REGIONAL EATING DISORDERS UNIT
Information for Patients
What to expect from my Inpatient Stay?
REDU PATIENT INFO BOOKLET – March 2023 https://services.nhslothian.scot/seeds/wp-content/uploads/sites/12/2023/08/REDU-PATIENT-INFO-BOOKLET-March-2023.doc
We would like to welcome you to REDU. This handout is designed to help you to understand the nature of inpatient treatment for eating disorders, and to help you to set realistic expectations for your stay.
What to expect from your admission in REDU
Although REDU is a hospital ward, the eating disorder unit is based on a very different concept to other more ‘medically-focused’ wards. One of the most important functions of our unit is to keep you medically and nutritionally safe, and to help you to reach a healthier weight. Some people are ready to start working on their nutritional needs as soon as they are admitted to REDU, whilst others may need to gain some weight and start to explore the psychological factors that drive their eating problems before they are ready to start actively taking responsibility for weight gain.
We provide a range of treatment options in REDU, mostly in group format. Once you are sufficiently medically stable, attendance at groups will be your main ‘medicine’ while you are here. It is important that you attend all groups. We ask that you come to the lounge room before groups begin, so that they can begin on time. The progress that you make on the ward will depend on the degree to which you engage in the therapeutic program. This will involve attending all groups, as well as other therapeutic input which has been offered to you, including Individual Psychotherapy and Occupational Therapy, and Nutritional Therapy. You may also be required to carry out between-session exercises that are designed to challenge you to take steps forward in your recovery journey. The nursing team will also be working alongside you to support you on your therapeutic journey throughout your time on the ward, and will be by your side to provide therapeutic support during meal-times. You will be assigned a nurse keyworker, who will provide guidance as you work on learning new coping strategies.
Setting Expectations for Recovery
Although the REDU team will support you in your journey wherever you are at, the real progress begins when you start giving yourself permission to eat and gain weight. This can elicit high levels of fear and anxiety, as well as thoughts that you are undeserving, or ‘wrong’ in some way. Sometimes the feelings that arise during weight gain tend to be linked to underlying psychological struggles and unmet emotional needs. When you attend the psychotherapy groups and/or individual sessions on the ward, you will have the opportunity to explore and understand these thoughts and feelings further, as well as learning ways of starting to overcome these, so that you can begin to get your emotional needs met in healthy ways.
The physical and emotional changes associated with weight gain can be uncomfortable and frightening. These are all temporary and pass with time. Many people find that they are more in touch with their emotions as they gain weight and may notice more feelings of anxiety, sadness, and other emotions. This is a healthy sign, as you start to ‘thaw’ from the emotional numbness that is caused by low weight anorexia nervosa.
How long will it take for me to be ‘cured’ in REDU?
Everyone who comes to REDU has a slightly different level of motivation to recover – this is normal and understandable. REDU works as a therapeutic unit, and therefore our primary purpose is to give you all of the support you need to enable you to work on your own recovery. This is different from the medical idea of coming to hospital to find a ‘cure’. In the case of eating disorders, true recovery can only come about as a result of the emotional and nutritional changes that you make. Although we can provide support, ultimately only you can be the author of your own recovery story. This journey may involve several visits and you may encounter several obstacles along the way. Although there is a requirement to gain weight (i.e. 1kg/week up to your target weight range) while you are in REDU, voluntary patients can often find it easier to do this work in stages. For example, if you are unable to follow the ward guidance on reducing eating disorder behaviours, and as a consequence are not gaining weight, we will make every effort to help you to move through this roadblock. However, if this is ineffective, then it can often be more helpful to return home for a period of time, with the possibility of returning to the ward to complete the next phase of weight gain in a future admission. This is not a sign of failure. In fact trying to recover too quickly can be unrealistic, given the parallel psychological changes required for a true recovery. Without working on the underlying emotions and thoughts that accompany your eating disorder, and facing the discomfort of weight gain, you will be more prone to relapse.
We aim to provide a facility which will provide support for you to work at your pace and to start you off on your psychological and nutritional therapy journey. Our goal is to make your transfer to the community team as seamless as possible, so that you can continue to work both nutritionally and psychologically when you are discharged from REDU.
What kind of recovery should I be aiming for?
True recovery from an eating disorder is only possible when a person is ready to start to take responsibility for eating and gaining weight, knowing that this will evoke strong feelings (e.g. guilt, shame, fear). Our goal in REDU is to help you to start this journey, so that you can work on these issues more actively when you are discharged back into the community, with the support of the community-based eating disorder treatment teams. The goal is not for you to completely recover from your eating disorder whilst you are with us. In fact, inpatient treatment is just the first step of this process, and research shows that it is likely that you will need at least 6-12 months of active outpatient therapy for you to reach a state of recovery.
Research shows that outpatient psychotherapy is the best form of treatment for recovery from eating disorders. Although there are a range of excellent therapies available, they are only effective if you are ready to engage in the work of recovery, and to take risks to try new foods and challenges outside of your comfort zone. This is likely to feel uncomfortable, and might even be an alien concept if you are used to more of a medical treatment model that is based on the idea of waiting for the doctor to ‘fix’ you with ‘strategies’.
Recovery is not about getting everything ‘right’, nor is it about finding a perfectly healthy diet. In order to find a healthy and sustainable diet which does not put you at risk of relapse in the future, it will be important to balance all food types, and to challenge yourself to overcome fears of the foods you currently avoid. This may seem frightening at first, but we undertake this in a very gradual way, at a pace that is right for you. Although most patients fear losing control over their eating, it is important to realise that the more you restrict your eating, the greater your fear of losing control. So, in other words, as you relinquish your tendency to overcontrol your diet, the urge to eat large quantities will also eventually reduce. If you continue to avoid some foods or to restrict at some level, then it is likely that the urge to eat larger quantities will remain until this is addressed. It is only by learning to eat normally and regularly that you can learn to trust and understand your own body sensations (such as hunger, and fullness).
Obstacles to Recovery
For some, recovery can be hindered by the prospect of having to face difficult situations or emotions, such as the fears associated with: being alone or abandoned by others; having to take responsibility; taking risks and not getting everything perfectly right; uncertainty and unpredictability; criticism and judgement; meeting unrealistic expectations and pressures from others; being required to take care of the needs of others; responsibilities of becoming independent and an adult. These anxieties are all very common and it is important to discuss these with your key workers and therapists.
Where to from here?
You can discuss any concerns that you have about this handout or any aspect of your stay in REDU both with your outpatient and inpatient teams and keyworkers. We are here to support you as best we can on your journey, wherever you are at. We believe that each person who is admitted to REDU is worthy of a place here, and our goal is ultimately to help you to reach a sense of self-worth, and a life that is free from rigid rules and rituals, as defined by your own goals and hopes for the future.
