The Eating Disorders Service
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1 Contact us Clinical Team Leader Eating Disorders Service Steps Unit Southmead Hospital Bristol BS10 5NB The Eating Disorders Service PALS To make a comment, raise a concern or make a complaint, please contact the Trust s Patient Advice and Liaison Service (PALS). Tel: Freephone: awp.pals@nhs.net Other formats and languages Information for relatives, carers and friends who care for people with eating disorders If you need this information in other formats (such as large print, audio, Braille) or in another language, please call the PALS number. Lead: Clinical team leader Leaflet code: AWPApr Review due: April 2016
2 Who are we? The team offers a specialist eating disorders service to adults in the Bristol, Bath, South Gloucester and North Somerset area. We have been based at the Steps Unit at Southmead Hospital in Bristol since The team is made up of psychologists, psychiatrists, mental health nurses, occupational therapists, a physiotherapist, an arts psychotherapist, a dietician, mental health workers and administrators. What we can offer? We work in partnership with local mental health services, offering in-patient, out-patient and community-based services. The care that we offer is based on the individual s needs. Assessment and treatment of eating disorders Recommended reading Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method by Janet Treasure, Grainne Smith and Anna Crane Overcoming Binge-eating by Chris Fairburn Getting better bit(e) by bit(e) a survival kit for sufferers of bulimia nervosa and binge eating disorders by Ulrike Schmidt and Janet Treasure Anorexia Nervosa a survival guide for families, friends and sufferers by Janet Treasure The Compassionate Mind by Paul Gilbert We have a few copies of these and other books available for loan from our office at the Steps Unit please ask if you would like to sign one out. People who have problems with eating, food, shape and weight may show it in many different ways. We accepts referrals for people who have been diagnosed with Anorexia Nervosa, Bulimia Nervosa or EDNOS (Eating Disorder Not Otherwise Specified). It is common for the symptoms of the eating disorder, and therefore the diagnosis, to change over the course of the illness. Other mental health problems may be present alongside the eating disorder. 1 10
3 Other organisations that can help BEAT (Beating Eating Disorders) have information and support forums available through their website and run a support group in Bristol. SWEDA (The Somerset and Wessex Eating Disorders Association) also have a lot of useful information on their website. MGEDT (Men get eating disorders) are a UK charity dedicated to representing and supporting the needs of men with eating disorders. Please ask for information about other carer organisations in your area. What causes eating disorders? There is never one cause of an eating disorder. There may be a number of things that make someone more likely to develop an eating disorder; some things that trigger the onset of difficulties with eating or weight, and others that make the problem continue and make it difficult to recover. Recovery and motivation We do not assume that everyone wants to get better from their eating disorder right now most people have mixed feelings about recovery. There is evidence to show that work to change is unlikely to be effective or long lasting, unless the person has been able to make sense of these mixed feelings. This means that a stage of preparation work and exploring motivation is often required before beginning treatment focused on active change. In this stage, it may appear from the outside that nothing is happening for example the person is not regaining any weight but useful work is going on. As part of our overall assessment, we will assess the person s readiness to change and offer treatments that are likely to be most useful to them at the stage they are at. These are outlined in our Menu of Options leaflet. 9 2
4 Managing risks Eating behaviours like restricting food or fluids, bingeing and vomiting can cause serious health problems. For this reason, we may advise a monitoring plan involving regular weighing and/or blood tests. Rapid weight loss, severely low weight, or problems with blood chemistry may make it necessary for the person to be admitted to a medical ward. We will liaise with GPs and the person to arrange these actions when needed. Sharing information Discharge from the service We recognise that discharge from the service while there are still eating problems can be a time of more difficulty and concern for carers. This is particularly true where there are disagreements about discharge. A person may choose to leave the service themselves, or the team may say that continued treatment at this point will be counter-productive. Remember the door is not closed. A person can ask to be reassessed after a period of time or if circumstances have changed. In some cases, the team may continue to offer liaison and support to the General Practitioner or other medical teams. At the first assessment, individuals will be asked to give details of someone who they rely on for support and comfort, who we would call a carer. They will be asked whether they wish to give permission for information to be shared with you and if so, to sign a form giving this permission. We understand that from time to time, you may wish to communicate information to the team or to the GP, and you have a right to provide such information. You also have a right to your information being given in confidence. There are no issues of confidentiality involved in this communication. However, remember that the team member that you speak to may not have permission to share information or be able to answer questions relating to the person in their care. 3 8
5 Where can you get support and information? You can attend and contribute to care planning meetings, with the persons consent. These meetings are when important treatment decisions are made together with the person and their carer(s). A carers Information and Discussion Group is held every two months at Steps and can be attended by family members, partners and friends of our service users. An assessment of carer needs can be requested. This is an opportunity to discuss your needs. We can also meet individually with families and carers to provide information and support. This is usually for 1-6 sessions approximately monthly. There may be a waiting list before an appointment can be arranged. Details of other organisations offering support are at the end of this leaflet. What can you do? It is often difficult for carers to know what to do. It can be frustrating and painful to support someone with an eating disorder. You may find it helpful to get some support about specific issues you face. These general points may be of use: It may be helpful to: ask the individual about aspects of the eating disorder you are unsure about. openly talk about behaviours that affect you or other family members and which you find unacceptable. take time out spend time with your own friends and pursuing your own interests. ask about the signs that someone is physically at risk, and what the plan is to monitor these risks. contact emergency services if you feel the person is at risk now. get support for yourself, either as a carer, or about other issues you are facing. share your concerns with the GP or Steps team. 7 find out about normal eating To normalise eating, people have to eat regularly (up to six times a day), eat adequate portions and not exclude any food groups. If someone is low weight, they need to eat a lot more to restore their weight. If someone is bingeing, then regular eating, eating enough and not excluding any food groups is important in overcoming the physiological urge to binge (even if they are overweight). 4
6 If you are supporting someone to eat It may help to try to establish expectations for both sides beforehand, away from the table. find out what a normal portion is, agree who will prepare the food and serve it out. Talk about the kind of support the person finds helpful or unhelpful. agree a time limit on meals. find out what is included in their agreed meal plan, for example puddings and snacks. set realistic limits on how much time or support you can offer. It may be unhelpful to: comment (even positively) on appearance, weight or shape. take on too much responsibility for helping someone overcome their eating disorder or manage a meal ask how you can help, but recognise that you can t make it happen. comment on progress at mealtimes many people find praise or comments such as well done following meals unhelpful. comment on the size or calorie content of meals. discuss your own eating. It may be helpful to acknowledge if you are dieting, have an eating disorder or worry about your weight, but unhelpful to talk about it a lot expect too much. Lapses are likely, and learning to deal with them can help the recovery process. assume that someone will feel better when they are eating in a more regular pattern distress is likely to increase, but if they learn to manage this, longer term change is possible. 5 6
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