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Rharian Fields specialist eating disorder service “The service that has been offered to me has been a life saver, and I mean that literally. It provided me with support, information and understanding. If this service had not being here, I don’t think I would be able to get better, in fact, I know that I wouldn’t.” Contact Us Write to: Rharian Fields The Gardens Second Avenue Grimsby N. E. Lincs DN32 Telephone: (01472) 302482 Email: [email protected] 1 Welcome to Rharian Fields Our eating disorder service offers a multi-disciplinary and comprehensive provision to individuals suffering from complex eating disorders that require the assistance and support of a specialist service. We provide specialist treatments determined by individual need, based on clinical expertise and good clinical practice, working to NICE guidelines (2004) and The Marsipan Report (2nd Edition, 2014) The Rharian Fields service is designed to deliver specialist secondary and tertiary services to adults age 17 and 6 months and above. There are four levels of services that an individual can receive: outpatient, day patient and an inpatient services. Our specially designed inpatient unit (based in North East Lincolnshire) has five beds overseen by Dr Fadahunsi, consultant psychiatrist, who is responsible for service user therapy. The small nature of our unit means that we are able to offer a highly personalised level of care with a high staff to client ratio. Wherever possible we will try to care for our clients on an outpatient basis with individual therapy in order to help maintain their day to day life and routine. However if there is not a significant improvement in the client’s symptoms, the team will look at either a combination of individual / family work, day care or inpatient care. 2 Our Aims Rharian Fields offer a service that not only maximises engagement and encourages choice in treatments to promote recovery but also improves quality of life and social functioning while developing positive coping strategies to prevent physical and psychological deterioration as well as preventing/assisting in the management of relapse. We ensure a comprehensive assessment (specialist, psychological, and psychiatric) for all clients accepted into this specialist service. Assessment safeguards that health, social care, physical and risk needs are identified and acted upon and our resources are used to gain maximum benefit for the client. We feel strongly that the client is an equal partner in the management of their eating disorder and we respect that they are the expert in their individual illness. We aim to deliver a service that focuses on the individual, working with each client to develop a bespoke treatment package to suit them and their stage of recovery. We also know that family and carers have an important role to play on the journey to recovery and so we ensure that their needs are met and that their opinions are heard and, where appropriate, they are offered their own carers assessment. “I always feel much better about things when I leave the clinic.” 3 The Rharian Fields philosophy: Our Approach to Care At Rharian Fields, all of our staff take the time to develop and build an empathic, supportive and collaborative relationship with our clients based on compassion, professionalism, and respect. Our staff are sensitive to the suffering and fluctuating motivation to change that our clients often exhibit and strive to promote change motivation during their treatment while maintaining a deep commitment to try to relieve their suffering. Staff have an acceptance of the highly positive value some symptoms have on the client and their denial of the potentially life-threatening nature of their disorder. Our approach is holistic in its nature with a great emphasis on empowering our clients to reach their full potential. We understand that eating disorders often start at an age where most of us are finding ourselves through new and exciting things and that having an eating disorder can sometimes mean that individuals do not experience these events in the same way meaning that development of the self can be limited. 4 Our programme of psychological therapies aims to assist the individual in making sense of their disorder, its precipitating and maintaining factors and ultimately how to manage symptoms to allow them to reach their full potential. This goes hand in hand with our philosophy that normal life co-exists with the eating disorder so we aim to pull this into all aspects of our therapy and recovery by allowing the individual to focus on their potential lifestyle as a motivating factor to change. While we strongly aim to continually work collaboratively with our clients, we recognise that there may be occasions when we will need to focus on life preserving weight restoration. At these times it may be necessary to use treatment under Mental Health Act, such as nasogastric feeding* however we always aim to make voluntary treatment the goal of our clients. *Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. NICE 2006. 5 Urgent BMI < 15 and one or more of the following: • Rapid/severe weight loss • Evidence of system failure • Daily purging • Electrolyte disturbance • Recent discharge from inpatient care • Co-morbid diabetes Rharian Fields (in hours) or NAViGO crisis service (out of hours) to contact the referrer within four hours of receiving the referral to develop a management plan Assessment within 48 hours by Rharian Fields team All health and social care referrals to complete Rharian Fields referral form in full and fax to NAViGO Single Point of Access (01472) 252375 Routine (all other referrals) Rharian Fields specialist eating disorder service Referral reviewed at the Rharian Fields weekly team meeting (Tuesdays) Referral not meeting specialist service criteria Referral information not sufficient to make informed decision about care Rharian Fields team contact referrer by letter to suggest other possible care options Rharian Fields team to request further information from referrer Triage assessment offered Referral to other service GIFT group offered Further information received Rharian Fields outpatient service offered Rharian Fields day patient service offered Rharian Fields Care Pathway Rharian Fields inpatient service offered Medical admission Rharian Fields unit Services Available at Rharian Fields Rharian Fields offers a range of services for people who are suffering from eating disorders. Each service is detailed in this booklet, however should you require any further information, please do not hesitate to get in touch with the team. Outpatient service ....................................page 8 Day patient service ....................................page 10 Inpatient ..................................page 12 7 Outpatient Service The Rharian Fields outpatient service offers assessment and treatment to individuals aged from 17 years 6 months and above who meet the eligibility criteria as detailed below. Service users may be new referrals, they may have had treatment in our community group programme (GIFT), or have been discharged from the day or inpatient service. The treatment is highly individualised therapy focussing on promoting psychological and physical recovery, a healthy BMI, healthy eating, treating other comorbidities (depression, OCD, anxiety disorders, etc.) and improving quality of life. Dependent on the severity of symptoms treatment can last for a longer period; this will be discussed in the review at session 15. Eligibility Criteria From 17 years and 6 months and above Male or female Need to meet diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder or Eating Disorder Not Otherwise Specified (EDNOS) which are Atypical Eating Disorders and usually include a Exclusion Criteria Severe and florid psychosis Obesity without the presence of an Active illicit substance use Moderate or severe learning disability 8 Expected Outcomes 9 Improvement in symptoms or recovery Better quality of life Greater psychological functioning and Ability to nutritionally support self in the community Ability to maintain or develop new relationships Ability to support self in the community Improved understanding of their eating disorder and how to manage Relapse prevention Day Patient Service The Rharian Fields outpatient service offers assessment and treatment to individuals aged from 17 years 6 months and above who meet the eligibility criteria as detailed below. Service users may be new referrals, they may have had treatment in our community group programme (GIFT), or have been discharged from the day or inpatient service. The treatment is highly individualised therapy focussing on promoting psychological and physical recovery, a healthy BMI, healthy eating, treating other comorbidities (depression, OCD, anxiety disorders, etc.) and improving quality of life. Treatment usually consists of two sessions per week for the initial three weeks then weekly sessions for at least 14 more sessions. Dependent on the severity of symptoms treatment can last for a longer period; this will be discussed in the review at session 15. Eligibility Criteria From 17 years and 6 months and above Step-down care following inpatient treatment Male or female Medically safe to attend day care including the travel to and from the Need to meet diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder or Eating Disorder Not Otherwise Specified (EDNOS) which are Atypical Eating Disorders and usually include a combination of Anorexia Nervosa and Bulimia Nervosa Has previously received outpatient treatment that has not been sufficient to support recovery and requires more intensive input from the team 10 Exclusion Criteria Severe and florid psychosis Active illicit substance use Obesity without the presence of an eating disorder Moderate or severe learning disability Medically unstable BMI <15 Expected Outcomes 11 Healthier weight Improved psychological Improved family and social relationships Improved quality of life and social functioning Improved understanding of their eating disorder and its management Return to employment/education or have the skills to seek new employment/education Inpatient Service Our inpatient unit provides a safe and tranquil space where individuals can learn to gain control and mastery over their difficulties with the support of highly skilled professionals committed to aiding recovery. Rharian Fields is a five bedded specialist eating disorder inpatient unit situated within The Gardens, in the grounds of the Diana, Princess of Wales Hospital, Grimsby. Inpatient admission will be the preferred option when there is a high risk to the individual should they remain at home. Wherever possible, so long as care can be managed effectively, the first option for any inpatient admission would be the specialist eating disorder unit. If this is not immediately possible and a general hospital admission is the only option to manage the physical risks posed effectively then the eating disorder team will stay in close liaison with the general hospital offering advice where necessary. This will be seen as high priority within the workload of this service and the general hospital can expect to have regular contact with this team to offer joint care and specialist advice. Transfer to the Rharian Fields specialist inpatient unit will be arranged by the team as soon as it is safe to do so. 12 Treatment Treatment will include both psychological and physical interventions with the goal to increase weight by 0.5 - 1kg per week to achieve weight restoration and psychological wellbeing. Psychological treatments will focus on eating behaviour and attitudes to weight and shape and on wider psychosocial issues. There will be a structured daily programme and protected, supported meal times. Approximate treatment length will be discussed prior to admission with both the referrer and the service user and will be dependent upon physical risks and weight gain required to reduce these risks. All service users will have an identified, named worker/ therapist who will oversee their care while they are an inpatient. All service users will be assessed by the consultant psychiatrist qualified in management of eating disorders on initial assessment and throughout their whole treatment to ensure that their medical and psychiatric needs are met. Additionally, all service users will be reviewed by the dietician on admission and throughout their admission to ensure that their nutritional needs are met. All service users will see their named worker on a 1:1 basis at least three times a week. 5 Core Pathways 1. Physical Monitoring 2. Nutritional Development 3. Physical Acitivity and Leave Planning 4. Psychological Development 5. Discharge and Transfer Planning 13 Mental Health Act While we strongly aim to continually work collaboratively with our clients, we recognise that there may be occasions when we will need to focus on life preserving weight restoration. In high-risk cases where the service user does not wish to engage in treatment, the Mental Health Act 1983 should be considered to ensure that the service user receives the necessary care at the appropriate time. Under the Mental Health Act service users will have access to all statutory legal support and appeals procedures. 1.1. In the case of children the Mental Health Act can be used but should be considered in relation to the Children’s Act (2004). 1.2. The Mental Capacity Act 2005 assumes all adults have capacity. It defines where an adult does not have capacity that treatment can be given in their best interest so long as the principles of the Act have been followed. The Mental Health Act supersedes the Mental Capacity Act in all cases and so should always be used where appropriate to do so. 14 Eligibility Criteria From 17 years and 6 months and above Physical complications associated with rapid weight Male or female Formal and informal admissions, although we would always look to the least restrictive option and work Support from the individuals local CMHT care co-coordinator Need to meet diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder or Eating Disorder Not Otherwise Specified (EDNOS) which are BMI <15 and need for re-feeding with one or more of the following: Daily purging Diabetes Recent self harm episode Falling weight (1kg per week) Electrolyte/ECG abnormality Pregnancy Exclusion Criteria Moderate or severe learning disability Active illicit substance use 15 Severe and florid psychosis Expected Outcomes Weight restoration and establishment of regular and Improved understanding of their eating disorder and its management Stable biochemistry Clarification of diagnosis Improved psychological functioning Improved social functioning Improved family and social Identifying and understanding underlying emotional problems Following discharge from the Inpatient or Day Patient Service, Rharian Fields offer an ongoing, free, support group up to 6 months following discharge. It is held once per month and focusses on relapse prevention work. For more information contact us using the details in the front on this booklet, or ask a member of staff. 16 Weekly Timetable for Day Patients and Inpatients Monday 7:30-8:30 Breakfast, Rest and Reflection 9-9:30 Planning Meeting Wednesday Thursday 7:30-8:30 Breakfast, Rest and Reflection 9-10 Planning Meeting and Community Meeting 7:30-8:30 Breakfast, Rest and Reflection 9-9:30 Planning Meeting 9:30-10:30 MDR with Dr Atkin 7:30-8:30 Breakfast, Rest and Reflection 9-9:30 Planning Meeting and Meet with Catering 9:30-10:30 Crafts 9:30-10:30 Games 10:30-11 Snack and Rest 11.00-1 MDR with Dr Akin 10:30-11 Snack and Rest 11.15-12.15 DBT group 10:30-11 Snack and Rest 11-1 1:1 Time 9:30-10:30 Getting to Know You 10:30-11 Snack and Rest 11-1 1:1 Time 1-2.15 Lunch and rest and Reflection/ relaxation/ distraction 1-2.15 Lunch and rest and Reflection/ relaxation/ distraction 1-2.15 Lunch and rest and Reflection/relaxation/ distraction 1-2.15 Lunch and rest and Reflection/ relaxation/ distraction 2:15-3.15 Meal Planning with Bex and Liz 2:15-3.15 Life Skills group/ Anxiety and stress management 2:15-3.15 Education with ward Doctor 2:15-3.15 Nutritional Group with Bex 3.30-4 Snack and Rest 3.30-4 Snack and Rest 3.30-4 Snack and Rest 3.30-4 Snack and Rest 3-6 Reiki with David 4-6 1:1 Time 4-6 1:1 Time 4-6 1:1 Time 6-7.15 Tea and Rest and reflection Reflection 6-7.15 Tea and Rest and reflection Relaxation 6-7.15 Tea and Rest and reflection Mindfulness 6-7.15 Tea and Rest and reflection Relaxation Evening Activity Goal Setting Evening Activity Games Evening Activity Pamper Night Evening Activity Quiz Mandatory Groups 17 Tuesday Optional Groups Friday 7:30-8:30 Breakfast, Rest and Reflection 9-9:30 Planning Meeting Saturday Sunday 7:30-8:30 Breakfast, Rest and Reflection 9:30-10 Planning Meeting 7:30-8:30 Breakfast, Rest and Reflection 9:30-10 Planning Meeting 10:30-11 Snack and Rest 11-1 Therapeutic art group 10:30-11 Snack and Rest 11-1 Community Outing 10:30-11 Snack and Rest 11-1 Arts and Crafts 1-2.15 Lunch and rest and Reflection/relaxation/ distraction 1-2.15 Lunch and rest and Reflection/relaxation/ distraction 1-2.15 Lunch and rest and Reflection/relaxation/ distraction 2:15-3.15 Body Image 2:15-3.30 1:1 Time 2:15-3.30 1:1 Time 3.30-4 Snack and Rest 3.30-4 Snack and Rest 3.30-4 Snack and Rest 4-6 1:1 Time 4-6 1:1 Time 4-6 1:1 Time 6-7.15 Tea and Rest and reflection Mindfulness 6-7.15 Tea and Rest and reflection Relaxation 6-7.15 Tea and Rest and reflection Mindfulness Evening Activity DVD Night Evening Activity Bingo Evening Activity Pamper Night 9:30-10:30 Pamper Session 18 Treatment and Interventions Staff within the Rharian Fields team will adhere to NICE guidelines for the treatment of individuals with eating disorders. Treatment will include evidence-based interventions such as CBT-E, motivational enhancement work, cognitive remediation therapy, dialectical behaviour therapy, emotional freedom technique, mindfulness, family interventions, art/drama therapy, nutritional interventions, supported mealtimes, physical monitoring, Indian head massage, Thai foot massage and reiki (this is not an exhaustive list). There are a wide range of groups offered as part of the service, designed to aid service users’ recovery in all aspects of their life. These include psychological therapies, education, social and leisure, self-esteem, relapse prevention, anxiety, diet, relaxation, tai chi, body image and flexibility (this list is not exhaustive). The full range of our group programme can be seen on the previous page. Service users will be given information on all proposed treatments to enable them to make informed choices at all stages of their treatment. Where formal psychological therapy is indicated discussion will take place with the team clinical psychologist. 19 Our Facilities Rharian Fields’ specially designed unit based in North East Lincolnshire offers a highly personalised level of care with a high staff to client ratio. Our inpatient unit is based at The Gardens, Diana, Princess of Wales Hospital, Scartho Road, Grimsby, North East Lincolnshire, DN33 2BA. We offer modern, stylish accommodation that fosters a relaxed, calm atmosphere. We have five individually designed bedrooms that allow our clients privacy and space. All the bedrooms are en-suite. There are two living areas, both are individually styled and offer comfort and homely yet sophisticated areas. We have a main kitchen and dining area which offers a modern but inviting space, this area lends itself well to supervised cooking and dining. Our other kitchen offers a space for the preparation of snacks and offers an area for more independent dining. We have dedicated therapy rooms for use for individual or group therapy. All accommodation looks out onto beautiful private gardens where we will encourage the growing of fruit and vegetables. Our garden offers a tranquil area that is large enough to facilitate privacy and dignity for individuals using it. We also have a sensory area within our garden for relaxation. 20 Meet the Team As Rharian Fields is a small team, we’d like to introduce each member to you and the role they play within the ward. During your loved ones stay, you will come into contact with most members of the Rharian Fields Team. Dr Akin– Consultant Psychiatrist Dr Bodo– Speciality Doctor Amanda Simpson – Eating Disorder Service Manager Mandy Barker – Eating Disorder Service Lead Natalie Minard – Senior Eating Disorder Nurse Practitioner Hayley Batchelor – Senior Eating Disorder Nurse Practitioner Kerry Green – Senior Eating Disorder Nurse Practitioner Laura Hammond – Senior Eating Disorder Nurse Practitioner Susan Popoola – Eating Disorder Nurse Practitioner Alison McMullen— Eating Disorder Nurse Practitioner Sarah Heaton—Eating Disorder Nurse Practitioner Janette Hodgson—Eating Disorder Nurse Practitioner Emma Nixon—Eating Disorder Nurse Practitioner Liz Scott – Nursing Assistant Mellissa Robbins – Nursing Assistant Linda Harpham—Nursing Assistant Carrie Strandt—Nursing Assistant Jennie Hudson– Nursing Assistant Romana Knight-Nursing Assistant Dawn Harris—Nursing Assistant Rebecca Kilby – Team Dietitian Hollie Ingoldby – Trainee Health Psychologist Victoria Wolfe—Team Admin Genevieve Cummings—Team Secretary 21 Referrals Process Referral to all the services provided by our specialist team can be made via the NAViGO single point of access. Call(01472) 302482 Fax(01472) 302311 [email protected] [email protected] Referral forms can be obtained from the contacts above or can be downloaded from our website: www.rharianfields.co.uk To increase the accessibility of our service, we accept referrals made by any health or social care professional. All relevant information is required before a referral will be considered. This is so that the team can make an informed decision about the risks associated in each case, to aid decision making and ultimately in the client receiving the most appropriate care package for their identified needs. All referrals will be reviewed for seriousness on the day they are received (or on the following Monday if the referral is received at the weekend) by a senior eating disorder practitioner. 22 Urgent Referrals Urgent referrals will need to meet the following criteria: BMI <15 with one or more of the following: Rapid/severe weight loss Evidence of system failure Daily purging Electrolyte disturbance Co-morbid diabetes Pregnancy Recent discharge from inpatient Urgent referrals are those that pose a physical risk or a risk of suicide or self-harm. Urgent referrals will be actioned within four hours of receipt by the eating disorder manager or nominated deputy during working hours, out of working hours this will be done by the NAViGO crisis service. This will involve a senior practitioner contacting the referrer via telephone to discuss the referral and the joint establishment of a management plan. Following urgent referrals, priority will then be given to those at medium risk and who meet the following criteria: BMI <17.5 and one or more of the following: History of self-harm Depression Recent in-patient care Purging 2-3 times weekly Falling weight > 0.5kg/week Please note that GPs will retain responsibility for the physical risk management of all referrals including clients in community treatment. 23 Out of Area and CAMHS Clients We recognise that transferring to a new service can be daunting which is why we proactively manage the transition into the specialist service in collaboration with our CAMHS colleagues. We will be able to ensure a professional transition for young people with eating disorders moving from our CAMHS service into adult services and our approach will prevent those clients from long inpatient admissions. All out of area and local CAMHS referrals will be required to complete a funding acceptance form prior to any treatment being delivered. Working Alongside the General Hospital Wherever possible, admission to our specialist unit would be the first option, so long as care could be managed effectively. If this is not immediately possible and a general hospital admission is the only option to manage the risk posed to the individual, then we are ideally placed alongside our acute colleagues on the Diana, Princes of Wales Hospital site to have close liaison and offer advice where necessary. Transfer back to the Rharian Fields unit would then be arranged by our team as soon as it is safe to do so. 24 Safeguarding at Rharian Fields At Rharian Fields we are dedicated to adhering to the six safeguarding principles, with our primary objective being the prevention of neglect, harm and abuse. We will empower individuals by involving them in all aspects of their care and treatment so that they maintain as much control over their lives as is possible. We will protect individuals by supporting and advocating for them at all times and we will endeavour to risk manage in the least intrusive way possible while maintaining the individuals safety and preventing harm. We will ensure that we work with the individual’s local community to ensure multiagency involvement. In our vision to ensure safeguarding procedures are transparent, open and honest and that we learn from any issues raised we will support our staff to raise concerns. We will ensure that individual safeguarding concerns are identified immediately and managed safely. Collaborative Links with Local Specialist Services We have a proven track record in liaising closely with local specialist services, such as systemic family therapy and the personality disorder partnership to ensure service users are supported where necessary and have straightforward access to other specialist care should it be needed. 25 National Collaboration The Rharian Fields team have received several comprehensive training courses in the last three years delivered by leading academics and clinicians in ED field (Prof. Chris Fairburn, Prof. Janet Treasure and Deanne Jade from National Centre for Eating Disorders) leading towards advanced diplomas or master practitioner in ED and obesity as well as diplomas in CBT. Other Qualifications and Skills Mindfulness techniques, emotional freedom techniques, motivational interviewing, cognitive remediation therapy, body image, supported meal times, working with carers, DBT module, systemic family therapy, nutritional interventions, anxiety management, relaxation, self-esteem and confidence building, art therapy, physical monitoring, nasogastric feeding, Indian head massage, reiki. Rharian Fields also has collaborative links with both The Institute of Psychiatry in London and The National Centre for Eating Disorders. 26 Outcome Measures Service user experience is important to us and so we ensure that everyone who accesses our service is given the opportunity to provide feedback on their treatment. A service user satisfaction questionnaire is given to all service users. We also value their opinion of carers and so they too are issued with a feedback from. Outcome measures at Rharian Fields are based on the Quality of Life scale (QLS), Eating Disorder Examination Questionnaire (EDE Q5) and Clinical Impairment Assessment (CIA) which are given at assessment and on discharge from this service. These are audited on an on-going basis to ensure the quality of our service. Beck depression inventory scores are also conducted at both the beginning and the end of treatment which are audited on an on-going basis. Payment by results scores will also be audited on an on-going basis and effectiveness of the treatment provided by Rharian Field is subject to regular audits. Training and Consultancy We provide basic to more advanced level training and consultancy for other eating disorder professionals, mental health staff, dieticians, health trainers, primary care staff, and doctors. In October 2010 the North East Lincolnshire eating disorder specialist service held a national conference to raise awareness of eating disorders and nutritional interventions. The event brought together a number of well-recognised national speakers and covered a wide range of topics relating to both eating disorders and nutritional interventions. 27 NAViGO Health and Social Care Rharian Fields is part of NAViGO Health and Social Care Community Interest Company, a not for profit social enterprise providing award winning mental health services in North East Lincolnshire. Previously part of North East Lincolnshire Care Trust Plus, NAViGO CIC was established as an independent provider as of April 1, 2011 as part of the Government’s Right to Request scheme. NAViGO is a unique membership organisation made up of staff, people who use services, carers and interested parties from the local community, all with equal rights and an equal say in how the organisation is run. NAViGO also provides a wide range of training and consultancy, both nationally and internationally, on mental health and related issues such as employment. Award Winning Services Overall winner The Guardian Public Service Awards 2011 Winner: Medipex NHS Innovation Award in the Mental Health and Wellbeing Cateogory Social Enterprise of the Year 2014 Winner: Employee Ownership Rising Star Award Philip Baxendale Awards 2011 28 A Service User’s Perspective Prior to my admission at Rharian Fields Eating Disorder Clinic, my life was controlled by anorexic thoughts. The thoughts seemed so real, I imagined them as a person who became my closest and only friend. She encouraged me to engage in compulsive exercise and restrict my diet to dangerous levels. Anorexia took my energy and passion until I became numb, emotionless and alone. As my weight decreased, the thoughts became more powerful and convincing, I had no time or energy for a social life and my efforts at college were poor. I saw eating as unnecessary and only allowed myself to eat once I had exercised. Soon, I understood that I wasn’t healthy and I faced the realisation that I was killing myself. Walking through the door of Rharian Fields, I immediately sensed the calming, caring, family atmosphere. I was so excited by the modern furniture and surprised by the efforts of the staff choosing the furniture and design. Picking my room was the first bit of excitement I had experienced for a while and I subconsciously accepted that the clinic would be my home for a while. I was able to hand over the intense control I had been harbouring over my eating disorder and allow staff at the clinic to support me in my recovery. At the beginning, my thoughts made me dislike and mistrust the staff but now I have so much to thank them for. I appreciate the care, sensitivity and efforts integrated into my care. As my health improved, I saw food as my medication and became determined to lead a healthy lifestyle. My sense of humour and personality began to return. I became passionate again and excited to study to become a midwife and aim to help people as the staff at Rharian Fields helped me. 29 Goddess of the bountiful harvest and the nurturing spirit In Greek mythology the goddess Demeter was the most generous of the great Olympian goddesses. She was beloved for her service to mankind in giving them the gift of the harvest, the reward for cultivation of the soil. Also known as the Roman goddess Ceres, Demeter was the goddess of the harvest and was credited with teaching humans how to grow, preserve, and prepare grain. Demeter was thought to be responsible for the fertility of the land. The Rharian Field was located in Eleusis in Greece and was supposedly where the first plot of grain was grown after Demeter taught humanity agriculture. She was the only one of the Greek goddesses who was involved on a day-to-day basis in the lives of the humans. While others occasionally “dabbled” in human affairs when it suited their personal interests, or came to the aid of “special” mortals they favoured, the goddess Demeter was truly the nurturer of mankind. Demeter also was the only one of the Greek goddesses who could truly empathize with the human experience of suffering and grief, having experienced it fully herself. The story of Greek goddess Demeter illustrates the tremendous capacity of a woman to love and nurture, within her own family and the world at large. It also reminds us to stand firm for what is good and right, even in the face of adversity, when powerful forces are aligned against us. The goddess Demeter’s message also reminds us of the seasons of a woman’s life, that even though there are times of great sorrow there is also great joy to be found. 30 Rharian Fields, The Gardens, 2nd Avenue, Grimsby, DN33 1NU (01472) 302482 Email: [email protected] NAViGO, NAViGO House, 3 - 7 Brighowgate, Grimsby, DN32 0QE T: (01472) 583000 E: [email protected] W: www.navigocare.co.uk Registered office: NAViGO House, 3 - 7 Brighowgate, Grimsby, DN32 0QE Company Registration Number 7458926 search NAViGO Health and Social Care follow @NAViGOCARE Issue version: RF002-1029