CONNECT: The West Yorkshire Adult Eating Disorders Service

Assessment

Individuals accepted to the service will be offered a comprehensive biopsychosocial assessment   by an experienced member of the assessment team and the service will endeavour to offer an assessment within 1-4 weeks for ‘urgent’ referrals and within 8 weeks for ‘routine’ referrals.

Referrals are deemed urgent if:

• Inpatient treatment is indicated (1 week target)
• The individual meets FREED criteria: 1) suspected diagnosis of Anorexia Nervosa (core psychopathology and BMI <18.5 kg/m²) or Bulimia Nervosa (core psychopathology and weekly bingeing AND purging), 2) less than 3 years duration of illness and 3) age 18-25 (2-4 week target)
• The individual has a BMI less than 15
• The individual is pregnant (4 week target)
• The individual has type 1 Diabetes Mellitus (4 week target)

Individuals who require inpatient admission will be offered an inpatient assessment over a 4 week period on ward 6 at the Yorkshire Centre for Eating Disorders in Leeds.  Prior to admission the service user will be offered a preparatory visit where they will have the opportunity to view the ward, meet other service users currently engaged in inpatient treatment and discuss the different inpatient treatment programmes with the inpatient team.

Treatment

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. 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.

For service users with Anorexia Nervosa most individuals will be offered 20-40 weekly sessions of MANTRA (The Maudsley Model of Treatment for Adults with Anorexia) 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.

For service users with Bulimia Nervosa most individuals will be offered 20-30 weekly sessions of cognitive behavioural therapy for eating disorders (CBT-ED) 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 which can be provided as a second line intervention include cognitive analytic therapy (CAT) (see Table 2), 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.

The length of treatment offered to Individuals accessing the CONNECT service is determined by their individual needs but is usually up to 12 months in the community and 3-9 months for inpatient treatment.

In most cases individuals will be discharged from CONNECT to their local community mental health team or to their GP with post discharge support available through the CONNECT tier 1 advice and consultation service if required.

Therapeutic breaks

In some cases a therapeutic break from the service may be considered when a service user has struggled to achieve their treatment goals. This allows the person to re-engage with their life and acts as a period of “respite” without expectations being placed upon them to be continually making behavioural change. They are however encouraged to continue setting manageable goals and making changes at their own pace.

Holidays and travel

We recognise that many service users may travel with their work or be away from home for extended periods of time which may at times impact on their treatment. In such circumstances our  CONNECT service can still offer support and treatment whilst the person is away however this will require that the person continues to engage in regular weight and blood monitoring and continues to remain in contact (e.g. via telephone) with their lead professional and/or their therapist so that treatment can continue.

Our team welcomes enquiries from service users and family and carers about self-referrals, but referrals can only be made by an appropriate healthcare professional.

To make a referral:

1. Complete this referral form
2. Send completed copies by email to: connectreferrals.lypft@nhs.net

Referral criteria (updated 22 October 2020)

From the 1 October 2020 CONNECT will resume accepting referrals for individuals who:

• Are 18 years of age or above. The service will consider referrals for individuals who are 17 years of age but only in exceptional circumstances or if they meet CAMHS transition criteria.
• Have a suspected diagnosis of moderate/severe Anorexia Nervosa, i.e. core psychopathology and BMI<17kg/m². The service also accepts referrals for adults with mild Anorexia Nervosa (core psychopathology and BMI 17-18.5 kg/m²) if they meet FREED (First episode and rapid early intervention for eating disorders) criteria, i.e. less than 3 years duration of illness, age 18-25.
• Have a suspected diagnosis of severe Bulimia Nervosa, i.e. core psychopathology with bingeing AND daily purging/compensatory behaviours (e.g. self-induced vomiting, misuse of laxatives/diuretics/insulin or other medication, excessive exercise) occurring at least 7 x per week. The service also accepts referrals for adults with mild/moderate Bulimia Nervosa (core psychopathology and weekly bingeing AND purging) if they meet FREED (First episode and rapid early intervention for eating disorders) criteria, i.e. less than 3 years duration of illness, age 18-25.
• Have a suspected atypical eating disorder and they are pregnant or have type 1 Diabetes Mellitus.

At present the CONNECT service has temporarily suspended accepting all requests for second opinion assessments due to the current clinical demands arising within the service. It is regretful that we are not able to undertake such clinical work at this time. We will endeavour to resume such activity as soon as possible.

Exclusion criteria

CONNECT does not accept referrals for individuals who have a current history of psychosis or any other psychiatric or physical health disorder which requires treatment before their eating disorder can be addressed.

Screening

All individuals will require a screening assessment of physical risk before their referral can be considered. This screening assessment should include a minimum of:

• body mass index (BMI) (weight/height²)
• blood investigations (full blood count, urea and electrolytes, phosphate, calcium, magnesium, glucose, creatine kinase, liver function tests)
• examination of blood pressure (erect and supine), pulse and core temperature
• an electrocardiogram (ECG)

If the referral is accepted it will be passed onto the appropriate CONNECT referrals team for further discussion. Each team has a weekly referrals meeting where referrals are discussed and allocated for assessment and treatment. The referrals teams aim to provide the referrer with a referral decision within 5 working days from receipt of the completed referral form.

Please note that whilst the CONNECT service prioritises referrals for individuals from the West Yorkshire and Harrogate region it can also consider inpatient and second opinion referrals for individuals who are registered with a GP outside the West Yorkshire catchment area. In such cases the individual will require a named care coordinator from adult mental health services and the referral should be made via the NHS England Adult Eating Disorders Case Manager for Yorkshire and Humber in the first instance.

Care coordination

CONNECT accepts direct referrals from GPs and all other health professionals from the West Yorkshire region. Having an allocated care coordinator from secondary mental health services is not required to access the CONNECT service.

For Dual Diagnosis referrals all service users will require a named care coordinator from secondary mental health services and referrals should be made via the local single point of access (SPA) pathway.

CAMHS transitions

CONNECT provides a CAMHS transition service for individuals less than 18 years of age who are accessing CAMHS services.

Referral criteria for CAMHS transition service users are in line with the standard CONNECT referral criteria however CONNECT is able to offer an initial assessment 6 months prior to the individuals 18^th birthday with a 6 month transition support service to facilitate safe and effective transition between services. Referrals for CAMHS transition service users should be made prior to the individual turning 17 ½ to ensure that an effective transition period is achieved. Referrals for individuals who are 17 ½ – 18 years of age will not be accepted.

Enquiries

All enquiries should be made by email to connectenquiries.lypft@nhs.net. The service aims to provide a response within 5 working days. If a more urgent response is required then the enquirer will be advised to make a formal referral.

Connect Teletherapy Contract

Download the Connect Patient Teletherapy Contract

Connect is currently providing 1:1 and group therapeutic interventions via video and telephone calls as we are unable to provide face-to-face treatment in light of the Covid-19 pandemic. We assume that when you take part in one of these sessions you are giving your consent to work in this way. In giving your consent, you are agreeing to the conditions.

Connect Guidelines for Responsible Social Media Use

Download the Patient Agreement for Responsible Social Media Use

Connect is currently offering open access support online which is available to people using our service, ex-service users, people on our waiting list and any member of the public affected by an eating disorder. We are offering regular live chats via Instagram and we are facilitating our ‘Hub’ support groups (that usually take place face-to-face in Leeds and Huddersfield) via Zoom. Notification of future Instagram live chats and Zoom ‘Hub’ support groups will be communicated via Instagram and Twitter. If you would like to take part in any of these opportunities for online support, then we ask that you please read and adhere to the guidelines in order to ensure that these spaces are safe for you and for everyone else using them.

Here is a useful document which holds contact details for a variety of services across Leeds, Harrogate, Kirklees and nationally.