Intensive Outpatient Treatment
Date Of Publication: 09/10/2019
Intensive outpatient treatment for eating disorders, including day or home-based treatment, could significantly reduce costs to the NHS and still be as effective as inpatient treatment – but has not been made widely available.
While inpatient treatment will always be necessary for the most severe and urgent cases of eating disorders, it also appears to be used for a large number of patients who could reasonably be treated in the community if appropriate options existed. As research suggests the forms of treatment are similarly effective, intensive day- and home-based treatments are a promising, less expensive alternative option to inpatient treatment, which could also be less intrusive to family life. They also allow patients to transfer the skills they learn to their home environment immediately, so helping to create the condition in which treatment gains are more likely to be maintained.
The NICE eating disorder guidelines recommend that most patients with eating disorders should be treated on an outpatient basis with evidence-based therapies such as eating-disorder-focused cognitive behavioural therapy (CBT-ED) and family based treatments. However, when an individual’s physical health is severely compromised, the guidelines recommend that the sufferer is referred to either a medical inpatient or day patient service to medically stabilise them and initiate refeeding where needed. Despite this, a Royal College of Psychiatrists survey conducted in 2012 found that eating disorder services tend to mainly use traditional models of care, such as outpatient and inpatient treatment, rather than more 2 innovative models such as day treatment . Inpatient units are unevenly distributed across the UK, with large parts of the country having no inpatient beds within easy travelling distance. Many people with eating disorders are therefore admitted to hospitals a very long way from home. Between 2016 and 2018, over 12% of patients in England had to drive over 50 minutes to their nearest adult eating disorder inpatient provider. In five regions of England, over 25% had to travel more than 90 minutes to receive this care. Additionally, at least 154 patients from England were sent to Scotland for inpatient care between 2016 and 2018.