National Specific Phobia of Vomiting Service, Bethlem Royal Hospital

Our unit provides a specialist cognitive behaviour therapy service on the NHS. There are various referral routes, which depend on your GP's registered address and the service agreements our hospital has agreed with your local Primary Care Trust (PCT). For people who are in the South London (for example Lewisham, Southwark, parts of Croydon and Lambeth), a GP may refer direct to me. Outside South London, a small number of PCTs will allow direct access from their GP but most will require a referral from a community mental health team (for example a local psychiatrist or psychologist) to enable us to obtain authorisation to offer an assessment, and/or treatment. Sometimes this means trying treatment locally before being referred. Our Administrator Kaye Wake may be able to inform of the requirements of your local area if you let her know the name of your Primary Care Trust as she can find out what type of contract exists between your PCT and the South London and Maudsley Trust.

A written referral should be sent to me:
Dr David Veale
Anxiety Disorders Residential Unit
The Bethlem Royal Hospital
Monks Orchard Road
Beckenham, Kent BR3 3BX
Tel: 020 3228 4146
Fax: 020 3228 4051

In certain cases, once we have received the referral we would have to approach the local PCT on an individual basis to request authorisation to offer you our service. This is quite a routine thing to happen, similar to any specialist services that are required on the NHS i.e. the service user starts at their local hospital, but if more specialist expertise is necessary they may be referred on to a more expert specialist in the disorder they have. We endeavour to offer a choice of appointment within 11 weeks of the date of the authorised referral.

Once you have accepted an appointment you will be sent out some rather lengthy, but very important questionnaires covering different aspects of Specific Phobia of Vomiting, anxiety and depression. It is important that these are completed prior to the assessment and brought with you on the day. The assessment appointment usually takes at least 2 hours; sometimes it can take longer in which case we may need to ask you to come back. You will be asked detailed questions about your problem with emetophobia and any other problems they may have. It is important that we get a very clear understanding of your problems in order to establish what kind of help you may need. We will not make a decision about what is the best way to proceed on the day. We will consider your case and discuss it with the team, and aim to let you know within a couple of weeks. If we feel we can help you is normally a wait of 1-2 months before we are able to start out-patient therapy. If we think a more intensive programme is required then we may offer admission to our residential unit.

RESIDENTIAL UNIT CARE
Most people with phobia of vomiting can be treated as out-patients but a few are suitable for a more intensive programme and admission to the residential unit. This is usually up to 12 weeks, comprising regular therapy sessions, group support, occupational therapy, and weekend leave. Most people at the residential unit are suffering from obsessive-compulsive disorder. However because the unit does not have any nursing staff then patients accepted for treatment should:
• Not be recently or actively suicidal
• Not be actively psychotic
• Have no recent history of violent or impulsive behaviour that requires treatment in its own right?
• Not be currently dependent on alcohol, illegal substances or benzodiazepines?
• Be aged 17 or above
• Be able to self-medicate (if they are prescribed medication)
• Be able to travel alone (or accompanied initially)
• Have basic self-care skills and not require nursing care?
• Must have accommodation which is maintained in the community to enable weekend leave during admission
• Referrals can be made to the address above.

IN-PATIENT CARE
A very small number of people with vomit phobia are very underweight (from restricting food) and need more nursing care as part of their care and treatment of their vomit phobia. In this case then it is possible to obtain funding from one's Primary Care Trust to be admitted to the Priory Hospital North London. There is also an adolescent unit where patients can be admitted. However a referral will require support from a local consultant and many other hoops to go through. Most of our NHS patients have been admitted to an eating disorder unit in the past where they have felt misunderstood and their vomit phobia not effectively treated.

NHS Referrals for in-patient care can be sent to:

Dr David Veale
The Priory Hospital North London
The Bourne
Southgate
London N14 6RA
Telephone 020 8920 5611 or 020 8882 8191.
Email: david@veale.co.uk
My secretary is Chrissy Stylianou: ChrissyStylianou@priorygroup.com

Dr David Veale, FRCPsych (www.veale.co.uk)

Consultant Psychiatrist in Cognitive Behaviour Therapy, South London and Maudsley Trust and The Priory Hospital North London.