Accessing Support through the NHS
Within the NHS you almost always have to go and see your GP first. They can then refer you onto a specialist counsellor, psychiatrist or psychologist. However, at some universities, local Eating Disorder Units run drop in services, so it is worth having a look at whether anything like this is available in your area.
Going to see your GP for help can have a range of outcomes. Your GP may refer you to a specialist, and we’ll have a look below at some of the treatment options that you might be recommended. Your GP may suggest that they monitor your condition for a while, which may mean booking several appointments with your GP. There is a possibility that your GP will do neither of these things and may not be entirely helpful. We will have a look below at how you can manage some of the challenges involved in asking for help through the NHS.
Seeing Your GP
You may find that your university GP, or a GP who is regularly seeing university students, has a better understanding of mental health difficulties than other GPs. This is not always going to be the case. Your GP may have a good knowledge of the local availability of appropriate treatment and can be a good source of immediate support. Although they are not trained specifically in giving psychological therapies and ongoing support for your eating disorder, they can refer you to people who are.
When you book an appointment, you can ask the receptionist for a double appointment – you don’t have to explain why, but simply saying “it may take me a while to explain to the doctor what is wrong” should suffice anyway. A double appointment will give you more time to explain what is going on for you.
For your GP to help, you will need to explain what is going on and allow them to understand the problems you are facing. This will mean talking openly and honestly about what you are experiencing. It may also require you to be more specific and use language that you might not have used before, such as “I think I have an eating disorder”. Going to see the GP and saying something along the lines of “I sometimes find it a bit difficult to eat my meals, but I don’t really have a problem, I’m sure everything is fine” may not alert your GP to the help and support you need.
Some people say that it helped to take a friend or family member with them to help explain the problem. If you don’t want them to attend the appointment, you could always ask them to stay in the waiting room or meet you after the appointment.
People are often unsure about what to say to their doctor or explain what is going on. You might start by saying:
If you are worried about what you might say, you could write down notes before the appointment and take these with you. You could even write your GP a letter and hand this over during the appointment.
GPs are bound by confidentiality; they cannot talk to others about what you have said in an appointment. If you are worried however, you can ask your GP to tell you who they will talk to and what they will tell them before s/he talks to anyone else.
Generally your GP will want to look at how you are doing both physically and emotionally. This will usually mean that they need to check your height and weight and they may also want to run blood tests and an ECG. Your GP should be able to give you information about help that is available in your area. The NICE guidelines for treatment for eating disorders provide details on what should be made available for someone suffering from an eating disorder.
You may be referred to a psychiatrist or psychologist who will want to talk with you and find out when the problem started and how it developed. You may be recommended a course of psychotherapy or counselling which will involve seeing a therapist regularly (usually weekly) to talk about your thoughts and feelings. Therapy often focuses on building a sense of self-esteem to make it easier to cope with challenges. Sometimes group therapy will be recommended as it can be positive to share experiences with others who are facing similar challenges.
Cognitive Behavioural Therapy is also recommended and has become increasingly popular as a treatment for depression and anxiety in particular. CBT usually follows a self-help book or manual. It is designed to help you look at your thoughts and feelings in detail. You may be asked to keep a diary to help monitor triggers and allow you to think about ways to deal with difficult situations.
Hospital treatment is uncommon but may be considered if you are having trouble controlling your eating. Hospital treatment provides more supervision and structure. Compulsory treatment is unusual and only considered if it is clear that someone is so unwell that he or she cannot make decisions for themselves and needs to be protected from serious harm.
The Challenges of Accessing Treatment through the NHS
We’ll admit, it isn’t always easy to access treatment through the NHS, but we think that this is an argument for being savvy and trying to learn how to get what you need, not an argument for not trying in the first place. There are wide variations in the provision of eating disorder services and models of service delivery throughout the UK. Unfortunately, it can be difficult to learn about the range of treatment options and services if the GP lacks experience of working with eating disorders. This may mean that you need to do more leg work, looking online for what support services are available in your local area/ NHS Trust and thinking about what might help you. Once you’ve found information on the services available, you might be able to find out whether there are any referral criteria and who makes referrals – you can then put together a list of options and give these to your GP. Don’t be afraid to ask for what you think might help!
Some doctors may have more experience with treating people with eating disorders than others. If your GP is not sympathetic or you find it hard to talk to your GP there are things you can do. You can see another doctor in the same practice – and you don’t have to give the receptionist a reason for changing – or you can talk to someone else at the surgery, such as the practice nurse. You can also register with another doctors’ practice in your area.
There is often a time-lag between raising the issue, getting a diagnosis and accessing treatment, which can leave you feeling ‘let-down’ or rejected and compound feelings of unworthiness after having found the courage to speak out. We know that delays in getting help provide the opportunity for ‘ambivalence’ to creep back in again – you may begin to ask: “Do I really want this treatment anyway?” It is important to remember that the delays in accessing treatment are not about you – they are not personal and are no reflection on how much you need or ‘deserve’ help. NHS services are often overstretched and most students that we speak to have to wait. In a survey we conducted in 2013, 25% of students surveyed had waited over 6 months to see a specialist, so waiting is very common.
This waiting time means three things:
You may find it helpful to see your GP regularly while on the waiting list. You should talk to your GP about this and ask him/ her to continue to see you while you are waiting to see a specialist. You may also find it helpful to test out some self-help resources – check out the end of this guide for some suggestions.
Put together notes for a GP appointment you might find it helpful to try to answer the following questions:
Glossary: ECG - Electrocardiogram: This is a simple and useful test that measures and records the electrical activity of your heart. If there are any effects on the heart as a result of your eating disorder (such as low pulse, electrolyte imbalances, fainting or dizziness), an ECG is helpful in detecting any problems you may have with your heart rhythm. Small sticky patches called electrodes will be placed on your chest. These patches are connected to an ECG recording machine, which records the electrical signals that make your heart beat. The machine records a few beats from each set of the electrodes. The test will only take a few minutes and does not hurt.
You can read the NICE guidelines for treatment for eating disorders here: http://www.nice.org.uk/Guidance/CG9
The Royal College of Psychiatry has further information on Cognitive Behavioural Therapy: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx
The NHS Choices website can help you find a GP in your area: