Rharian Fields is a nine bedded inpatient unit for those that are suffering with an eating disorder. The service was initially set up as a 5 bedded unit, however with the growing demand for beds and a real desire to treat people as close to home as possible, we recently extended the service to ensure that people did not have to travel hundreds of miles away from their homes for an inpatient bed.
Rharian Fields is a nine bedded inpatient unit for those that are suffering with an eating disorder. The service was initially set up as a 5 bedded unit, however with the growing demand for beds and a real desire to treat people as close to home as possible, we recently extended the service to ensure that people did not have to travel hundreds of miles away from their homes for an inpatient bed.
We have the benefit of a consultant gastroenterologist working alongside the team so there is consistency in the approach to medical care when needed. The consultant gastroenterologist assesses service users on Rharian Fields and assists us in ensuring that their general health is maintained. If any of our service users need to receive medical care in a medical ward then they would go to his ward with Rharian Fields staff input throughout their stay. This is to ensure continuity of care and to continue work on eating disorder behaviours in a medical setting (this could not be done by the general hospital team). We work closely with all staff on the medical ward so that the service user can be transferred back to Rharian Fields as soon as their general health allows and with the assistance of the gastroenterologist this can happen more readily. This ensures that there are no delays in this process as we recognise that the best place to receive care for an eating disorder is on an eating disorder unit and not on a general medical ward.
Because Rharian is a small unit it is able to give a very personal touch to the care that it delivers. The philosophy throughout the service is that the therapeutic relationship is the vehicle for change in most situations. The emphasis on the therapeutic relationship has been fostered from the start, with staff being recruited on a values based basis. I believe this is fundamental in the unit achieving the good outcomes that it has achieved. The staff are in essence the success of Rharian Fields, they are dedicated and motivated and most of all they really care about the people that use our service. The staff at Rharian Fields truly uphold the philosophy of NAViGO, which is that all staff treat service users as they would wish their loved ones to be treated. I believe that this is achieved within Rharian Fields and the evidence from the many testimonials suggests that Rharian is a place where recovery is possible.
Staff within Rharian Fields have the benefit of a supportive management team and a very supportive organisation motivated to develop its staff in order to support its service users. We are a service that recognises the value of its staff, without them, the service would not be the success it is now. NAViGO has supported the staff within the unit to train specifically in eating disorders and has supported numerous areas for continued development that staff have identified as important to them in developing themselves into expert practitioners in this specialist field. Staff have attended training courses locally but also in America. This is testament to how flexible and supportive NAViGO are with regard to developing its staff.
Our staff are trained in Cognitive Analytic Therapy, Dialectical Behavioural Therapy, Cognitive Behavioural Therapy Enhanced, EMDR, Art as Therapy, Family Therapy, Brief Solution Focussed therapy, Motivational Interviewing,
We also recognise the importance of developing our nursing assistants and so they have been trained in many complimentary therapies to assist service users in their recovery, these include, Indian head massage, reiki, reflexology, mindfulness, Emotional Freedom Technique (EFT) and relaxation.
We feel that our approach is very much a holistic one that focusses on the whole person and not just on their illness. We strive to ensure that food is not the focus of our treatment programme but is just one of the parts important to recovery.
Rharian fields has enjoyed many success stories of our service users, indeed it is the most rewarding job that I have ever experienced in my career in mental health. Service users often state that the staff are the reason that they were able to change their mind set in order to start to tackle their eating disorder.
As a manager of this team I am motivated by the staff, they demonstrate to me on a daily basis that they can think outside of the box, that they want to always do better and that they believe in recovery for each of the service users that pass through our door.
A case example of the positive approach adopted by the staff at Rharian fields is as follows:
I received a referral of a young lady who was being nursed within a CAMHS inpatient unit. I was told that this young lady was being fully restrained several times per day and generally the referral appeared to be that of a very challenging young lady with an eating disorder complicated by other factors. My initial thoughts were that she would not be suitable for Rharian Fields but I went to carry out the assessment and I was presented with a very frightened and broken young woman. I had confidence that she would do well on the unit with the approach that Rharian delivers. She did come to us and I am happy to say that we never had cause to restrain her, she struggled with the programme but she did do very well, she regained her weight to a healthy state and she returned to the community and went back to school to complete her A levels.
Her success story is one of many and as with so many we received heartfelt words from her mother just days after her admission as there had already been a vast improvement during only a few short days at Rharian Fields.
“I just want to thank you so very much for all that you are doing for my daughter. As soon as I walked in your doors last week I knew that finally she was in the right place to be able to recover. You have shown nothing but kindness, care and compassion to both my child and me and for that I thank you from my heart. Seven weeks ago she was admitted to hospital when I thought she would start her journey to recovery I couldn’t have been so wrong. We had seven weeks of watching her deteriorate badly and so it was a huge relief that you Rharian Fields could take her. Already, after only a few days of your love and support I can see a change in her. Thank you completely.”
This is just one example, but I feel that it emphasises that the approach, dedication and values of the staff group at Rharian Fields demonstrating the significant difference the team makes to the journey service users have whilst with us.
Both staff and service users benefit from the added value of having a gastroenterologist as part of the team, it gives us as a mental health staff group the confidence and support needed to care for very physically ill people on a mental health unit. Without this support we would be more reliant on the medical ward in treating those that are very physically compromised by their eating disorder.
We work closely with neighbouring organisations who are essentially our referrers, this relationship is essential in breaking down any problems with transition of care from community to inpatients services. It is important that community teams have a good understanding of what Rharian Fields can offer and so we invite them to come to the unit regularly and we share our pathways with them so that when the time comes for discharge they can continue with the work that we have started. This allows for shorter admissions where appropriate which are very costly but allows for the essential work relating to recovery to be continued in the community.
We keep referrers informed of their service users progress weekly by sending them copies of the multi-disciplinary review. This puts them clearly in the picture in regard to the work we are focussing on and on what we still need to achieve before we can start to plan discharge. We have received very good feedback in relation to keeping community teams informed of progress in this manner.
We work alongside our fellow eating disorder units within the region, often working together where one unit has a waiting list that Rharian can assist with, this allows for a more timely admission for some service users that might otherwise have to wait on waiting lists for many months, we know that the more entrenched the eating disorder becomes the more difficult it is to treat and the longer the admission will be.
We believe that our service users, carers and our staff are the people that can drive the service forward. It is only with their honest feedback that we will be able to challenge custom and practice effectively. We encourage feedback in many forms as stated below.
We have a carer elected as a community representative for our membership who represents around 370 community members at our membership board.
Service users and carers join us on all interview panels for new staff.
A carer jointly runs a carers support group with our community service lead.
We hold a carer and service user support group on the unit. This group came about from a carer’s feedback form which stated that they were particularly struggling when their relative was home on leave. The group is now running, it starts with just the carers so they can discuss amongst themselves any general concerns they have that the group can help them with then we invite the service users to join us so that any joint concerns or success stories can be raised. We also discuss if there are any improvements that can be made to the service.
The service users meet with the catering lead bi-weekly, this is so that they have direct contact for raising any issues or compliments. In addition to this service users are able to complete meal evaluation forms that are fed back to the catering lead for action and feedback is brought to the bi-weekly meeting.
The unit holds a weekly service user meeting, the independent forum are invited to this meeting where we discuss any concerns, problems, joint code of conduct etc, this meeting is chaired by our service users on a rotation.
We recognise that some people do not have the confidence to speak up and so have a comments/suggestions box placed on the unit where people can put comments/suggestions anonymously; these are looked at within the weekly community meeting. The ward manager attends all of these meetings so that any suggestions can be acted upon immediately.
We would have had more specific roles for the staff and we would have developed the care pathways sooner. Recently we have introduced specific roles such as carer and service user liaison, nutritional support worker. These roles have enabled more focus on these important factors within the unit.
We have evolved over the three years in which we have been open, we were a very naïve team at the start with little experience in the management of eating disorders within an inpatient setting and so we have learnt a lot along the way. We were fortunate in that we were able to develop our unit within the standards set by the royal college of psychiatrists and maybe we were in a better position than other more long standing units, as they needed to make major changes in some areas whereas we were able to start from that good position in developing a service around the standards set.
We have learnt a lot from more established eating disorder services and I would encourage the sharing of information and practices within services so that we can all provide better services.
One of the major challenges we have is where we have to discharge a service user back to their local area without a specialist community eating disorder service. An inpatient admission is only a small part of the recovery journey for a service user with an eating disorder and where there is no specialist provision in the community it is a real challenge to discharge.
In some cases, a longer inpatient stay is required as we know that the chances of relapse without this specialist community input is high. In other cases we have worked very closely with general Community Mental Health Services, sharing our knowledge and skills with them and preparing them for the service users discharge. We also share relapse prevention resources which we have utilised with the person while they have been on the unit for practitioners to work with in the community.
In addition to this, we always advise that we are happy for any care co-ordinator to contact us with any concerns and we will be happy to advise.
Where we can we offer an outpatient service for those who do not have a specialist community team, however, this is limited to those service users who are able to physically get to Rharian Fields for an out-patient appointment.
We also have a recovery group for all service users who have been discharged from Rharian Fields. This is completed monthly and is a great support, particularly for those service users who do not have specialist community support.
From the outset Rharian Fields has dedicated time and resources in developing staff in the area of specialist interventions with specific focus on eating disorders. The service advocates a team working approach and has committed to developing each and every staff member to ensure the delivery of this specialist service in all circumstances.
The service manager has developed the team so that there are shared vision and values and all the team are committed to delivering the service with this shared vision in mind.
The success of the team is reliant upon the efforts and dedication of each individual, who each contribute equally in line with their unique and specialist skills.
NAViGO as an organisation promotes the ethos of values based recruitment and places great emphasis on engaging the entire workforce and wider membership in decisions related to service development. This ensures that development is inclusive of all staff and not just the most senior in the hierarchy.
The success of Rharian Fields is not about the leader but about the whole team and each team member’s individual contribution, it is as important for the domestic as it is for the consultant psychiatrist to share the values of the service and the philosophy of the unit for its continued success.
The service was evaluated by the Royal College of Psychiatrists (accreditation for Eating Disorder units) and we were awarded a rating of ‘excellent’. This level of award is difficult to achieve with only a small percentage of units achieving excellence. This shows that the unit has a real commitment to quality and service user and carer involvement.
FFT score is 97% this is for all PREM records on Silverlink for community, day care and inpatients. The evaluations that we value the most are from the people who really matter, the people who use our service. It was difficult to choose what feedback to include here as there are so many positive things that are fed back to the team from our service users. The ones I have included below reflect what I as I felt that it is easy for me to say why we should win this award, however, the real judges should be the people who use the service, so here are some of their comments:
“I couldn’t have asked for a more supportive team to help me during my recovery. I can say for both myself and family, we have never felt alone or without care and support throughout my time here so far. Every sufferer needs a team and facilities like Rharian Fields.”
“Rharian Fields are fantastic. The kindest, most supportive and dedicated team of staff with an excellent service, which has helped me immensely. I deem myself lucky to have had the opportunity to have had a bed here and received the support offered.”
“The staff and service here at Rharian Fields has been phenomenal. I don’t think I would have got to where I am now if I didn’t have the help, support and understanding that I’ve had here and I could not be more grateful. Everyone is so lovely and very welcoming. Every staff member will go above and beyond to help you in whatever way they can and seem to be very passionate about their job, which is lovely to see.”
“This team of people have literally saved my life. Without their care and support, I would not be alive today. I am truly thankful for all they have done for me. The holistic approach has helped me recover and helped me discover a new way of viewing mental wellbeing. They all deserve gold medals for all their hard work and dedication. Thank you.”
“The staff are so supportive, caring, kind, funny and down to earth. They helped me through the toughest of times and get my life back. The staff are very willing to help and genuinely care.”
“Rharian Fields is an amazing organisation and I can honestly say that it’s the best Unit I’ve ever experienced. It’s a safe and secure Unit to recover in and I’ll be forever grateful for the care I received.”
“You have been like a surrogate family to me. Thank you for caring, listening and talking to me. I can’t express how much it meant to be treated as an equal and as if I mattered. Your smiles and hugs helped me transform from a timid little rabbit (as I was on admission) to the giggly fun-loving person I am today. I know my journey has not been easy, but you all gave me hope and helped me see a life without anorexia and without that I could never have gotten to the stage I am now. You have really thrown me a lifeline and given me a second chance in life. You are all incredible people and your work is eye-opening. Thank you for putting me on the platform for recovery.”
“You are lovely. Thank you for this Unit. I am lucky to have had my recovery here and the staff are just magical.”
“From having to deal with something that made me feel so anxious, I could not have received more support and been made to feel more valued.”
“Thank you. You have been an amazing support and made me feel normal at times when I felt like a complete maddo. You understand me and for that I am forever grateful. I will miss you masses.”
“I do not know what to say to you, other than thank you! You have turned my life around in ways that I will never be able to thank you enough for, and I will be forever grateful for everything that you have done for me. I think about you, and all of the staff, every time I challenge something and take another step to my recovery. I would not have got this far if you had not taken me under your little wings! I have already started along the path of developing a career in helping other sufferers and have applied to go back to University to study Nutrition and Public Health.”
“Thank you so much again for all that you have done for me. You have helped me to get my life back and I am more than grateful. I value all the time each and every one of you have spent to help me get back on the road to recovery and I am going to keep going until I get there! Me and my parents could not be more thankful for the help and care I received from such an amazing team.”
“Thank you so much for your patience, wisdom and love… You have given us our daughter back.”
“The whole team are exceptional and meet the right balance between professional and caring. It’s an excellent service.”
“The care I’ve received has been amazing. I thought recovery wasn’t possible but with their help, I’ve achieved it. The Carers group sessions were very helpful for my husband to understand about Eating Disorders.”
“A big thank you for all the kindness, support, laughs, hugs, being there to rant at and for being a friend. There are so many kind things I want to say about you all.”
“Very friendly and supportive – I was able to say everything I wanted without judgement. You answered my questions with openness and honesty.”
“Kind, caring, supportive staff… always listened and made things feel like normal life.”
The service manager is a CQC inspector and a QED assessor (this is the accreditation process for eating disorder units at the Royal College of Psychiatrists) and as such is keen to share learning through these processes. The QED network is particularly interested in organisations sharing knowledge and skills in eating disorders so that all services can achieve the best care for all and Rharian Fields is dedicated to this philosophy. The service manager has completed many assessments of other units for QED and she shares many positive practice examples that she has picked up during these reviews. She also sits on the QED advisory committee and so is able to influence how units are assessed.
The service is involved in regional meetings with other local eating disorder services and this is also another forum for the sharing of skills and knowledge. Rharian Fields shares with these organisations any developments within the unit.
A neighbouring NHS organisation had major difficulties in recruiting experienced staff in the treatment of eating disorders for children. Following discussions with them we were able to negotiate a secondment of 2 experienced staff from Rharian fields to ensure that their service had experienced staff within it to deliver specialist care to children with an eating disorder. We did not have problems in recruiting to Rharian Fields and so this was a viable option for us. We felt passionately that it was important for children to receive support from specialist staff. It has also fostered a good relationship between the 2 organisations and we are looking to share resources for further development of specialist services for children with an eating disorder in the future.
The staff have given teaching sessions to teachers in schools, the sessions were around early detection of an eating disorder and this has been a great success with feedback stating that the teachers felt more equipped to detect a potential eating disorder and what to do about it. Early detection is essential and the team hopes to do more work around this.
The staff have also presented at GP surgeries to GP’s and primary nurses, again the focus here was on promoting early detection.
We have also promoted the MARSIPAN guidance within the general hospital which guides non specialist clinicians on what to look out for.
Staff have presented at universities to nursing students, the sessions have been around promoting eating disorders and the work of Rharian Fields.
We have been open for only 3 years, in this time we have grown as a service and I feel that the outcomes we achieve and the service we provide to our service users is of the highest quality. In three years to have developed such a successful service like Rharian Fields is a great achievement and testament to the dedication and commitment of the staff who work within it.
