I have been continuing with my NHS clinical placement and have been fortunate to shadow the work of one of the largest and oldest established Eating Disorders Services in the world. The service is for anyone from the age of 11 years (with no upper age limit) who are requiring assessment, care and treatment. The course of treatment is offered on an outpatient, day-care or inpatient basis dependent upon the severity and the individual needs of the patient. The Service also accepts patients detained under the Mental Health Act and provides specialist opinions.
The patients present with very severe symptoms and can remind you that psychiatry has its own unique challenges. It has been interesting to note the wider health-care team working with eating disorders, and areas of expertise include occupational therapy (OT), psychotherapy, social work, dietetics, psychology, family therapy, psychodrama and exercise therapy. However, treatment has the very obvious input from nursing and medicine as this is after all a psychiatric setting.
The extent of the severity of the symptoms can be gauged from the in ward unit which offers re-feeding including naso-gastric feeding and medical monitoring of people with severe anorexia nervosa in crisis. The service also takes male patients, though I haven’t seen one yet. There is a full programme of groups and individual psychological therapies.
The outcome measures and audit include patient experience, quality of life, and change in eating behaviours. Results show that the majority of patients leave having increased their BMI, reduced use of behaviours and having learned new skills.
I have been intrigued about the approaches taken with such a vulnerable client base. In the outpatient services the multidisciplinary team offers a wide range of evidence based therapies including Cognitive Behavioural Therapy for Eating Disorders, Cognitive Analytical Therapy, Mentalisation Based Therapy, Dialectic Behavioural Therapy, OT, psychodynamic behavioural psychotherapy, psycho-education, psychotherapy groups, and non-specific supportive clinical management or person centred treatment and the nurse led intervention.
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