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Inpatient Treatment for Anorexia Nervosa; My Experience/What to Expect

17th May 2015

At the end of February of this year, I was admitted into Springfield University Hospital in London after months of my mother battling the services in order to seek out the help I so desperately needed. I had met with an endless list of therapists, dieticians and life coaches; both privately and in my local service, however I seemed unable to pull myself out of the restriction and control cycle I was in. I had been consumed by self-destruction, with seemingly no way out. I hated it, I hated the life I was stuck in, I had never asked for it, I had never wanted it and I desperately wanted a way out; whether this was help with recovery, or death I simply did not care. This scared me more than anything as I had always been frightened of death and the unknown which comes afterwards, however all of a sudden I was not frightened anymore.

Realizing this I begged my mother to hospitalize me, to find somewhere that would give me the direction I needed, to show me that it was okay to sit and relax, that it was okay to eat normal meals. I have differed from many anorexics in that sense; I have never been scared of food, I eat everything that is put in front of me, however I would second guess every meal I made, and walk it all off afterwards. I was constantly standing and moving; despite being exhausted I would not allow myself to rest, which subsequently resulted in me collapsing several times. I was days away from potentially having a heart attack when we received a call from my local eating disorder service with the news that a bed had become available in Springfield Hospital. The shock of the setting, and the help from the various members of staff has broken this destructive lifestyle I found myself in. They have saved my life, and I am now back to my carefree, bubbly, happy self.

Each inpatient setting is slightly different and as this is my first and ONLY admission I can only give a rough outline of what you may expect in an inpatient setting; this may not apply to each hospital however from various conversations with other patients on the ward, the concept is very much the same. Patients have their own rooms, a lounge space, and access to one to one time and support from nurses. Therapists are assigned to patients according to their care plan and if their treatment requires such intervention. Dieticians and doctors are also on hand for a patient to speak with, weight and bloods are monitored weekly and diet and medication adjusted accordingly.

Upon arrival, a patient will be placed on a meal plan with a similar calorific value to what they have been eating outside of the hospital. This is then gradually increased over the first few weeks of admission. This gradual increase is essential to not only correctly re-introduce food, but to also unsure that the patient does not begin to suffer from re-feeding syndrome. Re-feeding syndrome can occur in the precious few days after re-feeding a patient begins; if a patient that has been starved begins to receive a sudden surge of energy, the molecules within your cells can fuse together in order to conserve this energy. This fusing of the cells means that precious oxygen is unable to enter them and so blood clots and heart attacks can occur. Many starved victims of the world wars died not from being in concentration camps, but because they were suddenly given too much food and energy and their bodies simply could not cope with this. Bloods tests are therefore carried out every few days for the first two weeks of a new admission to ensure that this is not happening to the cells. It is therefore important to highlight NOT to increase your diet without medical monitoring; re-feeding can be treated, however it is best not to let it get to this stage.

Semi skimmed milk is also given as snacks during this period. Many starved patients have extremely low phosphate and protein levels, and semi skimmed milk provides enough phosphate and protein without overloading the system with a massive amount of energy. Milk, as the majority of the population is aware, also provides essential calcium to help strengthen your bone structure, which can also be put under a massive amount of pressure when suffering with anorexia. Fluids are also restricted as starved patients are also at risk of edema (in layman’s terms; water loading). Though this may not be life threatening, this can be extremely uncomfortable for the patient and will of course influence their weight.

You will meet with the dietician to discuss increases to your diet either weekly or at request. Obviously if you lose weight at any one time, your meal plan will be increased to take this into consideration. Please note however that they should not do so without your knowledge, and that meal plans are rarely decreased unless the dietician, doctors and consultant feel you have reached a point at which you no longer require specific things on your meal plan.

You may also be allocated a nurse who will be your Key Worker. In Key Work sessions, you will be able to discuss diet changes, meal plans for day or home leave, how you are coping and your care plan. A care plan for all intense and purposes, acts as a guide for all members of staff in regards to the level of care you require, it will document your goals, behaviours, triggers, signs of distress and plans for self serving. Each inpatient set up SHOULD have the option and facilities for a patient to prepare/serve their own meals when the time comes that they feel that they are ready to begin taking back some control over their food. Staff facilitates this to ensure no behaviours or restriction occurs, however until such time all meals are prepared and served by staff, including snacks.

Meals are eaten in a communal dining room. Only in extreme cases are patients allowed to eat in their rooms with one to one support. The dining room in Springfield Hospital, has three different stages; stage 1 is for patients who need more support than most, stage 2 is for patients who require less support and stage 3 is for patients who are able to eat on their own without the need for staff intervention or prompting. There is a member of staff allocated to both stage 1 and 2 dining tables and will give support and prompting to those who require it.

There should be programme or structure in place, timetabling specific meal times and groups. This timetable may also include a rest period after main meals, during which patients are encouraged to spend time in the patient lounge; the toilets are also locked for an hour after meals. This should be staff facilitated and will allow patients to speak about their day, how they found the meal and any issues which may need addressing.

Groups will include various recovery focused discussions, meal preparation, and arts and crafts. These are focused on distracting patients from unwelcome thoughts, or addressing these thoughts with the help of staff. These will be staff facilitated.

You will be set a target weight by your consultant that you must reach in order to be discharged from the service. If you are an informal patient you are allowed some input into this, however if you are sectioned under the mental health act, you will have little say over your treatment and targets, as these will be set out by all those involved in your care. You will also discuss leave with your consultant when your weight is stable enough for you to be able to go home etc. to “test” whether or not you are able to manage. Your care plan will therefore be adjusted on the basis of feedback you give to your team, and whether or not the leave went well. It is important to remember that everyone struggles at some point, and not to beat yourself up if the first leave does not go as you expect. It is part of the treatment to get you back into as “normal” a life as possible. Personally I have experienced no issues when on leave; my exercise compulsion and need to calorie count and control food has all but disappeared. Being at home now, is much like how it was before I got ill.

I do hope this helps to clear any questions anyone may be having if they are facing inpatient treatment. The only other piece of advice I can give is not to fight the system. Though some methods may seem harsh to you, at the end of the day the people in the hospital are there to look after you, and they only have your best interests at heart.

I do hope this has helped!

Katrina x