The Regional Eating Disorder Unit (REDU) is a 12 bedded specialist inpatient unit for people with a severe Eating Disorder.
The unit is located on the lower ground floor of St John’s Hospital in Livingston. The unit works closely with community healthcare services across South East Scotland to provide individualised care for patients with an Eating Disorder from the Borders, Fife, Forth Valley and Lothian regions.
(https://vimeo.com/721439154).
Who can refer to the service and what are the referral criteria?
The regional inpatient unit accepts admissions for patients who are 18 years or older with a primary diagnosis of an Eating Disorder. Patients younger than this may be considered for admission but only if this is deemed appropriate after a full discussion with all parties involved. Referrals are only accepted from an established community team specialising in Eating Disorders. GP’s can only refer to the community teams and are unable to refer to the unit directly.
Referrals are screened by the Consultant Psychiatrist to assess the suitability and urgency of the referral. Referrals are prioritised by the clinical need of the patient. In the event of the unit having no beds, staff at the unit would seek to remain updated on the clinical and psychological condition of each patient referred, to ensure those with the most pressing need receive highest priority for admission.
It is preferred that admissions are arranged for Mondays to Fridays and between the hours of 9am – 4pm, except in emergencies, to coincide with appropriate staff cover. The Consultant Psychiatrist and other senior staff are available to discuss and plan the admission with the referring team, patient and relatives or carers. Prior to admission, (when appropriate) patients and their relatives are welcome to arrange a visit to the ward via their Community Eating Disorder Team .
Patients may need to be treated under the Mental Health Act for their ongoing safety and recovery and this is determined by the Consultant Psychiatrist who is the Responsible Medical Officer. We work fully with the Mental Welfare Commission and Patient Advocacy groups in order to ensure the rights of patients are upheld at all times in the unit. We also make patients aware through these organisations and the Mental Welfare Officer, of their rights to named persons to represent them and advanced statements of how they would like to be treated if detention under the Mental Health Act became necessary.
Inpatient Care
People may require admission to the inpatient unit to address the nutritional, psychological and/or physical health aspects of their Eating Disorder. The broad ways in which the regional unit can help people with a severe Eating Disorder are:
- medical stabilisation
- provision of nutritional support and re-feeding
- addressing psychological & psychiatric instability causing worsening physical health
- ongoing psychological assessment and treatment
Nursing Care
The nursing team consists of mental health registered nurses and nursing assistants. Nursing staff are involved in all aspects of care and treatment, supporting patients in their recovery, working towards eating independently. Nursing staff key and co-work patients and will attend ward round and clinical reviews to support their key patients.
Dietetic Input
All patients admitted to the regional inpatient unit are assessed by the Dietitian and a meal plan will be implemented. Meal time support will be provided before, during and after all meals and snacks by members of the multi-disciplinary team.
The dietetic team will provide support to patients (both group and individual) throughout their admission, and work alongside other members of the multi-disciplinary team to assist patients in planning for their transition to home. Patients are encouraged to work towards managing their nutritional needs independently. This may involve planning, shopping, cooking and eating meals independently.
Therapeutic Programme
Each patient will be allocated a key and co worker from the nursing team who will be responsible for developing a care plan with that person. If it is deemed appropriate, individual therapy may be offered. There is also a full group programme on the unit and groups run by various members of the multi-disciplinary team which all patients are encouraged to attend when appropriate.
An individual psychological formulation is also offered to each person. The formulation is like a jigsaw – it is a way of piecing together all the possible factors that may have contributed to the development of an eating disorder. In psychological therapy sessions (group and individual) there will be an opportunity to explore any areas an individual is struggling with in their life, including mood, relationships and eating problems. The therapist will help make sense of these and will work with individuals to develop healthy goals that enable a sense of greater fulfilment. Most people notice that they develop more connection and understanding of their emotions in therapy. Although this might seem unfamiliar and even uncomfortable at first, this is the first step towards developing healthier self-awareness. On the ward, patients are encouraged to develop insights and strategies to help them in their road to recovery from their Eating Disorder.
Physiotherapy – (currently vacant)
Patients will be seen by the specialist physiotherapist on admission to the ward. Assessment will address exercise history and body image/body awareness.
Musculoskeletal issues will be assessed if indicated.
Physiotherapy interventions focus on reduction of unhelpful exercise behaviours and beliefs, promote a return to healthy activity, body image and movement. This is carried out individually and in group-based therapy. There is access to a hydrotherapy pool if suitable for individuals and this will be assessed by the multi-disciplinary team.
Occupational Therapy
Occupational Therapy (OT) looks at all aspects of a person’s life, to enable them to participate in meaningful and purposeful activities of daily living. Often when someone is experiencing an eating disorder, it may be that they disengage with previously enjoyed roles and activities. Occupational Therapy uses everyday activities as therapy to re-establish, or discover new occupations such as engaging in leisure activities, volunteering, studying, work or socialising with friends and family.
On admission, patients will meet with the OT for assessment and an individual OT care plan will be agreed. This may take the form of individual or group work and may be within, or out with the ward environment.
Social Work Involvement
When a requirement for an assessment of social care needs is identified during a person’s stay in hospital, a referral to social work can be made.
If a referral to REDU is being considered this should be directly from the community team from the appropriate area.
