Cosmetic Surgery Psychiatry is a specialist service of Harley Street Mental Health
www.hsmh.co.uk →

What we offer

Our clinical services

Six specialist services, all led by a Consultant Psychiatrist. Every report is structured for a surgical audience, legally defensible, and delivered within a clear timeframe.

01
For surgeons & practitioners

BDD Screening Assessment

The BDD Screening Assessment is designed for patients who have triggered one or more red flags during your consultation — a positive BDDQ screen, multiple previous procedures with persistent dissatisfaction, extreme or disproportionate distress, or a combination of features that concern you without fitting a neat clinical picture.

The assessment is focused and efficient. It uses the BDDQ and Y-BOCS-BDD as its primary instruments, supplemented by a structured clinical interview and mental state examination. The resulting report gives you a clear answer: does this patient have BDD, and is surgery indicated?

What the assessment covers

  • BDDQ and Y-BOCS-BDD administration and clinical interpretation
  • DSM-5 diagnostic assessment for BDD with insight specifier
  • Focused psychiatric history relevant to appearance concerns
  • Mental state examination with emphasis on insight and reality testing
  • Functional impairment assessment
  • Suicide and self-harm risk screening

Who this is for

  • Patients with a positive BDDQ screen at consultation
  • Patients requesting correction of features you cannot identify on examination
  • Patients with three or more prior procedures and persistent dissatisfaction
  • Patients using extreme language about a minor or imperceptible feature
  • Any patient where you are uncertain but cannot clearly articulate why

Report includes: BDDQ and Y-BOCS-BDD scores with clinical interpretation, DSM-5 diagnosis, insight rating, risk summary, and a direct recommendation on surgical suitability.

02
Comprehensive

Full Pre-operative Psychiatric Assessment

The Full Pre-operative Psychiatric Assessment is Cosmetic Surgery Psychiatry’s flagship service — a comprehensive evaluation that goes well beyond BDD screening. It is appropriate for patients with a known or suspected psychiatric diagnosis, complex psychiatric histories, disclosed self-harm, eating disorders, personality difficulties, or where there are multiple overlapping concerns.

The assessment takes 60–90 minutes and covers the full spectrum of psychiatric risk relevant to cosmetic surgery. The resulting report is a complete clinical document, suitable for a patient’s permanent record and for any subsequent medico-legal review.

Full assessment domains

  • Full psychiatric history — previous diagnoses, admissions, treatments, medications
  • Comprehensive Mental State Examination
  • BDD screening (BDDQ + Y-BOCS-BDD)
  • Depression and anxiety screening (PHQ-9, GAD-7)
  • Alcohol and substance use screening (AUDIT-C)
  • Eating disorder screening (SCOFF) where relevant
  • Personality assessment — traits relevant to surgical outcome
  • Insight and motivation assessment with documentation
  • Full risk assessment — suicide, self-harm, risk to others
  • Capacity assessment (MCA 2005) if requested
  • Social circumstances and support network

Report includes: All of the above with full clinical reasoning, DSM-5 diagnoses, validated scale scores, risk stratification, and a four-option recommendation: proceed / defer with conditions / defer pending treatment / contraindicated.

03
Urgent pathway

Rapid Pre-surgical Assessment

When a patient has a surgery date imminent and you have only just identified a concern, the Rapid Pre-surgical Assessment provides a prioritised pathway. We aim to offer an appointment within 48–72 hours of referral, and a verbal summary to you within hours of the assessment concluding.

The assessment covers the same domains as the Full Pre-operative Assessment. The difference is pace and communication — a verbal debrief call immediately after the appointment, and the full written report within 3 working days.

When to use the rapid pathway

  • Surgery scheduled within the next 1–2 weeks
  • A concern has emerged late in the surgical planning process
  • Patient or surgical team require urgent clinical clarity before proceeding
  • Post-operative concern flagged and urgent risk assessment needed

Please note: urgency from the patient is not itself an indication for the rapid pathway — and in BDD presentations, patient urgency is often a clinical red flag. Use the rapid pathway when the surgical timeline is clinically set, not simply because a patient is pressing for a decision.

04
Legal / consent

Capacity Assessment

The Capacity Assessment applies the four-stage Mental Capacity Act 2005 framework to the specific decision of consenting to a cosmetic procedure. It is indicated when cognitive impairment, acute mental illness, delusional beliefs, or significant intoxication raise doubt about whether the patient can form valid consent.

The assessment is decision-specific — capacity is assessed for the particular surgical procedure being proposed, not in general. The result is binary (capacity present or absent) with detailed clinical reasoning that can withstand legal scrutiny.

The MCA 2005 four-stage test

  • Understand — can the patient comprehend the procedure, its risks, and alternatives?
  • Retain — can they hold the information long enough to make a decision?
  • Weigh up — can they use the information in their decision-making? (This is the critical stage in delusional BDD — delusional beliefs block appropriate weighing)
  • Communicate — can they express their decision by any means?

Important: A psychiatric diagnosis does not automatically mean capacity is lacking. Capacity is always decision-specific and time-specific. Equally, full capacity to consent does not mean a procedure is in the patient’s best interests — a separate clinical and ethical judgement.

05
Post-operative

Post-operative Crisis Support

Post-operative psychological crises — suicidal ideation, extreme dissatisfaction, threats directed at the surgical team, or severe anxiety in recovery — are among the most difficult presentations in cosmetic practice. They often indicate that a psychiatric condition (most commonly BDD) was not identified before surgery.

If you are managing a patient in crisis after a procedure, we can provide urgent psychiatric review, risk assessment, and a clear management plan for both the patient and the surgical team. This is not a service that can be planned in advance — if you have a patient in immediate danger, please contact us directly by phone.

What we provide

  • Urgent psychiatric assessment — typically within 24–48 hours
  • Risk assessment: suicidal ideation, self-harm, harm to others
  • Mental state evaluation and working diagnosis
  • Immediate management recommendations
  • Signposting to appropriate ongoing treatment
  • Written report for the surgical team and the patient’s GP

If a patient is in immediate danger, call 999 or direct them to their nearest A&E. For urgent but non-emergency situations, call our line directly: +44 (0)20 3488 3655.

06
Education & CPD

Practice Education & Training

The most effective protection against psychiatric harm in cosmetic practice is a well-trained team that can recognise the signs before a referral becomes necessary. Cosmetic Surgery Psychiatry offers bespoke educational sessions for surgical practices, aesthetic clinics, and professional societies.

Our Consultant Psychiatrist has presented to BAAPS, BAPRAS, and regional training programmes, and is available for grand rounds, in-practice workshops, and conference presentations.

Training formats available

  • In-practice workshop (half day) — hands-on training on screening, red flag recognition, documentation, and referral pathways for up to 12 practitioners
  • Grand rounds lecture (60–90 min) — didactic teaching suitable for hospital departments or large practice groups
  • Conference keynote or panel — tailored to the event theme and audience
  • Online CPD module — self-directed learning with MCQ assessment, suitable for remote teams

Topics covered

  • BDD — recognition, neuroscience, why surgery fails, red flags
  • Implementing the BDDQ in your practice
  • Other psychiatric conditions: depression, eating disorders, personality disorders
  • Consent, capacity, and the Mental Capacity Act
  • Medico-legal pitfalls and documentation best practices
  • Building a referral pathway — practical implementation

The most effective protection against psychiatric harm in cosmetic practice is a well-trained team that can recognise the signs before a referral becomes necessary. Cosmetic Surgery Psychiatry offers bespoke educational sessions for surgical practices, aesthetic clinics, and professional societies.

Our Consultant Psychiatrist has presented to BAAPS, BAPRAS, and regional training programmes, and is available for grand rounds, in-practice workshops, and conference presentations.

Training formats available

  • In-practice workshop (half day) — hands-on training on screening, red flag recognition, documentation, and referral pathways for up to 12 practitioners
  • Grand rounds lecture (60–90 min) — didactic teaching suitable for hospital departments or large practice groups
  • Conference keynote or panel — tailored to the event theme and audience
  • Online CPD module — self-directed learning with MCQ assessment, suitable for remote teams

Topics covered

  • BDD — recognition, neuroscience, why surgery fails, red flags
  • Implementing the BDDQ in your practice
  • Other psychiatric conditions: depression, eating disorders, personality disorders
  • Consent, capacity, and the Mental Capacity Act
  • Medico-legal pitfalls and documentation best practices
  • Building a referral pathway — practical implementation

Comparison

Which service
is right for your patient?

Feature BDD Screening Full Pre-op Rapid Capacity
BDD diagnosis (BDDQ + Y-BOCS-BDD)✓✓✓—
Full psychiatric historyBrief✓✓✓
Mental State Examination✓✓✓✓
Depression & anxiety screening—✓✓—
Personality assessment—✓✓—
Full risk assessmentScreening✓✓✓
Capacity statement (MCA 2005)—On requestOn request✓ Core
Verbal debrief to surgeon——✓ Same day—
Written report5 days5–7 days3 days3–5 days
Starting price£450£650£750POA

All prices include the written report. For practice arrangements and bulk referral pricing, contact us at assess@cosmeticsurgerypsychiatry.co.uk

Get started today

Ready to refer a patient?

We respond within one working day. No GP referral required — just a brief description of your clinical concern and the procedure planned.

Refer a patient → Email us directly
Referral emailassess@cosmeticsurgerypsychiatry.co.uk
Telephone+44 (0)20 3488 3655
Response timeWithin 1 working day for all referral enquiries