Treatment in NHSGGC is based on the best research evidence.
Eating disorders are serious and potentially life threatening conditions affecting a young person’s physical, emotional and social development. The serious nature of an eating disorder, in childhood or adolescence, makes it very important that assessment and treatment are offered as early as possible. It has been shown that early identification and treatment of eating disorders improves outcomes and promotes full recovery for young people. Connect-ED works to support Child and Adolescent Mental Health teams to ensure that the best possible treatment is offered to young people and their families at the point of need. Tackling an eating disorder can be a long and difficult journey. It is important to have the right kind of help and support.
Treatments available are based on the most up to date research. Organisations such as The National Institute of Clinical Excellence (NICE) publish treatment guidelines based on the best research, see the most recent 2017 guidelines below:
In Scotland the Scottish Intercollegiate Guidelines Network (SIGN) produce guidelines, eating disorder guidelines are currently being reviewed and aim to be completed in 2021
In the mean time NHS Education Scotland in 2015 has published The Psychological Therapies 'Matrix' which is a guide to planning and delivering evidence-based Psychological Therapies within NHS Boards in Scotland, which includes eating disorders, see the eating disorder section of the matrix in the link below:
These types of guidelines and good quality research are what tell us about the best treatments available for children and young people with eating disorders. It is these treatments that have good research evidence that we aim to provide in Greater Glasgow and Clyde.
The young person’s diagnosis, individual difficulties and situation will be taken into account when treatment options are discussed. The young person and parents/carer then decide, with clinicians, which will be the most effective and most suitable treatment. A treatment plan can be drawn up which may involve one or a variety of therapists and treatments.
The best place for all young people to be treated is at home, the research evidence shows that young people who are treated at home and start to recover early in treatment have a very positive recovery.
The main treatment options are explained further below:
Family Based Treatment (FBT) – the therapy with the strongest research evidence
FBT is a manualised therapy that is provided only by clinicians working within Connect-ed, who have had a high level of training and supervision. The whole family is invited to attend sessions. The treatment typically is for 12 months duration with 3 phases. The 1st phase of weekly appointment focuses on the restoration of physical health, the 2nd phase of fortnightly appointments focuses on returning control of the eating disorder related behaviours to the young person, and the final phase aims to ensure the young person is back on their developmental track. FBT is a well established treatment within NHS GGC CAMHS and increasingly across Scotland. Outcomes are in line with the research studies. The majority of patients with Anorexia Nervosa presentations, approx 95%, will commence FBT.
See more information below:
Cognitive Behavioural Therapy – Enhanced for Eating Disorders (CBT-ED)
CBT works to help the young person understand how thoughts, feelings and actions link together. CBT-enhanced for eating disorders (CBT-ED) is an approach that enhances CBT for eating disorders and includes a map called a formulation of all the young person’s difficulties with CBT-ED targeting the main issues that are preventing full recovery, in one episode of therapy.
CBT-ED is identified as the second line treatment. In NHS GGC, this is primarily adjunctive to or following FBT when high levels of eating disorder cognitions +/- body image distress persist. In addition when FBT has not been opted for CBT-ED maybe chosen instead. However CBT-ED is demanding and requires sufferers to be motivated to change and work hard to understand how they think, feel and behave. One Connect-eating disorder CBT-ED clinician works full-time and some CAMHS clinicians are trained in CBT-ED but are supported and supervised by the Connect-eating disorder clinician who is also the author of this research.
Specialist Supportive Clinical Management
Specialist Supportive Clinical Management (SSCM) is graded similarly to CBT-ED in the adult part of NICE 2017 guideline with a small amount of evidence in the adolescent literature, therefore is considered only when the other 2 therapies have been exhausted or not taken up (this is a very small proportion of cases).
Essential elements of SSCM include an: assessment, including psychiatric, medical and dietetic; clinical management with a persistent focus on weight restoration, normalised eating, symptom reduction, and understanding about the impact of the disorder has on the person; supportive psychotherapy driven by the young person where the therapist is supportive and focuses on the young person’s strength, in a flexible and holistic way.
Nutrition and Dietetic Care
There are specialist Eating disorder Dietitian’s within community and inpatient CAMHS is NHS GGC. Dietitians have a key role in supporting young people and families with eating disorders. The main areas are as follows:
Medical and Psychiatric Treatment
These are the elements of treatment that are managed by the Doctors in the team.
The following guidance is used to manage the risk that the eating disorder poses and make decisions regarding care.
The royal college of psychiatrists is currently in the process of updating this guidance
Physical Health Care
Eating disorder behaviours often result in physical symptoms, which can be severe. Careful monitoring of these physical symptoms is an important part of treatment of eating disorders. Common tests include; pulse and blood pressure, blood tests for biochemistry, physical examinations and bone scans. As eating disordered symptoms improve the physical risks reduce and less and less testing is required. However early in treatment physical health monitoring is a frequent aspect of treatment.
Medication in Eating Disorders
There is little research evidence for the use of medication in children and young people with eating disorders therefore it is not often used. However if the child or young person with an eating disorder has another psychiatric condition such as depression, then medication can be helpful..
Psychiatrists are likely to be involved in eating disorder cases where the patient is at higher risk. It is the Psychiatrist who refers children or young people to hospital, which in GGC CAMHS is rare. They are also able to use the mental health act to insist on an admission and treatment against the will of the child or young person. This rarely happens but is essential in making sure that children and young people do not die from their eating disorder.
Inpatient treatment can be required either in an acute or psychiatric hospital
Acute hospital admission
NHS CAMHS and the Royal Hospital for Children have a care pathway for under 16 year olds with an eating disorders. At the start of treatment a young person may require admission to be medically stabilised in hospital so that they are safe to return home to commence or continue treatment. The admission is typically for 14 days and parents/carers remain very much part of their care team. Paediatric staff and CAMHS mental health staff work together to support all aspects of the young person and families needs during the admission.
RHC Leaflet (coming soon)
A very small proportion of children and young people in NHS GGC require an admission to a Psychiatric hospital for their eating disorder. However it is an important back up if young people are not recovering in the community.
The types of reasons for admissions are
In Glasgow and Clyde there are 2 general psychiatric wards, one at the Royal Hospital for Children for under 12 year olds and one at Stobill hospital for 12-18 year olds. Both these wards are experienced in treating eating disorder patients.
Young people who are discharged will not be fully recovered and a lot of work is required after discharge to continue to treat and support them to recovery. Young people after discharge will work intensively in CAMHS for at least 12 months, and often much longer, after discharge.
Intensive Child and Adolescent Mental Health team (ICAMHS)
There is a home intensive treatment team called ICAMHS that supports children and young people with psychiatric illness across Greater Glasgow and Clyde Health board. Nurses in this team work with patients of all diagnosis and the aim of their interventions is prevention admission to psychiatric hospital and support a discharge from hospital should it happen.
For young people with eating disorders they can support meal times, help manage eating disorder behaviours or other risk taking behaviours and provide physical health monitoring. They are able to work with young people for a 6 week period only.