Wales Needs World-Leading Eating Disorders Services, And Now Is Our Chance

My childhood in Wales was full of happy memories. Yet, like the record numbers of young people facing mental health problems today, I encountered a roadblock in my teenage years that I’m still struggling to overcome today – an eating disorder.

I was already in Child and Adolescent Mental Health Services (CAMHS) when anorexia reared its ugly, skeletal head. You’d have thought that this would’ve made for good outcomes, that the specialists I was already seeing would’ve been able to spot the early signs and provide rapid treatment. But this wasn’t the case.

Unlike the OCD and depression I had come into CAMHS for, there didn’t seem to be a treatment manual for anorexia, especially not in a teenage boy. Staff were at a loss as to what to do with me – besides argue with my refusal to eat or be weighed, or threaten me with detention under the Mental Health Act if I didn’t drink their sickly fortified milk.

Instead of psychological therapy, what I experienced was a managed decline of my physical and mental health, with severe health complications and increasingly erratic emotions. My weight dropped to the point that when I was transferred to adult services, I was considered “too underweight” to be accepted for treatment, as though that wasn’t part of the illness that needed treating in the first place. Apparently I had to show that I was motivated to improve in therapy by first of all mastering the ability to improve on my own.

And I was one of the lucky ones. I’d been in services already and was a prime candidate for early intervention. I was willing and keen to go to appointments and had sought support for myself in the first place. If services weren’t getting it right for me, they weren’t getting it right for anyone. The best they could offer was no psychological treatment, just a patchy oversight of physical risk where I nearly slipped through the net far too many times. Surely we can do better than this?

Eventually, I got specialist treatment when I moved back to Wales after dropping of out medical school (a pretty hard thing to keep up with when you’re in and out of hospital). By this time, the Eating Disorders Framework for Wales (2008) had been put into place – thanks to the tireless work of Bethan Sayed AM – to provide those specialist services for more severe cases of eating disorders like mine. Still, this treatment came more than 6 years since anorexia had first wreaked havoc on my life. The weight of this wait is something I am still coming to terms with in the therapy room today.

Nobody should have to wait that long to receive the treatment they need. The costs in terms of missed opportunities, human suffering and quality of life are something that we should not tolerate as a society. The financial costs of eating disorders cannot be sustained by the Welsh economy either, so investing in services to prevent and treat them is a no-brainer.

Following my treatment, I’ve volunteered with services in Wales and been involved with the Cross-Party Group on Eating Disorders at the Assembly. Having seen the way things operate on the inside, I’m even more convinced that things need to change.

One of the things that has struck me most throughout my own journey is how ill-equipped the people who were meant to help me were. This has shown up in so many ways; from the CAMHS psychiatrist lacking in specialist knowledge (“why do you want to look like that, surely only girls want to be skinny”) to the GP lacking in knowledge of eating disorders in general (“but bulimia is just attention seeking really, isn’t it?”). My parents were given no skills to help the situation, and my school exacerbated it by blaming my problems on a bad attitude.

The specialist services that treated me as an adult were a different story. They had the knowledge, the skills and the ability to undertake life-changing therapeutic work. But the sheer level of demand for skills like theirs was not matched by the resources they needed. This is still the case today.

There are so many ways in which things could be better. There could be day centres where people drop in for meal support; higher-intensity support services for when people come out of hospital to prevent relapse at home; using technology to support people living in more remote parts of the country from a distance; a greater range of extra activities to support recovery such as mindfulness-based groups and yoga… the potential is endless. These ideas shouldn’t be seen as a luxury. Providing fully comprehensive support across Wales for people of all ages, backgrounds, genders and situations is a necessity.

The time to act is now. The Welsh Assembly Government has commissioned a national review of eating disorders service in Wales which is being led by Dr Jacinta Tan from Swansea University. People from across the country are being called to contribute their experiences. Workshops have been organised for people who’ve been affected by eating disorders in Wales (as well as their families and carers), aiming to give real people a meaningful say in deciding what kind of support should be available.

The recommendations that will be made to the Assembly need to be ambitious. They must offer a bold vision of world-leading support and innovation in this complex, growing and historically underserved area of need. For too long we have lagged behind, and people have suffered terribly. If the Welsh Government chooses not to embrace the potential of this review and invest dramatically in the development of eating disorders services in Wales, then they are only choosing to store up further, more costly problems for the future.

My hope is that instead of this, we can all work together to turn Wales into a leader of best-practice for eating disorders – setting an example that others will want to follow. If that means being radical, brave and honest about our current failings, it’s only because we simply can’t afford not to be any more.

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