A new care model arrives for the treatment of adolescents with highly complex eating disorders.

In recent years, there has been a significant increase in cases of eating disorders (EDs), with diagnoses being made in increasingly younger individuals and with more severe symptoms. The Minerva High Complexity Unit at Sant Joan de Déu Hospital in Barcelona aims to provide intensive and comprehensive treatment to the most severe and complex cases of EDs in girls and adolescents under 18 years of age who have not been stabilized despite more than a year of inpatient or partial hospitalization. This initiative seeks to reduce the length of hospital stays and shift treatment to the patients' natural environment, thereby increasing the likelihood of success and preventing the disorder from becoming chronic.

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In this way, the unit provides the individual and their family with an intensive, holistic, and evidence-based treatment program in a natural environment. This program gives the family a key supporting role, empowering them and providing them with the tools to cope with the disorder. It is an innovative and effective response to the care needs of these individuals who require highly specialized attention.

Until now, there was no specific device in the public health system for the care of highly complex eating disorders in girls or adolescents.

Increase in cases of eating disorders

Eating disorders represent a significant health problem. They affect between 5 and 8% of the adolescent and young adult population. In one out of every two cases, the disorder manifests before the age of 14, and in 20-30% it becomes chronic. In fact, it is the third most frequent chronic disorder in the adolescent population and has become one of the most prevalent in child and adolescent mental health centers (CAJHCs), while discharges from day hospitalization and acute hospitalization have also increased.

Mental health professionals have also observed that, as a result of the COVID-19 pandemic, they are increasingly diagnosing eating disorders in younger girls, and that these girls generally present with more severe symptoms. Since 2020, the percentage of pre-pubertal girls with an eating disorder requiring hospitalization has risen from 8% to 20%.

Multidisciplinary team

In this context, the new high-complexity Child and Adolescent Eating Disorders Therapeutic Unit, called UTTCA-Minerva, was created, which provides coverage to all of Catalonia and is part of the Improvement Plan for Care for people with eating disorders, presented by the Department of Health in 2023.

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A team made up of a dozen professionals from different disciplines - psychology, psychiatry, nutrition, nursing, TCAI, social education, social work, and a teacher - evaluates the complexity of each case, makes a differential diagnosis and designs the treatment plan.

An intensive treatment in 4 phases

The new unit offers a treatment program that includes, as a novelty, intensive therapeutic interventions within the family and the natural environment of the person receiving care. It comprises four phases with a therapeutic care plan that gradually decreases in intensity until the affected individual is linked to the relevant eating disorder treatment services in their area.

1. Hospitalization . The person receiving care is admitted to the hospital. During their stay, which is expected to last an average of 30 days, the professional teams work to help them re-establish a healthy eating pattern. They also begin empowering the family through the "family meal" methodology, which involves recreating a meal together as a family, guided by the care team. This guide provides tools for better nutritional and emotional management of the affected person. This hospitalization unit has a capacity of 7 beds.
2. The family and the affected person move into an apartment . In this second phase, the family is more intensively integrated into the treatment, moving in with the person receiving care in one of the apartments that Sant Joan de Déu Barcelona Hospital has made available near the center. There, professionals continue the treatment—which consists of individual and group therapy—and empower the family by providing them with tools to cope with the challenges of daily life resulting from the disorder. This treatment period lasts an average of 15 days, although it is adapted to the needs of each individual case.
3. Home transfer and intensive home treatment . When the professionals consider that the family and the person receiving care are ready to return to their normal lives, they return home. From then on, the professionals travel to the person's home periodically to continue treatment. During this stage, the professionals work to promote, on the one hand, the person's independence with regard to eating, and on the other hand, their return to school. This period has an estimated duration of 60 days.
4. Linkage to the designated Eating Disorders Unit . This is the final stage of treatment, in which the hospital's team of professionals accompanies the individual with an eating disorder during their referral to the Eating Disorders Unit (UTCA) in their local area. The goal is to ensure continuity of care throughout the therapeutic process.

The four phases of the treatment have a total duration of approximately 4 months.

This is an innovative project that offers a therapeutic response to the high complexity of eating disorders in individuals under 18 years of age. At the Minerva High Complexity Unit, the family is at the heart of the therapeutic approach, requiring their involvement and empowerment to independently manage eating and emotional symptoms at home. This complexity necessitates a holistic approach that also includes the siblings of those receiving treatment.