Care and treatment of eating disorders - national specification: consultation

Outcome 7: Discharge

Outcome Statement

Discharge from eating disorder services is planned, collaborative, and based on individualised goals of treatment.

Rationale

Effective and person-centred discharge from services is important for people experiencing services, as well as for staff and organisations. Discharge can be a point of anxiety for individuals with eating disorders and their representatives and wider support networks. It can also be influenced by service pressures and clinical demands, meaning discharge processes have the potential to become service-led rather than person-centred.

In parallel to the requirements to access eating disorder services, discharge should never solely be based on a person’s BMI, weight, or frequency of binge and purge episodes. Instead, discharge should be planned and based on a continuous holistic assessment of an individual’s needs and person-centred treatment goals. A co-produced discharge plan should include a detailed relapse management plan, advice on the process and expectations of re-entering treatment if required, and signposting for ongoing support in the community from health, social care, and third sector on discharge. For individuals who have had a long duration of illness, it might be preferable for services to provide flexible ‘light touch’ contact as a means of maintaining the quality of life they have reached, rather than full discharge to external community support. This is of particular importance for patients who have been involved with services for many years and for whom the transition from services will require support.

Outcome in Action

7.1 Organisations ensure that discharges from care are:

• based on a holistic assessment and review of an individual’s circumstances, needs, and preferences
• not be based solely on clinical measurements such as BMI
• planned following informed decision making involving patients and their representatives where appropriate, and
• phased with the ability to re-engage directly with the same service if there is a need to do so.

7.2 Organisations ensure that there are options for ongoing support with the service as an alternative to full discharge to the community which are responsive to need, for example, for individuals who have had a long duration of illness and who benefit from ad hoc checking in/support.

7.3 NHS services work with social care and third sector organisations to facilitate any ongoing support that may be required post discharge from specialist eating disorder services.

What does this mean for the person receiving care?

You can be confident that:

• discharge from treatment will be planned with you, and your representative as appropriate, and with your consent
• discharge will be based on your need not on your behaviour or clinical measures such as weight
• you will be able to re-engage directly with the same service within an agreed time frame rather than being referred and waiting to be assessed again, and
• if you have been involved with services for a long period of time and have experienced a longer-term eating disorder, any ongoing contact you have with the service will be right for you and agreed with you.

What does this mean for staff?

Staff are:

• supported to co-produce discharge plans which are responsive and flexible to the person’s individual needs, preferences, and goals
• able to signpost people for ongoing support in the community from health, social care, and third sector support, and
• supported to be creative in co-designing alternatives to full discharge to best support people who require person-centred and responsive ongoing support.

What does this mean for the organisation?

The organisation:

• ensures that discharges are planned collaboratively with patients, and their representatives where appropriate, and with consent
• develops protocols to ensure discharge plans are person-centred, flexible, responsive to needs, and based on holistic assessment of preferences and individual goals
• has systems in place for people to re-engage directly with services within an agreed time frame after discharge, and
• ensures there is a specific care pathway for people who require long-term support as an alternative to discharge into the community.

Practical examples of evidence of achievement (Note: this list is not exhaustive)

• An eating disorder service develops flexible and person-centred discharge pathways enabling individuals to be supported to re-engage with the service via self-referral within 6 months if they experience deterioration in their eating disorder symptoms.
• An eating disorder service develops pathways as an alternative to full discharge for individuals who have had a long duration of illness and who may benefit from irregular check-ins to support personalised recovery process.
• Clinical audit of discharge pathways with documentation of information and support to enable people to re-engage with services and have irregular check-ins.