North Yorkshire and York Specialist
Eating Disorder Service
Joanie Barber Bee, Nicola Birkin and Liz Hill
Specialist Practitioners; Eating disorders
Not everyone is for us: what to
do:
• BMI higher than 17.5
• Normal bloods
• Bulimia with no physical problems
• Binge Eaters with no physical problems
• Refer to Primary Mental Health Worker
attached to the GP surgery
• Counsellor attached to the GP surgery
Aim of service
• Service commissioned by NYYPCT Dec
2007 to:
– Improve the quality and effectiveness of
services in North Yorkshire & the City of York
for people with eating disorders
– Decrease the length of time between the
onset of eating disorders and access to
appropriate help
– Limit the physical and psychiatric morbidity,
social disability and mortality caused by eating
Who Are We?
Lesley Hudson: Team Secretary
Bootham Park Hospital tel 01904 721173
Dr Mark Willis: Consultant Psychiatrist
X 3 sessions per week
Bootham Park Hospital
Nicola Birkin: Specialist Practitioner
York & Selby
Bootham Park Hospital
Who Are We?
Joanie Barber-Bee: Specialist Practitioner :
Scarborough, Whitby & Ryedale
Tony Brownbridge: Specialist Practitioner
Harrogate, Ripon & Craven
Liz Hill: Specialist Practitioner
Ripon, Hambleton & Richmondshire
Who Are We?
Bernadine McDonald: Advanced Dietitian
Harrogate, Ripon & Craven
Hambleton & Richmondshire
Elaine Sargeson: Advanced Dietitian
York & Selby
Scarborough, Whitby & Ryedale
Service Remit
• Our service is directed at working with
clinical cases which represent a moderate
to severe eating disorder presentation:
– severe purging (severe bulimic episodes
resulting in physical signs and symptoms)
and/ or
– rapid rate of weight loss (25% body weight in
6 months) and/or low BMI (<17).
– Essentially these are cases where there is a
high probability of interface with specialist inpatient services and community services.
Service remit cont’d
• Less severe physical presentations would
typically be seen within primary care services,
although it is acknowledged that such cases
often represent similar levels of complexity.
• Primary care cases would usually have a BMI of
17 or over and the compensatory weight control
behaviours would not put them at immediate
risk. We are happy to offer consultation to
primary care services.
Who do we work with ?
• Work collaboratively with:
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Service Users/Carers
CMHT
Local Mental Health inpatient units
CAMHS
Primary Care
Medical units
Tertiary services
Specialised Commissioning Group
Other agencies
Information needed at referral
• Weight, height & Body Mass index
• Information about eating patterns and
frequency of binge/ purge behaviours
• Information about associated mental
health problems
• Information about additional risk factors
such as diabetes, pregnancy or substance
misuse.
Information needed at referral
• Results of blood tests/physical monitoring
and medical risk
• Information about any previous
interventions/admissions
• Information re aim of referral and level of
motivation
Service user journey
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Referral to be sent to CMHT initially
Joint assessment undertaken by CMHT/Seds
CMHT take on role of Care Coordinator
Outcome of assessment sent to GP and often
service user; with summary of risks,
management plan and recommended physical
monitoring.
The GP remains responsible for physical
monitoring; we recommend monitoring in line
with Kings College Guide to Medical Risk
Service user journey
• If presenting with very low BMI/high
medical risk medical admission may be
indicated
• May need admission to specialist eating
disorder unit
• May need to consider use of MHA if
resistant to treatment and presenting as
high medical risk
Service user journey
• In less severe case; management plan
may include:
– Joint working with CMHT
– Alternate sessions with Seds Practitioner/
Dietician /CMHT
– Individual work with Seds Practitioner
– Individual work with CMHT supervised by
Seds Practitioner
Service user journey
• Many service users on caseloads for
several years
• Some require several inpatient admissions
• Some not ready to change; discharge from
service if no response to motivational
enhancement
• Some drop out of treatment; often represent at a later stage
Service user journey
• Tragically, but very rarely some die; in our
experience this has been with other
complex co-morbidity
• Some move on to other areas
• Some reach “safer BMI” then either drop
out or mutual decision to discharge
• Some engage very well and complete
treatment
What Is My Role as Specialist
Practitioner?
• Devise care pathways for people with ED
• Offer specialist skills & interventions as part of
care package working with CPA care coordinator
• Offer specialist supervision to CPA care co-
ordinators, CMHT’s, GPs. Additional advise can
be offered to PCMHW’s and counsellors.
What Is My Role as Specialist
Practitioner cont?
• Individual work with a small amount of
clients considered as within the more
severe range of ED
• Offer training/educative role and provide
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evidence based research across all stakeholders
Maintain regular contact with tertiary service
support transition in and out of care – access
tertiary care after conducting assessment
Promote and maintain multi disciplinary
involvement in all aspects of patient care
Role of the Dietitian?
• To work as an integral part of the ED team to
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offer advice and support in all aspects of
nutrition to both staff and clients.
To provide psycho-education sessions around
nutrition to clients.
To ensure optimal nutrition is achieved
throughout all parts of treatment.
To work with the client to plan the step by step
recovery process and challenging beliefs around
food issues.
Limitations of service
• Office space not available in all localities
• Difficulty accessing clinical space in some
localities
• No IT system available for clinical
notes/data other than York & Selby locality
• Specialist Consultant Psychiatrist only
available in York & Selby locality
• Limited dietetic availability to cover large
geographical area.
Limitations of service
• Early interventions not available within
service remit.
• Limited Support Worker availability within
localities to work more intensively with
service users
• Reluctance of some GP’s to complete
physical monitoring
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A few stats:
140
120
100
80
Mar-11
60
Mar-12
40
Sep-12
20
0
Not everyone is for us: what to
do:
• BMI higher than 17.5
• Normal bloods
• Bulimia with no physical problems
• Binge Eaters with no physical problems
• Refer to Primary Mental Health Worker
attached to the GP surgery
• Refer to a Counsellor attached to the GP
surgery
Not everyone is for us: what to
do cont:
• If under 18 years of age then you can
refer to the Castlegate Counselling
Service.
• If the client is a York University student
then they can be referred to the ‘Open
door’ facility at the University
• Offer the self help material outlined