Eating Disorders in the North of Scotland

These are exciting times for the development of improved services for Eating Disorders throughout the North of Scotland.

What are Eating Disorders?

The best-defined disorders are anorexia nervosa and bulimia nervosa. In anorexia nervosa, there is usually severe restriction of eating despite normal appetite. This is driven by an exceptional fear of being fat and leads to being seriously underweight sometimes to a degree that is life threatening. Other behaviours such as excessive exercising can be involved. In bulimia nervosa, patients are often normal weight and binge eat very large amounts of food. They also greatly fear weight gain and take action to prevent this happening by what are called compensatory behaviours. These commonly include spells of restricting eating, vomiting and sometimes involve the misuse of laxatives and other drugs affecting weight. Although these classical disorders are well recognised, often patients have mixtures of symptoms and change from one diagnosis to another because these conditions are very closely related. Also, there are shared underlying psychological processes at work. These include a crippling lack of self-esteem, high levels of anxiety from which the abnormal eating behaviour may produce temporary relief and a powerful feeling of lack of control.

Health Services for Eating Disorders in the North of Scotland

Since 1994 there has been an outpatient service based in Aberdeen for patients from Grampian, Orkney and Shetland. This service has been innovative in various ways eg pioneering the use of videoconferencing to provide therapy to patients in areas remote from Aberdeen. More recently, a service has developed based in Inverness for Highland patients, and at the end of 2007, a new service started up in Tayside. Referral to all these services, which are all for adults, is normally through the general practitioner. Younger patients are generally referred to generic services for children and adolescents.

North of Scotland Managed Clinical Network for Eating Disorders

A few years ago it was recognised that there would be merit in bringing together all those in the NHS in the North of Scotland who are involved in the provision of help for eating disorders and a Managed Clinical Network (MCN) was funded. At the centre of this network are a manager, a secretary and part-time lead clinician.

The broad aim of the MCN is to improve services for those with eating disorders. This remit includes activity at the community level to raise awareness of eating disorders and help general practitioners and others identify eating disorders early. At a more specialist level the MCN has been looking at how to lead the improvement of intensive treatments for severe eating disorders.

The MCN has been involved in educational conferences, lectures and other training events and has set up a website (www.eatingdisorder.nhsgrampian.org). This contains useful information, not only for professionals but also for sufferers and carers.

An important theme of the MCN work plan is the involvement of patients and carers in advising about services and they also contribute to educational activities. There are links with local self-help support groups including the North East Eating Disorder Support (NEEDS) Scotland group who arrange much appreciated monthly support meetings.

The MCN links with colleagues elsewhere in Scotland through involvement in the Scottish Eating Disorders Interest Group (SEDIG), which involves professionals, sufferers and carers and meets for a national meeting 2 or 3 times a year. The MCN is also involved in national discussions about provision of services for those with eating disorders.

A New Inpatient Unit

A major task for the MCN has been to lead discussions at local, regional and national level regarding the best provision of inpatient services for severe eating disorders. The current arrangements involve referring the few patients who require inpatient treatment to specialist units in central Scotland, paid for by the NHS. It has been recognised that the NHS ought to be able to provide something more suitable closer to home and, in February 2008, the discussions culminated in agreement by all health boards in the North of Scotland to fund a 10-bed inpatient unit in Aberdeen. This will be another very important step towards providing a truly comprehensive network of care for patients with eating disorders.