulties. It is unlikely that someone will have symptoms of OCD that are very similar to those of personality disorder - it will usually be possible to separate them out.

Where there is diagnostic uncertainty, we would suggest that the clinician gets in touch with us to discuss further. Further discussions about previous treatment, and current symptoms may be helpful in understanding if it would be helpful for us to see someone for further assessment.

Sometimes. Although we are not commissioned to provide assessment and treatment of bipolar disorder, we are able to assess patients with bipolar disorder if:

1. The prevailing pattern is one of chronic or recurrent depression, rather than a more unstable or rapid-cycling pattern;
2. The current episode is chronic depression (i.e. symptoms persisting for at least two years);
3. Guideline-based treatment for bipolar depression has been followed and the patient has not responded to treatment.

We would advise clinicians to get in touch with us to discuss these (and other) presentations.

We are not commissioned to see patients with primary body dysmorphic disorder (BDD). Unfortunately, there are no specialist services for BDD in Scotland.

However, where the BDD is occurring as a symptom within comorbid OCD, or where there is significant diagnostic uncertainty we would advise the referrer to discuss the case with us prior to referral. We may be able to advise on whether referral to us is the preferred option, or if a referral to specialist BDD services in England would be recommended.

There is more information on specialist BDD services in England on the BDD Foundation website.

Please note that any assessment and/ or treatment for BDD outwith Scotland will require funding from the referring NHS Board. A recommendation/ assessment from us should not be required in order for NHS Boards to make a referral for such services.

Again, overlaps between OCD and OCPD can be complex, and both can often co-exist. It's probably worth bearing in mind that with the introduction of ICD-11, a distinct diagnosis of OCPD will no longer exist (although 'anankastia' as a type of personality disorder will still exist).

The transition to a different way of approaching personality disorder in ICD-11 is likely to be a slow one, but there is no reason why someone cannot have both OCD and 'anankastic' personality disorder/ personality difficulties. It is unlikely that someone will have symptoms of OCD that are very similar to those of personality disorder - it will usually be possible to separate them out.

Where there is diagnostic uncertainty, we would suggest that the clinician gets in touch with us to discuss further. Further discussions about previous treatment, and current symptoms may be helpful in understanding if it would be helpful for us to see someone for further assessment.

Although many of the people we see have a concurrent diagnosis of ASD, we cannot provide assessment or treatment for individuals with autism alone. If a clinician is referring someone who has ritualised behaviour but few obvious obsessions, we would normally have a discussion with the referrer about whether it is more likely that the patient has a primary diagnosis of autism. If it is unclear, we might suggest a more detailed diagnostic assessment for ASD prior to referral to us.

We are happy to offer general advice to clinicians who are treating someone with a diagnosis of both OCD and ASD as any psychological/ behavioural therapy needs to be mindful of the similarities and differences between the diagnoses. For example, exposure-based therapy is the preferred treatment for OCD but may make anxiety and distress much worse for someone with ASD; so understanding which symptoms are related to which diagnosis is important.

Although we are not commissioned to provide assessment or treatment for eating disorders (anorexia nervosa) we recognise that many of the core features of anorexia are similar to those of OCD. The conditions may mimic each other and/ or co-exist. Although we don't have very specific criteria we would probably be expecting referrals to have the following characteristics:

1. The primary diagnosis is OCD and anorexia is thought to be a secondary feature. It is common for secondary weight restriction to occur as a result of severe OCD symptoms relating to contamination. It would be unusual for OCD to develop secondary to anorexia.
2. The patient's weight is stable and they are able to maintain their weight without active refeeding.
3. Although there aren't strict BMI thresholds, it is understandable that BMI may be reduced. However, it is important that there has not been sufficient weight loss to affect cognitive function (for example) since this will affect the patient's ability to respond to targeted treatment for OCD symptoms.
4. There have been robust approaches to weight restoration and weight maintenance and these are ongoing (where required).
5. There are no issues relating to blood test abnormalities, ECG abnormalities, or muscle power. Essentially, the patient is physically stable and not requiring active treatment.
6. The patient is under active review by secondary care MH services.
7. All the same criteria for referral for OCD patients would apply. This would include the expectation that evidence-based treatments for OCD have been tried and demonstrated to be ineffective. This will usually involve prospective ratings of OCD symptoms and monitoring of weight/ anorexic symptoms.

In all cases we would advise referrers to get in touch with us. We will probably ask for more information about the patient's presentation, history of OCD symptoms, current physical health, current and previous treatment.