Plate as weighing scalesIntroduction

Eating disorders have a major impact on the physical, psychological and social areas of a young person and on family life.

Research informs us that recovery and outcome is good in young patients with a short duration of illness.

To this end, early recognition and early intervention are the key principles of our service. Parents, teachers and healthcare professionals (especially GPs) are at the forefront for early recognition. When a child or young person or a parent consults about eating behaviours or eating concerns, these concerns are not likely to go away without any intervention.

The National Institute for Clinical Excellence (NICE; 2004) suggests that assessment and treatment should be provided at the earliest opportunity particularly in those at risk of severe malnourishment.

Healthcare on Demand is committed to promoting both early recognition and early intervention.

Promoting Early Recognition and Early Intervention

Eating Disorders are complex psychiatric illnesses with variable and multiple presentations. Parental worry and concerns also need to be addressed as early as possible.

A referral should be made by the school or GP when there are concerns with eating or behaviour around food, and should not depend on simply weight alone.

Initial queries and outline referrals can be made in the first instance to info@HealthcareOnDemand.org.uk.

The most appropriate lead clinician will then contact you to discuss the referral further; this discussion will be subject to full patient confidentiality guidelines.

The Multidisciplinary Approach

We offer a comprehensive multidisciplinary assessment of the difficulties which includes physical, psychological and dietary needs. At the end of the assessment, the young person and the family will be offered a formulation of the difficulties and an initial management care plan. The care plan would be individualised for the needs of the young person and family.

The Typical Pathway:

  • Referrals should normally come from the young person’s GP as close liaison with the GP is desired.
  • The first meeting is an assessment with a medical doctor (Dr Tauseef Mehdi) and a member of the Psychological Therapies team.

Q – Why Do We Need to See a Specialist Medical Doctor?

Consultant Child and Adolescent Psychiatrists are integral to the Eating Disorders multidisciplinary team in several ways. The psychiatrist will be available to the young person and family to offer information about Eating Disorders and potential physical complications, for physical health monitoring, for close liaison with the GP and the local paediatrician if necessary. The psychiatrist would be available to the MDT to offer input should there be challenges in recovery as well as offer assessments and/or interventions for co-occurring mental health difficulties such as depression or anxiety.

The psychological therapies practitioner may be a Psychologist, such as Dr Paul Osler who has a particular interest in Eating Disorders in boys and young men or a specialist Counsellor/ Psychotherapist such as Becci Hayward.

A range of psychological interventions are recommended by the NICE Guidelines. Psychological therapy, delivered alongside other key interventions are a key component in the treatment of eating disorders.

Initial queries and outline referrals can be made in the first instance to info@HealthcareOnDemand.org.uk.

The most appropriate lead clinician will then contact you to discuss the referral further, including details subject to full patient confidentiality guidelines.

Q – What might the Psychological Therapies consist of?

Following an initial assessment, we will work together to develop a personalised treatment plan which will be tailored to suit your specific needs. This treatment plan will comprise of evidence based treatments such as Family Based Treatment (FBT), The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT). You may choose to come to therapy on your own, or you may decide to include your family, partner, or carer in aspects of your treatment.

This is the 1st stage in the journey to recovery

  • The main emphasis of the initial assessment is to offer a formal diagnosis and written treatment plan. A parent-focussed intervention is the first phase of the treatment programme with weekly weight monitoring.

Psychological Therapies that Might be Suitable for You

Click on the links below to see further details on each approach

Family-Based Treatment (FBT)

Family Based Treatment (FBT) is a treatment for adolescents and young adults with anorexia nervosa and bulimia nervosa. It is one of the few eating disorder treatments available that has demonstrated efficacy in controlled clinical trials and is recommended in international treatment guidelines as the first line of treatment for this age group. The distinguishing characteristic of this treatment is that parents are recognised as the key resource to facilitate recovery of their child. While clinicians may be experts in eating disorders, in FBT parents are identified as experts in their children and are empowered to re-establish their footing as parents in the recovery process of their child. FBT takes an agnostic view of the development of eating disorders and is non-blaming of parents or families. It has the distinct advantage of involving all family members and recognising that each member can play an important role in the recovery process.

Traditional treatment duration is about one year and is divided into three distinct phases.

Phase 1:  Parental control of weight restoration with parents co-operating on finding ways to re-feed their child. The therapist’s support and encouragement is crucial for both patient and parents.

Phase 2:  Parents gradually reduce their control of their child’s eating and weight recovery, gradually allowing them to increase their own responsibility for food and eating.

Phase 3:  Once eating disorder symptoms have resolved, and full weight recovery achieved, the focus shifts to addressing any developmental issues of the adolescent as well as relapse planning in preparation for completion of treatment.

Although targeted originally to the treatment of anorexia, FBT has also been shown to be effective with young people with bulimia nervosa.

At Healthcare on Demand we also offer a revised version of FBT, lasting approximately 6 sessions.

CBT: Cognitive Behavioural Therapy

CBT focuses on present day issues, whether based on what was learned at earlier stages of life or focusing on current patterns of behaviour that maintain unhealthy thoughts and behaviours. Applying specific strategies to make active changes in these thoughts, behaviours and the associated emotions to overcome these problems is at the core of CBT.

CBT is a collaborative approach in which the therapist helps the client become their own agent of change by guiding them towards healthier patterns of thoughts and behaviours.

CBT can be helpful in a range of eating disorders. In bulimia it  is used to help a person understand how their negative thinking patterns and low self-esteem can influence their eating patterns and behaviour. As well as looking at a person’s negative thinking styles, CBT is also very practical. It often involves keeping a food diary, identifying patterns of behaviour and then looking at alternative coping strategies for binges and associated behaviours such as vomiting or laxative misuse.

MANTRA – Maudsley Model of Anorexia Nervosa Treatment for Older Adolescents (and Adults where appropriate)

MANTRA originated at the Maudsley Hospital in London and is an evidence-based manualised treatment for adults with Anorexia. The treatment addresses factors that are known to maintain anorexia. These factors are often linked to underlying personality traits like being more quiet, sensitive and shy, anxious and perfectionistic; thinking styles that are often characterised by inflexibility and excessive attention to detail, a fear of making mistakes and a tendency to avoid emotional experiences. Once anorexia is present these traits tend to get magnified and further maintain the illness and the sufferer tends to develop positive beliefs about how the anorexia helps them manage their life.

Together we will explore your strengths, resources and goals and values building a picture as to how the above factors might maintain your anorexia. This picture will then inform a treatment plan, this will include behavioural experiments to help you change some of these patterns and develop new skills. These new behaviours will eventually be linked with changes of eating behaviour.

The average length of treatment is 20 weeks and is designed so that people who study or work can continue their daily activities. The approach is collaborative and motivational, involving families and close others should that be considered helpful.

The treatment focuses on key factors that maintain the illness, including (a) a thinking style characterised by rigidity, focus on detail and fear of making mistakes, (b) an in-expressive, avoidant emotional and relational style, (c) positive beliefs about how anorexia may help the person, and (d) the response of close others which often enables and accommodates the illness. These maintaining factors are considered within the context of the sufferer’s underlying temperament. Recent research evidence suggests that Anorexia sufferers prefer MANTRA to other gold-standard recommended treatments.

DBT: Dialectical Behavioural Therapy Based Approaches

Dialectical Behaviour Therapy helps individuals who have difficulty regulating their emotions as well as those who engage in self-defeating or self-destructive behaviours in response to intense or painful emotions and is particularly helpful for those with bulimia and binge eating disorder.

The Healthcare On Demand Early Intervention practitioners are able to offer  DBT informed approaches as part of a  personalised programme for individuals.

Input from A Specialist Dietitian

Referral to The Healthcare On Demand specialist dietitian, Clare Thornton-Wood is available where appropriate.

Q – What is the Role of the Dietitian in Eating Disorders?

A dietitian has an important role within the multidisciplinary team assessing and treating patients with eating disorders. The dietitian can explore past and current weight and eating habits and knowledge and views of nutrition.

A dietitian can review food intake and devise an appropriate nutritional plan. This can encompass education in nutrition, questioning ‘dietary rules, an explanation of physiology, moving towards a nutritionally adequate diet and learning to trust food. The dietitian will aim to instil a sense of confidence in the client to change behaviours.

The dietitian will work collaboratively with the multidisciplinary team and client to set realistic and achievable goals. The dietitian can also support carers/family members.

After the Assessment Phase, your treatment plan will be formulated.

Ongoing care

  • Physical health monitoring: Physical health monitoring of young people with Eating Disorders is vital. We would expect to share this responsibility with the local GP and would like the GP to be aware of the on-going engagement of the young person with HoD. This is important should a child or young person need to be seen urgently for any physical health complaints and, if necessary be referred for an emergency paediatric assessment.
  • Family members, including siblings, will normally be included in the treatment of children and adolescents with eating disorders. Interventions may include sharing of information, advice on behavioural management and facilitating communication.
  • A staged treatment approach consisting of:
    • A six week parent-focussed intervention
    • Followed by individual/group intervention for the young person where appropriate
    • Family based therapeutic approached, where appropriate
    • Nutritional assessment and devising and monitoring of eating plan by specialist dietitian where appropriate
  • Weight and physical monitoring
    • The monitoring of weights and physical health may be carried out by the GP, the Practice Nurse at the GP surgery or school health centre, the HoD dietitian or the psychiatrist, as is deemed appropriate. If generated outside the Healthcare on Demand clinic, the results can be faxed or securely emailed to us for the treating clinician to review.
    • We would ensure close monitoring of growth and development in children and adolescents. Where development is delayed or growth is stunted despite adequate nutrition, we would seek paediatric advice.
  • Psychiatric reviews: After the initial assessment meeting, further psychiatric input can be arranged based on need or at the request of the young person, parents or the clinician who is engaging the family on a regular basis. It is good practice to have regular progress reviews with the family and the professionals involved.

Outcome Measures:

  • Weight for height
  • EDEq (Eating Disorder Examination questionnaires)
  • Depression/anxiety questionnaires when appropriate

Costs for the Early Intervention Clinic Service are based on:

  • Initial Psychiatric Assessment £300
  • Initial Psychological Assessment   £100
  • A programme of Psychological sessions.

Following the Psychiatric and Psychological Assessments a therapy contract recommendation is made. The cost is based on the number of sessions agreed at the practitioners standard rate (see individual practitioners’ web pages for specific cost information). This may include liaison with the school or other third party as required.

A common recommendation might be for a series of 6 sessions at £90 per session i.e. £540.

  • Where required, the costs for dietetics input are £90 for a 60 minute initial appointment and £45 for a 30 minute follow up.

Additional fees for additional services agreed will be charged at usual costs for the individual clinician.

Initial queries and outline referrals can be made in the first instance to info@HealthcareOnDemand.org.uk.

The most appropriate lead clinician will then contact you to discuss the referral further, including details subject to full patient confidentiality guidelines.

Cancellation Policy

Please note that the full session fee will be charged for appointments missed or cancelled without a minimum of 24 hours prior notice.