EUPD AND Eating Disorder

Emotionally Unstable Personality Disorder (EUPD) and Eating Disorder (ED) – Inpatient Care and Rehabilitation

Spencer South is an inpatient care a rehabilitation service providing highly specialist care for women with emotionally unstable personality disorders (EUPD) and associated complex eating disorder needs.

The service offers a solution for women who bounce between mainstream personality disorder and eating disorder services who are unable to support the complex co-morbidities that present.

The rehabilitation-focussed service allows women to learn and develop skills (psychological and occupational) that will enable them to discharge to community services at the earliest stage.

Admissions criteria

The service aims to help adult women, including transgender, who are 18 years+ old who:

  • present with a primary diagnosis of EUPD and an associated eating disorder as defined in DSM-V / ICD-10. This will include anorexia nervosa and its atypical variants, bulimia nervosa and its atypical variants, and Eating Disorders Not Otherwise Specified (EDNOS)
  • have significant eating issues as part of their principle diagnosis of EUPD
  • may have a forensic history
  • have complex needs and who pose a significant risk to themselves or others requiring hospitalisation for treatment.

Exclusion criteria

  • Women who are unwilling or unable to engage in comprehensive Dialectical Behavioural Therapy (DBT) adapted for eating disorders
  • who have a significant Learning Disability (not ASD)
  • who have dissocial Personality Disorder, anti-social Personality Disorder, or a primary diagnosis of eating disorder. Those with a diagnosis of PD may be supported in more appropriate services within the charity.

The national service is a Clinical Commissioning Group (CCG) and Healthcare Foundation Trust funded service and is able to accept referrals from these boards. Referrals from health boards outside of England will also be accepted when required.

Service aims and objectives

The service aims to provide:

  • A specialist solution for women with a dual-diagnosis of EUPD and ED, simultaneously treating both conditions
  • Provide a recovery and rehabilitation clinical experience, with skill learning (psychological and occupational) at its core
  • Reduce hospital length of stay and readmission for this patient cohort, addressing co-morbidities and supporting community discharge.

Patients who are admitted are unable to engage in an outpatient DBT programme due to their ongoing risk and need for hospitalisation.  Spencer South aims to teach skill and coping mechanisms (from the psychological and occupational programme) that enables patients to return to community settings within the shortest time possible. 

Innovative care model

Located in Northampton, Spencer South is part of a pathway with other non-secure Personality Disorder services, including Spring Hill House and Hereward Wake House. It is perfectly located to meet the needs of women with a comorbid diagnosis of EUPD and ED in the West Midlands and East Midlands.  In areas where there is a lack of inpatient beds Northampton is centrally placed within England.

 The treatment includes:

  • The five functions of a comprehensive DBT programme: enhancing capabilities (2 hours of DBT Skills group weekly); enhancing motivation (1 hour individual therapy weekly); generalising skills (coaching from DBT Assistants alongside DBT therapists); structuring the environment (Occupational Therapy programme, Incentive Programme, the unit’s operational policy); and enhancing skills and support for therapist/staff (training and weekly Consultation). 
  • A fifth DBT Skills group is added for Eating Disorders (Eating Awareness), which includes focusing on acceptance and validation to address eating difficulties and how mindfulness skills can be specifically applied to eating difficulties.
  • Adapted therapy groups, including body image, self-catering, shopping, self-esteem, motivation and exercise
  • Naso-gastric tube feeding (as required), bloods and naso-gastric management expertise
  • Community/Out-reach programme supporting in-patient discharge, including DBT input via telemedicine.

Pathway of care

Spencer South is part of a pathway of care consisting of three non-secure personality disorder services. These include:

  • a 12-bedded Specialist rehabilitation unit,
  • a 23-bedded Specialist rehabilitation service that has a stepped pathway from an extra care facility through 3 units with less environmental restrictions ending with a 3-bedded hostel-like accommodation
  • a 12-bedded specialist rehab unit for women with a dual diagnosis of EUPD and an ED.

The St Andrew’s site provides an unrivalled range of facilities and leading therapeutic care. Delivered by an extensive in-house clinical team (comprising  or Psychiatry, Psychology, Dietitians, Speech and Language, Physios and physical healthcare clinicians) patients are able to access a multitude of vocational, educational, creative and therapeutic interventions tailored to their specific mental and physical health needs. These include sport, exercise, horticulture, art and crafts and animal care.

Vocational opportunities offer patients the chance to develop work and life skills, in a fully supportive environment.  Those women with community leave are able to attend Workbridge (our on-site vocational centre which includes a garden centre, coffee shop, IT and design suite, woodwork and ceramics workshops) or community vocational placements.

Well-established teams

The Clinical Lead, Operational Lead and Responsible Clinician have extensive experience working with women diagnosed with EUPD and eating disorders.  Alongside them is an established multi-disciplinary team with specialist EUPD knowledge and expertise.   Staff regularly work across all 3 units ensuring that specialist skills and knowledge are shared across the IPU.  Staffing levels remain stable and turnover low with staff reporting high engagement scores. 

Family inclusion

Carer involvement is key to patients in our care.  Ensuring that they have as much information as they require (including a Carer’s Pack sent to them when their loved one is admitted) and regular contact from the Social Work team to ensure their views are heard in CPA meetings.   Overnight accommodation, an onsite Carer’s Centre, as well as Family Visiting rooms are available to ensure that visits are facilitated in comfortable environments. Family members are invited to our Carer’s events with their loved ones to ensure they are part of the patient’s care.

For referrals please contact 0800 434 6690 or email [email protected]

For further information about our clinical model, please contact Dr Emily Fox, Clinical Lead and Consultant Clinical Psychologist [email protected] or Dr Jonathan Baggott, Consultant Psychiatrist [email protected]

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