Tier 4 Children and Young People’s Mental Health Services

About Ancora Care

Ancora Care assess young people in Cheshire and Merseyside who are either experiencing a mental health crisis or have long standing mental health difficulties that have not improved in community treatment. Ancora Care will work with young people, their parents and carers, and the community team to figure out whether an inpatient admission may be beneficial to the young person. 

If an inpatient admission is recommended, Ancora Care will then provide time-limited step down work to the young person and their family to help reduce the inpatient stay. They will offer additional support to help with the transition to community care.

Ancora Care can also be offered to support young people at home following a Tier 4 Access assessment. This support is for young people who require tier 4 input but do not require the relational security of the ward.

The Ancora Care team

The team includes the following staff members:

• child and adolescent consultant psychiatrist
• specialist doctor
• team manager
• trainee advanced clinical practitioner
• specialist occupational therapist
• speech and language therapist
• senior nurses
• mental health practitioners
• the psychology team

About CHEDS 

The Cheshire and Merseyside Adolescent Eating Disorder Service (CHEDS) is a specialist outpatient team that offers assessment, treatment and support to young people aged 13-18 with a broad range of complex eating disorders. Ths includes disorders such as anorexia nervosa, bulimia nervosa, binge eating disorder or atypical eating disorders.

CHEDS support people to keep well in the community without needing admission to hospital. The CHEDS team are able to offer:

• consultation to community teams (scheduled and additional/intensive) 
• assessment
• additional input to existing care packages, such as family therapy, radically open dialectical behaviour therapy (RO-DBT) and dialectical behaviour therapy (DBT) informed coping skills
• intensive outpatient treatment
• intensive inpatient treatment
• gatekeeping of specialist eating disorder unit beds

Sapphire Day Hospital

Sapphire Day Hospital is a hospital for children and young people with eating disorders. It is designed to provide intensive, community-based care for young people (aged 13-18) with eating disorders, preventing long-term inpatient admissions and supporting recovery in the community. It aims to support those who are likely to need a Tier 4 admission if intensive input is not provided. 

Located at Ancora House in Chester, the service can accommodate up to eight young people at a time on an eight-week rolling programme. Young people in need of this service will have typically received a period of treatment in the community which has been deemed unsuccessful. Referrals are taken exclusively through CHEDS. 

The programme aims to:

• work with young people and their families to help them make progress towards recovery from an eating disorder
• teach valuable skills to young people and their parents through a comprehensive group programme, which can then be transferred into daily life
• offer young people and their families a more intensive treatment to try to avoid hospital admission

The CHEDS team

The team includes the following staff members:

• child and adolescent consultant psychiatrist
• specialist doctor
• team manager
• trainee advanced clinical practitioner
• specialist link nurse
• youth intensive psychological practitioner
• specialist dietician
• family therapist
• specialist psychotherapists (including art therapists)
• the psychology team

The CHEDS referral process

Initially, community CYPMHS eating disorder teams are encouraged to discuss any concerning cases during their monthly consultation meetings. CHEDS will then consider whether a young person meets the following criteria for a referral:

• the young person is aged 13-18
• the young person is currently open to a community CYPMHS eating disorder service
• the young person has a diagnosis (or a suspected diagnosis) of an eating disorder that cannot be managed in the community
• there is a lack of clarity around the young person's eating disorder diagnosis
• community teams have exhausted all at-home treatment options and need a second opinion or advice