Our hard working, passionate, and dedicated eating disorder Leads from across London meet every six weeks to support each other make meaningful, positive changes to support our residents living with eating disorders. We are also extremely lucky and privileged to be supported by our colleagues with lived experience who are equally passionate about creating change and using their expertise to help services reflect and change.
Eating disorders have a significant impact on people’s lives
Eating disorders affect around 1 in 50 people in the UK – and around 1 in 4 of these are men. As one expert-by-experience says, eating disorders can be an illness of contradictions, pushing people to feel like they are achieving something or controlling an aspect of their lives whilst at the same time punishing and harming themselves. This pervasive nature of these destructive thought patterns and behaviours have a huge impact on peoples’ lives. From the physical impact of an eating disorder on the body, to the emotional impact that can come with isolation from friends and family. That is why talking about eating disorders and encouraging people to feel more confident to come forward for help is so important.
It’s important to raise awareness while improving services
The London Adult Eating Disorder Programme is committed to overcoming these barriers and making sure that everyone can access the care they need, when they need it. We’re working to reduce waiting times for patients accessing services and to make sure that clinicians are trained to spot and treat eating disorders early, especially in groups of people who might find it more difficult to make themselves heard. This includes men, whose symptoms can often go unnoticed by those around them.
Raising public awareness of eating disorders is crucial to achieving this goal, but we’re also working closely with services across London to make sure that when people do come forward for help, they’re met with compassion and consistently high-quality care. We also want to make sure that people are able to access high quality support, no matter where they are. If we know that one area in London is doing exceptional work, we want to make sure this is replicated across other services.
Despite challenges, we are determined to improve care for people with eating disorders
There has been some really exciting progress this year, with more eating disorder services across London introducing early intervention pathways for residents – the earlier we can support someone with an eating disorder, the greater their chance of recovery.
The ongoing cost of living crisis has impacted us all. Clinical teams are also feeling the effect of this, and are increasingly stretched for resources. However, as a collective, we are committed to delivering the best clinical care we can despite these ongoing challenges.
If you have used or provided eating disorder services in London (or further afield) and want to support the evolution of eating disorder services across the capital, please get in touch with us to find out more at rf-tr.mhtransformationlondon@nhs.net
By Dr Brian Sreenan, Consultant Psychologist, Clinical Lead for the London Adult Eating Disorder Programme – NHS England and Improvement (London Region)
A wide range of mental health conditions can occur during this time, most commonly depression and anxiety. There are some conditions specific to this time in a woman’s life such as tokophobia – a severe fear of childbirth, and post-partum psychosis – a severe but treatable illness that occurs after having a baby.
It is not always possible to predict whether or not a woman is likely to experience perinatal mental health problems. However, some groups of women are at much higher risk, for example, 1 in 4 women with bipolar affective disorder experience post-partum psychosis.
It is vital that women receive treatment and support as early as possible. If left untreated, mental illness can have a significant and long-lasting impact on women and their families.
Getting appropriate treatment and support for perinatal mental health problems can help prevent avoidable suffering and isolation, strengthen families, ensure children have a healthy start and help prevent suicide – which is a leading cause of maternal death in the UK.
Here you will find a wide range of information and resources on perinatal mental health support available across London.
This toolkit offers best practice guidance about identifying and treating tokophobia. It draws on the current evidence and recommendations of a group of experts in the field.
We would like to thank all the many people who have contributed to this toolkit in order that it can reflect the voices of women with lived experience and the realities of working in Maternity and Mental Health Services. In particular, Rebecca Webb and Susan Ayers at City, University of London, conducted systematic reviews of the literature.
Across London there are a variety of practitioners from different backgrounds, services and organisations who have been trained as Perinatal Mental Health Champions. Their role is to increase awareness and knowledge of perinatal mental health by cascading the training onwards to local colleagues, helping to improve engagement and access to services for those affected by, or at risk of perinatal mental illness; and promoting local integrated perinatal mental health care pathways. The training programme is designed to:
Increase competence and confidence in perinatal mental health practice
Develop place-based leadership for perinatal mental health across complex systems of care
Raise awareness of the importance of perinatal mental health across the workforce
This regional evaluation was undertaken by the McPin Foundation and was commissioned and supported by the London Regional Perinatal Mental Health Programme. Mcpin is a research charity specialising in mental health research using peer research methodology.
The evaluation focuses on the personal experiences of staff working in the London pilot MMHSs and the women and birthing parents using these services. It draws on in-depth, semi-structured interview data – collected between February and May 2021 – in order to answer key questions around the needs of staff and women/birthing parents, the extent to which those needs are being met, and the lessons that can be learned from their experiences.
This toolkit provides guidance for health care professionals involved in planning the care of women at high risk of severe postnatal illness.
A pre-birth planning meeting is key to ensuring everyone has a clear understanding of the care the woman will receive in the weeks surrounding the birth of her baby, so everyone knows what to do and whom to contact if there are concerns.
This toolkit is designed to offer advice to doctors and informs the multi-disciplinary team of best practice in providing preconception/family planning advice to women with a mental illness.
The document contains both information and resources and also recommendations that shift the clinical approach towards a collaborative model of care, using a strengths-based formulation.
This document is to provide guidance for health care professionals involved in the care of babies born to women who have taken medication for mental disorders (psychotropic medication) during pregnancy.
Its aim is to optimise and standardise the care of exposed babies and to provide guidance to health professionals (in particular neonatologists, paediatricians and midwives) on the appropriate assessment and management of the risks and needs of the newborn baby.
Any psychotropic medication that has been taken by the mother during her pregnancy and / or delivery should be documented in the baby’s notes. Babies who have been exposed to such medication should undergo a relevant assessment as set out in this document. This assessment will take place in the hospital, birthing unit or home (if home birth). Information on this process should be given to mothers during their pregnancy and at the time of the post-birth assessment, so they can feel confident about their baby’s wellbeing.
Chelsea is mother of two young girls, a military wife, worked as Midwife for three years and now works as a Lived Experience Practitioner at Transformation Partners in Health and Care.
Shavarnah wanted to share her truths, the struggles she faced with her mental health as a young mum and how she created MumStyleLDN, which was her first step to healing.
Lynette shares her experiences, as both a member of the public and as a professional within maternity services. Her experiences extend across nearly thee decades.
Having a baby can be joyful, exciting, and rewarding. However, it is also common for pregnant women/birthing people and new mothers or fathers/partners to experience anxiety, depression, or emotional distress.
As many as one in five women/birthing people experience emotional difficulties during pregnancy and in the first year after their baby’s birth. This can happen to anyone.
Every London borough has a Talking Therapies service which offers free, confidential talking therapy for people who have symptoms of anxiety or depression. They give priority to pregnant women/birthing people and fathers/partners.
Support across London
Below you’ll find a list of services available across London.
As part of its commitment to improving Maternity and Neonatal Services, the NHS Long Term Plan outlined the introduction of the Maternity Outreach Clinics (subsequently renamed Maternal Mental Health Services) to: “integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience”. The target is to have MMHS in every area of the country by 2023/24.
Who can access maternal mental health services?
The MMHS is intended to treat moderate to severe mental health difficulties presenting in four main pathways:
Maternal Mental Health Sites within London – there are four sites accepting referrals in London including The Maple Team based in North Central London, Maternity Trauma and Loss Care Service (M-TLC) in North West London, The Ocean service and the Tulip Service in North East London.
Please note that the sites in South East London and South West London are preparing to open services in 2023.
How to make a referral
Referrals can be made by any health or social care professional and self-referrals are being accepted by some sites. Not all pilot sites are offering all four pathways.
Partners are also able to be referred to an MMHS for assessment only, after which they will be signposted appropriately to other support services within their areas.
Each pilot site has its own referral form and criteria. Please see links and contact email addresses for each service.
Support across London
Below you’ll find a list of services available across London.
Maternity Trauma and Loss Care Service (M-LTC) for women and birthing people who live in North West London. Please view the following links for more information:
The Helix service is for women and birthing people who live in the boroughs of Lambeth, Southwark, Bexley, Bromley and Greenwich who are experiencing emotional distress, or mental health difficulties following a perinatal loss.
To make a referral to Lambeth or Southwark please access referral and leaflets here: Service Detail – South London and Maudsley (slam.nhs.uk) or contact the team directly here: Helixreferrals@slam.nhs.uk
To make a referral to Bexley, Bromley, and Greenwich please access referral and leaflets here: Our services | Oxleas NHS Foundation Trust or contact the team directly here: Oxl-tr.Helix@nhs.net
*The service will be opening in Lewisham and Croydon boroughs in 2023, please watch the SLAM Helix website for updates.
Regional Evaluation of The London Pilot of Maternal Mental Health Services
February 2023
In 2016, the independent Mental Health Taskforce published its Five Year Forward View (FYFV) on behalf of NHS England, which stipulated that women required access to specialist perinatal mental health services at the local level. NHS England recognised there was a gap in service provision for those requiring psychological intervention specifically related to their birthing experience.
In 2019, NHS England published its Long Term Plan, which set out the need to provide appropriate care to women and birthing parents who develop moderate to severe mental health difficulties due to certain maternity experiences (birth trauma, tokophobia, loss, and child removal due to safeguarding concerns) through the development of Maternal Mental Health Services (MMHS) as this had not previously been provided within existing services.
In 2020 MMHS came into being, to address the gap in provision between specialist services designed to address severe and complex maternity-related psychological difficulties on the one hand, and generalist services designed to address common mental health problems on the other.
This regional evaluation was undertaken by the McPin Foundation and was commissioned and supported by the London Regional Perinatal Mental Health Programme. Mcpin is a research charity specialising in mental health research using peer research methodology. The evaluation focuses on the personal experiences of staff working in the London pilot MMHSs and the women and birthing parents using these services. It draws on in-depth, semi-structured interview data – collected between February and May 2021 – in order to answer key questions around the needs of staff and women/birthing parents, the extent to which those needs are being met, and the lessons that can be learned from their experiences.
Community perinatal mental health teams support mothers who are experiencing moderate to severe mental health problems in the perinatal period to recover in the community. They also offer pre-conception advice to women with existing mental health problems who are planning a pregnancy.
They are staffed by a range of professionals and offer family-focused interventions, and work closely with maternity services, health visitors, IAPT, GPs, other community services and third sector organisations.
Support across London
Below you’ll find a list of services available across London.
The perinatal period is usually defined as the time between conceiving a baby and one to two years after giving birth. About one in every five women experience mental health problems during this time, making this a relatively common experience. Women may experience mental health problems prior to pregnancy and/or develop mental health problems during pregnancy or in the postnatal period.
People experiencing homelessness are among the most vulnerable and isolated in our society, with the poorest health outcomes. Traditional systems of health and care often struggle to meet their needs. Consequently, they are more likely to die young, with an average age of death of 45 for men and 43 for women (ONS, 2019).
Transformation Partners in Health and Care works with our regional partners with the aim of improving access to healthcare and the capacity and capability of the system to respond to the needs of people who are homeless, to improve their health and reduce their hospital admissions.
Browse this playlist of podcast episodes exploring homelessness and health, produced by the Transformation Partners in Health and Care Homeless Health programme team.
Personality disorders have been called the most misunderstood mental health condition. They have a legacy of confusion and controversy around diagnosis, language, what it means and how it impacts on individuals, even what they should be called.
Yet it is estimated that worldwide, around 8% of the general population report having complex emotional needs These figures rise to around 25% of people accessing primary care services and 50% accessing community mental health services will experience symptoms or behaviours related to the formally diagnosed.
This podcast series talks to people living with them – aiming to raise hope and understanding.
Good Thinking supports Londoners to look after their mental health and wellbeing in a way that works for them. Since its launch in 2017, more than half a million people have used our digital service to tackle anxiety, stress, low mood, sleep problems and other concerns.
Their podcast series captures the thoughts, feelings, and experiences of Londoners directly or indirectly affected by coronavirus. They ask them about the approaches they are taking to stay mentally well and share with you top tips on what you can do to stay mentally healthy.
The #AskAboutAsthma campaign encourages children and young people, their families, and those involved in their care, to ensure four simple and effective measures to help them control their asthma.
Their podcast below talks to people about their connection with the condition.
Personality disorders have been called the most misunderstood mental health condition. Now a team of people who have mental health and social difficulties commonly associated with a diagnosis of personality disorder, supported by Healthy London Partnership, is launching a campaign on Wednesday 25 May 2022 to raise awareness of a condition which affects an estimated 10-13% of the population, but which can result in rejection and stigma, rather than support.
The campaign centres on a series of podcasts, devised, produced and led by those with lived experience of personality disorder, to increase awareness and understanding, and raise hope regarding support and treatment options. In the first podcast, available from Wednesday 25th, three people diagnosed with personality disorders discuss what it is like to live with the condition.
On this page is a campaign toolkit including an article for your own publications/websites, a shorter article for websites and social media assets. The assets link to a web page which hosts the podcast and more information about personality disorders.
We hope you can use the resources on your own social media pages – using #UnderstandPersonalityDisorders – and with your own contacts and networks.
Personality disorders have been called the most misunderstood mental health condition. They have a legacy of confusion and controversy around diagnosis, language, what it means and how it impacts individuals, and even what they should be called.
Yet it is estimated that worldwide, around 8% of the general population report having complex emotional needs These figures rise to around 25% of people accessing primary care services and 50% accessing community mental health services will experience symptoms or behaviours related to the formally diagnosed.
A team of people who have mental health and social difficulties commonly associated with the diagnosis of ‘personality disorder’, supported by Transformation Partners in Health and Care, launched on Wednesday 25th May 2022, to raise awareness of a condition which affects an estimated 10-13% of the population, but which can result in rejection and stigma, rather than support.
The campaign centres on a series of podcasts, devised, produced and led by those with lived experience, to increase awareness and understanding of the conditions, and raise hope regarding support and treatment options.
The importance of diagnosing personality disorders
Personality disorders can be difficult to diagnose, and in the past, there has been controversy as to how far treatment can help. Research and the voice of those who have accessed help have made it clear that mental health services can and should help people with personality disorders
Diagnosis can help make sense of the condition – both for the person and for their family and friends. But for others, it may result in feeling marginalised by health care services, family and community.
There is too often a lack of understanding of the various personality disorders, even among health professionals. There is a need for more training, better access to information and, for some, a mindset change when it comes to addressing the conditions.
The NHS Long Term Plan for Mental Health makes a renewed commitment to improve and widen access to care for children and adults needing mental health support. Crucially, this includes ensuring change is co-produced, from design to delivery – with people with lived experience.
The Royal College of Psychiatrists defines a personality disorder as “an enduring condition which interferes with the sufferer’s sense of wellbeing and ability to function in full in ordinary social settings.”
There is disagreement about the term ‘personality disorders’, with some people finding it confusing or stigmatising. It can feel like being told that your personality is ‘wrong’. Some clinicians and people with lived experience prefer the term complex emotional needs or CEN.
Personality disorders are in fact a range of 10 different mental health conditions. However, some peopled find these classifications unhelpful, as most people with a personality disorder do not fit neatly into one category. According to the mental health charity Mind: “Some people believe the focus should instead be on what each person needs in order to deal with their problems and discover new ways of living, not what category they are in.”
Life can be difficult for people with a personality disorder as they can also develop other mental health problems such as depression and anxiety.
2. How many people are affected by personality disorders?
It is not known exactly what causes them, but it is thought to be a combination of genetic factors and life events.
4. How are personality disorders diagnosed?
Personality disorders can be difficult to diagnose. To receive a diagnosis of personality disorder, somebody must meet some or all of a set of diagnostic criteria.
Diagnosis can help make sense of the condition – both for the person with the personality disorder, and for their family and friends. But for others, it may result in feeling marginalised by health care services, family, and their community.
5. How are personality disorders treated?
In the past there has been controversy as to how far treatment can help., Recent research however has made it clear that mental health services can and should help people with personality disorders. Many people with a personality disorder do recover over time. Psychological or medical treatment is often helpful, but support is sometimes all that is needed.
There’s no single approach that suits everyone and treatment should be tailored to the individual.
6. Where can you get help for personality disorders?
If you are concerned that you might have a personality disorder, there are a range of resources available online which will help you further understand the signs and symptoms of personality disorders. This piece from the Royal College of Psychiatrists is a good place to start but we’ve also compiled a short list of other useful resources at the bottom of the page.
When starting a conversation about a potential diagnosis, the first thing you should do is visit your GP.
7. What is the NHS doing to better help people with personality disorders?
The NHS is providing an increase in funding from 2022 to enable transformation of community mental health services. It will work with GPs, commissioners, local authorities and the voluntary, community and social enterprise sector, and, crucially, with service users, their families, and carers to create a new, flexible, model of community-based mental health care for people with personality disorder/complex emotional needs.
The new models will offer dedicated services, jointly created with people with lived experience of personality disorders. Services will aim to provide timely access to evidence-based psychological therapies, and provide care for co-existing needs, such as substance use. People with personality disorder/complex emotional needs have sometimes experienced punitive approaches from services. The new models of care focus on compassion and an understanding of the trauma that so many people have experienced.
To find out more about personality disorders – and to get help in supporting someone who is living with one – please take a look at the further reading below:
A group for those who care for people living with borderline personality disorder or emotional unstable personality disorder, providing mutual support through discussions and the opportunity to speak to our lived experience facilitator.
This piece from mental health charity, Rethink, tells you what personality disorders are, what the symptoms are, and how you can get treatment. You might find it useful if you have a personality disorder yourself, or if you care for someone who does.
A briefing paper by think tank, the Centre for Mental Health, running through the policy implications of the research conducted on community support for people with complex emotional needs.
A supportive piece by Help Guide, which is a great resource for anybody supporting someone who is living with a personality disorder. It provides tips and best practices to improve communication, set healthy boundaries, and stabilise your relationship.
The Access, Delivery and Outcomes Task and Finish group preparing this statement was part of a larger Clinical reference Group originally set up by TPHC in Nov 2020 to contribute to the Long-Term Plan aims to increase recognition and treatment of people with a Personality Disorder. The group includes Clinicians, Lived Experience Practitioners and Charities from the London area.
This document has been created to inform conversations between clinicians, commissioners, and leaders within organisations and systems such as Integrated Care Systems (ICS), with the purpose of highlighting key considerations and priorities to shape improvements in access to care and support.
It has been created using the knowledge and experience of all the varied membership of the CRG to drive forward change that offers long term benefits to those who may attract or have a diagnosis of Complex Emotional Needs/ Personality Disorder.
the term ‘personality disorder’ is a necessary compromise that can still be stigmatising and limit the development and provision of adequate help for a broad and complex population.
Access this population involves an understanding of the basic emotional struggle with trust in relationships and engagement in this complex population
Clear, inclusive criteria for specific services and an open, flexible matrix of interventions aimed at engagement and coproduction of clients and their carers should coexist.
A consistent, ongoing practice of training and clinical reflection for clinicians and practitioners is necessary for rewarding integrated experience of smooth transitions in, between and out of care.
The Carers Guidance was written by Jarka Hinksman and supported by the wider Clinical Reference Group and TPHC. The guidance has a focus on Complex Emotional Needs carers however the principles outlines are relevant for all care givers.
The motivation for compiling this guidance is the experiences of carers of people living with Complex Emotional Needs (CEN) receive virtually no attention directed towards their particular characteristics, needs and requirements, despite mental health carers being increasingly recognised by healthcare services.
As such, this Guidance provides evidence-based reasons for them to be supported in their caring role so they can become confident and effective partners in care.
Colleagues in Dementia and OPMH Policy Team at NHS England & Improvement team have also produced standards for older adults. The prevalence and importance of complex emotional needs in older adults is now being increasingly recognised. The document provides recommendations on what needs to be considered when thinking about how these services will meet the needs of older adults.
In doing this, services will be addressing health inequalities, by ensuring that age-appropriate access to care and support is available to all.
Perinatal peer support is an active intervention where people use their own experiences to work directly with women/birthing people and their families. Perinatal peer supporters or peer support workers have experienced some form of perinatal mental ill-health and recovery which they draw upon to offer a safe space, a listening ear and support to others going through similar experiences. Accessing peer support during the perinatal period has been shown to have a positive impact on women’s overall health and wellbeing.
There are several peer support options in London provided by both the third sector and the NHS. NHS services such as Community Perinatal and Maternal Mental Health Services provide this support to women with moderate to severe mental ill-health. Women and birthing people can access mental health and emotional wellbeing support flexibly through the third sector.
To help support women and professionals to understand and access peer support, TPHC and London’s third sector organisation have developed a directory of organisations that offer perinatal peer support across London.
Third sector organisations working with specific groups
Certain organisations from those already listed above provide support to women with special circumstances:
Support in multiple languages – Manor gardens (NCL), Parents in Mind (NEL), Newham Nurture Programme (NEL), Maternity mates (NEL), The Ectopic pregnancy trust (Citywide)
Support for women from Black and ethnic minority backgrounds – The motherhood group (SEL), Prosperity’s birth companion (SEL)
Support for women in prison – Birth companion (Citywide)
Support for women living with HIV – 4M Network (Citywide)
Young mothers – YoungMumsAid (SEL)
Women in high deprivation – Newham Nurture Programme (NEL)
Listening to experiences and voices
To ensure women and birthing people on the maternity pathway have their voice heard, a team of women and their families, commissioners and providers work together through Maternity Voice Partnerships (MVP) to review and inform the development of local maternity care. To contribute to developing your local maternity care services, click here to find your local MVP and their contact details.
Support across London
Below you’ll find a list of services available across London.
