THE EDEN UNIT

1. THE EDEN UNIT GUIDE FOR PATIENTS & THEIR FAMILIES & FRIENDS The Eden Unit, Block C Clerkseat Building, Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH

2. Using this Folder We want you to feel welcome here and we know it takes a while to get used to the way things are done. Eden Unit Patients asked for this information pack, and have been lead authors and editors in its production. We are indebted to Amanda Brooks who produced the first draft in consultation with her peers in May 2010. Many other patients, carers and staff members have contributed to each draft, and the aim is to continue to update the folder with each new development. We don’t want you to feel overwhelmed - please don’t feel you have to read all of this folder on the first day or indeed ever. Some people keep the information for reference and others like to consult it to get an idea of expectations, guidelines and attitudes to treatment. Let us know if you notice any inaccuracies or omissions. We are always open to improvements and welcome creative suggestions.

3. The Eden Unit – history and geography • What happens when you are first admitted? • Your rights and responsibilities as a patient here • The dining room and afterwards • Confidentiality • Who’s who? • Our Weekly Timetable • Treatment for patients with weight-losing disorders • Arrangements for discharge •  Day Programme • Further work of the Eden Unit – research, publicity, education CONTENTS

4. The Eden Unit – history and geography For many years Scottish patients suffering from severe eating disorders had to go to England, at great expense and with the added hardship of being treated far from home and often the transition back home led to relapse because of lack of continuity.. Even when private facilities opened in the South of Scotland there were similar problems In 2005 Grampian, Highland &Tayside set up the North of Scotland Managed Clinical Network for Eating Disorders. The work of this group and its Lead Clinician, Dr Harry Millar, resulted in the decision, in 2006, to open our 10 bedded inpatient unit and its associated Day Programme. On 25th May 2009,we had our official opening by Sheila Robison, Minister for Health and Sport.

5. The Unit is hosted by NHS Grampian and situated in the Royal Cornhill Hospital in Aberdeen. We take referrals not only locally from Aberdeen and wider Grampian but also from Tayside, Highland, Orkney, Shetland and the Western Isles. We have close links with specialist outpatient eating disorder services and general adult mental health services in all of our partner areas. In addition we enjoy a close relationship with Dr Alastair McKinlay and colleagues in the specialist Gastrointestinal services at Aberdeen Royal Infirmary. The Eden Unit – history and geography

6. When you first arrive you will have a physical and psychological examination from the admitting doctor and nurses – if they have serious concerns about your medical state you may be temporarily treated in Dr McKinlay’s ward at the Infirmary to make sure it is safe for you to start the Eden programme of treatment • You will be allocated a key nurse who will take a special interest in your care and will ask about your medical and personal history as well as asking you to complete some assessment questionnaires. The whole nursing team will be looking after you, but the key nurse leads the development of your care plan What happens when you are first admitted?

7. You will have your own bedspace – and if possible your own room, at least in the early part of your admission. There also is a dorm of four beds, each with curtains . It is not possible to guarantee that you will occupy the same bed for the whole of your stay – this is a hospital rather than a hotel! – and staff may not always be able to give as much warning as they would like before asking people to move. Please do try to be understanding about this. Voluntary patients are of course free to come and go as they wish – the door is locked to keep patients safe from theft or inappropriate visiting. It is also helpful for staff to have to open the door for people so that they are aware of who is out and who is in the Unit. When you first join us

8. When you first join us Some of your biggest anxieties will be about the dining room and about ‘the rules’. So the next page is an attempt to explain what the hospital expects and what the Eden Unit prescribes as the best treatment for its patients. We try to be as flexible as possible in making treatment an individual matter for each patient – this means that you may be asked to do, or not do, things that do not apply to other patients. It may seem ‘unfair’ – it may even BE unfair. But we believe it would be wrong to make everyone follow the same treatment plan if they have different needs or find themselves at a different stage of treatment. All the same there are certain matters which have been laid down as essential by the Hospital Management or other authorities to protect all of us - staff and patients - who live and work here.

9. YOUR RESPONSIBILITIES IN THE EDEN UNIT You are expected to make reasonable efforts to take part in the unit programme and work with staff on treatment. Ambivalence is part of the disorder, but we ask you to open your mind to the experiment of recovery whilst you are a patient here. Violent, abusive or destructive behaviour is unacceptable and is treated seriously. Being a resident of the Inpatient Unit does not protect against the involvement of Police when necessary (in cases of violence or stealing, for instance). We do of course attempt to assess to what extent people were behaving badly under the influence of illness. The use or possession of non-prescribed drugs, solvents and alcohol is not allowed. Patients must not return to the Unit under the influence of any intoxicating substance. In an eating disorders service, items of food and drink are regarded as ‘medicines’ which are prescribed for patients. Individuals should not keep supplies . Smoking is discouraged and is not allowed inside the hospital building. We accept that this is too stressful a time to ask someone to give up smoking. So patients may smoke in designated places (outdoors from the Unit) at times permitted by staff. We are delighted to provide help and support if you do chose to give up smoking.  There is no sexual contact between people in the Unit. We expect staff and patients to respect each other. Racist, sexist, or ‘size-ist’ bullying and intimidation are unacceptable and will be taken very seriously.  Confidentiality must be maintained - we particularly ask patients and their families not to make public any information which was entrusted to you by fellow patients or their families. You must not take any photographs of staff or patients.

10. On the ward there are two lounges - the larger lounge is used for supervision and many of the groups whilst the smaller one is a cosy sitting room for more informal use. There are freeview televisions with dvd players in all bedrooms and in each lounge and also a Playstation and in the big lounge. The tables adjacent to the main lounge can be used with the sewing machine and arts and craft supplies. There is also an array of DVDs and board games. There are two computers in the smaller lounge but you will need your own ‘dongle’ to use internet. The hospital asks you not to bring in blankets or duvets from home but to use what they supply – this is because of fire safety regulations. There are laundry facilities in Eden’s ‘Sluice Room’: washing machine, tumble dryer, clothes’ airers, iron and ironing board. You are requested to provide your own washing powder – but just ask if you don’t have any. Beyond the Unit, up by the Clerkseat Entrance to the Hospital, there is a visitors’ canteen and voluntary-run newsagents shop which also sells a few toiletries. Opening hours are 10-4 on weekdays and 2-4 at weekends for shop. At weekends visitors may use the Staff Canteen (just down the same corridor) since the Visitors’ canteen is shut. Visitors can also use staff canteen 2.30-5pm on weekdays. There is a visitor’s overnight stay room that can be booked through nursing staff for £5 if available. The Hospital has a side entrance at Berryden Road which is most convenient for the Unit, especially when shopping, but this and the door from the Corridor close at 9pm sharp every night and people must then use the main entrance from Cornhill Road and main door at the Clerkseat Building. FINDING YOUR WAY AROUND

11. Around the Cornhill/Berryden area - There is a Sainsbury’s, Next, Mothercare, Toys’r’us, JJB Sport, Argos, PC World, post office and other shops right by side entrance to Royal Cornhill Hospital and walking distance to Rosemount Place and Rosemout Viaduct where smaller shops, hairdressers and cafes are. It is a 15-20 minute walk to Union Street and shopping centres. • Travelling by bus Regular buses run from by hospital and a short bus ride will take you to newest shopping centre, Union Square, where the main Guild Street bus station and railway station are found. Buses that serve Aberdeen city centre to Royal Cornhill Hospital are numbers 5, 10, 12 and 59. • Travelling by car Free parking is available in the grounds of the hospital but spaces are limited and you may have to park a short distance from the Unit. There are Pay and display regulations in force on neighbouring streets. There are also a number of taxis available at taxi stances in the city centre or companies to telephone. There is a free-phone taxi telephone available at the main reception of hospital. More information on nearby facilities can be given by staff. (please insert maps – plan of RCH and google map of local area)

12. Cornhill Hospital’s policy is that personal property is brought in at the owner’s risk, so it would be unwise to bring items of high or sentimental value into the Unit. If you do bring things that are valuable, fragile or not permitted in your room, you may prefer to hand these to staff for safekeeping. Handbags, diaries and so on should not be left lying around even though obviously we hope most people will be trustworthy and respectful of all property, both private and that of the Hospital. You will not need too many changes of clothing – dress is fairly informal and there is a laundry room for patients’ use. We ask that neither patients nor their visitors bring in any of the following: -Drugs, alcohol, food, and drink, sweets, laxatives, chewing gum Any items that people may use to hurt themselves should be handed in to staff who can them let you have them back for appropriate use. These would include: -Razor blades, knives, scissors, tweezers, mirrors and other glass objects, matches and lighters. If you bring in personal electrical items, e.g. Hairdryers and mobile phone chargers, these may need to be checked by hospital electrician prior to use. Don’t forget to collect your belongings when you leave the ward again! Looking after your property

13. The day starts with breakfast – unless you are weighed that day. Most people will be weighed 3 times a week or even more often at first. Sometimes staff will ask you to be weighed unexpectedly, because anorexia can make people ‘fake’ their weight. We ask you not to have anything to eat or drink on the morning you expect to be weighed, but to go to the treatment room in pyjamas. You are asked you to empty your bladder and you may be asked to provide a urine sample too. This can be checked for signs of infection or other problems, and can also be used to assess whether you are under- or over-hydrated. First thing in the morning we would expect most people to have concentrated urine, and if this is not the case then it’s likely that your weight is an over-estimate of the true value. Of course, you may also have medication dispensed first thing too. Breakfast is at 8am . It is courteous to wear day clothes – dress is casual but you are expected to wear clothes that express consideration of other people’s feelings and that are appropriate to the time of year and temperature. Patients are expected to be punctual for all meals and snacks.. Most of the rest of the day’s events are described in the account of ‘eating for recovery’ or in the weekly timetable. Do ask staff to explain anything we have not made clear. THE DAILY ROUTINE ON EDEN

14. Each week the day starts with a 15 minute community meeting except on Tuesdays when the Staff meet for the morning Ward Round at which patients’ care is reviewed and developed. Patients themselves prepare a report for the staff to consider, and feedback is provided the next day (Wednesday) The rest of the week is structured by a series of meetings and groups between meal and snack times, and by the increasing number of individual appointments that will be provided for you as you become able to engage in therapy. We enclose a copy of the current timetable – this changes from month to month in accordance with the needs of the patient group and the availability of different opportunities. Weekends are quieter times on the ward, but still involve the hard work of tolerating renutrition and rest and their physical and psychological side-effects. They are also opportunities to practise re-engaging in interpersonal contacts and relationships without using eating disordered ways of coping with the stresses involved. Our Weekly Timetable

15. Everyone eats three meals and three small snacks each day in the Dining Room.WHAT DO WE EAT? Tina, the dietician, prescribes what you are to eat. Nursing staff decide on the portion size and serve it to you. Your job is to eat all of what you are given without any negociation.HOW DO WE EAT IT? Most patients need guidance from staff to learn the etiquette expected in the dining room. This is unlikely to be what you have been used to at home. It is not the only way for healthy people to eat, but because it is a way you can learn how to eat healthily again. Some members of staff will ask you to do things differently from others, and you may also notice that not al patients will be expected to follow the same guidance. Patients will be at different stages of recovery and not all will have the same difficulties. It’s not helpful to compare yourself with others but to accept the guidance of staff supporting you. On the other hand, if you are asked to do something that mystifies you it may be that staff are taking precautions against behaviours that have undermined other people’s recovery – please cooperate rather than quibble!HOW CAN WE HELP? Of course many people are terribly anxious and sometimes this takes the form of anger and stubbornness. Part of recovery involves trying to make the atmosphere as pleasant and ‘normal’ as possible, however hard this may feel. You are asked to save complaints or questions about the food or portions until you are alone with a member of staff, not to raise these at the table. ex Eating for RecoveryEveryone eats three meals and three small snacks each day in the Dining Room.WHAT DO WE EAT? Tina, the dietician, prescribes what you are to eat. Nursing staff decide on the portion size and serve it to you. Your job is to eat all of what you are given.HOW DO WE EAT IT? Most patients need guidance to learn the etiquette expected in the dining room. This is unlikely to be what you have been used to at home. It is not the only way for healthy people to eat, but we use this approach because it is a way you can learn how to eat healthily again. Some members of staff ask you to do things differently from others, and you may also notice that not all patients are expected to follow the same guidance. Patients will be at different stages of recovery and not all will have the same difficulties. It’s not helpful to compare yourself with others but to accept staff guidance. On the other hand, if you are asked to do something that mystifies you (for instance not to wear loose sleeves or scarves) it may be that staff are taking precautions against behaviours that have undermined other people’s recovery – please cooperate rather than quibble!WHAT HELPS? Of course many people are terribly anxious and sometimes this takes the form of anger and stubbornness. Part of recovery involves trying to make the atmosphere as pleasant and ‘normal’ as possible, however hard this may feel. You are asked to save complaints or questions about the food or portions until you are alone with a member of staff, not to raise these at the table. We make conversation about intersting things - not about food, diets , weight or appearance.

16. Tina, our dietician, will explain more about this – but in essence the aims of the eating programme are: • To make eating as manageable as possible rather than frightening. • To gradually set you free from the physical and psychological effects of starvation • To help you cope with the physical and psychological effects of refeeding • To help you to establish a regular eating pattern and eat a healthy variety of foods so that you get the best health benefits from a slim body. • To accustom you to healthy new eating habits that you follow regardless of the way you feel or what is going on around you • To support you to take back the responsibility for caring for yourself, including feeding yourself , digesting what you have eaten, and resting your body. Vitamin and mineral supplements are prescribed to restore deficiencies and prevent imbalances . Your meal plans need to be gradually increased as your body functions better, speeds up the rate of metabolism and repairs the damage done by starvation. At first your weight may oscillate a lot, then it is likely that you will gain an average of 0.5 to 1.0kg per week, usually a little faster at start, then slowing down as you body begins to work normally. Much of what the public hears about a ‘healthy’ diet is what is aimed at an increasingly overweight population. We are not taught about the importance of fats, for instance, because most people eat too much of such food, but they are essential to good health. Whilst your brain and heart, in particular, recover from starvation, it’s as important as when you were a growing child to take in food rich in phosphate, such a milk. The thinking behind the way we eat

17. WHAT HAPPENS IF WE ARE TOO ILL TO EAT ENOUGH? All of us have to eat – human beings, like other animals, don’t have any choice in the matter if they are to live. The only choices we do have are about how and what we eat, and how much is enough. People with severe eating disorders become too anxious to make these choices wisely and need to be guided by experts to master the fear and learn new eating skills. The staff on the Eden Unit have experience & skills to help you eat as normally and healthily as possible. Very occasionally people don’t manage to eat enough of the food on their plan so will be prescribed a nutritional drink instead (usually ‘Fortisip’ or equivalent). More rarely still, patients cannot manage to take in what is prescribed at all and then, after careful discussions between staff and with the Scottish Mental Welfare Commission, people may need to be fed by means of a soft plastic tube. Sometimes this is also used to start the refeeding process where a person is so fragile that a normal diet could be physically dangerous.

18. It is rather misleading to talk about ‘eating’ disorders, since most patients struggle not only to eat but also to allow the nutrients to stay in their body. For many people there is terrible discomfort leading to urges to be sick or to ‘burn off calories’ which leads people to purge or engage in obsessive physical activity, usually in secret. We therefore ask people to stay together in the sitting room for a period of about half an hour after each meal, for a period of ‘supervision’. This is of course a time of tension and anxiety for many people, and it is helpful if you can discuss with the group and with the supervising nurses how best to create a supportive atmosphere. Some people manage best by playing board games or cards, whilst others like to read, watch TV, knit or sew, or converse quietly. Please do be open minded about other people’s ways of coping and experiment with different ways to distract yourself. For patients who struggle particularly with compulsions to purge or overexercise, or who are so starved that they are in danger of losing control of their appetite, there may be extra supervision arrangements involving accompanying patients even in bathrooms or at periods other than after mealtimes. These will be carried out with maximum dignity and compassion. Coping after mealtimes

19. VISITORS Visiting times are 7-8.55pm during the week and 2 – 3.15, 3.30 – 4.55 and 7 – 8.55pm at weekends.. At other times visiting may be arranged with special agreement of the staff team, particularly if visitors have long distances to travel or work shifts. During normal ‘working’ hours patients have to concentrate on groups, activities and therapy so we ask visitors to respect the ward timetable. Obviously you need not receive a visitor unless you want to be visited!  Sometimes it’s not helpful for patients if there are too many visitors on the Unit - they may feel terribly exposed when they don’t feel well. Occasionally patients become distressed or confused and when they are well again feel embarrassed to think they had been visited by any people except the very closest. Patients may entertain visitors in their own rooms or in the shared spaces, but should always respect other people’s peace and privacy. Friends, family and other carers deserve some rest and respite from caring. Children – particularly young ones – may be upset to see their relative so ill, and may be frightened by the hospital or resentful of the time taken up by the illness. We can arrange a meeting to explain things to them if you feel this would be helpful

20. Confidentiality Please check out your expectations of confidentiality and privacy with staff members. The members of the team treating you do not make private information about you available to the public without your express permission. Indeed your medical records are only released if there is a ‘sub poena’ by a court of law. The staff team do share information with each other – and to some extent with your GP and outpatient staff – in order to maintain helpful communication. The balance between good and important communication on one side and privacy and confidentiality on the other is extremely difficult and sensitive. On the other hand , family, friends and other carers do not have an automatic right to have information about you without your permission. People who care for you do have a right to general information about the disorder from which you have been diagnosed to suffer. They may also be provided with information needed to care for you when on pass. They do not have automatic rights to staff confidentiality. Staff don’t pass on sensitive personal material unless they believe this is crucial, but in general they assume that communication from relatives can be made known to the patient involved.

21. Once people are well enough to safely go for walks in the hospital grounds or beyond, we negotiate this together. We do need to know at all times where the patient is, and who is with them. We may insist that patients go out only with nurses, or with family, and we often ask them to stay indoors when it is dark or cold . We have to bear in mind that we are part of a Psychiatric Hospital, where other people may at times inadvertently pose a risk of infection to underweight patients . We often offer drives or outings in wheelchairs to provide fresh air and a change of scene.  Weekend or indeed any other ‘home pass’ is not supposed to be simply a ‘break’ from treatment! In fact it is likely to be very hard work for everyone involved. The aim is to see whether the treatment set up in the Unit can continue at home. For instance, prescribed medication should be taken, food and exercise plans followed, and planned behaviours practised. Patients are expected to refrain from using alcohol, cannabis and other substances during pass, just as on the Unit. Much as you want to be back in the normal world, it is important to remember that unprepared passes can set back the treatment badly. Please help us all to plan and practice the work with you. Going on pass

22. Consultant Psychiatrist Dr Jane Morris Trained in both Adult Medical Psychotherapy and Child & Adolescent Psychiatry, she is Chair of the Scottish Eating Disorders Eating Disorders Interest Group, and leads a Research Group adopted by the Scottish Mental Health Research Network. She has published papers and books in the fields of Eating Disorders and Psychotherapies Medical Doctor Dr Lesley Pillans (insert photo and short bio) Consultant Physician Dr Alastair McKinlay Ward Manager Pauline Milne (insert photo and short bio) Deputy Ward Manager Lindsey Money (insert photo and short bio) Who’s who in Eden?

23. Dietitian Tina McGilton Occupational Therapist ShonaMcCulloch Physiotherapist Sandra Philip-Rafferty Art Therapist Leslie Spillman Cognitive Behavioural Therapist Jan Templeton Pharmacist Who’s who in Eden?

24. Secretarial/Admin Staff Wendy Pawlik and Rona Walker worked in the field of Eating Disorders even before the Eden Unit opened and have worked here from its inception. Rona is also administrator for the EEATS organisation Ward Cleaner Sangit leads the cleaning of our Unit Chaplains The Rev Muriel Knox and the Rev Jim Simpson lead the non-denominational Chaplaincy neighbouring the Eden Unit in the prefabricated building At present we have vacancies for a Social Worker and for a Psychotherapist Who’s who in Eden?

25. The Eden Unit is staffed by both formally trained nurses and by nursing assistants who, though they may not have a Nursing Degree, will have undertaken specialist Eating Disorders Training and in some cases other paramedical skills, such as phlebotomy (taking blood samples). The team is led by our two most senior nurses, Ward Manager Pauline Milne and her Deputy Lynsey Money. Our most experienced Staff Nurses are frequently entrusted with the role of Mentor to the Student Nurses who undertake work placements on our Unit. The teaching and learning roles allow our whole Team to engage in the continuing learning process that maintains the quality of the service we offer and often provides creative advances in the treatment of anorexia and related disorders. At times of intensive demand on the nursing team our regular staff may be joined by members of Cornhill Hospital’s Nurse Bank. These nurses may not have training specific to the care of people with eating disorders and are guided by our permanent staff. The Nursing Team

26. TRAINED NURSES: NURSING ASSISTANTS: Angie Milne – Day Programme Nurse (insert photo) Bernadette Laidlaw (insert photo) Debbie MacDonald (insert photo) Claire McFarlane (insert photo) Elaine Ross (insert photo) Emma Stephens (insert photo) Dawn Watt (insert photo) Kerri-Lee Watt Rose Amos (insert photo) Donna Campbell (insert photo) Jacqui Holmes (insert photo) Christine Leonard (insert photo) Emma Riley (insert photo) Kerry Robson (insert photo) Jenny Swankie (insert photo) Irene Thomson

27. Your individual care will be entrusted to a Key Worker identified from among the trained nurses. Your key worker takes a leading role in discussing, planning, implementing and monitoring your individual care plan. This may involve looking at past experiences to learn from which solutions and skills have worked well, which have not so far helped you and which may not have yet been tried. The Key worker may also act as your particular advocate with the team, for instance at Ward Rounds and other meetings, and will encourage you to complete questionnaires and assessments. However, you are encouraged to work with several different members of staff – it is not the case that you must put your entire trust in this one member of staff! When your own Key Worker is not on shift it is important to identify someone else who can take time to catch up with your progress and feelings The Key Worker Role

28. Members of the Eden and Aberdeen Eating Disorders teams were part of the group which met in 2006 to review the 2004 NICE Guideline on Eating Disorders, to update the evidence base and make recommendations specific to the Scottish context. These were published by QIS (Quality Improvement Scotland) and form the basis for treatment here. We are guided by evidence from other Eating Disorders and Medical Units to keep people alive and healthy in terms of warmth, rest, body chemistry, protection from infection and other aspects of health planning, and use dietetic expertise to inform nutrition. Unfortunately, there is very little research evidence for management of severe low weight anorexia nervosa and of complicated disorders. The best available evidence suggests positive results for the use of the drug Olanzapine. Younger patients and those living at home also benefit from Family treatments. The Eden Unit therefore offers these whenever possible but also returns to first principles in using individual ‘formulations’ to map out personalised care plans for each patient. ‘Formulation’ is a way of integrating the physical, emotional and psychosocial interactions of people’s strengths and vulnerabilities into a design for working towards recovery. Our multi-disciplinary team uses the 24/7 inpatient experience to build up a picture of each patient. We also incorporate the information provided by each patient, by families, and the results of questionnaires. Finally, we are proud to be part of several research initiatives exploringand developing best practice, and hope you will be interested in participating if invited. Treatments for weight-losing disorders

29. Family work is the most strongly evidenced treatment for Anorexia nervosa. We therefore include relatives and carers wherever possible. For many patients this will mean parents or partners are asked to take over the same sort of responsibilities at home as taken by the staff team here in the hospital. This is of course MUCH harder to do if you are emotionally involved with the patient and if you have already built up expectations of the way the relationship works. For patients, accepting a change in the relationship to help with earlier discharge home is an important part of progress. It’s also important to acknowledge that several studies have shown that the burden of stress involved in living with someone with anorexia nervosa is even greater than living with someone suffering from the most severe mental illnesses such as schizophrenia. It is helpful for carers to learn skills to deal with the extreme tension and often aggression that the illness can cause unless it ‘gets its own way’. The NEEDS groups are self-help monthly meetings for both patients and carers which we would encourage carers of our patients to attend. Staff can let you know of the dates, and the meetings are held just around the corner, in the Fulton Clinic. Working with families and other carers

30. Patients are given an individual dietary plan prescribed by the dietitian, and will be offered nutritional supplements such as vitamins and minerals to repair deficiencies. • The physiotherapist offers programmes for the appropriate levels of physical activity for each patient’s physical and psychological needs • Medical management may include medication for pre-existing medical or psychiatric disorders as well as symptomatic treatment and medications known to be helpful in the management of anorexia or other eating disorders • Eden offers a variety of individual and group treatments including Body Image therapy, Self Esteem enhancement, Nutritional Education, Cognitive Behavioural Therapy, Art Psychotherapy, Occupational Therapy and Physiotherapy. The programme varies from time to time to reflect the needs of the current group of patients • With your permission, family and other carers will be invited to participate in supporting your recovery • Individual key worker sessions will occur whenever your key worker is available. Other nurses will offer input too, particularly if your key nurse is not about. Our trained nursing staff have experience of counselling techniques and use the underlying principles of the therapeutic approach to inform their support of your needs as well as to contribute to an assessment of your readiness for... • More formal individual psychotherapy, carefully matched to your stage of recovery. Please note that psychotherapy can be a stressful experience so that if this occurs whilst your automatic response to stress is to lose more weight, it can hinder rather than help your recovery. What are the treatments offered?

31. Most patients stay for a few months rather than weeks, although very short admissions can sometimes be planned. There are no no hard and fast criteria for discharge – it happens when you are able to continue recovery without the support of the inpatient unit, so it depends on your own levels of motivation, the skills you have learned and the support available to you outside the unit both in your home and at the local Eating Disorders service. Social workers and Out Patient team may be involved in your discharge planning meeting, which takes the same form as the 6 weekly review meetings you have been used to holding throughout your stay. Sometimes patients are discharged sooner than they expected, or decide to leave before the original date planned for discharge. The Team will usually host or attend a Discharge Planning meeting even after you have left, because of the importance of communicating what has been learned from your admission and the need to assess the follow up care you need. It is often the case that in-patients move over to join the Day Patient programme as a stepping stone to full discharge to out patient care. The Day Programme expects people to commit to a minimum of a 12-week session, with 6 weekly reviews. Some patients will need substantially longer to consolidate recovery. The Day Programme is unique in Scotland in offering intensive support to translate the new skills learnt in the inpatient unit to your home setting. Arrangements for discharge

32. Day ProgrammeThe Day Programme attached to the Eden Inpatient Unit provides suitable patients with an opportunity to generalise progress made in IPU or to avoid requiring admission altogether in some cases. Some patients may be treated for more than 12 weeks. All patients are asked to prioritise attendance on a Tuesday, as this is currently the day on which the Day Programme weekly Community Support Group is held. In addition to this, Day Patients will meet for individual sessions, therapy on an individual, couple or family basis, and groups which may be shared with Inpatients or may be pitched to a more advanced level of motivation. Some patients may attend on 5 weekdays plus weekends, whereas others may need only one or two days. This will vary, usually decreasing during the admission.Not all inpatients benefit from Day Programme attendance. In some cases it is preferable to resume links with a well known outpatient therapist as soon as possible. Other patients may have to travel too far for attendance to be feasible. In these cases we hope to have offered opportunities for extensive home passes to allow patients to test out their capacity to live independently and still continue to progress.All patients are reviewed after 6 weeks. The Outpatient worker or their representative attends reviews as well as the discharge planning meeting

33. The Eden Unit telephone numbers are as follows: Nurses’ Office: 01224 557586 Nurses’ Station: 01224 557521/557699 Ward Secretaries 01224 557769/557758 There is a cordless phone available for your incoming calls and if you are available a member of staff will bring this to you. The number for this phone is 01224 557440 – calls to be limited in length. If you or your carers wish to communicate by email, the Unit’s email address is grampian.edenunit@nhs.net. Emails are receievd and accessed by our secretaries who then forward them to the individual member of staff to whom they are addressed. They may also be printed and stored in patients’ medical records where, theoretically they may be accessed by other medical staff. • We welcome any comments you have regarding your stay in hospital. If you would like to comment on the care you have received or on any aspect of your stay in hospital please let us know by completing one of the Grampian NHS Feedback Cards. These are available from any member of nursing staff. • If you are unhappy with any aspect of the service you receive, please speak to the Unit Manager, Pauline Milne (or in her absence to the Nurse in charge). • If you have any suggestions or complaints and for any reason you would prefer not to speak to a member of staff, you may wish to complete a Feedback Card. • The Hospital Advocacy Service is also available to help represent your expressed views. Their office is next to the canteen, opposite the WRVS hospital shop. COMMUNICATING WITH US AND MAKING YOUR VIEWS KNOWN