1. North Yorkshire and York Specialist Eating Disorder Service
Joanie Barber Bee, Nicola Birkin and Liz Hill
Specialist Practitioners; Eating disorders

2. 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

3. 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 disorders

4. Who Are We? Lesley Hudson: Team Secretary
Bootham Park Hospital tel
Dr Mark Willis: Consultant Psychiatrist
X 3 sessions per week
Bootham Park Hospital
Nicola Birkin: Specialist Practitioner
York & Selby

5. 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

6. Who Are We? Bernadine McDonald: Advanced Dietitian
Harrogate, Ripon & Craven
Hambleton & Richmondshire
Elaine Sargeson: Advanced Dietitian
York & Selby
Scarborough, Whitby & Ryedale

7. 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 in-patient services and community services.

8. 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.

9. Who do we work with ? Work collaboratively with: Service Users/Carers
CMHT
Local Mental Health inpatient units
CAMHS
Primary Care
Medical units
Tertiary services
Specialised Commissioning Group
Other agencies

10. 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.

11. 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

12. Service user journey 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 Assessment for Eating Disorders

13. 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

14. 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

15. 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 re-present at a later stage

16. 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

17. 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 co-ordinator
Offer specialist supervision to CPA care co-ordinators, CMHT’s, GPs. Additional advise can be offered to PCMHW’s and counsellors.

18. 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 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

19. Role of the Dietitian?
To work as an integral part of the ED team to 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.

20. 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.

21. 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

22. A few stats:

23. 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

24. 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