First Episode Rapid Early Intervention for Eating Disorders (FREED)

Suffering from an eating disorders can impact on all parts of a person’s life and the NHS is committed to providing evidence based treatment and support to those who need it. The First Episode Rapid Early Intervention for Eating Disorders (FREED) is an innovative service model that has offered support to over 1,200 16 to 25-year-olds who have had an eating disorder for three years or less.

There are two key things that can prevent early intervention in eating disorders: difficulties spotting the illness early, and difficulties in accessing help. FREED has made its aim to address both sets of difficulties.

Services across the country using the FREED model provide rapid, specialised treatment for young people with a recent onset eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder or another eating disorder). The FREED model gives special attention to challenges young people face during these critical years of their life as they transition to adulthood, making it much more effective than traditional service models at reversing the changes to brain, body and behaviour caused by eating disorders. As a result, young people are less likely to miss out on study, relationships and other opportunities because of their illness.

George moved to London when she was 21 and shares how her eating disorder worsened as she moved to the capital on her own. After persuasion from her family, George visited the GP who referred her to an eating disorders service delivering the FREED programme. Within two weeks, George was meeting with a psychologist for a Cognitive Behavioural Therapy (CBT) session. George was with the service for 18 months and recognises the service not only supported her to manage her eating disorder but also with other challenges she had to face: having surgery, changing jobs, moving homes and acclimatising to the new city.

George said: “My treatment was completely tailored to me and my lifestyle. After my treatment was finished, I left the programme so optimistic and grateful for everything they had given me.”

The FREED model is highly recommended by patients and families and is associated with substantial improvements in clinical outcomes and cost-savings through reduction in hospital admissions.

Having been designed to reduce barriers and improve access to treatment for the 16- 25s, it provides a truly equitable and specific early intervention eating disorder treatment pathway (duration of less than 3 years) for all of young people and families within the service.

Sue shares her experience of the FREED programme as it helped support her 18-year old daughter who was the first person outside of London to use the programme in her local eating disorder service. Sue noted how her daughter was a bit apprehensive at first, but she built a genuine bond with her psychotherapist. Sue witnessed how the support from FREED was having a positive change to her daughter’s approach to food and exercise. From the dedication from her support worker, to the involvement of the dietician, Sue watched her daughter’s life and eating disorder improve.

“I totally trusted the professionals involved in my daughter’s FREED experience and that’s what helped me help her. Without any question FREED should be seen as the gold standard of eating disorders care.”

The focus on early intervention works towards removing disparities in perceived diagnosis and need for treatment. The promotion of the early intervention pathway, with the proactive community outreach is hoped to assist those from a Black and Minority Ethnic background to feel more confident to come forward for help.

An anonymous service user shared: “I was knocking on doors for two years before I got here, passed from service to service. I think they just didn’t believe black girls had eating disorders, so I started to think maybe it was all in my head until I got here [FREED] and got help”    

The COVID-19 pandemic has affected everyone across the country but the need for support and care for young people with an eating disorder has not been forgotten.

Psychological therapies, care and support have been delivered remotely to ensure people can still access the support they need. Innovation is happening across the service with increases in access to remote treatments, comprehensive remote group programmes and workshops and seminars to ensure outreach.

Over 1200 young people have been and are being supported by FREED programmes across the country to date, it has more important than ever to ensure that those who need help, can get it.