Eating Disorders

Overview

See CKS guidelines for Eating Disorders which give advice on assessment and diagnosis of patients with eating disorders. For medical emergencies in eating disorders guidance, see MEED guidelines. 

The community eating disorder service STEPs accepts direct referrals from GPs in Bristol, North Somerset and South Gloucestershire.

Individuals with suspected binge eating disorder can now be referred to the local eating disorder charity SWEDA (see below).

Please see Red Flag section below for indications for admission.

STEPs

STEPs (community and the specialist inpatient service) is a specialist eating disorder service for adults aged 18 and over in BNSSG (and BaNES), providing assessment and treatment for patients suffering from anorexia nervosa and bulimia nervosa, including atypical presentations.

The community eating disorder service provides a range of interventions, including evidenced-based therapies. Patients at higher medical risk will have a more intensive treatment care plan.

The community and inpatient teams are based at The Acer Unit, Blackberry Hill Hospital in Fishponds. They are a multidisciplinary team with a wide skill mix including medical, psychological, dietetic, occupational therapy and nursing input. They have a 10 bedded inpatient ward.

Early intervention support is also available for people aged 18-25 who are within the first three years of developing an eating disorder. The First Episode and Rapid Early Interventions for Eating Disorders (FREED) pathway sits within the STEPs team. The services on offer range from psychoeducational and psychotherapy sessions to advice from dieticians and occupational therapists.

Provision for people with binge eating disorder has recently been commissioned and is provided through our voluntary sector partner SWEDA (see below) rather than STEPs.

STEPs is not currently commissioned to work with people with avoidant restrictive food intake disorder (ARFID), but will assess and signpost, or offer some brief intervention, for those with high risks.

See link to the STEPs page on the AWP website for further information.

Referral

• Advice and support

Duty worker number  (Monday-Friday 9am-5pm) 0117 354 6920

Contact email for Healthcare professionals and the public: awp.contactsteps@nhs.net

• Referral

BNSSG GPs can refer registered patients direct to STEPS ED Community Service. Patient should be aged 18+ with suspected anorexia nervosa or bulimia nervosa or atypical presentation of these.

If an individual has a requirement for an assessment for an eating disorder and another mental health condition (that may require secondary services) then as a service STEPS aim to complete joint assessments with PCLS to help reduce the amount of times that a person has to be assessed. In these circumstances, a referral sent to both PCLS and STEPS would be helpful to ensure that there are no delays in assessing an individual’s presenting needs. However if a GP does send a referral to only one of the services, services  will contact each other to arrange an assessment.

Please see the attached AWP Referral Flow Chart for further details

Referrals can be made using the STEPS Referral Form (word doc) which provides the information to process referrals effectively without requesting further information. Email the referral form to:  Awp.STEPS@nhs.net

• SWEDA

SWEDA  provides support for anyone who is in the early stages, or is showing some of the symptoms of an eating disorder, as well as with people presenting with binge eating disorder. They offer guidance, counselling and therapeutic interventions for individuals, and advice for parents or carers.

Patients can self-refer on the website. Choose: Contact Us, Self-refer from the drop down where it says 'Select Enquiry Type'.

GPs can refer directly to SWEDA, or via STEPs. Both services meet weekly to discuss referred cases and will identify the most suitable service. The Eating Disorders Service work with ‘no wrong door’ principles. Between STEPs, SWEDA and PCLS cases will be directed to the most appropriate team without being sent back to the GP to make sure the person is getting their needs assessed.

GPs can refer patients directly to SWEDA by Choose: Contact Us Select “professional referral” from the drop-down menu where it says 'Select Enquiry Type'.

Red Flags

Be aware that some medically unstable people with eating disorders can appear deceptively well – a low threshold for concern is essential, seek specialist advice if unsure.

See CKS for advice on When to admit a person with a suspected or confirmed eating disorder.

There are guidelines on Medical emergencies in eating disorders (MEED) from RC Psych.  Full report: - https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-(meed)-guidance.pdf?sfvrsn=2d327483_50

In-particular see Table 1: Risk assessment framework for assessing impending risk to life P31-35

Supporting annex document  (college-report-cr233---annexe-1.pdf (rcpsych.ac.uk) which includes Summary sheets for assessing  and managing patients with severe eating disorder.  GP specific information on page 7 and 8. 

Self Help

Eating Disorder Support App

The Eating Disorder Health Integration Team (Bristol Health Partners) have developed an 'Eating Disorder Support' app.  

The app is free to download and had lots of information for people struggling with their eating and those supporting them. 

You can find out more here - Eating Disorder Support app launched - Bristol Health Partners

The app is certified by the Patient Information Forum 'PIF Tick' and does not collect any personal user data. 

Feel free to recommend this as an information resource to those who need easy access to trusted information and links to available support, both local and national.

Self-Help guides

Please also see the highly recommended Mental Health Self-help guides which includes one on eating disorders.

SWEDA

Patients can self-refer to SWEDA as above.

Support & Resources

The Eating Disorder Health Integration Team (EDHIT) have created an ‘Eating Disorders Support & Resources’ guide for those living in Bristol, North Somerset and South Gloucestershire (BNSSG).  

This guide is designed to support anyone affected by eating disorders; those struggling personally and their parents, families and friends, as well as professionals. This guide contains a range of signposting information, advice and guidance from both local and national organisations and charities. Many of the organisations listed contain advice on self-help as well as access to support.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.