Eating disorders
working in partnership with
psychiatrists and carers
- Survey: as a carer of someone
with a mental health problem, we would be interested on learning
how to improve the information we provide for carers. Please take 5
minutes to complete this survey.
Introduction
This leaflet is aimed at:
· the carers of
people with an eating disorder who provide continuing help and
support, without payment, to a relative, partner or friend;
· the psychiatrists
and the members of the mental health team involved in the care and
treatment of a person with an eating disorder.
It suggests ways of improving communication and
partnerships when the person has first been diagnosed.
For the carer
About
eating disorders
Eating disorder is a term used to cover disorders,
such as Anorexia and Bulimia Nervosa, Binge Eating and Eating
Disorder Not Otherwise Specified. These can vary in severity and
there are a range of treatments available.
Changes
in the person’s behaviour
As a carer you may notice:
- a change in body weight
- secretive behaviour around food
- changes in mood or personality
- loss of interest in hobbies and friends
- a tendency to isolate oneself
- changes in eating patterns
- tension in relationships and general
irritability
- sensitivity about body weight and shape,
including excessive weighing
- smoking more, or chewing gum to keep weight
down
- increased exercise
Making a
diagnosis
There are clear criteria for diagnosing each eating
disorder. A diagnosis is made by talking to the person and a
close relative or friend to get an understanding of the person’s
history, as well as considering all other possible causes of the
symptoms.
As a
carer you may feel:
- scared about admitting there is a problem
- exhausted by caring and trying to ensure the
person is eating
- anxious about the person’s physical state
- scared that this is your fault, or that
something dreadful has happened to cause this
- angry that the person is so secretive or is
perhaps lying about their problems
- powerless to help
- confused about what treatments are available,
and where to get them
- that you want the person to be treated
immediately
- worried that the person won’t accept
treatment
- worried about the stigma attached to eating
disorders
- worried about the risk of suicide, death or
severe injury.
Tips for carers
In
partnership with your doctor and members of the health
team
Good communication between a doctor, the key
worker, other members of the mental health team, the person and
their carer is important, but takes time and effort.
Forming a positive long-term relationship with all
the staff and doctors involved in the care of the person is
especially important in the treatment of Anorexia Nervosa, which
can take up to five years. Treatments for other eating disorders,
depending on severity and nature of the condition, can be more
rapid.
Family support is particularly important as much
work needs to be done outside treatment sessions.
Treatment
Treatment usually starts with the GP who will
consider the patient’s history, weight and height, and try to
establish what the problems and behaviours are around managing food
and weight. The GP may then refer the person to the Community
Mental Health Team (CMHT), or sometimes to a specialist. A quick
referral can often be important, as non-NHS treatment has financial
implications.
A CMHT will repeat the GP assessment, but in more
detail, to establish if a referral to a specialist is
necessary. Specialists you are likely to come across include:
psychiatrists, nurses or nurse therapists, psychotherapists,
occupational therapists, psychologists, dieticians.
Specialist teams can offer outpatient assessment
appointments. These may be carried out by one or more members of
the team, and may take more than one appointment.
Remember to arrange your next visit before
you leave.
Aftercare
programme
The carer needs to have access to an aftercare
programme, including explanations about an eating plan, how to
treat meal times, expected weight, gain targets and how to cope
with difficult behaviour, including suicide threats.
Accepting
help
Treatment for an eating disorder is most effective
when the person is able to accept help. Waiting for a person to
recognize the need for treatment can be a frightening and
frustrating time. Ask the specialist team about strategies to help
motivate the patient to accept treatment.
Advice which will help you prepare for
follow up visits
- Jot down your view of how things have been,
clearly listing for yourself any points of concern.
- If possible, share this with the person before
you attend the appointment.
- Review all the information that you have
collected since your last visit and write down your main
concerns.
- Remember to talk about the things that
matter.
Your concerns may include:
- questions about changes in symptoms
- side-effects of medication
- general health of the person
- your own health
- additional help needed.
It is important to agree, beforehand, with the
person what they would like you to know about their treatment and
what they want to keep confidential.
- Has their key worker discussed confidentiality
with them?
During
your visit
- If you do not understand something, ask
questions. Don’t be afraid to speak up.
- Ensure there is agreement between you and the
team regarding care and treatment.
- Take notes during the visit. At the end, look
over these and tell your doctor what you understood. This gives
your doctor a chance to correct any information or repeat something
that has been missed.
Further
tips for carers when dealing with doctors and other health
professionals
Doctors and healthcare professionals can be
reluctant to discuss a person’s diagnosis or treatment with the
carer. There is a real duty of confidentiality between doctor and
patient. Have a conversation about confidentiality at regular
intervals. By continually checking what the patient is happy to
share, and stating what your needs for information are as the
carer, a compromise can usually be reached. (See our leaflet,
‘Carers and confidentiality in
mental health'’).
If the
doctor is unwilling to involve you as the carer, there are a number
of things you can do:
- ask the person you are caring for if you can
stay for part of their appointment
- talk to other carers as they may have some
helpful suggestions
- contact B-eat’s helplines and carers’
networks
- develop a relationship with your key
worker
Don’t
forget to take care of yourself
- Share your worries with trusted friends or
family members.
- Don’t bottle your feelings up – there is
nothing wrong with a good cry.
- Try not to let the symptoms of the eating
disorder take over your life – don’t become isolated.
- If you are anxious and are unable to sleep, go
and see your GP.
- Do not put your life completely on hold, and
try to avoid being drawn into their world.
For the professional
As a professional working with people with an
eating disorder and their carers, we hope that the following is a
helpful guide to good practice.
When
making an assessment, do you?
 |
|
Try to see the person and the
carer separately, as well as together
|
|
|
Try to see them at home first |
Do you
allow yourself enough time to?
In the
management of the illness, do you?
Points to remember
- Everyone needs some respite.
- Make it clear that you will be happy to talk to
other members of the family.
- Refer carers to the B-eat or other carer
organisations.
- Make it clear that someone will always be
available.
- Give an ‘out of hours’ telephone number.
- Make sure that there is a named professional
person whom the family can contact at any time.
- Make sure the patient and carer have adequate
information about their care and treatment.
- When you write to the GP, consider sending a
copy to the carer.
- Think about talking to the GP as well as
writing.
Further help
Royal College of
Psychiatrists
17 Belgrave Square, London SWX 8PG Tel: 020 7235
2351 ext 6259,
Produces information for the general public on
common mental health problems and treatments.
B-eat
103 Prince of Wales Road, Norwich NR1 1DW
Adult Helpline: 0845 634 1414; Youth Helpline: 0845
634 7650;
Provides information and help on all aspects of eating
disorders.
Young Minds
48-50 St John’s Street, London EC1M 4DE
Parents Information Line: 0808 802 5544
Provides information and advice to young people,
parents and professionals.
The Princess Royal Trust for
Carers
Unit 14, Bourne Court, Southend Road, Woodford
Green, Essex IG8 8HD
Tel: 0844 800 4361; email:
support@carers.org
Provides information, support and advice for
carers.
This leaflet was produced as part of the
Partners in Care campaign, a joint initiative between the Royal
College of Psychiatrists and The Princess Royal Trust for
Carers.
One of the aims of the Partners in Care campaign was to show
that if all
those involved in the care of people with mental health
problems or learning disabilities can work together, a trusting
partnership can be developed between carers, patients and
professionals which will be of benefit to all.
Original authors: Beverley Murphy, Veronica Kamerling and Peter
Tihanyi
Carer input: The Princess Royal Trust for Carers
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists'
Public Education Editorial Board.
© February 2011. Review date: February 2013.
Royal College of Psychiatrists. This leaflet may be
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For a catalogue of public education materials or copies of our
leaflets contact:
Leaflets Department
The Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351
ext. 6259
Charity registration number (England and Wales) 228636 and in
Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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