My Practice – Mark Sloman

The daily casework of a community mental health team social worker is vast and varied. The need to be able to continue to develop the skills and understanding of all types of mental health problems struck home to me a couple of months ago when I was asked to work with a woman with a serious eating disorder.

Janet Dyson* is a white British woman who had a very unhappy childhood. She was physically and sexually abused for many years. These experiences have, as with other people who have experienced similar distress, continued to devastate and dominate her daily life more than 30 years on. She had been experiencing difficulties with her relationship with food since her teens and was diagnosed with the eating disorder anorexia nervosa at the age of 25.

Anorexia is classified as a mental illness. Janet felt repelled by food and having a destructive eating pattern was the only way she could achieve any control in her life. Janet would starve herself for days having become obsessed about putting on any weight. She often described being able to visualise lumps of fat on her unclothed body. When I first met Janet she weighed less than six stone, which brings home how complicated and distressing this illness can be.

What Janet required (and continues to require) is a support and care plan which focuses on the three facets of mental health services: psychiatric, psychological and social care. Janet needed help to be able to both look back at her life experiences but also daily support to try and maintain even a simple diet which would provide her with the basic nutritional needs.

The implications of maintaining such a low weight for a sustained period of time are associated physical health problems such as kidney damage and osteoarthritis – a degenerative joint disorder that is the most common form of arthritis. Of course, the difficult reality is that, aged 50, the prognosis is not as good as it would be for someone in their twenties or thirties. The early detection and subsequent support, care and treatment of eating disorders is vital but they can often be “hidden” and go undetected.

In Somerset we are lucky to have a specialised team for eating disorders which works alongside the mental health services to offer support, advice and training for professionals working with men and women diagnosed with eating disorders.

At its extreme, people with a diagnosis of anorexia nervosa can be detained under the Mental Health Act 1983 and hospitalised. In my continuing work with Janet I have found the internet a helpful resource when learning about eating disorders, in particular www.swedauk.org

Mark Sloman is a social worker, community mental health team, Somerset
* Not her real name