Sarah Fuller is a CAMHS Dietitian, based in Luton and Bedfordshire CAMHS, who specialises in Eating Disorders. She has recently been added to the British Dietetic Association's (BDA) Roll of Honour in recognition of her ground breaking work on naso-gastric tube feeding under restraint as well as work on understanding veganism in eating disorders. This would usually be celebrated at the BDA's annual award ceremony but sadly this year, the awards were conveyed virtually so her moment in the spotlight didn't happen. Sarah is also shielding, so we are highlighting her achievements with an interview to understand her work and find out how the Eating Disorder service has been supporting young people and their families during the pandemic.
Congratulations on being added to the BDA's Roll of Honour for your work in eating disorders with young people. Can you tell us a little about these two studies? What did your work on veganism entail?
Veganism is an increasing choice for many people for a range of reasons. But sometimes, it might be symptomatic of someone who is trying to control their intake of food which can lead them to become seriously underweight. Our role as dietitians is knowing when to support veganism and knowing when to call it out. Veganism is a protected status by law and a patient cannot be denied or discriminated for their belief and practice of veganism. So we have worked with The Vegan Society to develop meal plans which provide up to 3,000 calories to enable someone reach a healthy weight and be vegan too. If someone is resisting food because it's not vegan, we can say, that's fine. We have some good options for you that are all vegan. Sometimes, later down the line, a young person will acknowledge that veganism enabled them introduce restrictions which supported their view of their body. But my job is not to dissuade anyone from following their values about veganism, it is to unpick what is going on, and support them in their choice and work with that choice, so they achieve a healthy balanced diet.
And your work on least restrictive practices when tube feeding?
As you can imagine, this is a sensitive area. When someone's weight is gravely low, as well as therapy and other interventions, there may be the need to feed them against their wishes because their weight has reached a point where not to intervene could be life threatening. In such cases, people would be admitted under a section of the Mental Health Act. There was very little guidance or research out there about this and the usual approach was to administer a feed each day via a naso-gastric tube using a pump to deliver a litre of feed over several hours. In my view, this is the equivalent of asking the person to stay in a burning room! If you are scared of eating, this is a long time. As a result of our findings, the recommendation now is to administer up to one litre of feed over ten minutes. This change in practice allow the patient to engage in a more meaningful way with therapeutic activities.
Who is in the working group and what has been the response of young service users with an eating disorder?
There are 16 people in the working group with representation from the BDA and the Irish Nutrition and Dietetic Institure. (INDI) From the very start it has taken us five years to work through the literature and relevant studies to completion and endorsement of the guidelines. It has been a great forum for discussion and there has been national and international interest in our work into this complex area of care. The feedback from individual young people, their families and staff is that this approach is greatly preferred. It protects the patient and the professionals because there is a clear process for this procedure.
How did you come to work in CAMHS as an Eating Disorder specialist?
I kinda fell into it. I worked as a paediatric dietician at Luton and Dunstable Hospital. Patients would turn up emaciated in our unit. It was very upsetting and they were generally transferred to a specialist facility. I just felt that we could probably do more before that. That we needed to understand what was happening to the young person which led to them being in this situation. It started small. I did three days a month to start with and now there are three dietitians supporting the CAMHS eating disorders service now.
How have you been able to support young people and their families during the lockdown?
The whole team is working remotely now. Working online has been good. Initially there were no new referrals; people were anxious about going to their doctor and were worried about being admitted to hospital, but now we have a large increase. We are busier than ever but the feedback from patients and their families has been good. There has been the odd problem when a family have internet difficulties but mostly it has been fine and we have been able to provide good support.
What have been the benefits of working in this way?
More collaborative working. We have had good feedback from young people and their families. They thought that they would not be able to get a service during the pandemic, but actually, there is a lot we can do and people want to be managed at home. We have introduced a new assessment for face to face consultations.
How have the team stayed connected and in touch?
We have a daily huddle at 9am which is good to understand who may need extra support that day (both staff and patients.)
Once a month we have a shared lunch. We each have our lunch at our screens together. This is much more relaxed and when we talk about normal stuff like the excitement of booking a haircut!
Working at home, how do you manage to switch off?
I don't think I really am and that something I need to work on. I walk my dog every day which helps to clear my mind.
I am working in the kitchen on my University work as I am finishing off a MSc in Child and Adolescent Mental Health and our dining room is full of my NHS work stuff. My partner is also working remotely but is working in another room as I need to safeguard confidentiality when talking to service users. Like many couples, we bickered over the broadband at the beginning when we were both using it but we upgraded to a better deal and now and there are no more problems. It's nice to check in on each other during the day.
Sarah was interviewed by Janet Flaherty, ELFT's Head of Communication