The second of a series on what to expect if you ask for help for an eating disorder. First one here.
Outpatient or Inpatient?
Once you’ve had an initial assessment with your doctor, you may be referred to tertiary care, eg; a specialist ED unit, hospital or mental health unit.
They usually organise a care plan for and with you – and will decide whether you qualify for inpatient or outpatient care.
Inpatient care involves more intensive medical supervision, usually in a more structured and defined atmosphere. With inpatient treatment, everything is provided at one location. The patient can be protected from suicide or self-harm and this also gives respite to carers. Outpatient treatment is often more flexible – and enables those attending to continue normal life as much as possible. However, you may have to travel back and forth to different appointments. You will also have to take more responsibility, and make your own decisions – e.g; on what to eat and choosing not to overexercise or purge. As an outpatient you may be able to keep the condition more secret, but eating disorders thrive on secrecy, so this may not be ideal.
Outpatient care ranges from one-off appointments to attending clinics as a day patient (including supported meals, snacks, group or individual therapy etc). A simple form of outpatient treatment might mean visiting a therapist who specializes in eating disorders. More involved types of outpatient treatment may involve both individual and family therapy programs as well as specialized therapy eg; art or music therapy.
Group therapy is usually facilitated by a professional therapist. It can be held in a range of venues eg; private homes, treatment centers, hospital, university or church. It’s worth finding out in advance what their aims are, as these can vary. Topics may include: spirituality, art therapy, coping strategies, family issues, general discussion, communication, body image work etc.
Sometimes what you need and what you want will be very different. Depending on the severity of your condition, inpatient treatment may be necessary. If for example, you are at a very low weight, your thinking and reasoning will be seriously affected. Counselling will not be useful until you’re physically stronger. If your health is at serious risk but you won’t accept treatment, the team in charge of your care may recommend that you are sectioned, (or, if you are under 16, parents or carers can ask for it).
Sectioning means that two professionals, such as a doctor (psychiatrist) and an approved mental health practitioner can make your stay compulsory under the Mental Health Act of 1984 and 2007. There are 10 sections to the act and the main ones that are used are 2, 3 and 4.
Under section 2 you can be made to stay as an inpatient for 28 days to assess you, make a diagnosis and decide what type of treatment would be best for you. Usually a section 2 will be converted to a section 3 once these decisions have been made.
Under section 3 you can be made to stay in the hospital for up to 6 months of treatment. This can be reviewed for another 6 months and then for a year at a time.
Section 4 is also for assessment but only lasts 72 hours and is used in emergency situations.
When you are sectioned you can be made to have treatment if your team decides that it is necessary even if you do not agree to it. You should be given a leaflet explaining all of the terms of your section and it should include details of who to contact if you would like to appeal against the section. If your team decides you are well enough to be discharged they can take you off the section at any time. However while you are under section you will not be allowed to leave the unit/hospital and must continue with treatment until your section finishes. You can only leave the unit when your section finishes after the 72 hours or 28 days or when the team has decided that you are well enough to leave.
Next: what you might expect from inpatient care.