More and more people are suffering from eating disorders. Patients are becoming younger and illnesses such as anorexia nervosa and bulimia affect both males and females. Around 25% of the 1.25 million people in the UK with an eating disorder are male, according to the patient support charity Beat. And it estimates that 130,000 people fall ill with an eating disorder every year.
But what is it like working on the frontline of eating disorders services? And what are the personal qualities and professional skills you need to help people on the road to recovery?
Consultant Dr Ewa Zadeh worked in general psychiatry in the South West London and St George’s Mental Health NHS Trust before moving to her current post in specialist eating disorders services nearly four years ago. “I think I was attracted to working in eating disorders because of its combination of medicine and psychiatry,” she says. “I was also interested in the constant challenge that you face as a clinician – the hope that things can change.”
The service has a 20-bed adult ward that looks after patients aged 18 and above. Patients are typically in their early 20s, but it is not uncommon to have people in their 50s and 60s with ongoing disorders. There is also a 12-bed ward for children, both boys and girls, aged from five to 17. The average age on the ward is about 14 years old.
It’s a niche service, says Tracey Ugbele, psychiatric nurse and clinical pathways manager. Ugbele joined the trust in 2016 and moved on to the eating disorders services last November after working in secure units for 25 years. “I was looking to do something different and I had the opportunity to come in at a senior management position, which appealed to me,” she says. “I had no eating disorders experience but my core nursing skills were transferable.”
Ugbele tapped into the trust’s in-house bespoke training, which gave her the specialist skills she needed including how to administer nasogastric feeding (when a tube is passed into the stomach through the nose) and offer therapeutic support around food and mood. “Eating disorders services give nurses the chance to develop a really unique set of skills, which you are able to transfer to other services,” she says. “You are likely to meet people with eating disorders in whichever field of nursing you are in.”
According to Ugbele, it’s important to have “personal resilience” to work in the service: “It’s the challenge of working with really complex emotional issues around food and being able to manage yourself. Families are also coming in with an enormous amount of stress and you have to manage the child as well as the anxiety of the family.” It is also important to be “recovery focused,” Ugbele suggests.
Support for those working on the ward is equally important, according to Zadeh. “You must have the ability to understand your limits, identify your weaknesses and be able to learn from what has happened,” she says. “There is emotional support in reflective practice where we can discuss difficulties and positives and how they make us feel or affect our practice.”
Eating disorder patients will typically stay on a ward for between six months to a year, which allows nurses and other clinicians to develop strong professional relationships. “The length of stay will depend on the complexity of the presentation, but it does mean you have the chance to develop a key core relationship with these patients to get their trust around eating and food,” says Ugbele.
The multidisciplinary team is at the heart of the services. The team includes consultants, nurses, occupational therapists, therapists, family therapists, dieticians and social workers. “Skill mix is very important in the team because we feel that all different elements of treatment work best towards positive outcomes,” says Zadeh. “Multidisciplinary work is particularly important here, you have to have an understanding of each other’s expertise and that needs to be equal.”
According to Ugbele, working in eating disorders services may be challenging, but it brings rich rewards. “For me, the reward is seeing young people recover and become more engaged and go back into their community,” she says. And for Zadeh? “I think the rewards are hearing from the patient that things have turned around for them, that there has been a positive change. It’s really very emotional,” she says. “Recovery means different things to different people, but it’s really special when a patient says: ‘I realise my life is better.’”
Find out more at swlstg.nhs.uk
