We accept referrals for patients who fulfil one or more of the following criteria:

• Low body weight i.e. a Body Mass Index (BMI) of less than 18 usually as a result of rigid and purposeful dietary restriction and often a co-morbidity with low mood, depression or suicidal ideation (but not requiring immediate general hospital admission).
• Recent history of rapid weight loss e.g. more than 0.5 kg a week for 12 consecutive weeks or more, as a result of rigid and purposeful dietary restriction.
• Moderate binge eating, purging behaviours or self induced vomiting several times a week for three months or more. This may be indicated by low electrolyte levels, particularly potassium and calcium.
• Patients who have recently been discharged from inpatient services having made some improvement and now require support in the community

Before we assess a patient, a written referral is required to include:

• Recent details of eating disordered behaviour
• Weight history
• Presenting BMI
• Treatment history
• Current care plan

Referrals should be emailed to cotswold.house@oxfordhealth.nhs.uk

We may request joint assessments with the local PCLS if we feel that the patient will benefit from input from other services.  We aim to arrange assessments as soon as possible; often assessments are arranged within a few days of receiving the referral.

After assessment, we will send the assessment report to the patient, GP and PCLS/Recovery Team (if applicable), which will include recommendations for treatment. This could include day or inpatient treatment at Cotswold House Marlborough.

We will contact the patient following the assessment to arrange their treatment appointments. If inpatient or day patient treatment is recommended, but we are do not have the capacity to offer these services immediately, we will look at outpatient support in the interim period.

Professional opinions vary as to the best way to manage the long term patient who is not motivated to recover from her/his eating disorder, so-called SEED patients (Severe and Enduring Eating Disorders).

We believe that these patients may require inpatient management when the medical risks become too great to be managed in the community, when the history suggests that a threshold for serious medical or psychiatric sequelae is approaching, or as a ‘stitch-in-time’ to prevent a much longer admission being required later on.

Patients become more entrenched than ever in their eating disorder behaviours as their weight drops, and so can be caught in a spiral of decline into which they may not have insight if their cognitive abilities have been affected. We further believe that some such patients may need to be assessed under the Mental Health Act if the risk to their health or safety is great enough to warrant inpatient treatment but they are not willing to accept it.

The aim for this group of patients is to maximise their level of functioning and quality of life in the community, whilst leaving the door open to more active engagement and treatment should they be able to commit to recovery at some point.