Anxiety Disorders Residential Unit
Bethlem Royal Hospital
Monks Orchard Road
Mode: Residential Unit 24 hours unstaffed from 5pm. Emergency service provided by Bethlem Royal Hospital.
Referrals are accepted from: We accept referrals across the UK, the Channel Islands and the EU. Access to this service is subject to clinical commissioning group (CCG) specialist mental health commissioning arrangements.
We provide the service in a way that respects patient individuality. Our service complies with all relevant Trust policies and legislation:
- complaints and serious incidents
- patient satisfaction survey information
- outcome monitoring data
Where conditions for discharge are met but the patient is unable to be discharged because of other issues within the power of either the relevant borough or CCG, we will notify the partner in question. This might be housing issues or awaiting residential placements, for instance. We will pass information about these issues to the service and commissioner concerned, setting out progress and outstanding issues. Where these issues prevent discharge, the Trust will continue to be paid the full occupied bed days care option price.
We offer intensive cognitive behavioural therapy (CBT) during a three to four month stay. We work hard with our patients to help them to make the best possible gains in this time, with the aim of becoming their own therapist. A patient should not need or expect a further admission to our unit in future. At discharge we will agree with a local team the patient's needs for any further local therapy, support, voluntary work, employment, housing or medication.
Should a patient relapse or not make sufficient gains, we will only accept a further referral at least one year after discharge and when there are exceptional circumstances and good clinical reasons. This is to allow patients to consolidate the gains they have made, to allow fairer access to our services and because there may not be much more benefit to a further similar residential stay within a short period of time.
We would only consider a third referral to our unit in very exceptional circumstances. This would again depend on the clinical discretion of the team, and where we consider there are good clinical reasons why a further stay might be beneficial to a patient who has relapsed or not maintained gains from previous stays. In these cases, we may recommend other options. These may include local therapy, inpatient treatment at another hospital, or a delay before any further treatment.
We aim to offer high quality CBT aimed at reducing symptoms of anxiety disorder and improve functioning and quality of life. This would lead to reduced need for local service provision.
The advantages of admission to a residential setting are the ability to deliver CBT in a more intensive format. Staff or residents may assist in frequent exposure or behavioural experiments in a supportive environment. There are more opportunities for modelling and positive reinforcement by others in the moment. There is increased flexibility in delivery of the therapy that can keep the momentum going. Sometimes there are advantages to removing a person from their home context.
We integrate occupational therapy into the therapy. Living in a residential unit increases responsibility that may not occur on an inpatient unit with nursing staff as well as the support and reinforcement from other residents. Lastly the unit can monitor any medication changes or adherence.
For patients with obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD), we operate at the highest level of stepped care in the National Institute for Health and Care Excellence (NICE) guidelines. We do this by providing intensive CBT for the treatment of severe OCD and BDD.
For patients with other anxiety disorders (post-traumatic stress disorder (PTSD), social phobia, agoraphobia/panic, specific phobias, generalised anxiety disorder) the service also operates at the highest level of stepped care in the respective NICE guidelines. We do this by providing intensive CBT and optimisation of medication for the relevant anxiety disorder. The service is for those who have severe symptoms and who have failed treatment locally.