Amy Pratt and Rebecca Deeley have written a new supplement to the BDA Nutrition and Hydration Digest to support dietitians and catering teams working in mental health and learning disabilities.
This month, the BDA Food Services Specialist Group launched a supplement to the BDA Nutrition and Hydration Digest (2023), which supports dietitians and catering teams in mental health and learning disabilities inpatient settings.
The Digest is a fundamental resource, providing expert knowledge and essential guidelines for catering in healthcare. Compliance with the Digest is mandated in NHS England’s National Standards for Healthcare Food and Drink (2022).
This new supplement focuses on the ways that mental health and learning disability settings differ significantly from acute settings. It aims to empower dietitians and catering teams to provide care that meets the unique needs of their inpatients.
Why do we need to think differently about catering in mental health and learning disability settings?
Physical health inequalities
People with severe mental illness die on average 15 to 20 years earlier than the general population and have a rate of obesity more than 20% higher. Two-thirds of deaths among people with severe mental illness are from preventable physical diseases, typically those linked with obesity, such as cardiovascular disease, type 2 diabetes and hypertension. There is a range of contributory factors, including rapid weight gain as a side effect of antipsychotic medications.1
Similarly, people with learning disabilities have a life expectancy 20 to 23 years shorter than the general population. More than a quarter of avoidable deaths among people with learning disabilities are attributable to cardiovascular conditions.2 Some 37%of people with a learning disability are living with obesity – again, a significantly higher prevalence than in the general population.3
Couple these shocking physical health and life expectancy statistics with the typically far longer lengths of stay among these service users, and it is clear that healthcare settings have a responsibility to offer catering that supports healthier lifestyles and are an opportunity to contribute positively to a vulnerable population.3
Eating disorders
Re-establishing nutritional adequacy for restoration of weight and health is an essential component of treatment for restrictive eating disorders. Weight gain is key in supporting the psychological, physical and quality of life changes required to improve and recover.4 It is therefore imperative that inpatient services providing care to people with eating disorders have the catering provision to effectively meet this need.
As treatment progresses, supporting the reintroduction of ‘feared foods’ and social eating to reflect pre-morbid eating norms becomes a crucial stage of recovery. Again, it is incumbent upon services to ensure they have the catering provision to support this vital aspect of treatment.
How was this document created?
This document was drafted following consultation with NHS mental health and learning disability dietitians from across the UK. A team of MSc dietetics students on were tasked with conducting structured interviews with catering and clinical dietitians and a thematic analysis of the discussions was undertaken.
To ensure service user voices were represented in the document, an MSc dietetics student was supported to conduct workshops with inpatients in an NHS mental health trust and complete a dissertation on this topic.
The document has been peer reviewed by representatives of a range of BDA specialist groups, as well as representatives of NHS England, the Hospital Caterers Association, the Royal College of Psychiatrists and other leaders in the field.
How will this document help?
The purpose of this document is not to specify the precise requirements mental health and learning disability inpatient settings must offer, but instead to give food service dietitians and catering departments within those settings guidance on the niche considerations for optimal food service. It is intended to provide direction and support for this previously underserved area of dietetics and a framework for locally appropriate decision-making.
This document is the first of its kind setting out the key considerations in this specialist area of healthcare food service.
There is much more work to be done. We hope this is a starting point in raising awareness and understanding in this field and look forward to seeing how this can develop in the future.
Resources
BDA Nutrition & Hydration Digest
Nutrition & Hydration in Mental Health & Learning Disability Inpatient Settings
NHS England National Standards for Healthcare Food & Drink
References
- Public Health England (PHE) (2018), Severe mental illness (SMI) and physical health inequalities: www.briefing.gov.uk/government/publications/severe-mental-illness-smiphysical-health-inequalities/severe-mental-illness-andphysical-health-inequalitiesbriefing [accessed 22.11.24]
- LeDeR Autism & Learning Disability Partnership (2022), Learning from lives and deaths – People with a learning disability and autistic people (LeDeR) report for 2022, https://www.kcl.ac.uk/research/leder [accessed 22.11.24]
- Public Health England (2020), Obesity and weight management for people with learning disabilities: guidance https://www.gov.uk/government/publications/obesity-weight-management-andpeople-with-learning-disabilities [accessed 22.11.24]
- NICE (2020), NICE guideline NG69 Eating disorders: recognition and treatment https://www.nice.org.uk/guidance/ng69
