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Visiting some friends in eating disorder units (EDUs) has made me think about the best methods of helping those with anorexia. The conditions in these units aren't always those which are going to promote recovery.

EDUs often virtually force feed patients whether informally or on a section. Patients accept that they have to eat to get out of the unit and to avoid peer pressure but resent every mouthful. On some units those who try to leave the dining room at mealtimes are physically restrained - occasionally a patient is pinned down and fed high-calorie liquid through a syringe down her throat for refusing to eat.

There can be 24-hour toilet supervision or patients have to use a commode to conserve energy if on bed rest. Patients are often weighed early every morning and the day involves shuttling between the dining room and the lounge for rest periods.

I am a recovered anorexic who was once under the care of an EDU for 18 months and in a residential project for two years. I had two in-patient admissions lasting six months each time. I was funded to go to a private clinic since there was a long waiting list to get into the nearest NHS hospital EDU.

The difference between the care I received and what some of my friends have experienced is that there was a programme on the unit I was in. There was a morning group every day, a weekly psychotherapy group, drama therapy, body image work, yoga and OT groups such as assertiveness. The food was high quality and we were given a choice. I met an eating disorders dietician who I talked to every week about all my food worries. She convinced me fat wasn't deliberately being added to the food and there was nothing hidden in it. However, my anxiety was over-medicated and I was given strong antipsychotics that usually knocked me out. Sometimes it was distressing to watch very ill patients being spoon fed and we all had to sit at the table until everyone had finished.


In-patient care should still be there for those with eating disorders whose weight is life-threatening or with health problems resulting from starvation, laxative abuse or vomiting. There also needs to be a high staff-to-patient ratio with a lot of support at mealtimes instead of just surveillance. Food should be appetising and not just the usual hospital fare. Therapy should be on site and ward rounds at least every week. A primary nurse should be allocated and seen every few days - time with other staff should be unconditional. Social workers should be connected to the unit.

People in the community with anorexia should be provided with therapies and long-term work with therapists, social workers or psychiatric nurses. Weight should be monitored in case it falls dangerously but professionals must realise it is not always a true indicator of how someone is feeling.

Alex Williams is a volunteer and uses mental health services

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