We provide integrated nutritional, medical and psychological care for people with severe eating disorders, such as anorexia nervosa, bulimia nervosa and other eating disorders.

Care is delivered by a multidisciplinary team, including psychiatrists, nurses, cognitive behavioural therapy (CBT) and cognitive analytic therapy (CAT) therapists, occupational therapists, dietetics, physiotherapy and family therapist.

The group treatment programme is seen as a core component of eating disorders care and is available to all day and inpatients. Groups are designed to target maintaining factors for eating disorders, and to meet the diverse needs of the patient group. Patients are encouraged to take an active role in attending and developing the group programme. We now offer cognitive behavioural therapy (CBT) group for Bulimia.

All inpatients and day patients are offered either a specialist individual cognitive behavioural therapy (CBT), cognitive analytic therapy (CAT) for eating disorders or the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA).

The choice of therapy is guided by evidence-based information about specialist therapies and a shared understanding of the clinical assessment. Continuity of therapist is also provided across inpatient, day-patient and outpatient treatment to help patients continue to assist with step-down care following admission.

The therapy models offered are evidence-based approaches to eating disorders treatment, adapted for the specialised needs of inpatient and day patients when necessary. The service monitors the outcomes of therapies, as well as patient satisfaction.

All therapists are supervised by leading experts in CBT and CAT for eating disorders. The strength of the therapist team is demonstrated by the fact that most of the team has been involved in presenting skills-based clinical workshops at national and international conferences and training events. Clinical audit data demonstrates outcomes of a standard reported in published trials.

The day patient treatment programme functions flexibly to offer an intermediate intensity of care as a step up from outpatient care or step down from inpatient care.

The multidisciplinary team provides nutritional, medical, psychological, occupational and social components of care through a combination of individual, group and family work with an emphasis upon community care and rehabilitation.

Intensity of treatment varies from one to five days a week according to individual clinical need. We can also provide more intensive long days and weekends, which include patients attending breakfast and evening meals if and when required.

Inpatient treatment is provided for eating disorder patients at high medical or psychiatric risk and those who are motivated to make changes but have been unable to do so after an effective period of outpatient treatment.

The service has 14 bedrooms for local and national patients with severe eating disorders. Of these, 12 are reserved for women and two for men.

If admission is required, patients and their carers are offered the opportunity to visit the unit and to meet with inpatient staff for an introduction and preparation for admission. On admission a keyworker from the nursing team is allocated to each patient, and this keyworker will remain the same until discharge. They will meet weekly with the patient and coordinate their care. An initial Care Programme Approach meeting is organised soon after admission, to begin the process of discharge planning and liaison with relevant after care services.

Care plans and length of stay at the unit is guided by individual need and not by fixed programmes of treatment. The inpatient treatment packages combine meals and nutritional support with more intensive medical, psychological and social care than can be provided by outpatient attendance. Care is delivered through a combination of group work, individual sessions, specialist psychotherapies and occupational therapy interventions within a framework of motivational enhancement.

Ongoing day patient and outpatient treatment is recommended for at least one year following discharge from inpatient treatment. For the majority of patients this will be offered at Vincent Square, although for some patients it is sometimes more appropriate to transfer care to a local eating disorder service.

Many of the components of the day treatment programme are accessible to both inpatients and day patients, in order to facilitate flexible and graduated movement between these two levels of care. Transitions between services (or components within a service), are associated with high risk of disengagement and relapse. Continuity of relationships with staff and peer group, structure of the programme and familiarity of the environment help to reduce the risk of disengagement or relapse at the time of transition from inpatient to day patient care.

Transitions are graded, with periods of increasing home leave in preparation for discharge to day patient care. Timing of transition is determined by progress with weight gain during periods of home leave and not by fixed length of stay or body mass index (BMI) criteria. Thus, if a patient is able to continue to make progress with weight gain on leave, they will be able to continue care as a day patient, even if BMI remains low. Where geography precludes the use of day patient care, inpatient care is extended until there is evidence from periods of extended leave that progress is likely to continue with local outpatient care.

The outpatient treatment programme provides a range of evidence-based therapies for people with eating disorders.

Typically, these therapies are cognitive behaviour therapy (CBT) or cognitive analytical therapy (CAT) or Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA).

Long-term outpatient treatment may be offered for those with chronic severe illness, where specialist treatment is necessary to maintain slow progress toward recovery or to prevent deterioration. Patients are usually seen once a week and each session lasts for approximately an hour.

We also offer family therapy for those that would benefit from this service. The number of sessions will depend on the therapeutic needs of each patient.

During treatment, responsibility for medical care and prescribing of any medication remain with the patient's GP, with access to specialist medical review at Vincent Square when required. We aim to maintain good liaison and consultation with other services involved in care throughout treatment and follow-up.

Those assessed as needing urgent treatment, usually due to high medical or psychiatric risk, are offered start of treatment as soon as possible. This is usually within two to 12 weeks.

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