Step-by-step guide to eating disorder treatment

1. GP

Anorexia risk assessment and referral

There will be physical tests, such as weight (including not only current BMI but also severity of recent weight loss), a blood test to measure nutritional status and a check about whether menstruation has stopped. Personal history should be discussed. The role of your GP is to assess the likelihood of an eating disorder and when necessary, to refer you to specialist services for a full assessment.

Second Opinion

You are entitled to seek a second opinion from another GP, either within or outside the practice, if you feel you are not receiving the help you need. Your GP is unlikely to have extensive expertise in eating disorders, but they should carry out a full examination and support you to obtain the services you require.

2. School Nurse

Referrals

Like GPs, school nurses can refer pupils to services and can be the first professionals to identify and act upon a possible eating disorder.

3. Eating Disorders Assessment

You will be seen by your local CAMHS team

You will have an eating disorders assessment by a psychiatrist or other specialist professional from your local CAMHS team (child and adolescent mental health service). This will be based on some of the tests and information from your consultation with a GP, but it will be a much more detailed process, including a diagnosis if you do have an eating disorder, or an assessment that you could be at risk of an eating disorder. The type of treatment you need will also be given.

4. Child and Adolescent Mental Health Services (CAMHS)

Treatment by your local CAMHS team

Apart from a relatively small number of young people with very severe anorexia who are admitted to inpatient services immediately on diagnosis, for most, treatment starts with outpatient services. This means regular sessions with professionals and may include a psychiatrist, specialist nurse, dietitian and family therapy. It is normally the psychiatrist from your CAMHS team who is responsible for making a referral for a further assessment if your child is not responding to treatment and may need more support, including the possibility of inpatient treatment. If you have concerns, you can ask the psychiatrist to explain what the criteria would be for this referral.

5. Specialist NHS Commissioners

If your child is not responding to outpatient services

If there are concerns that a young person is not responding to outpatient treatment, is continuing to lose weight and is at risk, a further assessment will take place to judge whether the young person needs to move into inpatient treatment. In the West Midlands, this is called a Gateway Assessment. In other areas, it is usually called an inpatient assessment. The purpose of this assessment is purely to judge whether more intense treatment and care in an inpatient setting is required. If this is judged to be necessary, the young person and parents are entitled to be able to have choices and preferences about where inpatient treatment takes place. However, if the young person is assessed as needing urgent inpatient treatment for their own safety, choice may be limited to the eating disorders units with availability at that time.

6. Inpatient Treatment

Comprehensive, integrated 24 hour care

Inpatient treatment may take place in a specialist eating disorder unit, although many young people are admitted to general adolescent psychiatric services for some or all of their inpatient treatment. We believe and many studies support the view that the best outcomes for patients are achieved in specialist eating disorders units, where services are fully integrated and there is a multi-disciplinary team of eating disorders specialists to provide a comprehensive treatment approach.

7. Towards Recovery

Continuing Support

With effective treatment, delivered as early as possible, it is possible to achieve very good outcomes. A study of Newbridge House patients after discharge showed 90 per cent had a BMI over 17.5 and 100 per cent had continued with outpatient support. We also seek to achieve effective treatment as soon as clinically feasible, so young people are in the inpatient setting, apart from their family and community, for the least amount of time in order to affect longstanding change and recovery.