Great comments Melinda! I completely agree that this conversation needs to broaden and eating disorders need to be more on the agenda for the right reasons- inadequate treatment, early intervention and so forth. So much more needs to be done, and return to school is a tricky problem for everyone- families, sufferers and schools to manage.
My two cents on the issue:
*From the perspective of the young person:
It is a difficult one. My experience with private schools in Australia is that they tend to have a “care plan” when a person returns from hospital from Anorexia and it is not differentiated from other physical illnesses. That this is guided by medical advice & the treatment team & the school works collaboratively to try to accommodate the requests. School is typically a huge motivator for an AN sufferer as they tend to like the structure of school, be well liked by peers & benefit from focusing on achievements. Returning to school is therefore framed as a “privilege” that that young person can work towards, and they need to demonstrate they are “bigger than the anorexia” to be able to attend. This means being able to demonstrate capacity to manage ED urges such as to exercise, as well as to be able to “eat normally”. Usually its about 90% ideal body weight that a sufferer should have achieved before returning to school is considered. The basis for this is primarily to enable a focus on recovery given it is a life/ death illness.
So I do not agree with them banning a young person from school in the example, except for the fact that she still has a NG feed. This is quite visually shocking/ confronting and I would be concerned about how this would impact on peers. Further, for many people with EDs, the NG feed can be seen as a “badge of honour” . However ultimately I would consider if she still requires this she may not be well enough to return to school. Obviously this is a decision of the current treatment team & I cant help but wonder how they would consider her well enough to return to school if she still required this (NG feed is necessary if significant weight gain is required, and is usually necessary in cases of food refusal).
* From the perspective of the school:
I do not think they run the risk of copy cats given that people just dont wake up and decide to develop an ED. Ginny has highlighted this well in her comments. Usually onset is a result of a combination of risk/ resilience factors and I think this is the wrong approach for the school to be taking. Yes anecdotal there is a contagion effect for EDs, however I think this is far more the case with bulimia and I think this is a controversy that is debated as to whether or not you can “catch” an ED. Ultimately the school really needs to have is policies around this type of thing based on what they think they can manage and the welfare of other students. This prevents situations such as this arising, or from them looking like this is a personal issue against a particular student. If this is part of the school policies that is presented to parents & students, available on the website etc this issue would have never arisen and the young person would not have had any expectations about returning to school.
One Response
Great comments Melinda! I completely agree that this conversation needs to broaden and eating disorders need to be more on the agenda for the right reasons- inadequate treatment, early intervention and so forth. So much more needs to be done, and return to school is a tricky problem for everyone- families, sufferers and schools to manage.
My two cents on the issue:
*From the perspective of the young person:
It is a difficult one. My experience with private schools in Australia is that they tend to have a “care plan” when a person returns from hospital from Anorexia and it is not differentiated from other physical illnesses. That this is guided by medical advice & the treatment team & the school works collaboratively to try to accommodate the requests. School is typically a huge motivator for an AN sufferer as they tend to like the structure of school, be well liked by peers & benefit from focusing on achievements. Returning to school is therefore framed as a “privilege” that that young person can work towards, and they need to demonstrate they are “bigger than the anorexia” to be able to attend. This means being able to demonstrate capacity to manage ED urges such as to exercise, as well as to be able to “eat normally”. Usually its about 90% ideal body weight that a sufferer should have achieved before returning to school is considered. The basis for this is primarily to enable a focus on recovery given it is a life/ death illness.
So I do not agree with them banning a young person from school in the example, except for the fact that she still has a NG feed. This is quite visually shocking/ confronting and I would be concerned about how this would impact on peers. Further, for many people with EDs, the NG feed can be seen as a “badge of honour” . However ultimately I would consider if she still requires this she may not be well enough to return to school. Obviously this is a decision of the current treatment team & I cant help but wonder how they would consider her well enough to return to school if she still required this (NG feed is necessary if significant weight gain is required, and is usually necessary in cases of food refusal).
* From the perspective of the school:
I do not think they run the risk of copy cats given that people just dont wake up and decide to develop an ED. Ginny has highlighted this well in her comments. Usually onset is a result of a combination of risk/ resilience factors and I think this is the wrong approach for the school to be taking. Yes anecdotal there is a contagion effect for EDs, however I think this is far more the case with bulimia and I think this is a controversy that is debated as to whether or not you can “catch” an ED. Ultimately the school really needs to have is policies around this type of thing based on what they think they can manage and the welfare of other students. This prevents situations such as this arising, or from them looking like this is a personal issue against a particular student. If this is part of the school policies that is presented to parents & students, available on the website etc this issue would have never arisen and the young person would not have had any expectations about returning to school.
Ive written the following guidelines, if this is helpful for anyone reading your Blog Melinda!
http://bodymatters.com.au/eating-disorders-in-schools/