Variations of Treatment Available for NHS Purchasers

Variations of treatment available for N.H.S. Purchasers
Programmes available for the treatment of Anorexia Nervosa

The Eating Disorder Unit at Priory Roehampton is a 20 bed unit licensed to accept for treatment girls from the age of 14yrs. The layout of the unit is designed so that there is a special area for younger patients and at any one time these will be limited to 8 patients. There is also an intensive care area which will allow for the management of 4 extremely ill patients at any one time. These are patients who may require nasogastric feeding and one to one nursing. The unit is designed to generate a treatment alliance between patients and staff but can accept a limited number of patients under a section of the mental health act. These three groups of patients, younger, at high risk, and under section, will only be accepted when the unit is able to manage them. This decision will be made by the unit manager in consultation with the lead consultant of the unit.

There are a number of ways in which we can offer to help fulfil the needs of a health authority.

This is offered to assist with a patient who is acutely ill but who is not ready or not able to undertake a full recovery programme. Such patients will often have a very low BMI (under 13) or will have been causing anxiety about their physical state because of rapid weight loss or extreme purging. Sometimes the emergency will arise because of other self destructive behaviours. The admission will be kept as short as practicable but often will last for 8 to 10 weeks because the necessary weight gain to achieve physical safety will often be to a BMI of about 15 and this will often need 6-10 kg . Patients will not normally take a full part in the group programme as they will be too unwell but they will attend some of the programme as is practicable. They will not normally have time to benefit from formal psychotherapy or family therapy. They will normally be discharged by agreement back to the referring consultant.

This programme is aimed at providing inpatient support treatment for consultants who wish to remain in control of the overall treatment of a patient. The concept is that the local consultant and team will agree with the E.D.U. team what help they need and therefore what will be achieved during the admission. They will remain in weekly contact with the patient so as to deliver continuity of care and enable appropriate after care to take place. It will also allow for full communication of the patient’s progress to the local team. When possible all major decisions will be taken in conjunction with the local area team.

There are certain conditions that need to be met in order for this programme to be possible:

1. The patient will be being treated locally by a local area consultant with a recognised special interest and appropriate experience in eating disorders.
2. The treatment locally is able to provide multi-disciplinary treatment for eating disorders in a day care or an outpatient setting.

3. The area consultant and his / her team is able to agree appropriate aims and management with the unit consultant and staff. (agreement usually made in advance) These aims will need to be clearly specified to all, including the patient and her family. These will include the target weight, the expected length of stay and the process of follow up care.

4. The area consultant and other team members remain in contact with the patient during the inpatient stay. (this may require a combination of visits by staff to the unit and by the patient to the local unit). This contact will need to be a minimum of weekly.

5. There will need to be agreement on who will provide the one to one therapy and family therapy.

6. Although the primary responsibility for the overall strategy will remain with the area consultant, the unit consultant will carry the day to day clinical responsibility and will be responsible for day to day decisions taken on the unit.

The parts of the treatment programme suggested as available to patients in the three different groups are summarised in the diagram below. These are for guidance and are subject to negotiation.

Dr Rowan's Secretary is stationed in the Priory Hospital, Roehampton.
Direct line Telephone Number: (0044) or (0) 208 392 4211
Fax: (0044) or (0) 208 876 4015

Email peter.rowan@psychiatrist4u.co.uk

Psychiatrist4U

Eating Disorder Section