Orri’s Director of Research and Development, Dr Paul Robinson, explores the uniqueness of Orri’s intensive day treatment service for eating disorder, and offers his professional insight into the mental health and eating disorders field.
For, we are more than a CQC rated ‘Outstanding’ specialist treatment centre – we are a community of people who care. Community is what makes recovery thrive, and “it takes a village” is also our theme throughout November.
Dr Paul Robinson,is Orri’s Director of Research and Development.He is a leading Psychiatrist for the treatment of Eating Disorders; a founding member and former chair of the Faculty of Eating Disorders at the Royal College of Psychiatrists; and clinical advisor to the newly launched MEED guidance, for recognising and managing medical emergencies in eating disorders. He is also a lecturer at University College London where he launched a postgraduate degree course in Eating Disorders and Clinical Nutrition.
Following on from his recent interview with Janet Treasure, leading Psychiatrist in eating disorders and Director of the Eating Disorder Unit and Professor of Psychiatry at the Institute of Psychiatry, King’s College, London, Dr Paul shared the history of his career and what he is most excited about for the future. You can watch the full recording below.
He explores below how his work at Orri impacts the delivery in service, and how Orri could shape the way we treat eating disorders in the UK…
You’ve had an enriching and long career in academia, research and mental health, especially in the eating disorders field. What about Orri drew you to work with us?
“That’s a good question, and in fact, they asked me to join. At the time, I had a book released, ‘Community Treatment of Eating Disorders’, which maybe someone from Orri read, as Kerrie then contacted me.
The service at Orri is fantastic, partly for the number of staff and the genuine attention clients receive. We are really focused on day care and are very good at risk assessment, so we know when somebody really does need to go into hospital. If this is the case, we have relationships with all the relevant inpatient units as well.”
Our day care treatment is unique in the industry. Based on your experience, how does day treatment help sustain successful recovery for clients?
“It’s a combination of autonomy and therapy. Therapy (including nutritional and occupational therapy) at Orri allows the client to maintain their home environment, their connections with their family and social networks in their life outside of treatment, which contributes to their wellbeing. Having the support and help from families and friends are maintained and recommended by the team at Orri.
“Therapy (including nutritional and occupational therapy) at Orri allows the client to maintain their home environment, their connections with their family and social networks in their life outside of treatment, which contributes to their wellbeing. Having the support and help from families and friends are maintained and recommended by the team at Orri.”
One of the horrible things about eating disorders is the social isolation that an individual can develop. To help combat this, we hold a strong occupational therapy presence in treatment, in aid to help clients find more satisfaction and purpose in their everyday lives, whether this be through education, voluntary work or simply setting a structure in the day. The eating disorder takes this all away, and at Orri, we strive to work collaboratively with the clients to get this back.
What we have at Orri, which I haven’t seen elsewhere, is a strong presence of the Head Chef, Dietetics and kitchen staff. They make trusting relationships with the clients when preparing meals and considering menus, which is essential in this process. This shows that we care for each individual who walks through the clinic door, catering to their individual dietary and cultural needs. This attention and care really does make a difference. Mealtimes are already tricky to navigate in eating disorder treatment settings but we do this really well at Orri – thanks to the support from our multi-disciplinary team – including the catering staff, the kitchen staff, the Eating Disorder Associates, the clinicians, and of course, the peers.
Peer support and connection in therapy is key at Orri. After all, the clients are the ones who really understand what having an eating disorder is like. They are important in the recovery process.”
Orri’s mission is recovery for all through outstanding care with compassion at the core. How do you see Orri’s growth benefitting the sector?
“In my opinion, more people get better at Orri than they would at other units. I think is due to the intensity of treatment and that good relationships are made between the staff and clients. One of the most important aspects of eating disorders is attachment; clients may have difficulties with attachment with their families, friends, with those supporting them, and with themselves. What we do at Orri is foster excellent attachment. I believe that satisfying attachment in a therapeutic context helps people feel better. If a client has trust in the clinician, that is the most important aspect in successful therapy and recovery.
In terms of our online daycare treatment, our data outcomes shows that Orri helps people get better. It looks as though online therapy is as powerful as face to face treatment. How have we done this? Well, the difference in our approach is the intensity. Our clients have treatment running throughout the day, with supervised meals/snacks, and with individual and group therapy, demonstrating the effort, care and engagement of Orri’s treatment – and how this makes a difference.”
Are you aware of any wider sector trends that may change the way we treat eating disorders?
“Covid had a huge impact on eating disorders. The referral rate increased enormously across the sector – by 30%. The admissions rate for under 18-year-olds doubled. What this has meant is that teams are really struggling.
The NHS and eating disorder sectors are looking to implement day care treatment for eating disorders, which may be an oddly beneficial effect of the pandemic. I think establishing more day care services would be a good thing – Orri is a very good model to follow from this point of view, and is definitely the best model I have ever been associated with.
“I think establishing more day care services would be a good thing – Orri is a very good model to follow from this point of view, and is definitely the best model I have ever been associated with.”
The waiting lists are getting longer. The whole system is overwhelmed and we are in a period of austerity. Public services are not being increased in line with inflation, so this is a double whammy for NHS services. It is increased demand with effectively decreased resource. Something has got to happen. I would suggest more day care treatment and more intensive outpatient care.
I’d like to say there are new therapies on the horizon – the use of CBT in eating disorder treatments has improved. We’ve introduced Mentalization-based Therapy and multi-family therapy has been introduced over the last few years too, which is promising.”
What is Mentalization-based Therapy (MBT-E)? Find out more here.
Your role as Director of Research and Development is pivotal in the delivery of our service, here at Orri. Can you talk us through some of the outcome data you find most interesting and meaningful?
“At Orri, we support a broad range of individuals with very different eating disorder experiences. In terms of outcome data, our results vary across the spectrum of eating disorder diagnoses. We monitor body weight and conduct eating disorder examinations for our clients. I have since introduced Orri’s Severity of Eating Disorder Questionnaire. Through the outcomes here, we hope to identify the clients who have severe eating problems, ensuring they are met with the right amount of support and care from Orri’s specialist team.
We also look at our clients’ evaluations and experiences of Orri’s treatment. The delivery of our service is absolutely key and we hold an open dialogue to learn from our clients; by collating their feedback, it helps influence our service and identifies what works and what does not for individuals.
The majority of clients who come to Orri do improve.”
Clients outcomes at Orri show a significant decrease of symptoms related to an eating disorder during treatment, e.g., depression; anxiety; shape and weight concerns; and restriction. Our outcome data shows that our online treatment is as effective as our in person treatment.
As always, we like to ask our team for their messages of hope for the future. If you could offer advice, for those hoping to pursue a career in this industry, what would you say?
“I came from the physical side of medicine and transitioned to the psychological .I would say that if you are interested in how the body, the mind and how families, work, eating disorders is a great speciality.
There’s a lot of improvement in this field to achieve, so that is why it’s interesting for those in frontline, in terms of treatment – nurses, doctors, nurses, dietitians, therapists, occupational therapists – but it is also of interest for those dealing in the psychological and medical aspects of research. It is a great field for research as we are only now gaining understanding of eating disorders. For example, when it comes to attachment theory and what happens as a child grows and develops, we only have little idea how this can develop into an eating disorder. Of course, we can factor in genetic predispositions and the influence of society and social media, but these factors will only develop as society continues to change.
There are things that society and professionals can improve upon, to help families raising young people. We don’t have the tools to do this yet but I feel this a great area to further develop.”
“Orri is an excellent unit and am very happy with the way they provide day care for eating disorders.”