Referral to WLMHT Child and Adolescent Mental Health Service (CAMHS) Eating Disorder Team
All sections must be completed to ensure the referral is accepted. We are required to register the full postcode, GP details and NHS number of all referrals. Please include this information in your referral.
Please complete this form and email to Faxed / posted referrals will also be accepted.
Eating Disorders Team (Ealing, Hounslow, Hammersmith & Fulham)Address:
1 Armstrong Way,
Southall.
UB2 4SA
Email:
Tel: 020 8354 8160
Fax: 020 8354 8391
Urgent referrals should be emailed or faxed.
/ Risk section (Health Professionals only)
One or more ticked boxes indicates urgent assessment required
HR< 50bpm (<40bpm – admit paediatric/medical ward)
Symptomatic postural tachycardia (admit if increase >30bpm)
ECG – prolonged QT, arrhythmia (not sinus) – admit
BP below 0.4th centile for age
BP postural drop >15mmHg (admit if >20mmHg)
Temperature <36oC (admit if <35.5 oC)
Hypokalaemia [If <3mmol, admit paediatric / medical ward]
Hyponatraemia [If<130mmol, admit paediatric / medical ward]
Hypernatraemia
Rapid weight loss
Signs of significant dehydration or malnutrition
Suicidality / significant mental health concerns
Date of referral / Priority: / Routine / Urgent
Details
Dates to avoid / i.e. any dates to avoid as patient may be away/unavailable:
Child/young person’s details
Full name / AddressDate of birth
NHS No. / Telephone no.
Gender / Mobile no.
Ethnicity / Email
Language / Interpreter required?
Yes No
Details: / Main spoken language at home
Disabilities Physical/Communication impairments, especially if requires assistance with arranging appointments? / Yes No
Details:
Referrer details
Name / TelephoneGMC / Address
Organisation / Fax
Organisation code
(if applicable) / Email (NHS)
GP details
Only required if the referrer is not the patient’s GP
Name / TelephoneJob title / Fax
Address / Email
Family details
Name of parents/carers(whom patient lives with) / Relationship to child
Telephone no. / Email
Who holds parental responsibility? (parent/carer/Local Authority (LAC)
Please give contact details if not already shown above.
Name / Telephone no.
Address / Email
Who else lives in the referred child’s/young person’s household? Please list.
Name and relationship to child/young person / Age / School/Occupation
Patient’s school/college/workplace
Name of school/college/workplace / Telephone
Address
Reason for current referral
(Continue on separate sheet if required)
Please indicate what is required from our service.Please provide details of significant history, concerns and any risks.
Past Medical History -- Include only relevant medical history:
Problems:
Summary:
Any other agencies currently involved/involved in the past with the child/young person/family; and any services for which they are on a waiting list, and attach any relevant reports.
Physical health assessment
Date of physical health assessment / Weight (kg)Allergies / Height (metres)
Please attach Blood Investigation and ECG results.
Medication
Current acute medication in the last 1 month
Name of medication / Dose / Prescribed by / obtained from / DurationMedication
Current repeat medication
Name of medication / Dose / Prescribed by / obtained from / DurationFurther information
Do the parents/carers (who have parental responsibility) consent to this referral?Yes No
If 16 or over, has consent been given by the young person?
Yes No
Has the child/ young person/family had previous involvement with this or any other CAMHS?
Yes No Unsure
If Yes: Date: Reason:
Has the child/young person ever had a Child Protection Plan?
Yes No Unsure
If Yes: Date: Reason:
Is the child/young person/family currently involved in Legal Proceedings relating to the child/young person?
Yes No
If Yes, please give brief details:
Are you aware of any domestic violence issues in this family?
Yes No
If Yes, please give brief details:
Are there any other matters, such as culture, language, illness, religion, or disability that we may need to consider when getting in touch with the family?
Referrer’s signature / Job title / Date
Suspected or Diagnosed Eating Disorder –Referral Guide for General Practitioners
Due to the complex medical and mental health presentation of eating disorders, the young person does require an assessment by a GP as part of the initial referral pathway to the Community Eating Disorders Service for Children and Young People.
This will:
• Assist with the prioritisation of the referral
• Assess whether a more immediate paediatric obtained intervention is necessary
• Ensure that the young person is responded to following the appropriate pathway
It is recommended that for a fuller assessment the Junior MARSIPAN Risk Assessment tool is referred to as in Appendix 2 page 14 of the full eating disorder care pathway document.
http://www.rcpsych.ac.uk/files/pdfversion/CR168.pdf
Prior to a referral to Community Eating Disorders Service for Children and Young People the information listed below should be obtained and sent with the referral or as soon as the results are received:
• Weight and height (no shoes)
• Information of history of weight loss – amount lost, rapidity and intention
• Blood pressure and pulse sitting and standing
• Temperature
• ECG if clinically indicated
• History of excessive exercising, vomiting, abuse of laxatives or other diet pills
• Menstruation history in females
• Bloods to include blood glucose, FBC, U+E, LFT, TFT, magnesium, calcium, albumin, creatine kinase, ESR and phosphate
When to be concerned:
• Heart rate- less than 50bpm, symptomatic postural tachycardia - ECG indicated
• ECG-prolonged QT, heart rate < 50bpm, arrhythmia associated with malnutrition and/or electrolyte disturbance
• Blood pressure-systolic, diastolic or mean arterial pressure below the 0.4th centile for age/gender and/or postural drop of more than 15mmHg
• Signs of significant dehydration and malnutrition
• Temperature < 36 degrees
• Evidence of Purging –hypokalaemia, uncontrolled vomiting with risk of oesophageal and other visceral tears
• Hypokalaemia - <3mmol/l –admit under paediatrics
• Hyponatraemia or Hypernatremia- related to dehydration or water loading- <130mmol/l admit under paediatrics
• Rapidity of weight loss, even when seemingly a healthy weight range
Psychiatric/Mental health risk
· Suicidality
· Evidence of self-harm
· Young Person not coping
· Family not coping
We recommend that whilst awaiting referral to CAMHS the referring GP continues to monitor the young person regularly taking into account the above information.
Safeguarding Risk
· Child/young person identified as child in need
· Child/young person lacking support and or identified as being at risk of abuse and harm
Helpline and Resources
Books Further Help
Anorexia Nervosa; A Survival Guide For Families,Friends and Sufferers by Janet Treasure
ISBN 0-86377-760-0 / Website: www.b-eat.co.uk
Helpline: 0345 634 1414 open Monday to Friday
10.30am–8.30pm; Saturdays 1.00–4.30pm
Email:
Eating Disorders a Parents’ Guide, from the Great
Ormond Street Hospital Eating Disorders
Clinic by Rachel Bryant-Waugh and Bryan
Lask, ISBN 0-14-026371-3 / For young people aged 25 and under
B-eat Youthline: 0345 634 7650 open Monday to
Friday: 4.30–8.30pm Saturdays: 1.00–4.30pm
Email: TXT 07786 201820
Eating with your Anorexic – How my child
recovered through family-based
treatment and yours can too by Laura
Collins ISBN 0071445587 / Mental Health Matters Helpline – 0800 1070160.
Offering confidential emotional support for
service users and carers 5pm to 9am Monday to
Friday and 24 hours at weekends and Bank
Holidays.
Boys Get Anorexia Too – Coping with male eating
disorders in the family by Jenny Langley
ISBN 1412920221 / Overcoming Anorexia for Carers
www.overcominganorexiaonline.com
Anorexia and Bulimia Care
www.anorexiabulimiacare.org.uk
Anorexia and Bulimia in the Family by Grainne
Smith ISBN 0-470-86161-4 / F.E.A.S.T Families Empowered and Supporting
Treatment of Eating Disorders
www.feast-ed.org
The Body Image Workbook: An 8-Step Program
for Learning to Like Your Looks by
Thomas F. Cash ISBN 1-57224-062-8 / Around the Dinner Table
www.aroundthedinnertable.org
Biting the Hand that Starves You: inspiring
resistance to anorexia/bulimia By
Richard Maisel, David Epston and Alisa
Borden ISBN 0393703371 / Young Minds
www.youngminds.org.uk/
Skills-based learning for caring for a loved one
with an eating disorder: The new
Maudsley method by Janet Treasure,
Gráinne Smith, Anna Crane ISBN
0415431583 / Royal College of Psychiatrists – website contains
links to leaflets and further information
www.rcpsych.ac.uk/expertadvice/problem
s/eatingdisorders.aspx
NICE (National Institute for Health and Clinical
Excellence): Eating Disorders treatment
guidelines for England and Wales. Available
online at www.NICE.org.uk / Self Help for Parents with Children who have an
Eating Disorder
www.parented.co.uk
CAMHS three-borough eating disorder service
Referrals: information and guidance
Who we are
The West London CAMHS Three-Borough Eating Disorders Service is a specialist community multi-disciplinary Eating Disorders service providing assessment and treatment for children and adolescents with eating disorders such as anorexia nervosa and bulimia nervosa. The service accepts referrals for young people registered with a GP in the boroughs of Ealing, Hounslow and Hammersmith and Fulham up to their 18th birthday.
Where we are
We are based at the Ealing CAMHS site (see map) and we provide assessment and treatment in this clinic. There is free car parking on site for patients and we are close to local bus service routes.
Who can refer
We accept referrals from GPs and other health professionals, education and social services professionals working with children, and self-referrals (parents and young people).
Consent to the referral is required. Parents are an integral part of the treatment programme and so we always recommend the referrer informs the parent of the referral here, unless there are exceptional circumstances.
How to refer
Professionals working with children can refer using our referral form (attached). If you are not the GP, we recommend the young person is seen by the GP to exclude a physical cause for their symptoms and to help the team assess the urgency of the referral, but we can accept the referral alongside this.
You can also call the service between 9am–5pm Monday to Friday on 020 8354 8160 and ask to speak to the Duty Eating Disorders clinician if you are unsure if the referral is appropriate or if you have other questions.
If you are a parent or young person, you can call the service between 9am-5pm Monday to Friday on 020 8354 8160 and ask to speak to the Duty Eating Disorders clinician who will discuss your concerns with you.
Occasionally, the underlying issue may not be an eating disorder – in this instance the team will recommend a more appropriate team or service.
How soon will the first appointment be?
The team use the referral information to make a decision on urgency. We aim to see urgent cases within five days of the receipt of the referral and routine cases within 15 days. High risk cases will be seen the next working day. Very unwell young people may need to be referred to the paediatric/medical team or A&E in an emergency.
Is this an eating disorder? Guidance for referrers
Eating disorders are classified as Anorexia Nervosa, Bulimia nervosa, Binge Eating Disorder, and variants of these. In anorexia and bulimia, there is an overwhelming preoccupation with weight and shape with attempts to lose weight. In anorexia there is restriction of food with consequent significant weight loss whilst in bulimia nervosa frequent episodes of bingeing occur followed by attempts to get rid of the food or calories consumed, e.g., by vomiting or using laxatives. In Binge Eating Disorder, there are episodes of intense bingeing of food with a sense of loss of control which occurs at least twice a week over six months. Eating disorders such as anorexia and bulimia are relatively uncommon in younger children but often start in adolescence.
Dissatisfaction with weight and shape is very common and young people will often try and diet or may skip meals to try to lose weight or prevent weight gain. If they are not losing weight and the behaviours are only of a few days or weeks duration, it is unlikely that they have an eating disorder but they may benefit from advice on regular healthy eating and the behaviours monitored to ensure they are not worsening.
Young people who need a referral to our service will have clinically significant symptoms and behaviours. For those whose eating disorder is of the anorexia nervosa type, there will be a significant reduction of food intake over a period of weeks or more with consequent weight loss. There will also be effects on their physical health and mental health. There may be thinning of the hair and skin dryness. The young person may look pale and they may appear tired and fatigued (although this may be masked in some who over-exercise); they may appear low in mood, more anxious or may lack concentration. They may miss school lunch or eat very little. The young person may complain of feeling dizzy or faint; girls may report their periods have become less frequent or have stopped altogether. Medical examination by the GP or school nurse may show effects on the heart rate and blood pressure. Some young people may neglect their general hygiene.
Bulimia nervosa is often harder to identify as it can remain “hidden” for months or years. The young person may disclose that they are overeating (bingeing) several times per week, with consequent attempts to get rid of the food by purging, e.g., by vomiting or using laxatives, or excessively exercising.
We do not have absolute criteria for referring as young people often do not have the full set of symptoms and behaviours so if you have concerns that a young person may be developing an eating disorder but are not sure, please call us to discuss your concerns and we can advise you. We do require the consent of a person with parental responsibility for a referral of a young person under 16 years or the young person if they are 16 or older; if you cannot obtain consent but remain worried we can offer advice to you on what you can do to get
What treatment is offered?
Our multidisciplinary team includes psychiatrists, family therapists, a psychologist, a specialist dietician, Nurses, and a psychotherapist. We have a close working relationship with our paediatric colleagues in the Acute sector.