The service supports young people with eating disorders (Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder) and their families.

In all of these conditions, the young person will have significant concerns about their weight and shape. The service is not commissioned to see young people with obesity or those who have feeding or eating problems related to other diagnoses (such as anxiety, depression, or ASD) where the core problem is not an over-evaluation of weight and shape.

The CAMHS Eating Disorder Service  supports young people who:

• are under the age of 18

• are registered to a GP located in Derby City or Southern Derbyshire

• have a suspected eating disorder as a primary problem: symptoms include avoidance or restriction of food, loss of weight, fear of weight gain, bingeing or purging, concerns about weight/shape

Young people approaching the age 18 may need to have a transition to the adult eating disorder service where you will have a more adult-focused treatment. 

The Eating Disorders Team includes people with a range of different jobs, this means that we can provide different perspectives on the eating disorder and a range of ways of helping. Collectively these people can sometimes referred to as the Multidisciplinary Team (MDT).

All clinicians in the team are trained to work with young people as individuals and with their families all together (which is our main treatment approach) and may be involved in monitoring your physical health. We also discuss patients together as a team so that you will have the benefit of different ideas on how to help.

Each young person will have one ED Practitioner/Care Co-ordinator allocated however they may need to discuss things with other team members to ensure the best recovery approach. These may be a combination of the following:

Nurses

Our nurses are trained in mental and physical health in children and young people and have a key role in assessing and treating young people with eating disorders. All of our Eating Disorder Practitioners are trained nurses. They may be involved in physical assessment as well as working with your family as a whole or seeing you for individual therapy using evidenced based therapies. They will listen to your concerns and work collaboratively with you to help you in your journey towards recovery.

Psychiatrist

These are medical doctors who have done additional training as a psychiatrist and are able to assess and treat mental health difficulties, as well as considering  physical health and how this impacts on mental health. They may need to assess your physical health, such as monitoring your blood pressure or arranging blood tests for you.

They can also help if you have other mental health difficulties, such as depression, alongside those to do with food or eating. They may see you on your own or with your family, using evidenced based therapies.

Dietitian​

Our dietitian is trained in nutrition and provides advice to the family and the team on nutritional aspects of recovery and what food is necessary to help you to be healthy.

They are experienced in working with your family to ensure a balanced diet which fits with your family lifestyle to ensure normal adolescent growth and development and nutrients to keep you physically & mentally healthy.

Therapist​s

Family Therapist

Our family therapist aims to help families work together towards the goals they identify for themselves – this usually means finding new ways of working together, identifying strengths and thinking about communication and relationships. They may also see your parents on their own.

Cognitive Behavioural Therapist 

Our Cognitive Beahvioural Therapist offers a specialised form of CBT focused on recovering from an eating disorder, also known as CBTE.

Interpersonal Psychotherapy for Adolescents (IPT-A)

this is a therapy for young people with depression.  With your therapist, you explore your relationships with those around you, making sense of your difficulties, increasing your understanding and working together on your relationship goals.  This is  important because how we feel is often related to how we are getting on with others and feeling better is certainly linked to receiving support from those around us and feeling successful in relationships. 

Administrative support​

Our admin team are a vital part of our service, helping to keep the systems functioning effectively. They may ring you to set up an appointment or be a friendly voice when you call the service. They will always leave a message if you are unable to answer when they ring.

Students​

We regularly have trainees and students attached to our team who are supervised closely by qualified members of the team.

Teaching is an important part of our role in DHCFT Health so there are likely to be students of all disciplines attached to our team and attending clinics. This includes medical students, nursing, dietetic and social work students.  If you would prefer not to have students involved, please let your team know.

Confidentiality

Staff must keep your details of care confidential. However they also have a duty to share information related to your care with the CAMHS team looking after you and your GP practice. It is often helpful to share information with families and carers. We would always discuss this with you before doing so and would be guided by you in most cases about what information is shared. Very occasionally there may be times when staff are concerned about safety, either your own or others. At these times staff may have to share confidential information with others on a need-to-know basis but they will always inform you that this is the case and seek your permission where possible.

We will often receive a referral from your GP, school nurse or other professionals along with self-referrals.

One of the duty team will phone you to find out some more information and if it is agreed that our team is best suited to support you we will arrange an initial assessment appointment to learn more about you.

If your referral is not from a GP, we will generally ask you to see your GP for a physical assessment to include:

- physical observations of blood pressure and pulse (sitting and standing)

-height and weight

- blood test 

- ECG

If you have any questions or concerns, we always have someone available on duty from Monday to Friday (9am - 5pm) who may be able to help, advise and talk to you. Please call us on 0300 7900264 and request to speak to the ED Duty Worker.

The assessment takes place over one morning or one afternoon and we will invite your parents/carers (and siblings) to be present during the initial appointment, so that we can get their views of your current difficulties as well as your own. We may then offer some time for you and your family to meet with us separately if it is felt this may be helpful. At the initial meeting (up to two hours), we like to get to know you a little better and we will ask you some questions so we can do this. Some questions may include:

• Looking at aspects of your mental health and how you have been feeling
• Your physical health 
• Your social and educational situation including your family and support networks
• How you developed as a child 
• Your eating habits/behaviours/thinking and how this affects your life

Initial appointments are usually carried out by two clinicians, so there will be an opportunity for you and your parents to be seen separately.

The appointment will include an assessment of your physical health. This involves measuring your height, weight, blood pressure, muscle strength, how well hydrated you are and other aspects of your physical health as relevant.  To ensure your physical health is OK, we may ask your GP to arrange some further tests, which may include blood tests. We will also discuss what you would like to be different and how our service could help you towards these goals.

Our aim is that at the end of the assessment you will have a clear understanding of the nature of the problem, be given clear information and, if you do have a clear eating disorder, a treatment plan to take home.

Psychoeducation

Psychoeducation is usually the starting point as it is a chance for you and your family to understand more about eating disorders. We will discuss with you what an eating disorder is, how it develops and gets maintained and what might be the effect on your child’s physical and mental health.

We will answer any questions you have about the eating disorder or the treatment. This can help you and your family gain greater understanding of the way eating disorders can impact on your child’s life and on the family. Sometimes this can also help to reduce feelings of guilt or blame.

The videos on the First Appointment page have answers to some common questions you might have.

It is up to you what you decide to share with us. We would hope you do not feel under pressure and we understand it can take time before you feel ready to talk. We will ask you questions such as 'how are things for you?' and 'how can we or others help you?'

Sometimes it can be useful to write any questions that you may have down on paper. We understand that people do sometimes feel nervous when speaking to someone they don’t know, and can forget what they wanted to ask.

Please help us to help you by giving us as much information as possible.

Treatment may involve different therapeutic approaches, depending on your child’s need. Treatment will be overseen by the care coordinator who will see you regularly, coordinate the care from other members of the team and set up review meetings.

Family-based approach: the most common treatment we use in our service. The aim is to explore the impact of the eating disorder on the whole family and identify how everyone in the family can support you in re-establishing a normal eating pattern.

Dietetic support

An individualised meal plan may be helpful to support your health and provide meal structure. We have standardised meal plans which can be adapted for your individual needs.

The predictability of the meal plan may help to reduce anxiety before eating and can make mealtimes easier to manage. When weight restoration is necessary the meal plan will be increased with appropriate dietary advice.

During the first stage of treatment your family may be invited to have a supported meal in the clinic to help the family and professionals work together to understand the eating disorder. 

Medical monitoring

This will be an important part of the care plan, as there can be considerable risk to physical health when someone has an eating disorder. It will include regular measurement of weight, blood pressure and pulse in addition to an assessment of general health.

This will be generally by done by the medical or nursing staff within the team, although other clinicians may need to record weights and monitor blood pressure.

You may also be asked to have a blood test with your GP or go to the hospital to have an ECG (to assess heart functioning).

Family Therapy 

This is a family-based approach is usually used in the treatment of child and adolescent eating disorders. The family is commonly seen together, as well as parents on their own, and occasionally siblings on their own. The aim is to explore the impact of the eating disorder on the whole family and identify how everyone in the family can support a young person’s recovery.

Individual therapy

This can take many forms. Initially this may be supportive work to assist you in making changes and help to motivate you towards recovery. We generally wait until physical health has improved before offering regular formal individual therapy.

In some cases individual therapy for an eating disorder may be recommended early on in the treatment. This is usually specialist cognitive behavioural therapy (CBT-E) or another model of therapy, depending on your needs.

Cognitive Behavioural Therapy for Eating Disorders (CBT-E): this is a specialised form of CBT focused on recovering from an eating disorder. 

The service can also offer individual psychological therapy for other mental health difficulties, for instance, anxiety, depression or obsessive-compulsive disorder, should these need addressing alongside the eating disorder. 

Intensive treatment

Some young people with eating disorders find it very difficult to make the changes needed in order to get better. If a higher intensity of support is needed, we have a Community Intensive Treatment Service that may become involved.

This service can provide intensive and home-based support, for example around mealtimes. Sometimes, this can be a way of avoiding a hospital admission. The need for higher intensity support will always be discussed with the family in advance.