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The Early Intervention Eating Disorders programme uses the First episode Rapid Early intervention for Eating Disorders (FREED) model, in which services provide a specialist care package for 16 to 25-year-olds with a first episode eating disorder of less than three years duration. The aim of the programme is to support trusts to implement and evaluate this model and improve the care, experience and outcomes of young adults with eating disorders across the East Midlands.
Eating disorders are severe mental disorders with high levels of disability and mortality. A 2015 report estimated the UK prevalence of eating disorders at 600,000-725,000 people, with an associated £3.9-4.6 billion in NHS treatment costs, £6.8-8 billion in lost income and £2.6-3.1 billion in carer-related costs each year.
Eating disorders typically develop in adolescence and early adulthood, when the brain is still developing and can cause brain changes that negatively affect chances of recovery. Treatment outcomes are significantly worse after an illness duration of three or more years, compared to earlier intervention.
A key barrier to early treatment is poor access to services. A 2013 survey of young people found that 30% had to wait more than 18 weeks for eating disorder care and another 34% had to wait more than 6 months, 74% said their symptoms got worse while waiting. Likewise, research has shown that eating disorder patients who wait for treatment tend to deteriorate or stay symptomatic whilst waiting.
FREED (First episode Rapid Early intervention for Eating Disorders) is an innovative, evidence-based, specialist care package for 16 to 25-year-olds with a first episode eating disorder of less than three years duration.
The model enables providers to start treatment within four weeks of referral to an eating disorder service. It also attends to the specific needs of young people in the early stages of an eating disorder. It emphasises early, pro-active engagement; early symptom change; family involvement; attention to the effects of eating disorders on the brain; attention to social media use; and attention to transitions (out of school, to university, into work) and ‘emerging adulthood’.
Across 2016-2018, FREED scaled successfully from the eating disorder service at the South London and Maudsley NHS Foundation Trust (SLaM) to three other eating disorder services in England. Across 2018-2020, it is scaling to 20 new services as a result of funding from NHS England. Services who adopt FREED join the FREED Network. The AHSN Network are backing the national spread and adoption of this programme, with regional AHSNs supporting the implementation and evaluation of services in their area.
In initial evaluations, and compared to treatment-as-usual processes, FREED:
FREED supports the priority areas outlined in the 5 Year Forward View for Mental Health (MH5YFV) and the recommendations for eating disorder care outlined by the National Institute for Health and Care Excellence (NICE). FREED operates as a ‘service within a service’. It complements, rather than replaces, existing eating disorder services and treatments.
FREED is a low-cost innovation. Training, an implementation toolkit (including clinical resources) and implementation advice are offered for free to NHS services. There are no ongoing costs associated with being part of the FREED Network. The cost to services comes from appointing a FREED champion. Cost savings come from the reduced need for day-patient or inpatient care with FREED, and the expectation of fewer chronic cases and fewer treatment re-presentations.
In initial evaluations and compared to treatment as usual processes FREED has:
For more information about the Early Intervention Eating Disorders programme, or to have a conversation on how we can support, email: This email address is being protected from spambots. You need JavaScript enabled to view it.