Provision of Bespoke Inpatient Adult Eating Disorder (AED) service for Northants/Leicestershire

To deliver a bespoke inpatient eating disorder service to a young adult outside of the usual contractual and financial framework for adult eating disorder inpatient services.<br/><br/>Due to the person’s complexity of presentation and current acuity levels, we are looking to procure a bespoke option that can meet the person’s treatment needs within a time-limited inpatient admission.<br/><br/>Below is a summary of the care that will be required:<br/>

• 24-hour care in an inpatient eating disorder environment under a section of the mental<br/>health act.<br/>
• A multi-disciplinary team that can meet the person’s medical, psychological and social<br/>needs.<br/>
• Nasal Gastronomy (NG) feeding under restraint<br/>
• Ability to manage high levels of distress including self-harm, verbal abuse and assaultive<br/>behaviour.<br/>
• A long-term segregation (LTS) environment initially with the ability to transfer out of LTS as<br/>soon as is reasonably possible.<br/>
• Clear focus on least restrictive practice.<br/>
• Ability to make reasonable adjustments for a working diagnosis of autism<br/>
• Advocacy.<br/>
• Carer support.<br/>Required Service / Aims of Admission<br/>One of the main aims of the admission would be to increase Body Mass Index (BMI) or<br/>restore weight, reduce the current restrictions (including LTS), develop a life plan (to<br/>support discharge planning) and prepare for discharge. It will involve a commitment to meet<br/>with the external stakeholders regularly and be actively involved in any legal framework<br/>planning that will be needed for discharge e.g. Condition Of Participation (COP) or Depravation of Liberty Safeguards (DOLs).<br/><br/>There should be regular reviews to assess the relative risks versus benefits (both physical and psychological) of the treatment plan, particularly given the likely high level of restraint and the need for LTS. This balance may shift as the BMI increases. <br/><br/>The overarching aim should be that treatment should be in the person’s best interests.<br/><br/>The service will need to be able to deliver the required expertise in the treatment of eating disorders (in accordance with the specification for AED inpatient services) whilst also making the necessary adjustments in relation to Autism Spectrum Disorder (ASD). This will include access to Multi-Disciplinary Team interventions and close monitoring of mental and physical state by the medical and nursing team.<br/><br/>The environment should be no more restrictive than is necessary.<br/><br/>Proposed care plan<br/>1. Adequate nutritional input under specialist dietetic guidance with clear target BMI goal and rate of weight increase<br/>2. Psychological support to ensure adherence to nutrition plan<br/>3. CBT-E informed care from MDT for continuous messaging re. need to address nutritional deficit, understanding food/fatness fears as illness to support motivation for change and recovery.<br/>4. Provision of NG feeding at least daily, if unable to adhere to oral intake<br/>5. Physical monitoring, weekly blood tests and weight, pulse, BP daily.<br/>6. Medical support to manage physical complaints, complications eg. refeed syndrome<br/>7. Administration of medication.<br/>8. ASD adjustment, includes clarity, precise communication style, consistency, limited decision making, addressing sensory needs, PEACE Pathway strategies<br/>9. Occupational Therapist to structure daily activities, social interests, examine educational input<br/>10. Management of acutely disturbed state associated with feeding and violence towards staff, with need for Restraint. This has required bespoke team of at least 5 to 1.<br/>11. Use of Safety Pod (under review with mx, but standard use on EDUs)<br/>12. Segregation: initial plan for short term management away from other patients because of past risk and assault. This will need to be reviewed regularly.<br/>13. Provision for one-to-one time to facilitate working towards emotional literacy work and then formal psychology. CBT-E informed therapeutic work. Autism self-awareness/understanding/acceptance<br/>14. Support to re-socialise with peers, family and friends.<br/>15. Support to navigate the transition from child-teen-youth to adult including physical development,<br/>16. Family therapy<br/>17. Support sessions for staff involved.<br/>18. Active discharge planning.