Dietitians in Practice: A day in the life of an Eating Disorders Dietitian

Jay KendallAs part of Mental Health Awareness Week (#MHAW16 16th-22nd May 2016) Jay Kendall, Dietitian (Eating Disorder Service, Forth Valley) gives insight into her role and her working day.

I start most days by checking emails to make sure nothing urgent has come through – as I work part time it’s a bit of a juggling act to keep on top of things within my contracted time of two days a week.

I work as a Specialist Dietitian for the Forth Valley Eating Disorders Service and see both adults and adolescents in the community setting.  The adult team consists of a Consultant Psychiatrist, Clinical Nurse Manager, Advanced Nurse Practitioner and two part time Dietitians.  The team for younger patients is called CAMHS (Community and Adolescent Mental Health Service) and is structured much the same way; however it is a larger team which is geographically split and there is more diversity of Nurse Practitioners, Family Therapists and Psychologists as part of this team.

My time is split one day with each although this can vary depending on caseloads.  Today is Tuesday, my adults clinical day so I head over to the unit to do an assessment with our Advanced Nurse Practitioner.  Referrals come into the service from a variety of sources, and these are triaged fortnightly by the team and allocated accordingly.  Each patient must be fully assessed to establish whether they will be taken on by the team or not – i.e. do they have an Eating Disorder.  Most assessments last about an hour and are always undertaken by two member of the team – one to carry out the interview and the other to scribe.  Our numbers vary and patients will be allocated or go onto the waiting list depending on their degree of urgency.  Assessment complete I have patients to see today and developmental work to get on with.

Patients seen and lunch eaten I go back to my office and make a cup of coffee ready to do my admin and crack on with development work for the remainder of the afternoon.

As part of a pilot programme we are running an 18 week nurse-led intensive group for patients with Binge Eating Disorder.  As a service we have seen a rise in the number of referrals we receive for this condition and anticipate that this is an area which will require urgent attention and recognition to ensure correct treatment and management is implemented.  It was felt that group therapy could provide the necessary skills and education for this more recently recognised Eating Disorder, and as such our Nurse Practitioner has developed this group based on Dialectical Behavioural Therapy (informed).  Dietetics has been closely involved within the 18 week course and we have strived to develop appropriate and manageable nutrition education sessions for our patients.  Importantly the aim of the group is to manage the Eating Disorder itself and to reduce the frequency of bingeing episodes through learning skills and mindfulness techniques.   An interesting development as many of these patients find themselves being referred directly into weight management services, therefore initially being treated for weight change as a starting point and as a result struggling to manage their Eating Disorder.  A fact which we now know may actually be detrimental to managing the Eating Disorder itself (i.e. the bingeing episodes), most certainly demonstrating the need to provide evidence-based and timely treatment.

We are currently in the process of developing a pathway in conjunction with our dietetic colleagues within Weight Management and Mental Health to provide the most appropriate care plan for patients within the Forth Valley Area.  Following cessation and evaluation of the group we will have a better idea of how this will evolve within each service and how we can establish the role of Dietetics within this framework.

As Dietitians working within Forth Valley we are working collaboratively to ensure best care for our patients, particularly those who we recognise require additional psychological support and who may be vulnerable to mental health problems associated with their eating habits, whether this is as a result of having a formally diagnosed Eating Disorder or not.  Through good communication and excellent working relationships between teams, and through evaluation and measuring outcomes, we hope to develop and provide experienced AHP practitioner care for these patients. This should ensure the condition is correctly identified, the patient is properly assessed and that subsequently they receive appropriate and timely care within the most appropriate service.

Working within Mental Health, specifically Eating Disorders, can be challenging at times but it is also hugely rewarding.   I enjoy working as part of a close-knit smaller team within Mental Health and it is of course beneficial to also be a part of the wider Dietetic department for support and guidance. I feel this  truly enhances our practice as a profession.

Development work done, I get ready to leave and collect my son from his childminder and look forward to going home for the evening’s activities.

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