Referrals will be accepted from Derbyshire Healthcare NHS Foundation Trust mental health consultants, secondary care mental health community/neighbourhood teams or other Trust tier 4 services.
Please note we only work with patients that have chronic, complex and severe anxiety, depressive disorder and or complex PTSD, with a severe mental illness.
Details and referral criteria for each pathway can be found by clicking on one of the links below:
Anxiety Disorder / Complex PTSD pathway
Mood Disorder pathway
- All referrals must be made via SystmOne, to “CBT Group Mood Disorders Team” or the “CBT Anxiety Individuals Team"
- Please use the WAA Referrals Template and then click on “refer to CBT”
- A fully completed SystmOne Core Assessment including SystmOne Risk Assessment/Safety Plan must be completed by a Statutory Regulated Mental Health Clinician
- Completion of a SystmOne Care Plan, involving other services is in place, where needs (other than CBP), are identified.
- HONOS questionnaire needs to be completed.
- The CBT Referral Form needs to be completed.
- A referral letter is required
To ensure safe clinical practice please continue to support your patient during the triage assessment process. The triage assessment process is when the service thoroughly reviews the clinical record to see if the service can meet your patient’s needs. If the patient is not accepted, we will not inform the patient but will write to you, as the referrer, with the outcome that the referral has not been accepted.
As the referring clinician. you are best placed, having already assessed the patient, to inform the patient and identify alternative care pathways.
The CBT Team will advise the referrer within 28 days of the referral regarding the outcome of the triage assessment, though, it is generally sooner.
Referring via SystmOne
If you are unsure how to make a referral via SystmOne, please contact the service on dhcft.psychotherapy-cbtteam@nhs.net, and we will email you the SystmOne referral guidelines
If a patient has been referred and deemed to be appropriate for the service, then they will be contacted and offered a suitability assessment to determine whether CBP can help with their mental health needs. The referrer and GP will be informed. The patient will be offered an appointment to discuss the problems / difficulties that they are experiencing and how this impacts on their life and relationships. Please note it is the Service expectation that all patients attend the appointments by themselves, as CBT is about independently being able to recover or improve the quality of life. The assessment process can take a number of sessions (2-3) due to the level of information required, this enables the clinician to develop a CBT formulation with the patient to understand their mental health needs and to explore the best way forward.
An assessment is not a guarantee of treatment, a number of factors will be considered regarding whether CBT Psychotherapy is offered at this moment in time. These factors are:
- Can the patient and therapist agree on a problem(s) to be targeted in therapy.
- The problem is expressed as observable behaviour.
- The problem is current and predictable.
- A clear formulation and set of goals can be agreed.
- The patient understands and agrees to treatment.
- The patient has potential for developing a working relationship with their psychotherapist.
- There are no contra- indications to treatment being provided, or presence of factors which may inhibit cognitive behavioural interventions or make the therapy less effective, e.g., medication issues etc.
- The level of risk to the patient and to other people is not manageable, or contra-indicating treatment being undertaken.
If a patient has been assessed as meeting the criteria for the Specialist CBP Department, they will be placed on the waiting list for treatment for either Group or one to one therapy or both.
Anxiety Disorder / Complex PTSD pathway
We offer group and one to one Therapy Treatment options.
This service offers individual formulation driven CBT psychotherapy for clients with severe and chronic anxiety disorders who have co-morbid diagnoses and complex needs in line with severe mental illness. In most cases patients will have already had some treatment in primary care via the IAPT Services, and will have been transitioned into secondary care services due to the level of complexity, risk and a multi-disciplinary approach requirement. It is also likely that CBT interventions may / will have been provided within secondary care services. Patients will have a diagnosis of a severe / chronic and complex anxiety disorder that has a significant impact on their level of functioning, co-morbid with personality / interpersonal difficulties associated with personality disorder, psychosis symptoms, bipolar disorder or autistic spectrum disorder.
We also offer the opportunity for patients with a diagnosis of OCD or Complex PTSD to engage in an Intensive group treatment approach over a shorter period of time with less of a wait.
The service offers Specialist CBT Psychotherapy for:
- OCD
- Health Anxiety / Somatoform disorders
- Social Anxiety/Phobia
- Agoraphobia
- Panic Disorder
- Generalised Anxiety Disorder
- Body Dysmorphic Disorder
- Complex PTSD
- Hoarding as an OCD spectrum disorder
- Disordered Eating Associated with a Mental Health Presentation
- Medically Unexplained Symptom presentations associated with PTSD
- Management of anxiety disorders preventing clients accessing necessary treatment for medical health conditions.
Referrals will be accepted from Consultants, Trust Community/Neighbourhood Teams, or other Trust tier 4 service providers. All referrals must be made via SystmOne to CBT Anxiety Individuals Team.
- The presenting problem is a severe and chronic anxiety disorder and requires specialist CBP at Tier 4 and above level.
- Evidence of treatment at lower tiers being unsuccessful to address the client’s therapeutic needs, or it is a treatment resistive disorder where previous / other tier 4 treatments have been unsuccessful.
- Presentation / symptom profile: severe chronic/enduring/recurrent/complex anxiety disorder (DSMV) with significant impact upon activities of daily living or relationship or physical problems. GAF – General Assessment of Function score of less than 50.
- Co-morbidity with other psychiatric conditions : Severe Mental Illness.
- The client is not receiving any other psychological therapy. Prior therapeutic gains and motivation will be considered.
- The client agrees to attend by themselves an assessment appointment and has a clear idea of what they want to achieve in therapy.
- The client is willing to engage in individual therapy and complete self-directed practice between sessions.
- The client is willing to attend therapy at the Resource Centre in Derby for assessment & treatment, although we do offer a limited number of home visits, or at some GP surgeries and community venues in certain circumstances.
- Video call therapy is also available when clinically relevant.
- The client is not overly sedated and has not had recent episodes of mania in the last 6 months, or a recent suicide attempt (e.g., within 3 months).
- It is expected that a combination of therapy and medication is required, however, the client should not be prescribed anxiolytic medication above 10mg Diazepam or equivalent.
- The client is currently stable where risk to self and others is assessed as low or is being sufficiently managed by the individual and the team involved in their care.
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The client has not recently (e.g. in the last 3 months) been an inpatient or under the crisis team.
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The client has not had recent (e.g. in the last 3 months) dependent drug or alcohol difficulties.
Mood Disorder pathway
This service offers formulation driven psychotherapy for clients with severe and chronic mood disorders who often have co-morbid diagnoses and complex needs. In most cases patients will have already had some treatment in Primary Care via the IAPT Services and will have been transitioned into secondary care services due to the level of complexity, risk and a Multi-Disciplinary approach.
Patients will have a diagnosis of a Mood disorder such as Complex Depression, Bi-polar Disorder where depression is the main feature, psychotic depression where the psychoses has been stabilised and often co-morbid with avoidant and/or dependant ways of coping. The extent of the depressive features has a significant impact on their level of functioning and ability to engage and maintain meaningful relationships. Patients will often experience a great deal of shame and self-criticism that may be linked to early attachments and as a result of adverse childhood experiences.
The Mood Disorder pathway currently run four different groups consisting of:
- Compassion Focused CBT Group Therapy - is an intensive weekly group with a 12 month duration that combines evidence based CBT and Compassion Focused Therapy. It is a formulation driven exploration of client’s difficulties identifying maintenance factors and problems in interpersonal relationships. Patients often have a negative sense of self, experience high levels of shame and avoidance and are highly self-critical. Exploration of early attachments and adverse childhood experiences help to ‘make sense’ of the development of negative core beliefs and difficulties with self-compassion.
- Behavioural Activation group therapy - Clients are currently chronically depressed, experience low motivation to engage in activity and who would benefit from a behavioural approach. Clients have had 3 or more episodes of depression, and are currently experiencing depressive symptomology, including low motivation and low levels of activity.
- Mindfulness Based Cognitive therapy - A 10-week group which uses mindfulness meditative practices and CBT methods as a relapse-prevention treatment for depression. It is aimed at clients have had 3 or more episodes of depression where rumination is a significant problem and remain susceptible to relapse in the future. Patients can commit to the home practice requirements of the programme which equates to approximately one hour each day.
- Follow on group - this group is aimed at clients who have completed other groups on the pathway. The group meets monthly for 6 months and continues to encourage habituation of the therapy in everyday life as we know that this is essential in maintaining progress and benefits of therapy. It also enables the pathway staff to monitor any potential relapse.
Referrals will be accepted from Consultants, Trust Community/Neighbourhood Teams, or other Trust tier 4 service providers. All referrals must be made via SystmOne to CBT Group Mood Disorders Team.
- We will offer therapy to those clients who are most likely to benefit from our interventions. We are happy to offer advice to other services in managing those patients who are not eligible or we do not have capacity to treat.
- The presenting problem is primarily severe and chronic Depression or complex Depression & requires specialist CBP at Tier 4 service level and above.
- The client is not receiving any other psychological therapy. Prior therapeutic gains and motivation will be considered.
- The client is aware that the therapy will be conducted at the Resource Centre, London Road, Derby, and is a weekly programme taking place between the hours of 10 am – 3:30 pm.
- Group treatment can also be provided by video calls.
- The client agrees to attend by themselves an assessment appointment and has a clear idea of what they want to achieve in therapy.
- The client is willing to participate in group therapy and engage in self directed work between group attendances.
- The client is not over sedated and has not had recent episodes of mania or psychosis in the last 6 months.
- The client is not over dependent on anxiolytic medication.
- The client is open to engaging with a psychiatrist to discuss medication associated with their depressive disorder.
- The client does not exhibit behaviours which will inhibit their, or others, interactions in a group setting.
- The client is currently stable where risk to self and others is assessed as low or is being sufficiently managed by the individual and the team involved in their care.
- The client has not recently (e.g. within 3 months) been in inpatient Mental Health care.
- The client has not had recent (e.g. in the last 3 months) dependent drug or alcohol difficulties.
