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National services

Adult services

National services

Adult services

National services

Adult services

National services

Adult services

Eating Disorders Service


The information on this page describes the Eating Disorders Service care pathways and associated treatments.

Email slm-tr.eatingdisorders@nhs.net for more information about care pathways.
This is typically a 13-step pathway from referral to discharge. The average waiting time from referral to assessment could be as little as 48 hours with treatment time of 10 to 14 months or 18 to 30 sessions.
This is typically a nine-step pathway from referral to discharge. The care pathway last between six and nine months.

‘Step Up’ to Recovery
This service was introduced in April 2011 in response to patients (with a BMI of 14 or less) often reporting that they felt unprepared to manage the full range of life experiences that follow inpatient treatment, and that without practise they can struggle or relapse.

The programme runs from 8am to 8pm Monday to Friday and supports people to increase their independence and take more personal responsibility for their health, social and emotional life. It is based at the Bethlem Royal hospital (partly on the TW2 ward), with access to facilities on the Inpatient Eating Disorders Service.

Step-up's client group typically takes low weight patients who are avoiding admission or have just come out of hospital. Some of their clients may not be working on weight restoration but are wanting to maintain a low BMI and achieve other recovery goals.

Day Care
Day Care treatment to people who have a BMI of 15.5 or above and may be diagnosed with anorexia nervosa or other severe and complex eating disorders. Patients are referred to the unit either as a step-down from inpatient care or where outpatient treatment is not sufficient. Occasionally, day care also deals with OPAL patients.

This service is for people who want to move towards full bio, psycho and social recovery from their eating disorder. The day care programme operates from Monday to Friday, 10am to 4pm, and includes active nutritional rehabilitation, key working, occupational therapy and evidence-based group and individual therapy.

There are two day-care services in the eating disorder services in the trust, one is day-care and the other is step-up.

Day-care is based at the Maudsley and runs from 10am to 4pm Monday to Friday. Day-care's client group tends to be those aiming for full weight restoration or may be at a healthy weight with complex mental health needs and people attend day-care for six to nine months. Patients are given a welcome pack to record their progress and activities. Typically, undertake a five day a week therapy course for the first three months and this reduces to two days per week from month six.

During their course of treatment, patients will attend one-to-ones, group sessions and self-managed tasks (for example, shopping and meal preparation) with and under instruction from the day care team.
This is typically a 13-step pathway from referral to discharge.
FREED is an innovative, evidence-based care package for 16 to 25 year olds with an eating disorder of up to three years’ duration. FREED provides rapid access to treatment and tailors treatment to the specific needs of young people and their families.

FREED during Covid-19
During the past weeks, there have been a lot of changes in our lives and we wanted to give you an update about how FREED is responding to these unprecedented times.

FREED is designed to give young people rapid access to specialised evidence-based treatment and support tailored to their needs; however, given the circumstances we find ourselves in, there will be an overall disruption affecting how we are able to provide this support. It’s difficult to be specific about when things might return to normal but we can expect further disruptions.

Having said that, we are aware the current situation can be very difficult. Having appointments cancelled or being unable to access services may put extra pressure on you and this may have an impact on your eating difficulties as well as your overall mental health. For these reasons, we are working hard to ensure we can provide some support to you and your close others. We have put together resources with some coping strategies, that we hope you will find useful.

You can find these resources on our FREED website as well as on our YouTube channel and Twitter. Additional helpful resources are the web pages provided by Beat on Covid-19.

If you need more support or your situation gets worse, please contact your GP who will continue to manage your care whilst you wait for a specialist appointment. Your GP will then update your clinical team if necessary. If you are in a mental health crisis and are worried about keeping yourself safe, you can call the Samaritans on 116 123. If you are under 35 years old you can also contact Papyrus on 0800 068 41 41. You can also make an emergency appointment with your GP.
The PEACE pathway is being integrated in and implemented across outpatient, day care, Step Up and inpatient care pathways.

Research from all over the world suggests that around 35% of people suffering from an eating disorder also have autism or high autistic features. Yet, there are still no official treatment guidance or support network for this group, their carers and their clinicians.

A lack of support and awareness has resulted in poorer treatment outcomes for this patient group which has led to understandable frustration for patients, carers and clinicians, as well as a decrease in confidence in ability and knowledge for clinicians. The Eating Disorders Service are leading a pathway for this under-recognised and supported group. With a focus on the patients, carers and clinicians, we aim to increase the quality of the eating disorder treatment provided to this group, and in turn the outcomes of their treatment and quality of life.
The OPAL approach was first considered in 2016 and was operational for about a year until the number of referrals ‘dried up’. The principle of and need for treating obese patients remains and such it is the EDU’s intention to ‘resurrect’ and ‘operationalise’ the service with greater visibility to patients and communication with General Practice and social prescribers.

In this one-off intervention, patients are received after their initial assessment via EDU’s clinicians (not GPs) for a 1 hour physical health assessment. Some of mental health and social situation is also undertake but is not the main focus of the assessment.

OPAL care pathway stages
  1. Referral made through a green form
  2. Allocation of referral
  3. Appointment letter sent to patient with patient information letter
  4. Spreadsheet on shared drive updated with patient information
  5. Patient assessment undertaken
  6. Letter sent to GP and patient sent treatment plan
  7. ePJS and spreadsheet on shared drive updated
  8. Follow up questionnaire sent to patient six to eight weeks later
The SEED clinic is run by nurses from the eating disorders team and is overseen by the team leader and senior psychiatry trainee. The structure of the clinic is for service users who are predominantly diagnosed with anorexia nervosa and a-typical anorexia to be offered 30 minute one-to-one sessions every three to four weeks and include physical monitoring as well as psychological monitoring and support. It is the Eating Disorders Service’s intention to develop group SEED support in the future.

A typical SEED patient is likely to be a long term eating disorder patient who will have relapsed on more than one occasion over a period of several years. The SEED care pathway would last up to six months in duration and will include outcomes which are deemed behaviourally or socially beneficial.

Physical monitoring is a vital aspect of the clinic, due to the long-term nature of SEED and the associated low BMI, deranged bloods and unstable physical observations.

Whilst SEED groups do not currently exist, it is hoped that in time EDU will provide service users with increased psychological support and psychoeducation whilst also improving social contact and confidence with others.

SEED steps
  1. First assessment one to four weeks after referral – 30 minutes
  2. Physical observation, weight monitoring and, risk dependent, blood investigation – 30 minutes
  3. General well-being check-in – 30 minutes
  4. Risk assessment and review – 30 minutes
  5. Meal plan review – 30 minutes
  6. Setting and review of personal and social goals – 30 minutes
  7. Practical support (might include assistance with benefits claim or application form completion) – 30 minutes
  8. Food and shopping list planning and support – 30 minutes
  9. Going out for a snack or hot drink as part of the patient session – 30 to 50 minutes
The Carer Handbook is for carers whose loved ones are accessing inpatient, daycare, outpatients, Step-Up treatment programmes to explain to you how we support you throughout our services.
Meal planning and Covid-19
Covid-19 is understandably causing a great deal of stress and anxiety, and how to manage your eating whilst in isolation or lockdown may feel very uncertain.

Do talk to people in your support network about any worries and don’t be afraid to ask for help if you need it. Professionals, support groups, family and friends want to help and need your guidance as to what sort of help they can give.

From the start of the pandemic there have been ideas and information about food for people with eating disorders shared on the internet. Whilst much of this is good advice, spending a lot of time reading different versions can be confusing and anxiety provoking. What will be most helpful to you will be for you to have a personal plan for how you will manage food and eating and then to follow your plan using whatever support is available to you.

BEAT offer some good points about managing eating and other concerns on their website.