Eating Disorders Service (Adult)

Welcome to our eating disorders page for healthcare professionals. Here you’ll find information on the referral process and other useful resources.

• Referral process and form
• Referral Criteria
• CONNECT referral criteria adjustment
• FREED
• Children and Adolescent Mental Health Service (CAHMS) transitions
• Exclusion criteria
• Screening
• Enquiries

Referral process and form

• Complete the Referral form
• Send completed copies by email CONNECT.

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.

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 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

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)

Children and Adolescent Mental Health Service (CAHMS) 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.

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.

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.

Enquiries

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.