Issue 12
EATING DISORDERS SECTION
Royal College of Psychiatrists
Winter 2013
INSIDE THIS ISSUE:
1) Foreword from the editors
2) Foreword from the Chair
3) Feedback on EDSECT strategy day and work plan 2013/14
4) Reflections on being the Psychiatric Trainee Committee Rep on
EDSECT
5) The EDSECT Annual Conference: feedback form a bursary
winner
6) Update from the Academy of Eating Disorders
7) Provision of services for people with EDs and Type 1 Diabetes
8) List of Executive Members of EDSECT
1. Forward from the Editors
If it seems a while since the last newsletter, circulated back in May, that’s
due to a new system introduced this year in which the newsletter will be
published only twice a year. Hopefully the Spring/Summer and
Autumn/Winter editions will still give plenty of scope to capture and
communicate the work of the Section and report the progress made with
our objectives each year.
At the end of June the EDSECT Committee met and reviewed the progress
made with our 2012/2013 work plan and developed the aims for the
coming year. A summary of the work plan for 2013/14 and progress to
date are described within.
Some EDSECT members have moved on this year as new members have
joined and Carol Wilson as the Trainee representative is one of those
whose enthusiasm and hard work for the section will be missed. As Carol
takes on the role of Vice Chair of the Psychiatric Trainee Committee she
has given some reflections on her time on EDSECT and in particular her
thoughts on the challenges that we face in encouraging trainees into the
specialty.
The annual EDSECT conference in November was a great success and
presented delegates with a range of speakers including some from beyond
the usual boundaries of eating disorders psychiatry. Several bursary
winners attended, one of whom has written a very thoughtful piece on
their experience on the conference and the questions raised by the
presentations.
As Dasha Nicholls leaves her post as President of the Academy of Eating
Disorders she reflects on the ICED in Montreal earlier this year and the
newly honed objectives and goals of the Academy, as well as looking
ahead to the ICED in New York next year for AED’s “coming of age “ 21st
birthday celebrations.
Finally we have included a request from Sylvia Dahabra for EDSECT
members to respond to a survey on the current provision of services for
patients with Eating Disorders with Type 1 Diabetes. Please do find the
time to complete the survey before the end of November.
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Wishing you all a happy and healthy festive season and New Year
Rebecca Cashmore
Irene Yi
Editor
Co-Editor
Rebecca.cashmore@leicspart.nhs.uk
Irene.Yi@sabp.nhs.uk
2. Forward from the Chair
The medical profession and Royal Colleges are currently assimilating the
Francis Report.
It would be tempting to adopt a defensive posture built on lack of
resources and management structures.
However, this would not address the need for compassionate care,
collaborative care and dignified care.
These are issues that permeate the eating disorder specialism, as we
strive to balance risk management with patient autonomy, vast demand
against finite resources and bureaucracies that may override clinical
judgment.
Eating disorders services have had their fair share of Staffordshire
scandals, based around abuse of power.
But the Francis Report also offers opportunities. Patient safety is now at
the forefront of policy, with medical leadership integral to its attainment.
Acute hospitals remember their compassion when psychiatric input
becomes properly integrated, as seen through MARSIPAN groups.
By taking ownership and accepting responsibility of the challenges laid out
in the Francis Report, eating disorder services can rightly assert the
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importance of medical leadership, compassionate and collaborative care
and added quality of a psychiatric presence in the acute healthcare trust.
These are issues that are likely to gain further prominence in the next
year, as the Academy of Royal Colleges grasps the nettle.
John F Morgan
3. Feedback on EDSECT strategy day and work plan 2013/14
The Executive Committee met at the end of June and after reviewing
existing priorities agreed that the following themes continue to be
important to the work of the Section:
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Commissioning
Training
Models of care
Co-morbidities
Risk/mortality
In order to focus our minds on what might be new areas on which to focus
our attention; Exec members worked in small groups to consider the
following question:
“What difference would we want to see in the Eating Disorders world?”
Following these discussions the Committee members agreed the following
4 statements which reflect the vision for improving specialist services,
educating and supporting allied professions who may an individual’s first
point of contact and broader public health messages which could influence
the development of eating disorders.
1) There should be equality in the quality and availability of services
across the UK
2) Patients should receive an integrated and well informed model of care
that works
3) EDSECT should promote the message that “Dieting doesn’t work”
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4) EDSECT would work to promote the message that “It’s OK to talk about
an eating disorder to anyone”
The Committee members considered the steps that would be required in
order that the above could be achieved:
1) To improve the quality and equality of services across the UK required:
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Mapping the provision of services to established networks
Influencing commissioning structures
Informing the QED process
Training and supporting carers across the UK
Dissemination of information
Include MARSIPAN guidance in Core training
Developing an implementation/training in MARSIPAN working group
– working with GPs, medical students, physicians, paediatricians,
nurses, dieticians, psychiatrists and student health professionals.
Improved audit of Outcome
2) Patients receive an integrated and well informed model of care that
works
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Working with carers across the age range
Hosting MARSPIAN training
Supporting the exploration of novel care pathways
Qualitative research
Joint conference with the Faculty of Medical Psychotherapy (eating
disorders and personality disorders)
Developing a New to Eating Disorders Training Programme Working
Group (working with EEATS).
3) The message that “Dieting doesn’t work”
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Influencing and promoting relationships with public health/obesity
professionals
Develop a College position statement
4) The message that “It’s OK to talk about an eating disorder to anyone”
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Joint work with RCGP
Making the first encounter with a health professional count (working
collaboratively with BEAT)
Develop/collate a transition guide (including university students).
Develop good practice guidelines (transitions)
In the months since the Strategy day, work in these areas has been
progressed by various working groups. Examples of the work still ongoing
with the named leads include:
Dr Jessica Morgan is leading on the work to map services, initially trying
to secure funding for this substantial project.
Drs Ayton and Sharma are the Exec committee members liaising with Dr
Paul Robinson on the training and implementation of the MARSIPAN
guidelines across different professional groups.
Dr Crockett is liaising with Prof Kam Bhui (College Lead for Public Health)
to consider how to promote the public health messages important to
EDSECT.
Dr Morris is leading the working group on the development of a “New to
Eating Disorders” pack for those clinicians who are new to eating disorders
or working in allied professions and seeking education in the area of
eating disorders.
Rebecca Cashmore
4. Reflections on being the Psychiatric Trainee Committee Rep on
EDSECT
From 2012-2013 I sat on the Eating Disorder Section (EDSect) of RCPsych
as their representative from the RCPsych Psychiatric Trainees’ Committee
(PTC). The PTC has approximately 40 elected trainee representatives and
we are in the unique position of having members sitting on almost every
committee within the College. Having just completed a 6 month
outpatient eating disorder post in Edinburgh I was immediately attracted
to EDSect. Of my core training years, this 6 months was where I learned
most about psychotherapeutic approaches, formulation and, seemingly at
odds with that, where I found myself most immersed in physical medicine.
Being relatively inexperienced in the former but feeling increasingly
unfamiliar with the latter when I had started that post, I recalled the
apprehension of those early days. In my view we do not hear enough
about eating disorders during our core training but the one thing we do
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get reminded of, starting in medical school, is the mortality rate
associated with Anorexia Nervosa. I approached the post feeling a bit of
fear and self-doubt: I suspect many of my peers have felt similarly. With
supervision I gradually gained confidence and whilst working alongside
some truly skilled therapists I undoubtedly developed as a psychiatrist.
It would not be an honest account of my experience on EDSect if I denied
that my first meeting was a nerve wracking experience. For all PTC
representatives, our first meeting on our first College committee may be
the first time we have ever stepped into the College building (our initial
PTC meeting is often held elsewhere). I found myself joining a group full
of established professional relationships, mutual respect and huge
collective experience. Extensive and detailed discussions took place
related to the NHS reforms in England. I searched in vain to find
something useful to say. However, during the first meetings I learned to
understand the challenges facing the Section, its members and the wider
eating disorder community. The provision of care to those with eating
disorders is provided across NHS and many non-NHS organisations. If
ever the term ‘post-code lottery’ was relevant to a patient group, my
sense was that the committee feared it was here. How do we move
further towards more standardised and evidence informed care when we
don’t even have a complete map of where the services are and what they
do?
The training that psychiatrists receive in eating disorder psychiatry is
acquired across core training, child & adolescent higher training, general
adult higher training or as CPD for non-training grades. A psychiatrist
could feasibly take up a post within an eating disorder service for the first
time in their career at any of these grades and as such there is no clear
curriculum that will have been followed and no assumptions that can be
made about the psychiatrist’s previous experience.
Within the committee there seemed to be a consensus that there were too
few trainee psychiatrists currently in eating disorder posts and a concern
about what this could mean for the future workforce. Efforts were being
made to promote eating disorder psychiatry to medical students and
trainees by offering bursaries for travel to the Section’s Annual Meeting
and by inviting applicants to the Section’s Poster Prize: some very high
quality entrants highlighted that the interest, enthusiasm and capability
the future of the service needs is out there. Why then does there seem to
be a dearth of core and, particularly, higher trainees in these services?
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In June 2013 EDSect held its annual strategy day. The Chair, Prof. John
Morgan, facilitated an enthusiastic discussion aimed at identifying the
main areas of focus for EDSect for the year ahead. During a wide ranging
conversation emphasis was repeatedly placed on the importance of high
quality training to good services. We also considered whether any factors
‘pushed’ trainees away from eating disorder services. Might it be that
psychiatric trainees are just put off by the need to get their stethoscopes,
BP cuffs, needles and tourniquets to hand on a regular basis? The early
jitters of my own involvement with eating disorder services came to mind.
It had, in fact, been an initially very daunting and very different
experience to work in an eating disorder service. With no assurance of an
adequate induction programme I believed it was this unfamiliarity and
self-perceived lack of competence that deterred some trainees. We
agreed this training gap was a problem and that the Section should
address it.
At the time of the strategy meeting I was working in a Forensic Psychiatry
post at The State Hospital, Carstairs, Scotland. There I had learned of a
multi-disciplinary induction programme called ‘New to Forensic’: a joint
venture between NHS Education for Scotland and The School of Forensic
Mental Health. The programme provides induction material that should be
worked through with an experienced mentor. Whilst not providing a formal
qualification, a certificate is issued upon completion of the programme.
There was agreement that there was a clear rational for creating a similar
programme for eating disorder services. Dr Jane Morris had already
created some induction materials for Scotland but these had not currently
been conceived to be used at a UK wide level. Dr Morris agreed to lead a
working group that would set to work in creating this national induction
programme.
As EDSect bids ‘goodbye’ to me it says ‘hello’ to a new PTC
representative, Dr Alex Keith, who is an ST5 in General Adult Psychiatry in
South East Scotland. Alex was attracted to the exciting opportunity of
getting involved in a piece of work that will make it easier for all of the
professional people who are taking up posts in Eating Disorder services
across the UK to acquire the unique knowledge and skills required in this
rewarding but complex area. As I leave EDSect I take on a new challenge
as Vice Chair of the PTC. As we welcomed a lot of new members to our
committee we encouraged them not to be observers but to recognise that
within the Faculties, Sections, Special Committees and Special Interest
Groups of RCPsych we can advocate for the needs of the trainees that we
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represent and we can bring perspectives to discussions that are valued by
the more senior psychiatrists, patient and carer representatives that we
encounter. My experience within EDSect undoubtedly supports this.
Carol Wilson
ST4 in General Adult psychiatry
Vice Chair Psychiatric Trainees Committee
5. Eating Disorders Section Annual Meeting: A personal Perspective
Whilst learning about the possible aetiological mechanisms that underlie
eating disorders during my psychiatry rotation, I couldn’t help but notice
that there was a stark resemblance to life as a medical student. It is those
same ideals of perfectionism, an eye for detail, and rigidity in following
rules set by ourselves that can precede both high achievers and the
development of an eating disorder. This sparked my interest, and as a
student associate of RCPsych, I was able to apply for a bursary to attend
the Eating Disorders Section Annual Meeting.
The thought of attending a conference predominantly targeted towards
specialists can feel daunting as a medical student, but in retrospect there
was nothing to fear. The conference opened with a presentation by a
neurosurgeon on Deep Brain Stimulation (DBS) - he provided a solid
introduction as to what DBS was, its use in treating symptoms of
Parkinson’s disease, and the result of a trial of its application in improving
BMI in patients with anorexia where psychiatric treatment had failed.
Be it my naivety as a student, but it was evident that this exciting
research had potential flaws- is DBS treating the underlying anxieties
associated with anorexia, or is it just increasing BMI? Why did the
inpatient psychiatric treatment that these patients had during the trial
before DBS have a significant impact on improving their BMI, if they were
treatment-resistant? The discussion forum at the end of the talk was a
comfortable environment for me to voice my ideas alongside those of
psychiatry consultants and trainees, and it was clear that there were
many possible directions for further research in this area. It is exciting to
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consider that the next generation of psychiatrists may have a role in
working alongside neurosurgeons within a multi-disciplinary team to
determine the suitability of DBS in specific patients.
This contrasted greatly with subsequent talks on the management of
malnutrition and the prevention of ‘refeeding syndrome’- the electrolyte
disturbances that can occur when feeding anorexic patients who have
been severely malnourished. Here, I realised how important it was for a
psychiatrist to have knowledge of general medicine, as acutely unwell
patients with anorexia nervosa may have a range of clinical abnormalitieslow blood pressure, nutritional deficiencies, electrolyte disturbances and
anaemia to name a few; and the same principles of diagnosis and
management in clinical medicine are equally applicable in these situations.
All in all, even in a glimpse of a sub-specialty, I was able to witness the
variety within psychiatry. The talks were engaging, thought-provoking,
and the only essential requirement that you really need is natural curiosity
about the subject!
Yathooshan Ramesh
(Year 5, Imperial College London)
6. Update from The Academy for Eating Disorders (AED)
My term as President of the AED is now complete, and it was with mixed
feelings that I handed over to Professor Pam Keel at the International
Conference on Eating Disorders (ICED) in Montreal in May. Mixed feelings
because it was not always easy leading a complex network of volunteers
and staff at long distance by means of late night teleconferences, trying to
keep an eye on the big picture whilst being bombarded with detail and
always having to be mindful of risks (although as an ED Psychiatrist this
should be familiar territory....). The plus side is the feeling of having
contributed something to a vision that I believe in: ‘Global access to
knowledge, research and best treatment practice for eating disorders’. The
energy of the volunteers is the lifeblood of the AED (over 400 AED
members volunteer for the AED in some way!), and I know it is that same
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energy that keeps EDSECT active and productive. I have likened this to
the energy and teamwork what made the Olympics so successful. It’s a
good feeling, having made a contribution, and one that will last I think. I
hope that’s a spur on to those of you have hesitated about joining the
EDSECT executive committee, volunteering for AED, or contributing in
your local ED organisations.
The highlight of the AED year is the ICED, and in May almost 1,000 eating
disorders professionals gathered for three days of unparalleled education
and networking in the beautiful city of Montreal, while the sun shone
every day in a cloudless sky. Despite formally adopting ‘European’
starting hours (9am instead of the usual US 8am), I seemed to be burning
the candle at both ends, there was so much to do. Highlights included a
dip into the anxiety field from our key note speaker, David Barlow of
Boston University. Kate Tchanturia’s observations about the way our
patients process, or fail to process, positive emotions particularly
registered for me. The use of the internet for delivery of interventions
featured highly, and I was delighted to find that some high quality
treatment modules are now freely available on line (e.g. those developed
by the Centre for Clinical Interventions in Perth, Australia
www.cci.health.wa.gov.au/resources/index.cfm). At the end of the
conference was a session from the Research-Practice committee on
recovery, in which some of the ‘them/us’ barriers were broken down as
professionals talked openly about having recovered from eating disorders
themselves, and raised the idea, quite common in the addictions and
other fields, that the recovered individuals may be best placed to help
those struggling to recover. It is a controversial area but one I think we
should not be afraid to grapple with.
Next year the ICED will be in New York, where our own Professor Glenn
Waller will be stepping into the Presidential role. Those of you who have
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been in the field a long time will recall that there were once only two
International ED conferences: the London Conference and the New York
(AED) conference and they took place in alternate years. As the field
grew, the AED-ICED became annual, and there is now an annual
International conference in London too, as well as many other training
events, including the fantastic EDSECT conferences. The last time the
AED-ICED was held in New York was in 2000, before the atrocities of
9/11. So this is a big event, coinciding as it does with the 21st birthday of
the AED. If you have flirted with the idea of joining the AED, this might be
the year to do it. The dates are March 27-29, 2014 with a Clinical
Teaching Day on the previous day (separate registration required) on
Wednesday March 26, 2014. For up to date info on the ICED meetings
past and future click here www.aedweb.org/ICED_Homepage.htm
The AEDs main achievement as an organisation last year was to hone our
objectives and restructure to maximise our chances of achieving them.
Our strategic goals are to:
1. Generate knowledge and integrate collective expertise about Eating
Disorders.
2. Provide platforms for the promotion of understanding, sharing of
knowledge, & research-practice integration in the field of Eating Disorders.
3. Build capacity in the next generation of Eating Disorder professionals.
4. Foster innovation & best practice by recognizing excellence in the field
of Eating Disorders.
Within this framework, the AED prioritised two main areas this year to
focus resources on: 1] development of the website (new version on its
way!), and 2] dissemination of the Medical care Standards Task Force
Brochure ‘Eating Disorders: Guide to Medical Management’. If you haven’t
seen it, the brochure can be downloaded and printed from
www.aedweb.org (left hand side, under publications). It focuses on early
recognition and medical risk management and is designed for frontline
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staff such as GPs, Paediatricians, A&E staff, so a slightly different audience
than MARISPAN and its Junior relative. It is now available in six
languages! Please use it, disseminate it, and most importantly, tell me if it
is useful or needs modifying for a UK audience. My email is
d.nicholls@ucl.ac.uk
Wishing you all the best
Dasha Nicholls
Immediate Past-President, Academy for Eating Disorders
Great Ormond Street Eating Disorders Team
7. Survey on the provision of services for patients with Eating Disorders
and type 1 Diabetes
Dear Readers
Some of you have already kindly completed the survey on the service
provision for people with eating disorders and type 1 diabetes.
In order to support future development of services, we are currently
trying to gather information on:
- what services exist and where
- nature of those services
- accessibility of these services and availability of expert advice/ joint case
working
- any training needs in your service
We do appreciate that surveys make extra demands on your time. The
questionnaire should take no longer than 10-15 minutes to complete and
your help would be much appreciated. We aim to complete the survey by
31st November 2013. If you have any comments/queries, please feel free
to email Dr Carol Kan (carol.kan@kcl.ac.uk) or Dr Sylvia Dahabra
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(Sylvia.Dahabra@ntw.nhs.uk).
To start, please clink on the link:
https://www.surveymonkey.com/s/7QXN3QP
We look forward to hearing from you.
Sylvia Dahabra and Carol Kan
8. Executive members of EDSECT
Member
Year of
joining
Position
Dr John Morgan
2011 (E)
Chair
Dr Nadia Micali
2013 (E)
Financial Officer
Dr Alexander Keith
2013 (A)
Psychiatric Training Committee
Rep
Dr Rebecca Cashmore 2011 (E)
Elected Member
Dr Niki Kern
2012 (C)
Academic Secretary
Dr Philip Crockett
2011 (E)
Elected Member
Dr Christopher
Freeman
2011 (E)
Elected Member
Dr Philippa Hugo
2011 (E)
Vice Chair
Ms Veronica Kamerling 2011 (C)
Co-opted Member
Dr Jessica Morgan
2011 (E)
Elected Member
Dr Elizabeth Morris
2011 (E)
Elected Member
Dr Sandeep Ranote
2011 (C)
Co-opted Member
Ms Susan Ringwood
2012 (C)
Co-opted Member
Dr Christine Vize
2011 (E)
Elected Member
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Dr Irene Yi
2011 (C)
Co-opted Member
Dr Joan Brunton
2013 (E)
Elected Member
Dr Helen Murphy
2013 (E)
Elected Member
Dr Carolyn Nahman
2013 (E)
Elected Member
Dr Sonu Sharma
2013 (E)
Elected Member
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