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Eating Disorder Service - Day Service Programme - Plymouth GP Practices
Aim of the Day Service Programme
To offer intensive eating disorder input within a community-based environment to several categories of client/patient groups:
- 'Step-down' support to individuals who discharge from in-patient services to maintain recovery (improving physical and psychological health) and prevent deterioration which may lead to further readmission to in-patient facilities.
- 'Step-up' support to those who suffer with severe eating disorder symptoms which if not treated, are likely to be at risk of in-patient admission to either general medical wards or mental health/specialist in-patient facilities.
- Clients who may be potentially at risk of decline but are committed to work on their eating difficulties in order to reduce the impact their problems may have on their daily life and on-going relationships.
- This client group will require intensive multi-disciplinary input from health-care professionals such as GP's, CMHT's and SEDCAS in conjunction with EDS to maintain a) the delivery of a seamless package of care and b) the close monitoring of physical and psychological health risks.
- Goals to include: normalisation of eating, weight restoration, symptom control, reduction of impairment and psycho-education.
Exclusion criteria
- No emergency referrals especially for clients who require acute medical or mental health admissions
- Clients who are in receipt of therapy/treatment input elsewhere for an eating disorder
- Clients who do not fulfil diagnostic criteria for an eating disorder as set out in DSM-5 or ICD-10
- Those who present with other mental health problems which are more significant than their ED symptomatology i.e. ED not their primary diagnosis
Referral Process/Criteria
Due to the existing or potential risks of these clients, referrals require careful planning; hence, no self-referrals can be accepted. GP's are required to refer clients initially to the CMHT for care co-ordination (if not already on caseload to CMHT), as soon as this is in place, SEDCAS Lead Psychologist will be involved in planning the care package alongside EDS and CMHT. In-patient referrals will access via similar process, i.e. via CMHT care co-ordinator in discussion with SEDCAS Lead Psychologist.
Inclusion criteria
- A desire to commit to the programme and to instigate some changes (negotiated individually) with existing issues (physical or psychological)
- Free from acute medical risks (i.e. severe emaciation, cardiovascular or gastrointestinal complications)
- Absence of acute suicidal risk or substance abuse
- Take responsibility for self-care & maintain physical & psychological safety on 'break' days and evening and weekend meals
- BMI of around 15 but not deemed to require in-patient admission
- Care co-ordination from secondary mental health team
Exclusion criteria
- No emergency referrals especially for clients who require acute medical or mental health admissions
- Clients who are in receipt of therapy/treatment input elsewhere for an eating disorder
- Clients who do not fulfil diagnostic criteria for an eating disorder as set out in DSM-5 or ICD-10
- Those who present with other mental health problems which are more significant than their ED symptomatology i.e. ED not their primary diagnosis
- BMI less than 14 or physically/psychologically too compromised to benefit from the programme (subject to individual risk assessments)
Care Pathway (Areas covered Plymouth & West Devon – no SEDCAS for W Devon)
Within the Plymouth area, there is a clear structure for the eating disorder care pathway. It is reliant on the close liaison between statutory and voluntary services. For clients who will be accessing EDS Day Service, the attached diagram clarifies the relationship between different stakeholders
Day Programme
- Operates on 3 days per week (Monday, Tuesday and Thursday, 9am – 3pm)
- 8 spaces maximum
- Group-based input
- 12-week per programme
Weekly Programme
The format of the programme is sub-divided into three separate themes:
- Skills based day
- Body based day
- Nutrition based day
This enables the clients to focus on specific information and support in these areas and also allows for flexibility for recovering clients to eventually only attend on the day/s that target their specific difficulties.
Physical Healthcare
Due to the nature of risks with this client group and that this day programme is community-based (as supported by the current NICE guidelines, 2004) as a recommended intervention for this vulnerable group; medical monitoring of physical health by the most appropriate clinician forms part of the treatment package within a multi-disciplinary approach within a community setting.
- Monitor and maintain medical checks as per Maudesley Medical Risk Assessment Guide (2009)
- Monitor refeeding risks and prescribe supplements as relevant/necessary
- Involve/participate in regular MDT to discuss on-going management plan
- Be involved with referral to other appropriate services e.g. in-patient admission to medical units when necessary
Dietetic Input
The role of the Specialist Dietitian is paramount in this programme. With staff support, clients are expected to have two snacks and a main meal during each day. Meals are carefully planned and tailored by the Dietitian according to individual's physical and calorific needs.
There are weekly psycho-educational sessions conducted by the Dietitian on various topics concerning nutrition and the effects of compensatory behaviours on healthy bodily functions and development. The aim of the dietetic input is to facilitate normalised, healthy and balanced eating.
Throughout the programme, clients will be seen and monitored by the Dietitian on a weekly basis, their weight and MUAC (mid upper arm circumference) will be recorded for assessments of progress and appropriate nutritional planning.
Therapy Groups
In addition to the psycho-educational sessions, the programme consists of the following groups:
- Compassionate Mind Group
- Body Image Group
- Social Engagement Group
- Skills for Change Group
- Self-catering Group
- Recovery Group (this will run towards the end of 12 weeks or 24 weeks depending on the client needs)
Long-term Condition Self-Management Programme
GPs and patients can refer to Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.
Pathway Group
This guideline has been signed off by the Psychological Therapies Strategic and Implementation Group on behalf of NHS Devon.
Publication date: October 2016
Updated: October 2018
