Emily’s history

Emily is an active young woman who had a happy upbringing with her family, where she attended a mainstream school. Emily loved to keep fit and joined her local running club as a cross-country runner, she loved nothing more than competing in local and national events.

Looking back now, Emily realises that her poor eating habits began at school, with what she thought at the time was ‘healthy eating’. As a growing young woman and athlete, Emily became very body conscious. After finishing her A-levels, she became unhappy with the way she looked and stopped eating. Some days she would only consume a very small number of calories. This led to a diagnosis of Anorexia Nervosa along with a 9-week admission as an inpatient on an eating disorder ward.

Emily recalls being discharged from that placement, knowing that whilst her weight was starting to become ‘healthy’, it hadn’t really changed her mind-set. Emily struggled throughout university to control her anorexia. In her final year, it all became too much whilst studying for her final exams and also working as a part-time support worker.

Emily was then referred to Sunrise Ward at Cygnet Hospital Ealing where she was admitted on an informal basis.

When Emily came to us

For the first 48 hours after arriving, Emily shut herself away in her bedroom. She lay on her bed, she wouldn’t eat and she wouldn’t talk to anyone. Emily knew that she needed to be there, but that didn’t stop her from resenting it.

The team on Sunrise Ward intervened and Emily was detained under the mental health act for her own safety.

“Being anorexic is really isolating, it takes up every minute of every day. It took me away from family, friendships and spending time with others because I was so preoccupied.”Emily

Emily’s care and treatment

Emily would meet with her key nurse on a weekly basis to discuss any issues or concerns. They would also discuss her progress and any goals, this helped to challenge her eating disorder and associated behaviours.

Initially, this was difficult for Emily to engage with and to get past a superficial level. With time and encouragement, they developed a therapeutic relationship, which enabled Emily to open up about her thoughts and feelings and share issues that she had not discussed with anyone previously.

Emily met regularly with the dietitian during her admission to discuss meal plan increases and changes, set goals and challenges and plan for time off the ward.

Cygnet Hospital Ealing offers graduated supervision of meals, enabling the individual to gain independence with preparing and eating meals, Emily progressed from the high support table to the moderate support table and then to the low support table. Emily became much more independent at the low support table and started preparing her own snacks, breakfast and drinks.

Emily engaged in food groups and community snack group while on the ward and utilised these sessions to challenge herself and develop skills. In the later stages of the admission, Emily utilised leave off the ward to practice following her meal plan at home.

It was agreed that Emily would benefit from cognitive remediation and emotion skills training (CREST). CREST is a manualised, 10 session structured intervention focus on developing emotional skills. The sessions initially focussed on the nature and function of emotions and then continued with the identification and expression of her emotions, particularly engaging with positive emotions. Emily engaged well and was able to practice new skills outside of the sessions. She reported benefiting from developing a greater understanding of the function of emotions and how she could begin to express rather than suppress her needs in relation to support from others.

Through assessment and discussions with Emily, it was appreciated that she struggled with motivation to change. In addition to CREST she was offered motivational enhancement therapy for eating disorders (MED-ED) with the assistant psychologist, again, finding benefit from the intervention in increased determination to recover from her eating disorder. In addition to individual therapies, Emily also engaged with the psychology group therapies programme.

Emily reached the final stage of her care, engaging in eating disorder relapse prevention. Emily actively engaged in transition work, with a focus on promoting independent functioning of her Activities of Daily Living as well as engagement in her identified meaningful activities and promoting occupational balance. Emily worked on setting goals for herself and planning a meaningful future for herself by looking for employment and identifying key hobbies and interests.

As Emily was preparing for discharge she saw an advertised job at Cygnet Hospital Maidstone as an Occupational Therapy Assistant. She sent off her CV and was invited for an interview. She used some of her leave from the ward to attend her interview and was delighted to be offered the position.

Emily was not only being discharged back home with her family with a new sense of being with her eating habits, but she had also managed to secure a full-time role in an industry that meant a great deal to her.

Emily today

It’s been more than a year since Emily left Cygnet Hospital Ealing and she is thriving. Whilst at Cygnet Hospital Ealing she made some good friends, who continue to be a strong support network for each other.

She is finding her job as an Occupational Therapy Assistant extremely rewarding and enjoying using her own experience to help others.

“The staff team were just amazing, without their support I wouldn’t be where I am today and for that I am truly grateful. However stuck you feel, it’s
important to realise that it’s only a moment in time – it is not forever. Things have turned around for me, and it can for everyone else.”Emily