Eating Disorders Service (Adult)

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CONNECT

CONNECT’s referral process and form

Please be aware that CONNECT need to be in receipt of bloods and ECG from the past four weeks. Referrals will not be processed without these up-to-date investigations attached and will be returned to referrer.

It is also important to note that in the clinical information section, where the form asks for information on bingeing, purging, laxative misuse and overexercising, the frequency of these behaviours MUST be complete, or the referral will not be accepted.

At present, the CONNECT service has temporarily suspended accepting 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.

CONNECT’s referral criteria

CONNECT accepts 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, i.e. on a DAILY basis.
  • 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, have type 1 Diabetes Mellitus or Hyperthyroidism.

CONNECT’s referral criteria adjustment

The CONNECT service has implemented a pilot trialling an adjustment to the referral criteria in line with the incoming ICD -11, to include a 20% weight loss or more over the past 6 months regardless of BMI, alongside the existing criteria (core ED psychopathology/daily bingeing and purging).

The connect service have encountered a recurring issue with individuals presenting anorexic psychopathology but not meeting BMI criteria, often due to significant weight loss from a previously higher weight, leading to referral rejections. It remains challenging for the service to turn people away when they meet all the criteria except for BMI, as we are all too aware that this may inadvertently encourage further weight loss. The diagnostic criteria are expected to change soon with the transition from ICD-10 to ICD-11. In ICD-11, BMI may be replaced by a criterion of losing 20% of body mass within 6 months, allowing an anorexia diagnosis for individuals with a ‘healthy’ BMI. Although ICD-11 is not yet in use in the UK, it will be eventually.

We plan to run this pilot with the adjusted eligibility criteria up until June 2025. There will be a review and evaluation thereafter.

Referrers: please include % weight loss on the referral form.

Percentage body weight loss can be calculated as follows:
Initial weight minus present weight
Divided by
Initial weight multiplied by 100 = % weight loss

 

Binge–Purge Frequency Criteria for Bulimia Nervosa (BN)

How this is changing referrals

We are piloting a revised approach from 10 April to 10 October 2025 where we will accept referrals for individuals with BN who meet one of the following:

  • Binge–purge frequency of at least 4 times per week,
    or
  • Presence of significant physical health concerns, such as GI bleeds, abnormal blood results, or other medical risks.

This is in line with the DSM-5 severity specifier for moderate BN and aims to better reflect the complexities of the individuals we support.

You do not need to change the way you refer, but please provide a clear summary of:

  • Binge / Purge frequency i.e. x number of times per week
  • Any physical health concerns.

We will continue to accept referrals where the individual meets eligibility at the time of referral, even if their symptoms have reduced by the time they are assessed. We will monitor this impact on referral data throughout the pilot.

Referral data (including acceptance/rejection rates and waiting times) will be tracked and reviewed throughout the pilot. We will share findings after the 6-month period to evaluate whether this change should be embedded more permanently.

We hope this pilot will support a more flexible, compassionate, and clinically sound approach to eligibility decisions, and we thank you for your ongoing collaboration and support.

If you have any questions or feedback, please don’t hesitate to get in touch with us at connectenquiries.lypft@nhs.net.

CONNECT’s 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. CONNECT requires a period of three months of abstinence following the misuse of/dependency on illicit substances and/or alcohol.

CONNECT 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/height)
  • 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 referral 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.
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 within West Yorkshire is required to access the CONNECT service.

Contact CONNECT

All enquiries should be made by email to CONNECT. 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.

Link-ED

Link-ED’s information for referrers

How we can support:

  • Provide practical support and guidance around meal planning and regular eating to improve physical health
  • Provide education and advice around physical risk monitoring, including liaising with GPs when necessary
  • Offer peer support from our specialist Peer Support Workers who have lived experience

Link-ED’s referral criteria

  • Are aged 18 years of age or older
  • Are currently receiving support within a CMHT across West Yorkshire (Leeds, Bradford, Wakefield, Calderdale and Kirklees)
  • Have a primary mental health issue and where disordered eating is secondary

Link-ED’s exclusion criteria

Link-ED are unable to support individuals who:

  • Are under 18 years old
  • Are non-concordant with their prescribed medication
  • Are non-concordant with their physical health monitoring
  • Are presenting with eating difficulties due to a decline in their mental health. For example, have stopped taking their prescribed medication and believe food is poisonous
  • Do not have a healthcare professional supporting with primary mental health issue eg. Care Coordinator
  • Have symptoms of/ diagnosed with avoidant/restrictive food intake disorder (ARFID)

Link-ED – making a referral

Please ensure all information within the referral form is complete to avoid any additional delays. Link-ED can only accept referrals for service users under the care of a Community Mental Health Team within West Yorkshire. Link-ED do not provide care coordination, but will work closely with the referrer to support specialist care plans related to the individual needs around their disordered eating issues.

Contact Link-ED

All general enquiries should be made by email. This email is managed Monday to Friday within working hours. The service aims to provide responses to requests within 5 working days.

Link-ED’s support groups

Please note that all individuals are welcome to attend our weekly service user support group even if they do not meet our referral criteria. Likewise, all family and carers of individuals affected by eating disorders are welcome to attend our monthly family and carers support group. For more information, visit the Open Access Pathway page.

Eating Disorders Screening Tool

We recommend professionals use the SCOFF Questionnaire to help determine whether or not a person has an eating disorder. This questionnaire uses five simple screening questions and has been validated in specialist and primary care settings as a reliable screening tool for detecting the existence of Anorexia Nervosa or Bulimia Nervosa in primary or secondary care settings.

A score of 2 or more indicates that there is an 80% chance that the individual has either Anorexia Nervosa or Bulimia Nervosa and that further assessment by specialist eating disorders services is indicated.

FREED

The CONNECT community teams 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 if FREED criteria are felt to be met following the initial contact
    • commencement of evidence-based treatment within 2-4 weeks following assessment
    • separate FREED therapy groups (MANTRA and CBT-ED)
Medical Emergencies in Eating Disorders (MEED)

In May 2022 The Royal College of Psychiatrists launched the Medical Emergencies in Eating Disorders (MEED) guidance, which replaces both the previous MARSiPAN guidance. MEED guidance is primarily aimed at any clinician likely to encounter someone with an eating disorder but is also relevant to the person themselves and their relatives and carers.

The guidance provides advice on recognising a clinical emergency in a person with any eating disorder and how to provide for the physical, nutritional and psychiatric care in that emergency situation. The goal of this guidance is to make preventable deaths from eating disorders a thing of the past.

The guidance can be found on the Royal College of Psychiatrists website.

Urgent medical admission should be considered for persons presenting with any of the red flag parameters indicating high impending risk to life, bearing in mind that even when seriously unwell, people with eating disorders can appear to be well, with normal blood tests right up to the point of collapse.

Should you wish to discuss a MEED admission please email Connect enquiries and your enquiry will be directed appropriately.

Children and Adolescent Mental Health Service (CAMHS) transitions

The referral criteria for Children and Young People – Certified Eating Disorders Specialist (CYP-CEDS) transition service users are identical to those for non-transition service users. However, CONNECT community service can offer an initial assessment six months before the individual’s 18th birthday. If this window is missed, CONNECT will support a six-month transition period to facilitate a smooth and effective transfer between services providing the transition spans a 6-month period and CYP-CEDS remain involved for that full duration.

CYP-CEDS will remain involved beyond the individual’s 18th birthday to allow for the full six-month transition, ensuring continuity and stability throughout the process.

If a patient aged 17.5 or older is referred to CONNECT but is not currently under CYP-CEDS, there are two options:

  1. Conduct a joint assessment with CYP-CEDS and provide collaborative care until the patient turns 18, with CYP-CEDS maintaining clinical responsibility throughout the six-month transition period.
  2. Request a re-referral closer to the patient’s 18th birthday.

For inpatient transitions: When considering whether a young person should be referred directly to an adult Specialist Eating Disorder Unit (SEDU) rather than CYP-CEDS, it’s important to carefully assess whether this is the most appropriate placement. Placing a patient under 18 on an adult SEDU is a reportable matter to the CQC, so it must be clearly justified as the best option for the individual.

If patients are referred aged 17.5, with the national average stay on an inpatient ward being around four months, the hope would be that an episode of care could be completed under CYP-CEDS before an individual turns 18. However, CONNECT are open to considering individual needs to determine the best course of action.

CONNECT Advice and Consultation Service

The Link-ED Team comprises of link workers and specialists who support local community mental health teams (CMHTs) to provide a tier one level advice and consultation service.

This allows CMHT-based mental health practitioners to provide safe and effective evidence-based treatment (e.g. guided self-help) for individuals who do not meet CONNECT referral criteria or 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 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 MEED pathways
General websites and useful resources
Latest research and evidence

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

FREED stands for ‘First Episode and Rapid Early Intervention Service for Young Adults with Eating Disorders’ and is an early intervention pilot service for young people aged 18 to 25 who have developed an eating disorder within the last three years.

As part of FREED, assessments and treatment are streamlined for early intervention cases 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 four 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.

Previous studies have shown that the FREED early intervention service model speeds up treatment for eating disorders and has a wide range of benefits, including:

  • shorter waiting times
  • reducing dropout rates
  • promoting more rapid recovery and improved prognosis
  • increased service user and carer satisfaction.

For more information on FREED visit www.freedfromed.co.uk

Publications

You can download a full list of publications including original research, policy documents, books and book chapters and training modules.

Training and supervision

We can offer the following training and supervision to health care professionals:

  • formal training and supervision to primary care and secondary care professionals to manage eating disorders in primary care/community in line with the NICE (2017) and MEED (2022) guidelines.
  • formal training and supervision to acute providers on Medical Emergencies in Eating Disorders (MEED) and support in developing regional and national MEED
  • support to develop clinical guidelines and resources including information leaflets and self-help packages
  • consultation in complex cases, where an eating disorder is part of the co-morbidity of an individual’s presentation
  • training programmes for improving health professionals’ knowledge of eating disorders for timely detection and referrals to appropriate services.
Open access pathway

The Open Access Pathway is a collection of resources provided by the West Yorkshire Adult Eating Disorders Services, Link-ED and CONNECT.

The Open Access Pathway does not require a referral, and anyone with disordered eating is welcome to access the resources. Services provided under the Open Access Pathway include the Hub and Twilight Hub support groups, the Carer’s group, and online support via Instagram.

For more information visit the Open Access Pathway page.

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Page last updated: 23rd Apr 2025 4:14pm

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