Skip to main content
×
×
Home

Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders

  • Paul M. Harris (a1) and Lynne M. Drummond (a1)
Abstract
Aims and method

To examine how often referring community mental health teams (CMHTs) utilised treatment recommendations made by the national highly specialised service for patients with severe obsessive–compulsive disorder (OCD) and body dysmorphic disorder (BDD). We analysed all patient notes for admissions to the unit (August 2012–August 2014) and recorded how many treatment recommendations were implemented by CMHTs prior to admission and at 6 months post-discharge.

Results

Overall, 66% of our recommendations were met by CMHTs prior to admission and 74% after discharge. Most recommendations concerned medication and the continued need for care coordination by the CMHT.

Clinical implications

A significant proportion of patients in our audit did not receive optimum treatment in the community as recommended by our service. As highly specialised services are a limited resource and these patients have not responded to previous treatment, this has implications for the use of such resources.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders
      Available formats
      ×
Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Paul M. Harris (pmharris@doctors.org.uk)
Footnotes
Hide All

Declaration of interest

P.M.H. worked for the National and Trustwide Services for OCD and BDD, South West London and St George's NHS Trust as a Core Trainee year 3 from August 2014 to February 2015. L.M.D. works for the National and Trustwide Services for OCD and BDD, and the National Specialist Commissioning Team Service for OCD and BDD.

Footnotes
References
Hide All
1 National Institute for Health and Care Excellence. Obsessive–Compulsive Disorder: Core Interventions in the Treatment of Obsessive–Compulsive Disorder and Body Dysmorphic Disorder. British Psychological Society & Royal College of Psychiatrists, 2006.
2 Lodge, G. How did we let it come to this? A plea for the principle of continuity of care. Psychiatrist 2012; 36: 361–3.
3 Tyrer, P. A solution to the ossification of community psychiatry. Psychiatrist 2013; 37: 336–9.
4 Drummond, LM, Fineberg, NA, Heyman, I, Veale, D, Jessop, E. Use of specialist services for obsessive–compulsive and body dysmorphic disorders across England. Psychiatrist 2013; 37: 135–40.
5 Boschen, MJ, Drummond, LM, Pillay, A, Morton, K. Predicting outcome of treatment for severe, treatment resistant OCD in in-patient and community settings. J Behav Ther Exp Psychiatry 2010; 41: 90–5.
6 Wittchen, HU, Jacobi, F. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15: 357–76.
7 Drummond, LM, Fineberg, NA. Obsessive-compulsive disorders. In Seminars in General Adult Psychiatry, 2nd edn (eds Stein, G, Wilkinson, G): pp. 270–86. Gaskell, 2007.
8 Fineberg, NA, Gale, T. Evidence-based pharmacological treatments for obsessive–compulsive disorder. Int J Neuropsychopharmacol 2005; 8: 107–29.
9 Drummond, LM. The treatment of severe, chronic, resistant obsessive–compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. Br J Psychiatry 1993; 163: 223–9.
10 Drummond, LM, Pillay, A, Kolb, P, Rani, S. Specialised in-patient treatment for severe, chronic, resistant obsessive–compulsive disorder. Psychiatr Bull 2007; 31: 4952.
11 Boschen, MJ, Drummond, LM, Pillay, A, Morton, K. Treatment of severe, treatment refractory obsessive-compulsive disorder: a study of impatient and community treatment. CNS Spectrum 2008; 13: 1056–65.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 2
Total number of PDF views: 14 *
Loading metrics...

Abstract views

Total abstract views: 53 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st July 2018. This data will be updated every 24 hours.

Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders

  • Paul M. Harris (a1) and Lynne M. Drummond (a1)
Submit a response

eLetters

Understanding challenges around implementation of specialist service recommendations for obsessive–compulsive disorder

Karen J. Walker, Senior Mental Health Nurse Psychotherapist, Advanced Interventions Service
David M. B. Christmas, Consultant Psychiatrist, Advanced Interventions Service
16 December 2016

Harris & Drummond’s (1) recent paper exploring the rate of adherence to recommendations made by their specialist obsessive–compulsive disorder (OCD) service is an important reminder of the need for tertiary and specialist services to liaise with clinicians in secondary care.

Their study found that almost 40% of their medication-related recommendations and 20% of the recommendations involving community mental health teams had not been implemented prior to admission to their specialised unit. In addition, 6 months after discharge around 25% of recommendations had yet to be implemented. This suggests that many patients may not be receiving potentially beneficial treatments, thus prolonging the detrimental impact that OCD has on the individual and their family.

Understanding the issues affecting implementation is important since it is neither possible nor appropriate for specialist services to mandate recommendations to be followed at a local level. Treatment recommendations should be a negotiation between the local treatment team and the patient. It is difficult to be critical of limited implementation without understanding the factors affecting low implementation rates.

In our nationally-funded specialist OCD service we are developing an outreach model, designed to enhance functional links with local services. This will target people who have been referred for consideration for the Intensive Treatment Programme for OCD, but have not completed the required pharmacological or psychological treatment trials during their contact with local services. The specialist service’s consultant psychiatrist will liaise with the local area consultant to discuss pharmacological options and will offer ongoing troubleshooting (via phone or email) regarding implementation. The specialist psychological therapy staff will support local psychology and nursing staff to provide behavioural treatment and will offer up to 10 hours of individual, patient-focused education and support to the local team. This will cover areas such as knowledge and understanding of OCD, assessment for cognitive–behavioural therapy, formulation, hierarchy building, treatment planning, and importantly, working with families. This time-limited, integrated working model is designed to help both services to develop a shared understanding of the diagnostic formulation, treatment recommendations and challenges to implementation. It also means that the specialist service has a much better knowledge of the patient should they require more intensive treatment subsequently.

By front-loading specialist input at an earlier stage in the pathway, patients will be supported to progress through treatment options more rapidly, and local teams will have the opportunity to develop skills and confidence in managing patients with severe and treatment-refractory OCD.

To better understand barriers to implementation we are in the process of reviewing all patients with OCD seen for assessment and/or treatment by our service since 2010. As part of this process we will be meeting with local clinicians to discuss both the perceived utility and the impact of our treatment recommendations, as well as any difficulties that were encountered during implementation.

Ultimately, we suspect that even if treatment recommendations have been fully implemented, many people will continue to struggle with disabling OCD. Indeed, even after intensive, specialised treatment within their own unit, Harris & Drummond noted that 70% of patients were either ‘non-responders’ or gained only partial benefit. Although disappointing, this is consistent with other published data indicating that full response or asymptomatic states in patients with a severe burden of symptoms are rare (2-4). This raises the important question of how to optimise treatment for people with OCD within both secondary and tertiary services. There is a clear need to improve our ability to identify earlier those individuals who may not benefit from standard treatments, and to explore and improve treatment options for this relatively large population with OCD that remains refractory to both state-of-the-art pharmacotherapy and psychological therapy. This is, arguably, the biggest single challenge facing both specialist services and secondary care teams.

References

1- Harris PM, Drummond LM. Compliance of community teams with specialist service recommendations for obsessive–compulsive and body dysmorphic disorders. BJPsych Bull 2016; 40: 245–248.

2- Veale D, Naismith I, Miles S, Childs G, Ball J, Muccio F, et al. Outcome of intensive cognitive–behaviour therapy in a residential setting for people with severe obsessive–compulsive disorder: a large open case series. Behav Cognit Psychother 2016; 44: 331–346.

3- Boschen MJ, Drummond LM, Pillay A. Treatment of severe, treatment-refractory obsessive–compulsive disorder: a study of in-patient and community treatment. CNS Spectrums 2008; 13: 1056–1065.

4- Björgvinsson T, Hart AJ, Wetterneck C, Barrera TL, Chasson GS, Powell DM, et al. Outcomes of specialised residential treatment for adults with obsessive–compulsive disorder. J Psychiatr Practice 2013; 19: 429–37.

... More

Conflict of interest: KM and DC both work within a nationally-funded NHS-based specialist service providing assessment for and intensive treatment of people with OCD.

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *