Inpatient: Episode One - Outpatient Difference and Daily Structure

There are two main setting in which therapy for eating disorders can occur in – outpatient, or inpatient. Outpatient is where the patient is treated outside of hospital or recovery centres, living at home, the Uni halls, school dorm, or in another environment in the community. While the therapy may be given through a hospital or residential setting, the patient does not reside there. In contrast to this, inpatient (also known as residential treatment) is when the patient is admitted into a hospital ward or residential where they will stay and receive their treatment in that environment. This option is more intense:

• Specialist nurses – Specific nurses are assigned to your care 24/7 – yes, even when you sleep, and even on weekends) to ensure that you are thoroughly supported throughout your stay whenever you need it

• Food - the meals and snacks you eat are from a set hospital menu which is either decided by your parents, your team, or yourself, the timing of these meals and snacks are mostly decided by the ward (unless you are nearing the end of your stay, or further along in your treatment where you have more freedom over your food), and you are required to have supported supervision after meal times to ensure that the meal remains eaten, and so that you have a bit more extra support around a difficult time for most patients. The inpatient environment also enables nasogastric tube feeding to occur if the patient is physically compromised, struggling with oral intake, and an array of other reasons

• Therapy – depending on your treatment, you will have appointments with psychiatrists, psychologists/therapists, occupational therapists, dieticians, social workers, physiotherapists, and other alternative forms of therapy

1. Psychiatrists – for medication changes, changes to your inpatient treatment plans

2. Psychologists, Therapists, and Social Workers – for therapy in addressing your mental health (CBT, DBT, ACT, family therapy, Maudsley therapy, and/or other alternative therapy forms)

3. Occupational therapists – can take you out on leave, give you opportunities to make and eat food yourself, and can address any areas in your wider life that may be impacting on your mental health/illness and greater recovery

4. Dieticians – for making sure that you are receiving the right nutrition and energy so that you meet the expected weight targets, and for re-educating you on food and its role in your life – we’re talking fear foods, fats, carbohydrates, sugar, processed foods, anything and everything

5. Physiotherapists – for addressing body image, body dysmorphia, exercise, and for offering restorative and relaxing yoga/stretching classes

6. Physical monitoring – blood pressure, pulse rates, ECG recordings (heart recordings), blood tests, body temperature, urinary output. This is to ensure that the patients physical and mental health needs are being monitored, improved, and maintained during your stay in hospital

7. Exercise – this is usually not on the cards for anyone until they are nearing the end of their stay or are progressing well in their care. Depending on the patient, you may be on bedrest, confined to a wheelchair, or you may be able to walk around the ward if you are physically stable. In my experience, I was allowed one 15-minute walk outside which was first taken with a ward nurse and I eventually was trusted to go alone. I was also allowed to go swimming a few times a week at a local public pool – but only when I was reaching my weight targets and with the approval from my care team. Sometimes, the physiotherapist offered gentle and relaxing yoga/stretching classes for some of the patients but once again, you needed approval in order to participate

8. Weight gain – the topic everyone wants to know but doesn’t want to accept. The expected amount of weight restoration is typically greater than when outpatient (1.0-1.5kg each week inpatient compared to 0.5-1.0kg each week outpatient), but this is to ensure that the patient’s stay is as short as possible and that you reach physical restoration and stabilisation as soon as possible. It is well known that the best progress and gains in mental therapy is when you are as least physically compromised

9. Other therapy – this will vary depending on where you are staying. Patients may have access to a craft room for art therapy, have animals come in for a pat, or have external professions provide their services such as massage or nail painting

So, now we know how inpatient differs from outpatient care, I’ve provided you with what a typical day looked like for me during my admissions to the ward (a reminder that this was specific to where I was staying – the routine and rules will no-doubt vary depending the residential/inpatient eating disorder facility):

• 7:00 – Wake-up, and get weighed before breakfast (only on certain days)

• 7:30-8:00 – Breakfast time

• 8:00-9:00 – Bloods and observations taken if needed (at least once a week), get ready for the day, medication

• 9:00-10:15 – School (for those young enough), free-time, or therapy (

• 10:15-10:30 – Snack/Morning Tea

• 10:30-12:30 – School, free time, therapy, or leave (if you are granted/approved)

• 12:30-1:00 – Lunch time (medication before if needed)

• 1:00-2:00 – Post-meal supervision

• 2:00-3:30 – School, free time, therapy, leave, or visitors

• 3:30-3:45 – Snack/Afternoon tea

• 3:45-5:30 – Free time, or visitors

• 5:30-6:00 – Dinner and dessert time (medication before if needed)

• 6:00-7:00 – Post-meal supervision

• 7:00-8:15 – Free time, or visitors

• 8:15-8:30 – Snack/Supper time

• 9:00 – Evening medication

• 10:00-10:30 – Bed time/retire to your room

As you can see, your day revolves around either eating food, making sure you keep the food down, distracting from eating food, and waiting for the next time to eat – your life runs in accordance with the clock. It’s a lot to adjust to when first coming in, but after a while you are able to find your feet and learn the ways of living within the hospital or residential setting.

Episode Two of Inpatient Treatment will delve further into being admitted to an inpatient care facility, your first few days, and tips to make that adjustment as smooth and easy as possible – so keep an eye out for this issue in a few blog posts time!

If your experience differed, or have questions or comments, as always – I would love to hear from you.

Until next time, your friend,

Rawing Meg,

xx