On Our Mind
Nottinghamshire Healthcare NHS Foundation Trust provides integrated healthcare services including intellectual disability, mental health, community health, forensic and offender healthcare services across Nottinghamshire, Leicestershire, Lincolnshire and South Yorkshire.
Our On Our Minds blog shares lived experiences from colleagues at the Trust and patients who use or have used our services on a variety of topics from a wide range of services.
Seeking more timely support for all in eating disorder care
For Occupational Therapy Week, Esther Dark, Specialist Occupational Therapist in the Trust's Nottinghamshire Eating Disorder Service delves into this year's theme, 'Right Support, Right Time: Unlocking the Power of Occupational Therapy' which centers upon highlighting occupational therapy's importance in prevention-focused care.
Eating disorders hold the highest mortality rates of any psychiatric illness; however, outcomes are more favourable with early intervention (Koreshe, et al., 2023). An example of early intervention in the UK is the development of the First Episode and Rapid Early Intervention for Eating Disorder (FREED) pathway for 16-25-year-olds with an illness duration of under 3 years. FREED aims to reduce the length of time between treatment seeking and receipt of specialist evidence-based treatment. FREED has been rolled out across many eating disorder services in the UK - including Nottinghamshire Healthcare Eating Disorder Service - and research demonstrates its efficacy in improved recovery outcomes (Fukutomi, et al., 2020). James Downs, an advocate of lived experience, considers that the principles of FREED can be replicated and broadened to those of any age however severe and/or longstanding this may be (Downs, 2025). This is particularly pertinent when considering the needs of those with longstanding eating disorders.
Individuals with longstanding eating disorders, or commonly categorised as 'severe and enduring eating disorders' within clinical domains and literature, are considered to be a sub-set of patients based on persisting illness duration, severity of symptoms and previous treatment utilisation (Robinson, Kukucska, Guidetti, & Leavey, 2015). A service evaluation within Nottinghamshire's Adult Eating Disorder Service is currently underway which seeks to understand and scope the needs of those with 'longstanding eating disorders' to inform future care.
As an Occupational Therapist leading this service evaluation, I feel the skills and values of occupational therapy are perfectly placed to prevent ongoing functional difficulties formed and maintained by the eating disorder. Prevention is at the heart of occupational therapy as it utilises a holistic approach to promote wellbeing and support independence. I believe intervening early to prevent further suffering and pain can be present in every interaction we have with patients, at any given moment, irrespective of length or severity of illness. Indeed, 'early intervention' is not only for interventions occurring prior to difficulties becoming entrenched, but can mean timely, prompt and rapid interventions for all (Downs, 2025). As such, this service evaluation has a vision to create care where course of illness is not prioritised, but is needs-led, and which seeks to implement compassionate, well-timed and effective treatment for all.
Occupational therapists are key members of the multidisciplinary workforce in eating disorders, providing holistic interventions to support individuals to develop and master skills and strategies within their everyday lives to overcome functional challenges (Willman, Hobbs, & Thomas, 2024). To truly understand the lived experiences of individuals with longstanding eating disorders, and to overcome potential barriers to interventions, this current service evaluation is embracing co-production whereby individuals with lived experience are invited to share their views and perspectives of care. Co-production has been considered a key pillar in improving eating disorder services in the UK (NHS England, 2019). By privileging the voices and experiences of individuals, co-production ensures future services and care are tailored to meet the needs and goals of individuals, increasing the likelihood of early intervention and prevention of more complex and entrenched difficulties.
Occupational therapy, as a profession, has a wealth of evidence to support its role in reducing and preventing mental health difficulties, improving social functioning and decreasing hospitalisation. The service evaluation seeks to make broader changes where it is hoped that our service will be more accessible for all our patients to prevent further decline, isolation and improve wellbeing. It is hoped this example of occupational therapy placed in an adult eating disorder service will inspire and educate colleagues within the Trust on the unique and incredibly important role of occupational therapy's role in prevention and early intervention.
If you would like to find out more about occupational therapy, please look at the resources on the Royal College of Occupational Therapists website.
Find out more about the Trust's Nottinghamshire Eating Disorder Service here.
Thinking about occupational therapy as a career, visit the Trust's recruitment website.
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