BOOK REVIEWS: Community Treatment of Eating Disorders

Reprinted from Eating Disorders Review
January/February 2009 Volume 20, Number 1
©2009 Gürze Books

Community Treatment of Eating Disorders

By Paul H. Robinson; Chichester, West Sussex, England: John Wiley & Sons, 2006; 204 pp; $170

Although this fine book was published in 2006, it somehow slipped under my radar screen and I didn’t come across it until recently. What’s offered here is so unusual, practical, and potentially helpful to clinicians and administrators working in and/or wishing to develop eating disorders systems of care that I wanted to bring it to readers’ attention in spite of the fact that it is now several years old. This is not outdated information.

Based on his team’s experiences with the Russell Unit of the Royal Free Hospital in London and its affiliated programs, Paul Robinson, an experienced clinical researcher who’s focused on health services and service delivery to patients with eating disorders, has authored a book describing the evolution, infrastructure and practical management of an effective home and community-oriented system of care for patients with eating disorders. While the story has a decidedly British take and program development depended on the social and financial structures of the National Health System in England, there’s a great deal here for eating disorders stakeholders from anywhere in the world including the U.S. For those responsible for initiating, growing, or maintaining eating disorders care systems, this book offers indispensable perspectives.

Here’s where community psychiatry meets eating disorders. Starting with epidemiology and an estimate of what it would take to provide eating disorders care for a population, Robinson describes how to develop a “spend to save” business model argument in which a wrap-around model of guidelines-appropriate care is money-saving. He offers the staffing pattern of their unit as a blueprint for how to proceed, detailing a functional analysis of the professions and of what the unit requires. Add to this Robinson’s discussions of recruitment, retention and organizational management and you have a manual that administrators will want to see.

But, there’s more. Robinson offers detailed descriptions of the unit’s approach to initial outpatient assessment, physical assessment and monitoring and the psychological treatments offered, including a variety of family interventions. Step-by-step guides to programming include day hospitalization, community liaison with GPs, and decisions and utilization of inpatient treatment.

In one of the most helpful chapters Robinson describes programs for patients with what he terms “SEED” (severe and enduring eating disorders), the topic of a new book he wrote, which will be published in 2009. Activities devoted to rehabilitation and attention to the family are illustrated. A section on technical and academic aspects addresses matters related to establishing an eating disorders database, the use of e-mail and, staff training and development.

Program directors, program coordinators, and health-care administrators involved with providing services for eating disorders patients will all want to see this book. It will give them a chance to contrast and compare what they’re doing with what’s outlined here, and so that they might re-envision what might be achievable locally.

– J.Y.

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