THE EDEN UNIT

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THE EDEN UNIT

• GUIDE FOR PATIENTS
• THEIR FAMILIES FRIENDS
• The Eden Unit, Block C Clerkseat Building,
• Royal Cornhill Hospital, Cornhill Road,
• Aberdeen AB25 2ZH

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We dont want you to feel overwhelmed -
please dont 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.

• 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.

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CONTENTS

• 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
• Whos 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

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• 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.

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The Eden Unit history and
geography

• 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.

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What happens when you are first admitted?

• 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 McKinlays 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

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When you first join us

• 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.

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• 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.

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• 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.
•  
•  

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FINDING YOUR WAY AROUND

• 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 Edens
  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 dont 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 visitors 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.

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• Around the Cornhill/Berryden area -
• There is a Sainsburys, Next, Mothercare,
  Toysrus, 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)

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Looking after your property

• Cornhill Hospitals policy is that
  personal property is brought in at the owners
  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.
• Dont forget to collect your
  belongings when you leave the ward again!

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THE DAILY ROUTINE ON EDEN

• 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 its
  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 peoples 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 days 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.

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Our Weekly Timetable

• 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.

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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. Its 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 peoples 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.
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. Its 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
peoples 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

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The thinking behind the way we eat

• 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, its as important as
  when you were a growing child to take in food
  rich in phosphate, such a milk.

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• WHAT HAPPENS IF WE ARE TOO ILL TO EAT ENOUGH?
• All of us have to eat human beings, like
  other animals, dont 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 dont 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.

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Coping after mealtimes

• 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 peoples
  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.

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•  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 its not helpful for patients if there
  are too many visitors on the Unit - they may
  feel terribly exposed when they dont 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
  peoples 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

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• 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 dont
  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.

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Going on pass

• 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.

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Whos who in Eden?

• 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)

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Whos who in Eden?

• Art Therapist
• Leslie Spillman
• Cognitive Behavioural Therapist
• Jan Templeton
• Pharmacist

• Dietitian
• Tina McGilton
• Occupational Therapist
• Shona McCulloch
• Physiotherapist
• Sandra Philip-Rafferty

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Whos who in Eden?

• 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

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The Nursing Team

• 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 Hospitals Nurse Bank. These
  nurses may not have training specific to the care
  of people with eating disorders and are guided by
  our permanent staff.

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• 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

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The Key Worker Role

• 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

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Treatments for weight-losing disorders

• 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 peoples 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 exploring and developing
  best practice, and hope you will be interested in
  participating if invited.

29
Working with families and other carers

• 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.
• Its 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.

30
What are the treatments offered?

• 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
  patients 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.

31
Arrangements for discharge

• 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.

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
COMMUNICATING WITH US AND MAKING YOUR VIEWS KNOWN

• 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 Units email address is
  grampian.edenunit_at_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.