Treatment for people suffering with an eating disorder in the South West is provided by the Devon Partnership NHS Trust which runs the only specialist unit in the region. In addition to the Haldon Unit, the trust provides the only independent-living home in the country for sufferers further along the recovery process. Fran McElhone visited the unit based at Wonford House in Exeter and met a woman from East Devon who has been battling anorexia nervosa for 10 years
FOR anorexic Ruth, life was about “managing to exist”, chronically underweight and constantly tired. At her most ill, she says she didn’t care how the pale, fragile young woman looking back at her in the mirror looked.
And despite its gruelling toll on her body, the 27-year-old even describes anorexia as a “friend”, at times, for the excuse it provided her to shy away from other issues.
The causes of the eating disorder and mental health condition has been described by health professionals and sufferers as tricky to pinpoint – a mixture of genetics, pre-disposition and personality, with environmental factors such as childhood trauma thrown in to the mix too.
The disorder manifests in the shunning of food, linked to a poor body image and the desire to be thin or “perfect”.
The number of people being referred to the Devon Partnership NHS Trust, which is responsible for mental health support and services, with an eating disorder is steadily rising – in 2010, 32 people in Exeter were referred, with 20 referrals in 2013.
The total number of referrals in this four-year period for the whole of Devon was 792.
Explaining the reason for the rise is difficult – statistics could reflect a willingness to seek help, rather than an increase in sufferers.
It is clear from meeting Ruth that this bright, friendly, creative, intelligent and pretty young woman has had little control over her anorexia. Rather it has controlled her. Her illustration degree had to be cut short and she had to give up a job she enjoyed to return to hospital.
But, now on her third admission to the trust’s specialist eating disorders unit, Haldon Ward in Exeter, she tells me that with the support of staff and the rehabilitation programme she has never felt so good.
“I’m not sure where it stems from,” she admits. “Everyone is different. For me I think it is a combination of things including being a twin and being a high achiever.
“Anorexia was a form of control when I first started becoming ill.
“It’s a very stereotypical view that it’s about being thin – to begin with I wanted to lose weight, but when I was at my most ill I didn’t care about what I looked like – I knew I was too thin.
“There’s an element of perfection mixed in, about feeling you have to have the perfect body.”
At 17, about eight months after the illness took a grip on her life, Ruth was admitted to a unit in Barnstaple, the pilot unit which later became established in Exeter, for eight weeks. She embarked on a re-feeding programme but at that point there wasn’t the therapy available that exists now.
“At that point I was eating very little,” she continues. “I was very lucky I had a GP who noticed something was wrong, whereas a lot of health care professional don’t.”
Sadly, although Meg left a little heavier, the root cause hadn’t been addressed.
“I just managed to exist being chronically underweight and I developed an obsession with exercise,” she recalls.
“I learnt to live with constant tiredness and lethargy, and getting cold easily. That became normal for me.”
Despite this, Meg went on to do A Levels, and complete a college course and a foundation degree in illustration.
It was during her university course that depression set in, preventing her from completing a full degree.
“A common misconception is that anorexics don’t eat, but you can eat what appears to be enough, but it isn’t,” she explains.
“When you’re that unwell you’re prone to depression because your body isn’t functioning properly.”
Ruth says she felt relief when she was admitted to Haldon again.
“I wanted that to be it,” she says. “I wanted the illness to be over.
“The first time I didn’t give the illness up properly. It’s easy to fool yourself you’re ready to give it up, that’s why people have so many repeated admissions.
“There are many things that anorexia can give you – it can be your friend, you don’t have to worry about friendships, or dealing with life or your emotions, it gives you power and you can feel strong as you have the control, it’s the only thing you have to worry about.”
Ruth did highlight a flaw in the system – when she left Haldon the first time and moved to North Devon, she lost her care coordinator and was placed on a three-month waiting list for another.
Meanwhile, she got a job at a pharmacy and started training to become a pharmacy technician.
She was eventually allocated another care worker, but was only able to see her for an hour every two to four weeks. She was also supported by a psychologist and by another “very supportive” GP.
There are currently still no eating disorder specialists who work in the community.
Unfortunately, Ruth’s illness remained defiant and it got to the point she couldn’t work anymore.
This time she was admitted to Redhills House, a six-bed home in Exeter city centre for people further along the recovery process which is integral to the “stepped down” approach to the discharge plan.
Ruth has been assigned a skills coach, nurse and therapist and most days she meets with one of the healthcare professionals.
There are also several therapy groups which take place at Haldon.
“It’s such a well-rounded approach,” Ruth adds.
“This is the first time I’ve felt so well.
“I’d never want to go back to where I was six months ago. It’s a horrible illness.
“This is it – I never want to have to come back.”
Both inpatients and day patients receive support at Haldon, which has a homely feel. There is a dining room, which has recently been given a “Jamie Oliver style” look with an open kitchen. And there’s a swish-looking new kitchen.
Sarah Bruford, unit manager of seven years, explains that the majority of the hard work takes place in the kitchen and rehabilitation includes shopping for meal times.
“Meal times are the most stressful event in the day for patients,” she explains.
“Food is now prepared openly which has improved the normality of meal times a great deal.
“Further down the line of recovery, the patients will prepare their own food in the big kitchen.
“This is where most of the work happens, it’s about becoming independent and preparing food for themselves and others and includes going out shopping.
“Everyone wants to get to the big kitchen.
“But this is the toughest part of the journey.
“The other dining room is fairly miserable, but there’s a lot of support there.”
Sarah explains that Redhills has more flexibility and the focus is on independent living with treatment interlinked with the community.
“It’s the transition period which is the most difficult,” she continues. “But being out there is the hardest. Here at the unit there is structure and support.”
Admissions are based on physical risk. All will have been diagnosed with anorexia.
She explains how hard it is to determine the root cause of anorexia, as it is often a mixture of personality and environmental factors.
Often the illness is associated with the need to be in control, a common trait among sufferers.
At any one time, there is normally only one person on the unit who is so ill they require a feeding tube.
“When people come to Haldon, they may have been suffering for months or years,” she adds. “Most people who come here will have targets or goals already set. Most will think the idea of recovery is great, but with that feeling of getting better will be fear, often of putting on weight, so all these body issues come into play.
“For us, coming here could be compared to jumping out of a plane; this is like the tandem leap and we’ll catch them in the dining room.”