According to an article published by the Guardian, eating disorder referrals have seen a stark rise during the pandemic of 2020/21, with lockdown causing eating disorders to thrive and available treatment being significantly impacted by pandemic-related issues. Additionally, the number of routine referrals rose from 915 in April to June 2016 to 1,850 in the first three months of 2020, this number then continued to rise to a record high from July to September, as it went up to 2,001. This data is based on routine referrals starting treatment in the community for children and young people. However, even prior to the pandemic, referrals have been rising, with a NHS Digital press release based on the Health Survey for England finding that 19% over women aged 16 and over screened positive for a possible eating disorder when question on their relationship with food in 2019. The same survey also found that almost one in eight men also screened positive for an eating disorder. This ongoing epidemic is clear when reviewing the eating disorder hospital admission statistics for 2018-19, which not only highlights the growing number of young people diagnosed with eating disorders, but also the amount that fall into the more complex category of ‘Other’, where they don’t fit into the bulimia or anorexia category.

Introducing an Eating Disorder service

At Care in Mind we have spent the last few years working on developing a specialist service for young people with complex eating disorders. Over the years, we have seen ourselves the truth behind the headlines and statistics, and witnessed the increase in demand across eating disorder services and stretched capacity nationwide for Specialist Eating Disorder Unit (SEDU) inpatient beds. During this time period our own data also shows an increase in referrals for our core services for young people with a primary diagnosis of an eating disorder, or comorbidity with complex mental health needs.

In 2021 we opened our first specialist residential service for young people with complex eating disorders. The service has been built on our core model of care, with additional specialised support for eating disorders.

Our commitment to least restrictive practice and the way in which we care for young people will reflect our core service offer. Therefore, there is an expectation that young people are of stable physical health and have managed at least 6 weeks without tube feeding by admission. Not only is this to ensure we can care for residents in the most therapeutic, least restrictive environment, but also to provide the best chance for a successful journey through our pathway to independence at a time when the young person is ready.

Developing the service was a lengthy process. We engaged in research in many forms, and held consultation sessions to gain insight from individuals, and their parents/carers, who have been treated by community and inpatient eating disorder services. These sessions were run by our Service User Coordinator who is also an expert by experience, and our Clinical Director. Individuals were given a chance to openly discuss their thoughts and feelings about the service following a brief explanation of our model of care for the service. Additionally, we worked closely with a dietician to gain valuable and specialist advice towards helping us to develop protocols.

Consultation Event Feedback

The research gathered during the consultation event was invaluable and gave us an important insight into what is truly required from an effective eating disorder service. Several key themes emerged from the feedback:

Hope: One of the strongest themes identified was the importance of hope, particularly when in inpatient settings where young people may feel stuck, and it can be difficult to be hopeful for the future and a life outside of hospital. Often young people in hospital with eating disorders can be subject to lengthy inpatient stays, or become ‘revolving door’ patients which may be down to a lack of appropriate pathways out of hospital. Giving young people the hope of a community-based residential treatment option could positively impact their motivation to move on from hospital.

Recovery: Another key theme was the importance of recovery from a ‘whole-person’ perspective. Participants felt that often there is an understandable focus on stabilisation of physical health but they felt it was important for services to consider what recovery means for each individual, and thinking about developing a sense of agency and achievement outside of their Eating Disorder identity. Ways we may do this include giving them more control over their lives, something we already do in our core residential homes, so that they are able to make decisions such as when they want to see their friends or what education they want to access. It’s important that young people are given this space for independence so that they can re-learn and build up their confidence in how to do everyday tasks that may have been done for them whilst in hospital.

Independence: Ensuring the building of independence skills will be a core focus, and it is important this is done in a way that meets people at their current level. Many of the young people we work with may feel de-skilled in many areas following lengthy inpatient stays and it is important that independence goals are developed around their needs and priorities. As with all elements of our service planning, the person-centred nature of this is key.

Individualised Care Planning: Individualised care planning is incredibly important to the way in which we work. We believe eating disorders cannot be treated with one single approach, particularly when working with individuals with different diagnoses. Recovery goals for each individual are tailored, based on maintaining and developing their own physical health and independence-related goals. Goals are developed in collaboration with young people to support their understanding of exactly why we do what we do, and why this will benefit their journey to recovery. Additionally, we take the time to explain to young people why it is that everyone in the home has differing goals and care plans, but that everyone will receive the same high level of input and support.

Systemic Approach: Our participants highlighted the importance of joined up and consistent care, both within and across systems. Building relationships and collaboration with local stakeholders is essential; particularly where a young person may require a short term re-admission to hospital to support stabilising their physical health. With collaboration, effective communication and clear joint working protocols, our hope is that admissions are short with a joined-up approach, supporting the young person to return to the home in a safe, structured and planned way.

Identity: The final key theme that emerged from the consultation event was Identity and in particular, who the young person is regardless of their eating disorder. Often young people who have had extensive inpatient admissions can feel robbed of key developmental stages in their adolescence which can lead to struggling with their identity outside of being a patient. Enabling young people to develop an identity is important whether that’s through giving our young people the ability to decorate their own rooms or supporting their interests in a new hobby.

The Home & Staffing Model

In many ways, our staffing model reflects that of our core homes, however, as this is a specialist eating disorder home, we have additional specialist staff to support the complex and differing needs of the young people. We provide dietetic input through a specialised dietitian as well as in-house chefs to help young people create healthy, balanced meals (where appropriate). The home has increased physical health monitoring in comparison to our core service. This will be to ensure we are maintaining the physical aspect of the young people’s health as well as the psychological side of their recovery. Staff who work within the home have been carefully selected, to ensure that the right people are chosen for what is a challenging job. Like with our core service, staff are well supported through regular staff support sessions and reflective practice in addition to standard supervision, as we know that supported, happy staff are more effective in supporting the young people.

All of our homes have a homely, caring feel and our young people are given a say in how to decorate both common areas and their own rooms. Furthermore, outside the home, there is a wealth of green space, including a duck pond and allotment. This will provide a mindful space for young people.

To make a referral or to find out more information about our eating disorder service, please call the team on 0161 638 3285 or email referrals@careinmind.com

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Inspectors examined services offered in December. They rated it ‘Good’ overall, and in each of the individual categories; safe, effective, caring, responsive and well-led. The inspection was prompted in part due to concerns around risk and the CQC noted that although there were risks present due to the young people’s mental health needs, these risks were mitigated appropriately with clear and robust procedures in place to monitor and manage this. They also noted that were appropriate staffing levels to support this with staff well qualified to work with vulnerable people. The report said,  “Staff at Ashurst were extremely well supported. There was a thorough induction programme and ongoing appropriate training throughout their employment.”

Inspectors found that the culture at the home was positive and inclusive, people’s needs were thoroughly assessed, and care plans included appropriate health and personal information. They noted staff worked with other agencies and professionals to ensure the young people’s needs were met appropriately with the young people being treated with respect and compassion.

Julie Smith, Business Development Director at Care in Mind said, “Ashurst is one of Care in Mind’s newest specialist residential services (opening in May 2021) and we are proud that in their recent CQC inspection, they achieved good in all outcomes. In particular, the young people felt cared for, treated with dignity and respect and that their opinion mattered.

The report also reflects how we work collaboratively with all external stakeholders and deliver individual person-centred care, carried out by well trained and skilled staff. We are always focussed on achieving the best outcomes for the Young People in our care, providing them with the skills to work towards independent life in the community.”

You can read the full report here.

To make a referral or to find out more information about our services, please call the team on 0161 638 3285 or email referrals@careinmind.com

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Here are their tips, in five separate categories, based on different ways to cope:

Coping strategies can come in many different forms and are useful for different people.

Part 1: Sensory Coping strategies:

There are two main sensory ways to help: one is via a sensory box and the other is creating a space that appeals to your sensory needs.

To create a sensory box you need to find items that appeal to your senses, this could be any of the senses you have. One way is to use something called a sensory hand. This is where you grab a piece of paper and draw around your own hand and each finger can be a sense. Write down next to each finger what you like with each sense for example: for your sense of smell it could be coffee, perfume, item of clothing or even a new item that has that classic “new item smell”.

A space that appeals to your sensory needs means items that help you relax can be put in a certain room (a snug, bedroom, living room) where you can go to relax. This could include LED lights, noise boxes, incense, candles, blankets.

Part 2: distractions

Distractions are for when you don’t feel like you can face the emotion, there are many different ways to distract yourself. Some examples are:

• playing games
• playing with or having your pet around you (if it wants to snuggle or play)
• playing music that allows you to think differently or move your mind to a different thought
• watching films or tv shows that will also distract you can be brilliant
• going on walks can help due to focusing on the outside, try to recognise what’s around you and the beauty of it all;
• photography can distract you because you are looking for the right angles, lighting, background etc.

Part 3: Facing the emotion head-on

The best way to deal with emotions is to deal with them as they come up so they don’t build up subconsciously and return. Here, we will share six steps for dealing with a specific situation – my friend didn’t come to meet me and didn’t apologise.

1. Be aware of how you feel and the emotion you are feeling. Trying to know what the emotion is and why it is there will best help you on a way to deal with it. For example “I’m so angry that my friend didn’t come to meet me and didn’t apologise.” Here, the dominant emotion is anger.
2. Remember not to start blaming when recognising an emotion. What we are trying to do is understand it, your friend isn’t trying to hurt you by not coming to see you. There are a variety of reasons why we may feel we need to blame, but at the moment we are trying to recognise and understand the emotion.
3. Understand that it is okay to feel that way about a situation. Everyone copes with emotions differently and it’s okay to feel the way you feel in whatever situation.
4. Think of the most positive way to deal with this emotion. For this there are ways to do so, such as communicating calmly with your friend that you feel hurt by their actions.
5. Remember to talk to someone about it, even if you feel it has been dealt with. This allows you to discuss different options for the future and evaluate what to do if a similar situation occurs again. This could be your parent or guardian, trusted adult, friend, or a healthcare professional. Sometimes even talking to your pet can help, just to get it out.
6. Finally, it’s okay to cry.

Part 4: Exercise for different emotional states

If you feel a certain emotion you may feel that a certain exercise can help, here are a few which we could recommend:

• Angry: High impact exercises like boxing, sprints, interval training with a bike or other cardio tools
• Sad: Low impact like walking, casual cycling or anything that isn’t strenuous
• Anxious: Calming exercises like yoga, Tai Chi or swimming

Part 5: Find a creative outlet

Sometimes finding a creative outlet to funnel your emotions is useful, but it can also be a good distraction technique. There are many ways you can be creative, such as:

• Painting, drawing or crafts
• Creating or producing music
• Writing lyrics, poems or stories
• Writing how you feel in a journal

There are lots of different ways to cope with tough situations, from facing them head-on to using distraction techniques. We hope our tips will help you if you are facing your own difficulties!

To make a referral or to find out more information about our services, please call the team on 0161 638 3285 or email referrals@careinmind.com

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Inspectors carried out an examination into services offered at the end of August. The CQC rated the home ‘Good’ overall, with each of the individual categories; safe, effective, caring, responsive and well-led each receiving a good in their domain.

Inspectors noted that staff had received the appropriate training and supervision to help support young people effectively. Staff were also praised for supporting service users in the least restrictive way possible and in their best interests with the policies and systems in the service that supported this practice.

The inspection report also noted that staff worked closely with other health and social care professionals to ensure that young people received appropriate and timely care with Stubble Bank placing a strong focus on developing and maintaining young people’s independent living skills and supported individuals based on their bespoke recovery goals. The report said, “The service had an open and honest culture and staff showed commitment to achieving good outcomes for young people with complex mental health difficulties” 

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Part 1: Catching you up to speed

Before I joined Care in Mind (CIM), I was in and out of hospital jumping in, getting meds and being discharged. The last time I was in hospital before moving to CIM, I did a severe attempt on my life and was sectioned on section 3 and was about 3 months into it. I felt hopeless about leaving Psychiatric units due to my recovery being very up and down. At this point, my Care Coordinator said she wanted to try something different than medication and wanted me to try psychology sessions, with a place to stay outside of the hospital while recovering. She told me that she had found a place called Care in Mind and that she wanted me to go there. A few days later, I got told I was going to be assessed by CIM with a Residential Manager and a CNS (Clinical Nurse Specialist) in the coming days. I felt excited about leaving the hospital, but also nervous that I may get declined or “not make the cut”. However, I knew the hospital wasn’t the right place for me and was preventing a successful journey to recovery. 

Assessment day soon came, and I met two men in the hospital meeting room, who immediately gave off warm vibes. They asked about my history, how I felt, what I wanted to do in the future and if I felt I would ever reach those goals. The conversation lasted around 45 minutes and they then left, after I met those two from CIM I hoped that the rest of the staff I meet if I go are like them, they were great. Around a week passed with no news about the placement or funding, but I kept pushing on in the hospital as I didn’t want to go on a downward spiral. However, my Care Coordinator rang one day and said that CIM had accepted me and I would go there as long as the panel accepted the funding proposal. It took another tough two weeks to get funding approved before I could start transitioning to my supported accommodation with CIM.

Part 2: Moving up and out (of the hospital)

The next step was two staff members from CIM coming to visit me in the hospital to talk me through the transition and show me pictures of the home – I was excited! The home looked nice, the two staff members were super friendly and I got told that the CNS that had assessed me was going to be my CNS at the house. This all made me feel like I might have a chance at recovery. The following week, I met the rest of the staff and we went out in the local area to get out of the hospital environment. After that, it was then about beginning to transition into the house. 

The first day of my transition into CIM was when I met the other young people, and I was happy because they were all nice. I spent a couple of hours in the home; playing board games and talking. After this though, I found it hard to go back to the hospital after being out, and I noticed a decline in my mental health at the hospital due to the environment and my want to move on. It took six weeks in total to transition into the house, and of course, there were ups and downs, but I quickly felt at home.

Part 3: The first six months

I loved being at the house for the first 6 months, even though there were difficult days, I felt motivated to try my best as I really didn’t want to return to the hospital. About a month in, someone close to me passed away from suicide, which hit me really hard, especially as I was just getting used to my new home and environment. However, I managed to get through this, mostly due to the team really helping me. The downs which I had in CIM weren’t as bad due to the freedom I had compared to a hospital environment, this was because the hospital was too restrictive and I felt completely locked in, there was also no therapeutic risk which was needed in my situation. I wasn’t as open with the staff as I should have been at first due to fears of past issues with staff and family giving up on me in the past

My weekly talks with the CNS really helped as we discussed the issues that arose during the week. Over time, I built a great relationship with him as he really understood me and knew how to adapt to each person he saw. He also helped me work through any issues I had in the house with staff or young people. For example, music is very important to me and helps me when I feel low or angry etc, but there was a blanket “no swearing” rule and as most people know, most music has some level of profanity. He managed to help me work with staff and the young people to play music that everyone felt comfortable with. His understanding of me and wanting to help me when I couldn’t speak up allowed me to gain confidence and speak up about issues I had more.

Part 4: Stuck in the middle

After the first six months, the progress I was making slowed down due to my own feelings of fear of abandonment. Subconsciously, I also felt I wasn’t ready, but this is where my psychologist really helped me with coping strategies and focusing on the now first so I have a stable base to move on from then tackling past trauma. The progress was slow but due to my great working relationship with my psychologist, she helped me to realise that progress cannot be made without a need to get better. This made me realise that I’m the only one who can help me in the end and what people tell me, I still need to put it into practice myself. 

My progress began to really gain momentum and I started dealing with real-life issues better than I had before, and I was able to evaluate them on my own and bring them to my sessions. Sad news came though when I found out that my psychologist was leaving, and there was a short break between her leaving and my new psychologist starting. It was a worrying time for me, but looking back, I can see that this time really helped me to cope with bigger issues alone, which I could then bring to sessions, and share what I had already done and how I coped with it.

When my new psychologist started, we decided that I was dealing well with current issues but needed confidence in knowing that I was doing the right thing and that the way I was coping with them was healthy. My progress continued to go well, and my CNS suggested I think about a date which I may like to start towards taking my next steps in recovery, was I ready?

Part 5: Moving on

I knew that I still wanted to stay with CIM but didn’t want to stay in the residential home much longer so it was decided that I would transition to the newly-created “Independence Package”. This meant I would be living in my own flat, but I would still have psychological input, CNS sessions and meetings with my psychiatrist. I loved this idea and we set a date for me to leave the residential home. 

By May 2020, the plans were sorted and a move-in date was set for some time in June. The time leading up to June was hard, as I felt my independence was only growing and my eagerness to be in my own space increased by the day. However, the day soon came and my slow transition from the home into my flat began, along with my ferret, Chase. I had gotten Chase earlier in the year to help with responsibility and to give me something to care for and build a bond with. By mid-June, I was being supported only by the Clinical Team and was living independently.

Part 6: Living alone and moving forward

For the first six months of living independently (June 2020 – December 2020), I spent a lot of time sorting out housing including funding, insurance, internet, electricity, things for the home, and generally getting acquainted with the area. However, I was also excited to catch up with my friends who I hadn’t seen that much due to being around an hour away from them when I was at the CIM home. During this time, I was so busy with moving in and getting used to living alone, I didn’t really think about my mental health and didn’t have time to ruminate or think about the next steps in therapy. However, in December me and my psychologist decided that I would start EMDR (Eye Movement Desensitization and Reprocessing). This was new to me and quite scary as I had never dealt with my past so deeply. It was the first time I felt genuinely scared about therapy, but my psychologist did a really good job at calming my nerves and preparing me for the therapy. In April 2021, I and my team decided that I would have three months of fortnightly therapy then it went down to once a month for three months, and then I completed the therapy. Therapy really helped me deal with past trauma as well as how to cope with issues that arise in the present. I am really looking forward to my future and feel there is a lot for me to do with my life and it has only just begun.

To make a referral or to find out more information about our services, please call the team on 0161 638 3285 or email referrals@careinmind.com

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