Making FREED (First episode Rapid Early intervention for Eating Disorders) a national and international model South London and Maudsley NHS Foundation Trust

Eating disorders are severe mental health conditions that usually start in adolescence or early adulthood. The first three years of illness offer a window for early, effective intervention in order to achieve a full recovery, but poor access to services remains a key barrier to this.

The FREED (First episode Rapid Early intervention for Eating Disorders) project has been shown to reduce treatment waiting times and the duration of untreated eating disorders in young people who have had an eating disorder for less than three years.

FREED interventions include a rapid screening and assessment protocol, evidence-based guided self-help interventions and psychological therapies for patients and carers, and an implementation toolkit for staff and services.

The FREED-UP: First episode and Rapid Early intervention service for young people with Eating Disorders – upscaled project, completed in 2018, demonstrated the scalability of the FREED approach by implementing it across four specialist eating disorder services in Greater London and Yorkshire.

This Spreading Improvement project continued this successful scale up by promoting FREED as a national and international service delivery model. Tailored resources and learning events facilitated scaling and dissemination in different settings and services. As a result, FREED has now been adopted by the eating disorders services in all 54 eligible NHS mental health trusts in England.

FREED has been cited as a model of good practice in the NHS England Adult Eating Disorders Guidelines 2019 and has been selected as an Academic Health Science Network (AHSN) national adoption and spread programme for roll out in 2022/23.

Studies have shown that young people with eating disorders who use the FREED pathway are seen earlier and spend less time with untreated eating disorder symptoms. They also show better post-treatment outcomes (across both eating disorder and general psychological symptoms) compared to treatment as usual. To date (2023), nearly 4,000 patients have been seen through FREED pathways in the UK and this figure is rising.

FREED has an active group of ‘FREEDom Finders’, young people who have directly experienced FREED treatment. Feedback includes:

“Thanks to FREED I managed to do my A-levels and thus maintain my prospects. Without this service it is likely my life would have been very different.”

“The FREED team have given me hope that I can make a full recovery.”

"Early intervention is imperative. I'm at my healthy BMI now and feel great…  just seven or eight months from being at my lowest weight, heart rate, mental state."

Evidence has shown that FREED reduces costs of care compared to treatment as usual, with cost savings for the NHS, to date (2023), in the region of £10 million. Per patient, it has been shown to save £4,472. This is due to the reduction in the need for more intensive treatments, and because providing treatment earlier reduces the number of outpatient treatment sessions needed. These savings outweigh the costs involved in setting up and maintaining FREED pathways.

Contact information

For more information, please contact:

• Danielle Glennon, Managing Director, Head of Psychology and Psychotherapy, Maudsley Private Care, South London and Maudsley NHS Foundation Trust
• Professor Ulrike Schmidt, Director, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust