Staying in hospital

When someone with an eating disorder is severely underweight, seriously unwell or refusing treatment they are sometimes advised to stay in hospital. Most will be treated as an outpatient but some will be admitted and treated as an ‘inpatient’. They are then treated in hospital in order to stabilise their health and help them participate in treatment.

James felt that his anorexia nervosa was so severe that the only thing that could stop his eating…

Age at interview 21

Gender Male

Age at diagnosis 20

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I mean I would have, like I said before I wouldn’t have stopped for anybody, until somebody actually forced me into hospital, and even when I was in the hospital the first day when the doctor seen me, and he, I was, I actually told him, You know, you’ve got better patients to look after because I’m, you know I’m, I should be out on the weekend [Laughs] You know and I actually still believed that when I first came into hospital. The first day I was there I thought I was going to be let out on the weekend and, and you know that’s, that’s it. But that weekend never came and I was in hospital for the, for the duration of this time so it’s, it’s been quite eye opening.

But just coming up to that point of when I was like, I just showed every sign of anorexia basically and coming from that, and I told you I was doing the exercising regimes, I wasn’t eating, or what food I was taking in was pretty much non-existent. I was isolating myself even more, well loads basically, and my, it was causing so many arguments around where I lived, my family, my friends, I just didn’t care anymore and when I actually did come into hospital and I was stuck on like strict bed rest and I felt like I was being punished and you know the toilet doors are locked.

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When people are admitted to hospital, they stay on a psychiatric children’s ward, adult ward, a general hospital ward or a specialist unit for eating disorders. The young people who we spoke with had stayed from a few weeks to a year or longer. The reasons for their admissions included:
  • Being very unwell and/or underweight
  • Outpatient treatment (outside of hospital) not being successful
  • Needing to remove young people from their home environment because it was contributing to them being ill.

Sometimes people relapsed after coming out of hospital and had to go back in again, several times.

Being admitted to hospital

People were often scared when they first went into hospital. They were often very ill at the time and afraid of losing control over the routines and habits that they had developed. Steph said, ‘It’s when they take away all your coping mechanisms, [you] feel so bare and vulnerable’. People could feel very ill physically and suffer from exhaustion. James was so ill at admission he was having ‘hallucinations and hearing voices’.

Some people found the ward frightening or ‘intimidating’. The ward could feel restless and some of the other people there could be very ill with a variety of mental health problems people had never seen before.

When she was in an environment which she found scary, Rebekah found it difficult to challenge the…

Age at interview 18

Gender Female

Age at diagnosis 16

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It’s a scary time being away from home and especially when you know you’ve got these emotions, these issues, these problems in your head. You try and have like, you’re trying to overcome them, you’re trying to battle through the like, the voices like of the eating disorder every day and then it’s like, you’re placed into an environment and, you don’t know anyone and you’re forced to eat and, it is scary.

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Even the idea of being in hospital could be shocking. Many didn’t feel they belonged in there as they didn’t think they were ill enough to be in hospital. Although ill with anorexia nervosa herself, Annabelle said she felt she was different from the other people and ‘nothing like the anorexics there’. Chloe said she was so upset she couldn’t speak and Rebekah described staying in as ‘heart breaking’ because she had no idea she was that ill. People had often expected to be out in a matter of days when in fact they ended up staying for much longer.

Being admitted was a surreal experience for Annabelle. She felt different to the real anorexics…

Age at interview 22

Gender Female

Age at diagnosis 14

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And so I went in. I remember, I remember this place so distinctly it was, I mean it was only, it was 8 years ago. But I remember going in and I was, I don’t know it was just such a surreal experience. I was pretty terrified and I was, I couldn’t believe how, what did I do to get here? I remember the staff going through all of my belongings and searching me and searching my suitcase and I was just like, Oh my Gosh, I’m like in prison or something. Like it’s weird And meeting all the other people on the unit and still thinking, What am I doing here I met the other girls with eating disorders and I thought, Oh my Gosh, they’re like real anorexics, but why am I bundled with them? Why am I not? I’m not like that. I’m not I’d, I shouldn’t be here, I don’t deserve to be here. And it was, it was hard actually, it was really hard being in treatment.

I think it took me several months to accept that I had a problem. Even when I was in hospital, even when I was admitted to hospital. Because, and I think it made me, what made me realise was that I just found eating so difficult and gaining the weight, it was so, it you know, I was absolutely crazy, you know I was in tears over I don’t know a potato or something. And it was a very, very slow process. A lot slower than I thought it would be. I had, in my mind I thought in three months I’d be out, and I’d be able to eat all the things that I used to eat, and I’d be at a healthy weight, and I’d be all happy la-la-la, that’s the end of it. But unfortunately it wasn’t like that. I ended up staying there for 18 months, because I just kept taking one step forward and then a few steps back or, you know it wasn’t a straight line.

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Those who had been in inpatient treatment in their early teens often felt homesick and missed their parents. Their families or friends often visited weekly, some every day and they could also phone home. On some wards, phone calls were limited to only a couple per week. Once they improved, they started meeting visitors outside of the hospital and went on home visits.
However, admission to hospital could also be a relief. Being moved from home into an environment that they could no longer control could be very helpful. Looking back, the beginning of the experience in hospital was often the hardest and things often improved.

Daily routines, therapies and schooling

Life on a ward involved adapting to different routines and activities. Treatment consisted of individual therapy, group therapies (such as art therapy) and workshops. For many, talking treatments were essential in recovery. (See ‘Talking therapies‘).Workshops often involved practical activities, such as cooking skills, beauty treatments/massage and creative writing. Sometimes people would join outings to the cinema or day trips. There was also free time for watching TV or resting.

Chloe found practical work with her occupational therapist helpful. They worked on her…

Age at interview 19

Gender Female

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But I had some like the occupational therapists when I was in hospital. I had some sessions with her and we did things about like confidence and being, I think I did something about being assertive but I don’t know why [laughs]. And we did things like we’d think of things that I was scared about and practice like one of the things that I was that really made me panic was choosing. I wouldn’t be able to go to the shops to choose like what to eat. So we’d go out together and I’d have to choose like something. We would go to Starbucks and get like a muffin and a drink and I had to choose it myself and sit and eat it like and not think everyone’s watching me sort of thing.

So sometimes if I was with my family, if I had we had like my gran and grandpa and or like aunties and uncles and stuff round or family friends, I just like they were watching me when I ate because of because they knew there was something wrong so they were kind of like watching me. So I had to practice like feeling a bit braver about eating in public and making decisions and eating like a bit of cake or something instead of like your usual apple afternoon snack or something. And just trying to practice getting more of that or getting used to being normal and so that was really good. It was like proper constructive work.

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Being on a ward involved certain restrictions. On some wards, all personal belongings like phones and money were taken away. In secure units people were not allowed to walk in and out. Freedom to move could also be restricted so that people were only allowed to use a wheelchair (chair rest) or lie down (bed rest), in order to limit the burning up of calories. People could be under ‘observation’, which meant having a staff member with them constantly, or checking them regularly, day and night. The purpose of observation was to prevent people causing harm to themselves through exercising, purging or self-harming. Having no control over personal belongings and experiencing very little privacy even when going to toilet, having a shower or sleeping could be ‘distressing’. People described feeling like they were ‘in prison’ or ‘being punished’. Steph said she couldn’t even be alone to cry. However, Charlotte felt ‘safe’ when everything was taken off her.

James felt like he was being punished when he was on constant observation. He felt his dignity…

Age at interview 21

Gender Male

Age at diagnosis 20

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And I wasn’t allowed, I was on constant obs. I was stuck next to a nurse station. It did, and it did feel like I was being punished for what I’d, what I sort of did at that time. But obviously I was really ill but I felt like I was just doing this to make myself happy.

So it was really hard because you know we, when I was in hospital I had to get used to getting nurses to watch me going to the toilet which was pretty hard, you know. And it’s, it’s one thing you know taking away your possessions, you know taking away your book or, your, you know your iPod or whatever, but once you take away your dignity and you’re not allowed to even go to the toilet without somebody watching you, or everything, all your food is recorded and you’re constantly watched, it’s, it’s made me who I am today because it’s, it was just so hard at that time. I remember a couple of times I just broke down completely because I couldn’t believe that my life sort of came to this point. Because it was really hard and I couldn’t talk to anybody at that point either because there was nobody as young as me on the ward. I was, there was no TV or anything like that. And I was basically just trapped around myself and I couldn’t even get off the bed basically. So that first month that I was in hospital was really, really hard for me.

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Sara describes how a staff member tried to make the experience of having a shower while under observation less uncomfortable;

‘There would be a curtain between us and I remember one nurse would sing because obviously it wasn’t really comfortable for her and she knew how uncomfortable it was for me to have that kind of privacy taken away. I can understand now why but at the time it was a bit distressing. So she sang Disney songs which was quite funny and kind of did break the ice between us.’ Sara

Many people attended hospital school but only if well enough. For many, school work was important and going to lessons or sitting exams in hospital helped them stay on track. School work also provided structure, ‘normality’ and a focus to the day.

Eva liked having a quiet, stress-free space in hospital where she could sit her GCSE exams.

Age at interview 17

Gender Female

Age at diagnosis 14

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And you sat your GCSE’s in the hospital?

Yeah.

But, well how was that?

It was quite good actually, because I hadn’t seen anyone from school for a really long time, so I think going in would have been a bit overwhelming, like queuing up to go into the big hall, and finding my seat and, because I was, I had special consideration because I wasn’t well obviously so, I was allowed extra time with my exams.

I think that would have been stressful having that in school, because I didn’t want people asking questions about why I had extra time when I wasn’t dyslexic or anything,

So it was nice to sort of have a bit of a quiet space and like, and I think, practically all of my exams bar one or two, a teacher from my school actually came and sat in the room with me, so sort of invigilate it. So it felt nice having them there because I knew that they wanted me to do well, and they were there to sort of keep me at ease. So that was nice having like a little room to myself to get on with my exam and not have to worry.

So you could just focus on that?

I could just pretend to myself it was a practice paper also, it didn’t feel as real because it wasn’t in the big hall and there wasn’t all the stern looking exam people peering over your shoulder to make sure you’re not copying so, that was better.

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Some had a lot of support from their own school and their teachers would regularly keep in touch to give them work. After their health had improved, sometimes people went to their own school and returned to the ward in the evening. Often people were allowed to increase their time at school as their condition improved and this could be an incentive to try and get better.
Not everyone was able to attend hospital school because they were too ill or didn’t feel motivated enough.
Relationships between people on the ward could be complicated. While people said they often felt supported by others, they could also feel ‘different’ and ‘an outsider’. James, who was the only male on his ward said:

‘I felt like I had to sort of step up because I was the only male there. It made me more determined basically to do it It was just so strange being in there at first because I was the only guy there and when all the staff are women as well it’s, it’s pretty hard. Everything that seems to be in there’s just talking about like women’s magazines and stuff like that I had to get used to letting women see me go to the toilet, and it’s really, it’s demeaning.’ -James

Spending time with other people with eating disorders wasn’t always helpful. Many shared a perfectionist mindset and some people described the atmosphere among patients as a competition over ‘who was thinnest’ or ‘who could eat the meal with the lowest calories’. Some of the things they learnt during inpatient care were unhelpful in recovery. Observing others, newcomers soon picked up ‘tricks of the trade’; for example how to try and minimise calorie intake, exercise in secret or try and trick the scales. Many had been unaware of such behaviours before; Felicity said she went in ‘as a novice anorexic’.

Zoe was the youngest patient on the ward. Seeing older patients whose lives had been ruined by…

Age at interview 23

Gender Female

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I was the youngest and in a way, it was quite nice because all of the other patients were quite kind of mummy-ish over me. They sort of cared for me and they were and they were sad to see this young thing, cos this was then twenty years ago.

And that was the thing, you know. My parents, I mean it was tough for my parents cos they would come in and see, you know, forty-year-old women who’ve who were had had anorexia all their lives and had their lives ruined by it and they thought this was, this was gonna be me. And I so it was quite a strange environment for someone quite young and quite new to the illness to be in. It was, yeah, I mean we weren’t messing around anymore. This was the real the real side of eating disorders. And I learned a lot about eating disorders whilst being in there about actually, I, you know, I had this awful disorder and I thought, you know, God, I’ve got a really bad eating disorder But it wasn’t until I was in there that I realised, actually, mine was just, you know, another case of anorexia. It was nothing special. It was nothing particularly bad, well, in terms of how far anorexia goes.

Everyone there had had it all their lives. They were, you know, a lot of them were lower weight probably, I mean I don’t, but I remember thinking, I’m not actually that underweight The sort of things that people got worked up about and upset about were, you know, really minor things and I sort of, because I was new to the illness, the people who’ve had it for a lot longer seem to, their whole world was eating, anorexia. Whereas I still had, you know, I still had friends coming in. I still had a boyfriend. I still had school. I was still working when I was in the hospital. I had all my books in there and I was adamant that I would not fall behind. So I was working all the time.

And these other people, they were just anorexia was their life and it was interesting to see that and to see the real anorexia illness, not this kind of snippet I had experienced. So it was a really interesting time for me. For someone who didn’t know anything about anorexia to be in that environment was very, very odd.

Very, I don’t know how to describe it, it was bizarre. You know, I was just a normal, you know, a few a few months ago I was just a normal sixteen-year-old girl sitting my exams and the next thing I know, I’m in this strange environment. But it was I mean the care was brilliant. It really was. I cannot, the care was brilliant.

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Some people made good friendships in hospital and found that peer support could be very helpful in their recovery (for more see ‘Working towards recovery‘).

Eating and being weighed

Learning to eat well again; nourishing the body properly and learning how to deal with food in a balanced way is the main aim of inpatient care. James compared food to ‘medicine’ that they were ‘prescribed’. It was often very difficult for people to let go of control over food and found it hard to follow the ward’s mealtimes and routines. Mealtimes could be ‘tense’ and ‘awkward’ and take hours. People with eating disorders often struggle to eat with others, which could add to the pressure.

Annabelle explains the difference between the supervised and non-supervised tables on the ward.

Age at interview 22

Gender Female

Age at diagnosis 14

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We all sat on a table. There was, well there was a supervised table and an unsupervised table. And the supervised table was for people that were either really struggling with their meals, or they’d just come in. It was like the default setting where you go in, you go on the supervised table. I was on there quite a lot. And on the supervised table it’s obviously supervised by a member of staff and then there was probably about maybe three eating disorder patients. And if there was more they’d have another member of staff. And it was one to, one to three was their, the minimum.

So yeah they’d sit and they wouldn’t make a, they wouldn’t just like sit there and, they’d like chat so it was fine. But they just, they were just there for support and, and to make sure that you’re not hiding food or throwing it out of the window.

And there was an unsupervised table where you could sit with anyone, you could sit with um people with, you know they didn’t have eating disorders; you could sit on your own if you wanted to, sit with a member of staff,, and it would be a lot less formal. And you’d just eat and get on with it. But on the supervised table you’d have to wait for the last person to finish, and you’d have to ask for permission to leave the table or to get your dessert, things like that.

And how did you find the meal times?

I found them quite stressful. Especially when I knew it was like a difficult meal that involved maybe a fear food or something. I’d find it very stressful and it was, I felt very self-conscious being supervised. I did. Even though they weren’t making a big deal necessarily, I just feel like, Oh they’re watching how I eat. I’m really struggling with this, but I don’t want to say anything to upset anyone Yeah this kind of thing. And when it was like the last person, you had to wait for the last person to finish, that was quite awkward, whether it was me or someone else, it was always quite awkward, you were sort of sitting there like, So..

And I think on the non-supervised, it was better but I think I was a bit, I mean I was quite a misbehaved one, and I would get up to mischief and I think that’s why a couple of times I was moved back onto the supervised table.

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For people with anorexia nervosa, food had to be introduced very carefully and gradually. Sometimes high calorie nutritional drinks were part of the diet. Once people started improving, they were often given choice over their meals and sometimes allowed to cook later on. People pointed out how important good quality hospital food could be for someone recovering from an eating disorder and how eating ‘frozen and vacuumed’ food wasn’t helpful.
Sometimes, if people refused to eat or their weight was life-threateningly low, they could be fed through a nasogastric (NG) tube. A NG tube is put into the body through the nose and is used to deliver a nutritional solution or medication straight into the stomach. Having an NG tube was often a very difficult experience. People described feeling ‘out of control’, ‘medicalised’ and ‘isolated’. At the same time, they said it had often been ‘a necessity’ and that having the NG tube had worked as an incentive to get better. Some people said they had been force-fed or threatened with NG tube feeding if they did not eat.

Sara explains how the NG tube is inserted. She had a lot of complications with the tube getting…

Age at interview 20

Gender Female

Age at diagnosis 16

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What about the tube and having, having that in. How, how does that work?

I remember I was really nervous before they put it down so the first time round, so they gave me a sedative but they gave me too much because [laughs] yeah, they cos obviously they don’t really know cos of my average height and my weight is kind of confusing when your average height doesn’t match your weight, so I can’t remember the first time. I remember it being a blurred vision and them putting it down but you have to, it goes through your nose and then you have to swallow, so they can get it down into your stomach and it’s got a little hole at the bottom. It’s connected like a drip so the food is a protein drink that’s just fed straight through there and they can also feed medication and vitamins and all that through the tube instead of you swallowing it.

It’s really awkward at the back of your throat because it is, if you open your mouth, you can see the orange tube going down. So it is really awkward and it’s, really aggravating on your nose cos it’s like stapled to your nose and things and, not stapled but like stuck to your nose. And taking it out is never nice at all, I always ask to take my own out so I can do it in my own time.

Because it can, it can get stuck on your, [laughs], it’s disgusting but it can, because it’s got a hole in the bottom and because it kind of moves around, you can feel it as it kind of comes out and it’s, it makes you feel nauseous and it can really sting especially around your nose when you’re taking it out. Then when they’re putting, it back in, it’s lubricated and things and it’s kind of, its fine because also I always was sedated slightly.

But yeah I always, always took it out, the going in was the easiest part I think of the whole thing.

And how long would you have it for at one go?

I think it was changed probably once, was it once every two days, or once, yeah probably about once every couple of days it was changed. But I had a lot of complications cos it always get, got clogged up. So nothing was going through or I’d end up feeling nauseous because they’d not put it in properly and it was sitting at the top of my stomach so that was a bit awkward at times.

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Steph felt that being fed by NG tube was a relief but she was also scared not to be able to…

Age at interview 23

Gender Female

Age at diagnosis 14

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For me, in a sense, sometimes the NG feeding can be a bit of a relief, because you do not have to eat the food yourself.

One of the times I was on the feeds, I was allowed into the dining room to eat as much as I possibly could, and then whatever I didn’t manage got put down the tube as a supplement. Whereas the last time I was in I was given the chance to eat, but I just couldn’t do it so I’d be sitting at the dining room, in the dining table with nurses and therapists beside me trying to make me eat and I could not do it and I felt so bad, it was like, I’m so sorry but I can’t do it you know, apologising for it, but I just couldn’t bring myself to do it, no matter what they threatened me with, or said, Look this is going to happen if you don’t eat this So the way it worked then was if you didn’t manage your meal, you got taken into another room, and you got given the meal in supplement form, and you had to sit there until you drank it. I still couldn’t drink it. So I was basically in there from breakfast until half past ten at night when they would let me go to bed, just sitting doing nothing and then when I could, wasn’t managing that and it was building up and building up, they says, Right, you’re going to have to go on the tube feeds

And that time I wasn’t allowed into the dining room. I wasn’t allowed to eat anything, all my intake was through the tube and I had to be on that until my BMI got up to a certain level, and then they would let me back into the dining room. But it was a relief in a sense because I didn’t have to do it, but the same time it was very, very scary because I didn’t have control over what was going in to me. I knew that I was getting more down the tube than I would be if I was eating the food, which was difficult to deal with, and you were very isolated because you weren’t in the dining room with all your peers, so you felt very left out from the rest of the hospital and almost like a bit of an outsider because it was like, they were all trying and they were all eating, whereas it might have looked as if you weren’t even trying. Which wasn’t the point because you did, I did try so hard but I just couldn’t manage it. But it worked as a bit of an incentive as well because, it’s, strange as it sounds, I wanted to be back in the dining room. I wanted to be eating the food, I wanted to do it the proper way so it worked as a bit of an incentive to get back into the dining room and as scary as it was going back in, I knew that I could do it then, I knew right, the only way I’m going to get home, I can’t go home on a tube, you know, so that, there was that added incentive as well in that I need to eat the food because you can’t be on supplement drinks for the rest of your life, and you’re not going to get home while you’re still taking supplement drinks so. So it was pretty hard going, I mean it was a lot of fluid that was going into you, so I spent most of my time bent double because my stomach was so full and everything, it wasn’t easy. But it got me out of a rut; you know it was necessary to get me started.

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Young people were also regularly weighed to assess their improvement. On some wards weigh-ins were organised ‘discreetly’ in private but for some people, the experience was very upsetting. Annabelle described shared weigh-ins in their underwear as ‘degrading’. Depending on a person’s weight or BMI, they could be rewarded with privileges such as exercise allowance, outings, leave, and meal choices. Francesca had always been unaware of her weight but after being regularly weighed in hospital she started weighing herself obsessively at home.

Being detained under the mental health act (section)

‘Being sectioned’ refers to the process when someone is required to be assessed, held against their will (detained) or treated by law. It often happens when someone is so ill they are ‘unable or unwilling’ to agree or ‘consent’ to go to hospital by themselves.

Being sectioned was a turning point for Nikki. She decided to accept help and put her trust in…

Age at interview 20

Gender Female

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I kind of didn’t want help not only did I think that I didn’t need it, or these people couldn’t help me. Or the help that they’re trying to give me doesn’t really apply to me, and it doesn’t work, and they don’t really know that yet. But I was convinced that I was gonna be dead so there was no big point in people even trying to help me, you might as well stop wasting your time.

And kind of when I was like you know, I was sectioned? I was like, No so I think from that point I just turned around and said, Okay fine, if I’m gonna live I want to live in a certain way. I don’t want to live like this And alongside that came you know, you kind of break down your wall and you start trusting people and trusting that people can be the ones to help you. And letting them kind of lead the way and I think it all went from there really.

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Sometimes people felt that sectioning had been used as a threat when they didn’t agree to go to hospital. Some worried about having a record of the section in their medical notes. Having their choice taken away could hold people back from wanting to get better and be involved in care. Sara felt very vulnerable when she was told if she didn’t agree to admission, she would be detained. She became ‘a shell’ and her recovery went backwards.

Fiona-Grace was sectioned because she didn’t comply with treatment. Being detained made her angry…

Age at interview 22

Gender Female

Age at diagnosis 14

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I felt quite numb at that time just simply because my emotions weren’t there at all because I was so exhausted and, and I was dehydrated and just not very well so I didn’t feel much then but it’s when, it’s when the treatments start that it actually gets hard when you have to eat, when you’re faced with fear foods, when you’re faced with weight gain cos I think it was, it was as soon as I gained some weight that, that I really freaked out and at that point had to be sectioned under the Mental Health Act..so.

Do you want to say what happened, how did you end up being sectioned rather than wanting to go?

Well I wanted to leave for a start and I
And was this kind of during the early days, like you said when the treatment started?

Yeah it was within a week and I wasn’t complying with the treatment because as soon as I gained weight, I refused to eat and I was getting dehydrated and my blood, my bloods weren’t very good. So I suppose they had to detain me to keep me safe and to feed me by nasogastric tube if they needed to.

In practice, how did the section work? Do they need two opinions, do you know or any of the details?

Yeah well there’s first of all, you’re put on a twenty eight day one. and for that I think all you need is a Mental Health Officer and a responsible Medical Officer which would be my doctor and then after the twenty eight days it’s reviewed as to whether it should continue or not and they chose to continue it to a six month compulsory treatment order so for that you do need two doctors’ opinions. I think it was a GP that was the second opinion.

And do you remember at the time, how did they tell you about this?

They were just very upfront and just came and told me and I was just so angry and I tried to run away quite a few times so was put under constant observations yeah.

Did you try to physically leave the building?

Yes I did on many occasions yeah

And you did, it wasn’t locked or you know, you went out?

There is a fire exit so I used.

So what happened?

Well when you go out the alarms go off so people are immediately alerted that someone has left so I just had to run very quickly and get as far away as I could. And because, because, because I was detained and I was a specified person it meant that they could keep my money from me, my keys and everything but I always found ways to get my money because I would just have, at that point, I had this massive urge to go out and binge and purge so I would need money for food and I managed to go into the bank and I got some anyway just by answering the security questions and I always found a way and I even got a new key for my flat to access it.

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People’s views of the role of inpatient care on their wellbeing varied, and often the same person had had both positive and negative experiences, depending on where they stayed and how much they wanted to get better.
Looking back, many people felt that inpatient care had been a necessary step. Eva said, ‘It saved my life’. Getting better was often a slow process, with a few steps forward and one back.

Staying in a private clinic for 6 weeks was the ‘best thing’ Annabelle ever did.

Age at interview 22

Gender Female

Age at diagnosis 14

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And I think my parents could see this, and they were so, they really wanted to see me well, and I’m really grateful to have parents like those, and they did research through Beat actually into the kinds of other, like alternative kinds of institutions that you can go into, and they found a private place a private treatment centre for all kinds of addictions and eating disorders and depression and things like that. And it was quite expensive, and I was just like, No, absolutely no way, you’re not paying. That’s not fair. I’m not having you pay anything. That’s ridiculous. Like, I’ll do it myself rather than having you pay. But of course I couldn’t do it myself.

But they kept on at me with this idea, and I just thought, They’re not going to give it up. Okay I’ll go for an assessment. And I went for an assessment and for some, for some reason I ended up being admitted a few days after my assessment. And I thought it was crazy, I really did. It was quite, I think it was sort of American influenced, and it was quite happy clappy and that hold hands, and there were all these like big drug addicts like holding hands and praying and stuff. It was like, I was like, Oh my Gosh where am I? Like, I cried on my phone, on the phone to my parents, like, It’s a weird place. They’re all weird here. What am I doing here? This is crazy, in the middle of nowhere.

But strangely enough it became the best thing I ever did. And it just changed my whole way of life, and yeah, I mean just the way I think, everything. I learned so much, and I made some amazingly good friends. And I think the most important thing, and the thing that helped me most was the staff because they were just so like caring and so amazing. And they really went out of their way to help. But it’s not like, because at other places that I’ve been to you just know that they’re just doing it to get paid and they’re like Eeergh, when can we go home? I’m just sitting here watching you. But these people you know, a lot of them had first-hand experience of something. Whatever it be, some of them eating disorders. And it was really, it seemed to be their mission in life to, to get people well. And I really appreciate it.

So I was only in there for about six weeks, and when I came out I wasn’t there yet, but I was, I had a more positive outlook and I thought to myself, I can do this. But I was still finding it hard.

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People described staying in hospital as a life changing experience; they learnt a lot about eating disorders and about themselves. Annabelle says she ‘grew up a lot’ and Rebekah said inpatient treatment helped her become ‘the person I was always meant to be’. Rob says staying in hospital was a ‘formative’ experience; he had always relied on his parents but became much more ‘self-sufficient.’

Nikki says inpatient care saved her life. She learnt a lot about life and about human suffering.

Age at interview 20

Gender Female

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In patient, it changed my life, I mean what can I say? You’ll never look at the world in the same way. But yeah I’ve learnt a lot, learnt a lot.

What do you mean by that?

You see a lot, you see a lot, I think, me and my friend were talking about it the other day. And you see the best in people and you see the worst in the people. And you’re kind of in this position where like you’re pulling like your best friend out of the way of like an on-coming car, or you’re kind of like pinning your other best friend, who’s like your sister against the wall and like taking something off her. But then you’ve got people that are doing, it’s family, you know, and I think you really learn about suffering, and human suffering of that sort and also about kind of, I learnt a lot about myself and the type of person I was, and the type of person I wanted to be. And I got a lot of role models through that, and it did, it was definitely it saved my life on a fundamental level; you know I wouldn’t be here if it wasn’t for them.

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Charlotte compares the care she received between an NHS and a private clinic.

Age at interview 22

Gender Female

Age at diagnosis 16

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Looking back, I mean I’ve discussed this with my Mum quite a few times, and looking back I wish that we had stuck with the NHS.

Because, we thought we were making the best decision that we could at the time, but from my experience with the NHS and kind of private, the unit that I went into was quite a new unit, and they didn’t really have any kind of procedures up and running, and also there was, there was an issue with funding after I’d been there for five months, that the health insurance weren’t going to give any more money, and so, and that made me feel awful cos it made me feel like, they only wanted me for their money, and no-one cared about me, and it actually made my mental health deteriorate quite a lot.

Cos I like, even though I know that it it’s professionals can’t become too attached to people, it, I do like to think that they care about me and to think that they only were kind of caring for me because it was their job, and because of money, and now they weren’t getting that they didn’t want anything to do with me, was really quite upsetting, and I think also with the NHS all the people that I’ve seen there, all the NHS hospitals I’ve been in have, they’ve had quite a lot of experience in more, I don’t want to use the term severe but that’s kind of what I mean, because people who get help there are usually people that have, are quite seriously ill, whereas in private services it’s maybe less kind of extreme cases that they get and so maybe the experience is there with the NHS. Having said that, I do know people who have found private services better because in the NHS they weren’t getting any treatment so, yeah, but for me that’s how I felt.

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Some people felt that their health got worse in hospital. Maria says because she was ‘uncooperative’ her health didn’t improve in hospital. Francesca and Nikki felt their eating had worsened during their stays:
‘The eating flared up while I was an inpatient, like the nutrition plans, it’s almost become a form of self-harm you know it’s a tool rather than a kind of a means to an end.’ Nikki
Nico, who had been hospitalised for severe depression, said he developed the eating problem while in hospital being treated for depression. He felt eating was the only thing he could control.
People’s relationships with hospital staff often had a huge impact on their experience.

Discharge and thinking about ‘what next?’

Leaving hospital (being discharged) was a process that usually happened over a period of time. Before discharge, people usually spent time at home at weekends, for example, or went first back to school. Moving from living on a ward to life at home could be a big change. It was often managed by a transition to outpatient care (treatment whilst living away from the hospital), with intensive home care. However, a couple of people said they left with no plan for their care in place.

Zoe decided to leave the hospital quite early on in her recovery. She felt anxious about missing…

Age at interview 23

Gender Female

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By that point, I was eating everything on my meal plan and so I thought, Okay. I’m pretty much better now You know, I realised I was still a bit underweight but I could eat again. I sort of thought I realised that I’d been quite silly and that, you know, it was, I I’d sort of seen the light and now I could eat again it was all gonna be fine. And also I was very anxious about school. And I was really worried about getting behind and so I, all these things together, I thought, Well, I’ll, you know, if I can get out, I can just focus on my work. I can, know how to eat again now so I’ll be fine And I was also yeah, I just felt a bit I needed to get out, just, I mean I wasn’t even in there that long but I just, being around people with eating disorders all day every day, it was just too much.

I needed to get out. And, you know, with all my friends coming in and telling me about all the fun things they’d been doing. And because I’d put on some weight and I was eating again, my mood was improving. I wasn’t feeling so hopeless about life. I was feeling ready but I probably, wasn’t actually, but, you know, I wasn’t actually, ready but I thought I was. So yeah, I decided I needed I wanted to leave. Which wasn’t received too well. Only because I’d been so unwell and, thing with me, I hadn’t been ill for that long but I’d sort of gone down very quickly and that’s what the worry was that once I’d get it in my mind and cos I’m so driven, I can just, you know, plummet.

And they thought, you know, She’s only just really started eating everything on the meal plan And usually, people are in there for a significant long, you know, a significant amount of time just kind of consolidating it and working on the psychological side, which, at that point, I was still like, Whatever I was, you know.

I was still very much about it was all about eating and kind of I didn’t really have a great understanding of what had gone wrong, I don’t think. So yeah, I was adamant that I was gonna leave and my, yeah, my sort of therapist and staff there, my parents didn’t think it was a good idea. But I can remember having a CPA meeting, so a sort of care plan meeting, and voicing my desire to leave. And, you know, it was a very long meeting and they decided that if I was adamant I was gonna do it, would give it a try but I’d have to come in, I think initially, I would have to come in every other day to be weighed and to see how it was going and if, like as soon as my weight dropped I would be back in and they kept my bed for quite a long time, well, not that long. You know, a sort of couple of weeks, which in in terms of hospitals that’s quite a long time for NHS, so that was really good of them because they didn’t think it was gonna work but because I wasn’t sectioned and I was so adamant that. I was gonna go they thought, Okay. Give her a chance

My mum, my dad was away on business and my mum really didn’t want me to but I did and I so I did. I left. I can remember coming out of that meeting and telling some of the friends I’d made that I was leaving and they were, you know, their faces just dropped. They, What are they, you know They couldn’t believe that I was allowed to leave. They thought it was ridiculous. Just because they, you know, all these people had had several episodes of severe anorexia and they know how it goes, you know, they, people get a bit better and it’s just like revolving door cases. They just come in go out, come in go out. So yeah, so I left.

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Talking therapies

When people are diagnosed with an eating disorder they are often offered some type of counselling or therapy. These 'talking therapies' are offered to help people...