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Neurosurgery for mental disorder (NMD)

Explains what NMD is, what the operation is like, possible side effects and alternative surgical treatments. Also covers the law around consent to treatment by NMD.

Who could be offered NMD?

NMD is extremely rare. Your psychiatrist will only suggest NMD if:

  • your mental health problem has a severe impact on your daily life
  • your mental health problem is long-lasting
  • you have tried all other treatments and they have failed, including psychiatric medication and electroconvulsive therapy (ECT).

If you are in this situation, your psychiatrist could offer to refer you to a multidisciplinary team for an assessment.

The team is made up of everyone who would be helping to look after you, including neurosurgeons (who would perform the surgery), psychiatrists, mental health nurses and psychological therapists.

Guidelines from the Royal College of Psychiatrists say that:

  • You must be given a thorough assessment by health professionals that specialise in mental health treatment to make sure that NMD is right for you.
  • You must be able to provide informed consent to treatment.
  • The surgery should only be performed by neurosurgeons experienced in functional stereostatic surgery within specialist centres.
  • You should be given a detailed assessment before and after the surgery.
  • You should have a detailed care plan for at least 12 months after the surgery.

Where is NMD performed?

Assessments can be done at the Maudsley Hospital in London, but there are only two hospitals in the UK where the operation can be performed. These are:

  • (Wales) University Hospital of Wales, Cardiff – this hospital uses the anterior capsulotomy technique.
  • (Scotland) Ninewells Hospital, Dundee – this hospital uses anterior cingulotomy for depression that hasn’t been helped by other treatments, and either capsulotomy or cingulotomy for obsessive compulsive disorder (OCD) that hasn’t been helped by other treatments.

There are no NMD treatment centres in England, so if you live in England you would have to travel to Wales or Scotland for the operation. It's important to be aware that the law on consent to treatment with NMD is different in Scotland to England and Wales.

This information was published in February 2018. We will revise it in 2021.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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