What are the indications for referring a patient with OCD to specialist mental health services?

Patients with obsessive-compulsive disorder (OCD) should be referred to specialist mental health services in the following situations:

• Severe OCD: When the OCD is assessed as severe, referral for specialist assessment is indicated ¹.
• Risk of suicide or life risk: If the patient is considered at risk of suicide or there is otherwise a risk to life due to OCD symptoms, urgent referral (same day) to crisis or specialist services is required ¹.
• Severe self-neglect: Patients exhibiting severe self-neglect related to OCD should be referred ¹.
• Significant comorbidity: Presence of significant comorbid conditions such as substance misuse, severe depression, anorexia nervosa, or schizophrenia warrants referral ¹.
• Uncertainty about risk from intrusive thoughts: When healthcare professionals are uncertain about the risk associated with intrusive sexual, aggressive, or death-related thoughts, referral or consultation with a specialist is advised ¹.
• Inadequate response to initial treatment: If initial treatment or treatments (including psychological and pharmacological) have not led to an adequate response, referral to specialist mental health services is recommended ¹.
• Children and young people: All patients under 18 years old should be referred to specialist services, following local policy and urgency dictated by clinical situation ¹.
• Severe functional impairment in adults: Adults with severe functional impairment due to OCD should be referred to secondary care mental health teams ¹.
• Complex or treatment-refractory cases: Patients with severe, chronic, treatment-refractory OCD should have continuing access to specialist multidisciplinary teams ².
• Need for intensive or inpatient treatment: Referral to inpatient services with specific expertise in OCD is appropriate when there is risk to life, severe self-neglect, extreme distress or functional impairment, failure to respond to adequate outpatient treatment, complex comorbidities, or severe compulsions preventing normal daily activities ².

In summary, referral is indicated for severe cases, risk of suicide, significant comorbidities, treatment resistance, children and young people, and when complex or intensive care is needed ¹,².