Gloucestershire
Eating Disorders Project
www.edglos.org.uk
E a tin g
D is o r d e r s
P r o je c t
©Sam Clark-Stone - Clinical Co-ordinator
01452 891206
(01/2003)
Reasons for the project
• Complaints from service users and carers
regarding lack of specialist provision
• Lobbying by professionals who had
developed a special interest
• Increasing cost of ECRs out of county
• 30K revenue allocated by previous H.A. CE
• Inability to appoint a specialist consultant
• Public Health Department’s recognition that
a health needs assessment was required
Original project aims (1995)
A Health Authority led multi-agency project
group agreed to appoint a Clinical Co-ordinator
to lead a 1 year project to:
• Undertake a health needs assessment
• Provide a programme of training for NHS,
education and voluntary sector staff
• Propose a strategy for eating disorders within
Gloucestershire
Eating disorders A local health service strategy
The strategy aims to:
• 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 disorders
This will be achieved by:
• increasing and improving early identification and
intervention in the community and primary health
care
• improving specialist clinical and resource
management within mental health services
Eating Disorders Strategy - Improve
early identification and intervention
•
•
•
•
Establish a public telephone helpline
Distribute a public information leaflet
Establish an EDA support group
Provide training for primary care, school
nurses, education, youth services and
voluntary agencies
• Produce guidance for management in
primary care
Helpline monitoring
•
•
•
•
250+ calls since summer 1997
Sufferers, carers and professionals
Reduction in the length of eating disorder
Reduction in the length of concern for
sufferers and carers
• Increase in the number who have not
previously received NHS help
• Increase in the number who are not
currently receiving NHS help
Raising awareness
• Press releases and media interviews to raise
awareness of the project
• 300+ attendees at EDA support group
• Multi-agency guidance for dealing with
eating disorders in schools and colleges
• On-going training programmes available
• Specific training available on request
Improve specialist clinical and
resource management
• Link worker within each CMH Service
(adult and child and adolescent)
• Training, supervision, consultation, written
guidance, joint assessment and clinical
work provided by Clinical Co-ordinator
• Measurement of outcome using EDEQ
• Contract with a private unit for specialist inpatient care
• Guidelines for management of out of county
in-patient referrals
Improve specialist clinical and
resource management
• On-going programme of training, including
outside experts teaching and supervising
development of evidence based therapies
• Clinicians encouraged to use evidence based
treatment manuals
• No waiting lists for community treatment
• 130+ patients registered on outcome
measurement database
• Follow-up at 6 months, 1,2, and 5 years
• Improvements in clinical scores over time
EDEQ Average Global Scores
(n = 48)
Assessment
One Year
Significance
3.95
2.79
P<0.0001
Case example
• Patient assessed jointly by CMHT and Eating
Disorders Project (EDP) staff
• Care plan agreed with patient and family
• EDP staff initially co-facilitate appointments
gradually reducing the frequency of
appointments attended
• EDP staff offer on-going supervision and
consultation
Improve specialist clinical and
resource management
• Ensure closer relationship with providers
• Establish guidelines for admission, liaison
and discharge for out of county referrals
• Take over responsibility for authorisation of
HA funding
• Clinically monitor and negotiate contracts
• Review the outcome of admissions
• Negotiate new packages of care
Improve specialist clinical and
resource management
• Outcome of admissions assessed
• Re-negotiated contract with private unit
providing adult in-patient re-feeding up to
75% average expected weight, then day care
(gradual reduction from 5 days per week)
for those working towards recovery
• Significant financial savings resulting in HA
supporting further service development
Adult admissions to
Priory Hospital
Left
early
96-98
Inpatient
98-02
IP/Day
care
Stable
BMI
>17.5
0
Unknown
4
Relapsed
BMI
<17.5
6
5
3
12
3
2
Gloucestershire in-patient costs
for eating disorders
Year
C &A
patients
C &A
cost
Adult
Adult
patients cost
Total
Total
patients cost
1996-97 9
442K
7
291K
16
733K
1997-98 13
300K
8
200K
21
500K
1998-99 5
215K
14
356K
19
571K
1999-00 6
536K
10
127K
16
640K
2000-01 8
257K
6
83K
14
341K
2001-02 4
46K
13
286K
16
332K
Gloucestershire day care costs for
adults with eating disorders
Year
Cases
Days
Cost
2000-01
5
319
57K
plus
transport
2001-02
13
473
89K
plus
transport
Eating Disorders Project – Development
of the service
• Options appraisal completed 2000
• Health Authority and Trusts agreed to
develop the project by employing an extra 2
WTE staff
• The project to provide input to specialist
clinics in CAMHS, patient and family
psycho-education groups and ongoing
project work
Current EDP staff
• 80K extra funding provided by HA
• Clinical Co-ordinator: whole time
• Senior Clinician (H grade equivalent,
MHSW background): whole time
• Clinician (OT Senior 2): 3 days
• Clinician (G grade): 3 days
• Involved with 180+ cases since August
2001 (referrals from CMHTs and CAMHS)
• 70+ active cases
Recent developments
• Education group for sufferers and carers
• CAMHS clinics evolving across county
• 6th form research study testing guidance for
secondary schools
• New primary care guidance as part of NSF
• Guidance for re-feeding on local medical unit
• Service users and carers forums (low attendance)
• Survey of service users (poor response rate)
• Training course at UWE
Gloucestershire Care Pathways for Eating Disorders
Assessment of patient and family
Motivational Enhancement
Education and Monitoring
Child or Adolescent
Adult
Focused Family Therapy
(Whole or separated)
Individual psychotherapy if required
In-patient treatment if severe
physical risk or failure to reach
healthy weight
Motivated to change eating behaviour
Dietetic advice
(occasionally if needed)
Cognitive Behaviour Therapy or
other focused treatment manual
Family intervention
if needed
Unmotivated to change eating behaviour
Interpersonal Psychotherapy
(if motivated to change relationships
& able to maintain safe weight)
Dietetic advice
(occasionally if needed)
1 Local (out of county) NHS adolescent mental health unit
Specialist in/day patient treatment 1 Local (out of county) private
2 Private (out of county) specialist eating disorders unit
specialist eating disorders unit
if remains motivated,
3 Local paediatric medical unit, if physical emergancy
but fails to reach healthy weight (BMI <15 in-patient, BMI >15 day care)
Support and review
including family intervention
(regular, but infrequent)
In-patient re-feeding to safe weight
(BMI 14-15) if severe physical risk
Informal or Section 3 MHA
1 Local medical unit re-feeding programme
Use of MHA and Mortality
• Prevalence of detention under S3 = 0-2
• Detained patients now treated in medical
unit (preferred option) or psychiatric unit
• NG tube feeding used sometimes on
medical unit, but no patients forcibly re-fed
• No deaths known during clinical life of the
project apart from one ex-patient who died
as a result of complications due to IDDM
• Expected death rate for AN = 1 per 8 years