Clinicians\u2019 perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic

Hannah Webb,Vanessa Lawrence,Janet Treasure,Catherine Mccombie,Stanimira Lazarova,Daniela Mercado,Gemma Peachey,A Louise Johnston,Bethan Dalton,Madeleine Irish,Tayeem Pathan,Hubertus Himmerich,Katie Au,Ulrike Schmidt,Jon Arcelus,Paul Robinson

doi:10.1186/s40337-022-00555-4

Abstract

BackgroundThe COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. However, the impact on clinicians working in these services is largely unknown. We therefore explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic.MethodsBetween May 2020 and June 2021, we interviewed clinicians (n = 21) who delivered IP and/or DP treatment to patients with severe AN in four specialist eating disorder services in the United Kingdom. Data relating to experiences during COVID-19 were analysed using reflexive thematic analysis.ResultsWe identified six themes: Disruptions to Routine Treatment; Introduction of Virtual Treatment; Separation from Treatment, Others and the World; Impact on Recovery; Impact on Staff; and Pressure on Referral Pathways. COVID-19 posed significant challenges to IP and DP services: forcing closures, operating with restrictions and virtual treatment, and impacting delivery of essential treatment components, referral pathways, clinician wellbeing, risk management, and patient isolation and recovery trajectories. Opportunities arose, in particular in DP services offering virtual support.ConclusionsCOVID-19 challenged the continuation of multidisciplinary treatment. The findings underline the necessity for medical, psychological, practical, and nutritional support, as well as carer involvement and fostering social connections to remain at the forefront of intensive treatment for severe AN. They also emphasise the uncertainty surrounding which intensive treatment may be best suited to which patient when, particularly within the context of virtual DP support.

Highlights

Since the start of the COVID-19 pandemic, there has been an increased demand for eating disorder (ED) care and support [1, 2]
We interviewed twenty-one clinicians working in specialist inpatient and day patient eating disorder services to explore their views on supporting people with severe anorexia nervosa during the pandemic
We identified that COVID-19 posed significant challenges for intensive treatment settings, forcing the closure or merging of eating disorder services, the delivery of treatment under restrictions, and the introduction of virtual treatment

Summary

Introduction

Since the start of the COVID-19 pandemic, there has been an increased demand for eating disorder (ED) care and support [1, 2]. Clinicians’ experiences of delivering ED treatment during the pandemic have been explored in a service evaluation of a young person’s ED service [3] and in an online survey of clinicians working in ED services in the initial stages (March–May 2020) of the pandemic [8]. These studies suggest COVID-19 has significantly impacted ED service delivery. The COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. We explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic

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