The West Yorkshire & Harrogate Adult Eating Disorders Service – Leeds – WINNERS – Eating Disorders #MHAwards18

The aim of the new CONNECT service is to develop a regional adult eating disorders service which addresses these issues whilst maintaining high quality care which meets service user’s needs. The new service, which was developed over a 9 month period and went live on the 1st of April 2018, has been developed to build upon the evidenced firm foundation of the Leeds Community Treatment and Outreach Service (CTS) and Outreach service established in 2010 and using this model as the basis for standardising and localising care across the West Yorkshire and Harrogate footprint.

https://www.leedsandyorkpft.nhs.uk/our-services/services-list/yorkshire-centre-for-eating-disorders/

WINNERS - EATING DISORDERS AWARDS - #MHAWARDS18

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: Yes

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

 

 

 

 

 

 

 

 Overview 

Prior to the development of CONNECT, service provision for adults with eating disorders across the West Yorkshire and Harrogate footprint was extremely varied with significant inequalities noted with regards to availability of integrated evidence-based community care, significant delays in accessing care and long distances required to access treatment. Moreover regional eating disorders care pathways lacked a cohesive framework meaning that service commissioning, design and provision were often disjointed across in-patient and community pathways resulting in potentially avoidable treatment delays, increased hospitalisation to out-of-area placements, poor clinical outcomes and service user and family dissatisfaction. 

The aim of the new CONNECT service is to develop a regional adult eating disorders service which addresses these issues whilst maintaining high quality care which meets service user’s needs. The new service, which was developed over a 9 month period and went live on the 1st of April 2018, has been developed to build upon the evidenced firm foundation of the Leeds Community Treatment and Outreach Service (CTS) and Outreach service established in 2010 and using this model as the basis for standardising and localising care across the West Yorkshire and Harrogate footprint. 

    • The CONNECT service has integrated and expanded existing regional adult eating disorders services including: • The Yorkshire Centre for Eating Disorders (YCED): a national specialist service for adults with eating disorders which provides inpatient, community and outpatient (tiers 2-4) care based at the Newsam Centre in Leeds and part of LYPFT. The service has won national (‘Service of the Year’, B-eat, 2012) and local (‘Clinical Team of the Year’, LYPFT Trust Awards, 2017) awards and is accredited by the Royal College of Psychiatrists Quality Network for Eating Disorders (QED) and the Care Quality Commission (CQC). 
    • • The Kirklees Early Response Eating Disorders (ERT) Service: a Kirklees-based outpatient (tier 2) level service delivered by SWYFT. 
    • • The North Yorkshire Eating Disorders Service: a North Yorkshire community-based service delivered by TEWV which provides specialist advice and consultation to primary and secondary care services (tiers 1-2) across the North Yorkshire area. Within the West Yorkshire and Harrogate footprint, the North Yorkshire Eating Disorders Service provides care in the Harrogate and Craven areas. 

In addition to this the CONNECT service has further developed existing links with local mental health services (both adult and CAMHS), primary care, acute providers and third sector and voluntary sector organisations across the region. This has supported the effective management of regional care pathways and built capacity within the local systems, as well as ensuring effective sign posting and support for service users and carers. The CONNECT clinical model and care pathway was developed through a consultation process overseen by the CONNECT clinical steering group, a multi-agency, multi-professional group whose membership includes representatives from LYPFT, BDFCT, SWYFT, TEWV and NHS England as well as representatives from CONNECT service user and carer reference groups.  

    • Aims The CONNECT service aims to provide: • a consistent and integrated pathway of care across the West Yorkshire and Harrogate footprint  which spans a number of tiers including specialist adult community-based eating disorder services and specialist tier 4 adult eating disorders In-patient beds (ward 6, Yorkshire Centre for Eating Disorders, Leeds).
    • • an improved, joined-up system approach to the care and treatment of adults with eating disorders across the West Yorkshire and Harrogate health system and wider services, resulting in improved service user outcomes and experience and improved transitions between services. 
    • • high quality treatments as recommended by the National Institute for Clinical Excellence (NICE) guidelines on eating disorders (NICE, 2017) to facilitate positive change in individuals with eating disorders
    • • a multi-disciplinary team (MDT) approach to care and treatment which allows individuals to develop and achieve personal growth
    • • consistent and equitable access to the same level and standard of care and services across the West Yorkshire and Harrogate footprint. 
    • • a significant reduction in length of stay within tier 4 in-patient services and out of area placements with admission only occurring when this is absolutely clinically necessary.
    • • maximised use of digital and other technological approaches (e.g. tele-consultation, therapeutic apps, online chatrooms) to enhance service delivery     
    • • a consistent, coordinated and strengthened approach to the delivery of ‘Management of Really Sick Patients with Anorexia Nervosa’ (MARSIPAN) (RCPsych, 2014) in partnership with acute hospital partners across the region. 

• enhanced links and accessibility of advice and support to local mental health services (both adult and CAMHS), primary care, acute providers and third sector organisations across the region. Values

    • The overarching values of the CONNECT service are: • Compassion. Compassion, care and respect are at the heart of the service and treatment that we provide. We believe that quality of care is dependent on the collective commitment and expertise of the team, including service users and carers, and the service’s ability to connect with the service user on a human level to promote trust, engagement and positive change.
    • Hope. Recovery and positive change are rooted in hope. We aim to instil a sense of hope and optimism in all those that use our service whilst maintaining a sense of pragmatism to create an environment which feels both caring and achievable.
    • Individualised. Our priority is the people who use our services and we aim to provide a personalised and flexible clinical service that will meet and treat the needs of individuals with eating disorders. What’s right for one person might not be right for another hence our care pathways need to be flexible and guided by the needs of the individuals who use our service. 
    • Autonomy. We promote independence, autonomy and empowerment to support our service users in steering their own care. We recognise that taking responsibility for your own care can be challenging at times but by developing trust, compassion and understanding, the service can help service users to find their life without an eating disorder. 
    • Quality. We are an evidence-based and evidence-generating service which aspires to provide high quality treatment in line with national standards of excellence and national guidelines. We are always looking to improve the services that we provide based on feedback from service users, carers and staff and through research and continued service evaluation and development we aim to provide the best service that we can. 
    • Engagement. Easy access to treatment and proactive engagement with service users, carers and other stakeholders is key to safe, collaborative and effective treatment. We understand that engagement is built on trust and understanding which in turn is formed on a foundation of a reliable, informative and flexible service which works with the service user as a person to challenge their eating disorder so that progress can be made.

Vision. Our vision is wedded to recovery from eating disorders and the promotion of independence and improved quality of life. The service starts treatment with the service users’ holistic longer-term goals in mind including those which may not be directly linked to their eating disorder but can be the motivators which drive them towards recovery, adopting a different perspective to life and positive change. Vision with action, not action without vision.

An Overview of the CONNECT Clinical Model

    • CONNECT provides outpatient, intensive home-based, outreach and inpatient treatment for adults (>18 years of age) with eating disorders from the West Yorkshire and Harrogate footprint. We aim to provide high quality treatments as recommended by the National Institute for Clinical Excellence (NICE) guidelines on eating disorders (NICE, 2017) to facilitate positive change in individuals with eating disorders. We provide a multi-disciplinary team (MDT) approach to care and treatment which allows individuals to develop and achieve personal growth. Our service consists of the following MDT sub-teams: • East Community and Outreach Team: provides tier 2 (outpatient) and tier 3 (intensive home-based treatment, outreach) specialist community-based eating disorders treatment for adults from the Leeds, Harrogate and Wakefield areas.
    • West Community and Outreach Team: provides tier 2 (outpatient) and tier 3 (intensive home-based treatment, outreach) specialist community-based eating disorders treatment for adults from the Bradford, Airedale, Craven, Kirklees and Calderdale areas.
    • The Yorkshire Centre for Eating Disorders (YCED) (Ward 6, Newsam Centre, Seacroft Hospital, Leeds): provides tier 4 specialist inpatient eating disorders treatment for adults from the West Yorkshire and Harrogate region.   YCED also accepts out-of-area inpatient referrals but prioritises referrals from the West Yorkshire and Harrogate region.

The CONNECT Dual Diagnosis Service (Newsam Centre, Leeds): a service delivered in partnership with Forward Leeds (addictions service based in Leeds) which provides assessment and treatment for individuals with a dual diagnosis of an eating disorder and a substance misuse disorder from the West Yorkshire and Harrogate region. An overview of the CONNECT clinical model is outlined in Figure 2

Figure 2. Overview of the CONNECT Clinical Model

Our Service

The CONNECT Community and Outreach Teams The CONNECT Community and Outreach teams are teams specifically designed to provide outpatient treatment (tier 2) and/or enhanced home-based community care (tier 3) for patients with moderate to severe anorexia nervosa (BMI<17) and severe bulimia nervosa (daily bulimic behaviours) across the areas of Leeds, Harrogate and Wakefield (East team) and Bradford, Airedale, Craven, Kirklees And Calderdale (West team).  The teams also accept referrals for mild anorexia nervosa (BMI 17-18.5) and mild/moderate bulimia nervosa (weekly bulimic behaviours) for early intervention cases and offer treatment for individuals with atypical eating disorders if they are pregnant or have type 1 diabetes mellitus. 

Both teams provide an intensive home-based treatment service which offers an alternative to inpatient treatment thus reducing the need for hospitalisation and promoting earlier and smoother transitions from hospital to community settings. The teams offer a wide range of evidence-based treatments based on a recovery model of care in line with NICE (2017) and MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) (RCPsych, 2014) guidelines with the aim of promoting weight restoration, eating for health and a reduction in eating disorder related symptoms alongside psychological change and improved quality of life. Both community MDTs (see Table 1) are made of up psychiatrists, psychologists, nurses, therapists, dieticians, occupational therapists, social workers, health support workers, peer support workers and administration staff who work together with service users and carers to provide high quality,  evidence-based treatments on both an individual and group basis.

Both teams also provide an outreach service specifically designed to support individuals with severe and enduring eating disorders (SEED), i.e. illness duration > 5 years, severe symptoms, marked socio-occupational dysfunction. This service aims to manage the complex needs of individuals with SEED without the need for hospitalisation and has consistently shown over time that it improves quality of life, reduces the need for hospitalisation, promotes collaborative working with other health providers and increases patient and carer satisfaction.   

Table 1. CONNECT Community and Outreach staffing model

East Community & Outreach team (Leeds, Harrogate & Wakefield)

West Community & Outreach team (Bradford, Airedale, Craven, Kirklees & Calderdale)

Consultant psychiatrist1.0

1.0

Specialty doctor1.0

1.0

Consultant psychologist0.5

0.5

Band 8a clinical nurse lead0.5

0.5

Band 8a psychologist1.0

1.0

Band 7 CTM1.0

1.0

Band 7 therapist1.0

1.0

Band 7 dietician0.5

0.5

Band 6 social worker0.5

0.5

Band 6 mental health practitioners5.0

3.6

Band 6 dietician 1.0

1.0

Band 3 health support workers 3.0

2.0

Band 3 peer support workers1.0

1.0

Band 3 admin support workers2.0

2.0

Total wte 19.0

16.6

The CONNECT community and outreach teams deliver tier 2 and tier 3 level services across the West Yorkshire and Harrogate region through a hub and spoke model. The East community and outreach hub is situated at the Newsam Centre (Seacroft Hospital) in Leeds with spoke sites in Harrogate and Wakefield. The West community and outreach team hub is situated at The Dales (Calderdale Royal Hospital) in Halifax with spoke sites in Huddersfield, Bradford, Keighley and Skipton. The Yorkshire Centre for Eating Disorders (YCED) The Yorkshire Centre for Eating Disorders (YCED), situated on ward 6 at the Newsam Centre (Seacroft Hospital, Leeds), is a 19-bedded tier 4 inpatient specialist eating disorders unit which offers a number of different evidence-based treatment programmes tailored to individual need which have recently been reviewed and modernised in line with the recently updated NICE guidelines (NICE, 2017) and MARSIPAN (RCPsych, 2014) guidelines. Structural changes have been made to the inpatient environment to include a two bedded male service user area, in line with Eliminating Mixed Sex Accommodation (EMSA) and CQC requirements. Our inpatient MDT (see Table 2) is made up of psychiatrists, psychologists, nurses (including an advanced practitioner), dieticians, dietetic assistants, occupational therapists, health support workers and administration staff who work together with service users and carers to provide high quality,  evidence-based treatments on both an individual and group basis.  Our inpatient unit is able to provide nasogastric feeding if required and can facilitate admissions for individuals detained under the Mental Health Act 1983.  Our inpatient team works closely with the CONNECT community and outreach teams as well as other community teams outside of the West Yorkshire and Harrogate region to ensure that the length of hospital stay is kept to a minimum whilst ensuring that individual care needs are met and to ensure that the necessary care and support is in place in the community at the point of discharge from the inpatient unit. 

Please note that YCED also accepts out-of-area inpatient referrals however bed availability is prioritised for service users from the West Yorkshire and Harrogate region.

Table 2. YCED staffing model

Consultant psychiatrist 1.0, Band 8b psychologist1.0, Junior doctor (FY2/CT) (rotation)1.0, Band 7 CTM1.0, Band 7 allied health professional lead1.0,Band 7 advanced practitioner1.0, Band 7 family therapist0.6, Band 6 occupational therapist1.0, Band 6 dietician1.0, Band 6 nurses4.0, Band 5 occupational therapist (rotation)1.0, Band 5 nurses 9.5, Band 3 health support workers 11.0, Band 4 admin lead0.8, Band 3 dietetic assistant1.0Band 2 admin support workers0.8

Total wte 36.7

The CONNECT Dual Diagnosis service

The CONNECT dual diagnosis service is a newly established service which provides assessment and treatment for individuals from the West Yorkshire and Harrogate region who have a dual diagnosis of an eating disorder and a substance misuse disorder (as per ICD-10 criteria). This clinic is specifically designed for individuals who meet referral criteria for the service however their substance misuse disorder means that they are not able to access standard community or inpatient treatment and is delivered through the dual diagnosis service in partnership with Forward Leeds.

The service is situated at the Newsam Centre (Seacroft Hospital) in Leeds and is delivered by a Consultant Psychiatrist in Eating Disorders and an advanced practitioner from the CONNECT service with input from an experienced dual diagnosis mental health practitioner from the addictions service Forward Leeds. The dual diagnosis service utilises an assessment and treatment model which adopts motivational enhancement therapy and an integrated care approach in line with NICE guidelines for the treatment of eating disorders and substance misuse disorders. The aim of this service is to support individuals with a dual diagnosis in reducing their substance misuse whilst simultaneously treating their eating disorder in a holistic and integrated way in preparation for more intensive community or inpatient based treatment within the CONNECT service at a later stage.

 

What makes your service stand out from others? 

The CONNECT service is the first adult eating disorders service of its size in the UK to offer a consistent and integrated pathway of care offering a multi-tiered approach to treatment in line with the newly revised NICE and MARSIPAN guidelines (2017, 2014). In addition to this it is one of only two adult eating disorders NHSE New Care Models initiatives trialling devolved commissioning as a means of delivering cost-effective, high quality care.

Since CONNECT went live in April 2018, the service has been able to offer evidence-based and equitable community and inpatient treatment to patients outside of Leeds who the vast majority had previously been unable to access to a level which was required to meet their complex needs. Although this service has only been live for two months at the time of writing, we have already received overwhelming positive feedback from service users, carers, GPs, secondary mental health services, commissioners and other stakeholders.

 

How do you ensure an effective, safe, compassionate and sustainable workforce?

The CONNECT service provides a diverse training, supervision and support programme for its staff members which is anchored in the wider values of the service (see above). We believe that by providing safe, compassionate, individualised and high quality training, supervision and support, our workforce will  feel safe and supported such that individual growth can be achieved which in turn will help the service to grow and flourish in the future. 

    • Examples of this include: • Weekly staff support and reflective practice sessions for each of the four CONNECT teams
    • • Monthly 2 hour staff development training sessions
    • • Employing 2 peer support workers across the service (1 peer support worker per community team) to enhance the support provided to service users and carers within the service.
    • • Regular organisational development workshops (e.g. away days) to promote team working and shared visions.
    • • Developing service champion roles within the service to ‘devolve’ responsibility such that service development initiative do not solely lie within the senior management team and also providing a platform for individual growth, career progression and continuous professional development across the workforce. 
    • • Exit interviews for all staff leaving the service to help future service developments and promote workforce retention and sustainability.
    • •A training budget to accommodate individual and service level training needs.

4. Who is in your team? Attach any relevant documents on structure if needed Band/grade Number Whole-time equivalent

Consultant psychiatrist 1.0, Band 8b psychologist1.0, Junior doctor (FY2/CT) (rotation)1.0, Band 7 CTM1.0, Band 7 allied health professional lead1.0,Band 7 advanced practitioner1.0, Band 7 family therapist0.6, Band 6 occupational therapist1.0, Band 6 dietician1.0, Band 6 nurses4.0, Band 5 occupational therapist (rotation)1.0, Band 5 nurses 9.5, Band 3 health support workers 11.0, Band 4 admin lead0.8, Band 3 dietetic assistant1.0Band 2 admin support workers0.8

Total wte 36.7

Working together 

How do you work with the wider system?

CONNECT: The West Yorkshire and Harrogate Adult Eating Disorders Service was developed through a New Care Models initiative for Adult Eating Disorders as part of NHS England’s ‘Five Year Forward View for Mental Health’ in partnership with Bradford District Care Trust (BDCFT), South West Yorkshire Partnership NHS Foundation Trust (SWYFT) and Tees, Esk and Wear Valley NHS Trust (TEWV).  Development of this new service has involved the expansion and tailoring of existing eating disorders services to significantly reshape both in-patient and community care for adults with eating disorders across the West Yorkshire and Harrogate Health and Care Partnership (HCP) footprint (see Figure 1)

Our Partners and Interface Services

The CONNECT Dual Diagnosis service

The CONNECT dual diagnosis service is a newly established service which provides assessment and treatment for individuals from the West Yorkshire and Harrogate region who have a dual diagnosis of an eating disorder and a substance misuse disorder (as per ICD-10 criteria). This clinic is specifically designed for individuals who meet referral criteria for the service however their substance misuse disorder means that they are not able to access standard community or inpatient treatment and is delivered through the dual diagnosis service in partnership with Forward Leeds.

The service is situated at the Newsam Centre (Seacroft Hospital) in Leeds and is delivered by a Consultant Psychiatrist in Eating Disorders and an advanced practitioner from the CONNECT service with input from an experienced dual diagnosis mental health practitioner from the addictions service Forward Leeds. The dual diagnosis service utilises an assessment and treatment model which adopts motivational enhancement therapy and an integrated care approach in line with NICE guidelines for the treatment of eating disorders and substance misuse disorders. The aim of this service is to support individuals with a dual diagnosis in reducing their substance misuse whilst simultaneously treating their eating disorder in a holistic and integrated way in preparation for more intensive community or inpatient based treatment within the CONNECT service at a later stage.

Adult Mental Health Services

There are 4 adult mental health trusts across the West Yorkshire and Harrogate catchment area which includes Leeds and York Partnership NHS Foundation Trust (LYPFT), Bradford District Care Foundation Trust (BDCFT), South West Yorkshire NHS Foundation Trust (SWYFT) and Tees, Esk and Wear Valley NHS Trust (TEWV). CONNECT works in close partnership with these 4 providers to enhance links and ensure accessibility of advice and consultation to local Community Mental Health Teams (CMHTs), Liaison Psychiatry services and inpatient psychiatric services. By developing enhanced links with CMHTs through regular training and supervision CONNECT offers a tier 1 level service (advice and consultation, link workers, guided self-help, support groups) across the region which ensures joined up working along the care pathway in keeping with a stepped model of care.

Child and Adolescent Mental Health Services (CAMHS) 

There are 4 mental health trusts which provide Child and Adolescent Mental Health Services (CAMHS) across the West Yorkshire and Harrogate catchment area which include Leeds Community Healthcare NHS Trust (LCH), Bradford District Care Foundation Trust (BDCFT), South West Yorkshire NHS Foundation Trust (SWYFT) and Tees, Esk and Wear Valley NHS Trust (TEWV). CONNECT works in close partnership with local CAMHS services to ensure a smooth transition of care between CAMHS and Adult services in line with NICE (2017) and RCPsych (College Report 208, 2017) guidelines.

Primary Care

Collaborative working with GPs and primary care health professionals is a crucial aspect of eating disorders treatment and CONNECT works in close partnership with local primary care services to promote early intervention, regular physical health monitoring, MARSIPAN and training helping to ensure that treatment and care pathways are both effective and safe.

Third Sector Organisations

CONNECT has close links with regional and national third sector organisations and employs 2 community-based peer support workers through local third sector agencies. This enhances the clinical model in numerous ways and brings another dimension to the treatments that we offer. 

Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) pathways

CONNECT provides a consistent approach to MARSIPAN across the region and formalised MARSIPAN pathways and expert working groups have been developed through partnership arrangements with local mental health providers, primary care services and local acute hospital providers in each of the following delivery areas:

    • East catchment area Leeds: Gastroenterology team, J91/92, Bexley Wing, St James University Hospital.

Wakefield and Dewsbury: Gastroenterology team, W44, Pinderfields General Hospital. Harrogate:  Gastroenterology team, Harrogate District Hospital. West catchment area Bradford and Airedale: Gastroenterology team, Bradford Royal Infirmary and Airedale General Hospital. Calderdale and Huddersfield: Gastroenterology team, Calderdale Royal Hospital and Huddersfield Royal Infirmary

 

Do you use co-production approaches? 

The CONNECT clinical model and care pathway was developed through a consultation process overseen by the CONNECT clinical steering group, a multi-agency, multi-professional group whose membership includes representatives from LYPFT, BDFCT, SWYFT, TEWV and NHS England as well as representatives from CONNECT service user and carer reference groups.  Moreover partnership working with other regional stakeholders is a crucial aspect of the foundation of the CONNECT clinical model as outlined in question 4. Likewise the evaluation and evaluation strategy of the service has been done in partnership with service users, carers, regional stakeholders and the health economics team at the University of Leeds.

    • CONNECT employs two peer support workers within their services and has established a service user reference group and family and carers reference group to support all aspects of service development and clinical governance such that a culture of service user and carer involvement is embedded across the service. Examples of this include service user and carer input into the development of: • The CONNECT clinical model including the newly revised inpatient treatment programmes on ward 6.
    • • Branding of the service and the service name which was decided by service users at a service user reference group branding workshop.
    • • Service user and carer involvement in recruitment and interviews.
    • • Service user and carer representative included in the membership of the CONNECT clinical governance council.
    • • Development of family and carer champions across the service to help instil a culture of family and carer support and engagement.
    • •Development of service user peer support groups, family and carer peer support groups and family and carer workshops.

Do you share your work with others? 

CONNECT recognises the huge benefits of sharing work and experiences with others. We provide an array of resources for service users and carers as well as health professionals on our website and regularly publish our work in peer-reviewed journals (see examples below). We are regularly invited to share our work at local, regional and national learned societies (Royal College of Psychiatrists, Royal Society of Medicine, b-eat, NHSE). 

In addition several members of our team work as media spokespersons with recent interviews for BBC Panorama, BBC Breakfast, the Guardian and the Yorkshire Evening Post (see links below).

Recent Publications

Original Research

    • Robinson P, Jones WR (2018) MARSIPAN: Management of Seriously Ill Patients with Anorexia Nervosa. BJPsych Advances; 24(1): pp. 20-32.
    • • Riaz H, Jones WR, Donnelan C et al (2017). Knowledge and attitudes of gastroenterologists towards eating disorders. ARC Journal of Psychiatry. 2(4): 29-40.
    • • Jones WR, Masood M, Huke V, Reid F, Roche J, Patel M, Morgan JF (2016) New trends in substance misuse in eating disorders: the emergence of novel psychoactive substances, prescription drug abuse and  internet drug purchasing. Research and Advances in Psychiatry; 3(2): 33-43.
    • • Jones WR & Morgan JF (2014) Balancing risk requires a balanced approach. Commentary on Severe and Enduring Eating Disorders. Advances in Psychiatric Treatment; 20, 402–404.
    • • Jones WR, Narayana U, Howarth S, Shinners J, Nazar Q (2014) Cardiovascular monitoring in patients prescribed clozapine. Psychiatric Bulletin; 38(3):140.
    • • Jones WR, Morgan JF, Arcelus J (2013) Managing physical risk in anorexia nervosa. Advances in Psychiatric Treatment; 19: 201-202.
    • • Jones WR, Schelhase M, Morgan JF (2012) Eating disorders; clinical features and the role of the generalist. Advances in Psychiatric Treatment; 18: 34-43. 
    • • Jones WR, Saeidi S, Morgan JF (2012) Knowledge and attitudes of psychiatrists towards eating disorders. European Eating Disorders Review; 21(1): 84-88.
    • • Jones WR, Morgan JF, Arcelus J (2013) Managing physical risk in anorexia nervosa. Advances in Psychiatric Treatment; 19: 201-202.
    • • Jones WR, Morgan JF (2012) Eructophilia in bulimia nervosa: a clinical feature. International Journal of Eating Disorders; 45(2): 298-301.
    • • Jones WR & Morgan JF (2010) Eating disorders in men: a review of the literature. Journal of Public Mental Health; 9 (2): 23-31
    • • Jones WR, Morgan JF (2010) Obesity surgery: Psychiatric needs must be met. BMJ; 341: 685
    • • Jones WR, Morgan JF (2010) Reproductive and sexual health needs of women with eating disorders. Advances in Psychiatric Treatment; 16: 476
    • •Jones R, Taylor M, Mojee M (2007) Treating psychiatric symptoms of Huntington disease. Progress in Neurology and Psychiatry; 11: 25-30

College Reports

Jones WR, Philpot U, Morgan JF (in press) Nutritional management during pregnancy and lactation. In: Guidelines for the nutritional management of anorexia nervosa.

Book chapters

Jones WR, Morgan  JF (2016) Eating Disorders. In Medical Psychotherapy. Eds Yakeley J, Johnston J, Adshead G,  Allison L. Oxford University Press.

Training modules

Robinson P, Davison R, Jones WR, Chapman S (in press) Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN). RCPsych, CPD online.

Jones WR, Shora S (2018) Eating disorders: risk factors and clinical management. RCPsych, CPD online. 

Jones WR, Robinson P (2017) Severe and enduring eating disorders. RCPsych, CPD online.

Recent Media Coverage

First Episode and Rapid Early Intervention in Eating Disorders (FREED)

https://www.yorkshireeveningpost.co.uk/news/campaigns/eating-disorders-awareness-week-service-utterly-changed-my-life-1-9040859

https://www.yorkshireeveningpost.co.uk/news/health/eating-disorders-awareness-week-leeds-consultant-hails-service-1-9040853

Eating Disorders in Men

https://www.bbc.co.uk/programmes/b08zk03z

https://www.theguardian.com/society/2017/jul/31/eating-disorders-in-men-rise-by-70-in-nhs-figures

 

 What outcome measures are collected, how do you use them and how do they demonstrate improvement?

CONNECT monitors service delivery and performance through the collection and evaluation of service users’ experience and satisfaction measures, key performance indicators and validated clinical outcome measures which are measured against national service specification (QED, NHS England and CQC) and standards outlined in NICE (2017) and MARSIPAN (RCPsych, 2014) guidelines. Formal service delivery, evaluation and performance are overseen by the CONNECT Programme Board with input from the CONNECT Service User Reference Group, the CONNECT Carers Reference Group and representatives from regional stakeholders. 

Data collection is completed at baseline and at the end of treatment and where possible is done with the service or carer with support from a member of the multi-disciplinary team. Data collection and data governance is seen as the responsibility of all members of the team with specific data collection leads identified within each of the individual teams to optimize data collection and ensure valid and reliable data governance.

Evaluation  data are reported monthly CONNECT Governance meetings with input from service users and carers and quarterly to NHSE as part of the New Care Models initiative. CONNECT will produce an annual report which will be available on our website so that our performance and experiences can be shared more widely. 

Quantitative outcome measures

    • Key performance indicators • Number of hospital bed days in specialist inpatient eating disorder services including out-of-area placements 
    • • Number of hospital bed days to acute trusts
    • • Average length of stay in specialist inpatient eating disorder services including out-of-area placements
    • Clinical • The Eating Disorder Examination Questionnaire (EDEQ)
    • • Clinical Outcomes in Routine Evaluation (CORE)
    • • Body Mass Index (BMI)
    • • Eating Disorders Quality of Life scale
    • • EQ-5D-5l
    • • Rosenberg’s self-esteem inventory
    • • Health of the Nation  Outcome Scale (Honos)

Qualitative outcome measures

    • Service users • Standardised interview schedules carried out at the point of discharge from the service which assesses service user experience and involvement in their treatment.
    • • Other service user satisfaction tools 

Family and Carers • Carers satisfaction questionnaire assessing carers’ experience of the service and their ideas about future service developments. Local stakeholders and health providers • Survey of local health providers and stakeholders experience of the service 

 

Has your service been evaluated (by peer or academic review)? 

The CONNECT clinical model and business case was evaluated by NHSE which led to the initial successful New Care Models (wave 2) bid in July 2017. The Yorkshire Centre for Eating Disorders (YCED), the service from which CONNECT was developed, is accredited by QED (Quality Network for Eating Disorders (RCPsych) and CQC.

The service is regularly involved in clinical audit, service evaluation and research with recent example including:

    • One of 4 service sites in the UK examining the feasibility of introducing an early intervention model with a community eating disorder service (Multi-centre FREED-UP study).
    • • Service evaluation of the YCED inpatient treatment programmes (2017)

• Baseline assessment of CONNECT’s performance against the standards set out in the newly revised NICE guidelines for eating disorders (2018).  

 

How will you ensure that your service continues to deliver good mental health care? 

The CONNECT service works closely with regional and central NHSE commissioners to ensure that the CONNECT New Care Models initiative complies with the agreed standards of care and cost-effectiveness. Through a process of ongoing evaluation and reinvestment of funds saved by reducing out-of-area placement we are able to further develop the service based on performance and stakeholder (e.g. service users, carers, staff, referrers) feedback thus promoting a culture of growth in line with the aims and values of the service. 

The CONNECT service has also reached an agreement with regional commissioners and the 4 mental health trust stakeholders that if the New Care Models initiative were to come to an end for whatever reason, that there would be a co-commissioning plan to ensure that the new service is sustained and that high quality adult eating disorders care is still provided across the region. 

What aspects of your service would you share with people who want to learn from you? 

We regularly share aspects of our service as outlined in question 7 including the challenges we have faced in implementing and delivering specialist adult eating disorders services across the West Yorkshire and Harrogate region. We have also worked in partnership with other NHSE New Care Models initiatives to promote shared learning.

 

Access 

How many people do you see?

Between April 2017 and March 2018 the service have received 311 referrals and 221 (71%) were offered assessment and treatment. During this time period our inpatient unit had 75 admissions with the average length of stay being 199 days

 

How do people access the service?

    • The CONNECT service accepts referrals from all health professionals and services and has made significant changes to referral criteria in line with stakeholder feedback and NICE (2017) guidance. Previously regional adult eating disorders services had previously used BMI as one of the main gatekeeping measures and often cases were excluded if they were younger than 18 years of age or had a history of substance misuse. With this in mind CONNECT introduced more flexibility in the referral and systems pathway by: • Upscaling the early intervention FREED model which promotes amongst many things the concept that referrals should be prioritised equally base on need and prognosis as BMI and physical risk. Moreover with FREED we have introduced a system whereby service users are contacted within 2 days of receipt of the referral, and assessment is arranged at a time suitable to the service user within 2 weeks of the initial contact and that evidence-based treatment is provided within 2 weeks following the initial assessment. This means that CONNECT aims to provide assessment and treatment within 4 weeks of referral (compared to the national average of 3 years as recently published by b-eat).
    • • Considering referrals for individuals who are 17 years of age with joint working partnerships formed with regional CAMHS services
    • • Development of an online referrals system following feedback from service users, carers and referrers (due to go live in December 2018)

•Developing the dual diagnosis service so that individuals with an eating disorder and a comorbid substance misuse disorder can receive the necessary treatment and avoid significant delays in treatmentIn future we aim to invest funding into the service so that further flexibility into the regional referral system can be offered in the form of self-referral.

 

How long do people wait to start receiving care? 

Individuals accepted to the service are offered a comprehensive biopsychosocial assessment   by an experienced member of the assessment team who will assess their individual physical, psychological and social needs in line with NICE (2017) and MARSIPAN (RCPsych, 2014) guidelines.  

The service offers an assessment within 1-4 weeks for urgent referrals (early intervention cases, inpatient assessment, high physical or psychological risk, pregnancy, type 1 diabetes mellitus) referrals and within 8 weeks for non-urgent referrals. Following assessment evidence-based treatment is offered within 2-4 weeks for urgent cases and within 8 weeks for non-urgent cases. 

Mean and maximum waiting times from referral to access and treatment is one of our key performance indicators and will be routinely monitored as the CONNECT service continues to develop. 

Evidence for our FREED study has shown that waiting time from referral to access and treatment has ranged from 4-6 weeks with only a 3% drop out rate (national average ranges between 30-60%) which is well below the national average of 3 years (b-eat). We aim to replicate and upscale this model across the West Yorkshire and Harrogate region.

 

How do you ensure you provide timely access?

As outlined in questions 13 and 14 the CONNECT service has prioritised timely access and treatment and has introduced a number of initiatives so ensure that assessment and treatment is provided in a timely fashion at a site most convenient for the service user. As part of the FREED study we learned that having a service champion who takes a lead in coordinating referrals and instilling a culture of engagement across the teams when managing referrals that this can quickly lead to reduced drop-out rates, enhanced engagement, better clinical outcomes, reduced waiting times,  and service user and staff satisfaction with minimal funding. From this evidence we have structured our staffing model such that all the CONNECT teams adopt this model for all referrals.

 

Advancing mental health equalities

What is your service doing to identify mental health inequalities that exist in your local area?

Within the CONNECT service we have three equality and diversity champions who together with service users and carers regularly collect service data (quantitative and qualitative) to ensure that health inequalities are monitored and reported accordingly. Moreover the champions provide regular equality and diversity training to staff in line with trust and national policy.

CONNECT works closely with the b-eat, a UK based eating disorders charity, to raise awareness about eating disorders and support their national work in prevention and addressing eating disorders stigma. This work has included support in developing their annual development plan, research portfolio, training of staff, delivery of helpline support and organising their annual conference. 

The CONNECT research portfolio also includes a number of studies which have examined knowledge and attitudes of health professionals towards individuals with eating disorders which has received public acclaim and has led to the development of training programmes for health professionals on eating disorders aimed at reducing stigma and enhancing system wide assessment and treatment standards for individuals with eating disorders.

 

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

One of the main inequalities that we have identified is the unmet needs of individuals with a dual diagnosis of an eating disorder and a substance misuse disorder, a group of patient who carry the highest mortality risk. In light of this the CONNECT service developed a dual diagnosis clinic in partnership with regional addiction services which provides assessment and treatment for individuals from the West Yorkshire and Harrogate region who have a dual diagnosis of an eating disorder and a substance misuse disorder. This clinic is specifically designed for individuals who meet referral criteria for the service however their substance misuse disorder means that they are not able to access standard community or inpatient treatment and is delivered through the dual diagnosis service in partnership with Forward Leeds. The dual diagnosis service utilises an assessment and treatment model which adopts motivational enhancement therapy and an integrated care approach in line with NICE guidelines for the treatment of eating disorders and substance misuse disorders. The aim of this service is to support individuals with a dual diagnosis in reducing their substance misuse whilst simultaneously treating their eating disorder in a holistic and integrated way in preparation for more intensive community or inpatient based treatment within the CONNECT service at a later stage.

Assessing needs and providing care

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

CONNECT starts to identify individual needs at the point of referral and through our referrals and early intervention pathways we aim to offer an assessment and/or treatment which best suits the individuals needs. Through the newly revised CONNECT referral criteria individuals referred to the service are triaged based on individual need with referrals prioritised on needs rather than physical risk alone in keeping with newly revised NICE (2017) guidelines and service user and carer feedback.

 All individuals accepted to the service are offered a 2-3 hour comprehensive biopsychosocial assessment   by an experienced member of the assessment team who will assess their individual physical, psychological and social needs in line with NICE (2017) and MARSIPAN (RCPsych, 2014) guidelines. Assessments are flexible both in time and site such that service users have at least 3 assessments slots available to them to choose from with the aim of promoting engagement from the point of referral.  CONNECT uses a standardised assessment tool which is based on NICE (2017) and MARSIPAN (RCPsych, 2014) standards of assessment which has been developed with input from service users and carers such that assessment is not solely focused on diagnosis and physical risk and includes domains focused on psycho-social needs and the individual’s views on their situation and views on future treatment.

All assessments are brought to the relevant team’s weekly assessment team meeting for further discussion where diagnosis, formulation, mode of therapy and an MDT care plan is agreed taking into account the service users views on treatment and their individual needs. The assessment team is made up psychiatrists, psychologists, senior nurses and senior allied health professionals who are trained in the assessment of individuals with eating disorders and provides a forum for training and monitoring of assessment standards. The assessor writes an assessment letter which is sent to the referrer and the service users GP within 10 working days of the assessment outlining diagnosis, formulation, mode of therapy and the MDT care plan. 

 

How do you meet the needs of people using the service and how could you improve on this?

The CONNECT service believes that to provide treatment which meets the needs of the service users who use our service we must be able to offer a variety of different treatment options which are both evidence-based and flexible in how they are delivered. CONNECT offers an integrated stepped care approach to treatment based on diagnosis, formulation, risk and service user needs which are in line with NICE (2017), MARSIPAN (2014) and RCPsych (2017) guidelines. The CONNECT stepped care treatment model includes outpatient treatment, early intervention, intensive home-based treatment, outreach (for severe enduring eating disorders), dual diagnosis and inpatient treatment as outlined in Figure 3. In addition to this CONNECT offers a tier 1 level advice and consultation service and service user and carer support groups through partnership working with primary care, acute providers, community mental health teams, Liaison Psychiatry services and third sector organisations.

Figure 3. The CONNECT Stepped Care Model

Community and Outreach Service (tiers 2-3)

The CONNECT community and outreach teams offer a wide range of evidence-based treatments based on a recovery model of care or a rehabilitation model of care for outreach service users in line with NICE (2017) and MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) (RCPsych, 2014) guidelines with the aim of promoting weight restoration, eating for health and a reduction in eating disorder related symptoms alongside psychological change and improved quality of life. The community MDTs (see Table 1) are made of up psychiatrists, psychologists, nurses, therapists, dieticians, social workers, occupational therapists, health support workers, peer support workers and administration staff who work together with service users and carers to provide high quality,  evidence-based treatments on both an individual and group basis.

The CONNECT Community and Outreach teams offer the following services:

Outpatient treatment (Tier 2)

Outpatient treatment is offered as a first-line intervention in most cases where the level of risk can be safely managed in the community and is provided at the most convenient CONNECT community site. Teleconsultations via Duo or Skype can also be used as an adjunct to face-to-face therapy sessions.

    • All individuals receiving outpatient treatment will have: • A lead professional (usually a band 6 mental health practitioner but could be any qualified member of the MDT)
    • • A therapist (a qualified member of the MDT trained in the relevant modality of therapy provided). Please note that the therapist may also act as the individuals lead professional. 
    • • A dietetic assessment which includes sessions with the community team dietitian as required

• An assessment by other members of the MDT if required For service users with Anorexia Nervosa most individuals will be offered 20-40 weekly sessions of MANTRA (see Table 4) as a first line intervention in line with NICE guidelines (2017). MANTRA is usually provided on an individual basis initially and then on a group basis after 4-6 individual sessions. 

Table 4. A description of some of the psychological therapies provided by CONNECT

PSYCHOLOGICAL THERAPY

DESCRIPTION

MANTRA (The Maudsley Model of Treatment for Adults with Anorexia)

A manualised treatment for individuals with Anorexia Nervosa.

20-40 sessions

MANTRA focuses on the different factors that maintain Anorexia Nervosa, including thinking styles, emotional and social functioning, pro-anorexic beliefs and carers’ stance. 

Treatment is formulation-based and the MANTRA workbook comprises a series of core and optional modules which the service user and therapist work through together. 

CBT-ED (Cognitive Behavioural Therapy for Eating Disorders

A treatment for individuals with Anorexia Nervosa or Bulimia Nervosa.

20-30 sessions

CBT-ED involves addressing the links between thoughts, behaviours and feelings and how these maintain the eating disorder. Typical components might involve food diaries to explore patterns in eating / bingeing and cognitive work to explore “all or nothing” thinking or specific cognitions about food, weight, and shape. 

CBT-ED helps service users make considered behavioural changes in their eating, sometimes in the form of “behavioural experiments”, alongside exploring and challenging rigid or unhelpful beliefs about food, shape and weight. 

CBT-ED may also explore how current patterns of behaviour and thinking link to early experiences and core beliefs.

CAT (Cognitive Analytic Therapy)

CAT is a structured therapy which focuses on repeating relational patterns that were set up in childhood as a way of coping with emotional difficulties and deprivations. 

The CAT therapist and the service user work together to recognise their maladaptive relational patterns and then to revise and change these where possible. 

Features specific to CAT include the service user and therapist working through the CAT “psychotherapy file”, identifying particular relational patterns and difficulties. The CAT therapist also writes a reformulation letter to the service user early in therapy, which is the working hypothesis for future therapy and helps promote change.

For service users with Bulimia Nervosa most individuals will be offered 20-30 weekly sessions of CBT-ED (see Table 4) as a first line intervention in line with NICE guidelines (2017). CBT-ED for Bulimia Nervosa is usually provided on an individual basis initially and then on a group basis after 2-4 individual sessions.

Other psychological therapies can be offered determined by service user need and  include cognitive analytic therapy (CAT) (see Table 4), drama therapy, art therapy, psychodynamic therapy, interpersonal psychotherapy (IPT), motivational enhancement therapy (MET), compassion focused therapy (CFT), dialectic behavioural therapy (DBT) skills and family therapy.

Individuals are also invited to attend the CONNECT community group programme which offers a number of psychosocial groups in addition to therapy and regular contact with their lead professional and therapist.

FREED (first episode and rapid early intervention for eating disorders)

    • The CONNECT community teams also provide a FREED (first episode and rapid early intervention for eating disorders) service for individuals who meet the following criteria: • suspected diagnosis of Anorexia Nervosa (core psychopathology and BMI<18.5 kg/m²) or Bulimia Nervosa (core psychopathology and weekly bingeing AND purging)
    • • less than 3 years duration of illness 
    • • age 18-25 Outpatient treatment for service users accessing the FREED service is the same as for those accessing the standard outpatient treatment pathway however assessment and treatment is streamlined as follows: • the service makes initial contact with the service user by phone or email within 48 hours of receiving the completed referral form to explore the person’s views on treatment and to  arrange an initial assessment • the offer of an initial assessment within 2-4 weeks
    • • commencement of evidence-based treatment within 2-4 weeks following assessment

• separate FREED therapy groups (MANTRA and CBT-ED) In addition to this the service has a dedicated FREED champion who supports the 4 CONNECT teams in managing the FREED pathway and ensuring that the FREED principles of early intervention, engagement and carers support is upheld across the entire CONNECT service. 

Intensive home-based treatment (Tier 3)

    • The CONNECT community teams provide an intensive home-based treatment service for individuals: • Where weekly outpatient treatment is unacceptable or contraindicated
    • • Where weekly outpatient treatment has been shown to be ineffective
    • • Following a period of inpatient treatment
    • • Where the level of risk can be safely managed in the community (BMI>14) All individuals receiving intensive home-based treatment will have access to: • A lead professional (usually a band 6 mental health practitioner but could be any qualified member of the MDT)
    • • A psychiatrist
    • • A dietician
    • • A therapist (a qualified member of the MDT trained in the relevant modality of therapy provided) 
    • • A health support worker
    • • A peer support worker The intensive home-based treatment service offers: • An alternative, flexible and innovative way of working that will meet and treat the needs of individuals with eating disorders in their own environment.
    • • A more intensive MDT approach to working which offers 1) an alternative to inpatient treatment thus reducing the need for hospitalisation and promoting earlier and smoother transitions from hospital to community settings or 2) a stepped-up model of care where outpatient treatment does meet the individual’s needs at that time.
    • • Practical home-based support and treatment which promotes weight restoration, healthy eating reduces eating disorder related symptoms and promotes recovery and quality of life.
    • • Facilitation of earlier discharge from inpatient treatment 
    • • MANTRA, CBT-ED and other psychological therapies as offered for individuals accessing in outpatient treatment with the option to have more than weekly sessions if necessary. 

• A community group programme. Please note that not all treatment will be delivered on an individual basis and much of an individual’s treatment will be delivered as part of the community group programme. Hence there is an expectation that individuals attend groups as part of their overall treatment package and care plan. Outreach (Tier 3)

The CONNECT community teams also provide an outreach service for individuals with severe and enduring eating disorders (SEED). Outreach treatment is only considered in cases where a traditional recovery model care approach, i.e. weight gain alongside psychosocial intervention, has been unsuccessful in promoting positive change despite attempts by services to use different evidence-based treatments in a variety of settings (e.g. outpatients, intensive-home-based treatment, inpatients). 

    • The Outreach service offers home-based support offered on a weekly basis with input from: • A lead professional (usually a band 6 mental health practitioner)
    • • A psychiatrist

• A health support worker or peer support worker Individuals accessing the outreach service can also access input from other members of the MDT on an ad hoc basis if required.

    • Outreach treatment aims to support individuals to: • maximise quality of life
    • • reduce hospital admissions 

• promote independence Duration of outreach treatment is not fixed however is reviewed at every Care Programme Approach (CPA) meeting.

Inpatient treatment (tier 4)

    • CONNECT offers inpatient treatment for individuals with eating disorders if: • Their physical health is severely compromised
    • • Outpatient or intensive home-based treatment is unacceptable or contraindicated

• Intensive home-based treatment has been shown to be ineffective The Yorkshire Centre for Eating Disorders (YCED), situated on ward 6 at the Newsam Centre (Seacroft Hospital, Leeds), is a 19-bedded tier 4 inpatient specialist eating disorders unit which offers a number of different evidence-based treatment programmes tailored to individual need which have recently been reviewed and modernised in line with the recently updated NICE guidelines (NICE, 2017) and MARSIPAN (RCPsych, 2014) guidelines. Structural changes have been made to the inpatient environment to include a two bedded male service user area, in line with Eliminating Mixed Sex Accommodation (EMSA) and CQC requirements. Our inpatient MDT (see Table 2) is made up of psychiatrists, psychologists, nurses (including an advanced practitioner), dieticians, dietetic assistants, occupational therapists, health support workers and administration staff who work together with service users and carers to provide high quality,  evidence-based treatments on both an individual and group basis.  Our inpatient unit is able to provide nasogastric feeding if required and can facilitate admissions for individuals detained under the Mental Health Act 1983.  Our inpatient team works closely with the CONNECT community and outreach teams as well as other community teams outside of the West Yorkshire and Harrogate region to ensure that the length of hospital stay is kept to a minimum whilst ensuring that individual care needs are met and to ensure that the necessary care and support is in place in the community at the point of discharge from the inpatient unit. 

Please note that YCED also accepts out-of-area inpatient referrals however bed availability is prioritised for service users from the West Yorkshire and Harrogate region.

    • Inpatient treatment at YCED provides: • Nutritional rehabilitation and refeeding in line with NICE (2017) and MARSIPAN (2014) guidelines.
    • • Daily physical health monitoring and medical reviews
    • • A choice of 6 different inpatient treatment programmes which are tailored to individual service user needs (see Figure 4)
    • • Psychological therapies in line with NICE (2017) guidelines (see Table 4)
    • • A psychosocial group programme which runs alongside the inpatient treatment programme
    • • Dietetics
    • • Occupational therapy
    • • Health support worker input
    • • Nasogastric feeding if required

• Compulsory treatment under the provisions of the Mental Health Act (MHA) if required. If bed availability does not allow for inpatient treatment at YCED then the inpatient assessment team will liaise with the service user and community team on a regular basis to keep them informed and updated on bed status. If the service user however requires a more urgent admission in the absence of bed availability at YCED then the inpatient assessment team will liaise with the local providers and NHS England where needed to arrange admission to an alternative inpatient unit which best fits the service user’s care needs. Thereafter the inpatient team will liaise with the out-of-area provider and local NHS England case managers to repatriate the individual back to YCED or the CONNECT community teams dependant on bed availability and individual clinical need.

For more information on YCED and our inpatient treatment programmes please read the YCED inpatient welcome booklet available at https://www.leedsandyorkpft.nhs.uk/our-services/yorkshire-centre-for-eating-disorders/.

Family and carers workshops (tier 2-4)

From August 2018 onwards CONNECT will provide a family and carers workshop for family and carers of individuals who are currently engaged in treatment with the CONNECT service. These workshops run on a rolling basis every few months and involve a structured programme which helps family and carers learn and develop specific skills which will help them support their loved one and optimise their care.

Dual Diagnosis Service (tier 2)

The CONNECT dual diagnosis service is a newly established service which provides assessment and treatment for individuals from the West Yorkshire and Harrogate region who have a dual diagnosis of an eating disorder and a substance misuse disorder (as per ICD-10 criteria). This clinic is specifically designed for individuals who meet referral criteria for the service however their substance misuse disorder means that they are not able to access standard community or inpatient treatment and is delivered through the dual diagnosis service in partnership with Forward Leeds.

The service is situated at the Newsam Centre (Seacroft Hospital) in Leeds and is delivered by a Consultant Psychiatrist in Eating Disorders and an advanced practitioner from the CONNECT service with input from an experienced dual diagnosis mental health practitioner from the addictions service Forward Leeds. The dual diagnosis service utilises an assessment and treatment model which adopts motivational enhancement therapy and an integrated care approach in line with NICE guidelines for the treatment of eating disorders and substance misuse disorders. The aim of this service is to support individuals with a dual diagnosis in reducing their substance misuse whilst simultaneously treating their eating disorder in a holistic and integrated way in preparation for more intensive community or inpatient based treatment within the CONNECT service at a later stage.

CONNECT Advice and Consultation Service (Tier 1) The CONNECT community teams have a team of link workers who support local community mental health teams (CMHTs) to provide a tier 1 level advice and consultation service which allows CMHT-based mental health practitioners and allied health professionals to provide safe and effective evidence-based treatment (e.g. guided self-help) for individuals who 1) do not meet CONNECT referral criteria or 2) have been discharged from CONNECT after a period of treatment. 

As part of the tier 1 level advice and consultation service CONNECT encourages the use of evidence-based guided self-help and endorses the use of the following resources which service users, carers and health professionals may find beneficial:

    • Overcoming anorexia nervosa (Freeman and Cooper, 2009). Little Brown Book Group.
    • • Overcoming bulimia self-help course: A self-help practical manual using cognitive behavioural techniques (3 Book Set) (Cooper, 2007). Robinson. 
    • • Overcoming Bulimia Nervosa and Binge Eating: A Guide to Recovery (Cooper, 1993). Robinson.
    • • The Invisible Man: A Self-help Guide for Men with Eating Disorders, Compulsive Exercise and Bigorexia (Morgan, 2008). Routledge.

• Skilled-based learning for caring for a loved one with an eating disorder: The new Maudsley method (Treasure, Smith and Crane, 2007). Routledge.  

Each region of the West Yorkshire and Harrogate catchment area will have an identified link worker from the local CONNECT community team who:

    • provides regular supervision to mental health practitioners and allied health professionals about eating disorder cases
    • • regular training to CMHT staff on eating disorders, guided self-help and local care pathways

• advice and consultation on accessing the CONNECT service and local MARSIPAN pathways CONNECT Service User Support Groups (tier 1)

Each CONNECT community team provides a weekly service user support group which is open to anyone with an eating disorder from that catchment area regardless of whether or not they are currently receiving treatment from CONNECT. This group is a 60 minute psycho-educational group which draws on guided self-help, motivational enhancement and peer-based support to promote positive change. Groups are facilitated by a peer-support worker and a qualified member of the CONNECT community team.

For more details on the CONNECT service user community support groups please visit https://www.leedsandyorkpft.nhs.uk/our-services/yorkshire-centre-for-eating-disorders/.

The CONNECT Family and Carers Support Group (tier 1)

CONNECT provides a monthly family and carers support group which is open to family and carers of anyone with an eating disorder from that catchment area regardless of whether or not they are currently receiving treatment from CONNECT. This group is a 90 minute peer support group which draws on psycho-education and peer-based support which is facilitated by a qualified member of the CONNECT community team and a local third sector counsellor.

For more details on the CONNECT family and carers support group please visit https://www.leedsandyorkpft.nhs.uk/our-services/yorkshire-centre-for-eating-disorders/.

What support do you offer families and carers?

As Above

In addition to this CONNECT offers family meetings to all service users receiving treatment with the service and has recently employed a family therapist onward 6 with future plans to employ a family therapist for the community teams.  

NCCMH mental health care pathways

Have you implemented any of the mental health care pathways developed by the NCCMH (on behalf of NHS England)? If so, what were the benefits and challenges?

The CONNECT service has implemented early intervention (FREED), MARSIPAN and CAMHS/adult transition pathways which draw from some of the early intervention and transition pathways developed by the NCCMH.

Further Information

Population details

CONNECT: The West Yorkshire and Harrogate Adult Eating Disorders Service is a new regional adult eating disorders service, part of Leeds and York Partnership NHS Foundation Trust (LYPFT), which has been developed through a New Care Models initiative for Adult Eating Disorders as part of NHS England’s ‘Five Year Forward View for Mental Health’ in partnership with Bradford District Care Trust (BDCFT), South West Yorkshire Partnership NHS Foundation Trust (SWYFT) and Tees, Esk and Wear Valley NHS Trust (TEWV).  Development of this new service has involved the expansion and tailoring of existing eating disorders services to significantly reshape both in-patient and community care for adults with eating disorders across the West Yorkshire and Harrogate Health and Care Partnership (HCP) footprint (see Figure 1) which has a collective population of 2.6 million people spread across a wide geographical area. Figure 1: West Yorkshire and Harrogate Health and Care Partnership (HCP) footprint

 

 

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England):

The CONNECT service is one of only two Adult Eating Disorders NHS England (NHSE) New Care Models initiatives in the UK and is part of a national NHSE trial to evaluate the benefits of devolved commissioning with LYPFT holding the budget for regional tier 4 specialist adult eating disorders beds in partnership with regional stakeholders.

Provided by (e.g. name of NHS trust):

The CONNECT service is provided by LYPFT in partnership with BDCFT, SWYFT and TEWV and other regional NHS and third sector stakeholders.

 

Hours the service operates:

0800-1800, 7 days a week

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