staff and student experiences of eating disorders in schools

www.eatingdisordersadvice.co.uk

Staff & Student Experiences of Eating Disorders in UK Schools

Pooky Knightsmith

www.eatingresearch.com


Consultation with Staff about their experiences of eating disorders in school

• 42 school staff took part in a 6 Focus groups

• 800 questionnaires completed by staff from primary, secondary and special schools


Are there any current cases of eating disorders in your school?

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Yes No Unsure

The high proportion of school staff who were aware of definite cases of eating disorders in their school highlighted the need for all schools to be aware of this issue.


Issues Highlighted in Staff Consultation

– Parents can be difficult to approach and can act as a barrier when trying to help a child

– Many schools do not have an eating disorders policy in place, but staff would welcome practical policies

– Eating disorders are often a taboo subject in schools

– Reintegration of students is only successful when adequate support and guidance is given


Working with Parents

• A successful relationship between staff and parents is key to securing a successful outcome for students with eating disorders as a consistent supportive approach can be applied at school and at home

• Referrals cannot be made without parental consent (in the UK)


Communicating with Parents: Positive Experiences

“They had been worrying about the same issues themselves and were grateful that someone else had noticed.”

“Most are pleased to have support from the school and do tend to follow it up with a doctors appointment leading to a medical referral.”

“All parents I have spoken to have been grateful that I have been in touch. Majority have been willing to accept suggestions to get further help where appropriate.”


Communicating with Parents: Negative Experiences

“I have had some bad reactions from parents, including abuse and complaints against me.”

“Some parents are in denial and don’t want to admit there is a problem as they see it as a reflection on their parenting.”

“One mother will not work with me. She is modelling dysfunctional behaviour around eating and actively encouraging her daughter’s anorexia.”


Communicating with Parents Common Barriers – and Ideas to Overcome Them

Parents only expect to communicate with school about academic issues

– Generally encourage parental involvement with and discussion about pastoral as well as academic issues e.g. at parents evenings.

– Promote your school as a physically and mentally healthy school - make it clear to all parents in prospectuses, school website, open days etc that your school cares for the whole child and that the staff will expect to work with parents on a variety of issues which may include mental health.



Parents may feel you are criticising their parenting skills

– Just being aware that this is how your good intentions may be interpreted can help to avoid this difficult situation

– Think carefully about how you are going to address your concerns to a parent. Prepare well for the first conversation and be aware that a parent may be emotional, angry or frightened: think about how you can respond to these emotions

– Acknowledge and work through any strong reactions: ensure that parents realise that you are fully on side by the end of the conversation and that you intend to work together to support the child



School can seem unapproachable and threatening to parents

– Try and ensure that a member of staff the parent is familiar with is involved at the meetings

– Allow parents to bring a friend with them if they would like to

– Meet at the parent’s home or on neutral ground if it is difficult for them to get to school or they are anxious about it

– Make meetings open and informal – never set tables up interview style and always offer a cup of tea, a biscuit and a smile


School Policy on Eating Disorders

Does your school have an eating disorders policy?

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Referred to inanother policy

•Majority of schools did not have a policy in place.

•Existing policies were often reported to be ineffective.


Why have a Policy?

An effective eating disorders policy can:– Raise staff awareness of warning signs– Make staff aware of what to do if they are concerned– Ensure that students causing concern don’t ‘fall through gaps’:

“A boy in year 10 was suffering badly from anorexia and ended up in A&E – when staff were debriefed several of us realised that although we were very concerned about him, we had all assumed someone else was dealing with it – but nobody was. We now have a policy with a named member of staff who all these concerns are passed to.”


Putting together an Effective Policy

• You are welcome to use the model policies which have been developed as part of this project.

• If you wish to develop your own, key things to bear in mind are:– Keep it practical: a policy should be written to be used and referred to,

not just to sit on a shelf– Name key members of staff so it is clear who is responsible for what– Ensure all staff are aware of the policy and that it sets out clear

guidelines about what to do if they are concerned about a student– Include key information about the major eating disorders and the

warning signs staff might look for


Tackling the TabooMany staff reported that eating disorders were a taboo subject at school:

“It’s almost like a superstition: like the head is worried if we discuss anorexia, suddenly we’ll have an epidemic on our hands.”

“It’s hard to know what to do, I have concerns about some students, but talking about mental health issues is so frowned upon at my school.”

“We’re an outstanding school, and everyone seems to think that means our students can’t have problems – it’s just not allowed! We’re certainly not allowed to ‘encourage it’ by talking about it…”

“I once suggested to the head that we have a training session about eating disorders as some students were worrying us – from the reaction I got you’d have thought I suggested we have a training day about how to shrink heads or something. Needless to say, it was a NO.”


Tackling the Taboo: What we can do

• Raise awareness of how wide spread eating disorders are and the fact that they are not discriminatory and can effect anybody.

• Help schools to realise that students do not suffer from EDs because of anything the school has done wrong – it is not a sign of failure – however, the school can play an important role in supporting the student.

• Recognise that EDs are unlikely to go away without adequate help and support – schools may make the situation worse by failing to acknowledge them.

• Encourage a wide spread culture of training and talking – and where possible implement clear, practical policies which help staff to understand the best next steps if they are concerned about a student.


Reintegration

– Staff highlighted the need for proper support and training when reintegrating students who had been absent due to a period of illness or inpatient care

– Well supported schools reported successful reintegration with few relapses and a positive prognosis

– Unsupported schools reported students relapsing, being permanently withdrawn, home taught, moving schools due to bullying and in one instance committing suicide


Reintegration: What We Can Do• Communication between school, student, parents and outside agencies is key.

If a student is returning from inpatient care, the outside agency involved should offer training, support and guidance to parents and the school.

• All staff should be prepared for the return of the student and told how best they can support. Academic expectations should be discussed.

• Peers should also be prepared, they will want to know how they can support their friend. It is important to decrease the chances of bullying by increasing student understanding but to be vigilant in case bullying does occur.

• Staff should be aware of relapse warning signs and know exactly what to do if they are worried.

• The returning student should be assigned a particular member of staff they can discuss their concerns with, a peer mentor can also be helpful and as can somewhere quiet they can go if lessons become too much.


Consultation with Students

• 400 questionnaires completed by students from secondary and special schools


Issues Highlighted in Student Consultation

• When concerned about a friend, students were not inclined to tell school staff; due to lack of trust and because the situation was likely to be mishandled

• Students would like to discuss concerns about a peer face to face with a trusted teacher but this is often impossible

• Most felt that their school was not a supportive place to recover from an ED and that bullying was frequent

• Students would like to learn more about EDs and how to support their friends


Student Disclosures

• Peers are often the first to become aware when a student is at risk of or suffering from an eating disorder

• It is important that students feel confident in disclosing their concerns to a member of staff so the student in question can be supported appropriately


Barriers to Student Disclosures

Lack of Trust:“I wouldn't tell a teacher, I don't believe they can be trusted”

Fear the Situation will be Mishandled:“They would be judgmental and not respect confidentiality”

“They’d tell the school counsellor, get my friend sent to the hospitaland screw up their life. It’s not worth telling them.”

No Appropriate Means of Making a Disclosure:“You’re not going to stop them in the corridor and say ‘by the way I think my friend is starving herself’ are you? And I’m hardly going to stick my hand up in class and blurt it out!”


Student Disclosures: Overcoming the Barriers

• Many of the barriers reported by students arise as a result of lack of communication and understanding.

• Schools can increase the likelihood of disclosures by communicating with students on the key points of who, where, what, why…



WHO?• Make it clear who students can talk to about

their concerns

• In an ideal world, all school staff should be trained to handle disclosures as students won’t always place their trust in the designated staff member if you pick one



WHERE?

• Make if clear where/how can students communicate with a member of staff

• When surveyed, students expressed a preference for either sitting privately face to face with a member of staff or being able to make an anonymous electronic disclosure e.g. via email

• Some schools have reported success where designated members of staff, or the school counsellor are available in a private office during specified hours

• Other schools have used their school website, email or texting service to enable students to make anonymous disclosures – this enables them to flag their concerns without worrying that their friend will find out who ‘betrayed their trust’



WHAT?

• Students worry that if they make a disclosure, the school will mishandle it, so make it clear what is likely to happen if a disclosure is made – share your school policy with your students

• Make it clear that all concerns will be taken seriously, students will never be accused of over reacting and that staff will not be judgemental of their friend

• NEVER promise confidentiality as this trust would have to be breached if serious concerns were raised

• Explain that if a student’s concerns are escalated beyond the member of staff they made the disclosure to e.g. to the head of pastoral care, or the parents of the student causing concern, that this is in order to offer the best possible help to their friend



WHY?• Make sure students realise why it is vital they share their

concerns about their friends at the earliest opportunity

• Explain that they are in a good position to help their friend before the situation worsens

• Students should be made to understand that the earlier the school is made aware and their friend is helped, the more likely they are to make a full recovery


Being a Supportive School

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Strongly Agree Agree Not Sure Disagree Strongly Disagree

Would your school be a supportive place to recover?



“I had extremely negative experiences when I wasn't hiding

my symptoms. Everyone just wanted me to not be a

problem.”

“People get made fun of nonstop for eating disorders”

“School would be a torturous place to seek recovery

because everyone is so eager to spread rumours. ”



Students suggested that schools could be more supportive in the

following ways:

– Create support networks e.g. peer mentoring

– Teach students and staff about eating disorders and encourage understanding rather than judgemental attitudes

– Keep a close eye on teasing and bullying and treat it seriously

– Make a counsellor available and make it possible to see them anonymously without parents / form tutors being told


Final Points

The key issues raised by both students and staff

all pointed to a need for:• Better communication between students, staff

and parents• Improved understanding of eating disorders by

staff and students• A consistent, supportive, non-judgemental

environment at school

staff and student experiences of eating disorders in schools

Health & Medicine

school policy

staff consultation parents

school website

school cares

healthy school

school anddo

parents home

parents evenings