Eating Disorders & Schools

Schools can play a key role in tackling disordered eating and other mental health issues among students. We provide some thoughts adapted from an article by Charlotte Lowe; CBT Today May 2018

Eating disorders in schools

eating-disorder-helpOne in 10 young people experience a mental health problem at any one time; equating to roughly three children in every classroom. The recent publication of the Transforming children and young people’s mental health provision Green Paper in 2017 highlights the vital role that schools can play in supporting children and young people’s (CYP) mental health. However, these plans are set to be rolled out over the next few years and in the meantime many schools are struggling to cope.

Schools need to take a proactive approach to combating poor mental health, encouraging a whole-school approach to mental health and suggesting targeted Interventions to support students.  This is because poor mental health in a student has a wide effect on their peers as well as their own capacity to make the most of their education. A guidance published by the Department for Education, identifies a range of elements to help meet the emotional well-being and mental health needs of CYP.

Eating disorders are serious mental health problems which injure mental and physical health and can be fatal. They rarely exist on their own and may be co-morbid with deeper issues like post traumatic stress disorder, intrinsic anxiety, OCD and depression; but they are not variants of these other disorders. Eating disorders have profound ripple effects on peers. Where one person in a class has an eating disorder, other vulnerable students may be “infected”.

A whole school approach is important for all mental health issues and will give attention to the following areas:

One in 10 young people experience a mental health problem at any one time; equating to roughly three children in every classroom. The recent publication of the Transforming children and young people’s mental health provision Green Paper in 2017 highlights the vital role that schools can play in supporting children and young people’s (CYP) mental health. However, these plans are set to be rolled out over the next few years and in the meantime many schools are struggling to cope.

Schools need to take a proactive approach to combating poor mental health, encouraging a whole-school approach to mental health and suggesting targeted Interventions to support students.  This is because poor mental health in a student has a wide effect on their peers as well as their own capacity to make the most of their education. A guidance published by the Department for Education, identifies a range of elements to help meet the emotional well-being and mental health needs of CYP.

Eating disorders are serious mental health problems which injure mental and physical health and can be fatal. They rarely exist on their own and may be co-morbid with deeper issues like post traumatic stress disorder, intrinsic anxiety, OCD and depression; but they are not variants of these other disorders. Eating disorders have profound ripple effects on peers. Where one person in a class has an eating disorder, other vulnerable students may be “infected”.

A whole school approach is important for all mental health issues and will give attention to the following areas:

 

  • Whole school approach:

    All staff and even students need to be responsible for identifying students who may be experiencing emotional challenges, being clear on the protocol to follow where there is cause for concern. Every school needs a mental health and well-being policy. This should exist alongside other school policies and needs to be available IN WRITING to all key stakeholders (school staff, governors, parents/carers).

  • Training staff:

    At least two members of staff in every secondary school should receive Mental Health First Aid (MHFA) training to assist them in ensuring school staff feel confident in identifying early signs and symptoms of mental health difficulties in young people and know what support is available for them. Early intervention is vital especially if a student is suffering from any eating disorder such as anorexia, bulimia or compulsive eating.

  • Promoting emotional well-being:

    National Centre for Eating Disorders.This is a tough call because from early adolescence students are exposed to many toxic influences in social media especially regarding diet, appearance and activity. Positive emotional well-being is taught in schools via PHSE, both to inform and deal with stigma toward mental illness. NCFED is concerned that many eating disorder prevention programmes unwittingly create anxiety about food and harm to vulnerable students. They do not actually deliver what they promise. Teaching people about eating disorders can provoke disordered eating practices among vulnerable students. Even teaching nutrition can foster abnormal attitudes toward necessary macro-nutrients like dietary fat. PHSE regarding eating disorders must focus LESS on description of eating distress and more on helping students develop positive body image, avoiding dieting and other unhealthy eating practices. For guidance on PHSE for eating disorders in schools contact NCFED.

    Where social media is concerned, we recommend social media awareness training if possible. Schools must also promote a culture whereby talking about how we feel, and seeking help when needed, is the norm. Practices for openness can be fostered by engagement with students; promoted in assemblies, tutor time and covered in the PHSE curriculum.

    Students need to be taught that it is not helpful to keep secrets if they think that a peer has eating issues. They also need to be taught that it is not their responsibility to help a friend or peer struggling with serious body image issues because this must be done by someone suitably trained to manage the underlying issues.

  • Single point of contact/mental health champion:

    Having a single point of contact, or a mental health champion, is important; it opens a single channel of communication with external agencies, such as Children and Young People’s Mental Health Services (CYPMHS) or Children’s Social Care (CSC). This nominated person may ensure that relevant staff are made aware of a student’s circumstances as necessary.

  • Parental support:

    Parental support is invaluable as they are often first to highlight concerns about their children. On the other hand, there are many parents who deny that their child has a problem. They may be afraid of disruptions to education or they may say this is just a phase, or, our child is just stressed at the moment, or, they are just doing a lot of sports. Schools need to make clear to parents in a handbook given to all carers when a child enters school, who they need to contact if they are worried about their child, with regular contact and signposting of parents to available support being important. Parents need to be aware that if a school has concerns, they are obliged to ask for a second informed opinion.
    Practical suggestions might be helpful such as providing a list of external practitioners who may sign up to providing assessment focused on the presenting issue such as eating disorders, or anxiety. Schools must be alerted to the fact that any psychotherapist marketing their services may not have the required expertise especially where eating disorders are concerned and a second opinion about therapist expertise might be needed from a specialist service such as the National Centre for Eating Disorders.

  • Targeted interventions:

    While a whole-school approach to mental health and well-being is paramount, it is important to meet the needs of any student experiencing mental health difficulties; and this is where specialist assessments are a useful tool; and a clear referral pathway is essential. School counsellors and support staff will require training in identification and classification of the usual mental health issues experienced by students.

  • Eating Disorder Assessments:

     If an assessment is done in school, the mental health needs of CYP can be assessed in school by making use of Routine Clinical Outcome Measures recommended by Children and Young People’s Improving Access to Psychotherapies (CYP-IAPT) programme. Conducting such assessments means referrals to CYPMHS are limited to those who actually need them, avoiding backlogs and ensuring that the students who need attention receive it. Clearly a member of staff will need training in initial assessment since denial and evasion are features of eating distress.

  • Specialist support in school for eating disorders:

    Employing a eating-disorder trained specialist or even a mental health practitioner is not a realistic aim for most schools, I believe it is essential for students to have access to some specialist mental health support in school. It may be useful to employ a part time practitioner versed in CBT, strategies for bullying, knowledge of addictions and an evidence-based qualification in eating disorder treatment. In the case of eating disorders, the lack of specialist training could be dangerous since early intervention is the best predictor of recovery.  One solution for schools might be for a local cluster of schools to share a mental health specialist and provide for their CPD.

  • Using & Up-skilling a pastoral team:

    A pastoral team may support CYP experiencing difficulties with eating, body image and other emotional.  They will benefit from ongoing training in identification of behavioural and other mental health problems to ensure that they are equipped to help students. A pastoral team could possibly include peer mentoring.

    It is helpful to develop a peer mentoring system among students to become peer mentors or “buddies” to younger students. We feel that only 6th form students are suited to this task. They will need some basic training in how to support students experiencing students with less serious issues such as low self-esteem and confidence. They may also need support if they hear material which can be traumatic.

  • Guarding staff well-being:

    Staff well-being must not be overlooked – they too are susceptible to eating disorders and other mental health issues, with a recent report suggesting a high number of school staff experience mental health difficulties related to their job role. Staff who are able to access help for themselves are better-equipped to support CYP experiencing mental distress.

Summary and Assistance from NCFED

For all mental health issues and particularly for eating disorders, early intervention and prevention is key to tackling poor mental health in CYP.  Anorexia is often present before a person is identifiably skeletal. Bulimia is hard to treat if it is not treated quickly. Students with eating problems often deny that there is a problem and wish to be left alone so schools need to set an assessment process in motion none the less. This is more easily accepted if it is rooted in an official school policy document given on admission of a student.  If you need help with developing and implementing an eating disorder policy within a generic mental health school policy, please contact NCFED for guidance.