Helping young people get rapid and specialist support for their eating disorder

February 28, 2022

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To mark Eating Disorders Awareness Week FREED Champion Dr Kirsty Manning, South West London & St George’s Adults Eating Disorders Service, shares her experiences about how FREED is helping young people get the rapid and specialised support they need for their eating disorders.

Did you know?

Since the start of the AHSN National EIED Programme:

  • 33 Eating Disorders Services across England have adopted FREED
  • We have recruited 45 FREED Champions across England
  • 960 young people have accessed evidence-based treatment, on average 10-12 weeks faster than treatment as usual

What is First Episode Early Intervention for Eating Disorders (FREED)?

Eating disorders are severe, often life-threatening mental health conditions that frequently begin in adolescence or early adulthood. The first three years of illness onset offer a window for effective early intervention in order to achieve full, enduring, recovery. However, difficulties recognising and acknowledging problems early, and poor access to services are key barriers to early interventions in eating disorders.

FREED aims to address these difficulties by reducing treatment waiting times and therefore the duration of untreated eating disorders in young people who are experiencing the illness for the first time.

Designed for 16-25 year olds, FREED is driven by the key principles of health care for young people: holistic, proactive and optimistic. It encourages flexibility and creativity in how professionals and services approach, and work with, young people. For example, treatment incorporates the impact of social media and major life transitions (e.g. in education, work, living circumstances, relationships) on individuals and their eating difficulties.

Is FREED making a difference?

All the data to date is really positive and supports the effectiveness of FREED across diverse treatment settings. Patients wait significantly less time between referral and assessment, and between assessment and treatment. What’s even more encouraging is that FREED patients tend to require less intensive treatment and are more likely to maintain their progress after treatment than non-FREED patients.

Direct feedback from patients also shows that in general they feel supported and understood by the service, and families also feel involved. For example, I worked with a young girl who was referred to us after presenting to her GP with her mother with a very low weight and really bad body image. The same day I tried to give her a call but couldn’t get an answer. I then sent a text and got an immediate response. The girl expressed difficulty talking on the phone, so we chatted through text to help her get comfortable and we arranged an assessment for the following week. She later told me that had we not had that initial contact she probably would never have attended.

At assessment, it appeared that her anorexia nervosa had developed and spiralled very quickly within a year. I encouraged her to bring her parents to the assessment who were really relieved to be included as they felt lost and helpless. This young girl was offered treatment two weeks later and we started to see changes almost immediately. Her parents attended our service’s workshops to help them develop understanding and skills to best support their daughter.

This young person’s journey is not over yet, and it has proven to be really challenging for her. But intervening early has meant that she stopped losing weight, has already got insight into her difficulties and is motivated to recover so she can go to university next year. Had there not been the FREED pathway, she would still be on the waiting list right now, without any support to make positive changes and therefore most likely deteriorating or stagnating.

What is it like to be a FREED Champion?

Being a FREED champion is a really exciting and novel role where you get to be involved in so many aspects of the service. For example, you might get involved in business meetings about funding and investment which really give you insight into how Trusts and services work, and how all these details impact our clinical work and staffing.

You also receive really good support and supervision from the FREED network and get to meet peers across the country who you can share ideas on how to implement FREED and improve your service with. For example, recently many FREED champions expressed interest in MANTRA groups for individuals with anorexia nervosa so a webinar was organised to help us think about how we could implement this model in our services.

One of the best things about FREED is that it is optimistic and aims to instil hope in others. It pays special attention to the challenges young people face during the critical years of their life as they transition to adulthood, making it much more effective than traditional service models at reversing the changes to brain, body and behaviour caused by eating disorders. As a result, young people are less likely to miss out on study, relationships and other opportunities because of their illness.

Finally, it’s also exciting to be part of something so innovative. For me, a real highlight is having a genuine and meaningful impact on service provision for young people, making sure that they have access to evidence-based treatment when they need it. All the data and feedback collected shows significant improvements and less need for intensive treatments, highlighting just how important this pathway is.

Further information about the FREED National Programme

The AHSN Network in partnership with South London & Maudsley NHS Foundation Trust (SLaM) and Kings College London (KCL) are leading on the national scaling of FREED (First Episode Rapid Early Intervention for Eating Disorders).

FREED is an innovative service for 16 to 25-year-olds who have had an eating disorder for three years or less, enabling rapid access to specialised treatment which gives special attention to challenges we know young people face during these years of their life, and in the early stages of an eating disorder.

We are working with 33 eating disorder services who have adopted FREED and supporting implementation at a further 12 Trusts who anticipate to launch their FREED service by Summer 2022.

As leaders in spread and adoption, the AHSN Network in collaboration with SLaM/KCL provides early and ongoing support to services interested in adopting FREED, working with the wider system to ensure all young people across England have rapid access to treatment by 2023.

Further information

Find out more about FREED and their work.

Click here

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