The Royal Free London (RFL) Child and Adolescent Mental Health Service (CAMHS) provides a specialist eating disorder service that aims to help young people with anorexia nervosa, bulimia nervosa, or atypical variations of these disorders to recover fully in the community and avoid unnecessary inpatient admissions into eating disorder units.

Research suggests that inpatient care for eating disorders offers no advantages over community treatment and has more disadvantages. The vast majority of patients make full recoveries with RFL in the community.

Outpatient treatment includes family and individual evidence-based treatment approaches. For more unwell patients, the Eating Disorders Intensive Service (EDIS) offers the full range of outpatient and day treatments at a higher intensity, including medical stabilisation, and school and home-based work.

Risk assessment

If the young person has weight loss of 1kg/week and one or more of the following, they will require the emergency/urgent referral pathway or possible admission:

• weight loss 1kg/week
• systolic blood pressure (sitting blood pressure, BP) <90mmHg
• postural tachycardia (standing pulse - sitting pulse)
• postural hypotension (sitting BP - standing BP)
• pulse (sitting) <40bpm
• temperature <35oC

Contact the duty clinician (m: 07929 791 290 or t: 020 7830 2931 ext. 39930) to discuss if needed or, if out of hours, send the patient to A&E.

Refer to the Medical Emergencies in Eating Disorders (MEED) guidelines to assess urgency for admission (page 40) via the link in Resources.

Monitoring until assessment

While the young person is waiting for an assessment with the eating disorder service, it is recommended that you consider arranging for a set of baseline blood tests for them.

The service suggests that you consider the following blood investigations:

• FBC
• serum iron
• U&Es
• bone profile
• vitamin D
• coeliac disease antibodies
• immunoglobulin A
• TFTs.

Send the results to e: rf-tr.camhsadmin@nhs.net so that they can be reviewed prior to the assessment.

The service also advises that you undertake physical monitoring of the young person, including regular weekly weighing and vital signs, to monitor for further deterioration while the young person is waiting for the assessment. 

If you notice further deterioration or you become more concerned, contact the duty clinician (m: 07929 791 290 or t: 020 7830 2931 ext. 39930) or advise the young person and their parents to attend A&E, depending on the urgency and risk (again refer to page 40 of the MEED guidelines in Resources).

Eligibility Criteria

Inclusions

• children and young people under the age of 18 (if aged 17 and nine months, refer to the adult service at St Ann's)
• registered with an NCL GP
• has anorexia nervosa, bulimia nervosa, or atypical variations of these disorders
• binge-eating disorder.

Exclusions

• the service does not treat Avoidant Restrictive Food Intake Disorder (ARFID); if your patient is presenting symptoms of ARFID, refer to the Eating Difficulties and ARFID Team at the Tavistock
• aged 18+

How to Refer