The truth about life on a locked eating disorder ward

[Sly Saint]

Telegraph article from 4 months ago

Holding my mouth to the one-inch window gap, I took a desperate breath in, swallowing the fumes from the outside vents that amounted to all the “fresh air” I would be getting that day. A banging came from behind the door of the bathroom, then a voice: “I don’t hear the water running. You’ve got three minutes left!” I inhaled again, turned around, and let the drips from the shower head wash away any tears, before the healthcare assistant knocked again to tell me time was up. I wrapped a towel around me, asked her to let me out, and stepped back onto the inpatient ward, my timekeeper locking the door behind me.

A few days earlier I had closed the door to my own flat, trading it for a temporary life under lock and key in an eating disorder unit; where doors don’t have handles, bathrooms are a privilege, and – though you may walk in freely – you must jump through hoops to walk back out.

I had arrived, ostensibly, by my own free will, after receiving an email at work from my psychiatrist – addressed not to me, but to my GP and parents. Admittedly, it wasn’t a surprise. Having been treated as an outpatient for an encroaching eating disorder, I’d been losing weight and verve in tandem, but I had never lost my autonomy. Until now, that is, when I was being spoken about, not to.

“Charlotte herself cannot make an informed decision,” she wrote, explaining that – divesting herself of my care – she had requested an urgent admission at my nearest NHS inpatient ward. It is true that I was sick, 29 years old and fighting a losing battle against a mental illness that had left me severely underweight and ridden with anxieties that festered for almost a decade, sparked by anxiety and OCD. It’s also true that, until that point, I had resisted inpatient treatment, deterred by a mix of fear, fatalism, and, in fact, a former 10-day stay at a facility, during which time my neuroses had multiplied. But once that email was sent, I was, officially, a passenger, cc’d into my own life story. And, with full encouragement from work, friends and family, I surrendered.

Twenty-four hours later, on a scorching July day, my mum and I arrived at the hospital grounds in north London.,.......
The door had a window, ensuring surveillance. A plastic, half-length mirror – which, crucially, couldn’t be shattered – offered up a bizarre, distorted reflection. And screaming cries could be heard from next door, which made me shiver in the heat.

Two healthcare assistants arrived to search my belongings, confiscating nail scissors, tweezers, a razor, even a Smints dispenser, as if I were a prisoner reporting for incarceration. I was given a “welcome pack” with “guidelines for community living”. Visiting hours were restricted, room checks were at random, bathroom use had to be requested, and a detailed dress code forbade long-sleeve tops, hoods, pockets, hats and bags at the dining table, presupposing any attempts to secrete food. But it was one particular caveat that left a bad taste in my mouth: “Doctors and nurses retain the right to section a voluntary patient under the Mental Health Act.”

To be clear, I do not wish to denigrate inpatient treatment, nor the NHS, which ultimately saved my life. Indeed, five years on since my admission I am a passionate advocate for medical intervention for eating disorders. However, there is a crucial difference between lack of resources, and lack of empathy and awareness from the bureaucracy at large, and it’s the latter which proved to be the most trying during my eight weeks inside.

The truth about life on a locked eating disorder ward (msn.com)

 

[cassava7]

I was on a locked eating disorder ward, although it wasn’t because I was considered as a mentally ill / eating disordered patient but only because this hospital unit is specialized in severe malnourishment and that was the state my gastroparesis got me in. I had my nasojejunal tube fitted (and later replaced) there.

So I didn’t have any harsh restrictions but it felt, to say the least, uncomfortable to have locked windows, a door with a window, and my belongings checked upon arrival with a bottle of water being taken away. Water was dispensed by nurses in 500 mL bottles with a maximum of 3 bottles a day.

The medical staff also insisted on me going through an entire bottle of feed even though I was having trouble tolerating it and clearly told them so. Similarly, all of the (visibly) anorexic patients that I saw had a nasogastric tube and were under strict monitoring by the staff.

Ultimately, even if an inpatient stay in a disordered eating ward can save someone’s life, I’m not sure that such a harsh approach achieves a benefit in the long term because I thought that even if these patients regained weight during their stay, they would probably feel distressed afterwards and plunge back into restrictive / disordered eating. Around that time I browsed subreddits on eating disorders for a brief while and that is certainly what was being reported by some people.

 

[hibiscuswahine]

Yes, there is a behavioural reward system for eating disorders as that is often the only way the staff have to achieve compliance from a person with a severe eating disorder. It is, of course, very stressful for the person and people often do not understand why these systems are put in place because it takes away the things that support them and they can earn them back by eating meals, which are done under supervision to make sure they do not go to the toilet to vomit it up. It can take several hours for a person to eat a meal but they are given one to one nursing. Behavioural rewards are usually overseen by a psychologist trained in the diagnosis and management of eating disorders.

It was brought into the treatment of severe weight loss due to an eating disorder to reduce the requirement of force-feeding which is highly distressing for the patient and the staff who have to use force for an extended period of time. Using force is counter-therapeutic. It is only used at very low BMI's with electrolyte disturbances that can cause cardiac arrhythmia/cardiac arrest and death. This is when the person due to the fixed false beliefs around eating and body form perception i.e. thinking they look healthy when their BMI is below 12 (75% of body weight lost) But also behaviours that maintain this severely malnourished state eg voiding food by vomiting, not drinking fluids, over exercising, different medications that inhibit appetite or increase voiding.

Also very low BMI's have an effect on the brain, making disordered thinking worse due to cognitive impairment from lack of nutrition. Ultimately it can cause brain atrophy, which is irreversible. Eating disorders have one of the highest incidences of death within all psychiatric disorders because of lack of nutrition and weight loss. The first aim is to resolve the electrolyte disturbances and slowly increase weight, this requires admission to a medical ward. When that has been achieved, they are transferred to an appropriate ward where psychological treatment looking at altering these beliefs is commenced and any psychiatric medication that may be useful is offered. Initially this will be in a locked psychiatric ward and if they continue to progress so it is safe for them to be discharged to outpatient treatment, they can go to a community facility which is not locked and they agree to work on maintaining a weight, that although may be still quite a lot less than the general population, is not a threat to life. There is a high risk of relapse but over time, some people do recover from even the most severe eating disorders.