Care and treatment of eating disorders: national specification

Background

The National Specification for the Care and Treatment of Eating Disorders in Scotland has been developed in response to the National Review of Eating Disorder Services (2021), with a working group forming to develop them (see Appendix 2 for membership of the group). The aim of the National Review was to provide an overview of the current system of support for people with eating disorders, and their families and carers in Scotland. This built upon a previous report by the Mental Welfare Commission for Scotland (2020) which included a mapping of national eating disorder service provision. A significant number of stakeholders contributed to the review including individuals with experience of an eating disorder, their families, and clinicians. People with living/lived experience noted that while many services provide excellent care, there are areas for development and improvement:

• It can take a long time to access care;
• People can experience barriers to accessing the right treatment;
• People experience variability in services across the county;
• People often experience the transition between child and adolescent services and adult services as being very difficult;
• There appears to be a focus on services for Anorexia Nervosa and people with other eating disorders may find it difficult to access appropriate treatment, and
• Carers do not always feel well informed or included in treatment, especially in adult services, even though they provide significant support.

National Review of Eating Disorder Services (2021)

The National Review of Eating Disorder Services (2021) identified two main issues: lack of consistency in service provision, and confusion as to whether physical health monitoring was the responsibility of General Practitioners (GPs) or eating disorder services. It was also identified that more training was needed for healthcare professionals to enable earlier detection, prompt referral, and appropriate treatment. (National Review of Eating Disorder Services, 2021). These findings were mirrored by the Mental Welfare Commission for Scotland (2020) who also noted the impact eating disorders can have on the whole family; concern about services using Body Mass Index (BMI) alone as a criterion for access to services; and inequalities in the national provision of eating disorder services.

In parallel to these national reports on eating disorder care, there have been two further prominent published guidelines that have informed the national specification for eating disorder care and treatment. The Scottish Intercollegiate Guidelines Network (SIGN) Guidelines for Eating Disorders (2022) provides recommendations based on the evidence for best practice in the management of people with eating disorders of all ages and gender groups, in any health or social care setting. The Medical Emergencies for Eating Disorders (MEED; 2022) provides comprehensive guidance on the recognition, assessment, and management of all eating disorders that people can present with as a medical emergency. Both documents are referenced throughout the Specification.

The Specification should be read alongside relevant legislation, policies, national health and well-being standards and health, and social care standards including:

• Core Mental Health Strategy (Scottish Government, 2023) [Available from: Core mental health standards – gov.scot (www.gov.scot)]
• Mental Health and Wellbeing Strategy (Scottish Government, 2023) [Available from: Scotland's Mental Health and Wellbeing: Strategy (www.gov.scot)]
• National Health and Wellbeing Outcomes Framework (Scottish Government, 2015) [Available from: https://www.gov.scot/publications/national-health-wellbeing-outcomes-framework/]
• Health and Social Care Standards: My support, my life. (Scottish Government, 2018) [Available from: Health and Social Care Standards: my support, my life – gov.scot (www.gov.scot)]
• Getting it Right for Every Child (GIRFEC National Practice Model) (Scottish Government, 2016) [Available from: https://www.gov.scot/publications/girfec-national-practice-model/]
• The Promise (Independent Care Review. The Promise. 2020 [cited 2021 Nov 1]; [Available from: https://www.carereview.scot/wp-content/uploads/2020/02/The-Promise.pdf]
• Realistic medicine, (Scottish Government 2016) [Available from: https://www.gov.scot/publications/chief-medical-officers-annual-report-2014-15/]
• Mental Health Act (Scottish Government, 1983) [Available from: Mental Health Act 1983 (legislation.gov.uk)]