CONNECT is a community and inpatient service which launched in April 2018. It provides treatment for adults with eating disorders across the West Yorkshire and Harrogate region.
In this short video, Consultant Psychiatrist Dr Rhys Jones and Psychological Therapist Mary Franklin-Smith introduce the CONNECT service and talk about how it can help people suffering from problems such as anorexia and bulimia.
The aims of the CONNECT service are to:
Increase the level of community based care for adults with eating disorders across the West Yorkshire and Harrogate region
Provide a full team approach to care and treatment
Provide community care closer to home
Reduce the need for lengthy inpatient treatment
Reduce the need for travelling long distances to access care
Who is this service for?
We provide early intervention, outpatient, inpatient and intensive home-based treatment for adults (people aged 18 and over) with eating disorders (anorexia nervosa and bulimia nervosa), from across the West Yorkshire and Harrogate region.
We offer a multidisciplinary team (MDT) approach to help people affected by eating disorders. Our teams consist of doctors, psychologists, therapists, nurses, dietitians, occupational therapists, social workers, health support workers, peer support workers and administration staff.
The CONNECT service is made up of 4 teams
The East Community and Outreach Service covering Leeds, Harrogate and Wakefield
The West Community and Outreach Service covering Bradford, Airedale, Craven, Calderdale and Kirklees
The Yorkshire Centre for Eating Disorders Inpatient Service (YCED)
The Dual Diagnosis Outpatient Service
The CONNECT Community and Outreach Teams
These teams provide outpatient treatment and/or home-based community care for patients with moderate to severe anorexia nervosa and severe bulimia nervosa.
The teams also accept referrals for mild anorexia nervosa and mild/moderate bulimia nervosa for early intervention cases, and offer treatment for individuals with atypical eating disorders if they are pregnant or have type 1 diabetes mellitus.
Both teams provide an intensive home-based treatment service which offers an alternative to inpatient treatment and reduces the need for hospitalisation.
The Yorkshire Centre for Eating Disorders (YCED) – our Inpatient Unit
This is our specialist eating disorders inpatient unit based at the Newsam Centre in Leeds. The YCED offers a number of different treatment programmes tailored to individual needs and works closely with the CONNECT community teams, as well as other community teams outside of the West Yorkshire and Harrogate region, to keep hospital stays to a minimum and make sure that the necessary care and support is in place in the community after discharge from the inpatient unit.
This is a new service which provides assessment and treatment for individuals from the West Yorkshire and Harrogate region who have both an eating disorder and a substance misuse disorder. The service is based at the Newsam Centre in Leeds and is delivered in partnership with the addictions service Forward Leeds.
Early intervention through FREED (First episode and rapid early intervention for eating disorders)
The CONNECT community teams also provide an early intervention (FREED) service for 18-25 year olds who have suspected diagnosis of Anorexia Nervosa or Bulimia Nervosa which has emerged within the last 3 years.
Outpatient treatment through FREED is the same for individuals accessing 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 a referral to explore the person’s views on treatment and to arrange an initial assessment
there is an offer of an initial assessment within 2-4 weeks
followed by treatment starting within 2-4 weeks following 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.
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.
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.
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, have type 1 Diabetes Mellitus or present with clinical symptoms indicating a high level of risk
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.
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 of the West Yorkshire and Harrogate 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 and Harrogate 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.
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 18th 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.
All enquiries should be made by email to firstname.lastname@example.org. 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.