A New Choice for Recovery: Developing Intensive Day Treatment for people with Eating Disorders

Orri’s Chief Executive, Helen England, joined the team in September of this year. Today, she explains why 2019 was such a significant year for eating disorders in the realm research and campaigning, but how there’s much to be done to improve access, transitions to and quality of eating disorder treatment. Intensive Day Treatment that’s embedded in the community is a new choice for recovery for those suffering with eating disorders and their families.

I have spent my entire career in health and social care. My original professional training was in music therapy and I worked as a clinician for 10 years in Child and Adolescent Mental Health Services (CAMHS) before moving into leadership positions in the NHS. I have held roles on the Boards of both commissioning and provider trusts in the NHS, in the independent sector in primary care and I am currently the Vice-Chair of a large national disability charity providing social care for young people and adults.

So – what brings me into a small and very new organisation in the field of eating disorders for this chapter of my career?

2019 has been a significant year in the Eating Disorder field. Key documents have been published nationally setting out the compelling case for improving access to eating disorder treatment in the UK. The tragic and untimely death of Averil Hart prompted an investigation by the Parliamentary Health Ombudsman into the quality and availability of Adult Eating Disorder services. The original report published in 2017 concluded that there are significant gaps in Adult Eating Disorder provision and a lack of specialist and experienced staff in many services. Transitions between adolescent and adult services also need to improve – the age of 18 is an artificial cut off point given that many people with eating disorders continue to need support into early adulthood. The original 2017 enquiry was followed up with an additional publication this year which suggests that there are still too many avoidable deaths from eating disorders and that further action and urgency is needed to make the progress required. This needs concerted leadership, commitment and collaboration between commissioners, providers and stakeholders so that positive change can be accelerated and achieved.

Beat is the national charity dedicated to ending the pain and suffering caused by Eating Disorders. In the past year they conducted research into access, waiting times and staffing levels at adult community eating disorder services in England. Their report ‘Lives at Risk’ was published in June this year and confirms that a major step towards improving timely access to effective treatment would be the introduction of access and waiting time standards for community adult eating disorder services, supported by sufficient financial and workforce resources. There have been access targets in the NHS for years, and yet the barriers to effective treatment for this particular client group have not been measured and monitored.

A further report published by Beat in September this year, stated that a review of the evidence suggests that equivalent outcomes are achieved by intensive day- and home-based treatment compared with inpatient treatment, along with improved patient and family acceptability, and considerable cost savings.

Here at Orri, we know that a day treatment model is often preferred by clients to the prospects of hospital admission and we are committed to offering a level of intensity in our programme that can provide the very best chance of securing a sustainable recovery and optimum outcomes. We agree with Beat’s recommendation that Eating Disorder services should develop and test different models of intensive day- and home-based treatment models so that options that can secure the best results can be identified and promoted for adoption nationwide. Orri is committed to playing our full part in this process and we will participate in formal research trials as well as service evaluations to achieve this goal.

It has been particularly encouraging this year to see the national focus by NHS England on improving services for people with eating disorders. There is a national implementation plan for Mental Health linked to the NHS Long Term Plan and this contains specific commitments on child and adolescent and adult eating disorder provision. Furthermore, a report on Specialised Eating Disorder Services in England published by NHS England in April acknowledged the changes needed to better manage demand for eating disorder treatment, particularly in the context of rising demand and the continued reliance on people travelling out of area to get the treatment they need, in some cases with beds in Scotland being used for English patients.

One of the routes through which this will be addressed is through the establishment of provider collaboratives – groups of providers working together to improve local and regional services. According to the national direction from NHS England, wherever possible these new collaboratives should work together to avoid inpatient admission through developing high-quality community services. Collaboratives will include providers from a range of backgrounds, including the voluntary sector, the NHS and the independent sector and through plans co-produced with people who are experts by experience, partners will provide co-ordinated care and treatment as close to home as possible, with hospital admissions being short and only used when absolutely clinically necessary. Orri is delighted to have the opportunity to be part of these new collaboratives so that we can play our part in helping to ensure that the right care is available to everyone who needs it at the right time.

Within my first 90 days at Orri, I have heard the personal stories of two families from two fathers, each with a daughter who developed anorexia nervosa in their teens. The stories are different but share some common strands, the battle faced by families to get the treatment their daughters needed, the variation in the criteria for different services and the treatment available in each, the risk of the nearest bed being hundreds of miles away from home and the impact that supporting someone with an eating disorder has on siblings, parents and the wider family.

It is impossible to hear this lived experience without wanting to be an agent for positive change. And it is impossible to suppose that if your own teenagers had such a condition, with all the long-term risks that we know about with eating disorders, that you would not want both leaders and organisations to step up to both the challenge and opportunity to make the difference needed to ensure that the right services are in place.

At Orri we want to rise to that challenge. We believe that high-quality day treatment should be widely available and that our own intensive day programme offers a new choice to individuals, families, referring professionals and the NHS.

For all of those reasons, in this chapter of my career, I am committed to improving community eating disorder provision for adolescents and adults in the UK. I have the privilege to work with a highly skilled and dedicated team at Orri. Together, and working with experts by experience and our partners, I am confident we can make a difference.

Helen England, CEO

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