The National Institute for Health and Care Excellence (called NICE for short) has issued information to the NHS on eating disorders. The aim of this is to improve care and treatment. If you think the treatment or care that you receive (or someone you care for receives) does not match the treatment or care described in the NICE guidelines you should discuss your concerns with the healthcare professional involved in your care, your GP, advocate or members of your healthcare team.
What to expect from the NHS under NICE guidelines:
Treatment should be supportive – It is very important that you develop a supportive and caring relationship between you and the professionals that you work with. You should be given information and support that can help you and your family or carers understand your problems better.
Everything you say should remain private, other people will only be told if you or others are at significant risk.
GP’s should co-ordinate treatment
Your GP should make a full assessment your needs and agree in writing who is responsible for checking health and progress.
As a family member you might consider asking for help from a healthcare professional or support group. You should be given information about treatments and how to talk about this with the person with the eating disorder. You should also receive support as a family to help you understand and cope with the problems you experience, because you are a key part in the recovery process.
Monitoring of physical health
As you progress through your treatment you should be given advice and monitored on the following: use of laxatives, weight, osteoporosis and eating disorders, diabetes and eating disorders, pregnancy and eating disorders, reducing dental problems.You should also expect the GP to do tests such as blood tests to check for health problems.
Medication – Antidepressants
NICE states that this should not be the only treatment received but alongside a self help programme or psychological treatment.
Care as an outpatient
“Outpatient” means that the patient does not live at the facility. Outpatient programs are sometimes run by centres that do inpatient care, but can also be offered at Eating Disorders Clinics or Mental Health Clinics. Any psychological treatment that you receive as an outpatient should last for at least 6 months. The NICE guidelines state that the person who treats you should be competent and experienced. Advice on only diet and food is not effective and should not be the only treatment you are offered.
Care as an inpatient
When a person is “inpatient” it means that they will be living at the facility for a certain period of time. This can range from a couple of weeks to several months. The facility usually has medical doctors, registered nurses, therapists, dietitians, volunteers and staff to work with the people in recovery on a daily basis. It is intended to provide a safe environment in which to recover from an eating disorder. The routine may include group sessions, one to one therapy, medical evaluations, weigh-ins, dietetics, art therapy, meal times, and social or leisure activities. Most programs will expect you to be somewhat medically stable before entering, meaning that if your health is extremely poor, you may require hospitalization before going in. If you are cared for in an inpatient unit you should be cared for in a unit that has specialist knowledge of eating disorders. Inpatient treatment should also consist of structured psychological treatment and should be a reasonable distance from home.
Care after hospital
Once you are well enough to leave hospital you should be offered psychological treatment lasting at least 12 months.
You and your family should be offered meetings with healthcare professionals. You should be offered your own private meetings with a healthcare professional. Your family should normally also be told about your treatment. The healthcare professionals should not neglect your educational and social needs while making sure you get the best treatment.
Psychological treatments you may be referred to
CAT – Cognitive Analytic Therapy involves a therapist and a client working together to look at what has stopped change in the past, in order to work out how to move forward.
CBT – Cognitive Behavioural Therapy – NICE states 16-20 sessions over 4-5 months. CBT can help you to change how you think (“Cognitive”) and what you do (“Behaviour)”. These changes can help you to feel better.
IPT – Interpersonal Therapy, may be offered if you have not improved after CBT. IPT is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills.
FPT – Focal Psychodynamic Therapy identifies a central conflict arising from early experience that is being re-enacted in adult life producing mental health problems.
DBT – Dialectical Behaviour Therapy, NICE states 20 sessions. DBT teaches patients skills for regulating and accepting emotions and increasing interpersonal effectiveness.
Family Therapy helps family members find constructive ways to help each other.
Self help is self guided improvement.
There are different types of people who can provide you with therapy:
Psychiatrists are generally more expensive and tend to focus on admissions, diagnosis, evaluations and medication administration.
Psychologists work with people of all ages who experience mental or physical health problems to reduce distress and promote wellbeing. A licensed psychologist can prescribe and administer medication if it is necessary.
Psychotherapists use a variety of approaches to treat people who have difficulties with behaviour, thoughts or feelings.
Social workers work with people who have been socially excluded or who are experiencing crisis. Their role is to provide support to enable service users to help themselves.
CPNs (Community Psychiatric Nurses) work with people suffering from various types of mental health problems. They may work with people in their own homes, in residential units, in the NHS or in private specialist hospital services and secure units. The work involves helping people to recover from their illness or come to terms with it in order to maximise their life potential.
Counsellors help people to explore feelings about their lives. This means they can reflect about what is happening to them and consider alternative ways of doing things. Counsellors do not give advice, but help clients to make their own choices.
A Nutritionist and Dietitian are sometimes referred to as the same thing. A Nutritionist may be someone who has completed some level of education in the area of Nutrition. A Dietitian has completed a 4-year college degree in nutrition and dietetics. The goal of the Dietitian will be to help improve your health and eating habits through nutritional counselling services. They will help you to incorporate healthy behaviours into your everyday life. Their goal should not be to “change” your habits overnight, but to teach you over a period of time how to promote a healthier relationship with the food you consume.
Additional Alternative Methods
The following is a list of alternatives that can be used in addition to more traditional methods of treatment. They have been helpful to quite a number of people… finding what works FOR YOU is important.
Occupational Therapists help people improve their ability to perform tasks in their daily living and working environments.
Creative Expressive Therapy is aimed at clients who find regular talking therapies such as counselling, psychotherapy and CBT difficult. Creative expressive therapy offers a different form of expression alternative to talking. We use drama, dance, music and art to explore our feelings and emotions within a safe environment. Often we will use a variety of objects, toys, art materials and musical instruments as a metaphor for our feelings to help provide a distance for traumatic experiences, memories and emotions.
Yoga utilizes relaxation and guided imagery to aid anxiety, stress and sleep deprivation.
Reiki Healing is simply the practitioner placing their hands on the client with the intent of bringing healing, and willing for Reiki energy to flow.
Touch Therapy such as massage, aromatherapy and reflexology assist in the release of stress and anxiety through both light touch and the clearing of your energy system without touch. The positive effects of this type of therapy have been experienced by many people worldwide.
Questions you might want to ask about your treatment
It is understandable if you get anxious when talking to a health professional, and it is easy to forget to ask important questions about your care. You may want to take a list of questions with you. You may want to ask:
What kind of treatment do you think will best help me with my problem?
Can you tell me in more detail what the treatment will involve?
Can you tell be why you decided to offer me this type of treatment?
Are there other treatments that might suit me better?
If you feel the treatment is not working you might want to raise this with the healthcare professional providing treatment, you might want to consider this question:
I am not getting better as I expected. Can we review the type of treatment that I am getting?
Questions for families and carers
Families and other carers can play a key role in helping and supporting people with eating disorders. In order to do this they will need to be well supported and informed. If, as a family member or carer, you are unsure about either of these issues consider asking the following questions:
What role can we have in helping the person with the eating disorder with their problem?
Can you please let us know how the treatment of the person with the eating disorder is progressing?
Can you advise us on the kind of support that you think we might benefit from as a family?
You have the right to be fully informed and to share in decision making about your healthcare. If you need further information about aspects of your eating disorder or treatment please ask your specialist, GP or a relevant member of your healthcare team. You can always take a copy of the NICE guidelines with you if you wish.
NICE contact details full copies of guidelines from the NICE website www.nice.org.uk or telephone 0870 1555 455 and give reference numbers N0407.