Health and happiness are what we all want for children. And yet, during this year’s Children's Mental Health Week, we, as adults, are struggling to provide either of these things for a generation of young people.
When the news is so grim, when we are all struggling with the practical and emotional toil of the pandemic and its repetitive lockdowns, when we often can’t see children and adolescents, it is hard to think of what we can do to help.
Into this gloom, I am sorry to add more bad news. But the Covid pandemic seems to have triggered a second epidemic in children and adolescents: eating disorders. As highlighted by the Royal College of Paediatrics and Child Health, since March last year the rise in referrals to child and adolescent mental health services (Camhs) for eating disorders has been astronomical.
In some services, there have been more than twice as many referrals as last year. And we are not yet sure we are at the peak of this eating-disorder increase: in some areas, the last three months of 2020 were the worst yet.
Coronavirus: A dramatic increase in eating disorders
Why? We don’t fully know, as there is yet to be any systematic research into what has caused this. But perhaps we can gain some understanding from the children’s minister, Vicky Ford, who wrote last weekend about her own teenage eating disorder: “Throughout this uncertainty and confusion, the one thing I could control was the…diet.”
Teenage years are often uncertain, but the pandemic has sent uncertainty to stratospheric levels. The uncertainty, for example, of the government opening a school one day and then closing it the next. Or of working towards exams for years, only to find them suddenly cancelled. It seems to have been a perfect storm for (mainly) teenage girls, who have coped with their lack of agency and control in the world by uber-controlling their food intake.
It is a huge worry. Eating disorders have the highest risks of mortality of any psychiatric condition. They have a toxic mix of psychiatric and physical symptoms, which interact with each other and can become hugely addictive.
The starvation state causes an obsession with food, which, in a young person desperate for some sense of certainty and control, can become channelled into dieting. Young people risk doing irreparable damage to their bodies at a time when they should be growing and developing. And the sense of hopelessness that can ensue – because someone with an eating disorder never feels thin enough – is also associated with suicidal ideation and behaviour.
Early intervention can help to nip this in the bud. But once it becomes established, it is notoriously difficult to shift, and a typical treatment package may last two years or more.
Camhs up and down the country are also noticing young people presenting as thinner and more unwell than usual. We think that is because schools are often where an eating disorder is picked up. We Camhs workers certainly miss your eyes on the pupils – often teachers pick up what parents miss.
Locked down with their children, parents can fail to see the incremental weight loss right under their noses. In fact, they’re sometimes impressed with their child’s “healthy” eating and exercising – until that child becomes dangerously unwell and needs hospital admission. And, of course, that’s not easy at the moment, either: many paediatric wards have been redeployed as Covid wards.
Anorexia, bulimia, obesity: What can teachers do?
What can you do? While it is difficult for you to notice weight changes, they are just one sign of an eating disorder. A young person becoming quieter or more withdrawn or altering their working style can indicate mental health concerns.
If you are concerned, just saying, “Hey, are you OK? I was thinking of you, and wanted to check you’re all right. You can come to me if things are tough for you,” can be the first step in picking up an eating disorder.
It is often a young person’s friends who notice the change first, and they may mention it to a teacher. Remind your pupils that they can still come and talk to you if they are worried about themselves or others.
Think of the messages that go out about food, eating, weight and shape, especially in subjects such as PE, food tech and biology. What is important is avoiding black-and-white messages about healthy and unhealthy, good and bad foods. In young people desperate for some sense of control, these messages can easily become a rule to cling to – an obsession.
Restrictive diets, with so-called unhealthy food groups banned, are linked to anorexia, bulimia and obesity, creating a feast-or-famine, overeat-then-diet mentality.
For most young people, eating together as a family is one of the only shared real-life experiences still available to them on a daily basis. Shared food is linked to culture, religion, family, tradition: all important concepts for mental health. Anything teachers can do to promote balanced eating in a family and societal context, rather than reducing food into various types, will be helpful.
In PE, think about exercise linked to fun and joyful movement, rather than fitness or sport per se. Moving is key to mental health. Perhaps you could ask the children and young people what their favourite type of movement is? Standing on their head? Pillow fighting? Bed trampolining? Online dance? Mental health movement is really inclusive and not limited to traditional sports or concepts such as being the best or the fastest.
Beat, the eating disorders charity, has many good resources for teachers, and the Healthy London Partnership has put together a leaflet especially to help educational professionals spot the signs of an eating disorder. While the numbers on this leaflet are London-based, every region in the country has a specialist child eating disorders service, which you will be able to access through Camhs.
Ultimately, if you are worried about a young person, please do encourage them to talk to their parents or GP. If they won’t take your advice, talk to your safeguarding lead about what to do. Young people with eating disorders sometimes refuse treatment, because the disease has such a hold on them, but their health and happiness may depend on receiving it.
Tara Porter is a clinical psychologist in the NHS and private practice. She also works at the Anna Freud National Centre for Children and Families, and is Tes' mental health columnist. She tweets as @drtjap. The views expressed are her own