Some individuals, following detailed assessment, are recommended to have treatment while staying in our local inpatient unit (Carseview Centre). The length of the stay is typically around 3-4 weeks. People are encouraged to use their new skills in managing their OCD in increasingly normal situations and latterly in their own homes. Currently the therapy is delivered on an individual basis.
The first week of the stay involves understanding how their OCD 'works' for them, and developing with the therapist an outline programme for the next week. This means that the therapist and person agree what will happen in their treatment programme in terms of exposure and response prevention. These plans are reviewed weekly. The agreed plan can be adapted or changed to suit the individual and their pace of progress. The aim of treatment is to deliver around 15 hours of therapist-guided ERP each week, supported by self-directed 'homework'. The overall goal of a treatment programme is to deliver 40-60 hours of treatment.
At the end of inpatient treatment, the AIS therapists will deliver around one week of treatment at home, helping the family to support the changes and to change the 'rules' that sustained previous behaviours.
In addition we believe it is an advantage for the services that originally referred the person to be involved in the later stages of the treatment. This enables them to understand not only the patient and their difficulties, but also the nature of their treatment and how to ensure progress continues when the person returns home.
Making a referral
We invite referrals from senior clinicians who have been involved in the previous management of the patient. Whilst we would consider referrals on a case-by-case basis, it is generally expected that patients will have failed to respond to a range of pharmacological and psychological treatments. This would typically include at least two trials of a Serotonin Reuptake Inhibitor (one of which should ideally be Clomipramine), and a trial of an antipsychotic drug (ideally Risperidone) as an augmentation agent.
In addition, patients should have had a robust trial of Exposure and Response Prevention (ERP) delivered by a therapist with expertise in OCD.
Where there have been difficulties in accessing or delivering ERP, we would suggest that clinicians discuss such referrals with us. We recognise that access to skilled ERP is sometimes difficult and we may be able to help with delivering local workshops and training.
Please note that the thresholds for referral to the AIS for specialist assessment and the thresholds for admission to the intensive treatment programme are different. Not all patients assessed will be considered suitable for intensive treatment - most people will receive further recommendations for treatment.
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