We have 12 in-patient beds for local and national patients. In-patient treatment is provided for those at high medical or psychiatric risk and those who are motivated to make changes but have been unable to do so after an effective period of out-patient treatment. Occasionally it is also necessary to provide admission for those experiencing such high levels of social adversity that treatment in the community is not possible.
If admission is indicated, patients and their carers are offered the opportunity to visit the unit and to meet with in-patient staff for an introduction to the unit and preparation for admission. On admission a keyworker from the nursing team is allocated to each patient. They will meet weekly with the patient and co-ordinate their care. An initial Care Programme Approach meeting is organised soon after admission to begin the process of discharge planning and liaison with relevant after care services.
Ongoing treatment in day patient and out-patient settings is recommended for at least one year following discharge from in-patient treatment. For the majority of patients this will be offered at Vincent Square although sometimes it may be appropriate to transfer care to a local Eating Disorder Service, where available.
Care plans and length of stay in in-patient and day patient care is guided by individual need and not by fixed programs of treatment. The day and in-patient programs combine meals and nutritional support with more intensive medical, psychological and social care than can be provided by out-patient attendance. Care is delivered through a combination of group work, individual sessions, specialist psychotherapies and occupational therapy interventions within a framework of motivational enhancement. Many of the components of the day-program are accessible to both in-patients and day patients, in order to facilitate flexible and graduated movement between these two levels of care.
This is particularly important in facilitating early discharge from hospital to ongoing day patient care. Transitions between services (or components within a service), are associated with high risk of disengagement and relapse. Continuity of relationships with staff and peer group, structure of the program and familiarity of the environment help to reduce the risk of disengagement or relapse at the time of transition from in-patient to day patient care.
Transitions are graded, with periods of increasing home leave in preparation for discharge to day patient care. Timing of transition is determined by progress with weight gain during periods of home leave and not by fixed length of stay or Body Mass Index (BMI) criteria. Thus, if a patient is able to continue to make progress with weight gain on leave, she is able to continue care as a day patient, even if BMI remains low. Where geography precludes the use of day patient care, in-patient care is extended until there is evidence from periods of extended leave that progress is likely to continue with local out-patient care.