Centre for Specialist Psychological Treatments of Anxiety and Related Problems Information for people interested in accessing treatment at the Centre and those who already have a referral Welcome Welcome to this information page. We hope that it provides useful information about the Centre for Specialist Psychological Treatments of Anxiety and Related Problems. We are keen that you have as much information as you feel you d like about the particular problem you are experiencing and the treatment options available to you. Below we describe the types of problem the Centre is able to help with, the psychological therapy it is able to offer, and what an assessment at the Centre would be like. We also include a guide to the administrative / funding stages in seeking a referral, assessment and treatment at the Centre. This guide has been written jointly by staff members and people who have accessed psychological services in the past. How the Centre was set up Prof Paul Salkovskis is a consultant clinical psychologist and the Clinical Director of the Centre. Paul moved to the University of Bath in 2010 to set up a new programme to train clinical psychologists. You may know that clinical psychologists offer psychological therapies. They do not prescribe medication. Previously Paul was one of the Clinical Directors at the Centre for Anxiety Disorders & Trauma at the Maudsley Hospital in London. In 2013, through a partnership between the University of Bath and the Avon & Wiltshire Mental Health Partnership NHS Trust, Paul set up the Centre for Specialist Psychological Treatments of Anxiety and Related Problems. It is a specialist NHS clinic. Alongside his teaching and research work Paul supervises members of the Centre staff in their clinical work and sees some patients himself. Paul supporting OCD-UK 1
What sort of problems can the Centre help with? As the name suggests, the Centre concentrates on treating anxiety-related problems. For example, the Centre has helped people with problems such as obsessive compulsive disorder (OCD), hoarding disorder, emetophobia (fear of being sick and the consequences of being sick), panic disorder, heath anxiety, phobias and social anxiety. We also specialise in working with people with anxiety difficulties within the context of physical health problems. The people we see have usually accessed local services previously but for whatever reason the treatments they have been offered have not helped, or not in a lasting way. We offer people psychological therapies recommended by the NICE (National Institute for Health and Clinical Excellence) guidelines for their particular problem. You may know that NICE is the scientific body that advises the health service about treatment. This usually involves offering a specialist course of cognitive behavioural therapy (CBT) specifically designed for the problem you are experiencing. You may know that distinct specialist CBT programmes have now been developed for each of the anxiety disorders. It is very common for people to have more than one problem. And each person s story and situation is unique. Working alongside you we would seek to understand the problems you are experiencing and develop a psychological treatment programme specific to your individual needs. For some people that we work with their problems can be so severe that they feel distressed to the extent they feel like harming themselves. Although we aren t able to offer emergency/crisis support services, if we have any concerns regarding your safety at any point we would discuss this with you and work in collaboration with you and your care team so that you can access crisis support services in your local area. If you are worried about your own safety you should seek help from local services for example local mental health services. Who can be referred to the Centre? We accept referrals made by any NHS health professional for any person within the United Kingdom who is experiencing an anxiety problem. There are no age or location restrictions, nor do we have any requirements for people to have tried any particular course of psychological or medical intervention previously. Often the people we see have tried many things before but we don t make this a condition for being accepted for treatment in the clinic. It is important to remember however, that funding authorities are likely to consider these factors when deciding whether to fund referrals or not. What would an assessment be like? In the assessment we aim to learn from you as much as we can about the problems you are experiencing so that we can find out together whether the therapy the Centre could offer would be appropriate for you. There would be ample opportunities for you to discuss your particular problem and the treatment options available to you. Please feel free to ask anything you would like to know about the Centre and the approach we take. We would ask if you could kindly fill out a number of clinical questionnaires before the day of your assessment. These questionnaires add to what you tell us during the assessment session. They help us understand more about the specific problems you are experiencing and how severely they are affecting your everyday life. We will of course share and discuss with you what we learn from the questionnaires. A typical assessment appointment will be approximately 2-3 hours in duration. While the assessment process can be quite emotionally tiring, we hope that you will come away from it feeling that you have been understood and listened to with respect and kindness, that you 2
and the therapist have been able to explore your problem in depth, and that you have a better understanding of your problem and the treatment options available to you, including the treatment that we could offer you at the Centre if this is appropriate. The University of Bath Flexible delivery of assessment and treatment One important feature of the specialist psychological treatment offered by the Centre is that it is flexible. For example, most people attending the Centre travel to the University of Bath for their assessment. But if your problem makes it impossible for you to leave your home and meet us in Bath we could come and meet you at your home, for example. When people get to the treatment stage some people prefer to have their CBT sessions in a traditional format e.g. weekly or fortnightly. But we can also offer the same number of CBT sessions in a more intensive format e.g. with all sessions taking place within a two to three week time period. Different people find different modes helpful. Some people choose to do a combination of both. We are keen to conduct assessment and treatment sessions in the place that will help people most, providing the maximum benefit. People often tell us that they have previously received treatment in a traditional therapy room context, and although often finding this very helpful, it has been a real struggle to implement this useful work in the environment where they experience the problem most severely. It is precisely these environments and contexts where we aim to be present and support you in putting the ideas from therapy into practice. Often, this means that what we are able to offer is intensive sessions in the most relevant treatment context. We sometimes get asked if we have an in-patient unit, which typically are clinics where people stay on a hospital ward for a few weeks and receive treatment in this environment. Although this can be very helpful for people, it is not a treatment option that we provide. Referral, assessment and treatment: a guide to the administrative / funding stages As an NHS clinic there are no fees to be paid by you to receive treatment. However, due to us being a specialist clinic which is part of Avon and Wiltshire Mental Health Trust, we can only offer assessment and treatment appointments when funding for both of these has been agreed by the relevant organisation in your region. We are still becoming familiar with the changes brought about by the reorganisation of the NHS, but referrals in England require funding by what is known as a Clinical Commissioning Group (formerly Primary Care Trust), but this differs in Wales, Scotland and Northern Ireland. We are aware that seeking a referral to a specialist Centre can feel quite a daunting, complex process but your GP or mental health professional will know or be able to find out what the local processes are to apply for funding to receive support from us. 3
To hopefully make things seem a little clearer and a little less daunting we have put together the following guide to the administrative / funding stages involved in seeking a referral, assessment and treatment at the Centre. A similar guide will be made available for referrers. Information regarding assessment and treatment at the clinic 1. The first step The first step in being referred to the clinic is to meet with an NHS health professional (this could be your GP, an OT, a psychologist etc.) with whom you feel comfortable talking with to discuss your problems and asking them to make a referral to see us for an assessment. They may not know about the processes and procedures of making a referral to us, so feel free to take this leaflet with you and let them know that they can contact us for further information. Typically the referral letter to us would provide information on how your problem is currently affecting you and the impact it is having upon you as well as providing any further relevant background such as previous psychological and pharmacological treatment received. They would then send this referral letter to the address below: Dr Claire Williamson C/o Fiona Mclean Suite 4 Corum Two Corum 2, Corum Office Park Crown Way Warmley, Bristol BS30 8FJ On receipt of the referral we read through it and make a decision about whether we could offer anything to help, which we often think we can. We then write to the referrer to advise them about making a funding application for assessment and we would also send you a copy of this letter, and any other correspondence relating to your referral. We would then advise that you meet with the referrer to both initiate and check on the progress of this funding application. Please note that if you think that you d be travelling to see us for the assessment in Bath and you would want to reclaim travel expenses you should also discuss this with the referrer so that they can include it in the funding application. 2. The Assessment Once we ve been informed that funding has been agreed we aim to meet up with you within three to six months for the assessment, but sometimes it can take considerably longer to arrange an assessment, depending upon how many people we ve been asked to assess. Assessments are typically 2-3 hours in duration and as mentioned above, these are usually at our premises in Bath, but often we see people in their home environments when they are not able to travel or where we feel we would learn more about the problem by seeing them in their homes. When you come to the assessment it is important to remember that there is no guarantee that treatment will follow; although we may recommend a course of therapy, it is the local funding authority that makes the decision on whether to fund our recommendations or not. In the assessment our main aim is to work with you to understand your current experience of the problem and a little about how it developed. Crucially we hope to understand the factors that are keeping you feeling stuck in relation to the problem, particularly those things that have not been covered in or benefited from previous treatments. We will then write a report within three weeks of the assessment and then a copy of this would be reviewed with you before then sending it to your referrer and also to you if would like to receive a copy. The report will provide details of our understanding of the development and maintenance of the problem, including our recommendations to address the difficulties. This will include the 4
number of sessions and how these would be delivered if funding was agreed for us to provide the treatment. To avoid any delays we recommend that once you ve received a copy of the report from us that you meet with the person who referred you and discuss the report with them. If you and the referrer decide to seek funding for treatment at the clinic then we d advise keeping in contact with them at regular intervals to check on the progress of the application. 3. Starting treatment Currently treatment appointments are usually offered within three to six months of receiving written confirmation of treatment funding from our mental health partners, Avon and Wiltshire Mental Health Trust; treatment waiting times, however, will vary according to the number of funded referrals we receive. Depending upon the treatment plan, sessions are delivered singly and/or in multiples (i.e. intensively) and at a range of locations which can include the clinic and your home. We will review the treatment with you at regular intervals to discuss the progress of the work and make changes to the approach as required. We also provide a brief update to the funder of the treatment and make recommendations for additional sessions to those already funded as required. 4. Ending treatment Towards the end of treatment you and your therapist will begin to reflect on the work that you ve completed together, which will include developing a plan to continue the therapeutic work beyond the sessions. You and your therapist will agree a date for the last session and the therapist will write a letter to you summarising the work that you have developed together and this would ordinarily also be sent to the person that referred you. 5
Clinicians at the Centre All of the clinicians that work at the centre are registered Clinical Psychologists with the Health and Care Professions Council (HCPC). This means that they are registered health professionals who meet national standards. Professor Paul Salkovskis is Professor of Clinical Psychology and Applied Science at the University of Bath and is the director of the clinic. Professor Salkovskis graduated in clinical psychology from the Institute of Psychiatry in 1979. He then worked as a clinical psychologist based in general adult psychiatry and in liaison psychiatry until 1985, when he moved to a clinical academic job at the University of Oxford. Professor Paul Salkovskis From 2000-2010 Paul was Professor of Clinical Psychology and Applied Science and Clinical Director in the Centre for Anxiety Disorders and Trauma at the Institute of Psychiatry. James qualified as a clinical psychologist from University College London in 2008 and he then completed a post-graduate diploma in cognitive behavioural therapy (CBT) at the Institute of Psychiatry in 2010. He is an accredited Cognitive Behavioural Psychotherapist with the British Association for Behavioural and Cognitive Psychotherapists (BABCP). James has worked in various mental health services, including Improving Access to Psychological Therapies (IAPT) services and secondary care services in London and Bristol. Dr James Gregory Lorna qualified as a clinical psychologist in 1985 and has worked in the NHS since, with experience of working both in the 2gether NHS Foundation Trust locally and Avon and Wiltshire Partnership Trust. She has a long-standing interest in working with adults, and expertise in working with people presenting with a full range of psychological difficulties including those that are persistent, severe and complex. Lorna has a special interest, and expertise, in working with people presenting with psychotic experiences. She set up Early Intervention in Psychosis Services in Oxleas NHS Foundation Trust as Clinical Lead in this field. Lorna Hogg 6
Dr Megan Wilkinson-Tough Dr Cara Davis Catherine Woodman (Administrator) Contact Details for General Enquiries Dr Megan Wilkinson-Tough qualified as a Clinical Psychologist from the Bristol Doctorate in Clinical Psychology in 2008 and completed a diploma in Schema Focussed Therapy in 2013 conferring accreditation by the International Society for Schema Therapy. Megan is a Chartered Clinical Psychologist with the British Psychological Society. Since qualification Megan has specialised in working in adult mental health settings, including secure settings. This work has included providing highly specialist assessments and interventions as well as providing expert witness opinions for court. Cara qualified as a clinical psychologist from the Bristol Doctorate Course in Clinical Psychology (accredited by the University of Plymouth) in 2008. Since qualifying Cara has specialised in working with children, adults and families living with chronic, life threatening and life limiting health conditions. As part of this work Cara has undertaken highly specialist assessment and intervention in NHS hospital and community settings, and provided consultation and training to individuals, families and professionals. She believes that partnership working is essential in the effective development, implementation and evaluation of high quality service provision. Catherine is the administrator for the Centre for Specialist Psychological Treatments of Anxiety and Related Problems and is happy to answer your general queries by phone or email. Whilst unable to give advice or clinical guidance, Catherine will be able to give information about the centre and can direct more detailed queries to the relevant clinician. The below contact details are for the administrator at the centre, whom you can contact for general information: Telephone: 01225 384554 Email: awm-tr.barpcentre@nhs.net Dr Claire Williamson and Fiona Mclean can be contacted on 01173 546304 Footnote: we would very much appreciate feedback on the information provided here. If you wanted to comment, please feel free to contact us at awm-tr.barpcentre@nhs.net 7