Eating disorder services
In partnership with the NHS, we provide intensive treatment for people suffering with severe eating disorders.
Priory works closely with the NHS to provide intensive treatment for people suffering with severe eating disorders. It is the largest single provider of specialist inpatient care in the UK, providing support for both adults and young people with conditions such as anorexia, bulimia or atypical eating disorders.
Community and inpatient teams across Priory work together to look at the best treatment pathway for each patient in our care. This approach also includes:
- Strong leadership from consultants, experienced in managing complex patients with eating disorders
- Comprehensive multidisciplinary teams with expertise in treating eating disorders
- Participation in national clinical quality forums in order to keep services at the forefront of emerging treatment in eating disorders
- Safe and supportive environments
- Quality service delivery and training
- Provision of evidence-based treatments
- Access to a wide range of therapeutic interventions
- Treatment tailored to individual needs
- Close working relationships with local community teams
Service overview
On a case-by-case basis, we will assess disordered eating in the context of other psychiatric disorders and offer the most appropriate treatment for individual needs. Therapeutic work is formulation based, looking at the function of the abnormal eating behaviours, as well as predisposing and maintaining factors. Our care and treatment address both the physical consequences of the eating disorder, as well as the related underlying psychological and social factors.
Our philosophy is one of collaboration and mutual respect. We work to create this atmosphere by listening to patients’ needs and adopting a flexible approach that allows individual needs to be met whenever possible. We adhere to clear, consistent boundaries and our rationale is transparent to patients, families, carers and staff teams alike. We believe this creates an environment of safety, which allows trust to develop, so that patients can explore their feelings, knowing they'll be empathically received.
We use an eclectic model of care, drawing on a variety of evidence-based approaches. The basic aim of treatment is to help to restore a healthier eating pattern, whilst providing psychological support to help with the feelings that emerge during this process.
Patient and carer involvement
From a patient’s first contact with us, we listen to views and goals around admission, involving them in treatment decisions. Entering into treatment for an eating disorder can be a daunting prospect and it's sometimes difficult to make decisions about certain aspects of treatment, especially involving food choices and taking part in activities, which may impact on physical health.
We always try to incorporate a patient’s wishes into the care plan as much as possible and carefully explain the reasons if this isn't possible. In the early stages of admission, we carry out a holistic assessment of social, psychological and physical needs, as well as starting to set short, medium and long-term goals.
As treatment progresses, we support patients in taking more control of their recovery, and work with them to develop an awareness of likes, interests and needs in all areas of their life.
We always try to involve families and carers in the care package, in a way that supports confidentiality, in order to improve communication which is often crucial in maintaining progress. Their views and support of treatment are an important part of recovery and we offer family therapy to help with this process, along with a more informal carers’ support group.
The aim of these sessions is to help families and carers understand how their loved one feels, so that we can improve relationships as a patient moves through treatment.
Outcome measures
It's important for us to understand if the treatment we're offering is leading to improvement. There are a number of ways we do this, including informally (listening to feedback) and formally (carrying out questionnaires and surveys). There are also a range of audits we carry out to make sure we're reaching quality standards. The main ones include:
- Health of the nation outcomes scores (HONOS) – measures mood, anxiety, relationships and quality of life
- Eating disorders examination (EDE) – specifically measures eating disorder symptoms
All of this information is regularly reviewed and we continually reflect upon how we can change our practice, to make further improvements to the treatments we offer.
Please note, objective measures vary in line with ever developing expectations from NHS England.
Care programme approach (CPA)
The CPA forms the basis of how we deliver inpatient care. We ensure that a patient is fully involved in defining the goals and treatment objectives within the care plan, and this provides the opportunity to review progress throughout the treatment programme. CPA review meetings take place every 4 to 6 weeks and involve professionals and family members.
Discharge planning commences from the point of admission and we engage patients, carers and home teams in looking at goals for treatment very early on. Knowing what services are available locally will have an impact on the goals of admission, as we aim to keep the admission as short as possible, so that patients can return to the community as soon as it is safe to do so.
We work with home teams to put together a robust discharge care plan, relapse prevention plan and crisis contacts. As well as emotional support, a large part of a discharge plan will be to develop structure, self-esteem, confidence and a sense of purpose. This may include helping with further education and various forms of paid and unpaid work, as well as exploring leisure activities.
In preparation for discharge, we will also organise increased periods of home leave to help with the transition. Prior to discharge, each patient will have a discharge CPA meeting together with their community team, and family and carers if appropriate.
More information
Our patients are often physically unwell when they enter treatment. Our first aim is to help them to begin to restore their physical health, which involves taking in nutrition. Close physical monitoring also takes place, which includes blood tests, electrocardiogram (ECG) readings, pulse, blood pressure and temperature. Everyone responds differently to this process and we have to monitor patients very closely, until it's safe to reduce the frequency.
We offer support around mealtimes to help people cope with this stressful time and our teams understand there will be times when nutritional drinks and nasogastric tubes may be needed, to ensure that patients are taking in the adequate amount of nutrition.
Eating disorders usually develop as a way of coping with intolerable feelings, so it's essential that we provide a full therapy programme to help patients to manage these thoughts and feelings. We provide a mixture of individual and group therapies which we adapt to meet a person's particular needs.
Patients will have an individual therapist throughout treatment who will help them to explore difficulties in a one-to-one setting. We offer focused therapy including:
- Maudsley model of anorexia nervosa treatment for adults (MANTRA)
- Cognitive behavioural therapy (CBT)
- Focused psychodynamic therapy, as many patients will have had MANTRA and/or CBT in the community and require a different approach
The group programme provides a variety of ways to help patients through their recovery. There are various groups to help address difficult issues in a practical way. For example:
- Meal preparation groups
- Trips out to enjoy leisure activities
- Relapse prevention
- Groups that help people to process their feelings
- Cognitive remediation therapy
- Body image work
Some of these groups are mainly verbal and others help patients through non-verbal means, for example, art, drama and dance therapy. There are also physically active groups which help patients put exercise back into a healthier way of life.
We also provide a key nurse who will be a guide through treatment, providing regular support through individual sessions called ‘key-work’, and in less formal settings on the ward. The ward doctor and consultant will review physical health and mental state regularly and may suggest medication if appropriate. This will be discussed and patients will have the opportunity to ask any questions.
We have a large multidisciplinary team involved in care. A consultant psychiatrist directs treatment and meets with patients regularly, while the rest of the team provide treatment and support on a daily basis. It is therefore important that we all work as a team and share information so that we can deliver care most effectively. The team also includes:
- Nurses
- Doctors
- A dietitian
- Family therapists
- Occupational therapists
- Psychotherapists
- Psychologists
Referrals and admissions
We have the ability to treat a constantly evolving group of higher acuity patients. We offer eating disorder treatment to those who meet the following criteria:
- Males and females
- Primary diagnosis of an eating disorder
- May present with an eating disorder that's too high risk, complex, severe or persistent to be managed safely within a community setting
- Patients who may have a high physical/psychiatric risk
- Patients who may have co-morbid conditions
- May be admitted informally or under the Mental Health Act (MHA)
- May have dual diagnosis or complex needs
We only accept referrals from community eating disorder services.
All of our hospitals have specific admission criteria relevant to the service and support they offer. In line with medical emergencies in eating disorders (MEED) guidelines, we attempt to admit most patients, but the most physically unwell may need a period of stabilisation on a medical ward first. This includes people requiring intravenous fluids, electrolytes, or cardiac monitoring, if their body mass index (BMI) is less than 10.
Patients with co-morbid physical conditions, such as diabetes, will need close liaison with their local medical team to ensure both physical and mental health are managed together.
Referrals will be reviewed by the hospital's multidisciplinary team and admissions for inpatient treatment are planned with the hospital, referrer and patient.
Please note, we are unable to take self-referrals for NHS services. Treatment funded through the NHS will need to be discussed with a local community eating disorder service.
For information on how to access treatment via private medical insurance (PMI), or to self-pay, please view our dedicated private eating disorder page.
Downloads
Service overview
Contact us for help, referrals or more information
For further information on Priory services offered to the NHS, or to make a referral, please call our dedicated 24/7 customer service centre.