Multidisciplinary care

Preparing for eventual discharge is an integral part of the treatment planning process, starting with the initial goals set at admission and continuing throughout every stage of patients’ care at Newmarket House as they develop the resources and practise the skills that will serve as the foundation for their ongoing, sustained recovery at home. Patients frequently start their admissions with a narrowly defined set of goals focused around eating and weight but find their aims for recovery expand to encompass a variety of domains as they come to understand themselves better, reconnect with interests and aspects of their identity that may have been eclipsed by their illness and develop a sense of optimism for the future. Discharge planning includes working with patients’ outpatient teams to offer the right level of clinical support to help step down from inpatient care and may also extend to supporting patients in accessing additional community services and planning next steps in education, employment and other vocational activities.

Group Programme

From the beginning of their admission, patients attend the weekly therapeutic group programme consisting of two to three groups per day. The programme includes a balance of psychotherapy groups (e.g., DBT skills, MANTRA, body image and self-compassion groups), occupational therapy interventions (e.g., occupational science-based groups, identity exploration and creative occupation groups), process groups (e.g., discussing living together and reviewing the week) and expressive arts groups (e.g., music and art).As their admission progresses, patients can also choose to participate in other activities such as the baking club and gardening group.

The programme is designed to offer patients new perspectives through which to understand themselves, their strengths and difficulties, equip them with an array of therapeutic strategies, foster their confidence and motivation for change, provide opportunities for self-expression and identity exploration and reinforce a sense of community in which everyone is working together on a common goal of recovery.

Psychiatry

Psychiatry at Newmarket House is holistic and recovery-focused, taking the position that good medical outcomes are necessary but not sufficient for patients to overcome their eating disorder. At admission, patients are assigned to one of our two consultant psychiatrists, Dr. Jon Wilson and Dr. Sarah Maxwell, who together have over forty years of specialist experience working in eating disorders. Jon and Sarah oversee their patients’ treatment, meeting with them weekly for a treatment review and chairing their broader CPA treatment planning meetings every four to six weeks. They also manage patients’ medical monitoring and review and adjust medications as clinically indicated. They liaise closely with other members of the multidisciplinary team to help maintain a safe, coherent and effective approach to each patient’s care focused on helping them to achieve their recovery goals.

Psychology

Patients receive weekly individual psychological therapy throughout their admission. This is designed not only to help support patients in the challenging process of progressing through the various treatment stages, but also to identify and address broader themes and difficulties that may underlie and contribute to the maintenance of their eating disorder. Psychological therapy is interwoven with other aspects of patients' care and our psychologists work closely with the rest of the multidisciplinary team. At the same time, therapy sessions offer patients the chance to reflect with the benefit of a little distance from other, daily aspects of the treatment programme. Meeting in self-contained therapy rooms located in quiet corners of the garden reinforces this sense of perspective-taking.

Our clinicians are trained in a variety of treatment approaches to include ACT, CAT, CBT-E, DBT, EMDR, MANTRA and RO-DBT and therapy is tailored to each patient’s particular personality style, strengths, challenges and goals. Enhanced Cognitive Behavioural Therapy (CBT-E) offers a tailored but focused approach primarily targeting eating, weight and body image-related difficulties. The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) focuses on the emotional, thinking and relationship patterns that can maintain anorexia and helps patients to re-establish a sense of identify that may have been undermined by their illness. If a patient’s eating disorder is underpinned by broader emotional and behavioural dysregulation difficulties, they may particularly benefit from Dialectical Behaviour Therapy (DBT), whereas if they are very overcontrolled and rigid in their thinking and behaviour, Radically Open DBT (RO-DBT) may be especially helpful. When patients' emotions and beliefs about themselves and the world are heavily informed by painful past experiences, Eye Movement Desensitisation and Reprocessing (EMDR) can bring resolution and help open a door to sustained recovery. Cognitive Analytic Therapy (CAT) is often particularly useful to patients whose eating disorder forms part of long-established and unhelpful patterns of relating and reacting to others and themselves. Acceptance and Commitment Therapy (ACT) can assist recovery by helping patients to “unhook” from the distressing emotions and unhelpful beliefs that fuel their eating disorder and to connect with a sense of self and related goals and activities that may have been eclipsed by their eating disorder.

Reflecting our personalised approach to care, therapy at Newmarket House is frequently integrative, incorporating elements of these different treatments. Whatever the approach, there is an emphasis on understanding the eating disorder as symptomatic of other challenges and supporting patients in resolving these, developing confidence and accessing a positive sense of self in order to promote their sustained recovery.

Occupational Therapy

Occupational Therapy (OT) forms a central part of Newmarket House’s recovery-orientated programme. OT is an holistic, person-centred approach that supports both mental and physical health, empowering individuals to live meaningful lives and reach their full potential.

Patients receive OT throughout their admission and in a variety of formats, including individual sessions, therapeutic groups and as part of our structured Recovery Goal Setting (RGS) programme. Beyond scheduled sessions, OT is embedded in every aspect of daily life at Newmarket House: by helping patients to build their occupational identity and engage with activities that matter to them, through assisting them in identifying their sensory and emotional coping styles and developing strategies that promote positive coping, by supporting them in establishing healthy routines and encouraging occupational balance.

Where indicated, OT can include sensory assessments and interventions to support emotion regulation, reduce distress and promote a sense of calm and safety. Based on assessed sensory preferences, patients may be introduced to calming or alerting strategies, sensory tools and routines that can be integrated into daily life as part of their personalised care plan. Newmarket House offers all patients the option to spend time in our sensory room, adapting the different tools and equipment to their sensory preferences. Sensory approaches are especially helpful for people who experience anxiety or emotional dysregulation and can be integrated into patients’ care plans and post-discharge relapse prevention plans.

A key focus of OT at Newmarket House is preparing patients to manage and ultimately thrive in their own environment following discharge. In the latter stages of patients’ admissions, OT sessions are used to create graded, personalised plans that help them transpose the skills and strategies they have developed at Newmarket House to their home context. Patients develop a variety of practical life skills to include managing domestic tasks and daily routines, grocery shopping and cooking, eating out in the community, making social plans and exploring future opportunities in work, study or volunteering.

Dietetics

The goal of dietetics at Newmarket House is to support patients’ physical health restoration in a safe and steady manner, to help them establish a consistent eating pattern that will serve as a foundation for their sustained recovery, to reduce their anxiety around food and to encourage an increasingly flexible approach to eating in line with their goals for the future. Meal plans are individualised and reviewed regularly by our dietitian and an alternative menu is available to accommodate neurodivergent patients.

Sessions between patients and the dietitian are typically limited, especially in the early part of service users’ admissions, in order to reduce the clinical focus on food and provide them with the mental space to concentrate on other aspects of their recovery.

The cooking of meals in our communal kitchen, clubs such as baking group, the use of vegetables from our garden and moving towards more flexible meal choices (e.g., ordering a takeaway or going out to a café) in the latter stages of their admission are all designed to help patients develop a more relaxed relationship with food.

Nursing and Support Work in the Therapeutic Milieu

Recovery is a 24/7 occupation. It takes place not only in groups, therapy sessions and review meetings but also through the day-to-day, minute-by-minute processes of challenging eating disorder thinking and impulses, confronting fears, practising new behaviours, finding new ways to communicate and seek support, acknowledging strengths, managing distress and celebrating change. Newmarket House has a strong and experienced team of nurses and support workers who approach the work of supporting patients through their treatment with the confidence, compassion and expertise that come from having assisted hundreds of patients in their physical and psychological recovery.

Our nurses are all highly experienced in and knowledgeable about the medical risks that can be associated with eating disorders, particularly in the early stages of an admission, and play a key role in monitoring and maintaining patients' safety. Every patient has a key nurse with whom they check in regularly about their current treatment progress and goals. They also receive daily support space meetings with support workers and are assigned a Recovery Goal Setting worker, who works with them individually on setting and working towards goals based on their values and linked to their current stage of recovery.

As well as these structured interventions, nurses and support workers assist patients in gradually taking responsibility for their eating and other aspects of self-care and in balancing seeking support from others with accessing their own internal coping resources. They support patients as they begin to reengage with activities such as cooking, eating out and shopping. Through their interest, empathy and positive regard, they encourage patients to share their interests, show vulnerability and express themselves in ways that have frequently been hindered by their eating disorder. These continuous, daily therapeutic interactions facilitate patients’ incremental upward spiral of recovery.